“Thinking the Unthinkable”

Housekeeping

• Alarms• Toilets • Smoking • Breaks • Register

Aim

A conference organised by the Multi Agency Safeguarding Forum

North East designed to challenge professionals in some of their

thinking about abuse.

Learning Outcomes

1. Getting professionals to challenge their own thinking and avoid fixed thinking.2. To consider how to develop professional curiosity.3. To consider the need for appropriate challenge4. To explore learning from serious case reviews5. To raise awareness of joint working protocols

HSCB Priorities

• Embedding the HSCB Quality Assurance Framework

• Ensuring compliance with the new Statutory Safeguarding Guidance

• Safeguarding disabled children• Tackling child sexual exploitation• Young people who self harm

Programme0900 – Arrival and registration 0930 – Welcome and administration - Lin Ferguson, Chair of MASF0945 – Keynote speech – Professor Eileen Munro1045 – Break1115 - Joint Working Protocol - Bruising Protocol - Dr Simon Jones 1215 – Lunch1300 – Case study exercise – Inspector Darren Murphy and Alison Nealis, IRO 1430 – Break1500 – Multi Agency Safeguarding Hub – Sarah Marston, District Manager Childrens Services 1530 – Plenary session – Alison Nealis1545 – Close

Break

Case Study exercise

Break

End

• Presentations will be sent out.• Please complete the survey

monkey evaluation.

Have a safe journey home!

Improving reasoning in child protection

Eileen MunroOctober 2014

Key message

•Improving reasoning is a shared responsibility

Outline You are human beings

Understanding how we use our intellect and emotions

Being critical

You work with human beings Importance of relationships Challenges

Importance of organisational context

Understanding how we use our intellect and our emotions

We have two processes for reasoning – intuitive and analytic

Emotions play an essential, valuable, but sometimes troublesome part

Intuition and analysis are on a continuum; we use both to varying degrees in different tasks.

Intuition has persistent biases that need to be consciously checked for by our analytic capacity.

The task determines the type of reasoning needed•The balance of intuitive and analytic reasoning needed depends on the task you are doing.

•Some need a mainly intuitive approach; some need a mainly analytic approach.

•Neither is ‘best’ is an absolute sense

Human reasoning

“System 2 [our analytic skill] is the supporting character who thinks she is the hero. The defining feature of system 2 is that its operations are effortful and one of its main characteristics is laziness. As a consequence, the thoughts and actions it thinks it has chosen are often guided by system 1 [intuition]”Kahenmann, D. (2011) Thinking, Fast and Slow, London, Allen Lane

Analytic thinking as a personal trainer•Intuitive reasoning is the basic process that we then improve by using analytic thinking to:

•articulate•check (being aware of biases)•test deliberately

Respectful uncertainty

Intellectually accurate but

Very uncomfortable

Workers need prompting and support to question their assessment –hard to do on own, however senior.

Being critical

Reluctance to change our minds

First impressions – anchoring

Using limited range of information

Attribution error

Hindsight error

De-biasing

•The common element in all strategies is to consider alternative perspectives:

– Thinking why your view might be wrong– Devil’s advocate deliberately taking

opposing view– Reducing attribution error by thinking

about how you might have behaved.

Supervision

•Where you help the worker articulate the reasons for their intuitive judgments

– Stories can be good mechanism

•Help them consider their emotional responses•Check for biases in their reasoning•Consider how else to test judgments•Consider relevant research

Articulating intuition: developing the story•Makes you think beyond the current snapshot: stories have a flow

•What happened? Need description

•Why did it happen? Need analysis

•What might happen? Devise plan to reduce chances of adverse and increase chances of good outcomes.

Dealing with dissent

Culture of good manners can stifle dissent at multi-agency conferences

Disagreement can feel like personal attack and so gets hostile response

Need culture that allows people to query judgments impersonally

Disagreements should be taken seriously and simple rejection not permitted.

You are working with human beings•You can deliver a pizza but you cannot deliver a child welfare service. You need the ‘customer’ to be an active agent in the production of the required outcomes. Child welfare services simply fail if the intended recipients are unwilling or unable to engage in a constructive way; outcomes are co-produced by citizens.

