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In a small proportion of childhood hospital attendances there are obvious child protection issues. In a much greater number there is concern about the child’s welfare. Only if concerns are recognised, documented, and addressed at an earlier stage, can we hope to improve “safeguarding” children.
In Peterborough District Hospital a “Concern Sheet” has been in use since 1998 to address child protection concerns throughout the Trust. Use of the Concern Sheet has been audited twice. Despite this, many failures of documentation, reporting, and follow up were identified. To address these problems, a joint hospital/community “Children’s Liaison and Discharge Coordinator” was appointed in October 2002. She is a registered children’s nurse, with child protection experience.
Our aim was to see if these two measures improved identification, documentation, and follow up of child protection concerns. We retrospectively analysed the Concern Sheet data collected for 2003 and noted a striking increase in child protection awareness in every hospital department where children are seen (table 1). The Coordinator has been very active in raising the profile of child welfare concerns, not just overt abuse, with all staff.
Table 2 shows the causes of concern for different age groups. It is interesting that 25% of reported concerns were about parents and their ability to care for their children. There is a potential risk to children cared for by adults with mental health problems, those who abuse drugs/alcohol, or when there are concerns regarding domestic violence. Hall1 has stressed that healthcare professionals must take the opportunity to prevent child abuse/neglect when faced with such situations.
We believed that we were addressing concerns which were less serious at an earlier stage, but it is noteworthy only 47 (9.6%) required no further action. Nearly half (230, 46.9%) of the concerns were serious enough to warrant a discussion with Social Services. The Coordinator liaised with health visitors in 229 (46.7%), school nurses in 21 (4.3%), Child and Adolescent Mental Health Services in 29 (5.9%), and police in 40 (8.2%) of the cases where Concern Sheets were completed.
Forty two children (18.2%) proceeded to an Initial Child Protection Conference, 14 (6%) had an early Review Conference, and 2 (0.8%) had an early Transfer-in Conference as a result of the concern reports. Of those subjected to an Initial Conference, 36 (86%) were registered.
From past enquiries into child deaths, the common reasons which have led to a failure to intervene early enough are poor training, documentation, information sharing, and follow up of concerns. Lord Laming2 has emphasised the importance of better training and introducing systems which allow quality monitoring. We have attempted to address these issues and conclude that “safeguarding children” may be improved by:
Having a person other than the named and designated professionals in the role of a Coordinator
Having a uniform way of recording child welfare concerns throughout a Trust.