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Neglect

Neglect is defined in Working Together to Safeguard Children as "the persistent failure to meet a child's basic physical, emotional and/or psychological needs, likely to result in the serious impairment of the child's health or development.&nbsp;Neglect may occur during pregnancy as a result of maternal substance abuse.&nbsp;Once a child is born, neglect may involve parents or carers failing to:
<ul>
<li>Provide adequate food, clothing and shelter (including exclusion from home or abandonment);</li>
<li>Protect the child from physical and emotional harm or danger;</li>
<li>Ensure adequate supervision (including the use of inadequate caregivers); or</li>
<li>Ensure access to appropriate medical care or treatment.&nbsp;</li>
</ul>
It may also include neglect of, or unresponsiveness to, a child's basic emotional needs.

Definition

The impact&nbsp;of Neglect during the first two years of a child's life can have profound and lasting effects on the development of the brain, leading to later problems with self-esteem, emotional regulation and relationships.
Neglect during the first five years of a child's life is likely to damage all aspects of the child's development. A neglected child may have difficulties with:
<ul>
<li>Basic trust;</li>
<li>Self-esteem;</li>
<li>Ability to control their behaviour;</li>
<li>Social interaction;</li>
<li>Educational attainment; and</li>
<li>Problem-solving.</li>
</ul>
Neglect in childhood can also lead to problems in adulthood, including:
<ul>
<li>Living independently in the community;</li>
<li>Accepting adult responsibilities;</li>
<li>Anti-social behaviour such as criminality, substance misuse;</li>
<li>Increased vulnerability to being in abusive relationships (including the risk of sexual exploitation, criminal exploitation and being trafficked);</li>
<li>Life chances and opportunities such as employment and education;</li>
<li>Parenting - children who experience neglect lack a role model for good parenting, and so are vulnerable to becoming neglectful or abusive parents; and</li>
<li>Self-care - for example, nutrition, general health, risk-taking behaviour.</li>
</ul>
A particularly damaging combination for children is growing up in an environment of low warmth and high criticism &ndash; that is, parents/carers who switch unpredictably between helpless (neglectful) and hostile (abusive) care.
Neglect can affect children of all ages.&nbsp;
Where parents/carers have specific beliefs that may influence their views on how the child receives healthcare and treatment, or general nutrition, the outcome can be that the child's health and well-being are dangerously compromised.&nbsp;&nbsp;
It is important to remember that neglect can be fatal to the child.
"The majority of neglect related deaths of very young children involve accidental deaths and sudden unexpected deaths in infancy where there are pre-existing concerns about poor quality parenting and poor supervision and dangerous, sometimes unsanitary, living circumstances which compromise the children's safety &hellip;. these issues include the risks of accidents such as fires and the dangers of co-sleeping with a baby where parents have substance and/or alcohol misuse problems (Brandon et al, 2014).

Risks

Neglect differs from other forms of abuse in that there is rarely a single incident or crisis that draws attention to the family.&nbsp;Rather, it is repeated, persistent neglectful behaviour that causes incremental damage over time.
It is important to avoid 'start again' syndrome. Neglect should not only be measured by the most recent set of events but should be judged by the cumulative impact on the child of any previous incidents.
There is no set pattern of signs that indicate neglect, other than the fact that the child's basic needs are not adequately met.&nbsp;In this context:
<ul>
<li>The child's basic needs are for food, shelter, clothing, warmth, safety, stimulation, protection, nurture, medical care, education, identity and play;</li>
<li>Adequately means sufficient to avoid harm or the likelihood of Significant Harm;</li>
<li>Failure to meet the child's needs does not necessarily mean that the parents/carers are intentionally neglectful, but it points to the need for intervention;</li>
<li>It is essential to monitor the outcome of intervention &ndash; are the child's needs being adequately met after the intervention, and is there a sustainable improvement?</li>
</ul>
The essential factors in demonstrating that a child is being neglected are:
<ul>
<li>The child is suffering, or is likely to suffer, Significant Harm;</li>
<li>The harm, or risk of harm, arises because of the failure of parents or carers to meet the child's needs;</li>
<li>Over time, the harm or risk of harm has become worse, or has not improved to the point at which the child is consistently receiving a "good enough" standard of care;</li>
<li>Persistent, severe neglect indicates a breakdown or a failure in the relationship between parent and child.</li>
</ul>
Where concerns arise about standards of care, an assessment following the <a href="https://committee.nottinghamcity.gov.uk/documents/s81771/Nottingham%20City%20Family%20Support%20Pathway%202018-2020.pdf" target="_blank" rel="noopener">Family Support Pathway</a> (Nottingham City) or&nbsp;the <a href="http://www.nottinghamshire.gov.uk/care/childrens-social-care/nottinghamshire-childrens-trust/pathway-to-provision" target="_blank" rel="noopener">Pathway to Provision</a> (Nottinghamshire) will usually be the first step. The assessment of neglect should consider all aspects of the child's development and the parents' and caregivers' ability to meet the child's needs. It may also help parents/carers who may have experienced neglect themselves to understand why such behaviours are harmful.

Indicators

When supporting a family where neglect is an issue, the greatest care must be taken to resist the pressure to focus on the needs of the parents/carers: intervention should concentrate on ensuring that the child's needs are being met.&nbsp;This may require action to ensure that parents/carers have access to specialist (and, if necessary, independent) advice and assistance, including support in communicating with professionals.&nbsp;
Neglect may arise from lack of knowledge, competing priorities, stress or deprivation. It may also be linked to parents/carers who retain cultural behaviours which are inappropriate in the context in which the family is living.&nbsp;
When a child's needs are unmet because the parents/carers lack knowledge or skills, the first choice for intervention should generally be the provision of Early Help services, such as information, training, and support services. If there is no progress and the assessment by professionals indicates that progress is unlikely without more proactive intervention, a referral to Children's Services should be considered, in line with the <a href="/chapter/referrals">Referrals Procedure</a>.
Neglect often occurs in a context in which parents/carers are dealing with a range of other problems such as substance misuse, mental ill-health, learning disability, domestic violence, and lack of suitable accommodation.
On many occasions, the birth of an additional child may add to the pressure on the family.&nbsp;Parents/carers may provide an acceptable standard of care until a new pressure or an unexpected crisis arises, after which they may lose sight of their child's needs.&nbsp;In this situation, the first choice for intervention should be to provide support in dealing with the competing pressures.&nbsp;This may require referral to appropriate adult services or family support services.&nbsp;
<h3>Messages for Good Practice</h3>
<ul>
<li>Practical resources are often beneficial, but their impact on meeting the child's needs must be kept under review;</li>
<li>Relieving financial poverty does not necessarily relieve emotional poverty;</li>
<li>Neglectful families are more likely to be isolated and to have weak informal networks. Providing volunteer support and facilitating better relationships with family and in the community can be effective in raising standards of care.</li>
<li>Dealing with neglect can be overwhelming for professionals: support and regular supervision are crucial.</li>
<li>It is important to carry out regular reviews of the rate at which the required change is being achieved in terms of the child's improved health and development.</li>
</ul>

Protection and Action to be Taken

Neglect is characterised by a cumulative pattern rather than discrete incidents or crises, and so drift is always a potential problem.&nbsp;Drift may result in&nbsp;a loss of focus on the needs of the child, and a change in professional expectations of what an acceptable level of care might be.
Accurate, detailed and contemporaneous recording by all professionals, and sharing of this information, are crucial to the protection of the child.&nbsp;In any service, professionals should work from a single set of records for each child.&nbsp;All entries in case notes should:
<ul>
<li>Be factual and evidence-based;</li>
<li>Rigorously separate fact and opinion;</li>
<li>Be dated and timed;</li>
<li>Give names and agencies in full; and</li>
<li>State agreed responses and outcomes.</li>
</ul>
Records should include a detailed Chronology of what has been tried and to what effect.&nbsp;
There is a risk of confusion regarding the distinction between the style of care and the standard of care. Styles of appropriate care vary widely, influenced by factors such as gender, class, culture, religion, and age. The common factor in all styles of appropriate care is that they address the child's needs. Neglectful care may have a host of common factors with various styles of appropriate care, but it fails to address the child's needs and falls below an acceptable standard.
Non-attendance at or repeated cancellations of appointments, as well as a lack of access to the child during visits, are indicators that should increase concern about the child's welfare.
All agencies should be aware of the need for supervision of staff who are monitoring cases of chronic neglect:
<ul>
<li>Professionals often want to think the best of the families with whom they work, and interpret events accordingly;</li>
<li>Familiarity with the family's lifestyle may cause professionals to minimise concerns and accept that the observed standards are normal for this family;</li>
<li>Changing the worker also carries risks, as it takes time to see the pattern of events that identifies care as neglectful.&nbsp;</li>
</ul>
Supervision must provide an independent review, keeping the focus on the child's needs and the adequacy of parenting over time.
If the child appears resilient, professionals should not accept this at face value; instead, they should check for evidence of unmet needs and impaired health and development.
When reviewing progress in cases of neglect, it is important to look for evidence of&nbsp;sustained&nbsp;improvement in the child's health and development.&nbsp;Where there is a pattern of short-lived improvements, the overall situation remains unsatisfactory. If adequate standards of care cannot be sustained, the child remains at risk of significant harm.&nbsp;
Professionals must resist the temptation to "start again" at key points, such as the birth of a new child or a change in workers.&nbsp;It is essential to view current events in the context of the comprehensive history of safeguarding and child protection issues, including past responses to support.&nbsp;The family histories of neglectful families are often complex and confusing, and professionals may be tempted to set them aside and concentrate on the present.&nbsp;This can lead to an overly optimistic approach to addressing a family with deeply entrenched problems.
As noted above, neglectful adults are often enmeshed in a complex network of problems.&nbsp;The clamour of the parents'/carers' needs tends to draw professional attention away from the unmet needs of the children. When addressing the needs of neglectful parents/carers, it is necessary to ask repeatedly:
<ul>
<li>Do they understand what action is needed and within what timescales?</li>
<li>Are they able and willing to meet the child's needs?</li>
<li>Are they doing so?</li>
<li>Are they able to access appropriate support services?</li>
<li>Is anything changing for the child?&nbsp;Is the change enough to bring the standard of care up to an acceptable level?</li>
</ul>
If adult services are supporting the parents/carers, it is essential to stress the importance of notifying children's practitioners if the parents/carers fail to engage with the services offered.&nbsp;
If there is a vulnerable adult living in the same household as a child whose needs are neglected, then their needs may also be neglected or unmet.&nbsp;Practitioners should report any concerns about the welfare of vulnerable adults to the relevant adult social care services.
<h3>Intentional Neglect</h3>
Where there is strong evidence that the parents/carers know and understand the likely effect of their actions or inaction on the child, but intend to cause harm or are reckless as to whether harm is caused to the child, this should be regarded as serious physical and/or emotional abuse. In these cases, support is unlikely to reduce the risk to the child. Unintentional neglect should not be confused with deliberate or malicious failure to meet the child's needs in the full knowledge of the potential effects on the child.&nbsp;
<h3>One Child Singled Out</h3>
Serious Case Reviews have demonstrated that in some instances, a child in a family may be singled out and cared for in a manner which amounts to serious neglect. Where a school or other agency raises concerns about the child, the parent's response and first assessments of the family may mask the particular treatment in the home of that child, particularly if the siblings appear well and cared for. Assessments where there are concerns of neglect should include speaking to the specific child on their own and viewing their sleeping arrangements, for example.&nbsp;&nbsp;&nbsp;&nbsp;
<h3>Neglect by Secondary Carers</h3>
This guidance relates only to the child's primary carers.&nbsp;Neglectful care may also be found in secondary caregivers, such as childminders, foster carers, daycare, or residential settings.&nbsp;In this situation, concerns should be reported to:
<ul>
<li>The child's primary carers, so that they can take appropriate action to protect their child;</li>
<li>The LADO team in Children's Social Care; contact details for&nbsp;<a href="https://nscp.nottinghamshire.gov.uk/contact/" target="_blank" rel="noopener">Nottinghamshire</a>&nbsp;and&nbsp;<a href="https://www.nottinghamcity.gov.uk/information-for-residents/children-and-families/are-you-worried-about-a-childs-well-being/" target="_blank" rel="noopener">Nottingham City</a>;</li>
<li>The registration authority for the secondary carer (for example, <a href="https://www.gov.uk/government/organisations/ofsted" target="_blank" rel="noopener">Ofsted</a>), who can consider the possible implications for other children;</li>
<li>In the case of emergencies, see <a href="/chapter/referrals">Referrals Procedure</a>.&nbsp;</li>
</ul>