•Adapted from Chapman J. (2004) System failure: why governments must learn to think differently,

London, Demos

Features of the Working Alliance

Family:

Agrees with worker on the tasks to work on

Agrees on goals

Develops an affective bond

Skilled workers

Challenges: emotionsChild maltreatment arouses strong feelings. We deal with families expressing strong emotions of anger, despair, fear.

Workers need support and critical reflective supervision in managing the emotions or they distort reasoning

Challenges: handling ambivalence•Families have strengths and dangers

•Holding both in mind as you work with them is difficult

•Focusing on good OR bad alone distorts understanding

Challenges: limited knowledge•We have limited understanding of all aspects of the work – causes, identification, responses

•In specific cases, we have limited knowledge of what is going on.

•We need to value and support expertise and professional judgment

We want to ensure that all children are safe but we can’t. There is too much uncertainty

Respecting this means that we stop talking of ‘ensuring’ all children are safe – aim to make them SAFER

Challenge anyone who believes managing risk = eliminating risk

Challenges: managing uncertainty

A just culture not a blame culture

Need to develop shared features of making decisions in uncertain conditions

Don’t set unrealistic goals of ‘ensuring’ all children are safe

Defensive practice does not AVOID risk but DISPLACES it, usually onto children and families

When are rules desirable?

•Need central prescription of goals and professional duties•Simple tasks – follow the rules, e.g. arranging payment for foster carer•Complicated tasks – needs professional skill in deciding what the task is and how to perform it, e.g. does this referral warrant a S47 investigation? •Complex tasks – no complete solution is known but we seek to minimise the problem, e.g. preventing child maltreatment

Supporting the workforce

Closer involvement with families has an emotional dimension. Workers are exposed to the most intensely painful of human emotions - fear, despair, anger, sadness. Do they feel helped to handle this? If not, they are more likely to show the features of burnout: emotional exhaustion and compassion fatigue. Emotional resilience in workers is associated with feeling that they have a manageable workload and a sense of personal accomplishment.

Organisational factors that discourage good thinking

•A blame culture•Risk management through defensive practice•Very prescriptive procedures that discourage creativity and flexibility•Heavy caseload so little time to think•Culture that devalues need for critical review•No feedback on outcomes

Key points

We are all vulnerable to intuitive errors of reasoning: they are a feature of being human, not of being stupid.

We will make most progress if we think of good reasoning as a shared responsibility

Simon Jones

Consultant Paediatrician

07774741471

• Joint Working Protocol

• Bruising Protocol

• Personal reflections

Joint Working ProtocolConsider children of parents with

mental ill-healthsubstance misuselearning disabilityemotional or psychological distress

All Children (11 million)

280,150 children in Hampshire

Vulnerable Children (4 million)

Children in Need (400,000)

~ 10,000 children in Hampshire

Children Looked After (60,000)

1,266 children in Hampshire

Child Protection Plan (29,000)

1,113 children in HampshireThe Protection of Children in England A Progress Report, Laming, March 2009

Joint Working ProtocolConsider children of parents with

mental ill-healthsubstance misuselearning disabilityemotional or psychological distress

Early help – secondary prevention

Not at level of significant harm

Joint Working Protocol1999 following SCR2004 – ‘Hidden Harm’2008 – young people2011 – parents with LD2014

Joint Working ProtocolRecord

Child’s name, dob, address, carer, schoolAsk ? CSD / CPP / CAF / young carer

DiscussProfessionals involved, safeguarding lead

ReferCSD for early helpor Drug/alcohol, LD, mental health services

Joint Working ProtocolKey messages

Hear the ‘voice’ of the childDiscuss concerns with the familyKnow when to act immediatelyShare information & update with new

concerns eg non-complianceStay involved

Joint Working ProtocolSharing Information

Share with consent if appropriateSeek advice, consider safetyNecessary, proportionate, relevant,

accurate, timely, secure (Data Prot Act)Keep a recordDuty to share written into all legislation

