Recognise, Respond, Refer, Record

In recognition of Dumfries & Galloway's Public Protection week, D&G NHS colleagues have developed 7-minute briefings to not only highlight the importance of partnership working but also reiterate the significance of "Public Protection being everyone's responsibility". 

Recognise, Respond, Refer, Record ("the Four R's")

All agencies have a responsibility to recognise and actively consider potential risks to a child, or adult at risk of harm, irrespective of whether the child or adult of concern is the main focus of their involvement. There must be consideration of the needs, rights and mutual significance of siblings and family members in any process or involvement with services.

Effective partnerships between organisations, professional bodies and the public are more likely to if key roles and responsibilities are well defined and understood from the outset. Practitioners and professional bodies set out clear responsibilities in relation to our duty of care and duty to report our concerns. There are also legal duties and responsibilities under specific child and adult protection legislation and the management of offenders Act, for example, Adult Support & Protection (Scotland) Act 2007, Children (Scotland) Act 1995 & 2020 and Management of Offenders (Scotland) Act 2019.

Concerns about possible harm to a child or vulnerable adult at risk of harm, abuse, neglect or exploitation should always be shared with police or social work, without delay.

Adult and or Child protection procedures are initiated when police, social work or health determine that a child may have been significantly harmed or may be at risk of significant harm.

The Four R's in Public Protection Practice act as a good aide memoire to ensure all practitioners are confident in recognising abuse or harm, can appropriately respond and know who and how to refer their concerns and ensure accurate record keeping.

ASP Health Responsibilities 7-Minute Briefing - D&G NHS (PDF, 150 KB)

Professional Curiosity

Professional curiosity is the capacity and communication skill used by practitioners to explore every possible indicator of abuse or neglect and try to understand what the life of that child or vulnerable adult is like on a day-to-day basis - their routines, thoughts, feelings and relationships with family members.

Professional curiosity is a concept which has been recognised as important in the area of safeguarding in child protection for many years. More recently however, both Initial and Significant Case Reviews (locally and nationally) have highlighted a similar need for professional curiosity in safeguarding work with adults.

It is important to remember that curiosity is required to support professionals to question and challenge the information they receive, identify concerns and make connections to enable a greater understanding of a person's situation.

Professional Curiosity 7-Minute Briefing - D&G NHS (PDF, 374 KB)

Neglect

Neglect is the persistent failure to meet a child's basic physical and/or psychological needs, which is likely to result in the serious impairment of the child's health or development. There can also be single instances of neglectful behaviour that cause significant harm. Neglect can arise in the context of systemic stresses such as poverty and is an indicator of both support and protection needs.

'Persistent' means there is a pattern which may be continuous or intermittent which has caused or is likely to cause significant harm. However, single instances of neglectful behaviour by a person in a position of responsibility can be significantly harmful. Early signs of neglect may be an indication of the need for support to prevent harm.

The GIRFEC SHANARRI indicators set out the essential wellbeing needs. Neglect of any or all of these can impact on healthy development. Once a child is born, neglect may involve one or more of the following: a parent or carer failing to provide adequate food, clothing and shelter, failure to protect a child from physical and emotional harm or danger; to ensure adequate supervision, to seek consistent access to appropriate medical care or treatment; to ensure the child receives education; or to respond to a child's essential emotional needs.

Faltering growth refers to an inability to reach normal weight and growth or development milestones in the absence of medical reasons. This condition requires further assessment and may be associated with chronic neglect.

Malnutrition, lack of nurturing and lack of stimulation can lead to serious long-term effects such as greater susceptibility to serious childhood illnesses and reduction in potential stature. For very young children the impact could quickly become life-threatening. Chronic physical and emotional neglect may also have a significant impact on teenagers.

The 7-minute briefing on neglect in childhood is a good source to refer to in practice to help staff understand why neglect is so harmful to children, how difficult it can be at times to identify as well as reaffirming the value and importance of multi-agency working and information sharing.

Neglect in Childhood 7-Minute Briefing - D&G NHS 7MB (PDF, 86 KB)

Self-Neglect

There has been increased concern in older adults in relation to self-neglect and this has been highlighted in recent Initial & Significant Case Reviews. This has been exacerbated by the impact of the pandemic with reduced face to face appointments and service provision in addition to increasing poor mental health. Self-neglect is an extreme lack of self-care and is sometimes associated with hoarding but may be as a result of other issues such as addictions.

People who neglect themselves often decline help from others; in many cases they do not feel that they need it. Family and neighbours can sometimes be critical of professionals because they don't do anything to improve the situation for the individual, however, there are limitations to what others can do if the adult has mental capacity to make their own decisions about how they live. This is when professionals must demonstrate professional curiosity and exercise their duty of care to fully assess and adequately protect the individual.

Sometimes even when all agencies have done everything in their power to support an individual, sadly, they may die or suffer significant harm as a result of their own action or inaction. It is therefore vital that all efforts to engage and offer support in an attempt to protect the individual are clearly evidenced and recorded.

Self Neglect and Hoarding Protocol - 7 Minute Briefing (PDF, 105 KB)

Attendance at Adult Protection Case Conference

This was an area for improvement identified for health staff within the recent ASP inspection undertaken across D&G Public Protection Partnership. The Adult Support and Protection Act 2007 stipulates that the assessment process should be based on information supplied by all relevant agencies, including health who are central to this part of the process The information gathering stage and initial assessment is co-ordinated with the Council Officer having the lead role in the process. The multi-agency assessment should be considered by an interagency Adult Support and Protection Case Conference. This will be assisted by the collation of up to date and well balanced inter agency chronologies. The Adult Support and Protection Case Conference will discuss the best approach to managing risk by agreeing a protection plan.

These meetings should be as inclusive as possible, with the presumption that the adult themselves will be in attendance. Consideration of timing, venue and accessibility of meetings can assist in making it easier for the adult to attend. If it is considered not to be in their best interests for the adult to attend, arrangements will be made to ensure that the adult's views and wishes are conveyed to the meeting. The adult does have the right to decide not to attend and this should be respected unless there is reason to believe that this decision has come about as a result of undue pressure.

During the Covid pandemic in 2020 greater use has been made of virtual meetings and case conferences. This has resulted in special consideration being given in enabling the adult to participate as fully as possible, not only in relation to how readily they can use new technology but also to prepare them in advance for what to expect as virtual meetings can feel very different to a face-to-face meeting.

It is crucial that any health professional involved with an individual involved in ASP processes attends all conferences they are invited to and  fully co-operate with partners and the Council Officer leading and co ordinating the case. If the health professional known to the individual cannot attend, they should provide a written report or send a colleague.

If a health practitioner has any worries or requires any advice or guidance regarding attending a case conference they can contact the DGNHS team between working hours Monday-Friday.

ASP Case Conferences 7-Minute Briefing - D&G NHS (PDF, 152 KB)