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Making Referrals to MASH

ADDITIONAL GUIDANCE

NICE Guidelines - When to suspect child maltreatment

AMENDMENT

The “Professional Consultation” content of Section 3, Deciding, was entirely revised and updated in April 2017 and should be re-read.


Contents

  1. Members of the Public
  2. Identifying Concerns - Procedures to be Followed by Practitioners Working with Children and Their Families
  3. Deciding
  4. The Referral Process for Children in Need of Protection
  5. Taking a Referral - Procedures to be followed by Children’s Social Care
  6. Practice Guidance - Recognising and Responding to Concerns


1. Members of the Public

The LSCB knows that the abuse of children often comes to light due to members of the public being vigilant and reporting concerns to the statutory agencies. This is an important aspect of protecting children from harm and any referral from a member of the public should be responded to in line with the procedures set out in Action to be taken following a Referral to Children's Social Care Procedure and Action to be taken where a Child is Suffering or Likely to Suffer Significant Harm - Section 47 Procedure.

Government guidance “What to do if you are worried a child is being abused” sets out what should happen when anyone is concerned about the welfare of a child and will help members of the public in making a referral.


2. Identifying Concerns - Procedures to be Followed by Practitioners Working with Children and Their Families

Concerns about the welfare of a child may occur:

  • In situations where there have been no previous concerns and the child has not previously received any services, other than those universal services accessed by all children;
  • Where an assessment has taken place by agencies other than Children’s Social Care under the Early Help Assessment and a plan has been put in place in order to improve the wellbeing of the child;
  • Where the child is already allocated to a worker in Children’s Social Care;
  • Where there is no current involvement by Children’s Social Care but there have been previous referrals.

The concern should be discussed with a senior member of staff / Safeguarding Lead in order to clarify the seriousness and urgency of the situation and decide the next course of action. The senior member of staff may be:

  • A manager;
  • A designated member of staff with responsibility for safeguarding children, for example: designated nurse/named nurse or doctor; designated person in an education setting.

If, following this discussion, there are still concerns about the welfare of the child, consideration should be given to contacting MASH for advice. This can be done by requesting a ‘Professional Consultation' and discussing your concerns with a Social Worker without necessarily naming the child in question. If a Professional Consultation is requested the Social Worker will contact you by the end of the next working day. MASH will send out a summary of your conversation detailing any advice or action suggested and agreed upon.

If the practitioner with the concerns believes that a child’s health or development is being impaired without the provision of services by the Local Authority (i.e. the child is a Child in Need), consideration should be given to making a referral to Children’s Social Care. In this circumstance, an Early Help Assessment should be completed (if this has not already been done) and used as a basis for deciding whether a referral is appropriate. The parent(s) and the child (where appropriate) should be consulted prior to a referral being made. See EHA Operational Guidance.

If the practitioner believes that a child or young person is suffering, or is likely to be suffering Significant Harm they should always refer their concerns to Children’s Social Care.

In most situations, concerns should be discussed with the child (as appropriate to their age and understanding), and with their parents, and their agreement sought to a referral being made. However, agreement should not be sought if doing so would place the child at increased likelihood Significant Harm. Where it does not place the child at increased likelihood of Significant Harm parents should be informed that a referral is being made. In most situations referrals should be discussed with the child as appropriate to their age and understanding. Additional Guidance on seeking consent is available in the Cambridgeshire Threshold Document.

The Government guidance on information sharing - (Information Sharing: Practitioners Guide) must be used to inform the decision about what information should be shared at the point of referral. The seven golden rules of information sharing set out in this guidance are in Practice Guidance


3. Deciding 

The definitions of Physical Abuse, Emotional Abuse, Neglect and Sexual Abuse in Working Together to Safeguard Children (2015) should be used to assist decision making about when a child is suffering to likely to suffer Significant Harm. See also Practice Guidance, Recognising and Responding to Concerns which is also designed to help professionals understand the concepts of ‘need’ and ‘harm’.