Issues

<a href="https://trixcms.trixonline.co.uk/api/assets/nottinghamshirescp/8c6da478-2b21-4ece-b6a7-7d2319ad5bed/neglect-toolkit.docx" target="_blank" rel="noopener">Child and Young Person&rsquo;s Neglect Toolkit for assisting in the identification of Child Neglect</a>
<a href="https://trixcms.trixonline.co.uk/api/assets/nottinghamshirescp/53e646e0-11e5-4d59-8b13-080e6f02a386/guid-practioners-neglect-toolkit.pdf" target="_blank" rel="noopener">Guidance for practitioners using the NSCP and NCSCP neglect toolkit</a>
<a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/379747/RR404_-_Indicators_of_neglect_missed_opportunities.pdf" target="_blank" rel="noopener">Missed Opportunities: Indicators of Neglect &ndash; What is Ignored, Why, and What Can be Done? November 2014</a>
<a href="https://www.nspcc.org.uk/preventing-abuse/child-abuse-and-neglect/neglect/" target="_blank" rel="noopener">Child Neglect &ndash; NSPCC resources on Neglect and Abuse</a>
<a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/602148/Childhood_neglect_and_abuse_comparing_placement_options.pdf" target="_blank" rel="noopener">The impacts of abuse and neglect on children, and comparison of different placement options (March 2017)</a>
<a href="https://trixcms.trixonline.co.uk/api/assets/nottinghamshirescp/517752f0-fc5b-4ab9-b4b7-6baaa26f01b6/safe-sleep-guid.pdf" target="_blank" rel="noopener">Safer Sleeping - A risk assessment tool for practitioners</a>
<a href="https://trixcms.trixonline.co.uk/api/assets/nottinghamshirescp/78975535-163f-4d4d-bc3b-040cd8b3c683/safe-sleep-assess.pdf" target="_blank" rel="noopener">Safer Sleep for Babies - A risk assessment tool for practitioners</a>

Further Information

Child Protection Enquiries

When the local authority social worker receives a referral and information has been gathered during an assessment (which may have been very brief), in the course of which a concern arises that a child may be suffering, or likely to suffer, significant harm, the local authority is required by Section 47 of the&nbsp;<a href="http://www.legislation.gov.uk/ukpga/1989/41/contents" target="_blank" rel="noopener">Children Act 1989</a>&nbsp;to make enquiries. The purpose of this multi-agency enquiry and assessment is to enable the agencies to decide whether any action should be taken to safeguard and promote the welfare of the child. Any decision to initiate an enquiry under Section 47 must be taken following a Strategy Meeting/Discussion.
Responsibility for undertaking Section 47 enquiries lies with the Local Authority Children's social care in whose area the child lives or is found. 'Found' means the physical location where the child suffers the incident of harm or neglect (or is identified as likely to suffer harm or neglect), e.g. nursery or school, boarding school, hospital, one-off event, such as a festival, holiday home or outing or where a privately fostered or looked after child is living with their carers. For the purposes of these procedures the&nbsp;Children's social care area&nbsp;in which the child lives, is called the 'home authority' and the&nbsp;Local Authority Children's social care area in which the child is found is the child's 'host authority'.
Multi-agency Information Checks:
The social worker together with their manager must decide at what point and whether to seek parental permission to undertake multi-agency checks. If the manager decides not to seek permission, they must record the reasons why, for example it may:
<ul>
<li>Be prejudicial to the child's welfare;</li>
<li>Have serious concern about the behaviours of the adult;</li>
<li>Have serious concern that the child would be exposed to immediate risk of harm;</li>
<li>Jeopardise a police investigation.</li>
</ul>
Where permission is sought from parents and carers and denied, the manager must determine whether to proceed, and record the reasons for the decision they make.
The police, health professionals, teachers and other relevant professionals should support the Local Authority in undertaking the enquiries. When requested to do so by Children's social care, professionals from other parts of the local authority such as housing, schools and those in health organisations have a duty to cooperate under&nbsp;<a href="http://www.legislation.gov.uk/ukpga/1989/41/section/27" target="_blank" rel="noopener">Section 27 of the Children Act 1989</a> by assisting the local authority in carrying out its Children's social care functions. The social worker must contact the other agencies involved with the child to inform them that a Child Protection enquiry has been initiated and to seek their views. The checks should be undertaken directly with involved professionals and not through messages with intermediaries. The relevant agency should be informed of the reason for the enquiry, whether or not parental consent has been obtained and asked for their assessment of the child in the light of information presented
Practitioners may refer to the&nbsp;<a href="https://trixcms.trixonline.co.uk/api/assets/nottinghamshirescp/4321aa59-363f-43f4-bd71-00355046cabe/info-sharing-pr.pdf" target="_blank" rel="noopener">Nottinghamshire Information Sharing Protocol</a>&nbsp;for further guidance.

Duty to Conduct Section 47 Enquiries

Where there is a risk to the life of a child or the possibility of serious immediate harm, an agency with statutory Child Protection powers (the police and children's social care) should act quickly to secure the immediate safety of the child.
When considering whether emergency action is required, an agency should always consider whether action is also required to safeguard and promote the welfare of other children in the same household (e.g. siblings), the household of an alleged perpetrator, or elsewhere.
Planned emergency action will normally take place following an immediate&nbsp;Strategy Discussion/Meeting&nbsp;between police, children's social care, health professionals and other agencies as appropriate.
If it is necessary to remove a child from their home, a local authority must, wherever possible and unless a child's safety is otherwise at immediate risk, consider whether it is necessary to apply for an&nbsp;Emergency Protection Order (EPO). Other options such as Police Powers of Protection, or short term use of section 20 should also be considered.
Police powers of protection should only be used in exceptional circumstances where there is insufficient time to seek an&nbsp;EPO&nbsp;or for reasons relating to the immediate safety of the child.
Where there is a risk to the life of a child or the possibility of serious immediate harm, an agency with statutory Child Protection powers (the police and children's social care) should act quickly to secure the immediate safety of the child.

Immediate Protection

A Section 47 Enquiry must always be commenced immediately following a strategy Discussion/Meeting when:
<ul>
<li>There is reasonable cause to suspect that a child is suffering or likely to suffer significant harm in the form of physical, sexual, emotional abuse or neglect;</li>
<li>Following an EPO or the use of police powers of protection is initiated.</li>
</ul>
The threshold criteria for a Section 47 Enquiry may be identified during an early assessment or it may become apparent at the point of referral, during multi-agency checks or in the course of a multi agency assessment.
A multi agency assessment (see&nbsp;<a href="/chapter/assessment">Assessment Procedure</a>) is the means by which Section 47 Enquiries are carried out. The assessment will have commenced at the point of receipt of referral and it must continue whenever the criteria for Section 47 Enquiries are satisfied. The conclusions and recommendations of the Section 47 Enquiry should inform the assessment which must be completed within 45 working days of the date when the referral was received.
The enquiries and assessment should always involve separate interviews with the child subject to their age and development and understanding &nbsp;In the majority of cases, the parents/carers will be interviewed, and the interaction between the parent/carers and child will contribute to the assessment.

Section 47 Thresholds and the Multi Agency Assessment

Whenever there is reasonable cause to suspect that a child or unborn child is suffering, or is likely to suffer, significant harm, there should be a strategy discussion involving local authority children&rsquo;s social care (including the residential or fostering service, if the child is looked after), the police, health, and other bodies such as the referring agency, education, early help, or other practitioners involved in supporting the child and more than one discussion may be necessary.
A strategy discussion can take place following a referral or at any other time, including during the assessment process and when new information is received on an already open case. Strategy discussions/meetings should be convened as soon as possible bearing in mind the needs of the child.
Where these concern new referrals it is likely that they will involve practitioners in the MASH/Assessment Team/Children and Families Direct. When new information comes to light regarding a child that is already open to children social care it is the responsibility of the allocated social worker to arrange a strategy discussion/meeting promptly.
The need for follow up strategy discussions/meetings will depend on the nature of the case. Where ongoing coordination of multi-agency work is needed during the s.47 enquiry or criminal investigation these should be scheduled to support the decision making and coordination of actions for that case.
The strategy discussion or meeting should be co-ordinated and chaired by a children's social care Team Manager. Any decision not to hold a strategy discussion or to delay a strategy discussion should be recorded along with the rationale.
<h4>Purpose</h4>
The purpose of a strategy discussion is to determine the child&rsquo;s welfare and plan rapid future action if there is reasonable cause to suspect the child is suffering or is likely to suffer significant harm.
A strategy discussion/meeting should be used to:
<ul>
<li>Share, seek and analyse available information;</li>
<li>Agree the conduct and timing of any criminal investigation including to decide whether a single or joint enquiry is appropriate;</li>
<li>Decide whether an assessment under Section 47 of the Children Act 1989 (Section 47 Enquiries) should be undertaken.</li>
</ul>
<h4>Attendees</h4>
A local authority social worker, health practitioners and a police representative should, as a minimum, be involved in the strategy discussion. Other relevant practitioners will depend on the nature of the individual case but may include those who have concerns about the child and/or those involved in the child&rsquo;s life, for example:
<ul>
<li>The practitioner or agency which made the referral;</li>
<li>The child&rsquo;s school/nursery/educational establishment;</li>
<li>Any health or care services the child or family members are receiving;</li>
<li>Youth justice practitioner and/or youth worker;</li>
<li>Adult mental health, substance misuse and/or domestic abuse specialist;</li>
<li>British Transport Police representative.</li>
</ul>
In the case of a pre-birth strategy discussion/meeting this should involve the midwifery services.
All attendees should be sufficiently senior to make decisions on behalf of their organisation and agencies. They should be sufficiently skilled and experienced to prepare for and engage with the strategy discussion and be able to critically assess and challenge their own and others&rsquo; input.
In some circumstances, strategy discussions by telephone may be adequate to plan an enquiry and must include the agencies directly involved with the child. For telephone strategy discussions, all agencies should make a record of the outcome of the telephone discussion and actions agreed at the time. The record of the notes and decisions authorised by the Children's Social Care manager should be circulated as soon as practicable to all parties to the discussion.
Some examples of circumstances where a strategy discussion/meeting should be considered:
<ul>
<li>Any new referrals in respect of a child where there are concerns that a child is suffering, or is likely to suffer, significant harm;</li>
<li>When new information on an existing case in Children's Social Care indicates that a child is likely to suffer significant harm;</li>
<li>Any new information that a child may be likely to suffer, or has suffered significant harm including sexual, physical or emotional abuse, neglect or domestic abuse (including controlling or coercive behaviour), exploitation by criminal gangs or organised crime groups, trafficking, online abuse, sexual exploitation, and the influences of extremism which could lead to radicalisation; When an adult or young person assessed as presenting a risk to children has moved into, or is about to move into, the child's household or such a person is regularly visiting or about to have sustained contact with the child;</li>
<li>When the likelihood of significant harm to an unborn child may be such as to indicate the need to develop a Child Protection Plan before birth. <a href="/chapter/safeguarding-unborn-babies#pre-birth-referral">When a baby is born prematurely and the planned safeguarding arrangements for the baby have not been completed</a>;</li>
<li>When the death of a child in family, in which abuse or neglect is suspected, is confirmed and there are other children in the household;</li>
<li>When a child lives in, or is born to, a household in which resides another child who is currently the subject of a Child Protection Plan;</li>
<li>When a child who is currently the subject of a Child Protection Plan in another area moves into the area unless the other authority is to retain responsibility for the case;</li>
<li>When a child has sexually assaulted another child or there is a risk of such an assault occurring to another child in the same household or in regular contact with the household (in which circumstances a Child Protection Conference should be held in respect of both children).</li>
</ul>
(This is not an exhaustive list).
<h4>Tasks</h4>
Whilst the local authority retain the legal responsibility to decide whether to make enquiries, it is a multi agency decision and if their isn&rsquo;t agreement the escalation process should be used to resolve this.&nbsp;
Where there are grounds to initiate an enquiry under section 47 of the Children Act 1989, decisions should be made as to:
<ul>
<li>What further information is needed if an assessment is already underway and how it will be obtained and recorded;</li>
<li>What immediate and short-term action is required to support the child, and who will do what by when;</li>
<li>Whether legal action is required.</li>
</ul>
<h4>Roles and responsibilities</h4>
Team Manager, children&rsquo;s social care should convene the strategy discussion and make sure they:
<ul>
<li>Consider the child&rsquo;s welfare and safety, including through speaking to the child, and identifying whether the child and any siblings are suffering or likely to suffer significant harm;</li>
<li>Decide what information should be shared with the child and family (on the basis that information is not shared if this may jeopardise a police investigation or place the child at risk of harm);</li>
<li>Agree what further action is required, and who will do what by when, where an EPO is in place, or the child is the subject of police powers of protection;</li>
<li>Record agreed decisions about the outcome of the strategy discussion and any further actions that are needed;</li>
<li>Share the record of decisions/actions in accordance with attendees, and other relevant professionals as soon as practicable;</li>
<li>Follow up actions to make sure what was agreed gets done.</li>
</ul>
Health practitioners should:
<ul>
<li>Advise about the appropriateness or otherwise of medical assessments, and explain the benefits that arise from assessing previously unmanaged health matters that may be further evidence of neglect or maltreatment;</li>
<li>Provide and co-ordinate any specific information from relevant practitioners regarding family health, maternity health, school health mental health, domestic abuse and violence, and substance misuse to assist strategy and decision making;</li>
<li>Secure additional expert advice and support from named and/or designated professionals for more complex cases following preliminary strategy discussions;</li>
<li>Undertake appropriate examinations or observations, and further investigations or tests, to determine how the child&rsquo;s health or development may be impaired.</li>
</ul>
The Police should:
<ul>
<li>Discuss the basis for any criminal investigation, including both reactive (where there is evidence to suggest a crime has been committed) and proactive (where further activity is required to establish if a crime has occurred), and any relevant processes that other organisations and agencies might need to know about, including the timing and methods of evidence-gathering;</li>
<li>Lead the criminal investigation where joint enquiries take place with the local authority children&rsquo;s social care leading for the section 47 enquires and assessment of the child&rsquo;s welfare.</li>
</ul>