GMC Guidance for Doctors

Importance of consent in most cases

Disclosure without consent justified if

Failure to disclose may expose patient or others to risk of serious harm

3rd parties who are of direct relevance to child protection eg adults who may

pose a risk to a child

Common law duty of confidencePersonal information should not generally be disclosed without consent of the subject

Disclosure without consent justified in the public interest to prevent harm to others

proportionate response

sanctioned by law (Art. 8 HRA)

go no further than necessary

Data Protection Act 1998Necessary, proportionate, relevant, accurate, timely, secure

Allows disclosure without consent

o Prevention or detection of crime

o Apprehension or prosecution of offenders

o Exercise of a statutory function eg s17/47

o Exercise or defend legal rights eg Art 3 (HRA)

Bruising Protocol

Bruising ProtocolBruises in infants and toddlers - ‘those who don't cruise rarely bruise’Sugar NH, Taylor JA, Feldman KW. Arch Paediatr Adolesc Med 1999;153(3):399-403

Bruises are rare in babies not mobile

366 < 6 months only 2 had bruises (0.6%)

973 < 36 months none had bruises on hands or

buttocks

Bruising Protocol

4 months of age

Bruising Protocol

o Raise awareness of significance of bruising in NIM (non independently mobile) children

o Reflect lessons learned from SCR

o Encourage sharing of concerns

o Consistent with NICE guidance

o Guard against professional optimism

o Joint Health & Social Care 4LSCB-wide policy

Bruising Protocol

20 days, bruise to right cheek ‘2y sibling threw a toy’

18 weeks, small bruise on forehead ‘hit with a teething ring’ by sibling

20 weeks, bruise under left eye seen by GP, no action taken

21 weeks, bruises on face and abdomen, seen by paediatrician, no action taken

26 weeks, fell out of chair, bruise to nose referred to CSD

Individual Management Review (IMR)

Health Practitioner observes bruise or suspicious mark SUSPECT child maltreatment1

A child who is seriously ill should be referred immediately to hospital

Seek an explanation, examine and record accurately Note any other features of abuse2 eg bruises on face and

‘soft’ areas, bruises in clusters or imprints

Explain to family the reason for immediate referral to Children’s Services Department

and Consultant Paediatrician3

Immediate Phone Referral to Children’s Services

Department for multi-agency assessment

and information sharing

Inform GP and HV

Immediate Phone Referral to Duty Consultant

Paediatrician3

and child seen urgently for further investigation to

exclude a medical condition

Inform GP and HV

Follow 4LSCB

Procedures4

Personal Reflections

Personal Reflections

Personal ReflectionsDealing with uncertainty

Team work

Good communication

Personal Reflections

“At no point during her stay in hospital, did any doctor speak to Victoria in a formal attempt to find out what had happened to her, either with or without the assistance of an interpreter... in the end she died a slow, lonely death – abandoned, unheard and unnoticed”

Lord Laming

Personal Reflections

“…these services knew little or nothing more about Victoria at the end of the process than they did when she was first referred…”

Lord Laming

Personal Reflections

We ‘protect’ data, when we could protect children

Personal Reflections

Investing for the future

Culture of openness

Changes in practice

Keeping Children Safe

“Think The Unthinkable”

MASF NE Training event 2014.

Think The Unthinkable• Working together guidance ‘makes

absolutely clear the legal framework and the expectations on different professionals’. This requires a major rethink in those agencies who still believe that their role in safeguarding stops with a referral to social care.

• the Government Guidance stresses two key principles:

• Safeguarding is everyone's responsibility, and • Where professionals are concerned each and

every agency has a role to play in safeguarding and protecting our children.

Think The Unthinkable• When it comes to “organisation culture” there is a

need to: • Create a culture of listening to children ensuring

there is senior buy in to safeguarding and ensure accountability of commissioned providers and contractors.

• Have a designated professional with sufficient time and support (including supervision) to promote the welfare of children. These professionals should recognise the needs of children including rescue from possible abuse and neglect.