‘Working Together to Safeguard Children (2015)' states that Local Safeguarding Children Boards should set out the criteria that should be used when deciding whether or not to refer to Children’s Social Care. These are set out in the detailed version of the Cambridgeshire Threshold Document. Professionals are reminded that they need to use their professional judgment in using these criteria and if in doubt to consult with a designated senior to decide what action to take.

The table and the more detailed Cambridgeshire Threshold Document distinguish between children who may need some support to achieve the five outcomes defined by government (children with additional needs) and those whose health or development is likely to impaired without provision of services by the local authority (Children in Need).

Children with additional needs will be identified through the use of the Early Help Assessment primarily by professionals in the universal services. Children’s Social Care are responsible for assessing Children in Need referred to them; such children are likely to have complex needs and will include those suffering or likely to suffer Significant Harm. Where an assessment under the Early Help Assessment has been completed, this should provide a basis for referral and information sharing between agencies.

Deciding how to act in situations of Neglect presents some of the greatest challenges to professionals, and may require careful, close observation of parenting, and child behaviour. Severe neglect of young children is associated with major impairment of growth and intellectual development. Persistent Neglect can lead to serious impairment of health and development, and long-term difficulties with social functioning, relationships and educational progress. Neglect can result, in extreme cases, in death.

Professional Consultations

If, as a professional working with children, young people and families in Cambridgeshire, you have a concern about a child or young person that you feel might be a safeguarding concern then this practice note will help guide you as to what to do next:

  1. Always contact the safeguarding lead in your organisation or a senior manager or supervisor
    In the first instance; you should discuss your concern with the safeguarding lead or senior member of staff in your own agency order to clarify the seriousness and urgency of the situation and decide the next course of action. This could be a manager or the designated member of staff with responsibility for safeguarding children, for example: designated nurse/named nurse or doctor; designated person in an education setting. The safeguarding lead should be able to provide you with the relevant advice and support as to whether to refer or to contact MASH to discuss a case;
  2. What if I don’t have a senior manager or safeguarding lead to talk to?
    The LSCB partner agencies fully recognise that some practitioners working with children and families may be working in small organisations without the necessary resources to support the approach above. MASH will always offer advice to anyone with concerns about a child or young person. In these circumstances please call MASH and request a professional consultation. It may make a real difference to a child’s life.

    Children Social Care: 0345 045 1362: (Mon – Thurs) 8am – 5.30pm, (Friday) 8am – 4.30pm or the Emergency Duty Team (Out of Hours) on 01733 234724.

    Consultation is a sharing of information between workers in order to gain the perspectives of another service. It is not a referral to MASH or a request for Early Help Hub, unless that is explicitly agreed during the consultation. ‘Ownership’ of the case remains with the agency initiating the consultation. Following internal line-management consultations, practitioners can discuss their safeguarding or wellbeing concerns with agency navigators in MASH. Any existing agency involvement at lower levels of concern can be identified.

    Consultation will provide an opportunity for those working with a child, young person and/or family to access additional knowledge and expertise from suitably qualified and experienced staff from a range of agencies in order to explore a concern, and decide how best to respond to it.

    As far as possible, you should:
    • Be clear about what the concern is and what is needed from the consultation;
    • Offer evidence to support the concern and its possible impact on the child or other children;
    • Outline what the agency has already done about the concern;
    • Indicate what the impact of this has been;
    • Share ONLY such other knowledge of the child and family as may be necessary to clarify whether the child or other children may be in need of support or safeguarding services;
    • Be open to suggestions made for the way forward;
    • Make notes of agreed decisions (as outlined in next sub-section).
    The professional giving advice should:
    • Seek clarification where there are any uncertainties about what is involved;
    • Determine whether consent has been obtained to share information;
    • Determine the appropriateness of not seeking, or overriding, parental permission.
  3. What happens next?
    You should record this discussion (as will the social worker) in a retrievable form that is recognised in your agency. The information is recorded on the child’s social care file, and a letter is then sent to the professional (only) outlining the discussions and the recommendations. If you have any concern about the advice or you don’t know what to do next please share this with your safeguarding lead.

Additional Guidance on consultation is available in the Cambridgeshire Threshold Document.