Strategy Discussion / Meeting

Local authority social workers should lead assessments under section 47 of the Children Act 1989. The police, health practitioners, teachers and school staff and other relevant practitioners should help the local authority in undertaking its enquiries.
The Lead Practitioner for section 47 enquiries should be a social worker who will be responsible for its coordination and completion. The social worker must consult with other agencies involved with the child and family to obtain a fuller picture of the circumstances of all children in the household, identifying parenting strengths and any risk factors. Practitioners should work collaboratively and proactively with multi-agency practitioners to build an accurate and comprehensive understanding of the daily life of a child and their family to establish the likelihood of significant harm and any ongoing risks.
Enquiries may also need to cover children in other households with whom the alleged offender may have had contact. All agencies consulted are responsible for providing information to assist.
At the same time, where there is a joint investigation the Police will have to establish the facts about any offence that may have been committed against a child and collect evidence as they lead the criminal investigation.
The Section 47 Enquiry should begin by focusing on the information identified during the referral/assessment and strategy discussion, which appears most important in relation to the risk of significant harm.
If the child is in hospital, decisions should also be made about how to secure the safe discharge of the child.
Outcomes:
There should be a clear and defined decision as a result of the strategy meeting which would result in one of the following actions:
<ul>
<li>A decision that the threshold has been met to initiate a Section 47 enquiry;</li>
<li>That further assessment is required;</li>
<li>That the case can be progressed within a Section 17 Child in Need framework;</li>
<li>That non statutory support can address the need through early help or targeted support;</li>
<li>No further action is required.</li>
</ul>
A record of the outcome of the strategy discussion, including decisions made and actions agreed, should be shared with attendees by children&rsquo;s social care within a maximum of two working days. The plan made at the strategy discussion/meeting should reflect the requirement to convene an Initial Child Protection Conference within 15 working days of the strategy discussion at which it was decided to initiate the Section 47 Enquiry. When Children's Social Care have concluded that an Initial Child Protection Conference is not required but practitioners in other agencies remain seriously concerned about the safety of a child, these practitioners should seek further discussion with the social worker, their manager and/or the designated safeguarding professional lead. The concerns, discussions and any agreements made should be recorded in each agency's files. This should be actioned within a timescale commensurate with the need to safeguard the child and in accordance with the <a href="/chapter/escalating-for-the-right-outcome-conflict-resolution-and-professional-disagreement-policy">Escalating for the right Outcome - Conflict Resolution and Professional Disagreement Policy</a>.
If the conclusion of the strategy discussion/meeting is that there is no cause to pursue the Section 47 Enquiry then consideration should be given to continuing a multi-agency assessment to meet the needs of the child for any Early Help support services or to provide family support services to them as a child in need.
See <a href="https://www.workingtogetheronline.co.uk/" target="_blank" rel="noopener">Working Together to Safeguard Children, Flowchart 5: Action Following a Strategy Meeting</a>.
For information on electronic and digital recording of meetings see related guidance in the&nbsp;<a href="/chapter/child-protection-conferences#membership-of-child-protection-conference">Child Protection Conferences Procedure, Membership of Child Protection Conference</a>.
<h4>Roles and Responsibilities</h4>
Social worker should:
<ul>
<li>Lead the assessment in accordance with the guidance Working Together to Safeguard Children;</li>
<li>Carry out enquiries in a way that minimises distress for the child and family;</li>
<li>See the child who is the subject of concern to ascertain their wishes and feelings, assess their understanding of their situation, assess their relationships and circumstances more broadly, and understand the child&rsquo;s experiences and interactions with others, especially where there are concerns of extra-familial harm;</li>
<li>Explain to parents or carers the purpose, process and potential outcome of the enquiries and be prepared to answer questions openly, unless to do so would affect the safety and welfare of the child;</li>
<li>Interview parents or carers and determine the wider social and environmental factors that might impact on them and their child, including extra-familial contexts;</li>
<li>Systematically gather information about the child&rsquo;s and family&rsquo;s history;</li>
<li>Analyse the findings of the assessment and evidence about what interventions are likely to be most effective with other relevant practitioners;</li>
<li>Determine the child&rsquo;s needs and the level of risk of harm faced by the child to inform what help should be provided and act to provide that help;</li>
<li>Follow the guidance set out in <a href="https://www.gov.uk/government/publications/achieving-best-evidence-in-criminal-proceedings" target="_blank" rel="noopener">Achieving Best Evidence in Criminal Proceedings: Guidance on Interviewing Victims and Witnesses and Guidance on Using Special Measures</a> where a decision has been made to undertake a joint interview of the child as part of any criminal investigation.</li>
</ul>
Health practitioners should:
<ul>
<li>Provide forensic medical assessments where appropriate;</li>
<li>Provide information to aid understanding of the impact of the known or suspected harm on the health of the child;</li>
<li>Gather an overview of the child&rsquo;s health needs, including identifying and treating any unmet health needs, or ensuring onward referral where necessary;</li>
<li>Review and analysis of health information held about parents / carers where the parent or carer is under their care, where it may impact on the care or safety of the child/ren.</li>
</ul>
In many cases review and analysis of the existing child&rsquo;s health record/s, will be sufficient to provide the necessary information and analysis.
The Police should:
<ul>
<li>Help other organisations and agencies understand the reasons for concerns about the child&rsquo;s safety and welfare by sharing information and analysis;</li>
<li>Decide whether or not police investigations reveal grounds for instigating criminal proceedings;</li>
<li>Make available to other practitioners any other relevant information gathered or known to inform discussions about the child&rsquo;s welfare;</li>
<li>Follow the guidance set out in <a href="https://www.gov.uk/government/publications/achieving-best-evidence-in-criminal-proceedings" target="_blank" rel="noopener">Achieving Best Evidence in Criminal Proceedings: Guidance on Interviewing Victims and Witnesses and Guidance on Using Special Measures</a> where a decision has been made to undertake a joint interview of the child as part of the criminal investigation.</li>
</ul>
All involved practitioners should:
<ul>
<li>Contribute to the assessment as required, providing information and analysis about the child and family;</li>
<li>Consider whether a joint enquiry or investigation team may need to speak to a child victim without the knowledge of the parent or carers;</li>
<li>Approach the work with parents and carers in line with the principles in chapter 1 of Working Together to Safeguard Children;</li>
<li>Seek advice and guidance as required and in line with local practice.</li>
</ul>
The National Multi-agency Practice Standards for Child Protection provide that:
Practitioners should:
<ul>
<li>Satisfy themselves that conclusions about the likelihood of significant harm give sufficient weight to the views, experiences, and concerns of those who know the child and/or parents well, including relatives who are protective of the child, and other relevant practitioners;</li>
<li>Share their thinking and proposed recommendations with other practitioners who hold relevant information and insight into the child and adults involved with the child;</li>
<li>Comment, challenge, and jointly deliberate, before making a final decision about the likelihood of significant harm;</li>
<li>Together with other agencies, clarify what family help from multiagency partners is necessary to reduce the likelihood of significant harm and maintain reasonable care for the children. They should seek assurance that this resource is available and of sufficient skill and intensity;</li>
<li>Remain alert to changes in circumstances for the child and family and respond as new information comes to light that needs to be reflected in the Child Protectionplan;</li>
<li>Reflect on the proposed protection plan and consider adjustments to strengthen the protection plan. The protection plan should be specific, achievable, and relevant to the likelihood of significant harm and the context in which it is occurring.</li>
</ul>
The assessment of risk will:
<ul>
<li>Identify the cause for concern, its seriousness, historical information and prior concerns (which may be in the form of a chronology) and the vulnerability and resilience of the child;</li>
<li>Evaluate the strengths, including the protective factors, and weaknesses of the family;</li>
<li>Evaluate the risks to the child/ren and the context in which they are living;</li>
<li>Consider the child's needs for protection; from whom and how this can be achieved;</li>
<li>Consider the capacity of the parents and wider family and social networks to safeguard and promote the child's welfare - this should include both parents, any other carers, such as grandparents, and the partners of the parents;</li>
<li>Consider risk factors that may suggest a higher level of vulnerability in the family and risk of significant harm such as parental mental health difficulties, parental substance misuse, and domestic abuse or combinations of these;</li>
<li>Determine the level of intervention required to improve the outcome for the child to be safeguarded in the immediate, interim and longer term.</li>
</ul>

