Chapter 1 Supporting Vulnerable Children and Young People and Families
- Provides information on identifying risks and needs.
- Gives detail on applying the principles of Getting it Right for Every Child (GIRFEC).
- Describes the key NHS professionals involved in the care of children, young people and families.
The NHS is the provider of universal health services for the people of Scotland. Staff working within the NHS may be the first to become aware that families are experiencing difficulties in looking after their children therefore, healthcare staff have a role in identifying risk factors for child abuse and neglect and must participate in single and multi-agency responses to concerns regarding a child or young person's welfare. The GIRFEC approach stresses the importance of understanding needs and risks within a framework of the child or young person's whole world and wellbeing. When assessing a child or young person, all staff should be alert to the potential risk factors in their life.
Intervention should be proportionate and timely and a holistic approach should be taken to identifying and responding to a child's needs as well as any risks they may face. Practitioners, if they are concerned about a child, should seek all the information they need to inform their assessment, including direct questions to the child to obtain the child's view.
Getting it right for every child (GIRFEC)
Using the principles and practice outlined in Getting it right for every child (GIRFEC) (Appendix 2) health practitioners can fully assess their contribution to the child or young person and plan what type of support or intervention they might require to maximise their wellbeing. In dealing with children and young people and their families, healthcare staff should consider the following questions when they have concerns, or if children and young people or families ask for help:
- What is getting in the way of this child or young person's wellbeing?
- Do I have all the information I need to help this child or young person?
- What can I do now to help this child or young person?
- What can my agency do to help this child or young person?
- What additional help, if any, may be needed from others?
These questions, along with the GIRFEC practice model, will help health professionals consider all aspects of a child or young person's life. When it is recognised that a child or young person's care and protection is compromised, healthcare staff must comply with local child protection policies and protocols and must be familiar with local procedures when they have a child protection concern and take the appropriate action.
National Risk Framework for Assessment of Children and Young People
Based on the GIRFEC approach to wellbeing, and using the National Practice Model as its basis, the Framework sets out a process for assessing risks of children and young people from harm and abuse, and a set of practical tools to consider key factors in their lives.
Under the GIRFEC approach, where a child or young person only requires support from a single agency or service (and consequently not requiring Lead Professional support), the Named Person is designated to be the contact for the child or young person and involved in supporting those who are in regular contact with the child or young person.
The Named Person - who can be the midwife, public health nurse-health visitor (PHN-HV), family nurse (at pre-school stage) and education staff (at school age) - will have an overview of the wellbeing of the child and will carry out a single agency assessment or participate in an interagency assessment framework in line with GIRFEC. This will inform the process of assessing and identifying the needs of the child and will be used during child support or protection processes.
If a health professional has concerns about a child or young person and/or is involved in child protection processes they must ensure the Named Person is informed. The Named Person must ensure that all relevant healthcare staff involved in providing a service to the child, young person and/or family are informed of the concerns. It is the Named Person's responsibility to liaise with the Lead Professional who, in cases where there are child protection concerns, is often the social worker.
During the assessment of the child's needs, using the GIRFEC approach, there may be cases where it is identified that a child or young person's safety is the primary issue, or there is a statutory requirement such as where a child or young person becomes Looked After. In such cases a worker from a specialist part of health or education or another agency may take the lead for co-ordinating help. This person will become the "Lead Professional". In child protection cases the Lead Professional is often a social worker, however, in cases where concerns are not part of formal child protection procedures the Lead Professional could be any practitioner involved with the family. The Lead Professional will sometimes commence the role through a formal meeting, including the key practitioners involved with a particular child. It is important that if child protection concerns emerge at any stage, the Lead Professional needs to follow local child protection procedures.
KEY PROFESSIONALS INVOLVED IN SUPPORTING VULNERABLE CHILDREN
Midwives have a significant role in identifying risk factors to the unborn child during pregnancy, birth and the post-natal period both in hospital and the community. Midwives should be alert to risk factors for the mother and infant including, but not limited to, alcohol and/or drug misuse, domestic abuse and mental health problems such as post-natal depression. HPI can be allocated during the antenatal period and the midwife and PHN services will work collaboratively in addressing the needs of the pregnant woman, unborn child and family as appropriate.
Unborn Babies and the Role of Healthcare staff
Healthcare staff must consider the needs of the unborn baby including whether there could be child protection risks after birth. Health Boards must have robust processes to consider the needs of vulnerable unborn babies/babies. This includes pre-birth planning with other agencies to address these needs in line with National Guidance. A Pathway of Care for Vulnerable Families (0-3)4 provides guidance to ensure that vulnerable children (from conception to age 3) and families in all parts of Scotland receive support that is equitable, proportionate, effective and timely.
