Improving practice in safeguarding at the interface between hospital services and children’s social care: a mixed-methods case study

Abstract

BackgroundHospital settings have an important impact on children harmed by parents and carers. Concern arises from the capacity of these settings to respond effectively to individual needs despite increased NHS policy awareness and actions on safeguarding. Patient safety initiatives have rarely modelled in detail the social and cultural dynamics of child health settings and children’s safeguarding. This study is focused on supporting and evaluating clinician-led service design in an acute trust. A suite of initiatives and artefacts has been designed, based on sociotechnical principles, on the premise that only a thorough understanding of human, social and organisational challenges will afford effective solutions.ObjectivesThe study addresses the following primary question: ‘Can a safeguarding culture be designed within the hospital environment that will provide the conditions for the detection of children at risk of abuse and support protective actions before discharge, including collaboration with external agencies?’ Objectives include the development of a sociologically rich understanding of why diagnostic failures and communication breakdowns occur; the design of a suite of integrated interventions for promoting a positive safety culture, following a user-centred approach; and the evaluation of the effectiveness of this package, including its generalisability across sites.DesignThe study took place in two sites: the primary site where the initiatives were developed and a further site with the original intention of transferring developments. The investigation follows a broaddesign scienceapproach. The evaluation of a design intervention relies on a rigorous understanding of the realities of everyday practice, and the study thus draws on mixed methods to examine the impact of service redesign on cultures and practices.FindingsThe data suggest that safeguarding children can become mainstream patient safety business. Board support is vital. In our primary site, there has been a steady integration of learning from serious case reviews and other child protection-related processes with ‘patient safety’-related incidents, with growing recognition that similar systemic issues impact on both domains. Making use of a familiar vocabulary to redescribesafeguardingas asafetyissue, and thus as something fundamental to the functions of an acute hospital, has been part of the success. The data suggest that persistence, resilience and vigilance from the safeguarding leadership and executive teams are crucial. Current policy includes the development of the Child Protection Information Sharing project, which is intended to improve information flow between the NHS, particularly hospitals and children’s social care. The findings from this study suggest the importance of good design, piloting, incrementalism and a thorough empirical engagement with everyday practices during implementation of this and any future information systems based reform.ConclusionsSafeguarding takes place in a complex system and even minor changes within any part of that system can impact on the rest in unpredictable ways. It is important that managers adopt a ‘design attitude’ and seek to mitigate unintended consequences through careful experimentation. The findings suggest the need for the design of systems to enhance communication and not simply to ‘share information’. Technological solutions impact on everyday decision-making and can have unintended consequences. Attention to forces of change and stasis in health settings, the factors affecting technology transfer and the impact of the configuration of local authority services are suggested as a key priorities for future research.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

Working together to identify child maltreatment: social work and acute healthcare

“…checklists or risk assessment screening tools), but also in terms of information about the family's previous involvement with LA social care services. While studies like White et al (2015) have begun to address this, these remain important areas for future research (Luckock et al, 2015).…”

“…Furthermore, in health settings, there can be too narrow a focus on decisions about whether or not to refer a child to social care, ignoring considerations of the help that might be offered in health and other settings (Davies and Ward, 2012). These challenges reflect the difficulty of forming a clear picture of risk and appropriate responses where information may be incomplete or ambiguous, where there are different professional cultures and expectations, and where there are high levels of pressure and anxiety (White et al, 2015). Recent studies have emphasised the importance, in the face of this complexity, of professional dialogue about risk and of professional safeguarding relationships (White et al, 2015;Luckock et al, 2015).…”

“…These challenges reflect the difficulty of forming a clear picture of risk and appropriate responses where information may be incomplete or ambiguous, where there are different professional cultures and expectations, and where there are high levels of pressure and anxiety (White et al, 2015). Recent studies have emphasised the importance, in the face of this complexity, of professional dialogue about risk and of professional safeguarding relationships (White et al, 2015;Luckock et al, 2015).…”

Recognition of risk and prevention in safeguarding of children and young people: a mapping review and component analysis of interventions aimed at health and social care professionals

“…Thirteen of the included cultural/organisational studies researched multi-agency working [66][67][68][69][70][71][72][73][74][75][76][77][78] .Additionally, one study on inter-professional working within a trust is discussed in this theme 79 , study characteristics are provided in Table 4.…”

Uncovering the Double-Edged Sword of Inter-Organisational Networks of Welfare Services: Tackling Wicked Issues in Social Work

“…Moreover, we argue that the mere sharing of information between the parties involved does not suffice to initiate further debates amongst them. Rather, they must develop and design a system to enhance communication, while equally safeguarding the well-being and privacy of clients (White et al, 2015). This is especially relevant as many interorganisational networks look after highly vulnerable groups of citizens (e.g.…”