CHSCB SCRs Fergus Smith, Independent Reviewer, CAE Child M: - - PowerPoint PPT Presentation

CHSCB SCRs

Fergus Smith, Independent Reviewer, CAE

Purpose of Seminar

• Remind Participants of Events & Issues

Emerging

• Encourage Multi-Agency Debate
• Maximise Understanding & Acceptance of

Opportunities for Organisational Learning Trigger: bi-lateral fractured femurs of 13 month + facial bruising

Child ‘M’: Serious Case Review

Case History: Summary (1)

• Mother Experienced Domestic Abuse in Early

2014

• Sib. 1 (< 3 years old in 2014 ) very obese –

Mother Denying

• Father of Child M on ‘Licenced Release’
• Child M born in May 2015 – Maternal Rejection
• f her Health Visitor

Child ‘M’: Serious Case Review

Case History: Summary (2)

• 1st Potential Non-Accidental Injuries: (Child M 3

weeks old) in August 2015 – Not Substantiated

• Arrest of Mother (Assault ) & Father (Drugs)
• ‘Team Around Family’ Service
• 2nd Potential Non-Accidental Injuries: (Child M

6 months old)

Child ‘M’: Serious Case Review

Case History: Summary (3)

• Children Made Subject of Protection Plans

(November 2015)

• Further Domestic Abuse – Mother Denying

Intimate Relationship

• Child M by April 2016 Obese / ? Engagement

with Parenting Support

• ? Supervision of Father’s Access to Child M

Child ‘M’: Serious Case Review

Conclusions / Systemic Vulnerabilities

• Avoidant Behaviour & Disguised Compliance
• Scope for More Professional Curiosity &

Challenge

• Some ‘Professional Optimism’

Child ‘M’: Serious Case Review

Organisational Learning

• Appreciation of Child Protection-related

expectations in GP Practices & Probation Service

• Improved Use of Documentation in Paediatric

Department

• Clearer Shared View Across the Network of

Options in cases of Non / Episodically Co-operative Individuals

• Consideration by Children’s Social Care of All

Relevant Contributors

Child ‘M’: Serious Case Review

Recommendations

• City & Hackney Safeguarding Children Board

(CHSCB)

• Clinical Commissioning Group (CCG)
• Homerton Hospital Paediatric Dept.
• National Probation Service
• Hackney Children’s Social Care

Child ‘M’: Serious Case Review

Case History: Summary (1)

• Unremarkable Ante-natal Care / Mother a Good

Attender

• No Reports or Evidence of Domestic Abuse
• Father Less ‘Visible’ in Records
• Linguistic Barriers Recognised

Trigger: fatal & non-fatal assault by father on 16 month old twins

Child ‘N&O’: Serious Case Review

Case History: Summary (2)

• Post-natal Exploration of ? Domestic Abuse

Constrained by Circumstances

• Some Observation of Maternal Anxiety
• Routine GP Presentations & 1 Year Developmental

Review (father’s ‘visibility’)

• Family’s Move to Hackney (March 1st 2017)

Child ‘N&O’: Serious Case Review

Case History: Summary (3)

• Monday March 13th: Employer’s Alert of Health

Visiting Service & a Paternal Referral to Children’s Social Care FAST

• Response: Checks (Tues); Phone Contact

with Mother (Wed & Fri)

• Assaults Occurred Late Saturday 18th (some

confusion with Ambulance Responses)

Child ‘N&O’: Serious Case Review

Challenges Faced by Practitioners

• Capturing Significance of Fathers
• Appreciating Linguistic / Cultural Barriers to

Communication e.g. of domestic abuse

• Factors Impacting on Responses (perceived risk/s +

what if allegation had been from mother / NSPCC?)

Child ‘N&O’: Serious Case Review

Conclusion / Systemic Vulnerabilities?

• Trigger Event Unpredictable but……
• Risk of Marginalising Fathers
• Challenge of Linguistic / Cultural Barriers

Child ‘N&O’: Serious Case Review

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