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4.4 Contact between Parents and their Children in Hospital where there are Safeguarding Concerns


Contents

1. Introduction
2. General Principles
3. Children Requiring Admission to Hospital where there are Concerns about the Risk of Significant Harm from Parents or Carers
  3.1 Children Admitted to Hospital in an Emergency or via GP Referral
  3.2 Children who already have Supervised Contact with their Parents
  3.3 Planned Admission to Hospital Resulting from a Paediatric Assessment (Child Protection Medical)
  3.4 Where a Child is in a Critical or has a Life Limiting Condition
4. New Born Infants and Safeguarding Concerns
5. Abandonment
6. Care Planning and Arrangements for Parental Contact with the Child
7. Discharge Planning Meeting


1. Introduction

This protocol provides outline guidance to all professionals on the need for effective communication, assessment and planning when it is identified that a parent or other adult may present a risk of harm whilst a child is admitted to hospital.

The separation of a child from their parents and families during a period of hospital admission is a draconian step and should not be undertaken lightly.

Such separation for a child is likely to be a traumatic and distressing experience for all involved. The importance of continuing contact between the child and their parents whilst the child is in hospital is recognised. In most cases contact will be beneficial and a significant factor in the care, treatment, recovery and rehabilitation of the child.

Any restrictions on contact between those with Parental Responsibility, or significant others, and their children in a hospital setting should be proportionate, based on the available evidence, the needs of the child, an assessment of risk, and in agreement with the family unless there is a basis to intervene with emergency protective or other legal action.


2. General Principles

The welfare and protection of children and young people is the paramount consideration for all professionals and should underpin all decisions and actions that are taken.

The need for parents and carers to be involved in the care and supervision of their children is a basic principle of the provision of effective health care within acute health care settings.

Children in hospital should, where possible, be cared for by their parents or carers or have sufficient contact with them in order to promote positive attachments and that this should be promoted and supported in accordance with their Human Rights.

Any restrictions on contact in a hospital setting between those with Parental Responsibility, or significant others, and the child should be proportionate and based on the available evidence, the needs of the child, and a documented assessment of risk.

Any such period of separation should be proportionate to that which the separation is required for and based on the least restrictive option e.g. supervised contact.

Any restrictions on or conditions for contact between children and their parents and Arrangements to support this should be on an agreed and consensual basis with the family unless there is a court order or Police Powers of Protection (Section 46 Children Act 1989) in place.

Professionals should assume that a hospital setting is NOT a place of safety for a child when they may be at risk of harm from their parents or others; and that hospital staff can NOT provide any supervision of contact arrangements.

Wherever possible a child should not remain in hospital if they are medically fit to be discharged. A child should not remain in hospital solely for the purposes of a Social Care led multi-agency assessment and or a criminal investigation to be undertaken.

Where any parent or family member, irrespective of the circumstances or status of the child, poses an immediate risk to their child or any other patient in hospital, hospital staff will be required to take any necessary action to ensure the safety of the child and other patients.

Hospital staff do not have the power to prevent those with parental responsibility having unrestricted access to their child without the support of a court order or Police Powers of Protection (Section 46 Children Act 1989) in place. This information MUST be recorded in the child’s Hospital Health Record.


3. Children Requiring Admission to Hospital where there are Concerns about the Risk of Significant Harm from Parents or Carers

A Multi-Agency Strategy Meeting should take place in all cases, when it is believed or suspected that a child may have suffered or is at risk of suffering Significant Harm. This meeting should involve Children’s Social Care services, the police and relevant health professionals, including a representative from the hospital nursing or medical team involved in providing the child’s care as a minimum. For more information see Strategy Discussions/Meetings Procedure.

The Strategy Meeting should examine all the available information and evidence in order to:

  • Agree what the type and level of risk of harm to the child is, and who from;
  • Decide what further assessments and investigations are required;
  • Agree what information should be shared with the child, parents and significant others;
  • Agree what needs to be done to safeguard and promote the welfare of the child:;
    • Immediately (for example seeking legal advice for an order);
    • Pending further assessment and investigation.
  • Agree the timescales and responsibilities for any actions;
  • A completed risk assessment and agreed action plan should be available immediately on completion of the strategy meeting signed by the senior Social Care and health representative to be filed in the child’s Nursing/medical record to ensure accurate communication of the outcome of the meeting to all agencies involved in the provision of care;
  • Such meetings should take place in a timely manner and with minimal delay, and within the same day if at all possible.

3.1 Children Admitted to Hospital in an Emergency or via GP Referral

Where a child is admitted in an emergency or via GP referral the strategy meeting should take place as soon as possible after any risk of significant harm has been identified. If it is out of hours then this should not delay initiating a strategy discussion involving as many relevant professionals as are available at the time, with a further strategy meeting if necessary in office hours.

Usually Out of Hours (OOH) Strategy Discussions will take place by telephone. They will include the OOH social worker, police officer and appropriate medical professional at the Hospital. In exceptional circumstances the social worker and police officer will need to attend the hospital and the hold the strategy discussion as a face to face meeting; including parental involvement as appropriate; in either case a clear record must be kept within Social Care and health records.

For more information see Strategy Discussions/Meetings Procedure.

3.2 Children who already have Supervised Contact with their Parents

Where a child already has supervised contact with their parents in the community there must be a working assumption from all agencies that these arrangements continue during the hospital admission. Any changes required will need to be discussed with the child’s named social worker by the senior nurse on duty. Usually this will apply to children who are Looked After, subject to a Court Order or already subject to Section 47 Enquiries or a Child Protection Plan where there are already documented restrictions and arrangements within plans for parental and family contact. This will also need to take account of any change in circumstances for example evidence of further harm which required admission.