The Section 47 Enquiry

The police and children's social care must co-ordinate their activities to ensure the parallel process of a Section 47 Enquiry and a criminal investigation is undertaken in the best interests of the child. This should primarily be achieved through joint activity and planning at strategy discussions/meetings.
The primary responsibility of police officers is to undertake criminal investigations of suspected or actual crime and to inform children's social care when they are undertaking such investigations, and where appropriate to notify the Local Authority Designated Officer (LADO) in specific cases where there are allegations against people working in a paid or voluntary capacity with children.
At the strategy discussion/meeting the police officers should share current and historical information with other services where it is necessary to do so to ensure the protection of a child. Working Together to Safeguard Children states that: The police should assist other agencies to carry out their responsibilities where there are concerns about the child's welfare, whether or not a crime has been committed. If a crime has been committed, the police should be informed by the Local Authority children's social care department.
The local protocol agreed between the Police and Children's Social Care for those cases, which will progress through joint enquiries, covers the following:
<ul>
<li>Sexual abuse;</li>
<li>Serious physical injury (including bruising and soft tissue injuries to babies, repeated referrals on pre-school children; bite marks which need further exploration);</li>
<li>Serious neglect;</li>
<li>Abandonment of young children;</li>
<li>Complex circumstances, for example, organised abuse or medical conditions involving fabricated and induced illness, particularly where the investigatory skills of the Police may be of assistance;</li>
<li>Enquiries concerning allegations of abuse whilst a child is in a foster, adoptive or child minding household and allegations of abuse by a worker or volunteer in contact with children.</li>
</ul>
The Detective Inspector, Child Abuse Investigation Unit should also be consulted and consideration should be given to joint enquiries in cases where:
<ul>
<li>There have been previous child abuse allegations in respect of the child or the alleged perpetrator;</li>
<li>The child is unable to give a clear, coherent and credible account of how the injuries occurred;</li>
<li>The explanation given by the child/other person is not consistent with the injuries;</li>
<li>Information from other agencies adds to the concerns or identifies new ones.</li>
</ul>
Where joint enquiries take place the Police have the lead for the criminal investigation and Children's Social Care have the lead for Section 47 enquiries and the child's welfare. Children's social Care will work in partnership with the Medical Examiners in local areas to ensure children receive appropriate and timely medical examinations, assessments and any treatment required as outlined in&nbsp;Section 8, Medical Assessments.
All other cases that meet the threshold for enquiries under Section 47 will be dealt with initially by Children's Social Care alone. Such cases are likely to include:
<ul>
<li>Emotional abuse;</li>
<li>Enquiries into the circumstances of unborn babies;</li>
<li>Children on Care Orders returning home under the Care Planning, Placement and Case Review Regulations 2011 where they are returning to the household from which they were removed for concerns regarding significant harm and assessment indicates the need for a protection plan;</li>
<li>Children moving into a household where another child is subject to a Child Protection Plan;</li>
<li>Children moving into the area who are subject to a Child Protection Plan in another area;</li>
<li>The presence in, or the return to the household, of a person who is known to have committed a relevant offence and presents a continuing risk of harm to children, or where further assessment of the individual is required.</li>
</ul>
Section 47 enquiries must be undertaken in respect of all children in the household.
See <a href="https://www.workingtogetheronline.co.uk/" target="_blank" rel="noopener">Working Together to Safeguard Children, Flowchart 4: Action Taken for an Assessment of a Child under the Children Act 1989</a>.

Single Agency and Joint Agency Section 47 Enquiries and Joint Police and Social Care Enquiries

You should approach the work with parents and carers in line with the principles of a child-centred approach within a whole family focus set out in <a href="https://www.workingtogetheronline.co.uk/" target="_blank" rel="noopener">Working Together to Safeguard Children</a>.
<h4>The Child</h4>
Practitioners should take care to ensure that children know what is being discussed about them and their family where this is appropriate. They should ask children what they would like to happen and what they think would help them and their family to reduce the likelihood of significant harm, including where harm is taking place in contexts beyond the family home. Practitioners should listen to what children tell them.
Children who are the subject of Section 47 Enquiries should always be seen and communicated with alone by the social worker if this is developmentally appropriate. The initial discussions with the child should be conducted in a way that minimises distress to them and maximises the likelihood that they will provide accurate and complete information, avoiding leading or suggestive questions. In addition, all children within the household must be directly communicated with during Section 47 Enquiries by either the police or Children's Social Care or both agencies, so as to enable an assessment of their safety to be made.
The children who are the focus of concern must be seen alone, subject to their age and willingness, preferably with parental permission.
If the child is the subject of ongoing court proceedings, legal advice must be sought about obtaining permission from the court to see the child.
Children's Social Care and the police should ensure that appropriate arrangements are in place to support the child through the Section 47 Enquiry. Specialist help may be needed if:
<ul>
<li>The child's first language is not English;</li>
<li>The child appears to have a degree of psychological and/or psychiatric disturbance but is deemed competent;</li>
<li>The child has a physical/sensory/learning disability;</li>
<li>Interviewers do not have adequate knowledge and understanding of the child's ethnic, faith and cultural background;</li>
<li>Unusual abuse is suspected, including the use of photography or filming (in which case the method of interviewing the child might need to be revised).</li>
</ul>
It may be necessary to provide information to the child in stages and this must be taken into account in planning the Section 47 Enquiries.
Explanations given to the child must be brought up to date as the assessment and the enquiry progresses. In no circumstances should the child be left wondering what is happening and why.
If the whereabouts of a child subject to Section 47 Enquiries are unknown and cannot be ascertained by the social worker, the following action must be taken within 24 hours:
<ul>
<li>A strategy discussion/ meeting with the police;</li>
<li>Agreement reached with the social worker or their Children's Social Care manager responsible as to what further action is required to locate and see the child and carry out the enquiry.</li>
</ul>
If access to a child is refused or obstructed, the social worker, in consultation with their manager, should co-ordinate a strategy discussion/meeting including legal representation, to develop a plan to locate or access the child/ren and progress the Section 47 Enquiry.
<h4>The Parents and Other Significant Family Members</h4>
Practitioners should engage parents and the family network, as appropriate, in the discussions, recognising previous involvement with agencies and services may influence how they engage. Practitioners should encourage parents and families to express what support would help them to reduce significant harm.
Practitioners should thoroughly explore the significance of the adults in contact with the child and their family or individual histories. They should pay particular attention to any serious criminal convictions, previous allegations of child abuse, domestic abuse or impulsive violent behaviour, restrictions on contact with children or involvement with children subject to Child Protection plans or care proceedings.
Practitioners should explain clearly to parents and the family network the implications of the threshold that has been reached for section 47 enquiries, the initial&nbsp; conference, and any ongoing Child Protection plan (including that this threshold may lead to pre-proceedings, should the likelihood of significant harm not reduce). Practitioners should do everything they can to ensure that parents and the family network understand and can engage purposefully with the enquiries and any protection plan.
If a parent has a specific communication difficulty or English is not their first language, an interpreter should be provided.
The&nbsp;social worker has the main responsibility to engage with parents and other family members to ascertain the facts of the situation causing concern and to assess the capacity of the family to safeguard the child.
Parents should be involved at the earliest opportunity unless to do so would jeopardise a police investigation or place the child at risk of harm. The needs and safety of the child will be paramount when determining at what point parents or carers are given information. Parents must be kept informed throughout about the enquiry, its outcome and any subsequent action unless this would jeopardise a police investigation or place the child at risk of harm.
The assessment should include both parents, any other carers such as grandparents and the partners of the parents, as applicable.
Where a parent lives elsewhere but has contact with the child arrangements should be made for their involvement in the assessment process.
Appropriate checks should be completed on a parent who assumes the care of a child during a Section 47 Enquiry.
An explanation of their rights as parents including the need for support and guidance from an advocate whom they trust should be provided, including advice about the right to seek legal advice.
Any objections or complaints expressed by parents during a Section 47 Enquiry, and the response to these objections or complaints, must be clearly recorded.

Involving Children, Parents and Other Significant Family Members

Child Protection Medical Assessments under S47

Early identification of the needs of a pregnant woman and her unborn child are likely to involve midwifery services and may involve a range of other agencies. In some circumstances, practitioners will identify more serious concerns about the welfare, including significant harm, of an expected baby. Specific guidance has been developed which covers actions and responsibilities with regard to high risk pre-birth assessments.
This guidance gives further information relating to:
<ul>
<li>Legal planning meetings;</li>
<li>Ante-natal parenting assessment;</li>
<li>Birth protection planning meetings including out of hours arrangements and babies born at home;</li>
<li>Pregnant women with learning disability and impaired mental capacity;</li>
<li>Children in care who become pregnant;</li>
<li>Plans for removal of a baby at birth;</li>
<li>Discharge planning processes;</li>
<li>A range of tools to support the assessment and protection process.</li>
</ul>
Where concerns or needs have been identified, that do not meet the criteria for intervention by Children's Social Care, then organisations should consider what single agency or multi agency provision is required to meet those needs. At this point the practitioner identifying the need should consider initiating a Common Assessment Framework to ensure this work is coordinated.
Practitioners should refer to the Safeguarding Guide and Practice Guidance - <a href="/chapter/parents-who-misuse-substances">Parents who Misuse Substances Procedure</a>, in relation to parental substance misuse, domestic violence (see <a href="/chapter/domestic-abuse">Domestic Abuse Procedure</a>) and others as appropriate (please consult Section 2 Safeguarding Guides for further information), where such concerns have been identified.
A referral to Children's Social Care should be made as soon as any agency identifies a concern or need that may place the baby at risk of significant harm when born. Social Care will accept the referral at the point that it is made. Agencies will not be asked to refer when the pregnancy has progressed to a certain point as such practice increases potential confusion and reduces the opportunity to ensure that clear plans are agreed and in place well before a child is born. In addition, any issues that raise concern about the health and well being of the baby whilst in utero should also be discussed with the appropriate health practitioner and referred where appropriate. A referral should always be made where:
<ul>
<li>A parent or other adult in the household has been identified as posing a risk to children;</li>
<li>A sibling in the household is or has been the subject of a Child Protection Plan within a relevant timeframe;</li>
<li>Another child has previously been removed from the care of either parent (or parents partner), either temporarily or permanently, by a voluntary arrangement or by Court Order. Where the parent, their partner or any other member of the household has previously had a child removed, this will always lead to a Core Assessment. It is highly likely in such circumstances that an Initial Child protection Conference (ICPC) will be appropriate;</li>
<li>The degree of parental substance misuse is likely to significantly impact on the baby's safety or development;</li>
<li>The degree of parental mental illness/impairment is likely to significantly impact on the baby's safety or development;</li>
<li>There are significant concerns about parental ability to self care and/or to care for the child even with the provision of services;</li>
<li>A parent previously suspected of fabricating or inducing illness in a child;</li>
<li>Where there is evidence of domestic violence initiate a risk assessment and refer to the Pathway to Provision (County) and Family Support Pathway (City);</li>
<li>Any concerns relating to an unborn baby must be reported to children's social care without delay and social care will plan assessments from 12 weeks gestation. A referral to the Family Nurse Partnership for 1st time mothers aged 19 or under should be considered in parallel and must have been made and accepted prior to 26 weeks gestation.</li>
</ul>
Upon receipt of such a referral, where it is judged that the criteria for accessing Children's Social Care are met, an assessment will be carried out by a qualified Social Worker. The assessment should proceed under Section 47, of the Children Act 1989. As indicated above where the household, or a member of it, has previously had a child removed this will always lead to an in depth assessment.
The timing of the pre birth assessment is crucial in order to ensure full information is gathered and analysed so that it can be used within planning that takes place prior to the birth. The following points must be considered:
<ul>
<li>As soon as Child Protection concerns are identified, the Section 47 enquiries and pre birth assessment should be initiated (but not earlier than 12 weeks);</li>
<li>The Initial Child Protection Case Conference (ICPC) should be held within 15 days of Section 47 enquiries commencing and the pre birth assessment must be completed by this date;</li>
<li>The ICPC should be held no later than 6 weeks before the expected date of delivery but may be held up to 3 months prior to this date;</li>
<li>In most circumstances the pre birth assessment must be completed 6 weeks prior to the due date;</li>
<li>In the event of a late presentation / concealed pregnancy, an immediate assessment is required incorporating checks with Health, Police, Probation, education, Mental Health, Adult services, and Family Community Teams and other local authorities where the family have lived previously;</li>
<li>In the case of twins and other high risk pregnancies it is likely that they may deliver prematurely and in these situations efforts should be made to complete assessments by 30 weeks of pregnancy. If the baby is born prematurely before this process has reached completion there should be consideration of convening a further strategy meeting as soon as practical after the birth of the baby to consider the impact of the premature birth on the risks already identified, any siblings in the family, support the family may need and to share information already gathered with the neonatal team;</li>
<li>The pre birth planning meetings must be convened following the ICPC and the birth protection plan clearly documented and shared with all agencies.</li>
</ul>
This pre birth assessment is undertaken with the purpose of enabling a full assessment of the:
<ul>
<li>Identified risks and how far these will impact on the care of the expected child;</li>
<li>Parental history, their family and community support networks and their ability to prepare for and adapt to the needs of the child, including parental capacity to change;</li>
<li>Support needs of parents and whether these needs can realistically be met so that (where possible) they can provide safe care for their baby;</li>
<li>Early identification of other family members who might be able to support or provide primary care.</li>
</ul>
As with all assessments, it is essential the pre-birth assessment includes the birth father and male partner (if different) wherever possible. If the birth father is not part of the household, it is still important to understand and assess what role the father/father's family will play in the baby's life.
Where the assessment concludes that the child will be at continuing risk of significant harm following its birth, then an Initial (Pre Birth) Child Protection Conference (ICPC) should be convened as detailed within these procedures. N.B. Where an existing child in the household is the subject of a Child Protection Plan then an ICPC in respect of the unborn child must be held at the earliest opportunity. Where the current assessment leads practitioners to actively consider separation of the child from the parent at birth, a legal planning meeting should be convened as soon as possible and prior to the conference. The outcome of the legal planning meeting will be considered at the ICPC.
The ICPC should be held within 15 days of Section 47 enquiries commencing and the pre birth assessment must be completed by this date. Serious case reviews have highlighted the particular vulnerability of pre-term babies and ideally the ICPC should be held no later than 4 weeks before the expected date of delivery but could be held up to 3 months prior to this date. This should not detract from or delay the need to undertake a full assessment and ensure appropriate interventions.
Please also see: <a href="https://trixcms.trixonline.co.uk/api/assets/nottinghamshirescp/c77fea2a-ea61-417c-95c3-9a5833b10f38/early-years-exist-inj.docx" target="_blank" rel="noopener">Early Years Existing Injuries Pack</a> and <a href="https://trixcms.trixonline.co.uk/api/assets/nottinghamshirescp/b449e2d0-5e84-43ec-bc13-da8e7e768da0/assess-subcon-haem.pdf" target="_blank" rel="noopener">Assessment of Subconjunctival Haemorrhage (SCH) in Infants</a>.

