“Thinking the Unthinkable” Housekeeping • • • • • Alarms Toilets Smoking Breaks Register Aim A conference organised by the Multi Agency Safeguarding Forum North East designed to challenge professionals in some of their thinking about abuse. Learning Outcomes 1. Getting professionals to challenge their own thinking and avoid fixed thinking. 2. To consider how to develop professional curiosity. 3. To consider the need for appropriate challenge 4. To explore learning from serious case reviews 5. To raise awareness of joint working protocols HSCB Priorities • Embedding the HSCB Quality Assurance Framework • Ensuring compliance with the new Statutory Safeguarding Guidance • Safeguarding disabled children • Tackling child sexual exploitation • Young people who self harm Programme 0900 – Arrival and registration 0930 – Welcome and administration - Lin Ferguson, Chair of MASF 0945 – Keynote speech – Professor Eileen Munro 1045 – Break 1115 - Joint Working Protocol - Bruising Protocol - Dr Simon Jones 1215 – Lunch 1300 – Case study exercise – Inspector Darren Murphy and Alison Nealis, IRO 1430 – Break 1500 – Multi Agency Safeguarding Hub – Sarah Marston, District Manager Childrens Services 1530 – Plenary session – Alison Nealis 1545 – Close Break Case Study exercise Break End • Presentations will be sent out. • Please complete the survey monkey evaluation. Have a safe journey home! Improving reasoning in child protection Eileen Munro October 2014 Key message •Improving reasoning is a shared responsibility Outline You are human beings Understanding how we use our intellect and emotions Being critical You work with human beings Importance of relationships Challenges Importance of organisational context Understanding how we use our intellect and our emotions We have two processes for reasoning – intuitive and analytic Emotions play an essential, valuable, but sometimes troublesome part Intuition and analysis are on a continuum; we use both to varying degrees in different tasks. Intuition has persistent biases that need to be consciously checked for by our analytic capacity. The task determines the type of reasoning needed •The balance of intuitive and analytic reasoning needed depends on the task you are doing. •Some need a mainly intuitive approach; some need a mainly analytic approach. •Neither is ‘best’ is an absolute sense Human reasoning “System 2 [our analytic skill] is the supporting character who thinks she is the hero. The defining feature of system 2 is that its operations are effortful and one of its main characteristics is laziness. As a consequence, the thoughts and actions it thinks it has chosen are often guided by system 1 [intuition]” Kahenmann, D. (2011) Thinking, Fast and Slow, London, Allen Lane Analytic thinking as a personal trainer •Intuitive reasoning is the basic process that we then improve by using analytic thinking to: •articulate •check (being aware of biases) •test deliberately Respectful uncertainty Intellectually accurate but Very uncomfortable Workers need prompting and support to question their assessment –hard to do on own, however senior. Being critical Reluctance to change our minds First impressions – anchoring Using limited range of information Attribution error De-biasing •The common element in all strategies is to consider alternative perspectives: – Thinking why your view might be wrong – Devil’s advocate deliberately taking opposing view – Reducing attribution error by thinking about how you might have behaved. Supervision •Where you help the worker articulate the reasons for their intuitive judgments – Stories can be good mechanism •Help them consider their emotional responses •Check for biases in their reasoning •Consider how else to test judgments •Consider relevant research Articulating intuition: developing the story •Makes you think beyond the current snapshot: stories have a flow •What happened? Need description •Why did it happen? Need analysis •What might happen? Devise plan to reduce Dealing with dissent Culture of good manners can stifle dissent at multi-agency conferences Disagreement can feel like personal attack and so gets hostile response Need culture that allows people to query judgments impersonally You are working with human beings •You can deliver a pizza but you cannot deliver a child welfare service. You need the ‘customer’ to be an active agent in the production of the required outcomes. Child welfare services simply fail if the intended recipients are unwilling or unable to engage in a constructive way; outcomes are co-produced by citizens. •Adapted from Chapman J. (2004) System failure: why governments must learn to think differently, London, Demos Features of the Working Alliance Family: Agrees with worker on the tasks to work on Agrees on goals Develops an affective bond Skilled workers Challenges: emotions Child maltreatment arouses strong feelings. We deal with families expressing strong emotions of anger, despair, fear. Workers need support and critical reflective supervision in managing the emotions or they distort reasoning Challenges: handling ambivalence •Families have strengths and dangers •Holding both in mind as you work with them is difficult •Focusing on good OR bad alone distorts understanding Challenges: limited knowledge •We have limited understanding of all aspects of the work – causes, identification, responses •In specific cases, we have limited knowledge of what is going on. •We need to value and support expertise and professional judgment Challenges: managing uncertainty We want to ensure that all children are safe but we can’t. There is too much uncertainty Respecting this means that we stop talking of ‘ensuring’ all children are safe – aim to make them SAFER Challenge anyone who believes managing risk = eliminating risk A just culture not a blame culture Need to develop shared features of making decisions in uncertain conditions Don’t set unrealistic goals of ‘ensuring’ all children are safe Defensive practice does not AVOID risk but DISPLACES