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Hampshire Safeguarding Children Board

Annual Report 2017/18

http://www.hampshiresafeguardingchildrenboard.org.uk/

http://www.twitter.com/HampshireLSCB


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Foreword from Derek Benson, Independent Chair of Hampshire Safeguarding Children Board I am pleased to introduce the 2017/18 Annual Report for the Hampshire Safeguarding Children Board (HSCB). I would like to thank all the partner agencies represented on the HSCB for their commitment and contribution to the Board, but more importantly, to the children and young people in Hampshire. Equally, I would also like to put on record my appreciation for the Board’s Partnership Support Team for their energy, enthusiasm and professionalism throughout the year. Against the backdrop of pending change in the form of the Children and Social Work Act 2017 and the revised Working Together to Safeguard Children 2018, the HSCB has maintained its drive for improvement with a critical focus on the safety and wellbeing of children and young people in the county. The purpose of a Local Safeguarding Children Board remains to coordinate safeguarding arrangements across agencies and to ensure these are effective. The uncertainty caused by legislative change and the re-drawing of local safeguarding arrangements has reaffirmed the need for partnership working built on understanding, respect and recognition of the interdependencies that exist. The annual report covers the local and national context, governance and accountability arrangements, priorities,

achievements and learning, and concludes with a formal summary statement about the sufficiency of arrangements to ensure children are safe in Hampshire. As well as conducting audits and reviews, HSCB receives a range of data and information from partner organisations, which allows the Board to assess child protection and safeguarding in the county. Whilst the work of children’s social care services receives much of the HSCB’s attention, it is important that we also continue to maintain a focus on health, education, the police and other agencies, both in terms of their individual service provision and how effectively they work together. Having developed a comprehensive multi-agency dataset over recent years, further work has been undertaken within the Partnership Support Team, and across the wider Board membership, to ensure that the shared dataset informs partnership working by focusing on the key criteria. The Joint HSCB/IOWSCB Neglect Strategy has been enhanced during the last year by way of a toolkit that helps practitioners across the partnership to better understand and address this vital issue. A further significant piece of partnership work was commissioned during 2017/18, which will help raise awareness of, and tackle the causes of Abusive Head Trauma suffered by young babies. Child exploitation and other forms of harm experienced by children continued to be a priority through the year, including children who are trafficked, those who go missing and those who suffer online exploitation.




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Our priorities for 2018/19 were agreed with partners with the aim of delivering improvements in key areas that affect the lives of children and young people. These include:

Adopting a family approach.

Strengthening our assurance programmes.

Engagement with children, families and professionals.

Leadership and transformation. HSCB will continue to seek innovative and effective ways to communicate with children and young people so that their voice is heard, understood and outcomes sought that meet their needs. The safety and wellbeing of all of Hampshire’s children and young people is paramount.

Derek Benson Independent Chair




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Contents

Foreword from Derek Benson, Independent Chair of Hampshire Safeguarding Children Board ...................................................................... 2

The Board .................................................................................................... 6

What is the Hampshire Safeguarding Children Board (HSCB)? .............. 6

How the Board works.............................................................................. 6

Structure of HSCB in 2017/18 ................................................................. 7

Finance .................................................................................................... 8

The Local Partnership and Accountability Arrangements .......................... 9

Independent Chair .................................................................................. 9

Local Authority ........................................................................................ 9

Hampshire Constabulary ......................................................................... 9

Designated Health Professionals ............................................................ 9

Lay Members ......................................................................................... 12

District Councils .................................................................................... 14

NHS England (Wessex) .......................................................................... 15

National Probation Service ................................................................... 17

Hampshire and IOW Community Rehabilitation Company ................. 17

Diocese of Winchester .......................................................................... 18

Key relationships with other partnerships ................................................ 19

Local Demographics and Safeguarding Context ....................................... 20

Local Demographics .............................................................................. 20

Vulnerable groups ................................................................................. 20

Children with a child protection plan .................................................... 21

Children in Care ..................................................................................... 21

Children who are privately fostered ..................................................... 22

Children with Disabilities....................................................................... 23

Children who offend or are at risk of offending ................................... 24

Early Help .................................................................................................. 25

The Family Support Service ................................................................... 25

Supporting Families Programme ........................................................... 26

Young people with mental health issues .................................................. 26

Children who are Electively Home Educated (EHE) .................................. 28

Local Authority Designated Officer (LADO) ............................................... 28

Children’s Reception Team ....................................................................... 29

Transforming Social Care - Partners in Practice Programme .................... 33

Serious case reviews and child deaths ...................................................... 35

Serious Case Reviews (SCRs) ................................................................. 35




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Child deaths .......................................................................................... 39

Progressing the Board’s business plan ...................................................... 41

Priority 1 – Neglect ............................................................................... 41

Priority 2 - The impact of substance misuse, mental health problems and domestic abuse in adults .......................................................................... 45

Domestic Abuse Pathway for Health Professionals .............................. 46

Operation Encompass ........................................................................... 46

HSCB and HSAB Annual Conference ..................................................... 46

HSCB and HSAB Joint Training .............................................................. 47

HSCB Follow-Up from the Joint Targeted Area Inspection ................... 47

Priority 3: Key safeguarding issues........................................................... 48

Children at Risk of Exploitation ............................................................. 48

Unaccompanied Asylum Seeking Children ........................................... 50

Suicide and Self-Harm ........................................................................... 52

Emotional Wellbeing ............................................................................. 54

Priority 4: Quality assurance ..................................................................... 55

Multi-Agency Safeguarding Hub (MASH) Audits ................................... 55

MET Local Effectiveness Assessment .................................................... 56

Section 11 Audit .................................................................................... 56

Safeguarding in Education Audit ........................................................... 57

Multi-Agency Safeguarding Hub (MASH) and Domestic Abuse Referrals Audit ...................................................................................................... 58

Joint Targeted Area Inspection Dry Run Audit ...................................... 59

Portsmouth Safeguarding Improvement Board .................................... 59

Children Living in Secure Accommodation ........................................... 60

Swanwick Lodge ................................................................................ 60

Bluebird House .................................................................................. 64

Leigh House ....................................................................................... 67

Hampshire CAMHS Safeguarding Practice ............................................ 69

Priority 5 – Stakeholder engagement ....................................................... 71

Multi-Agency Professionals ................................................................... 72

Children and Young People ................................................................... 72

Early Years Sector .................................................................................. 73

Voluntary Sector ................................................................................... 73

HSCB Website ........................................................................................ 73

Communication from the Board ........................................................... 74

Hampshire’s 5CCGs ............................................................................... 74

Spotlight on Fitfest ................................................................................ 75

Hampshire CAMHS Campaigns ............................................................. 75

Workforce Development ....................................................................... 75

Priorities for 2018/19 ................................................................................ 79




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The Board What is the Hampshire Safeguarding Children Board (HSCB)? HSCB is the key statutory body overseeing multi-agency child safeguarding arrangements across the Hampshire Local Authority Area. The work of the Board in 2017/18 is governed by statutory guidance Working Together to Safeguard Children 2015. Section 14 of the Children Act 2004 set out the statutory objectives of Local Safeguarding Children Boards, which are:

To co-ordinate what is done by each person or body represented on the Board for the purposes of safeguarding and promoting the welfare of children in their area.

To ensure the effectiveness of what is done by each such person or body for those purposes.

How the Board works Everything we do is underpinned by two key principles:

Safeguarding is everybody’s responsibility - For services to be effective each professional and organisation should play their full part.

A child centred approach - For services to be effective they should be based on a clear understanding of the needs and views of the individual children whilst recognising the support parents and carers may require.

HSCB has an Independent Chair and members who are leaders from a range of agencies. The Board is collectively responsible for the strategic oversight of local safeguarding arrangements. It does this by leading, coordinating, challenging and monitoring the delivery of safeguarding practice by all agencies across the county.




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Structure of HSCB in 2017/18 The main Board is supported by a range of subgroups that enable its functioning. The overall structure is illustrated below.

Day to day, the work of HSCB includes: Undertaking multi-agency thematic audits and partnership reviews into the effectiveness of services. Scrutinising quarterly data and producing a partnership analysis so that HSCB is clear on the needs of children and the challenges in relation to safeguarding. Overseeing the training and learning opportunities that are available for the children's workforce and reviewing the effectiveness of these through evaluations, observations and longer term impact audits. Managing completion and publication of Serious Case Reviews (SCRs) and other reviews ensuring that the learning from these improves services for children. Checking partners are fulfilling their statutory obligations in relation to safeguarding and promoting the welfare of children within their organisations through audits, visits and challenge days.




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Finance The budget for HSCB in 2017/18 was £404,790. This was based on the same level of Board partner contributions as 2016/17 and a carry forward underspend of £55,590. The year-end position provided an under-spend of £103,325. This was mainly due to new SCRs commissioned during the year overlapping into 2018/19 and a review of all training courses. The Board agreed to carry forward the under-spend to support new SCRs commissioned, further development of training and projects during 2018/19.

HSCB Expenditure




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The Local Partnership and Accountability Arrangements

Independent Chair The Board is led by an Independent Chair, Derek Benson, ensuring a continued independent voice for the Board. The Independent Chair is directly accountable to the Chief Executive of Hampshire County Council and responsible with partner agencies for the effective working of the Board and delivery of its agreed objectives. The Independent Chair works closely with the Director of Children’s Services and the Executive Lead Member for Children’s Services.

Local Authority Hampshire County Council is responsible for establishing an LSCB in their area and ensuring that it is run effectively. The ultimate responsibility for the effectiveness of the HSCB rests with the Leader of Hampshire County Council. The Chief Executive of the Council is accountable to the Leader. The Lead Member for Children’s Services is the councillor elected locally with responsibility for ensuring that the local authority fulfils its legal responsibilities to safeguard children. The Lead Member contributes to HSCB as a participating observer and is not part of the decision-making process.

Hampshire Constabulary Hampshire Constabulary is represented by the head of the Prevention and Neighbourhoods Command, Chief Superintendent Craig Dibdin, who has responsibility for the force’s Public Protection Teams and its local Neighbourhood Policing Teams. Specialist officers work within Integrated Offender Management (IOM), the Missing, Exploited & Trafficked (MET) Team and the Multi-Agency Safeguarding Hubs (MASH). These officers work with local Neighbourhood teams and partners to assist in identifying and developing safeguarding plans for those who are vulnerable and in targeting prolific and priority offenders who bring the most harm to our communities. Hampshire Constabulary’s current focus is around developing its partnership working to develop its safeguarding opportunities. An area currently being explored is reducing harm to the most vulnerable by taking a Trauma Informed Approach and identifying Adverse Childhood Experiences to better understand and mitigate the threats and risks in our communities, making them safer places to live.




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Designated Health Professionals The Designated professionals provide the Clinical Commissioning Groups (CCGs), NHS England, Public Health and partners with advice and support to ensure that outcomes for children continue to improve. Four Named GPs joined the Hampshire safeguarding and looked after children’s team in May 2015.

‘The Named GPs work with colleagues to provide advice and support to GPs and practice nurses. We provide safeguarding

training to primary care staff through nine educational half-days (including input from other partner agencies), practice visits,

biannual training for GP practice safeguarding leads, three GP trainee study days, a quarterly newsletter and an annual

conference. We are present on subgroups for Health, abusive head trauma, safer sleeping, child exploitation and domestic abuse. We also participate in serious case reviews; attend review panels and learning outcome events. We work closely with our Wessex and Surrey counterparts to build cross-border links and attend the

Wessex Safeguarding network. Nationally we are members of the Primary Care Children’s Safeguarding Forum’

(Hampshire’s Named GPs).




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Since the Named GPs came into post in May 2015, 93% (120/129) practices have had a visit from their named GP. Primary Care Training for the year (2017/18) has continued to demonstrate a steady increase in the number of GPs trained to Level 3 versus 2016/17. Examples of feedback from training:

‘I thought that this was an outstanding programme. Very thoughtful, pragmatic. Thank you’. ‘Excellent overall; well organised; excellent presentation’. ‘Very interesting, relevant topics as a practice child safeguarding lead I will implement in my surgery’.

Throughout 2017/18, the Named GPs have contributed to the safeguarding and Looked after Children (LAC) agenda. Examples of their involvement include:

Improving information sharing between Primary Care and Children’s Services. Forms have been in use for past year and we have demonstrated an improvement from 28% to 56% in the GP response rate of providing reports for Initial Child Protection Conferences.

Ongoing production of Children’s Safeguarding & LAC quarterly newsletter – to disseminate key advice and training messages to all clinicians.

Established links with military GPs to address the gaps in information sharing with a planned joint meeting of military GPs and local GP safeguarding practice leads.