4. The Referral Process for Children in Need of Protection

Where the child is not an open case in Children’s Social Care

If there are immediate concerns about the safety of a child a referral should be made to MASH (see Local Contacts or using the Safeguarding Referral Form). At the end of any discussion or dialogue about a child the referrer (if a professional from another service) and Children’s Social Care must record the decision taken in their records.

Telephone referrals should be followed up in writing within 24 hours. The EHA Form should be used to support a referral or a specialist assessment.

Where an Early Help Assessment has been completed by the referring agency this will form the basis of the referral. Where necessary the assessment should be updated in order to ensure that the most recent information is being passed to MASH. It is good practice to discuss the referral with the child (if appropriate) and parents/carers unless doing so would make the child vulnerable to suffering Significant Harm or, where police may become involved, be likely to prejudice a criminal investigation.

Where the child is an open case in Children’s Social Care

Practitioners from outside Children’s Social Care should contact the allocated worker to express their concerns and follow these up in writing within 48 hours.

If concerns come to light from within Children’s Social Care in relation to an open case, a decision should be made as to whether or not a Strategy Discussion should be initiated (see Action to be taken where a Child is Suffering or Likely to Suffer Significant Harm Procedure, Paragraphs 4.4-4.12). In these circumstances it may be appropriate to undertake a Single Assessment or update a previous one in order to understand the child’s current needs and circumstances and inform future decision making.


5. Taking a Referral - Procedures to be followed by Children's Social Care

Children’s Social Care have in place a centralised system for receiving and re-directing referrals Information Officers have access to immediate consultation and guidance from qualified and experienced MASH Manager in order to ensure that all necessary information is gathered and an appropriate response is made.

As soon as a referral is made about the welfare of a child, records should be checked in order to ascertain whether either the child or the child’s parents/ carers are known to Children’s or Adults’ Social Care. This information must be recorded.

In the event of a telephone referral which is passed to the relevant social work unit the duty worker should:

  • Give their name and designation;
  • Help the referrer give as much information as possible;
  • Clarify the information that the referrer is reporting directly and information that has been obtained from a third party;
  • Clarify who knows about the referral;
  • Clarify the whereabouts of the child and immediate action to be taken;
  • Explain what is going to happen next;
  • When the referrer is a professional, confirm that a written referral will be received within 48 hours;
  • Agree how to re-contact the referrer if further clarification is required;
  • Clarify whether the referrer gives consent for their details to be revealed to the child/family concerned (refusing consent should only be an exception in the event of a referral from another professional - see 2.28 below);
  • Explain how feedback will be given.

It may be appropriate to agree anonymity where:

  • The referrer is a member of the public;
  • There is evidence of intimidation or threats of violence towards the professional concerned.

All referrals should record details of:

  • Evidence of domestic violence;
  • Evidence of parental mental ill health, drug or alcohol use, parental learning disability;
  • Any known impairment of the child or parent or carer;
  • Convictions against children or previous suspected abuse.
Referrers should be asked specifically if they hold any information about difficulties being experienced by the family/household due to domestic abuse, mental illness, substance misuse, and/or learning difficulties.

Where a written referral is received by MASH, the MASH manager should decide on next steps within 24 hours.


6. Practice Guidance - Recognising and responding to concerns

Information Sharing

The following is taken from:

Information Sharing: Guidance for practitioners and managers

Seven Golden Rules of Information Sharing

  1. Remember that the Data Protection Act is not a barrier to sharing information but provides a framework to ensure that personal information about living persons is shared appropriately;
  2. Be open and honest with the person (and/or their family where appropriate) from the outset about why, what, how and with whom information will, or could be shared, and seek their agreement, unless it is unsafe or inappropriate to do so;
  3. Seek advice if you are in any doubt, without disclosing the identity of the person where possible;
  4. Share with consent where appropriate and, where possible, respect the wishes of those who do not consent to share confidential information. You may still share information without consent if, in your judgement, that lack of consent can be overridden in the public interest. You will need to base your judgment on the facts of the case;
  5. Consider safety and well-being: Base your information sharing decisions on considerations of the safety and wellbeing of the person and others who may be affected by their actions;
  6. Necessary, proportionate, relevant, accurate, timely and secure: Ensure that the information you share is necessary for the purpose for which you are sharing it, is shared only with those people who need to have it, is accurate and up-to-date, is shared in a timely fashion, and is shared securely;
  7. Keep a record of your decision and the reasons for it - whether it is to share information or not. If you decide to share, then record what you have shared, with whom and for what purpose.