it, usually onto children and families When are rules desirable? •Need central prescription of goals and professional duties •Simple tasks – follow the rules, e.g. arranging payment for foster carer •Complicated tasks – needs professional skill in deciding what the task is and how to perform it, e.g. does this referral warrant a S47 investigation? •Complex tasks – no complete solution is known but we seek to minimise the problem, e.g. preventing child maltreatment Supporting the workforce Closer involvement with families has an emotional dimension. Workers are exposed to the most intensely painful of human emotions - fear, despair, anger, sadness. Do they feel helped to handle this? If not, they are more likely to show the features of burnout: emotional exhaustion and compassion fatigue. Emotional resilience in workers is associated with feeling that they have a manageable workload and a sense of personal accomplishment. Organisational factors that discourage good thinking •A blame culture •Risk management through defensive practice •Very prescriptive procedures that discourage creativity and flexibility •Heavy caseload so little time to think •Culture that devalues need for critical review •No feedback on outcomes Key points We are all vulnerable to intuitive errors of reasoning: they are a feature of being human, not of being stupid. We will make most progress if we think of good reasoning as a shared responsibility Simon Jones Consultant Paediatrician 07774741471 • Joint Working Protocol • Bruising Protocol • Personal reflections Joint Working Protocol Consider children of parents with mental ill-health substance misuse learning disability emotional or psychological distress All Children (11 million) 280,150 children in Hampshire Vulnerable Children (4 million) Children in Need (400,000) ~ 10,000 children in Hampshire Children Looked After (60,000) 1,266 children in Hampshire Child Protection Plan (29,000) 1,113 children in Hampshire The Protection of Children in England A Progress Report, Laming, March 2009 Joint Working Protocol Consider children of parents with mental ill-health substance misuse learning disability emotional or psychological distress Early help – secondary prevention Not at level of significant harm Joint Working Protocol 1999 following SCR 2004 – ‘Hidden Harm’ 2008 – young people 2011 – parents with LD 2014 Joint Working Protocol Record Child’s name, dob, address, carer, school Ask ? CSD / CPP / CAF / young carer Discuss Professionals involved, safeguarding lead Refer CSD for early help or Drug/alcohol, LD, mental health services Joint Working Protocol Key messages Hear the ‘voice’ of the child Discuss concerns with the family Know when to act immediately Share information & update with new concerns eg non-compliance Stay involved Joint Working Protocol Sharing Information Share with consent if appropriate Seek advice, consider safety Necessary, proportionate, relevant, accurate, timely, secure (Data Prot Act) Keep a record Duty to share written into all legislation GMC Guidance for Doctors Importance of consent in most cases Disclosure without consent justified if Failure to disclose may expose patient or others to risk of serious harm 3rd parties who are of direct relevance to child protection eg adults who may pose a risk to a child Common law duty of confidence Personal information should not generally be disclosed without consent of the subject Disclosure without consent justified in the public interest to prevent harm to others proportionate response sanctioned by law (Art. 8 HRA) go no further than necessary Data Protection Act 1998 Necessary, proportionate, relevant, accurate, timely, secure Allows disclosure without consent o Prevention or detection of crime o Apprehension or prosecution of offenders o Exercise of a statutory function eg s17/47 o Exercise or defend legal rights eg Art 3 (HRA) Bruising Protocol Bruising Protocol Bruises in infants and toddlers ‘those who don't cruise rarely bruise’ Sugar NH, Taylor JA, Feldman KW. Arch Paediatr Adolesc Med 1999;153(3):399-403 Bruises are rare in babies not mobile 366 < 6 months only 2 had bruises (0.6%) 973 < 36 months none had bruises on hands or buttocks Bruising Protocol 4 months of age Bruising Protocol o Raise awareness of significance of bruising in NIM (non independently mobile) children o Reflect lessons learned from SCR o Encourage sharing of concerns o Consistent with NICE guidance o Guard against professional optimism o Joint Health & Social Care 4LSCB-wide policy Bruising Protocol Individual Management Review (IMR) 20 days, bruise to right cheek ‘2y sibling threw a toy’ 18 weeks, small bruise on forehead ‘hit with a teething ring’ by sibling 20 weeks, bruise under left eye seen by GP, no action taken 21 weeks, bruises on face and abdomen, seen by paediatrician, no action taken 26 weeks, fell out of chair, bruise to nose referred to CSD Health Practitioner observes bruise or suspicious mark SUSPECT child maltreatment1 A child who is seriously ill should be referred immediately to hospital Seek an explanation, examine and record accurately Note any other features of abuse2 eg bruises on face and ‘soft’ areas, bruises in clusters or imprints Explain to family the reason for immediate referral to Children’s Services Department and Consultant Paediatrician3 Immediate Phone Referral to Children’s Services Department Immediate Phone Referral to Duty Consultant Paediatrician3 for multi-agency assessment and information sharing and child seen urgently for further investigation to exclude a medical condition Inform GP and HV Inform GP and HV Follow 4LSCB Procedures4 Personal Reflections Personal Reflections Personal Reflections Dealing with uncertainty Team work Good communication Personal Reflections “At no point during her stay in hospital, did any doctor speak to Victoria in a formal attempt to find out what had happened to her, either with or without the assistance of an interpreter... in the end she died a slow, lonely death – abandoned, unheard