Designated Doctor for Looked After Children At the end of November 2015, the Designated Doctor for Looked After Children retired from the role. This meant that the five CCGs did not meet their statutory duty to have a person in post. It was swiftly identified across all five CCGs as a risk to their organisation and entered onto each organisations risk register and recruitment into the post commenced. After a number of attempts, using a variety of iterations of models for the role, a successful appointment was made in November 2017 to the post. The new Designated Doctor took up this strategic post in January 2018 for two sessions per week for the five CCGs.




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Lay Members HSCB had three Lay Members on its Board through 2017/18, all of whom played an important role in challenging, supporting and holding partners to account in the way they met their safeguarding duties. Lay Members also assist in developing stronger public engagement and awareness of children’s safeguarding issues. Lay Members help the Board stay in touch with local issues so that its work is relevant to local communities. One Lay Member was recruited during 2017/18 following the departure of a long-standing predecessor at the end of 2016/17.

‘This will be my final contribution to Hampshire Safeguarding

Children Board as other commitments have compelled me to offer my resignation. The Board has recently recruited two new lay

members and I know that ongoing independent scrutiny is assured.

During the last year, I have continued to be impressed by the determination of the members of the Board and of all those

involved in safeguarding the well-being of Hampshire’s children in ensuring that procedures are relevant and up-to-date. The Board and its constituent committees continue to provide the forum for professionals representing all of those involved in safeguarding to offer a robust, cooperative and timely response to trends, shared

concerns and new legislation. The Board is well-led by its Independent Chair and very well supported by an industrious and

knowledgeable administration team.

This coming year is likely to prove a little turbulent as the Board

responds to changing legislation concerning the function of LSCB’s throughout the country. From an independent standpoint, I would

offer the following observation. This particular Board functions particularly well in ensuring that all parties have a voice and are

able to effectively participate. I would go further than repeating the old adage that “if it’s not broken, don’t fix it” by urging that, as I

believe is the case in respect of this Board, “if it works well, preserve it”.

I wish all those involved in safeguarding Hampshire’s children continued success in their mutual effort in the face of ongoing

financial restrictions. All of you have earnt my admiration and it is my regret that I will no longer be able to offer my direct support’

(Graham Cull, HSCB Lay Member).




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‘I joined the Hampshire Local Safeguarding Children Board in late 2017. As a relatively new member, I am still very much learning the

ropes, but already I am hugely impressed with the work of the Board as a whole and with the professionalism of the members that

sit on it. It is enormously encouraging to see the commitment to good communication and cooperation between the many services that are represented on the Board (e.g. Children’s Services, Health,

Police, Education, Adult Mental Health), all in the context of protecting Hampshire’s children and enhancing their wellbeing. The

matters that are dealt with by the Board are broad and far-reaching, often covering subjects that are totally new to me. This

could have the potential to make me feel that I have little to contribute. However, I have found that any and all of my questions

are positively encouraged, are always taken seriously, and that sometimes the “stupid’ question has real value in bringing a

discussion back to basics. My own background was in children and families social work; whilst I often feel my personal contribution to the discussion is small, it is perhaps true that it is good to have a

view from the ground in amongst those of the hugely more experienced and senior professionals on the Board. I feel really well

supported and valued in my lay role and am grateful for the opportunity to serve in this way’

(Camilla Pearse, HSCB Lay Member).

‘I was appointed as a Lay Member to the HSCB in 2017. All of my interactions with the administrative support for the Board and the

Independent Chair have been extremely positive. I have felt nurtured and supported in this role. The Board meetings have the

potential to be intimidating due to the high number of participants and the importance of their role – however, the facilitative and encouraging approach of the highly skilled Independent Chair

means that I have felt able to contribute and challenge, and that my opinion has had value. Health, Social and Police Services are

immensely stretched and are desperately in need of more resources. Despite this, there is still a positivity, energy and passion evident to ensure effective Safeguarding. However, I am very concerned about this lack of resources, especially in the light of increasing demand in areas such as children’s mental health. I have been very impressed

with the Board’s provision of educational events and the development of educational resources, such as the Neglect Toolkit

which help to raise awareness of Safeguarding’ (Claire Cox, Lay Member).




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District Councils The 11 District/Borough/City Councils were represented on the Board by Bob Jackson, Chief Executive of New Forest District Council. There is also council representation on the Learning & Inquiry Group, Child Exploitation Group and the Workforce Development Group.

‘The involvement of District/Borough/City Councils in the work of the Board continues to help improve the welfare chances of children in Hampshire. Within our community, safeguarding is everybody’s

responsibility and many of the services provided by councils can assist with a child’s safety. The importance of access to good quality

housing and housing services is one example where a significant contribution can be made to the well-being of children. In April

2018, the Homelessness Reduction Act 2017 came into force which gave councils a duty to provide interim accommodation for those who are deemed priority need; this includes those families with

children, care-leavers and children aged 16-17. Councils also provide a local knowledge of their communities and open up local

points of contact which can provide an opportunity for better community engagement. Being part of the Board helps ensure that

the approach to children’s safeguarding is more broadly coordinated and, as a result, provides greater opportunity to help

improve the lives of children in Hampshire’ (Bob Jackson, Chief Executive of New Forest District Council).




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NHS England (Wessex) NHS England South (Wessex), in collaboration with CCG safeguarding leads and partner agencies, has successfully implemented a two-year safeguarding programme. NHSE Safeguarding Programme Report 2016-18 The aim of the programme is to support practitioner confidence in using their skills to identify and intervene to help those at risk. Partner agencies, safeguarding boards, NHS safeguarding leads and frontline staff were invited to identify local safeguarding priorities to inform the focus of the programme, these were; looked after children; learning from reviews; sharing early risk; transition; child sexual exploitation and abuse; post therapeutic pathways, workforce development and Female Genital Mutilation (FGM). A range of mapping exercises and independent reviews were undertaken to develop a baseline safeguarding profile of the local area. NHS England Child Protection - Information Sharing (CP-IS) project NHS Digital approached Hampshire professionals to take part in a promotional film regarding CP-IS due to the unique position that Hampshire are in with regards to the number of partners live with CP-IS. Hampshire was cited as being in the ‘best position nationally to talk about how the system works’.

The purpose of the film is to explain to influencers, local authorities and NHS settings that have not yet implemented CP-IS, and other national stakeholders:

What CP-IS is.

How it works.

What the benefits are for vulnerable children, and the staff and organisations that care for them.

The Designated Nurse (West and North Hampshire CCGs) with Named Nurse colleagues from Hampshire Hospitals, Portsmouth Hospital and Hampshire Local Authority participated in the production of the film in June 2017. What do the findings tell us? The programme highlighted the widespread commitment of staff; however, recurring themes suggests that key learning is not always being implemented effectively at a system-wide level. Through workforce leadership programmes, we have supported staff to influence the health system to embed safeguarding as core business.



http://www.hampshiresafeguardingchildrenboard.org.uk/wp-content/uploads/2018/07/NHSE-Safeguarding-Programme-Report-2016-18.pdf


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What Next? The following areas could be considered by individual organisations to ensure safeguarding is core business:

Empower staff to be competent and confident to take safeguarding action.

Ensure accessible scenario based training that can be applied in practice.

Provide clear guidance, referral pathways and supervision for all staff.

Promote a positive working environment that celebrates effective safeguarding practice.

Embed best practice guidance in all service delivery planning.

Regular update of organisational policy and training programmes.

Audit against quality standards to measure progress.

Include the perspective of the public/service user to inform protocol and service developments.

Measure the impact of our work by audit, data collection and user feedback.

Continue to develop a local safeguarding profile through quality assurance frameworks.

Monitor through safeguarding schedules as part of NHS quality contracts.




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National Probation Service The National Probation Service (NPS) are responsible for the management of offenders who pose a high or very high risk of serious harm. In addition, the NPS provide assessments to the courts to inform sentencing decisions and understanding of risk. The NPS also manage all offenders who are subject to Multi-Agency Public Protection Arrangements (MAPPA) including: most registered sex offenders, people who have committed serious violent offences (receiving more than 12 months custody either served or suspended) and other offenders who present a significant risk where a coordinated approach is required to manage them. As well as the direct management of offenders, the NPS provide a network of hostel places for high risk offenders as well as programmes to address sexual offending. The NPS works in collaboration with the Community Rehabilitation Company who provide some services to NPS offenders through a system called the rate card.

Hampshire and IOW Community Rehabilitation Company Hampshire and IOW Community Rehabilitation Company (HIOW CRC) supervise offenders aged 18 and over in the community who are sentenced by the court to either a Community Order or a Suspended Sentence Order, and are low or medium risk of serious harm. It also supervises people allocated to the service who are in custody and those released from prison on licence. HIOW CRC commissions a service called Through the Gate which aims to help prisoners preparing to make the transition from custody through to the community. HIOW CRC provides group work spaces for men convicted of more serious or persistent domestic abuse offences, who have been made subject to Community Orders with a requirement to attend Building Better Relationships – a 26 week accredited programme targeted at reducing domestic violence. These men are often living within the family home, where children could be impacted by their behaviour. While on the programme, a participant’s partner will be visited and supported by a Partner Link Worker. In addition, the CRC is commissioned by CAFCASS to provide a limited number of spaces on the BBR programme to men ordered by the Family Courts to undertake a targeted domestic abuse intervention.




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Diocese of Winchester The Diocese of Winchester covers most of Hampshire, takes in a part of Dorset and stretches through to the edges of Surrey suburbia, covering 1,048 square miles and 1.27 million people. The diocese has 407 churches and 102 schools. The Diocesan safeguarding team works across all of these, advising the Bishop of Winchester on safeguarding policy and processes, acting as link to statutory agencies, taking a multi-agency approach, making referrals and ensuring that all concerns are addressed in line with current guidance and legislation. In 2016 the Diocese appointed a new Safeguarding Manager, formed a new Independent Safeguarding Panel, and put a new team structure in place. The Independent Safeguarding Panel has developed its strategic priorities and published an implementation plan. This includes rolling-out a new national training programme, implementing the recommendations from the successful independent audit, and developing new policies and handbooks to support local safeguarding delivery. As a result, the Diocese’s priorities for the period focused largely on embedding these changes:

Being Proactive & Strategic - Embedding the role of the new Safeguarding Panel, building a new proactive approach to safeguarding across the diocese, growing our links to

statutory agencies to ensure an inter-agency approach is taken wherever possible.

Raising Awareness - Ensuring a consistent and high level of understanding of safeguarding matters is present in all clergy, ministers and worshipping communities.

To Embed Systems & Resources - Continue to develop and invest in the operational infrastructure of the Diocesan Team, ensuring systems and protocols are robust and embedded into the daily working of the team.

Andrew Robinson, Chief Executive, is a member of the Hampshire Safeguarding Children Board (HSCB). The safeguarding manager represents the Diocese and supports HSCB by being part of a number of working groups including the quality assurance group.

‘We are grateful for the important working relationship that has developed between the Diocese of Winchester and the Hampshire Safeguarding Children Board. HSCB’s multi-agency approach has played a crucial part in helping strengthen further our processes

and policies, whilst providing valuable independent scrutiny. We are delighted to have such an effective safeguarding partner for the

Church of England across Hampshire’ (Andrew Robinson, Chief Executive, Diocese of Winchester).




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Key relationships with other partnerships Hampshire Children’s Trust Hampshire Children’s Trust is responsible for developing and promoting integrated frontline delivery of services which serve to safeguard children. The Independent Chair of HSCB is a member of the Children’s Trust and the Chair of the Trust sits on HSCB. HSCB presents its annual report to the Children’s Trust outlining key safeguarding challenges and any action required from the Children’s Trust.

The Health and Wellbeing Board

The Health and Wellbeing Board brings together leaders from the County Council, NHS and District/Borough/City Councils to develop a shared understanding of local needs, priorities and service developments. The two Boards have an established protocol outlining how they will work together including consultation on commissioning proposals that affect how children are safeguarded. HSCB reports annually to the Health and Wellbeing Board and checks how it is tackling the key safeguarding issues for children. Police and Crime Commissioner

The Police and Crime Commissioner (PCC) is an elected official charged with securing efficient and effective policing services in his or her area. The Police and Crime Commissioner’s Youth Commission is actively involved in the work of HSCB. During 2017/18, this included attending and participating in the HSCB & HSAB joint annual conference along with a number of other initiatives.