3.3 Planned Admission to Hospital Resulting from a Paediatric Assessment (Child Protection Medical)

A Paediatric Assessment (Child Protection Medical) may sometimes lead to a hospital admission for treatment and or further clinical assessment. This may occur when a child or infant has unexplained injuries or illnesses which raise a suspicion of non-accidental injury, fabricated or induced illness. Complex symptoms may require further clinical assessments and consideration of differential diagnoses, including a possible transfer to a tertiary unit, for example Sheffield Children’s Hospital. Information sharing and strategy meetings must be undertaken in a prompt and timely manner and at a frequency that enables appropriate and proportionate safeguards to be put in place, a child’s needs to be met and avoids any undue delay.

3.4 Where a Child is in a Critical or has a Life Limiting Condition

Where there are safeguarding concerns and the parents need to be present with the child due to the clinical needs of the child, for example a critical or life limiting condition, then it is the responsibility of Children’s Social Care services, in full consultation with medical staff, to ensure that appropriate supervision arrangements are made for the family and necessary safeguards are in place. These arrangements must be written in the form of a Care Plan and shared with hospital staff, the parents and any significant others. A copy must be stored in the child’s medical/nursing record. The Care Plan should contain contingency arrangements for contact should the child’s condition deteriorate.


4. New Born Infants and Safeguarding Concerns

For information about Unborn and Newborn Babies, please see Safeguarding Unborn and Newborn Babies Procedure.


5. Abandonment

If a parent abandons a child in hospital then the local authority can assume parental care under Section 20 of the Children Act 1989 and appoint foster carers to look after the child. This would normally require legal advice to establish whether the child has been abandoned but in an out of hour’s situation, attempts should be made to seek legal advice and if such advice and assistance cannot be provided then there should be consultation with a Senior Social Care Manager and professional judgement will be used based on the evidence and assessment. If the parent returns and wishes to assume care of their child then the local authority, after negotiating for an agreement with the parents for a satisfactory outcome for the child, may wish to seek immediate legal or police advice if the child is considered to be at continuing risk of harm.

Where a child is Accommodated Section 20 the local authority does not have Parental Responsibility for the child and the Section 20 status is by consent and in agreement with those with parental responsibility. However, a child who is under Section 20 is a Looked After Child and the local authority has duties in accordance with that status. As part of the assessment process and with the aim of possible rehabilitation of the child to the care of the parent(s), foster carers will often work with parents to look after the child, though the Section 20 status puts the main day to day care responsibilities with the foster carers unless there are firm arrangements for this not to be the case, or care to be shared, and these should be documented in a Care Plan and shared with all relevant professionals and family members.


6. Care Planning and Arrangements for Parental Contact with the Child

In all cases where there are risks of significant harm and a child is either already in hospital or is admitted to hospital, a Care Plan must be developed to enable the child’s needs to be met and manage any risks of harm, including specific details about contact arrangements. The Care Plan must be dynamic and reflect any progressing assessment of risk or investigations, relevant changes in circumstances, updates from strategy meetings and must include as a minimum:

  • How the child’s needs are going to be met;
  • How any risks are going to be managed, including parental care and contact with the child;
  • A contingency for cases where the risks are escalated or not managed effectively;
  • A contingency should the child’s condition deteriorate;
  • What the child and parent’s views are about the Care Plan and any contact arrangements;
  • The plan should be shared with all relevant professionals as well as the parents, carers and other relevant family members where appropriate.

The plan should be an up to date working document and a copy stored in the child’s health record. The plan should be discussed and agreed at the Discharge Planning Meeting held before the child is discharged – for more information see Discharge Planning from Hospital when there are Safeguarding Concerns about a Child Procedure.

Following the strategy meeting and following the identification of any significant risks following the initial child protection enquiries / investigation a written agreement (Child Protection Agreement) is negotiated and agreed with the parents and other professionals about how the risk of harm will be managed in the short term. This must also contain all relevant details about the level of contact between the child, parents and family members and any supervision arrangements. Families should be encouraged to identify their own strengths and protective factors which can inform the Child Protection Agreement or Care Plan to enable the child’s needs to be met and minimise the impact on the child.

This may include the suggestion of alternative family members who may be available to offer a supervisory role for supervision of contact. It should also contain a clear contingency should the Child Protection Agreement not be adhered to and the child is placed at increased risk of harm.

The responsibility of developing this plan is with the child’s social worker but nursing and medical staff should be actively involved especially at the risk assessment stage. Once agreed the plan should be signed and dated by the Parents, Social worker, Paediatrician and/or Senior nurse. Updates to the plan should be clearly documented, dated and signed by the individuals making or agreeing to changes.

Parents and those with Parental Responsibility, including significant others, and advocates for them, should be:

  • Communicated with clearly with explanations about what the concerns are, unless this will prejudice the welfare of the child and has been agreed at the strategy meeting;
  • Provided with an explanation for what is needed to keep their child safe;
  • Given an opportunity to identify protective factors and seek alternative arrangements within their own family networks;
  • Provided with written information about what is happening for their family to help them understand and engage in the process;
  • Have their views and concerns listened to, recorded, and responded to professionally and sensitively;
  • Spoken to in a manner that allows them to understand the information that has been shared with them, including any medical terms or legal processes. This may also require the need for written explanations.


7. Discharge Planning Meeting

Before the child is discharged from hospital, a Discharge Planning Meeting should be held. The Discharge Plan should update any plan made during the child’s stay in hospital, or existing plans such as a Child Protection Plan or Child in Need Plan.

For more information see Discharge Planning from Hospital when there are Safeguarding Concerns about a Child Procedure.

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