This process should ensure that all vulnerable pregnant women, including those with drug-related problems, learning disabilities or mental health issues, receive appropriate ante-natal care5 and support to maximise both their own and their baby's health and wellbeing. Good practice indicates that regular information sharing between all agencies is vital. Healthcare staff often take a leading role in this process. If concerns continue, or are considered high, the need for a child protection referral must be considered.
After the birth of the baby where possible, the obstetric and midwifery teams should consider the need for a pre-discharge discussion/meeting to ensure that the correct support services and monitoring processes are in place to protect the child following discharge. Good inter-agency liaison, as appropriate, with social care and social work services is crucial, including the importance of clear communication on key issues and roles and responsibilities of different staff.
Public Health Nurses - Health Visitors
PHN-HV play a pivotal role in the prevention and early identification of concerns regarding the wellbeing of a child that may include more serious protection and care concerns. After the midwife's post-natal care ends, a PHN/HV will become a child's Named Person (or in some cases, their Lead Professional), normally until the child starts full-time primary education. PHN-HV nurses provide a consistent, knowledgeable and skilled point of contact for families, assessing children's development and planning with parents and carers to ensure their needs are met. As a universal service, they are often the first to be aware that families are experiencing difficulties in looking after their children and can play a crucial role in providing support.
The Family Nurse Partnership programme (FNP) is being delivered across many areas in Scotland. The family nurse works with first-time teenage mothers and their families from pregnancy until their child is 2 years old. The PHN-HV then supports the family after the child reaches 2 years of age. The family nurse works with parents to develop confidence in their parenting and focus on their strengths to do this.
Public Health Nurse - School Nurses
The PHN - school nurse has an important role in promoting the wellbeing of children and young people and can contribute to prevention and early detection of child abuse through a range of health promotion activities. These include: working with teachers on personal, social and health education; monitoring the health of the school population; liaising effectively with teachers and other practitioners; and profiling the health of the school population so that nursing services can be targeted where they are needed most. School nurses continue to monitor the development and health and wellbeing of all children and young people who have additional health plan indicators from Primary 1 onwards for as long as necessary. Where child protection concerns arise, the school nurse should always be alerted and, where appropriate, involved to ensure the health needs are fully identified and met.
The role of the General Practitioner (GP) and the practice team in child protection will be critical in detecting potential concerns, since they will often regularly engage with children and families. Their role includes prevention, early recognition and detection of concerns, assessments and ongoing care and treatment. Surgery consultations, home visits, treatment room sessions, child health clinic attendance, drop-in centre and information for staff such as PHN-HVs, midwives, school nurses, family nurse and practice nurses will all help to build up a picture of the child or young person's situation and highlight any areas of concern. Following the GMC guidance6 GPs must promptly tell an appropriate agency if they are concerned that a child or young person is at risk of, or is experiencing abuse or neglect unless it is not in the child or young person's best interest to do so. The possible consequences of not sharing relevant information will, in the overwhelming majority of cases, outweigh any harm that sharing concerns with an appropriate agency might cause. GPs can provide direct support to children, young people and their families and contribute to the child's plan, specifically, the child protection case conference and/or the child protection plan. GPs and practices must have protocols in place for engaging with other services where child protection concerns arise.
GPs are also key in the identification and support to adults with significant risk factors such as addictions and mental health difficulties which may impact on their ability to care. GPs should be familiar with national and local policy outlining key issues and recommendations for working with families where there are risks. Local guidance should be developed in line with the national change programmes and frameworks relevant to children affected by parental alcohol and or drug misuse. "Getting our Priorities Right" 7 specifically highlights important themes for all staff working with parents affected by substance misuse. GPs must also consider risks for children and young people registered with another practice where adult patients present with potential difficulties.
All paediatricians have a duty to identify child abuse and neglect and must therefore maintain their skills in this area and make sure they are familiar with the procedures to be followed where abuse of neglect is suspected.
Other Health Practitioners
Many other disciplines of health practitioners work directly and indirectly with children and young people and/or parents and carers. These not only include those working in children and family services but also those working with a wide range of adult orientated services. All practitioners should adopt a GIRFEC approach and therefore should be mindful of the wellbeing of any child or young person that they come into contact with or who may be in contact with their patients/clients. In particular, practitioners should be aware of local child protection policies, guidance and protocols and their responsibility to share information regarding concerns for a child or young person's wellbeing. Local protocols should be in place to manage any concerns or relevant information and to direct these to the Named Person for the child or young person.
Further specific advice on the role of GPs, emergency medicine specialists and paediatricians is detailed on pages 16-18.
Email: Fiona McKinlay
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