Background Good practice around child safeguarding involves taking children's views into account alongside a whole family approach. However there is little evidence of how often this directive is followed in clinical practice.
A review of case notes in a CAMH service (part of inter-agency audit under section 11 (WT) requirements) addressed this issue recently.
Aims To ascertain: a) Whether children's views were taken into consideration when dealing with safeguarding concerns; b) Whether a ‘whole-family approach’ was adopted around safeguarding issues.
Methods Retrospective audit of clinical records by two named safeguarding professionals in the borough. 96 case notes, representing 10% of cases open to the service, were reviewed.
In 36 notes (37.5%) safeguarding concerns were recorded; these were reviewed in detail. Each set of records was assessed using a traffic light system.
Red (unacceptable standard of practice),
Amber (acceptable practice, nearing standards).
Green (practice met or exceeded standards).
Results Overall, service was rated amber for both questions. Other interesting observations:
▶ Lack of narrative records.
▶ Difficult to locate sections in the notes regarding safeguarding concerns, referral and subsequent actions.
▶ Practice rated as ‘red’ did not lead to serious risks due to protective mechanisms - supervision and MDT discussions.
▶ There was little recording of the children's voice in the notes;
▶ Strong emphasis on parent's / carers' views.
▶ Whole family therapeutic approaches are a core part of CAMHS work but this was not seen to be applied to safeguarding issues.
▶ Safeguarding referrals and notes should be recorded in a separate, colour-coded section of case notes.
▶ Encourage practice of consciously recording children's views separate from parents'. Encourage reflective practice and discerning application of knowledge around safeguarding
▶ Use family therapy approaches to deal with safeguarding concerns.
▶ Implement identified training needs.
▶ Share and cascade good practice in monthly meetings with named and designated leads.
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