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Local Demographics and Safeguarding Context Local Demographics Hampshire County Council is the third largest county in the country (based on population) with 1.32 million people including 309,462 children and young people aged 0-19 (ONS Census, 2011). The population of Hampshire is forecast to increase to 1.47 million people by 2024 (Small Area Population Forecasts 2017). The population of children aged 0-17 is forecast to increase from 282,750 to 307,350 over the same period. Hampshire has a predominantly white ethnic population with 91% of children of compulsory school age and above of white ethnicity (DfE sfr/28/2017). 94% of children in Hampshire of compulsory school age and above have English as their first language (DfE sfr/28/2017). The county is a mix of urban and rural populations, with areas of affluence and areas of significant deprivation. There are six areas in Hampshire that are listed in the 20% most deprived in England, including Eastleigh, Gosport, Havant, New Forest, Rushmoor and Test Valley (Index of Multiple Deprivation, 2015).

Vulnerable groups Many groups of children in Hampshire are vulnerable and are at increased risk of being abused and/or neglected. These groups are not exhaustive and many factors, such as going missing from home, living in households where there is domestic abuse, substance misuse and/or parents with mental ill health can place children at increased risk of harm. The needs of these children, and other vulnerable groups, are outlined below to provide an understanding of local context. 1

1 Please note that some figures in this section are subject to official validation.




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Children with a child protection plan Children who have a child protection plan (CPP) are considered to be in need of protection from either neglect, physical, sexual or emotional abuse, or a combination of one or more of these. The CPP details the main areas of concern, what action will be taken to reduce those concerns and by whom and how we will know when progress is being made. Child Protection 2014/15 2015/16 2016/17 2017/18

Total number of s.47 enquires across the year

4,834 4,387 4,211 3,926

Number of children with a Child Protection Plan (CPP) (at year end)

1,352 1,435 1,263 1,294

Total number of new CPP during the year

1,836 1,665 1,582 1,536

Percentage of CPP at year end reviewed within timescales

86.2% 88.1% 87.5% 80%

The number of children subject to a CPP has remained reasonably consistent with 2016/17. Audit and other work confirms that thresholds are consistently applied and there are no significant changes in the rate of conversion of Section 47 investigations to initial child protection conferences (ICPCs) nor in the rate of ICPCs to child protection plans. Alongside a reduction in repeat plans, this indicates consistent risk management and effective planning to protect children.

The HSCB routinely scrutinises child protection activity at a county level and, where required, looks at what is happening at a local level to understand any specific trends or issues impacting on safeguarding activity.

Children in Care Children in care are those looked after by the local authority. Only after exploring every possibility of protecting a child at home will the local authority seek a court decision to move a child away from his or her family. Such decisions, whilst incredibly difficult, are made when it is in the best interest of the child. There were 1,599 children in care at the end of June 2018 compared with 1,439 at the end of March 2017. While the total number of children in care has increased, this is in part due to an ongoing increase in the number of Unaccompanied Asylum Seeking Children (114 at the end of June 2018 which is 7% of the total children in care population). Children’s Services also have an increasing number of children who are subject to Care Orders (thus making them ‘looked after’) but placed at home with parents (139 at the end of June 2018 which is 9% of the total children in care population). Significant work is underway to ensure that only those children who require public care are looked after by the Local Authority through pre-admission to care processes.. Alternative options to




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children being in care continue to be explored in all appropriate circumstances, such as Special Guardianship Orders. All children in care are subject to regular independent reviews to ensure that their circumstances are reviewed and their needs are met. The local authority and other agencies work together to ensure that children are offered the best possible care and this work is coordinated and overseen by the Hampshire ‘Care Matters Board’. The vast majority of these children are placed in foster care (72%). 14% of children were in some form of residential placements with 16% of those being children with disabilities and complex needs. The ethnic profile of children in care in Hampshire is similar to the general population and the overall profile is similar to that of England as a whole. Children who are privately fostered Private fostering is a statutory status afforded to children when they are placed by someone who has legal responsibility for them with a carer who is not a close relative and the arrangement continues for 28 consecutive days or more. In such situations, the local authority has a safeguarding duty to these children and is required to assess their situation and monitor their wellbeing. However, the authority can only assess the situations of which it is made aware, so inevitably the role of other agencies, and indeed the public, in recognising and referring such circumstances is of key importance.

Whilst it is recognised that there is no known culture of private fostering in Hampshire, the number of such cases referred to the authority remains low; eight children had a ‘Privately Fostered’ status at the end of March 2018. This follows previous engagement of the Hampshire County Council’s Communications Team to highlight private fostering as a particular issue. The Board’s Quality Assurance Group regularly monitors this data and will be considering what further action may be appropriate in 2018/19.




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Children with Disabilities The need to safeguard children with disabilities, and to provide effective strengths-based support to children and their families, is a priority both nationally and locally. Hampshire Safeguarding Children Board (HSCB) ensures that the voice of all children, including children with disabilities, is reflected across the broad subgroups including Health, Education, Child Exploitation, Workforce Development, Procedures and Learning & Inquiries. The Hampshire Parent Carer Network (HPCN) also provides valuable feedback from the parent/carer perspective.

The Workforce Development Team have been working with the Children with Disabilities Team Managers and Occupational Therapists to increase awareness and understanding of the

2 The 2017/18 figures are sourced from the DfE ‘Child in Need Census’ and are

provisional until formal sign-off within the Children’s Services senior management team.

particular vulnerabilities of children with disabilities and complex needs and to provide opportunities to explore ways in which we can effectively safeguard these children from harm. Bespoke courses have been commissioned to meet the needs of the service. A learning pathway for Disabled Children’s Teams is also in development. The Department for Education is working with leading local authorities as Partners in Practice (PiP) to support work to transform services and understand what is required to become a good and excellent authority. Hampshire County Council’s Children’s Services is one of the Partners in Practice and has appointed a specific transformation lead for the Children with Disabilities Service. As part of the PiP programme, Hampshire Children’s Services, alongside their partners, are driving process and cultural changes to develop personalised and strengths-based models of practice. Motivating families to build on their own resilience and keep children safely living in their communities, wherever this is, is both possible and appropriate. To enable this to happen, services and social work tools are being developed to provide strengths-based, targeted and timely responses to the whole family’s identified needs, with a programme of work specifically for children with disabilities.

Disabled Children 2014/15 2015/16 2016/17 2017/182

Referrals to Children's Services 1,817 2,495 2,765 2,007

Total number of children who became subject to a Child Protection Plan in the year

52 80 104 82

Number of children subject to a Child Protection Plan at year end

45 84 84 74

Total number of children Looked After by the Local Authority across the year

318 311 334 311

Total number of children Looked After by the Local Authority at year end

250 245 248 242




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Children who offend or are at risk of offending Children involved with Hampshire Youth Offending Team (HYOT) often present with complex needs requiring significant support both in and out of custody. HYOT has continued to see the number of children they work with decrease from previous years, although the complexity of cases has increased. The number of children worked with through pre-court disposals and community orders has increased marginally from 351 in 2016/17 to 377 in 2017/18. However, the number of children in custody (on remand or sentenced) has been decreasing year-on-year, most recently from 28 in 2016/17 to 23 in 2017/18. A slight, though consistent, rise has been seen in First Time Entrants since the second quarter of 2017/18; however, there has been a fall in reoffending, which offsets this. In the first full year since Youth Crime Prevention (YCP)3 returned to the YOT, programmes have been initiated with 275 young people. A change to the handling of police call-outs has also led to an increase in Community Resolutions. 259 young people had interventions as a consequence of receiving a Community Resolution in 2017/18. Including cases already open at the start of the financial year, Hampshire YOT and YCP worked with over 1,100 young people in 2017/18

3 Work with 10-16 year olds at risk of offending or anti-social behaviour.




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Early Help Hampshire’s ten early help hubs continued to operate during 2017/18 providing a single point for the coordination of targeted multi-agency early help across Hampshire (Level 3). The Family Support Service (FSS) has continued to offer innovative and effective interventions with a large number of children and families across Hampshire. Data evidences that more children and families have been reached and engaged within the new service through increased variety of activity than was the case with the former early help offer. At 31 December 2017, 1,296 families (3,044 children) were open to early help compared to 1,183 families (2,699 children) at the same point in 2016.

The Family Support Service The Family Support Service (FSS) remains the Hampshire County Council Children’s Service’s contribution to the overall Hampshire early help offer. The local FSS manager is the local strategic link and facilitates the early help hub which coordinates the multi-agency level 3 offer. The level 3 offer comprises of on-to-one direct work with families and an evidenced-based group-work offer (some places in each group can be filled with families at a lower level of need and also those open to statutory social care). For families with less complex needs, there is a group-work offer, often called priority groups, which aims to respond to local needs (e.g. young parents, service families and also appointment-based 30 minute surgeries).

Building capacity and confidence in practitioners is key to the early help developments in Hampshire and the FSS is continuing to work alongside partners in developing opportunities including training, peer supervision, surgery consultations and joint home visiting. There is also an updated online service directory and the FSS website.




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Supporting Families Programme In September 2017, Hampshire’s Supporting (troubled) Families Programme was renamed the Supporting Families Programme (SFP). SFP has operated since 2012 and since its inception 5,500 Hampshire families have been identified and engaged by the programme. Phase 2 of the expanded programme commenced in 2015 and government targets were significantly increased. In 2016/17 and 2017/18, Hampshire was short of their increased target number of families by 670 families, despite the rate that families are identified/engaged being much quicker than the early years of the programme. A recovery plan is now in place to ensure Hampshire makes up the deficit quickly. The programme remains targeted at families with more complex needs and so far, positive outcomes have been recorded for 2,200 families under the Government’s payment by results element of the programme. In 2018, Young Carers and new parents struggling to cope were added as target groups. Under Phase 2 of the programme, a significant number of families with mental health issues (63%) continue to be nominated to the programme. About half of the families nominated to the Phase 2 programme have children with poor school attendance/exclusion, require early help or are claiming out of work benefits. There are also significant numbers of families where anti-social behaviour, domestic abuse or substance misuse exists.

Young people with mental health issues During 2017/18, 8,376 children and young people were referred to the specialist Child and Adolescent Mental Health Service (CAMHS). This represents a sustained increase in referral numbers over the last two years. 4220 initial assessments were undertaken and 2828 young people started treatment. In excess of 79,000 clinical appointments were undertaken throughout the year. At the end of March 2018, there were 7173 open cases of young people receiving an on-going service; this is almost 1,000 more than this time last year. The service has seen a significant increase in the number of urgent and crisis presentations requiring immediate assessment. These are both those who present in Accident and Emergency departments, often with high levels of deliberate self-harm, as well as those




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referred directly into the service with complex and high risk behaviours. Waiting times Hampshire CAMHS waiting times for both Assessment and Treatment have remained outside of target levels in 2017/18 with the influence of continued higher than expected demand. 31.5% of young people were assessed within the 4 weeks target and 43% treated within 18 weeks of referral. The service received 607 referrals marked as urgent, 109 of these triaged by the service as urgent and 100% responded to within 4 hours of receipt of the referral. Inpatient admissions The total number of young people admitted to psychiatric inpatient care throughout 2017/18 was 87; this was 8 more than 2016/17. Though the number of admissions increased by a small level it is a downward trend from the first half of 2017 which saw a large increase. The admissions in the last six months of 2017/18 reduced dramatically and reversed the trend. This was largely due to the success of the crisis project, funded by NHS England which was in place from December 2017 to May 2018. This saw a £500,000 investment in clinical co-ordination, increased training and enhanced packages of care in order to reduce the numbers of admissions, decrease length of stay and ensure more young people are admitted locally, or repatriated to a hospital in their home area.

The crisis project has seen a significant return on investment with admission and inpatient numbers at the lowest that they have ever been. It is hoped that this work can continue as part of an ongoing new care model, with full delegated budgets from October 2018 creating a more sustainable crisis care pathway can be embedded across the wider Wessex footprint. Specialist Eating Disorder Team In 2016, CAMHS received some additional funding to develop a county wide specialist eating disorders team, which was launched in June 2017. The service modelled approximately 150 referrals a year. Last year 279 referrals had been made and in 2017/18, 345 referrals were made into the service. A number of cases have presented as acutely unwell due to late detection of their eating disorder or due to rapid weight loss requiring intensive treatment sometimes by multiple teams to manage their risk, this can include admission to an acute paediatric setting for physical recovery. Increasingly the team have found that there have been challenges where parents have struggled to see the severity of their child's illness and have consequentially struggled to engage in the treatment plan. On these occasions we have worked closely with our safeguarding lead and where appropriate Children’s Services. The newly developed service has been externally evaluated against national frameworks and, whilst the service is still developing, the




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treatment model appears to be effective and we are already seeing positive outcomes for young people.

Children who are Electively Home Educated (EHE) Since April 2017, an EHE coordinator and administrator have been appointed. Hampshire County Council (HCC) registers all children who are known to become EHE and completes a safeguarding check. Parents are provided with an information pack and the offer of a consultant visit. HCC offers to pay a contribution to the cost of GCSEs (conditions apply) and maintain a website.