Confidentiality

In deciding whether there is a need to share information you need to consider your legal obligations including:

  1. Whether the information is confidential;
  2. If it is confidential, whether there is a public interest sufficient to justify sharing.

Information is not confidential if it already in the public domain e.g. a teacher may know that one of her pupils has a parent who misuses drugs. That is information of some sensitivity but may not be confidential if it is widely known or it has been shared with the teacher in circumstances where the person understood it would be shared with others. If however, it is shared with the teacher in a counselling session it would be confidential.

Confidence is only breached where the sharing of confidential information is not authorised by the person who provided it or to whom it relates.

Even where sharing of confidential information is not authorised you may share it if this can be justified in the public interest.

A key factor in deciding whether or not to share confidential information is proportionality, i.e. whether the proposed sharing is a proportionate response to the need to protect the public interest in question.

Where there is a clear likelihood of a child suffering Significant Harm, or serious harm to adults, the public interest test will almost certainly be satisfied. However there will be other cases where practitioners will be justified in sharing some confidential information in order to make decisions on sharing further information or taking action - the information shared should be proportionate.

Circumstances in which sharing confidential information without consent will normally be justified in the public interest:

  • When there is evidence that the child is suffering or is likely to suffer Significant Harm; or
  • There is reasonable cause to believe that a child may be suffering or is likely to suffer Significant Harm; or
  • To prevent Significant Harm arising to children and young people or serious harm to adults, including through the prevention, detection and prosecution of serious crime.

Please note:

It is essential that staff do not give false reassurance that information will be kept confidential when information will need to be shared if a child is likely to suffer harm.

Do’s and Don’ts (adapted from “What to do if you are worried a child has been abused”, 2006)

  • Do record full information about the child(ren) or young person(s) at first point of contact, including name(s), address(es), gender, date of birth, name(s) of person(s) with Parental Responsibility (for consent purposes) and primary carer(s), if different, and keep this information up to date;
  • Do ensure that the child(ren)’s records includes an up-to-date Chronology, and details of the lead worker in the relevant agency - for example, a social worker, GP, health visitor or teacher;
  • Do know who to contact within your own organisation to express concerns about a child’s welfare;
  • Do know who to contact in police, health, education, Children’s Social Care and MASH to express concerns about a child’s welfare;
  • Do talk to your manager and other professionals: always share your concerns, and discuss any differences of opinion;
  • Do listen to what the child or young person has to say and record in their own words what has been said. Sign and date all records;
  • Do note visible marks or injuries on a body map and document details in your records;
  • Do NOT attempt to physically examine a child(ren);
  • Do record any conversation with parents or carers fully and accurately;
  • Do NOT ask leading questions or attempt to investigate allegations;
  • Do ensure that you have all the information held by your agency relating to the child(ren) or young person(s), their family and the details of your concern to hand when making a referral; 
  • Do record all concerns, discussions about the child(ren) or young person(s), decisions made, and the reasons for those decisions;
  • Do follow up your concerns. Always follow up oral communications to other professionals in writing and ensure your message is clear;
  • Do keep careful and detailed notes;
  • Do record any unusual events and make a distinction between events reported by the carer and those actually witnessed by others including professionals. Notes should be timed, dated and signed.

Children in Need

Section 17 of the Children Act 1989 confers a general duty on the local authority to:

  • Safeguard and promote the welfare of children within the area who are in need;
  • So far as is consistent to promote their upbringing by families.

By providing a range and level of services appropriate to their needs.

Section 53 of the Children Act 2004 amends section 17 to now also require that before determining what if any services to provide, the local authority shall:

  • ascertain the child’s wishes and feelings regarding those services; and
  • give due consideration to those wishes and feelings.

