GP Update 2015 Level 3 Helen Mutch Named

GP Update 2015 (Level 3) Helen Mutch, Named GP Sandy Marwick, Independent Social Worker 2015

Learning objectives Ø To understand what constitutes child maltreatment and identifying features Ø To understand the local and national framework, including service reorganisations, serious case review messages and recent developments Ø To gain confidence in managing potential safeguarding issues by reflecting on cases.

Ø Case Scenarios Ø Background information Ø Useful resources and Guidelines Ø Local multi-agency working and serious case reviews Ø Questions

Case Scenarios

Ø When discussing the following case scenarios please consider the following four points: Ø 1. WHAT FACTORS DO YOU NEED TO CONSIDER? Ø 2. WHAT FACTORS WOULD HEIGHTEN CONCERN? Ø 3. WHAT FACTORS WOULD REASSURE YOU? Ø 4. WHAT WOULD YOU DO NEXT?

Ø You have a patient who has been on a long term methadone script and becomes pregnant. You refer her to specialist services for drug using mothers but she does not attend.

Ø A teenage girl known to you consults on a busy Monday afternoon. She attends with her older boyfriend. She is asking for emergency contraception after a condom had split following intercourse on Saturday. She sits holding her boyfriends hand throughout and says her parents mustn't find out as they would kill her. She will be thirteen the following day.

Ø A patient comes to see you asking for contraception as she is in a new relationship. After you have finished consulting her she asks you to check her 4 month old baby over as she has a bad cough and fever. Ø While listening to her chest you notice a small bruise on the baby’s chest which mother explains was caused by the baby’s older brother.

Ø A 13 year old boy is brought to you by his mother. He has been excluded from school following a fight where he punched and kicked another student. Mum says they want him referred to CAMHS before he can go back. You have seen the mother previously for depression. The boy isn’t very communicative. When asked about his behaviour at home his mother says there is a lot of arguing between him and her partner but she is unwilling to say much more.

Ø A mother attends the surgery with difficulty passing urine. She has recently given birth to a baby girl. She has 2 other children at home 1 girl aged 6 and a boy aged 3. her country of origin is the Sudan

Ø A 16 year old girl comes to see you asking for sleeping tablets. She says there have been a lot of break-ins round where she lives and she is scared at night. She isn’t well known to you but from her notes you see that she lives with her grandmother and her uncle. She is very overweight and has seen the nurse practitioner several times about painful periods. Ø

What can GPs do? Ø Record concerns in the primary care electronic health record Ø Discuss the matter with colleagues Ø Arrange for monitoring/seeing the child or YP (you or another health professional) Ø Regular practice meetings to discuss management of vulnerable families. Ø REFER

Families should be referred on to social workers either because they need support services that the local authority can provide (for example respite care for a disabled child) or because there are concerns about abuse or neglect. Ø Referral threshold guidance 2014: Ø Ø http: //www. bristol. gov. uk/sites/default/files/docu ments/children_and_young_people/child_health _and_welfare/Final%20 Thresholds%20 guidance %20 February%202014. pdf

Ø Questions to ask yourself: Ø • If nothing changes, or if I do nothing, in what way is the child likely to be harmed? Ø • What is it I am most worried about? Ø • Have I asked consent from the parent (and child where appropriate) to share this information? (and if not, why not? ) Ø • What is prompting me to ask for help or support now? Has the problem or issue got worse recently? Ø • What needs or concerns have been identified? Ø • What has already been done to address the needs or concerns? (including actions by other agencies where known). Ø Ø Ø • What positive resources and abilities do the child and family currently have? • What do we already know about the child’s development issues and parental capacity within the family?

Ø Coding Ø Recording Ø Scanning Ø Family key - EMIS Ø Safeguarding protocol Ø DNA policy Ø Communication policy Ø Information sharing

Useful codes ØSubject to child protection plan 13 Iv ØNo longer subject to child protection plan 3 Iw ØChild protection Case conference 3875 ØChild in need 13 Is ØVulnerable child 13 IF-1 Øvulnerable family 13 Iq ØVictim of domestic abuse 14 XG ØDomestic abuse victim in household 13 WD

Issues for sessional GPs and STs Ø Ø Ø Communication – PN/task to usual GP Link/lead GPs – email or PN/task Coding Locum packs/folders Local contact numbers If in doubt discuss. Within practice or with named GP/designated nurse

The Child Abuse Jigsaw Child’s Disclosure Past Medical History Growth and Development Parents’ and Family History Behaviour Physical Examination Other third party information Medical Investigations Information from School, Health Visitor and GP

Useful resources (1) GMC guidance – protecting children and young people: Ø http: //www. gmcuk. org/static/documents/content/Child_protection_guidance_update_25_4_13. pdf Ø Bristol safeguarding board: Ø http: //www. bristol. gov. uk/page/children-and-young-people/bscb-protocols-multiagency-action Ø South West Safeguarding Procedures: Ø http: //www. swcpp. org. uk Ø summary of Working Together 2013 – by NSPCC Ø http: //www. nspcc. org. uk/inform/research/briefings/Working_together_2013_wda 9500 1. html#summary Ø Ø Ø BSCB Threshold Guidance 2014 http: //www. bristol. gov. uk/page/children-and-young-people/bristol-safeguardingchildren-board