EHE numbers have continued to rise; now 1,385 but 663 new cases were registered between April 2017 and March 2018. A data cleansing exercise has seen downwards adjustment of the number of older cases, which accounts for the apparently small increase in EHE numbers compared to the number of incoming cases.

The EHE Coordinator has increased the profile of EHE in local services including schools, increased the uptake of home visits and developed the following: Liaison with Social Workers, Youth Offending Teams, Family Support Services, School Nursing Teams, Health Visitors, HCC Services for Young Children, Further Education College under 16 provision and Hampshire School Admissions and Special Educational Needs (SEN) teams. With the SEN team, the coordinator has been increasing communications with a view to maintaining school placements if appropriate. Good links with EHE community groups have been maintained and HCC has increased the challenge to parents where a lack of suitable education provision is evident. HCC’s Inclusion Support Service Manager, has continued working with the Association of Elective Home Education Professional (AEHEP), the DFE and Lord Soley. The DfE has commissioned a detailed national consultation, with draft guidance, to which Hampshire has provided a comprehensive response. A Private Members Bill is progressing through the parliamentary process with proposals for compulsory registration of EHE children, monitoring and support for EHE families. HCC have reviewed the current provision for home visits and are planning to recruit up to 2 EHE staff for home visits to provide a more effective, value for money provision with scope to share services with another local authority.




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Local Authority Designated Officer (LADO) The LADO role is statutory, sits within the local authority and plays a key part in ensuring the children’s workforce is a ‘safe’ workforce. LADOs are charged with the oversight of all relevant allegations against adults working with children in a voluntary or paid role, providing advice and guidance to ensure individual cases are resolved as quickly as possible. LADO work in Hampshire is measured over the academic year as a significant proportion of the work relates to referrals involving staff in academic settings. The last full year’s data for referrals therefore runs to 31st August 2017. In this period in Hampshire 719 referrals were taken, 42% of which related to school or college settings. This represents a small reduction (43) on the previous year’s data. Hampshire LADOs also discharge a broader safeguarding advisory role which is much appreciated by those contacting the service. An annual ‘customer survey’ again gave very positive results.

‘I have always found the LADO to be incredibly swift in responding

to queries and/or referrals. The advice is always clear and guidance is much appreciated.’

(School Designated Safeguarding Lead)




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Children’s Reception Team Contacts from professionals/practitioners and members of the public regarding child welfare or safeguarding concerns are reviewed by the Children’s Reception Team.

Children's Reception Team Contacts 2017/2018

Total CRT Contacts

Police Contacts Combined Contact

Calls/Emails

Out of Hours Contacts (not

included in total CRT Contacts)

77,602 36,808 40,794 18,124

In 2017/18, the Children’s Reception Team (CRT) in Hampshire was managing in excess of 6,400 contacts per month, peaking at 7,561 in July 2017. The volume of Public Protection Notices (PPNs4) from Hampshire Constabulary accounted for approximately half of the contacts received. In order to address this high volume, the following was undertaken:

4 A form completed by officers and staff who become aware of children who are

‘at risk’ and/or who are either witnesses to, or victims of, a crime. The form is shared with partner agencies via the Multi-Agency Safeguarding Hub.

MASH Managers delivered a series of training workshops aimed at improving the quality of contacts and referrals into CRT.

The Interagency Referral Form was redeveloped to improve efficiency.




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Referrals Into MASH 2017/2018

Police

Health

Education

Local Authority Services

Voluntary Sector

Referrals to Hampshire Multi-agency Safeguarding Hub (MASH) Following a review by the Children’s Reception Team, a decision is made as whether a referral to the Multi-Agency Safeguarding Hub (MASH) is required. MASH provides triage and multi-agency assessment of safeguarding concerns. It brings together professionals from a range of agencies into an integrated multi-agency team.

Police and education are the main sources of referrals. Police account for 29% of the total number of referrals into MASH with education making up 21%. As previously noted, fewer than 15% of referrals received from PPNs result in assessment by a social worker.

Referrals to MASH 2017/18

Police 9,492

Education 6,906

Health 4,696

Other 4,566

Friends/ Relative/ Neighbour 3,610

Local Authority Services 2,404

Voluntary Sector 767

Total 32,441




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Outcome of Referrals into MASH 2017/2018 S47 Investigation

Single Assessment

Specialist Assessments

Progress to Post-AdoptionServicesProgress to Assessment(A&OP)Early Help

Other Local Authority ChildProtection PlanReferral to Another Agency

Advice Information

Outcomes Following Referral to Hampshire Multi-agency Safeguarding Hub

Outcomes of Referrals to MASH 2017/18

Advice/Information 16,593

Children & Family Single Assessment 11,836

S47 Investigation 2,528

No further Action/Not recorded 816

Early Help 349

Other Local Authority Child Protection Plan 151

Specialist Assessments 155

Progress to Assessment (A&OP) 8

Referral to Another Agency 4

Progress to Post-Adoption Services 1

Total 32,441

Over the last 12 months, 36% of all MASH referrals progressed to Children & Family Assessments, which remains consistent with figures from 2016/17. Over 2017/18, MASH have managed a total of 32,441 referrals of which 2,528 (7%) progressed to Section 47 investigations. The progression rate illustrates that thresholds within CRT and MASH have remained consistent. This is particularly relevant for the percentage of contacts resolved and those progressed to referral. Regular audit of work undertaken within MASH, along with the multi-agency audit days, led by the HSCB Partnership Support Team, ensure that the thresholds in MASH are consistent and




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robust. This has been further reinforced within findings of previous Ofsted inspections plus the Joint Targeted Area Inspection of the multi-agency response to domestic abuse in Hampshire which stated that: ‘thresholds for referral into children’s social care are clearly understood and consistently applied’. CRT/MASH have worked closely with the Willow Team to review and update the initial sexual exploitation screening tool used at first contact to assist with the identification of Child Sexual Exploitation. This screening tool is completed for all contacts where a child is over the age of ten years and ensures that the need for a full Sexual Exploitation Risk Assessment Framework5 (SERAF) form is identified where required. Since August 2017, the initial screening tool has been used within the Out of Hours Service. All PREVENT referrals are managed through CRT and MASH, ensuring a consistent multi-agency response to concerns about radicalisation. There is ongoing work with partners to introduce High Risk Domestic Abuse meetings into MASH. Once implemented, these meetings will ensure a faster more coordinated response to high risk domestic, enabling a timely multi-agency response. The Inter Agency Referral Form (IARF) has been reviewed and updated and will replace email referrals, enabling staff within CRT to manage contacts and referrals more efficiently. MASH managers

5 A screening and assessment tool developed by Barnardo’s to identify children

at risk of sexual exploitation.

continue to be involved in the delivery of PREVENT training and throughout 2017/18 have delivered workshops across the county. These workshops, aimed at improving the quality of contacts and referrals, were well received by partner agencies.




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Transforming Social Care - Partners in Practice Programme The Department for Education (DfE) is working with leading local authorities as Partners in Practice to understand how local authorities get to good and what it takes to move from good to excellent. Hampshire County Council Children’s Services has successfully bid to become a Partner in Practice with the DfE from 2016-2020. This government programme aims to understand excellence in children’s social care and to lead and support the sector in improvement. Hampshire’s work centres around three main areas:

Family focused and evidence based practice.

Dynamic and sustainable multi-disciplinary teams.

Building capacity.

As part of the Partners in Practice Programme, Hampshire Children’s Services, together with partners, are driving both process and more importantly cultural changes, rolling out a model of practice to enhance families to build their resilience and keep children living safely in their families and communities wherever possible and appropriate. Hampshire Children’s Services have called this the ‘Hampshire Approach’; it is about building quality, collaborative, strength-based and purposeful relationships with families. In doing so, the programme aims to:

Build successful and purposeful relationships with all the families, leading to better engagement, impactful interventions and sustained change.

Enable more children and young people to stay safely at home with their families and communities.

Reduce the number of family re-referrals to Children’s Services because they’ve sustained positive change.

To achieve these aims, services and social work tools are being developed to provide targeted and timely responses to a family’s identified needs. Hampshire is building and developing plans for multi-disciplinary teams, enhancing the number of specialist workers from different disciplines within core teams and promoting a holistic family approach.




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Serious case reviews and child deaths Serious Case Reviews (SCRs) A serious case requiring review is one where: (a) Abuse or neglect of a child is known or suspected; and (b) Either — (i) the child has died; or (ii) the child has been seriously harmed and there is cause for concern as to the way in which the authority, their Board partners or other relevant persons have worked together to safeguard the child. LSCBs must always undertake a review of cases that meet the criteria of an SCR. The purpose of an SCR is to establish whether there are lessons to be learnt from the case about the way in which local professionals and organisations work together to safeguard and promote the welfare of children. HSCB has also been committed to undertaking smaller scale multi-agency case reviews for instances where the case does not meet the criteria for an SCR but it is considered that there are lessons to be learnt. During 2017/18, the Learning and Inquiry Group (LIG) has seen a small decrease in the number of cases being referred. Of the cases referred, there was an increase in the number of Serious Case Reviews and other reviews commissioned. Within 2017/18, the LIG received 10 referrals.

Of the 10 cases referred to the LIG:

Five resulted in SCRs being commissioned.

Three resulted in Multi-Agency Reviews (MARs) being commissioned.

Two did not result in any requirement for a review.

Outcome 2012/

13 2013/

14 2014/

15 2015/

6 2016/

17 2017/

18

Referrals 36 13 11 17 12 10

No further action

32 9 2 10 6 2

SCRs 1 3 4 1 2 5

MAR/Single agency reviews

3 1 5 6 4 3

These figures illustrate the increase in volume of work since the additional guidance and definition was given in Working Together 2013, and again updated in 2015. Working Together to Safeguard Children 2018 was published in July 2018. The guidance sets out the new processes in respect of undertaking case reviews. A national panel has also been established to undertake reviews where it is determined that the case(s) raise issues which are complex or of national importance.




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HSCB is committed to exploring and using different methodology for all types of reviews and will consider which methodology is the most appropriate to extract learning. During 2017/18, HSCB published a SCR on Child U which is available on the HSCB website. Child U died at seven weeks of age following a significant injury including swelling and bruising to the brain and a fractured skull whilst under the care of her father. Some of the key themes arising from the SCR included:

Awareness, understanding and implementation of key policies and procedures.

Promoting the participation of parents in multi-agency meetings and the importance of involving fathers.

The need for assessments to be a continuous process including at times of increased vulnerability.

The need for high quality supervision to enable practitioners to plan and deliver assessments that are both proportionate and robust.

The need for effective information sharing within and across agencies involved with the family.

The Child U SCR recommended that HSCB undertake a campaign on abusive head trauma in babies.

Abusive Head Trauma In the spring of 2017, a task and finish group was established following a recommendation from the SCR on Child U to look at preventing Abusive Head Trauma (AHT) in babies. The Designated Nurse for West Hampshire CCG presented a proposal to the Board for a multi-agency, multifaceted preventative campaign designed to raise the awareness amongst parents and carers regarding Abusive Head Trauma (AHT) and the research regarding the link between crying and AHT. The proposal was endorsed by Board members and a task and finish group was commissioned to design, deliver and evaluate the associated ICON campaign. The idea for the ICON programme, and the different interventions within it, was conceived by Dr Suzanne Smith following a Winston Churchill Memorial Trust Travel Fellowship to the USA and Canada in 2016, which included the study of effective interventions and research into the prevention of AHT. Research suggests that some parents/carers lose control when a baby’s crying becomes too much. Some go on to shake a baby with devastating consequences. Dr Smith found that the most effective evidence based programmes provided a simple message that supports parents/care givers to cope with infant crying. Apart from preventing AHT, most people who have ever cared for a baby appreciate some advice about how to comfort a crying baby and how to cope when it goes on for a long time.




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The core of the campaign is based around coping with a crying baby. The Board’s task and finish group developed the acronym ‘ICON’ which supports this message. This acronym has also been adopted by other LSCBs and CCGs nationally. ICON represents:

Infant crying is normal.

Comforting methods can help.

It’s OK to walk away.

Never, ever shake a baby.

The ICON work is informed by a group of parents, carers and relatives who have all been affected in some way by Abusive Head Trauma. The parent group was a pivotal part of the collaborative process and have endorsed the work the work completed to date. The task and finish group were very privileged to have a mother whose son died as a result of AHT attend their meetings and advise the group based on her family’s experience. The funding provided by the HSCB has supported the development of a variety of materials that will be shared with professionals, parents and carers across Hampshire including:

DadPad – The HSCB has fully funded the DadPad App for two years, the launch of which will coincide with the September 2018 launch. The Hampshire ICON task and

finish group have worked with the DadPad’s creator to include bespoke information relevant for Hampshire parents/carers.