Pre-Birth Assessments

Visually recorded interviews must be planned and conducted jointly by trained police officers and social workers in accordance with the <a href="https://www.gov.uk/government/publications/achieving-best-evidence-in-criminal-proceedings" target="_blank" rel="noopener">Achieving Best Evidence in Criminal Proceedings: Guidance on interviewing victims and witnesses, and guidance on using special measures (Ministry of Justice)</a>. All events up to the time of the video interview must be fully recorded. Consideration of the use of video-recorded evidence should take into account situations where the child has been subject to abuse using recording equipment. Achieving Best Evidence (ABE) promotes a strong victim-centred and trauma-informed approach throughout the guidance. It covers the interview process for child and adult victims and witnesses during a criminal investigation, the pre-trial preparation process and the support available to witnesses in court.
Visually recorded interviews serve two primary purposes:
<ul>
<li>Evidence gathering for criminal proceedings;</li>
<li>Examination in chief of a child witness.</li>
</ul>
Relevant information from this process can also be used to inform Section 47 Enquiries, subsequent civil childcare proceedings or disciplinary proceedings against adults, where allegations have been made.

Achieving Best Evidence Interviews

The social worker, under the supervision of their manager is responsible for deciding what action to take and how to proceed following section 47 enquiries. They should make these decisions based on multi-agency discussions informed by the voice of the child.
It is important that they ensure that both immediate risk assessment and long-term risk assessment are considered. Where the child's circumstances are about to change, the risk assessment must include an assessment of the safety of the new environment (e.g. where a child is to be discharged from hospital to home the assessment must have established the safety of the home environment and implemented any support plan required to meet the child's needs).
The outcome of the Section 47 Enquiries may reflect that the original concerns are:
<ul>
<li>Not substantiated; although consideration should be given to whether the child may need services as a child in need;</li>
<li>Substantiated and the child is judged to be suffering, or likely to suffer, significant harm and an initial Child Protection conference should be called.</li>
</ul>
<h4>Where Concerns of Significant Harm are Not Substantiated</h4>
Social Workers and their managers should:
<ul>
<li>Discuss the case with the child, parents and other practitioners and be prepared to answer questions openly and be clear on next steps;</li>
<li>Discuss whether support from any services may be helpful and help secure it;</li>
<li>Consider whether the child's health and development should be re-assessed regularly against specific objectives and decide who has responsibility for doing this; and</li>
<li>Discuss with the family whether they wish to be referred to a family group decision-making forum, such as a family group conference, to determine ongoing support for the child and family.</li>
</ul>
All involved professionals should:
<ul>
<li>Participate in further discussions as necessary;</li>
<li>Provide information about support available to the family, make onward referrals or offer services as specified in the plan for the child;</li>
<li>Monitor and review the impact of the actions identified in the plan;</li>
<li>Contribute to the development of any plan as appropriate;</li>
<li>Provide services as specified in the plan for the child;</li>
<li>Approach the work with parents and carers in line with the principles of a child-centred approach within a whole family focus set out in <a href="https://www.workingtogetheronline.co.uk/" target="_blank" rel="noopener">chapter 1 of Working Together to Safeguard Children</a>;</li>
<li>Seek advice and guidance as required and in line with local practice guidance; and</li>
<li>Consider the plans for ongoing assessment and reviewing the child's circumstances.</li>
</ul>
Arrangements should be noted for future referrals, if appropriate.
<h4>Where Concerns of Significant Harm are Substantiated and the Child is Judged to be Suffering, or Likely to Suffer, Significant Harm:</h4>
Social Workers should:&nbsp;
<ul>
<li>Convene an initial Child Protection conference. The timing of this conference should depend on the urgency of the case and response to the needs of the child and the nature and severity of the harm they may be facing. The initial Child Protection conference should take place within 15 working days of a strategy discussion, or the strategy discussion at which section 47 enquiries were initiated if more than one has been held;</li>
<li>Consider which practitioners with specialist knowledge or relevant professional disciplines should be invited to participate so that the plan will meet the child's needs;</li>
<li>Seek to communicate the outcome and rationale to the referring practitioner or agency, and give particular consideration to whether they should be included in the Child Protection conference;</li>
<li>Ensure that the child and their parents understand the purpose of the conference and who will attend. Parents should be given appropriate information to support their participation in the conference;</li>
<li>Help prepare the child if they are attending or making representations through a third party to the conference;</li>
<li>Give information about advocacy agencies and explain that the family may bring an advocate, friend or supporter.</li>
</ul>
All involved practitioners should:
<ul>
<li>Be sufficiently skilled and experienced to prepare for and engage with the Child Protection conference, and able to critically assess and challenge their own and others' input;</li>
<li>Contribute to the information their agency provides ahead of the conference, setting out the nature of the agency's involvement with the child and family;</li>
<li>Offer clear analysis based on their perspective;</li>
<li>Consider, in conjunction with the police and the appointed conference Chair, whether the report can and should be shared with the parents and if so when;</li>
<li>Approach the work with parents and carers in line with the principles of a child-centred approach within a whole family focus set out in <a href="https://www.workingtogetheronline.co.uk/" target="_blank" rel="noopener">chapter 1 of Working Together to Safeguard Children</a>;</li>
<li>Attend the conference and take part in decision making when invited;</li>
<li>Seek advice and guidance as required and in line with local practice guidance.</li>
</ul>
Suitable multi-agency arrangements must be put in place to safeguard the child until such time as the initial Child Protection conference has taken place. The Lead Practitioner and their manager will coordinate and review such arrangements.
Feedback from Section 47 Enquiries:
The Social Worker is responsible for recording the outcome of the Section 47 Enquiries consistent with the requirements of the recording system. The outcome should be put on the child's electronic record with a clear record of the discussions, authorised by the Children's Social Care manager.
Notification, verbal or written, of the outcome of the enquiries, including an evaluation of the outcome for the child, should be given to all the agencies who have been significantly involved for their information and records.
The parents and children of sufficient age and appropriate level of understanding should be given feedback of the outcome, in particular in advance of any initial child conference that is convened. Issues affecting the communication with the parent and/or the child(ren) should be taken into account when deciding how best this should be achieved including an appropriate format for younger children and those people whose preferred language is not English. If there are ongoing criminal investigations, the content of the social worker's feedback should be agreed with the police.
Feedback about outcomes should be provided to non-professional referrers in a manner that respects the confidentiality and welfare of the child.
Where the child concerned is living in a residential establishment which is subject to inspection, the relevant inspectorate should be informed.
Where the decision about the outcome of the Section 47 Enquiry is disputed:
If local authority Children's Social Care decides not to proceed with a Child Protection conference, then other practitioners involved with the child and family have the right to request that local authority children's social care convene a conference if they have serious concerns that a child's welfare may not be adequately safeguarded. See <a href="/chapter/child-protection-conferences#complaints-by-children-and-or-parents">Complaints in Relation to Child Protection Conference</a>.

The Outcome of Section 47 Enquiries

The speed with which an assessment is carried out after a child's case has been referred into the local authority Children's Social Care should be determined by the needs of the individual child and the nature and level of any risk of harm they face. This will require judgements to be made by a social work qualified Practice Supervisor or manager on each individual case. Adult assessments, for example, parent carer or non-parent carer assessments, should also be carried out in a timely manner.
The timescale for the assessment to reach a decision on the next steps should be based upon the needs of the individual child, consistent with the local protocol and no longer than 45 working days from the point of referral into the local authority Children's Social Care. If, in discussion with a child and their family and other practitioners, an assessment exceeds 45 working days, the Lead Practitioner should record the reasons for exceeding the time limit. In some cases, the needs of the child will mean that a quick assessment will be required. In all cases, as practitioners identify needs during the assessment, they do not need to wait until the assessment concludes before providing support or commissioning services to support the child and their family.
The maximum period of an enquiry from the strategy discussion/meeting to the date of the initial Child Protection conference is 15 working days. In exceptional circumstances, where more than one strategy discussion/meeting takes place, the timescale remains as 15 working days from the strategy discussion/meeting which initiated the Section 47 Enquiries.

Timescales for Section 47 Enquiries

A full written record must be completed by each agency involved in a Section 47 Enquiry, using the required agency proforma, authorised and dated by the staff.
The responsible manager must countersign/authorise Children's Social Care Section 47 recording and forms.
Practitioners should, wherever possible, retain rough notes in line with local retention of record procedures until the completion of anticipated legal proceedings.
At the completion of the enquiry, the Lead Practitioner or the social work manager should ensure that the concerns and outcome have been entered in the recording system including on the child's chronology and that other agencies have been informed.
Children's Social Care recording of enquiries should include:
<ul>
<li>Agency checks;</li>
<li>Content of contact cross-referenced with any specific forms used;</li>
<li>Strategy discussion/meeting notes;</li>
<li>Details of the enquiry;</li>
<li>Body maps (where applicable);</li>
<li>Assessment including identification of risks and how they may be managed;</li>
<li>Decision-making processes;</li>
<li>Outcome/further action planned.</li>
</ul>
All agencies involved should ensure that records have been concluded and countersigned in line with agency policies and recording procedures.
All records should be checked for the correct spelling of names and any alias as well as correct dates of birth.