and unnoticed” Lord Laming Personal Reflections “…these services knew little or nothing more about Victoria at the end of the process than they did when she was first referred…” Lord Laming Personal Reflections We ‘protect’ data, when we could protect children Personal Reflections Keeping Children Safe Investing for the future Culture of openness Changes in practice “Think The Unthinkable” MASF NE Training event 2014. Think The Unthinkable • Working together guidance ‘makes absolutely clear the legal framework and the expectations on different professionals’. This requires a major rethink in those agencies who still believe that their role in safeguarding stops with a referral to social care. • the Government Guidance stresses two key principles: • Safeguarding is everyone's responsibility, and • Where professionals are concerned each and every agency has a role to play in safeguarding and protecting our children. Think The Unthinkable • When it comes to “organisation culture” there is a need to: • Create a culture of listening to children ensuring there is senior buy in to safeguarding and ensure accountability of commissioned providers and contractors. • Have a designated professional with sufficient time and support (including supervision) to promote the welfare of children. These professionals should recognise the needs of children including rescue from possible abuse and neglect. • Follow safe recruiting practices. • Ensure all staff and volunteers are competent to safeguard the welfare of children and that their practice is reviewed. There should be a mandatory induction and procedures about responding to concerns about a child’s welfare followed. Think The Unthinkable • Here are the key messages from WTSC 2013 …Are these new messages? • Child-centred practice • Improving inter-agency working relationships to support effective safeguarding practice • More effective prevention and early help • Better Assessments • Strengthening accountabilities and creating learning frameworks • Supporting the development of professional’s expertise and effective social work practice. Think The Unthinkable PROFESSIONAL COURAGE AND CURIOSITY • The views and feelings of children are actually very difficult to ascertain. • Professionals do not always listen to adults who tried to speak on behalf of the child and who may have important Information to contribute. • Parents and carers can easily prevent professionals from seeing and listening to the child • Professionals can be easily fooled with stories we want to believe are true • Is it too difficult to explore thinking/develop and test hypotheses when parents are present in meetings? • Effective multi agency work does not just happen by accident. It needs to be co-ordinated. • Challenging parents (and colleagues) requires expertise, confidence, time and a considerable amount of emotional energy Think The Unthinkable • Table exercises: • We would like you read the case study on your table, complete the tasks requested. • Please feedback your table’s 3 practice principles or “Golden Rules” to support practice which in turn can improve professional curiosity and professional courage. Hampshire Multi Agency Safeguarding Hub MASH • Hampshire Children’s Services Department have developed a Multi Agency Safeguarding Hub which operates alongside Hantsdirect and Children’s Reception Team. • MASH became operational on 31/01/14 Referral Pathway to Children’s Social Care Direct Public Social Care Professionals Line Hantsdirect Children’s Reception Team Embedded Social Work Team Signposted R&A Partners involved in MASH • Children’s Services inclusive of education and YOT • Police • Adult Social care • Health Virtual Partners • • • • Probation Housing District Councils Hampshire Fire and Rescue Service • Hampshire Ambulance Service MASH CYP triage CA12 Children Social Care & Education Health Adult Services Police Virtual Hampshire Probation Hampshire Fire / Rescue Hampshire Ambulance service Housing Borough and District Councils Community Safety Troubled Families Benefits of MASH • A faster, more co-ordinated and consistent response to safeguarding concerns about vulnerable children and adults. • An improved ‘journey’ for the child or adult with a greater emphasis on early intervention and better informed services provided at the right time. • A more straightforward and responsive process for the professional or customer raising a concern • Closer partnership working, clear accountability and improved multi-agency communications. • A reduction in the number of inappropriate referrals and re-referrals leading to effective targeting of services Benefits continued • Avoids duplication and silo working. • Staff and agencies have an increased understanding and appreciation of each others roles and responsibilities leading to increased skills, better multi agency working and more effective judgement. • Development of flexible working patterns and providing enhanced customer service. Workflow April – June 2014 Hampshire • • • • • 17743 contacts managed by CRT 5723 referrals through MASH 401 Section 47 2778 C&F Assessments 186 referrals stepped down to Early Help Current Position • MASH service has been operational for 8 months. • Service to Hampshire and Isle of Wight • Face to face strategy discussions are working well. • CP referrals are managed within 2 hours. • Children in Need referrals managed within 24 hours • Good support from Early help to improve Step down Current Position • CRT using SERAF tool to screen for sexual exploitation • Domestic Violence (Claire’s Law) and Sex Offenders (Sarah’s Law) Disclosure Service managed through CRT/MASH • Temporary Child Protection Plans held within CRT for HCC and IOW • Social workers on MASH now work shifts Next Steps • Potential for Probation to work from MASH once per week • YOT trial of workers in MASH • Police are recruiting extra officers and Staff • Health have increased resources • Work commenced to increase involvement of virtual partners. Questions?