Leaflet – The Hampshire ICON task and finish group developed a leaflet, which has been fully endorsed by the parental advisors.

Posters – The Hampshire ICON task and finish group developed an ICON poster aimed at parents/carers.

Fridge Magnet – The Hampshire ICON task and finish group developed a fridge magnet for parents/carers.

Primary Care Questionnaire – The Named GPs for Safeguarding Children have developed a questionnaire for Primary Care use at the six week baby check.

ICON Film – The HSCB agreed to fund a proportion of a national film which reflects the core ICON message.

Early years and Portage – The ICON message will be delivered through the early years/portage services.

Parenting Courses – Hampshire County Council have developed a programme which will include the ICON messages within parenting courses and for those families who request early help and for those who may be stepping down from Level 4 social care.

Training for professionals – Training for professionals has been developed and is being rolled out.

Webpage Development – Working collaboratively with other areas including Gloucestershire to develop the ICON webpage which will be for professionals, parents and carers.




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Work for 2018/19 includes:

Fixers – The HSCB are working with Fixers to produce a suite of materials and information produced for children by children. The Hampshire ICON task and finish group are working to include this information within PHSE lessons for upper secondary aged children.

Launch in September 2018 – The Hampshire ICON task and finish group have developed a launch event aimed at multi-agency professionals. The launch will reach 600 professionals across Hampshire and will include presentations from Dr Suzanne Smith, a parent representative to share her son’s story and members of HSCB.

Develop the National links – The Chair of the Hampshire ICON task and finish group, on behalf of HSCB, is developing links with other areas to ensure that the ICON programme is a national initiative.

Evaluation – The Hampshire ICON task and finish group, alongside Dr Smith, are seeking to work with a university to help evaluate the local and national ICON programme.

An ICON online toolkit is being developed to support frontline practitioners.

Task and Finish Groups In addition to commissioning and overseeing SCRs and MARs, the Hampshire Learning and Inquiry Group established two further task and finish groups in early 2017. The first group undertook a thematic review of SCRs and MARs completed since 2014. The report was published during the summer of 2017. It included a number of themes that have arisen in previous reviews, examples of good practice and useful tools including guidance, policies and training available to support staff working with children and families. The second task and finish group was set up to review awareness within the workforce of unidentified adults, which is a theme that arises nationally as well as locally in SCRs. Having undertaken the review, an Understanding Unidentified Adults tool kit was developed and launched in 2017/18. The toolkit was developed to build upon learning identified in recent Hampshire Serious Case Reviews and other learning reviews. The resources provide professionals with useful tools to inform their work with children and families including:

Understanding Unidentified Adults – Best Practice Guide. This includes agency flow charts and ‘Top Tips’.

A recommended tool for practitioners to use when working with children and families.

Understanding Unidentified Adults Audit – Survey Monkey (multi-agency).

Primary Care Audit.




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Hidden Adults – Slide Deck (Training materials for agencies and HSCB use).

Posters for professionals and general public to promote Think Family/Hidden Adults.

The online toolkit is available on the HSCB website: HSCB Understanding Unidentified Adults The promotion of the toolkit has formed part of the HSCB Learning Lessons Workshops and the Board’s Regional Practitioner Forums which were delivered in a number of sites across Hampshire.

Disseminating Lessons Learnt from reviews 10 Learning Lessons workshops were held during 2017/18 utilising learning from SCRs and MARs completed since 2014. Case studies were written to include a mixture of the complex needs identified in reviews pertinent to Hampshire. The sessions were aimed at frontline staff and team managers in all agencies involved in working with children and families. The sessions were interactive and required frontline staff to consider what information in relation to a family may be held within other agencies and the importance of information sharing. Learning from SCRs has also been included in the quarterly Regional Practitioner Forums and Early Years briefings for frontline practitioners.



http://www.hampshiresafeguardingchildrenboard.org.uk/toolkits/understanding-unidentified-adults/


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Child deaths The arrangements for the review of child deaths continued from 2016/17 with deaths being reviewed individually by the 4LSCB Child Death Overview Panels (CDOPs) across the Pan-Hampshire area. Data and analysis is shared to identify any common themes and patterns, and, to inform the 4LSCB CDOP Annual Report. The CDOP in Hampshire has worked with agencies to improve the quality, timeliness and analysis provided. This has been undertaken in a number of ways including reviewing updated recording forms tailored to individual agencies to improve the receipt of targeted information and the multi-agency awareness of the correct process, including the importance of notifying a child death. The CDOP database, developed by the Board’s Partnership Support Team, has enabled a comprehensive analysis of cases reviewed by the panel to inform this year’s CDOP Annual Report. During 2017/18, the Hampshire CDOP was notified of 93 child deaths. Of these, 51 were reviewed within the year. In addition, CDOP reviewed a further six cases of child deaths that occurred in 2016/17. The largest proportion of child deaths was in very young babies between 0-27 days old which is in line with national findings. There was an increase in the number of reported child deaths in 2017/18, which is likely due to improved notifications to CDOP in a timely manner.

Learning from child death reviews conducted in 2017/18 includes the need to:

Promote safe sleeping messaging.

Ensure language barriers including communication issues are raised within health, education and social care agencies.

Work with health commissioners and agencies to ensure that clinical teams deliver better management of children with chronic medical conditions, especially children within chaotic families, address safe transition in adult services and ensuring age-appropriate processes following deaths of older children.

Engage clinical leadership to tackle smoking in pregnancy and/or household smoking and maternal obesity.

Work to identify appropriate bereavement support for parents, families and communities.

Further information on the full range of recommendations made to HSCB can be found in the CDOP Annual Report 2017/18 available on the HSCB website.




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Progressing the Board’s business plan During 2017/18, HSCB focused on the following five priorities:

Priority 1: To enhance the understanding of neglect amongst professionals across Hampshire, and give them the tools to better identify indicators of neglect, and, understand what interventions are available to support and protect children affected by and / or at risk of neglect. This will build on the information contained in the joint Hampshire and Isle of Wight Neglect Strategy that was published in 2016.

Priority 2: Ensure that Board partners recognise the needs of children and young people when considering the impact of domestic abuse, substance misuse, and mental health in adults.

Priority 3: To ensure a coordinated multi-agency approach and response to key safeguarding issues including: Missing, Exploited and Trafficked Children, Suicide and Self Harm, Elective Home Education and Unaccompanied Asylum Seeking Children.

Priority 4: Quality Assurance, Measuring Impact and Embedding Learning.

Priority 5: Improve the way the Board communicates with and engages key stakeholders.

Priority 1 – Neglect Neglect seriously impacts on the long term life chances for children. Neglect in the first three years of life can seriously effect brain development and have significant consequences through adolescence and into adulthood. Neglect is defined as: ‘The persistent failure to meet a child’s basic physical and/or psychological needs, likely to result in the serious impairment of the child’s health or development. Neglect may occur during pregnancy as a result of maternal substance abuse. Once a child is born, neglect may involve a parent or carer failing to:

Provide adequate food, clothing and shelter (including exclusion from home or abandonment).

Protect a child from physical and emotional harm or danger

Ensure adequate supervision (including the use of inadequate care-givers).

Ensure access to appropriate medical care or treatment. It may also include neglect of, or unresponsiveness to, a child’s basic emotional needs’ (Working Together to Safeguard Children 2018).




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The table below indicates a reduction in the number of children in Hampshire who are subject to a Child Protection Plans (CPP) under the category of neglect. The proportion of cases on a CPP due to neglect has increased over previous years. It is thought that this is due to greater awareness of the indicators of neglect among professionals including development of the HSCB Neglect Strategy and online toolkit. Number of children who were the subject of a child protection plan (CPP) at 31 March by initial category of abuse6

2014/15 2015/16 2016/17 2017/18

Ham

psh

ire

CPP 1,354 1,441 1,263 1,294

Neglect 828 916 829 950

% 61.2% 63.6% 65.6% 73.4%

Sou

th E

ast CPP 7,790 8,070 7,980

Comparative data not yet

available

Neglect 3,850 4,340 4,490

% 49.4% 53.8% 56.3%

Engl

and

CPP 49,690 50,310 51,080

Neglect 22,230 23,150 24,590

% 44.7% 46% 48.1%

6 Each period is a snapshot as at 31 March of each statutory year. Statutory year

statistics extracted from DfE published reports.

Neglect has also featured in the learning from national Serious Case Reviews (SCRs) and local learning reviews, which highlights the need for an enhanced understanding and more coordinated multi-agency responses to the complex issue of neglect. The triennial review of SCRs identified that neglect featured in the lives of almost two-thirds of the children experiencing non-fatal harm and more than half of the children who died7. Building on the work undertaken in 2016, and the publication of the joint HSCB and IOWSCB Neglect Strategy, the HSCB and IOWSCB developed an online neglect toolkit. The toolkit provides professionals with a range of material to further illustrate the four types of neglect, as well as embed the principles outlined in the strategy, and apply them in frontline practice. The toolkit was designed to be web-based to allow easy access from any device by all members of the multi-agency workforce. It also allows for frequent updating as and when new information is developed and available, which is then immediately accessible to professionals. The toolkit was given a ‘soft launch’ in October 2017 at the IOWSCB conference and the Regional Practitioner Briefings in Hampshire, to enable direct feedback from professionals on the content, format, ease of access and application to frontline practice. Feedback from professionals in both areas has been positive with staff reporting using the tools in their team discussions, assessments and direct work with families.

7 Triennial Analysis of SCRs 2011-2014



https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/533826/Triennial_Analysis_of_SCRs_2011-2014_-__Pathways_to_harm_and_protection.pdf


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The soft launch provided opportunities to consult with groups of professionals to further develop the toolkit. This included groups of Early Years professionals, members of the disabled children’s team and workshops with mixed groups of professionals, social workers and family support workers. The online toolkit has been updated and added to through that process, including specific additions relating to neglect in disabled children and tools to assist in identifying neglect in pre-school children. Feedback from Family Support Workers

‘The neglect prompts and the practice examples will be particularly helpful in supporting the FSW’s to be able to recognise when a case needs to be referred to as neglect is often difficult to evidence. The questions in ‘A day in the life’ will also help to provoke new ideas when FSW’s are feeling they have tried everything they can and

have still not been able to reach the required outcome with a family.’

‘Extremely user-friendly. Useful for professionals in our role as well as offering additional information to share/support both children of

all ages and parents.’

‘The toolkit is something that I would recommend to all

professionals involved with children and families’.

In addition to consulting with professionals, HSCB and IOWSCB have sought the views of children on the contents of the toolkit, and whether it covers the points that they would want professionals to understand and ask about. Feedback was received from members of the Police and Crime Commissioner’s Youth Commission, as well as members of the young people’s forums in Hampshire CAHMS. Their comments directly informed the development of the ‘day in the life’ tools for children and teenagers.

Feedback from a child on the neglect toolkit

‘I think that the questions that are on this website are very useful. They can be used by professionals to patients to gently encourage

them of gaining their [a child’s] trust. The questions are subtle and could also gain access to information of their care without upsetting

them’.

‘I think these questions are also good for the professionals as they learn lot about their client and can gain a better relationship with

them’.




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HSCB and IOWSCB have commissioned bespoke multi-agency training to support the implementation of the neglect strategy and toolkit. The training was developed during 2017 and commenced delivery in 2018. Its roll out will continue during 2018/19. A longitudinal evaluation of this training will take place throughout 2018.

The two Safeguarding Children Boards have also developed a joint performance management framework for neglect to further enhance understanding of the data in relation to neglect cases and the impact of the strategy, toolkit and workforce development programme. This performance framework has been integrated into the Boards’ overall performance programmes.




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Priority 2 - The impact of substance misuse, mental health problems and domestic abuse in adults In the Hampshire Local Authority Area, it is estimated that the following numbers of people have been affected by domestic violence and abuse in the last year:

15,607 men and 30,083 women aged 16-59.

734 men and 2,306 women aged 60-65.

1,345 men and 5,615 women aged 66 and over. This includes:

At least 544 men and 705 women who identify as lesbian, gay or bisexual.

1,000 women and 368 men of Asian origin.

481 women and 323 men of Black origin.

13,296 women and 5,799 men with some degree of limiting disability or health problem.