Recording

<a href="https://www.workingtogetheronline.co.uk/" target="_blank" rel="noopener">Section 3 in Working Together to Safeguard Children</a> sets out national multi-agency practice standards for Child Protection for all practitioners working in services and settings who come into contact with children who may be suffering or have suffered significant harm within or outside the home.
Local safeguarding partners need to ensure all practitioners are supported to be able to achieve the national multi-agency practice standards for child protection, including through:
<ul>
<li>An unrelenting focus on protection and the best outcomes for children;</li>
<li>Creating learning cultures in which practitioners stay up to date as new evidence of best practice emerges;</li>
<li>Creating an environment in which it is safe to challenge, including assumptions that relate to ethnicity, sex, disability, and sexuality.</li>
</ul>
A: Recognising actual or likely significant harm for all practitioners
<ul>
<li>Practitioners are alert to potential indicators of abuse, neglect, and exploitation, and listen carefully to what a child says, how they behave, and observes how they communicate if non-verbal (due to age, special needs and/or disabilities, or if unwilling to communicate). Practitioners will try to understand the child's personal experiences and observe and record any concerns;</li>
<li>Practitioners communicate in a way that is appropriate to the child's age and level of understanding and use evidence-based practice tools for engaging with children, including those with special educational needs and disabilities;</li>
<li>When practitioners have concerns or information about a child that may indicate a child is suffering or likely to suffer significant harm, they share them with relevant practitioners and escalate them if necessary, using the referral or escalation procedure in place within their local multi-agency safeguarding arrangements. They update colleagues when they receive relevant new information;</li>
<li>Practitioners never assume that information has already been shared by another professional or family member and always remain open to changing their views about the likelihood of significant harm.</li>
</ul>
B: Section 47 enquiries, Child Protection conferences and Child Protection plans
<ul>
<li>Practitioners are aware of the limits and strengths of their personal expertise and agency remit. They work collaboratively and proactively with multi-agency practitioners to build an accurate and comprehensive understanding of the daily life of a child and their family to establish the likelihood of significant harm and any ongoing risks. Practitioners respect the opinions, knowledge and skills of multi-agency colleagues and engage constructively in their challenge;</li>
<li>Practitioners have an applied understanding of what constitutes a child suffering actual or likely significant harm. They consider the severity, duration and frequency of any abuse, degree of threat, coercion, or cruelty, the significance of others in the child's world, including all adults and children in contact with the child (this can include those within the immediate and wider family and those in contexts beyond the family, including online), and the cumulative impact of adverse events; Practitioners take care to ensure that children know what is being discussed about them and their family where this is appropriate. They ask children what they would like to happen and what they think would help them and their family to reduce the likelihood of significant harm, including where harm is taking place in contexts beyond the family home. Practitioners listen to what children tell them;</li>
<li>Practitioners engage parents and the family network, as appropriate, in the discussions, recognising previous involvement with agencies and services may influence how they engage. Practitioners encourage parents and families to express what support would help them to reduce significant harm;</li>
<li>Practitioners thoroughly explore the significance of the adults in contact with the child and their family or individual histories. They should pay particular attention to any serious criminal convictions, previous allegations of child abuse, domestic abuse or impulsive violent behaviour, restrictions on contact with children or involvement with children subject to Child Protection plans or care proceedings;</li>
<li>Practitioners satisfy themselves that conclusions about the likelihood of significant harm give sufficient weight to the views, experiences, and concerns of those who know the child and/or parents well, including relatives who are protective of the child, and other relevant practitioners;</li>
<li>Practitioners share their thinking and proposed recommendations with other practitioners who hold relevant information and insight into the child and adults involved with the child. Practitioners comment, challenge, and jointly deliberate, before making a final decision about the likelihood of significant harm;</li>
<li>Together with other agencies, practitioners clarify what family help from multi- agency partners is necessary to reduce the likelihood of significant harm and maintain reasonable care for the children. They seek assurance that this resource is available and of sufficient skill and intensity;</li>
<li>Practitioners explain clearly to parents and the family network the implications of the threshold that has been reached for section 47 enquiries, the initial Child Protection conference, and any ongoing Child Protection plan (including that this threshold may lead to pre-proceedings, should the likelihood of significant harm not reduce). Practitioners do everything they can to ensure that parents and the family network understand and can engage purposefully with the enquiries and any protection plan;</li>
<li>Practitioners remain alert to changes in circumstances for the child and family and respond as new information comes to light that needs to be reflected in the Child Protection plan;</li>
<li>Practitioners reflect on the proposed Child Protection plan and consider adjustments to strengthen the protection plan. The protection plan is specific, achievable, and relevant to the likelihood of significant harm and the context in which it is occurring.</li>
</ul>
C: Discharging the child protection plan
<ul>
<li>Practitioners work as part of a multi-agency team to create lasting change for families and ensure the child, parents and family network know that further help and support is available if needed or further concerns arise;</li>
<li>Following a decision to discharge a Child Protection plan, practitioners ensure that appropriate support is in place for the child and family and respond to changing circumstances and new information;</li>
<li>Where a child becomes looked after, practitioners ensure that this is well planned and that the child, parents and family network are appropriately supported. Ongoing need is monitored as part of care planning.</li>
</ul>
See also: <a href="https://www.gov.uk/government/publications/childrens-social-care-national-framework" target="_blank" rel="noopener">Children's social care: national framework</a> - Statutory guidance which sets out the principles behind children's social care, its purpose, factors enabling good practice and what it should achieve.

National Multi-Agency Practice Standards for Child Protection

<a href="/chapter/referrals">Referrals Procedure</a>
<a href="/chapter/assessment">Assessment Procedure</a>
<a href="/chapter/information-sharing">Information Sharing Procedure</a>
<a href="https://trixcms.trixonline.co.uk/api/assets/nottinghamshirescp/de97d178-ef38-4f3c-9973-344914fbb1a2/birth-prot-plan-remove.docx" target="_blank" rel="noopener">Birth Protection Plan - When The Baby Is Going To Be Removed</a>
<a href="https://trixcms.trixonline.co.uk/api/assets/nottinghamshirescp/3291ea6e-d4c4-4c2f-b12e-d4a20a4db316/birth-prot-plan-dis-home.docx" target="_blank" rel="noopener">Birth Protection Plan - Discharge Home</a>
<a href="https://trixcms.trixonline.co.uk/api/assets/nottinghamshirescp/72891c19-3b2d-47c3-b58f-1c06b5bc4bfc/bruise-babies-flowchart.pdf" target="_blank" rel="noopener">Brusing in Babies Flowchart</a>
<a href="https://trixcms.trixonline.co.uk/api/assets/nottinghamshirescp/b449e2d0-5e84-43ec-bc13-da8e7e768da0/assess-subcon-haem.pdf" target="_blank" rel="noopener">Assessment of Subconjunctival Haemorrhage (SCH) in Infants</a>

Escalating for the right Outcome - Conflict Resolution and Professional Disagreement Policy

When working in the arena of safeguarding and child protection, it is inevitable that from time to time, there will be practitioner disagreement. Whilst this is understandable and generally acceptable, it is vital that such differences do not affect the outcomes for children and young people. This procedure provides a process for resolving practitioner disagreements and ensuring there is effective challenge in the system. It also provides practitioners with advice and support to enable them to escalate concerns where disagreements are not resolved at a practitioner level.
Professional challenge is a positive activity and a sign of good practice and effective multi-agency working. Being professionally challenged should not be seen as a criticism of the person&rsquo;s professional capabilities.
Both national and local Child Safeguarding Practice Reviews (CSPRs) continue to draw attention to the importance of interagency communication and have identified an apparent reluctance to challenge interagency decision making with concerns that were not followed up with robust professional challenge which may have altered the professional response and the outcome for the child.
Disagreements can arise in a number of areas of multi-agency working such as (this list is not exhaustive):
<ul>
<li>Thresholds applications;</li>
<li>Outcomes of assessments;</li>
<li>Decision making; roles and responsibilities of workers;</li>
<li>Service provision;</li>
<li>Information sharing and communication in relation to practice or actions which may not effectively ensure the safety or well-being of a child or young person or his/her family.</li>
</ul>
It is important:
To avoid professional disputes that put children at risk or obscure the focus on the child.
To resolve difficulties (within and) between organisations quickly and openly.
To identify problem areas in working together where there is a lack of clarity in existing procedures and to promote resolution via necessary amendments.
Throughout any dispute between individuals or organisations practitioners must remain child focused. The safety of individual child(ren) remains the paramount considerations.
With any dispute about thresholds, please refer to the appropriate pathway documents (Thresholds of Need in the City, Pathway to Provision in the County) to help articulate your concern. The interagency policy and procedures should be used to support professionals to explore the roles and responsibilities and options for professionals and consideration of the role of supervision, chronology and tools such as the neglect toolkit should be considered as ways to help resolved the concerns.
At no time must professional disagreement detract from ensuring that the child or young person is safeguarded. Any unresolved issues should be escalated with due consideration that might exist for the child. Every effort should be made to resolve the disagreement as quickly and openly as possible, within a time frame which clearly protects the child, determined on a case-by-case basis. Effective working together depends on resolving disagreements to the satisfaction of practitioners and agencies and a belief in a genuine partnership.
At every level professionals should consider if seeking advice or supervision from their line manager and&nbsp; / or safeguarding organisational lead would support them to manage the issues.
<a href="#appendix-2-escalation-contacts-nottingham-and-nottinghamshire">Appendix 2: Escalation contacts Nottingham and Nottinghamshire</a> provides a table of roles in partnership organisations to support professionals to identify their equivalent professional in order to escalate to NB. Whilst email contacts are provided wherever possible it is likely that a telephone conversation will often provide a more timely and effective resolution. If using email then ensure any out of office redirections are noted and responded to and it remains the person making the email contact to chase up non response in a timely manner.
Please contact the relevant SCB Business Manager for assistance if you are escalating to Stage Two and you do not know who the safeguarding lead is for the organisation you wish to contact.
Nottingham City: <a href="mailto:safeguarding.partnerships@nottinghamcity.gov.uk" target="_blank" rel="noopener">safeguarding.partnerships@nottinghamcity.gov.uk</a>
Nottinghamshire County Council: <a href="mailto:info.nscp@nottscc.gov.uk" target="_blank" rel="noopener">info.nscp@nottscc.gov.uk</a>

Introduction

Appendix 1: Flowchart Describing Stages of Escalation

<a href="https://trixcms.trixonline.co.uk/api/assets/nottinghamshirescp/7f09064f-4e10-48b1-824d-c63f174e8970/app-2-escalation-contacts.pdf" target="_blank" rel="noopener">Click here to view Appendix 2: Escalation Contacts Nottingham and Nottinghamshire</a>.

Appendix 2: Escalation Contacts Nottingham and Nottinghamshire

<a href="https://trixcms.trixonline.co.uk/api/assets/nottinghamshirescp/ba2df33c-dd98-417b-a619-55b05323d51e/app-3-req-escalation.docx" target="_blank" rel="noopener">Click here to view Appendix 3: Form to Document Case Identified Requiring Escalation for the Purposes of Safeguarding a Child/ren</a>.

Appendix 3: Form to Document Case Identified Requiring Escalation for the Purposes of Safeguarding a Child/ren

Homepage

In January 2026 the Child and Young Person Neglect Toolkit has been updated.