Useful resources (2) Ø Ø Ø NICE – when to suspect child maltreatment March 2013 http: //www. nice. org. uk/nicemedia/live/12183/44914. pdf forced marriage and honour violence http: //www. karmanirvana. org. uk/ Serious case review themes http: //www. nspcc. org. uk/Inform/resourcesforprofessionals/scrs/at-a-glancebriefings_wda 99475. html Child sexual exploitation – spotting the signs toolkit Ø http: //www. bashh. org/documents/Spotting-the-signs-CSE%20 a%20 national%20 proforma%20 April%202014%20 online. pdf Ø Ø sexual Violence Referral Pathway http: //www. survivorpathway. org. uk/bristol/ Ø

Useful Resources (3) NSPCC collate all eth Serious case reviews across the UK, they also undertake thematic reviews of key concerns http: //www. nspcc. org. uk/Inform/resourcesforprofessionals/serious_case_reviews_homep age_wda 82779. html Ø Safeguarding Children’s training: e-learning Package http: //www. e-lfh. org. uk/programmes/safeguarding-children/ Ø Female genital Mutilation –Resource Pack https: //www. gov. uk/government/publications/female-genital-mutilation-resourcepack/female-genital-mutilation-resource-pack Ø E-learning Package on Female Genital Mutilation http: //www. fgmelearning. co. uk/ Ø

Young People Under 16 Involved in Sexual Activity Fraser Guidelines Ø Ø Ø Ø Can you give contraceptive and sexual health advice and information to under 16 year olds without parental consent? Are you satisfied that: The young person can understand the advice and has sufficient maturity to understand what is involved in terms of the moral, social and emotional implications. You can’t persuade the young person to inform their parents, nor allow you to inform their parents that contraceptive advice is being sought. The young person would be very likely to begin or to continue having sexual intercourse with or without contraceptive treatment. Without contraceptive treatment the young person’s physical or mental health or both would be likely to suffer. The young person’s best interests requires the professional to give advice without parental consent.

Ø Bichard checklist Ø Ø Ø Ø Should you tell the police and social services? Do any of the following apply: • Age or power imbalances • Overt aggression • Coercion or bribery • The misuse of substances as a disinhibitor • Does the child’s own behaviour, because of the misuse of substances, place him/her at risk so that he/she is unable to make an informed choice about any activity? • Has any attempt to secure secrecy been made by the sexual partner, beyond what would be considered usual in a teenage relationship? • Is the sexual partner known by one of the agencies (n. b. police)? • Does the child deny, minimise or accept concerns? • Are the methods used consistent with grooming? Ø Ø

Safeguarding and substance misuse Ø Risk assessment ( including partner) Ø Prescribing Ø Safety of medicines Ø Neglect and abuse Ø Shared care protocol

Local services CYPS/Multiagency Ø First Response ( Bristol) Ø First Point ( S Glos) Ø Early help Ø New team structure 2015 Police Ø Public Protection Unit (PPU) organisation MARAC Child Sexual Exploitation (CSE) FGM

Contact details and information for referrals First response - Bristol ØTelephone: 0117 9036444 Øhttp: //www. bristol. gov. uk/page/children-and-young-people/report-concerns-about-child- social-worker-first-response ØFirst Point = (South Gloucestershire’s First Point is Gloucestershire’s a single point of access to children's preventative and social care and specialist services, their telephone number is 01454 866000 and their email is firstpoint@southglos. gov. uk ØOut of hours Emergency Duty Team- 01454 615165 ØNorth Somerset Children’s Services, Single Point of Access: 01275 888808

Signs of safety Ø Systems based approach to assessing and planning safeguarding work with children and families Ø Solution focussed Ø https: //www. nspcc. org. uk/Inform/research/ findings/signs-of-safety-pdf_wdf 94939. pdf

Local SCRs Child M 2010 - toddler who drowned in pond Ø Child N 2010 – 10 yr child stabbed by mother Ø Children A & Z 2011 – 2 children 7 & 5 year old died in a house fire Ø Child K 2012 - toddler died from methadone ingestion Ø Child T 2013 – not yet published Ø Sarah- Current Bristol SCR Ø South Glouc about to publish their latest SCR Ø

Ø Telephone numbers for routine advice and support: NHS BRISTOL and BRISTOL COMMUNITY HEALTH Ø Designated Doctor for all Bristol Trusts and NHS South Gloucestershire: Dr Maria Bredow. Tel: 0117 9002670 Email: maria. bredow@nbt. nhs. uk Designated Nurse for Safeguarding Children: Jackie Mathers. 4 th Floor, South Plaza, Tel: 0117 9002670, Email: jackie. mathers@bristolccg. nhs. uk Deputy Designated Nurse for Safeguarding Children: Julie Henderson. Email julie. henderson@bristolccg. nhs. uk Named GP for Safeguarding Children: Dr Helen Mutch 0117 9640900 Mob: 07768414789 The Lennard Surgery. helen. mutch@gp-l 81053. nhs. uk Ø Ø

Ø Summing up Ø Questions Ø Contact Ø Helen Mutch