safeguarding and MDT

Question 1

how many children in the UK have an emotional behavioural disorder? How does this present?

Answer 1

1 in 5 children have an emotional behavioural disorder.

Presents with externalising or internalising behaviour.

Question 2

Describe the healthy attachment cycle

Answer 2

1) baby has a need —> 2) baby cries —> 3) needs met by the parent/ caregiver –> 4) trust develops —-> 5) secure attachment is promoted

Question 3

Describe disturbed attachment cycle

Answer 3

Baby has a need –> baby cries –> needs not met by primary caregiver –> rage develops instead of trust –> insecure or disorganised attachment is promoted

Question 4

What do securely attached infants have?

Answer 4

Optimal functioning across a range of domains:

BESS Practice

Behavioural adjustment

Emotional

Social

School achievement

Peer related social status

Question 5

What percentage of children with a child protection plan (CPP) have disorganised attachment?

Answer 5

80% children with a CPP have DISORGANISED attachment

Question 6

What is the purpose of identifying the dyad relationship?

Answer 6

To identify ATTUNED interactions and to be able to identify LESS than sensitively RESPONSIVE interactions

Allows early intervention

Question 7

What are the three dimensions of interactional behaviour to keep in mind when observing the DYAD?

Answer 7

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

Question 8

What behaviours should you look for when observing dyad?

Answer 8

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

Question 9

Define 1001 critical days

Answer 9

Important developmental period between conception and 2 years for building optimal security and healthy brain development.

Question 10

Why is it urgent to intervene in an unsatisfactory dyad interaction?

Answer 10

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

Question 11

Define attachment

Answer 11

Biobehavioural mechanism activated by anxiety, key role to reduce stress and restore security

Question 12

What is maternal antenatal stress and how will this affect foetal development?

Answer 12

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.

Question 13

what are the obstetric consequences of antenatal anxiety?

Answer 13

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

Question 14

how does prenatal stress affect neurodevelopmental outcomes for children?

Answer 14

Increases the risk of child emotional problems (anxiety and depression)

Increases risk of symptoms of attention defecit and hyperactivity disorder

Conduct disorders

Question 15

What is the foetal stress thermostat?

Answer 15

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.

Question 16

How can we break the intergenerational transfer of trauma?

Answer 16

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.

Question 17

what percentage of abused parents go on to abuse their children?

Answer 17

1/3rd will go on to abuse their children

however 2/3RDS will not go on to harm their children

Question 18

What is infant mental health?

Where do problems occur?

Answer 18

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

Question 19

GMC relationships with patients, children and young people states?

Answer 19

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.

Question 20

What does GMC guidance (para 14) state?

Answer 20

effective communication between dr and children/ young people essential to provision of good care.

Question 21

what does effective communication between drs / children/ young people require?

Answer 21

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

Question 22

When are you obliged to break duty of confidentiality to a child / parent?

Answer 22

obliged to break duty of confidentiality and act in best interests if you believe child is or may be victim of abuse

Question 23

Define child abuse

Answer 23

Abuse and neglect are forms of MALTREATMENT.

Person may abuse/ neglect child by infliciting harm, or failing to prevent harm.

Question 24

what settings can child obuse occur in?

Answer 24

Child abuse can occur in family, institutional, community setting

by those known to them or rarely strangers.

Question 25

What are some types of abuse?

Answer 25

Physical –> non accidental injury

FGM

Munchausen syndrome by proxy

sexual

emotional

neglect

Question 26

What is the children act?

What is the lord laming report?

what does it focus on?

Answer 26

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.

Question 27

What is every child matters?

Answer 27

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)

Question 28

What are the 5 key outcomes of every child matters (2003?)

Answer 28

Be healthy

stay safe

enjoy and achieve

make a positive contribution

ahcieve economic well being

Question 29

Child protection in england is the overall responsibility of who?

Answer 29

Child protection = overall responsibility of Dep of Edu who issue guidance to LA’s.

Question 30

what guidance is used to make policies of local safeguarding childrens boards>

Answer 30

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.

Question 31

What is a local safeguarding children board?

What does it do?

Answer 31

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

Question 32

What are recommendations for the NSPCC?

Answer 32

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.

Question 33

What are named professionals and what is their purpose?

Answer 33

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

Question 34

What are the three sides of the child ax. framework triangle?

Answer 34

1) child developmental needs
2) family and environmental factors
3) parenting capacity

Question 35

What is a child protection referral?

Answer 35

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.

Question 36

What is a child protection conference?

Answer 36

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)

Question 37

What are the aims of a child protection plan?

Who implements it and when is it reviewed?

Answer 37

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.

Question 38

What is the most common reason for a child to be subject to CP referral?

second most common?

in northern ireland?

Answer 38

most common = Neglect

Followed by emotional abuse

northern ireland differs –> physical abuse main reason for CPR.

Question 39

Who is particularly vulnerable in child protection cases?

Why is neglect difficult to define?

Answer 39

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.