Children in Need of Protection before Identifying Likelihood of Suffering Significant Harm

Section 47 of the Children Act 1989 confers a duty on the local authority that where a child in the area is:

  • Subject of an Emergency Protection Order/Police Protection; or
  • They have reasonable cause to suspect a child is suffering or is likely to suffer Significant Harm.

The authority shall make or cause to be made necessary enquiries to decide whether they should take any action to safeguard or promote the child’s welfare.

Where enquiries are being made the authority should:

  • Obtain access to him/her or ensure access is obtained by an authorised person.

Section 53 of the Children Act 2004 amends section 47 so that for the purposes of making a determination as to what action to take the authority shall:

  • Ascertain the child’s wishes and feelings about such action; and
  • Give due consideration to the child’s wishes and feelings.

Under s31 (9) of the Children Act 1989 as amended by the Adoption and Children Act 2002:

‘harm’ means the ill-treatment or the impairment of health or development, including, for example, impairment suffered from seeing or hearing the ill-treatment of another

‘development’ means physical, intellectual, emotional social or behavioural development;

‘health’ means physical or mental health; and

‘ill-treatment’ includes sexual abuse and forms of ill-treatment which are not physical.

Under s31 (10) of the Children Act 1989:

Where the question of whether harm suffered by a child is significant turns on the child’s health and development, his health or development shall be compared with that which could reasonably be expected of a similar child.

Significant Harm may be associated with a single traumatic event but most often it is a compilation of significant events, both acute and longstanding, which interrupt, change or damage the child’s physical and psychological development.

“Harm” is attributable to care given not being what it would be reasonable to expect a parent to give.

To understand and establish Significant Harm, it is necessary to consider:

  • The nature of harm, in terms of maltreatment or failure to provide adequate care;
  • The impact on the child’s health and development;
  • The child’s development within the context of their family and wider environment;
  • Any needs as a result of the child’s medical condition, physical or mental impairment that may affect the child’s development and care within the family;
  • The capacity of the parents to meet adequately the child’s needs; and
  • The wider and environmental family context.

Consideration of whether harm is significant should therefore include:

  • Accuracy of what has been alleged/reported;
  • Impact on this particular child  - evident now or probable given research studies/information available regarding children in similar situations - taking into account:
    • Whether what has been done to, or omitted regarding a child’s care forms a ‘pattern’ of behaviour towards this child  -  or was it a one off and is it likely that it will it recur or not?
    • Severity of abuse/impact - and how the child may have reacted/changed as a result;
    • The overall wellbeing and/or robustness of the child;
    • Specific vulnerability/ies of the child stemming from young age or impairment;
    • The views of the child.
  • The context in which the act or omission occurred - is all the available past information available and does any still need to be sought - how important might missing information be?
  • Causal link to parents/carers against what would have been reasonable/is reasonable to expect of any parents in relation to this child and its needs (with or without provision of services);
  • Parental reaction - both immediately and in the long term;
  • What protective/positive factors or individuals (e.g. extended family) are there?
  • What engagement with professionals in recognition of the need for change is there? What acceptance of responsibility/what insight/what capacity and what motivation for changing and sustaining change is there? Are the causes of problems identified and needs established so that clear targets for parents and agencies can be set and linked to clear outcome expectations?

Thresholds and Significant Harm

It must be remembered that when it is identified that a child is suffering or likely to suffer Significant Harm they will also be a Child in Need. The focus on harm should not mean that the overall needs of the child are ignored. Section 47 needs to be understood as a specific “extra” within the overall requirements of Section 17, not separate from it. Complex cases can move between Sections 17 and 47 status in this way rather than ‘get lost’ due to a threshold debate as to whether they are one or the other.

FIG 2 Tiers of Need and Intervention:

Adapted from Hardiker, Exton & Barker (1991) in Vision for Services for Children and Young People affected by Domestic Violence- guidance for local commissioners of children’s services. (2005) Local Government Association; CAFCASS: Women’s Aid.

Click here to view the Flowchart - Tiers of Need and Intervention.

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