• Follow safe recruiting practices. •  Ensure all staff and volunteers are competent to

safeguard the welfare of children and that their practice is reviewed. There should be a mandatory induction and procedures about responding to concerns about a child’s welfare followed.

Think The Unthinkable• Here are the key messages from WTSC

2013 …Are these new messages? • Child-centred practice • Improving inter-agency working

relationships to support effective safeguarding practice

• More effective prevention and early help • Better Assessments • Strengthening accountabilities and

creating learning frameworks • Supporting the development of

professional’s expertise and effective social work practice.

Think The UnthinkablePROFESSIONAL COURAGE AND CURIOSITY

•The views and feelings of children are actually very difficult to ascertain. •Professionals do not always listen to adults who tried to speak on behalf of the child and who may have important Information to contribute. •Parents and carers can easily prevent professionals from seeing and listening to the child •Professionals can be easily fooled with stories we want to believe are true •Is it too difficult to explore thinking/develop and test hypotheses when parents are present in meetings? •Effective multi agency work does not just happen by accident. It needs to be co-ordinated. •Challenging parents (and colleagues) requires expertise, confidence, time and a considerable amount of emotional energy  

Think The Unthinkable• Table exercises:• We would like you read the case study

on your table, complete the tasks requested.

• Please feedback your table’s 3 practice principles or “Golden Rules” to support practice which in turn can improve professional curiosity and professional courage.

 

Hampshire Multi Agency Hampshire Multi Agency Safeguarding HubSafeguarding Hub

MASH

• Hampshire Children’s Services Department have developed a Multi Agency Safeguarding Hub which operates alongside Hantsdirect and Children’s Reception Team.

• MASH became operational on 31/01/14

Referral Pathway to Children’s Social Care

Children’s Reception TeamEmbedded Social Work Team

Direct Professionals Line

PublicHantsdirect

Social Care

Signposted

R&A

• Children’s Services inclusive of education and YOT

• Police• Adult Social care• Health

Partners involved in MASH

Virtual Partners

• Probation

• Housing

• District Councils

• Hampshire Fire and Rescue Service

• Hampshire Ambulance Service

Adult Services

PoliceHealthChildren

Social Care& Education

CYP triageCA12

HampshireProbation Hampshire

Ambulance service

Borough and District

Councils

MASH

HampshireFire /

Rescue

Virtual

HousingCommunity

Safety

Troubled Families

Benefits of MASH• A faster, more co-ordinated and consistent

response to safeguarding concerns about vulnerable children and adults.

• An improved ‘journey’ for the child or adult with a greater emphasis on early intervention and better informed services provided at the right time.

• A more straightforward and responsive process for the professional or customer raising a concern

• Closer partnership working, clear accountability and improved multi-agency communications.

• A reduction in the number of inappropriate referrals and re-referrals leading to effective targeting of services

Benefits continued

• Avoids duplication and silo working.

• Staff and agencies have an increased understanding and appreciation of each others roles and responsibilities leading to increased skills, better multi agency working and more effective judgement.

• Development of flexible working patterns and providing enhanced customer service.

Workflow April – June 2014 Hampshire• 17743 contacts managed by CRT

• 5723 referrals through MASH

• 401 Section 47

• 2778 C&F Assessments

• 186 referrals stepped down to Early Help

Current Position• MASH service has been operational for 8 months.• Service to Hampshire and Isle of Wight• Face to face strategy discussions are working

well.• CP referrals are managed within 2 hours.• Children in Need referrals managed within 24

hours• Good support from Early help to improve Step

down

Current Position• CRT using SERAF tool to screen for

sexual exploitation

• Domestic Violence (Claire’s Law) and Sex Offenders (Sarah’s Law) Disclosure Service managed through CRT/MASH

• Temporary Child Protection Plans held within CRT for HCC and IOW

• Social workers on MASH now work shifts

Next Steps

• Potential for Probation to work from MASH once per week

• YOT trial of workers in MASH

• Police are recruiting extra officers and Staff

• Health have increased resources

• Work commenced to increase involvement of virtual partners.

Questions?