Managing Concerns about Children and Young People where there are Medical and/or Complex Health Issues and Escalating Safeguarding Concerns

SCOPE OF THIS CHAPTER

The scope of the protocol relates to all individuals who work with children, young people and carers across Bedfordshire whether they are working in a paid or voluntary capacity in the statutory or voluntary sector. The protocol is to assist practitioners in working in a timely and coordinated way to underpin effective joint working, timely assessment and decision making where there is a child or young person with medical and/or complex health issues and escalating concerns about the child or young people’s welfare and/or safety.

This chapter was added in November 2024.

1. Introduction

Children with a disability or additional health needs can present challenges to the parents and carers, and can place great demands practically, emotionally and potentially financially on the parents/carers. Evidence suggests that disabled children/young people are particularly vulnerable to abuse and neglect and the primary focus of interventions may be on a child/young person and their medical/complex health condition, indicators of abuse may be misinterpreted, and the risk of significant harm go unrecognised. Moreover, children may be at risk of significant harm where they are present as follows:

  • Refusal and/or non-compliance with medication and/or treatment and understanding the impact of this on the child/young person e.g. Diabetes, Epilepsy, skin conditions, chronic head lice, Asthma, physical or learning disabilities;
  • Exaggeration/misinterpretation of chronic health conditions;
  • Recurrent attendances at Accident and Emergency Departments and/or avoidable admissions due to failure to adhere to medical advice;
  • Children/young people with escalating emotional/behavioural issues which may include self-harm;
  • Children/young people not brought for Health appointments/dental appointments;
  • Lack of parental engagement with the child or young people’s therapies e.g. Child and Adolescent Mental Health Services, Speech and Language Therapy, physiotherapist;
  • Children/young people with escalating eating disorders.

This Protocol should be read in conjunction with:

Pan Bedfordshire policies, procedures and guidance including

2. Principles of Practice

The philosophy of care should be based on supporting parents and strengthening families. Practice should focus on keeping the child or young person at the centre of care planning using the Graded Care Profile 2 (GCP2) where appropriate. Where there is evidence of rapidly escalating medical or complex health issues the emphasis should be on the early identification of concerns and risks and a joint multi-agency assessment and agreed interventions to ensure a coordinated and timely response to the child or young person’s needs and the safeguarding concerns.

For practitioners working with children/young people with medical/complex health and social needs, the GCP2 should be embedded in practice and form part of the assessment process.

In the event of a young person or parent/carer refusing to give consent to information sharing and/or medical treatment, the practitioner needs to:

  • Act in the best interests of the child or young person;
  • Seek urgent safeguarding supervision or line management advice;
  • Work in accordance with section 47 safeguarding processes.

Appendix 1: Care Pathway Medical and/or Complex Health Issues Flowchart

Appendix 1: Care Pathway Medical and/or Complex Health Issues Flowchart.