Over 40,000 children affected. The effects of domestic abuse on children are well-researched and there is a wealth of good evidence on its significant impact on children’s mental, emotional and physical health, and on the development of their subsequent choices and behaviours as adults. The importance of early identification and intervention is stressed in national and local strategies – both to prevent further immediate

harm to the children concerned; and to promote healthy relationships for those children’s futures. National research indicates that 12% of children aged under 11 and 18% of children aged 11-17 had been exposed to domestic violence between adults in their childhood. If these percentages are applied to the Hampshire population, it suggests that 21,034 under 11s and 19,351 11-17s have experienced domestic abuse between adults in their homes (40,385 in total). The Hampshire Domestic Abuse Partnership (HDAP) reports to the Hampshire Safeguarding Children Board and has a number of subgroups working to achieve the following objectives:

Promote healthy relationships and prevent domestic abuse from starting: to prevent domestic abuse from happening in the first place by challenging the attitudes and behaviours which foster it, and intervening early to prevent it taking place.

Ensuring victims are protected and supported: to protect victims and their children from abuse and provide adequate levels of support where violence occurs.

Reducing the impact of abuse on children, adults at risk, families and communities: we need to achieve the best outcomes for children, adults at risk, families and communities to protect those most vulnerable to the impact




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of abuse and to reduce the cycle of abuse through a whole family approach.

Reducing those who perpetrate abuse: take action to ensure that perpetrators are identified, supported to change behaviour and brought to justice where appropriate.

Domestic Abuse Pathway for Health Professionals A Task and Finish Group led by the Named GP (NHCCG) and the Designated Nurse (West and North Hampshire CCGs) have developed a health specific screening tool, which includes ‘opening questions’ and ‘screening questions’ and a pathway for victims of Domestic Violence and Abuse. The pathway was piloted in quarter four (2017/18) and some minor changes have been made following the feedback from professionals. The pathway was presented to the 4LSCB Procedures Group in February 2018 to allow the other areas to consider its adoption. The pathway is to be presented in its final form to the Hampshire Domestic Abuse Partnership and then the HSCB and HSAB in quarter one (2018/19) and will be launched in 2018/19.

Operation Encompass Operation Encompass, implemented within Hampshire in 2017/18, involves information-sharing between police and schools when a child or young person has been exposed to, or involved in, any domestic incident. This enables schools to make provision for

possible difficulties experienced by children, or their families involved in these situations. Since 18 September 2017, 2,127 notifications have been sent to schools across Hampshire County Council area. Hampshire Constabulary has commenced an evaluation process by means of a survey to schools to assess the impact of the initiative. Further work is being undertaken to consider including schools located close to, and across, county boundaries where Hampshire children are educated in either Sussex or Surrey. Ten schools from Surrey have signed-up to receive this information and the constabulary are in contact with counterparts in Sussex to identify further opportunities. Operation Encompass was paused in the middle of March 2018 for just over two weeks; this was due to an information security breach where a notification was sent to a school incorrectly. This school, and the intended school, had a similar name. Measures have been put in place to prevent this from happening again and the police Information Governance department were informed. HSCB and HSAB Annual Conference The HSCB and HSAB held a joint conference for multi-agency professionals entitled ‘Adopting a Family Approach to Domestic Abuse’, which was attended by over 200 delegates. The conference included a range of presentations covering the national and local




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response to domestic abuse including the support available within Hampshire; perspectives from a survivor, child and perpetrator and the

drama ‘Behind Closed Doors’ by Alter Ego Productions. Evaluations indicate that there was an increase in understanding by all delegates following attendance at this conference.

‘I will be ensuring the perpetrator is always part of the

conversation’.

HSCB and HSAB Joint Training To follow on from the first joint annual conference, HSCB and HSAB jointly commissioned training for the adults and children’s workforce on ‘Adopting a Family Approach to tackling Substance / Alcohol Misuse, Mental Health and Domestic Abuse’. This training was developed specifically for Hampshire professionals. Courses are open to staff from all partner agencies across children and adults areas to enable attendees to learn the subject but also better understand the perspectives and processes from staff in different organisations and working with different family members. The course was developed in 2017/18 and began delivery in mid-2018. In order to inform this course, HSCB sought feedback from members of the Police and Crime Commissioner’s Youth Commission on their views on healthy relationships and mental health in adolescents. Their feedback was used to inform briefings for professionals and also the formal training offer.

HSCB Follow-Up from the Joint Targeted Area Inspection

In response to feedback from the Joint Targeted Area Inspection (JTAI) of the multi-agency response to abuse and neglect in Hampshire, undertaken in December 2016, two audits were undertaken in 2017/18 to address the following feedback: ‘In social care, a very small number of cases were stepped down from child protection to CiN before significant change had been maintained in a family’s life, or there was an element of over-optimism of the change that had been achieved’. The most recent audit demonstrated that the decisions to step-down from Child Protection to CiN were appropriate and supported by evidence. Areas for improvement were identified in regards to the multi-agency contributions to child protection conferences along with the need for more robust application of CiN planning across HSCB partner agencies. In addition to this audit, the Board’s Quality Assurance Group monitors the single and multi-agency action plans that were agreed following the JTAI with progress reported at quarterly meetings. The 4LSCB Joint Working Protocol was also republished in the first quarter of 2017/18. This multi-agency protocol is written for professionals working with families whose complex problems might impact on their ability to care for children (e.g. mental ill health, substance misuse, learning disability and emotional or psychological distress).




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Priority 3: Key safeguarding issues

Children at Risk of Exploitation Multi-agency work to identify children and young people who may be at risk of exploitation and trafficking in Hampshire remained a Board priority for 2017/18. Children deemed at risk are managed through the Hampshire Operational Missing, Exploited and Trafficked Group. The work from this group is carried forward through the multi-agency specialist Willow Team and Hampshire Constabulary’s Missing, Exploited and Trafficked Team. At the end of May 2018, 22 children were at high risk of exploitation and 46 were assessed as being at medium risk. The dominant themes of child sexual exploitation in Hampshire present as:

County Lines/Criminal Exploitation – There is increasing evidence of transient/out of county drug dealers exploiting vulnerable children to commit criminal acts through drug dealing. This will include children going missing and being trafficked and groomed to engage in criminal activity such as shop lifting.

On-Line exploitation – Perpetrators using the internet to groom and exploit vulnerable children with the aim of committing sexual offences as well as enticing children to engage in criminal activity. Given the global nature of the internet, the perpetrators are not always present in the UK.

Peer-on-Peer sexual exploitation - Particularly notable in cyber enabled sexual exploitation offences where there are higher levels of young people communicating on line, using Apps dangerously and sharing sexual images. Peer groups also can have elements of sexual behaviours as part of gang/peer group activity.

There are cross-overs between all three themes and usually we find that missing episodes, trafficking and exploitation are all interlinked and affect both boys and girls from any background. In line with the South East Regional Crime Unit study in 2017, Individuals rather than gangs continue to pose the biggest threat in the Hampshire area. Victims are mostly white British females aged around 15 years; offenders are commonly white British males aged around 18 years. The internet remains a key thematic threat and helps perpetrators exploit children. As expected, areas of deprivation with high levels of poor school attendance, children being in need and high levels of teen pregnancies can be areas perpetrators target. The impact of exploitation on boys is not always recognised in the same way as girls and this remains a priority for the HSCB’s Child Exploitation Group. Over the coming year, HSCB will also be strengthening the remit of its child exploitation group to focus on Complex Adolescent Safeguarding, which encompasses all forms of exploitation.




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4LSCB County Lines Conference HSCB led on delivering a pan-Hampshire conference entitled ‘Criminal Exploitation of Children and Vulnerable Young People across - County Lines’. The conference, attended by over 200 professionals, involved national and local speakers including: Gwenton Sloley (Director of Crying Sons), Junior Smart (St Giles Trust), the Home Office, Safer London, The International Centre: Researching Child Sexual Exploitation, Violence and Trafficking, Hampshire Constabulary and Local Authority exploitation leads. As a result of attending this conference, all delegates rated their understanding of the subject as positive (an increase of 55%).

‘One of the best presented and most insightful conferences I have

attended’.

The Willow Team The Willow Team is a children’s social care led specialist multi-agency child exploitation team launched in October 2015. The team comprises a team manager, three social workers, two specialist CAMHS practitioners, one child and family support worker and administrative support. The Willow Team works collaboratively with Hampshire Constabulary’s MET team, Hampshire’s Youth Offending Team, Barnardo’s workers and various health teams. The team operates across Hampshire and works directly with children identified at risk of one or more elements of child exploitation. The team receives referrals from Hampshire’s Multi Agency Safeguarding Hub (MASH) relating to children who are not currently open to Children’s Services and where concerns are raised that they are at high risk of being exploited. In addition, the Willow Team support missing children and those at risk of, or being, trafficked which often goes hand-in-hand with child exploitation. The team takes cases from the CAST teams within social care for children already open. In these cases, support can be offered in a number of ways such as:

Direct work with the child/parent/carers/residential workers.

Mentoring to professionals including teachers, social workers and school nurses to support them to undertake direct work with the child.

Consultation advice and support to professional groups.




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Undertaking awareness initiatives.

Disruption of perpetrators in collaboration with Hampshire Constabulary.

An external evaluation was undertaken by The Institute of Public Care at Oxford Brookes University, which focussed on the quality and impact of support to young people identified as being at risk of sexual exploitation. The report highlighted that: ‘Local agencies have a good understanding of the remit of the Willow Team and that there is strong support for a dedicated multi-disciplinary team providing a range of services including 1:1 work with children at risk, or who have suffered from CSE’. ‘Where the young person engages with the Willow worker, they and their key carer(s) almost invariably appreciate the warm, non-judgemental approach and the ability of the worker to educate both the young person and the broader family about risks relating to sexual exploitation (through use of one to one conversations, DVD’s, and worksheets)’.

Unaccompanied Asylum Seeking Children There was a sustained increase in the number of Unaccompanied Asylum Seeking Children (UASC) over 2017/18 from 80 at the end of March 2017 to 113 at the end of March 2018. The increase is partly due to Hampshire Children’s Services being proactive in the National Transfer Scheme. This is a national scheme whereby those local authorities with high numbers of UASC are able to transfer

young people to an authority where with lower numbers. In addition, there has been a steady increase in the number of spontaneous arrivals in Hampshire, for example children who have been trafficked or smuggled into the country. Hampshire County Council continues to offer foster care as a first response including all of the support that comes with a wrap-around Children Looked After plan. The Willow Team support all unaccompanied asylum seeking children (UASC), undertaking trafficking assessments on all new UASC to Hampshire. Social workers from the team will also support with age assessments where deemed necessary. Willow Team also refers to the Barnardo’s Independent Trafficking Advocates (ICTA) Service. Children’s Services also undertake a Section 47 investigation on all new UASC coming into Hampshire.




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Willow Team Case Study A female aged 15 was referred to the Willow Team following a sexual assault. Further assessment revealed a child with many incidents of sexual and physical abuse in her past relationships with carers and family so she had significant ‘push’ factors exposing her to dangerous peer and relationships with older abusive men. Eventually, all her ‘friendships’ were with older males who readily groomed and took advantage of her drawing her into an exploited life. Home life was difficult with a parent who worked long hours so not physically available to be there for her or able to keep her safe. Father was also using substances so emotionally unavailable and normalised drug use as a coping mechanism in the home. The child looked for love and affection outside her family and found it with abusive males where repeat sexual assault for drugs was a common activity. The Willow worker took time to engage in a positive way and developed a child-focused relationship. Willow Team worked with the child for approximately 18 months and during that time focused on direct work on dangerous and positive relationships, consent issues, accessing other agencies (e.g. CAMHS and sexual health) as well as employment support. The worker was readily available emotionally and physically, always offering positive encouragement. On reflection, the worker feels strongly that the key to the work was the ability to be available and a consistent and positive adult in the child’s life. This included supporting key social work tasks as the

family did not want to engage with the local team. Positive examples of support included taking the child to get her GCSE results and being with her for visits to the sexual health clinic. All of these things highlight that being positive and available, as well as a trusted adult, are key strengths to working with exploited children. The child now is closed to Children’s Services, has a full time job and is able to make decisions about risk more carefully. She has a much safer, brighter and happier future ahead of her. Hampshire Constabulary Missing, Exploited and Trafficked Team Throughout 2017/18, Hampshire Constabulary’s Missing, Exploited and Trafficked Team (METT) has developed a greater focus on perpetrators of exploitation and the trafficking of unaccompanied asylum seeking children, whilst maintaining the current partnership management of young people at risk from criminal and sexual exploitation. The METT continues to proactively manage those children who are at the highest risk of Child Sexual Exploitation (CSE) and now those at highest risk of Child Criminal exploitation (CCE). This includes those children involved with drug dealing networks often referred to as ‘county lines’. The safeguarding of young people often involves a focused review and management of missing incidents, with a renewed focus on targeting and disruption of perpetrators. The use of Child Abduction Warning Notices (CAWNs) has proved an effective tool in managing and preventing further harm. The




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team is also pioneering the use of the C5 perpetrator notice to identify and divert those people who display worrying sexual behaviour but whose actions have not reached the threshold for a prosecution. One of the METT aims is to decrease the demand that frequent missing children place on colleagues by seeking practical solutions to reduce the number of incidents. This is achieved through proactive intervention and effective partnership working. The team also support colleagues conducting missing person investigations, providing up-to-date information on risk management plans and, where possible, offering practical support and expertise. In addition, the team seek to identify victims and perpetrators at the earliest opportunity and to coordinate the initial police response, as well as raising awareness within districts of vulnerable individuals, directing any intervention and safeguarding work where it is appropriate to do so, allowing leaders to better manage and reduce the risk of harm. The engagement with perpetrators and management of vulnerable young people allows the METT team to develop a detailed understanding of mechanisms underpinning and driving exploitation of young people. From this process, intelligence gaps are identified and public, police and partners can be tasked to assist with filling those gaps. The public is encouraged to use Crimestoppers or local police to report intelligence, and partners make use of a bespoke intelligence submission process using a Community Partnership Intelligence (CPI) form.