Guidance for Neglect Toolkit.pdf

1   guidance for practitioners using the nscp and ncscp neglect toolkit  the neglect toolkit was produced alongside the nscp and ncscp child neglect strategy.  it should be used in conjunction with the nottinghamshire and nottingham city pathway and threshold documents which provide guidance on requests for support for families and what services are available to meet families’ needs.       please also see the neglect section in the nscp and ncscp interagency safeguarding children procedures.  two short videos are also available for professionals and families designed to raise awareness of the impact of neglect: recognising and responding to neglect – for professionals and raising awareness about neglect - for families  what is the child and young person’s neglect toolkit?  the child and young person’s neglect toolkit is provided to assist practitioners from organisations across nottinghamshire and nottingham city in identifying and assessing children and young people who are at risk of or experiencing neglect. it is to be used when practitioners are concerned that the quality of care of a child/young person suggests that their needs are being neglected. the toolkit can be used in a number of ways.  • when working in partnership with parents to assess levels of concerns and identify areas of strength. • when working with an older child to help them to understand their lived experience. • to identify priority areas for work with the child and areas of focus for change. • it can be used within supervision to support and develop a practitioner’s assessment of strengths and needs. • it should be used in partnership with families. the toolkit will support good practice and enable honest conversations regarding levels of care.  it will also prompt practitioners to recognise strengths in the family which can be extremely motivating for families when faced with professional’s concerns. • the toolkit can assist with the early identification of neglect. • it can be used to track improvements in the child’s lived experience, or where their situation is getting worse, or failing to improve.   the toolkit does not replace assessments carried out by social workers such as the early help assessment or the child and family assessment but can be used to inform these assessments.   using the neglect toolkit  the toolkit focuses on seven key areas of need, including the extent of the parent’s commitment to care for the child and the extent to which children and young people’s needs are being put first or come secondary to the needs of their parents/carers.  in using the neglect toolkit practitioners should keep in nottinghamshire:  pathway to provision nottingham city:  threshold of needs 
2  mind that although poverty does not cause neglect it can make the impact of neglect worse.    practitioners are encouraged to use the toolkit in the areas they are familiar with to inform discussions with their safeguarding lead, and to enable productive discussions either with the social worker allocated to the child or with the mash if needs indicate this. the most important part of the summary sheet is the examples of impact on child section for each area of need where detail and analysis are provided.  if practitioners have a wider knowledge of the child’s lived experience, more sections of the toolkit can be completed, and a picture of the family’s strengths and needs can be built.      the summary sheet is designed to give a visual picture of the areas of good and worrying care.     the toolkit helps practitioners to assess strengths and needs of a family across the seven key areas.  the trigger for further action is not a specific score and relies on professional judgement and reference to the pathways documents for nottingham city and nottinghamshire.  if there are mainly 3s and 4s and there are detailed examples of the negative impact on the child, then this is cause for concern and should be discussed with the relevant safeguarding lead or manager.  this must be done as soon as possible so that a clear plan of support can be agreed and put in place.    best practice    • decide how you will involve the parents/carers and the child/young person and how you will share the toolkit with them. • depending on your role, you might visit the child’s home, or you might have a conversation with someone who has and who has discussed the toolkit on your behalf with the family. • ideally complete the toolkit with the adult in the home who is the main carer and speak to the child to inform your completion of the toolkit.  ask the parents/carers to give their views and where they would place themselves in the descriptors in the toolkit. • as far as possible comment on the usual state of the house, is this normal or has there been a recent improvement or deterioration? • don’t take into account any external factors such as a family support worker arranging for the house to be cleared or cleaned, unless the parents have positively contributed in some way. • allowances should be made for background factors such as recent bereavement or loss of job. • where explanations do not match observations/assessments this should raise concern. • include all children in the home and consider them individually as well as looking at things in the home which impact all of them.  for example, poor housing conditions are likely to impact all of the children, but there may be differences in the love and care provided to individual children. care must be taken to capture the voices and lived experiences of all the children.     if concerns about neglect are identified     practitioners need to make a judgment about the appropriate response by discussing with their safeguarding lead or manager, and considering the levels of need for the child which have been identified and if requests for support for the family should be made.    decisions following the use of the toolkit may include:  • talking about your concerns with the family and continuing to support as a single agency.  this may be a suitable response if there is potential for positive change and if the risks to the child are manageable.  it is important to clearly record decisions make and regularly review; • making referrals to community-based services who will be able to meet the family’s needs; • alternatively, it may be appropriate to make a request for support to early help or the multi-agency safeguarding hub (the mash), using the separate front door arrangements for city and county depending on the child’s address;  
3  • if at any point you are concerned that a child may be at risk of or may be suffering significant harm contact the city or county mash urgently for advice.    reviews     the neglect toolkit should be reviewed regularly with the family to look at what changes have taken place in response to the support offered.  your safeguarding lead or manager will advise on how often review should happen, which will be in line with the level of the child’s need and your organisation’s procedures.       if progress has been made and sustained it is important to celebrate this with the family at reviews.     issues to consider at reviews:  • is the support in place working and is it making a positive difference to the child? • has there been a change in the circumstances which originally caused concerns? • have the needs increased, or is there a lack of improvement and if so is the involvement of other services now needed? • is there an indication that the child is at risk of significant harm? • if there has been an improvement, has this been sustained over time and can the support to the family be reduced?    further considerations    when discussing parental conflict in a relationship (section 5.2 in the toolkit), practitioners should be vigilant and confident there are no indicators of domestic abuse, including fear, imbalance of power and controlling behaviour.  during discussion of the toolkit with parents, practitioners may be given information suggesting that domestic abuse is a risk.  this may require urgent actions such as the completion of the dash ric form, if it is safe to do so, which is a request for support for an adult who is experiencing domestic abuse.      for further information regarding the difference between parental conflict and domestic abuse please see reducing parental conflict: what is parental conflict? - gov.uk (www.gov.uk)    


Child and YP Neglect Toolkit.docx

guid_practioners_neglect_toolkit.pdf

  1    guidance for practitioners using the  nscp and ncscp neglect toolkit    the neglect toolkit was produced alongside the nscp and ncscp child neglect strategy.  it should be used in conjunction with the nottinghamshire and nottingham city pathway and threshold documents which provide guidance on requests for support for families and what services are available to meet families’ needs.     nottinghamshire:  pathway to provision   nottingham city:  threshold of needs    please also see the neglect chapter in the nscp and ncscp interagency safeguarding children procedures.  two short videos are also available for professionals and families designed to raise awareness of the impact of neglect: recognising and responding to neglect – for professionals and raising awareness about neglect - for families    what is the child and young person’s neglect toolkit?    the child and young person’s neglect toolkit is provided to assist practitioners from organisations across nottinghamshire and nottingham city in identifying and assessing children and young people who are at risk of or experiencing neglect. it is to be used when practitioners are concerned that the quality of care of a child/young person suggests that their needs are being neglected. the toolkit can be used in a number of ways.    • when working in partnership with parents to assess levels of concerns and identify areas of strength.  • when working with an older child to help them to understand their lived experience.  • to identify priority areas for work with the child and areas of focus for change.  • it can be used within supervision to support and develop a practitioner’s assessment of strengths and needs.  • it should be used in partnership with families. the toolkit will support good practice and enable honest conversations regarding levels of care.  it will also prompt practitioners to recognise strengths in the family which can be extremely motivating for families when faced with professional’s concerns.  • the toolkit can assist with the early identification of neglect.  • it can be used to track improvements in the child’s lived experience, or where their situation is getting worse, or failing to improve.     the toolkit does not replace assessments carried out by social workers such as the early help assessment or the child and family assessment but can be used to inform these assessments.     using the neglect toolkit    the toolkit focuses on seven key areas of need, including the extent of the parent’s commitment to care for the child and the extent to which children and young people’s needs are being put first or come 
  2  secondary to the needs of their parents/carers.  in using the neglect toolkit practitioners should keep in mind that although poverty does not cause neglect it can make the impact of neglect worse.      practitioners are encouraged to use the toolkit in the areas they are familiar with to inform discussions with their safeguarding lead, and to enable productive discussions either with the social worker allocated to the child or with the mash if needs indicate this. the most important part of the summary sheet is the examples of impact on child section for each area of need where detail and analysis are provided.  if practitioners have a wider knowledge of the child’s lived experience, more sections of the toolkit can be completed, and a picture of the family’s strengths and needs can be built.        the summary sheet is designed to give a visual picture of the areas of good and worrying care.      the toolkit helps practitioners to assess strengths and needs of a family across the seven key areas.  the trigger for further action is not a specific score and relies on professional judgement and reference to the pathways documents for nottingham city and nottinghamshire.  if there are mainly 3s and 4s and there are detailed examples of the negative impact on the child, then this is cause for concern and should be discussed with the relevant safeguarding lead or manager.  this must be done as soon as possible so that a clear plan of support can be agreed and put in place.      best practice      • decide how you will involve the parents/carers and the child/young person and how you will share the toolkit with them.  • depending on your role, you might visit the child’s home, or you might have a conversation with someone who has and who has discussed the toolkit on your behalf with the family.  • ideally complete the toolkit with the adult in the home who is the main carer and speak to the child to inform your completion of the toolkit.  ask the parents/carers to give their views and where they would place themselves in the descriptors in the toolkit.  • as far as possible comment on the usual state of the house, is this normal or has there been a recent improvement or deterioration?  • don’t take into account any external factors such as a family support worker arranging for the house to be cleared or cleaned, unless the parents have positively contributed in some way.  • allowances should be made for background factors such as recent bereavement or loss of job.  • where explanations do not match observations/assessments this should raise concern.  • include all children in the home and consider them individually as well as looking at things in the home which impact all of them.  for example, poor housing conditions are likely to impact all of the children, but there may be differences in the love and care provided to individual children. care must be taken to capture the voices and lived experiences of all the children.       if concerns about neglect are identified       practitioners need to make a judgment about the appropriate response by discussing with their safeguarding lead or manager, and considering the levels of need for the child which have been identified and if requests for support for the family should be made.      decisions following the use of the toolkit may include:    • talking about your concerns with the family and continuing to support as a single agency.  this may be a suitable response if there is potential for positive change and if the risks to the child are manageable.  it is important to clearly record decisions make and regularly review;  • making referrals to community-based services who will be able to meet the family’s needs;  
  3  • alternatively, it may be appropriate to make a request for support to early help or the multi-agency safeguarding hub (the mash), using the separate front door arrangements for city and county depending on the child’s address;   • if at any point you are concerned that a child may be at risk of or may be suffering significant harm contact the city or county mash urgently for advice.      reviews       the neglect toolkit should be reviewed regularly with the family to look at what changes have taken place in response to the support offered.  your safeguarding lead or manager will advise on how often review should happen, which will be in line with the level of the child’s need and your organisation’s procedures.         if progress has been made and sustained it is important to celebrate this with the family at reviews.       issues to consider at reviews:    • is the support in place working and is it making a positive difference to the child?  • has there been a change in the circumstances which originally caused concerns?  • have the needs increased, or is there a lack of improvement and if so is the involvement of other services now needed?  • is there an indication that the child is at risk of significant harm?  • if there has been an improvement, has this been sustained over time and can the support to the family be reduced?      further considerations      when discussing parental conflict in a relationship (section 5.2 in the toolkit), practitioners should be vigilant and confident there are no indicators of domestic abuse, including fear, imbalance of power and controlling behaviour.  during discussion of the toolkit with parents, practitioners may be given information suggesting that domestic abuse is a risk.  this may require urgent actions such as the completion of the dash ric form, if it is safe to do so, which is a request for support for an adult who is experiencing domestic abuse.        for further information regarding the difference between parental conflict and domestic abuse please see reducing parental conflict: what is parental conflict? - gov.uk (www.gov.uk)       


