safeguarding and MDT Flashcards
how many children in the UK have an emotional behavioural disorder? How does this present?
1 in 5 children have an emotional behavioural disorder.
Presents with externalising or internalising behaviour.
Describe the healthy attachment cycle
1) baby has a need —> 2) baby cries —> 3) needs met by the parent/ caregiver –> 4) trust develops —-> 5) secure attachment is promoted
Describe disturbed attachment cycle
Baby has a need –> baby cries –> needs not met by primary caregiver –> rage develops instead of trust –> insecure or disorganised attachment is promoted
What do securely attached infants have?
Optimal functioning across a range of domains:
BESS Practice
Behavioural adjustment
Emotional
Social
School achievement
Peer related social status
What percentage of children with a child protection plan (CPP) have disorganised attachment?
80% children with a CPP have DISORGANISED attachment
What is the purpose of identifying the dyad relationship?
To identify ATTUNED interactions and to be able to identify LESS than sensitively RESPONSIVE interactions
Allows early intervention
What are the three dimensions of interactional behaviour to keep in mind when observing the DYAD?
GEP
Genuiness –> vary from true and genuine affect to false and deceptive affect
Engagement –> from overintrusiveness to unengagement
Predicatability –> consistency of their behaviour, predictable to unpredicatable
What behaviours should you look for when observing dyad?
mutual gaze and reciprocal vocalisations
interaction and engagement is balanced
positioning of the baby and caregiver respect of infants body
warmth and affection shared and noticable
mother expresses empathetic understanding and mind mindedness
agenda (what the dyad does) is not scewed towards caregiver
turn taking is paced and reciprocal
babys self soothing strategies are minimal
Define 1001 critical days
Important developmental period between conception and 2 years for building optimal security and healthy brain development.
Why is it urgent to intervene in an unsatisfactory dyad interaction?
urgency due to babys developmental timetable:
brain growth and synaptogenesis which is dependent on experience dependant mechanisms
Enables secure attachment to develop to promote optimal functioning across all developmental domains
Define attachment
Biobehavioural mechanism activated by anxiety, key role to reduce stress and restore security
What is maternal antenatal stress and how will this affect foetal development?
maternal antenatal stress refers to the emotional state of the mother which changes the placental filtering capacity meaning higher amounts of cortisol may reach the foetus.
what are the obstetric consequences of antenatal anxiety?
LBW or small for gestational age
Preterm labour
impaired blood flow or raised resistance index to the foetus via maternal uterine arteries –> intrauterine growth restriction and preeclampsia
how does prenatal stress affect neurodevelopmental outcomes for children?
Increases the risk of child emotional problems (anxiety and depression)
Increases risk of symptoms of attention defecit and hyperactivity disorder
Conduct disorders
What is the foetal stress thermostat?
refers to higher levels of cortisol that can be toxic to the fetal brain, adversely affecting foetal and child brain development especially the HPA axis which sets the stress thermostat.
Result is higher levels of stress experienced by children from childhood to adulthood.
How can we break the intergenerational transfer of trauma?
Potential to break the cycle of intergenerational trauma and promote secure attachment.
Give unresolved parents the opportunity to address issues from childhood and learn/ understand their own mental state and that of others.
what percentage of abused parents go on to abuse their children?
1/3rd will go on to abuse their children
however 2/3RDS will not go on to harm their children
What is infant mental health?
Where do problems occur?
Developing capacity of child from birth to form close relationships
manage and express emotions
explore the environment
Problems occur within context of parent- infant, caregiver- infant relationship
GMC relationships with patients, children and young people states?
be aware of NEEDS AND WELFARE of children and young people when seeing parent/ carer patients, and be aware of patients that may represent a DANGER to children/ young people
must SAFEGUARD and PROTECT health and wellbeing of children and young people.
OFFER ASSISTANCE to children/ young people if you have reason to believe rights have been abused or denied.
What does GMC guidance (para 14) state?
effective communication between dr and children/ young people essential to provision of good care.
what does effective communication between drs / children/ young people require?
Find out what children/ young people/ parents want and need to know
what issues are important to them
what opinions/ fears they have about health or treatment
When are you obliged to break duty of confidentiality to a child / parent?
obliged to break duty of confidentiality and act in best interests if you believe child is or may be victim of abuse
Define child abuse
Abuse and neglect are forms of MALTREATMENT.
Person may abuse/ neglect child by infliciting harm, or failing to prevent harm.
what settings can child obuse occur in?
Child abuse can occur in family, institutional, community setting
by those known to them or rarely strangers.
What are some types of abuse?
Physical –> non accidental injury
FGM
Munchausen syndrome by proxy
sexual
emotional
neglect
What is the children act?
What is the lord laming report?
what does it focus on?
Children act is an act to reform the law relating to children, to provide local authority services to children in need and amend law wrt childrens homes.
Lord laming report was a report into the victoria climbie case, that made recommendations to ensure child protection.
It puts a focus on universal and targeted services.
What is every child matters?
Every child matters = Green paper to protect and maximise potential of children, hase 5 key outcomes for children and revised the Children act 2004.
(green paper= preliminary report of gov proposal published to provoke discussion)
What are the 5 key outcomes of every child matters (2003?)
Be healthy
stay safe
enjoy and achieve
make a positive contribution
ahcieve economic well being
Child protection in england is the overall responsibility of who?
Child protection = overall responsibility of Dep of Edu who issue guidance to LA’s.
what guidance is used to make policies of local safeguarding childrens boards>
Most recent guidance is “working together to safeguard children 2015”
Local safeguarding children’s boards (LSCB’s) use this guidance to produce their own procedures to be followed by practioners/ professionals.
What is a local safeguarding children board?
What does it do?
Local safeguarding children board replaced Area child protection committees
Statutory multi agency body
Coordinates and leads child protection activities in an area
Audits and review safeguarding and welfare promoting strategies
What are recommendations for the NSPCC?
For early intervention and effective protection need improve info sharing
develop common ax. framework
introduce a lead professional
develop on the spot service delivery
accountability and integration –> locally, regionally nationally
formation of local safeguarding children boards.
What are named professionals and what is their purpose?
Each trust must have a named dr, nurse and midwife to take the lead on child protection matters
Responsibilites incld education, support, supervision
App. person to contact with any child protection matter
Referral to children’s social care
What are the three sides of the child ax. framework triangle?
1) child developmental needs
2) family and environmental factors
3) parenting capacity
What is a child protection referral?
is the first stage of the child protection process in all 4 nations
Referral will be made when aspect of the childs life is giving cause for concern
referral = request for services to be provided by childrens services where child not known previously or when case previously open but now closed.
What is a child protection conference?
Child protection conference is designed to look at all relevant info and circumstances to determine how best to safeguard child and promote their welfare.
May be held following under an investigation under section 47 of the children act 1989 (a child protection investigation)
What are the aims of a child protection plan?
Who implements it and when is it reviewed?
Aim of a child protection plan:
- ensure child is safe, prevent child from suffering further harm
- promote childs health and development
- support family to safeguard child and promote welfare
- child protection plan is implemented by the Core group and reviewed regularly at child protection conference.
What is the most common reason for a child to be subject to CP referral?
second most common?
in northern ireland?
most common = Neglect
Followed by emotional abuse
northern ireland differs –> physical abuse main reason for CPR.
Who is particularly vulnerable in child protection cases?
Why is neglect difficult to define?
Infants particularly vulnerable, babies 8 x more likely to be killed than children.
Due to cumulative effects, its coexistence with other forms of maltreatment which means boundaries between abuse and neglect are blurred. Also due to the subjective nature of deciding what is “good enough” care.