In 2017/18, the METT was led by Detective Chief Inspector Nick Plummer, with support from Detective Inspector Ross Toms and Detective Sergeants Abbie Leeson and Matt Gillooly.

Suicide and Self-Harm The Hampshire suicide prevention strategy was signed off by the health and wellbeing board in 2017/18. This strategy outlines the Hampshire approach to suicide prevention which requires statutory agencies, the voluntary sector and others, including the media, to work together to reduce the number of suicides and the effect of someone taking their life. It covers the following themes:

Reduce the risk of suicide in key high-risk groups.

Tailor approaches to improve mental health in specific groups.

Reduce access to the means of suicide.

Provide better information and support to those bereaved or affected by suicide.

Support the media in delivering sensitive approaches to suicide and suicidal behaviour.

Support research, data collection and monitoring. Key actions for the strategy include:

Further understand factors influencing suicide in high risk groups.

Work with Primary Care supported through STP funding (HCC lead).




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Progress a postvention8 protocol for workplaces.

Building on work with South Western Railway to strengthen partnerships with the Highways Agency and the Maritime and Coastguard Agency.

Develop work with Hampshire Constabulary on the response to suicide.

Development of a Safety App.

Work with the Criminal Justice System on embedding learning from the Rebalancing Act9 Plan.

Pre and Postvention Protocol Hampshire Public Health developed a suicide Prevention and Postvention Protocol for Hampshire Schools and Colleges. The protocol aims to:

Provide guidance on developing a plan when there has been a (suspected) suicide (postvention) in the case of a student at the school/college

Provide guidance on developing a plan in advance of an event taking place.

8 An intervention conducted after a suicide, largely taking the form of support for

the bereaved (family, friends, professionals and peers, reduce the risk of imitative suicidal behaviour and promote the healthy recovery of the affected community. 9 A resource intended to support a broad range of stakeholders at local, regional

and national level, to understand and meet the health and social care needs of people in contact with the Criminal Justice System.

Enable agencies/organisations working to reduce suicides in Hampshire the opportunity to reduce the possibility of any ‘clustering’.

Provide details of support available following a suicide/suspected suicide.

Enable agencies/organisations working to reduce suicides in Hampshire the opportunity to learn from events leading to the suicide/suspected suicide.

Help prevent suicides in schools or colleges.




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Emotional Wellbeing A new partnership group focusing on the emotional wellbeing and mental health of children and young people met every two months throughout 2017/18 to support the implementation of the previous strategy to review next steps for future work and to improve outcomes. The Starting Well for Emotional Wellbeing and Mental Health Partnership chaired by Public Health, and supported by the deputy chair from the CCG, has received ongoing support from a range of organisations and service leads, many of whom see emotional wellbeing of children and young people as a key priority for Hampshire. Public Health, supported by members of the partnership group, undertook a comprehensive needs assessment in order to support development of new strategy for 2018 and beyond. The Hampshire Children and Young People Emotional Wellbeing & Mental Health Needs Assessment Report is available via: https://www.hants.gov.uk/socialcareandhealth/publichealth/jsna/startingwellsummary Hampshire Child and Adolescent Mental Health Service (CAMHS) Reflective Review CAMHS requested at the HSCB Quality Assurance Subgroup for a review to be undertaken following a number of children who have significantly self-harmed within a specific geographical area. To provide a level of independent scrutiny, the review was led by the

Designated Nurse (West and North Hampshire CCGs) in collaboration with representatives from Public Health, the Board’s Partnership Support Team and the Named GPs for NHCCG and SE, F&G CCGs. The intended outcomes from the review were to:

Identify where the multi-agency response to self-harm could be improved (e.g. through access to additional training, contemporary research and good practice information).

Identify any indicators of high risk self-harming behaviour that can be shared across Board partner agencies.

Identify supplementary information for inclusion within the 4LSCB self-harm pathway.

Identify learning to inform HSCB and single-agency training.

Inform multi-agency planning and escalation routes for children with mental health problems.

A thematic analysis of the Serious Incidents Requiring Investigation (SIRI) reports was conducted by the CCG leads, HSCB and Public Health followed by a multi-agency workshop. The workshop had representation from CAMHS professionals, school representatives and Children’s Services Department. The report was ratified 2018/19 and the learning shared across partner agencies. Public Health will also review the themes from this report together with results from a previously conducted suicide audit. A summary of findings will be discussed at a future Starting Well Partnership meeting.



https://www.hants.gov.uk/socialcareandhealth/publichealth/jsna/startingwellsummary

https://www.hants.gov.uk/socialcareandhealth/publichealth/jsna/startingwellsummary


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Priority 4: Quality assurance HSCB undertakes regular auditing of multi-agency safeguarding arrangements in Hampshire. This work is commissioned by the Board’s Quality Assurance Group and learning is disseminated to front-line practitioners via a programme of events, briefings and conferences. Over the last year, the Board undertook a programme of multi-agency audits to establish how well agencies work together to identify and respond to key safeguarding issues.

Multi-Agency Safeguarding Hub (MASH) Audits In September 2017, a multi-agency group comprising members of the Quality Assurance Groups of HSCB along with staff and partners who work as part of the Multi Agency Safeguarding Hub (MASH), reviewed 16 cases referred to MASH. The audits followed the journey of each child from the point of referral into MASH through to the actions and outcome reached, including decisions taken by district social work teams. For this audit, the cases reviewed featured alleged neglect. This audit identified timely information-sharing between partner agencies, consistent and appropriate application of thresholds, robust case decisions in-line with expected time-scales, timely actions taken within district teams and appropriate management oversight. This audit also evidenced an improved position compared to previous years in respect of professionals capturing the ‘voice of the child’. Learning was identified in relation to the

importance obtaining the full family composition, particularly in relation to fathers/male partners. Overall, there is confidence that the ongoing multi-agency auditing of MASH is ensuring the Board, and partners, understand the effectiveness of current practice and where improvements may be needed.




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MET Local Effectiveness Assessment Working Together 2015 (Ch. 3 para 18) places an expectation on LSCBs to conduct regular assessments on the effectiveness of Board Partners’ responses to child sexual exploitation (CSE). For 2017/18, the Board’s Child Exploitation Group reviewed agencies’ self-assessments covering 22 questions linked to the provision and development of single and multi-agency child exploitation training. This assessment proved effective in identifying areas of strength across HSCB and opportunities for further improvement in regards to training and learning opportunities. Areas for improvement, which will be addressed in 2018/19, include the sharing of intelligence with Hampshire Constabulary and the need to evaluate the impact of in-house training events across the wider partnership. The findings of this self-assessment will inform the ongoing development of HSCB’s training programme, which is provided at no cost to its partner agencies and other key safeguarding professionals.

Section 11 Audit Section 11 of the Children Act 2004 places duties on a range of organisations and individuals to ensure their functions, and any services that they contract out to others, are discharged having regard to the need to safeguard and promote the welfare of

children. As part of its statutory duty to ensure the effectiveness of what is done by each organisation in relation to safeguarding and promoting the welfare of children, Hampshire Safeguarding Children Board undertakes annual monitoring of compliance with Section 11 safeguarding standards. The purpose of the audit is to support Board partners in achieving compliance with safeguarding standards. This is achieved through:

Seeking assurance from Board partners that services are compliant with safeguarding standards.

Enabling Board partners to showcase areas of good practice where positive outcomes for children can be evidenced.

Enabling Board partners to reflect on their safeguarding priorities and to identify areas for improvement.

Providing a feedback mechanism to Boards on progress against areas for improvement including any barriers to partnership working.

For 2017/18, the audit process was strengthened by seeking assurance that areas for improvement, as identified in the 2016/17 audit, had been taken forward within agencies. This involved completion of an action plan review tool, which was reviewed by an audit team. For organisations crossing two or more LSCB areas within Hampshire and the Isle of Wight, this action plan, and any additional information highlighting good practice, was presented to a panel comprising key members of the 4LSCBs’ Quality Assurance




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Groups/Monitoring & Evaluation Committees. These events were chaired by Derek Benson, Independent Chair of Hampshire and Isle of Wight LSCBs, on behalf of Hampshire, Southampton, Portsmouth and Isle of Wight. A clear commitment to keeping children safe was evident along with positive examples of how agencies ensure compliance with safeguarding standards across their services. Agency feedback was issued formally via the Independent Chair, which identified areas of good practice and opportunities for strengthening safeguarding arrangements. For 2018/19, the Section 11 audit is being further strengthened through inclusion of an online survey for frontline professionals. This will enable the Board to test and verify the extent to which safeguarding strategies, policies and products have been embedded across the safeguarding partnership. Safeguarding in Education Audit In 2017, there was a 97.5% return rate from education settings, across all sectors, in relation to the annual education audit (compared to 97% in 2016). This slight increase is encouraging, but more work needs to be done by the education sub-group to increase compliance with the audit deadline. The figures below show the return rate across all sectors by the deadline of 30 September 2017:

LA Maintained schools 95%

Academies 75%

Independent 73%

Colleges 75% The returned audits indicate compliance across all areas and good levels of compliance with statutory obligations under Section 175 of the Education Act 2002, the Education (Independent School Standards) Regulations 2014, and the Non-Maintained Special Schools (England) Regulations 2015. Where schools returned evidence of non-compliance, immediate supportive and remedial action was undertaken with schools receiving input and assistance from the Local Authority safeguarding unit and the education and inclusion service. In the autumn term of 2017, Hampshire Safeguarding Children’s Board and the Assistant Director (Education and Inclusion) of Hampshire Children’s Services commissioned a quality assurance process in relation to the annual school audit process. This looked at a range of information regarding safeguarding procedures and practice in schools, generated through the annual safeguarding audit return. There were ten randomly selected, state funded schools across Hampshire involved in the quality assurance process. These were a mix of seven maintained schools and three academies across both the primary and secondary sector, as well as one Education Centre.




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The process focused on the following:

Schools’ approaches to undertaking the annual safeguarding audit.

How closely school audit submissions reflect practice in schools.

Schools’ use of the audit process to strengthen practice.

Identification of what is working well and what could be improved.

The two key areas of focus were:

Online safety, including curriculum delivery.

Governance. It is important to note that although practice varied across the sample schools, pupils were being kept safe. The findings should be viewed in the context of aiming to further improve practice. The findings have been shared across all education settings and with the Board. The Education Sub group has organised the third annual conference for designated safeguarding leads across all sectors. This conference is highlighting changes in guidance, learning from local and national safeguarding experiences, child exploitation and best practice in relation to child protection conferences. The events are being delivered in multiple locations across the county during the summer and autumn terms 2018.

Multi-Agency Safeguarding Hub (MASH) and Domestic Abuse Referrals Audit The MASH and Domestic Abuse Audit was a recommendation from a Serious Case Review (SCR) which indicated that ‘West Hampshire CCG, with MASH will undertake a review across health agencies to ascertain staff understanding and confidence levels when making referrals to Children’s Services. This should include confirmation of which risk assessment is currently being used across health agencies in Hampshire’. The Joint Targeted Area Inspection (JTAI) which took place in December 2016 also gave a recommendation to undertake an audit to ‘establish the number of referrals made by health professionals to Children’s Services where the DASH Risk Assessment has been completed’. The Designated Nurse (West and North Hampshire CCGs) and the Named Nurse (SHFT) made a decision to combine the two audits together and review cases which were referred into the MASH from across the health economy considering both recommendations concurrently as highlighted above. Overall, the results of the audit indicate that health professionals from across the health economy were not consistently using the Interagency Referral Form (IARF) or a risk assessment tool. There were concerns regarding the number of referrals faxed to Children’s Services and also the number of referrals made by




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telephone and not followed up in writing. The report made seven recommendations. Following the audit of health referrals into MASH, it has been agreed that the Children’s Services lead for MASH, the Designated Nurse (West and North Hampshire CCGs) and an HSCB representative would review the current referral form and develop a safeguarding reference tool to help prompt professionals when making a referral. This tool will be implemented in 2018/19.