neglect_toolkit.docx

Safer Sleep risk assessment tool 2025.pdf

safer sleep for babies a risk assessment tool for practitioners this tool should be used with parents / carers to support them to consider how to keep their baby safe and to help identify if their baby is at high risk of sudden infant death syndrome (sids) safer sleep advice is given out to all new parents in pregnancy and the first few days and weeks of a baby’s life by universal health services. to prevent further deaths, we need everyone working with families in nottinghamshire to help ensure safer sleep advice is understood and that families have the support to follow it. this tool supports practitioners to identify, and therefore support, families who may be vulnerable by identifying the risk factors. all practitioners coming into contact with families with infants up to 15 months are encouraged to use this tool to assess the baby’s sleeping environment and support a discussion reinforcing safer sleep practices. remember, every sleep needs to be a safe sleep – whether the baby is sleeping at night or during the day, at home or away from home (staying with grandparents, another parent, friends or babysitters). safer sleep advice for parents and carers • always put babies on their back for every sleep. • keep your baby smoke-free day and night. • the safest place for a baby to sleep is in their own clear, flat, separate sleep space such as a cot or moses basket in the same room as you for at least the first six months. • breastfeeding your baby lowers the risk of sids as well as providing many other physical and emotional health benefits. support to breastfeed is available. • use a firm, flat, waterproof mattress in good condition. • we know some parents choose to bedshare or may do so in an unplanned way. it is very dangerous to co-sleep with babies if: • you or anyone in the bed has recently drunk any alcohol. • you or anyone in the bed smokes. • you or anyone in the bed has taken any drugs or medication that make you feel sleepy. • your baby was born prematurely (before 37 weeks of pregnancy) or weighed under 2.5kg or 5½ lbs when they were born. • avoid letting your baby get too hot. • car seats should only be used whilst travelling. • don’t cover your baby’s face or head while sleeping or use loose bedding. • to avoid accidents, remove all pillows, soft bedding, cot bumpers and soft toys from the cot. • never sleep on a sofa or in an armchair with your baby a review of child deaths in nottingham city and nottinghamshire from april 2008-march 2024 has identified the key characteristics/risk factors of sids. they are similar to what is known from national evidence. • 70.4% of babies were in an unsafe sleep environment. • 38.7% of babies were known to social care at the time of their death. • there was parental smoking in 79.7% of households. • in 27% of households, one or both parents had taken a drug which could make them drowsy, either prescribed or illegal. • in 24.3% of households, one or both parents had been drinking alcohol. • 81% of babies were aged 6 months or less. • there has been an increase in the incidence of sofa sleeping-either baby alone or with an adult. • there has been an increase in use of unrecommended sleep products such as pods/nests, pillows, cot bumpers, hammocks and sleep positioners. • co sleeping with a breastfeeding mother with no other risk factors has not been shown to be a significant hazard but information about safer sleeping should always be provided. on average 6 babies* die every year in nottinghamshire where unsafe sleep arrangements were thought to be the cause *under 15 months of age 
 how to use the tool research evidence key learning from a national review conducted by the national child safeguarding practice review panel in 2020. of the 40 cases of infants who had died of sids notified to the panel in one year (june 2018 – august 2019): • almost all involved parents co-sleeping in unsafe sleep environments with infants. • often when the parents had consumed alcohol or drugs. • frequently wider safeguarding concerns, e.g. neglect, domestic violence, parental mental health concerns and substance misuse. the report stressed the need for safer sleep advice to be firmly embedded within safeguarding practice and identified a continuum of risks that are reflected in the risk assessment tool below. click here to view the full report in 2022, the national child mortality database (ncmd) child death review identified that one of the most common modifiable factors (a factor that if changed might reduce the risk of future child death) is unsafe sleep arrangements. for babies, this includes hazardous co-sleeping and sleeping a baby on their front. click here to view the full report breastfeeding and skin-to-skin care a recent research study (united states) concluded that increasing rates of breastfeeding initiatives and skin-to-skin care are associated with decreasing sudi prevalence in the first 6 days after birth (this is additional to the already known long-term protection of breastfeeding). read the paper here how to use this tool this tool helps you to identify who is most at risk of sudden unexpected death in infancy due to unsafe sleep practices. it is designed for use by any practitioner working with families with young babies. health professionals with access to the ‘red book’ will continue to use this to complete safer sleep risk assessments. the tool will be used in conjunction with the red book to identify key risk factors and may be completed if a referral to social care is made on the basis of continued unsafe sleep practices. for practitioners that don’t use the red book, for example family hub practitioners, children’s social care, housing services, voluntary sector services, domestic abuse and substance use services, we encourage the tool to be embedded into assessment processes for families with young babies whenever possible. the tool can help support you with giving advice and guidance when there are concerns about unsafe sleeping practices (either observed, shared with you in conversation, or if the parental circumstances mean safe sleep may be an issue e.g. fleeing domestic abuse), or if parents / carers are asking for advice and support. the tool should be completed together with the parent(s) or caregiver(s) and used to guide a conversation about safer sleep practices. having open conversations and creating an environment where families can discuss their individual situation, worries and queries without fear of judgment is crucial. it’s really important that dads and partners are included in the conversation whenever possible. at the end of this document you will find some tools that can be shared with parent(s) or caregiver(s). a copy of the action plan (not the whole assessment), the ‘red flags’ list and the ‘sharing a bed with your baby’ checklist can be discussed and left with them. you can complete the risk assessment below either by using a printed paper copy or electronically, depending on what works for you and the family, or as guided by your organisation. it’s not about how many boxes are ticked; the factors below are all risks in their own right and some are more dangerous than others. 
safer sleep for babies – assessment tool predisposing vulnerability and risk (child) ☐ low birth weight (<2.5kg or 5 pounds 8 ounces) ☐ prematurity (<37 weeks) predisposing vulnerability and risk (parenting / family circumstances) ☐ smoking in pregnancy ☐ smoking in household ☐ parent / caregiver mental health difficulties ☐ parent / caregiver alcohol or substance use ☐ domestic abuse wider and environmental factors ☐ sleeping with the baby on a sofa or chair ☐ unsafe sleep environment e.g. position, sofa, cluttered cot, excess covers or clothing, unsafe or unsuitable products used for sleeping in (such as pods or nests), too close to a radiator ☐ socio-economic deprivation ☐ poor or overcrowded accommodation ☐ adverse childhood experience of parents impacting on parenting ability ☐ ongoing and cumulative neglect (neglect - nottingham city council) ☐ relationship breakdown and/or new partners ☐ limited or concerning engagement with services e.g. missed or no access appointments, late booking, hostile to professionals, disguised compliance ☐ parental criminal behaviours situational risks / out of routine incidents ☐ altered sleeping arrangement without a plan in place ☐ alcohol or drug use on the night in question, including use of prescription drugs causing drowsiness ☐ temporary housing ☐ change of partner child’s name click or tap here to enter text. date click or tap to enter a date. form completed with (insert parent / caregiver name/s) click or tap here to enter text. date of review click or tap to enter a date. 
 red flags – if these are present then further action is required* bed-sharing with associated risk factors ☐ parent or anyone in the bed has recently drunk any alcohol ☐ parent or anyone in the bed smokes ☐ parent or anyone in the bed has taken any drugs or medication that may make them sleepy ☐ baby was born prematurely (before 37 weeks of pregnancy) or weighed under 2.5kg or 5½ lbs when they were born ☐ other children or pets in the household who share a bed with parents some or all of the night. (including if your baby is one of a multiple birth safer sleep for twins - the lullaby trust). ☐ sharing a bed when a parent / carer or baby is unwell or has had a recent illness, or if you or anyone in the bed feels excessively tired (too tired to respond to the baby) *bed sharing with a breastfeeding mother with none of these risk factors has not been shown to be a significant hazard but information of how to make the bed a safer place for co-sleeping should always be provided remember, every sleep needs to be a safe sleep – whether the baby is sleeping at night or during the day, at home or away from home. if you identify any of the above risk factors, follow these steps: • explore with the family their understanding of the safer sleep advice, why it is important to help keep their baby safe and what the barriers to them being able to follow it might be. help them think about what they will do on nights which might be more challenging such as when they are very tired, their baby is unwell, or is crying for a prolonged period. more information about soothing crying babies is available for parents here • if there is high risk of out of routine or emergency situations, discuss content from the lullaby trust ‘safer sleep advice for emergency situations’ • where you can, put in place support and follow up as much as your professional role allows. • consider referral to other services such as the nottinghamshire county healthy family teams or nottingham city children’s public health 0-19 nursing service. consider referrals to relevant support services such as smoking cessation, mental health or domestic abuse. follow up any referral you make. • liaise with other professionals working with the family. • share the lullaby trust guide for parents in their first language (an easy read card is available in 25 languages and can be downloaded using the link below (click on safer sleep easy read card-translated versions). professionals resources | the lullaby trust • signpost to relevant videos or specific guidance if risk factors identified (link below). video resources | the lullaby trust if there are ongoing unmet needs or concerns consult the threshold of need document (nottingham city) nottingham-city-threshold-of-needs-2023_2025pdf.docx or the pathway to provision document (nottinghamshire county) pathwaytoprovisionhandbook.pdf. this will help you to understand the level of need and identify the services that may be available, including whether or not a safeguarding referral is required. the neglect toolkit neglect - nottingham city council may help you to further assess the level of concern. : risk assessments should be saved and uploaded to children’s/family records. what to do next 
 what are the things which will help keep your baby safe whilst sleeping? what are the things that might put your baby at risk of sudden infant death syndrome? what actions have we agreed that you will take as a result of our talk around safer sleep for your baby, based on your particular circumstances and choices? remember every sleep needs to be a safe sleep so you need to make a safe plan for whether your baby is sleeping at night or during the day, at home or away from home. date action plan filled in with parent(s)/caregiver(s). date when we will look at this again. our safer sleep plan of care <insert name of baby and parents / carers> 
 the safest place for a baby to sleep is in their own clear, flat, separate sleep space. however, we know that being a parent isn’t easy and many parents find themselves co-sleeping whether they mean to or not. wherever you’re planning for your baby to sleep we recommend making your bed a safer place for your baby. the lullaby trust advice on co-sleeping with your baby will tell you how it is never safe to co-sleep with your baby on a sofa or armchair. this increases the risk of your baby dying from sudden infant death syndrome (sids) by up to fifty times. if you choose to co-sleep with your baby or think it might happen even though you plan not to, it is important that you review the red flags and checklist below with the people supporting you. this will help you see if there are risk factors that would make co-sleeping very dangerous for your baby. if you answer yes to any of the questions below you are advised not to co-sleep/bed share due to the increased risk of sids. we understand this may be hard and want to support you to keep your baby safe. if you need help to think about how you can make this work for you and your baby ask the people supporting you, for example public health practitioners (health visitors). you can text them anytime of the day or night. out of hours you will receive a return text with emergency contact numbers in case you need them, but someone from the service will still pick up the text in working hours and get back to you to offer advice and support the next working day. • nottinghamshire county (healthy family teams). telephone the advice line tel: 0300 123 5436. or text parentline 07520 619919 • nottingham city (children’s 0-19 public health nursing service). telephone the children’s health advice hub on 0300 300 0040. or text the ‘text health’ messaging service on 07480 635002 sharing a bed with your baby – checklist to help you co-sleep more safely 
there are times when it is very dangerous to share a bed with your baby. do not share a bed with your baby if: you or anyone in the bed has recently drunk any alcohol. you or anyone in the bed smokes or you smoked during pregnancy. you or anyone in the bed has taken any drugs or medication that make you feel sleepy. your baby was born prematurely (before 37 weeks of pregnancy) or weighed under 2.5kg or 5.5lb when they were born. in these circumstances it is always best to put your baby in their own safe sleep space, such as a cot or moses basket. keeping the cot or moses basket next to your bed might make this easier. it is not safe to share a bed with your baby with other children or pets in the bed. if you have twins, take a look at this advice:www.lullabytrust.org.uk/safer-sleep-advice/safer-sleep-basics/twins/ you should not share a bed with your baby if you, the baby or anyone in the bed is unwell or has had a recent illness, or if you or anyone in the bed feels excessively tired(too tired to respond to the baby). 
 question yes/no why this increases the risk of your baby dying? do you or anyone in the bed smoke? (this includes smoking during pregnancy) smoking increases the risk of sids lullaby trust/safer sleep advice/smoking there is currently no research relating to e cigarettes and sids. nhs advice is to keep your baby away from e-cigarette vapour. the lullaby trust advises that you do not share a bed with your baby if you vape. will there be nights when you or anyone in the bed will have had any alcohol? any alcohol use changes your sleep pattern and increases the risk of sids will there be nights when you or anyone in the bed has taken any drugs or medication that make you feel sleepy? taking any drugs or prescribed medication that can make you feel sleepy increases the risk of accidental death whilst bedsharing do you have a plan of how you will settle your baby in their own clear, flat, separate sleep space if you feel excessively tired? if you or your partner feel excessively tired-too tired to respond to the baby- this may increase the risk of accidental death whilst bedsharing was your baby born early (before 37 weeks) or weighed less than 2.5kg or 5.5. pounds? babies who are born early or who are very small are at higher risk of sids do you have other children (including if your baby is one of a multiple birth), or pets, who come into your bed some or all of the night? babies who sleep in a bed with other children, or pets, are at increased risk of accidental death whilst bedsharing 
 do you have a plan of how you will settle your baby in their own clear, flat, separate sleep space if you or they are unwell or are recovering from an illness? babies who are unwell, or who have had a recent illness, are at higher risk of death whilst bedsharing. if you or your partner are unwell this may increase the risk of accidental death whilst bedsharing below are links to more information about safer sleep and soothing crying babies that you might find helpful. safer sleep advice for babies the lullaby trust safer sleep video resources some short videos for parents and carers the lullaby trust co-sleeping with your baby the lullaby trust advice on how to co-sleep more safely soothing a crying baby nhs advice for parents