Four-step briefing: Baby K – Children with complex needs and neglect

1. Reason for briefing

This briefing combines learning from circumstances of two children who were referred to the Safeguarding Practice Review Group in accordance with Working Together to Safeguard Children 2018.

Both children had a range of complex health needs. Their physical health needs meant that consistent communication between agencies was required. In both cases, parents were in regular contact with various professionals but were resistant to following health professionals. Both cases the children died unexpectedly from health-related conditions.

2. Safeguarding practice concerns

Baby K – Professionals were concerned that her mother was struggling to administer medications and comply with medical advice or requirements. The home circumstances were unsatisfactory. Practitioners found her mother difficult to engage on occasions. Offers of financial help were refused. Baby K was on a Child Protection Plan for neglect in the last 6 months of her life.

Child M – Following their move to Devon, parents disengaged from health professionals and removed their child from the specialist school as they did not agree that advice given was in best interest of their child. This meant that M missed out on school health input; alternative offers of health input were made. Parents restricted multi-professional team communication by refusing the multi-professional meeting to plan care and share information.

3. Key learning

The themes identified through the case reviews were:

• Working with resistant families;
• Multi-agency responsibility for children in need;
• Parental neglect and neglect of medical needs: the challenges of considering when a case is tipping the balance into significant harm;
• Effective information sharing and escalation of concerns by practitioners. The importance of effective supervision and management oversight of multi-agency working

4. Suggestions for improvement in practice as a result of this review

4.1 Working with resistant families

• Parental resistance is a common feature in Child Protection. Formal identification of unusually resistant families enables the development of a strategy to understand their motivation and plan appropriate intervention;
• Managers providing appropriate support and supervision allow practitioners to explore the impact of working in such situations, understanding the effect on their practice and developing strategies to enable progress;
• Be mindful of the risk of an adult focus overwhelming more child centred practice.
• Reflect on “stuck” cases with supervisors or safeguarding leads – a process known as “stop and review”;
• Agencies must clarify what would trigger action; for example, a child ‘not brought’ to appointments or school. See ‘Rethinking ‘Did Not Attend’;

4.2 Multi-agency responsibility for children in need

• Practitioners need to consider whether a child’s needs are being met, familiarising themselves with the threshold tool.
• With parental consent the Local Authority will conduct an assessment and, if threshold is met, organise a multi-agency meeting to draw up a Child in Need (CiN) plan.
• If parents refuse consent the family will either be offered Early Help and ongoing support of specialist services or, if it is considered that the child/ young person will suffer significant harm without social work intervention, the assessment will be carried out under Section 47 child protection procedures.
• Child in Need planning can also be a helpful step down from child protection (s47) support.
• Partners’ commitment to CiN plans and meetings is essential. Monitoring of the plan’s delivery and evaluation of impact for the child remain a shared responsibility for partners.
• Core Groups are a multi-agency meeting and may be chaired by any of the participating agencies, or an independent chairperson;
• Partners must hold each other to account.

4.3 Parental neglect and neglect of medical needs

• Toolkits are a valuable asset in working with neglect (see link below). Toolkits must always be used with professional judgement.
• Recording systems assist workers in identifying patterns of non-compliance and drift e.g. genograms and chronologies.
• Multi-agency meetings are more effective when they are based on a holistic assessment. Complex health needs make decisions on neglect thresholds more challenging, exploring this face to face very helpful.
• A comprehensive assessment is essential to:
  • gather important information about a child and family;
  • analyse their needs and/or the nature and level of any risk and harm being suffered by the child;
  • decide whether the child is a Child in Need (section 17) or is suffering, or likely to suffer, significant harm (section 47); and
  • plan support to address those needs (to improve the child’s outcomes and maintain their safety).

4.4 Effective information sharing and resolution of practitioners’ concerns

• A healthy resolution culture, which avoids blame, facilitates effective work with families when practitioners feel stuck. Every agency needs to ensure practitioners and managers understand how to problem solve with colleagues in partner agencies and escalate more formally where needed;
• All practitioners must be aware of the guidance on information sharing (Information sharing Advice for practitioners providing safeguarding services to children, young people, parents and carers, July 2018);
• When a family moves into the area, historic information should be sought.

Further Information

You can find more information about neglect and children with complex needs elsewhere on the Devon SCP website.

You can find the Devon SCP Child in Need framework and definition in the South West Child Protection Procedures, which aims to support safeguarding practice and provide a consistent approach to safeguarding children and young people

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