Joint Targeted Area Inspection Dry Run Audit Hampshire Safeguarding Children Board conducted a JTAI dry-run audit with a focus on children experiencing neglect. The audit identified some areas of learning for the partnership which were shared across HSCB. Six cases were selected and shared with agencies three days in advance of the audit. Agencies were required to submit their completed audit tools by 5.00pm on the last working day prior to the audit. Each case reviewed highlighted areas of strength in respect of multi-agency learning. Areas of learning were transferred into an HSCB audit recommendation tracker and monitored frequently until completion. West Hampshire CCG led the coordination of the health response and supported providers in feeding back to the HSCB.

Portsmouth Health Safeguarding Improvement Board

During 2017/18, the following inspection reports from the Care Quality Commission (CQC) were published regarding the quality of health provision in Portsmouth:

CQC Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital Quality Report (24 August 2017).

CQC Review of Health Services for Children Looked After and Safeguarding in Portsmouth (19 September 2017).

These reports identified areas of concern relating to safeguarding of children and adults in Portsmouth's health services. To ensure that the safeguarding boards for children and adults within Portsmouth had sufficient oversight of the improvement activity, a joint improvement board was established to seek assurance that appropriate actions had been identified and undertaken to address the areas of concern. Hampshire Safeguarding Children Board (HSCB) is a member of the improvement board as many of the children receiving services from Portsmouth Hospitals Trust live in the Hampshire Local Authority Area. Representatives from HSCB also attend the Health Group of Portsmouth Safeguarding Children Board, which oversees delivery of the associated action plans.




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Children Living in Secure Accommodation Hampshire Safeguarding Children Board receives annual reports from two secure establishments in the local authority area (Swanwick Lodge and Bluebird House). A report is also received from Leigh House, which is an open unit that provides acute psychiatric assessment, diagnosis, treatment and care for children experiencing a wide range of psychiatric problems. These reports, which include analysis of the use of restraint, are scrutinised by the Board’s Quality Assurance Group. Swanwick Lodge Swanwick Lodge, a Secure Children’s Home, is a national resource registered with Ofsted to care for 16 young people of either gender aged 10 to 17 years who are deemed to be at such a significant risk of harm to themselves and others that they need to reside in secure accommodation. This provision is usually made under Section 25 of the Children Act (1989). Occupancy During 2017/18, Swanwick Lodge did not operate at full occupancy. Staffing vacancies and absence, and planned improvements to the to the premises through a grant award from the DFE, and the challenging and complex needs of the cohort of young people accessing the secure welfare estate have been factors that have impacted on Swanwick Lodge being able to achieve full occupancy. Due to the staffing issues, the occupancy of the home declined over

the course of the year to a current percentage of 31.25%, compared to the average of 71.5% for the previous reporting period. Approach to behaviour management Swanwick Lodge has a ‘positive management of behaviour’ policy and procedure and continues to use the Team Teach approach to behaviour management. This approach promotes a continuum of gradual and graded techniques, with an emphasis and preference for the use of verbal and non-verbal strategies being used and exhausted before positive handling strategies are utilised. All care and education professionals receive two days of initial Team Teach training and receive one day refresher training every year. Restraint is also minimised via individual risk assessments which aim to identify triggers to challenging behaviour and controls to minimise incidents. In addition, all young people have an individual behaviour management plan developed both in consultation with the young person concerned and via input across a number of disciplines including (embedded) healthcare, psychiatric and psychology services and Team Teach instructors. All incidents involving the use of restraint are documented on incident report forms which are reviewed (along with CCTV recordings) by Swanwick Lodge management as part of a detailed de-brief. Management review and de-briefing of incidents is used to identify the antecedents to the incident and whether de-




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escalation strategies were used effectively by staff to prevent both the occurrence and escalation of the incident. Risk assessments and behaviour management plans are then updated accordingly. Incidents and the use of physical restraint are subject to regular review via internal performance monitoring arrangements and to external scrutiny Ofsted inspections (twice yearly) and by an Independent Regulation 44 Visitor (monthly). Use of Restraint

During the reporting period, there were a total of 182 recorded incidents in the home. Incidents related to aggressive behaviours by young people towards others, significant damage to property caused by young people, a lapse or breach in security or self-harm. 152 of those instances resulted in the restraint of a young person, a

decrease of 47.9% from 317 restraints in the previous reporting period. Thirty (almost 20%) of those restraints were staff intervening to prevent a young person from significantly harming themselves. Each restraint will usually involve multiple holds with the majority (99%) being guided moves and lower-level techniques. The majority of incidents and restraints during 2017/2018 reflected the challenging behaviours and complexity of need among a small proportion of the young people accommodated. Summary There was a significant reduction in the use of restraint in 2017/18 as compared with the previous reporting period. The reduction in the use of restraint can be linked with reduced occupancy and the cohort of young people being admitted. With fewer young people resident at Swanwick Lodge you would expect to a see a decrease in the number on restraints. Internal management reviews of incidents and analysis of trends suggest that there are no emerging themes/issues that would indicate deterioration in the quality of care or the inappropriate use of restraint.

010203040

Ap

r-1

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May

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Jun

-17

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-18

Apr-17

May-17

Jun-17

Jul-17

Aug-17

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Oct-17

Nov-17

Dec-17

Jan-18

Feb-18

Mar-18

Restraints Total 8 7 8 3 7 11 25 36 27 7 5 8

Figure 1: Number of Restraints per Month




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Swanwick Lodge Case Study James was a 13 year old male who had broken down numerous placements due to high substance misuse, prolific absconding, self-harm, fire setting, involvement in criminal behaviour and aggressive behaviour including assaults with weapons. The placement (Swanwick Lodge) was required to work with James around his substance misuse, aggression, self-harm and consequential thinking as well as to try and stabilise James and to engage him back into education and then the community. James was placed at the home in June 2018. At the start of the placement James was unwilling to engage in education or take the medication that had previously been prescribed. At the start of the placement, James was disruptive, unable to concentrate, verbally and physically aggressive towards staff and also refused to engage with substance misuse services. The home implemented a routine of boundaries and consistency for James which included a reward-based behaviour programme and took the lead in his plan by identifying what would help him. James stated that areas that would help him progress were:

Staff using easy to understand instructions.

Consistent boundaries.

Provide him with a ‘fun to live in’ environment.

In combination with individual child-focused staff sessions held with an educational psychologist, and a multi-disciplinary team approach put together by the education, care and the health team, James began to attend education and to engage with substance misuse services. James began to take prescribed medication and built positive relationships with staff and other young people in the home. Incidents of aggression and impulsive behaviour reduced and James commenced a full community mobility programme which culminated in the successful transition of James to a community placement that he was excited to go to. Prior to James leaving the home, a consultation was held with the staff team and a progress sheet was put together for him so he could see how far he had come and the positive progress that he made in all areas. Some of the areas on this really stand out are:

He grew a bit – during his stay James grew 11 centimetres in height.

He got up for school each day and fully engaged.

Formed age-appropriate relationships and liked a cuddle.

Increased resilience.

Took pride in his appearance and was able to open up to the staff.




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James

SL178741 - Summary of SL Progress

James Progress whilst at Swanwick Lodge – January 2018

Fun and able to present as a child in a positive way

Positive peer friendships and recognised if others needed help

Built confidence and self-esteem:• took pride in his physical

appearance• was able to open up to staff

Sense of humour / grew the ability to laugh at himself

Enjoyed and interacted well with carers:• formed age appropriate relationships• liked a cuddle

Personal hygiene improved

Achieved Sports Leaders Award

Improved family links and relationships:• had a visit with dad

Increased tolerance

Thrived –physically and mentally

Improved self regulation/ control:• calmed more quickly• developed emotional maturity

Increased resilience

Sleep improved

Was able to reflect

Improved health:• he grew a bit• attended the gym• fitter and healthier lifestyle

Always joined in

Improved education:• got up for school on time• fully engaged

Positive relationships with peers: • showed empathy towards

others

More aware of his situation

Able to articulate himself

‘I am more patient and can manage my behaviour in a more positive and mature way’

(Swanwick Lodge Resident Feedback).

‘It is clear you and your staff are doing extremely professional and demanding work at Swanwick Lodge. It was a privilege to be able

to see everyone’s dedication’ (Cllr Robert Taylor).




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Bluebird House Introduction Bluebird House is an adolescent forensic medium secure unit, part of the national network of adolescent medium secure services. It is a national unit, commissioned by NHS England, and admits young people from all over the country. Young people are aged between 12 and 18 years and admission criteria include that they suffer from a mental disorder, are detained under the Mental Health Act (MHA) 1983 and pose a high risk of harm to other people. There are three wards with 20 beds altogether. Since September 2017 one of the wards has been commissioned by NHS England as an adolescent low secure service. Use of restrictive interventions Young people admitted to Bluebird House pose many high risks of harm to others, and as such, present with a range of severely challenging behaviours. This sometimes requires the use of restrictive interventions such as restraint in order to manage the immediate risk in order to keep not only that young person, but the other young people as well as staff members, safe. All restraint is carried out in accordance with the legal framework as prescribed in the Mental Health Act Code of Practice and trust policies and procedures. All incidents, including episodes of restraint are reported on the Trust incident reporting system. This information is available to

clinical teams in Bluebird House to identify emerging trends, and to track the progress of individual young people. Use of Restraint Although Bluebird house has been commissioned for 20 medium secure beds, one ward closed in March 2016 due to the national shortages of qualified band five nurses. As previously noted, this ward was reopened as a temporary low secure ward in September 2017 at the request of NHS England to help alleviate the national shortage of low secure beds. Therefore, Bluebird House had 15 medium secure beds up to September 2017 but from that point onwards had a maximum of 13 medium secure and six low secure beds available for occupancy. The occupancy has been 70.1% for the reporting year.




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There were 3,756 episodes of restraint between in the reporting period 2017/18. 1,900 were required to manage the risk of harm to others, 1,547 interventions were to manage risk of harm to self, 297 to stop patients from inflicting serious damage to property and in 12 cases the incident forms did not specify the cause for use of restraint. This has been identified as a data entry issue to the governance team and should not reoccur in future reporting. The increasing level of acuity correlates with the opening of the third ward and five admissions over a relatively short period of time of young people with complex presentations. The chart shows a significant increase in the level of self-harm through various means from September 2017 when the new low secure ward was opened. Self-harm, in particular swallowing, is included and on the risk register as there is a trend of repeated swallowing of pens, batteries, toothbrushes and various other items in everyday use. The use of all types of hold has increased over the last year and prone restraint accounts for 19.6% of the positions over the year. This demonstrates a shift from the use of prone restraint and the team continues to work towards reducing this number further. However, in some cases prone restraint may be clinically more appropriate for individual young people, for example to prevent retriggering of past trauma associated with supine restraint. In these cases restraint position is specifically care-planned.

Summary

Restraint continues to be necessary as an intervention of last resort, when other measures such as de-escalation have failed.

The use of prone restraint has declined as a percentage overall over the last year.

The increase in incidents and restraints coincides with periods of high clinical activity in the service, such as admission of new patients and reopening of the third ward as a new low secure provision.

A number of initiatives are in place to reduce the use of restrictive practices in Bluebird House, described in an action plan which is reviewed regularly through a local governance forum.

Development programme now in place for all Band 6 staff that cover the duty senior nurse role and manage incidents as they occur within the unit.




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Bluebird House Case Study (Sam) Background Sam has a history of self-harming and suicidal behaviours since the age of 11 in relation to a family friend who reportedly emotionally and financially exploited his mother. His mother is known to have mental health difficulties and has received inpatient treatment. She has been described as ‘volatile and unpredictable and prone to rages which are confusing and bewildering to Sam’. Also, his maternal uncle has similar difficulties. Sam came in to contact with the local CAMHS team when he was 12, following an attempt to hang himself which coincided with his mother’s first hospital admission. Sam has had two previous hospital admissions before Bluebird House. Circumstances of admission to Bluebird house Sam was an unplanned admission to Bluebird House following a significant incident at his previous placement, whereby he made a sharp weapon and then attempted to harm staff and himself. He was subsequently arrested and transferred to an adult medium secure unit before being admitted to Bluebird House on the 19th May 2017.

Progress during admission to Bluebird House Sam was initially admitted to the high care area of Bluebird House due to his significant risk towards others. His aggressive presentation, coupled with his low mood, meant he was transferred to long term segregation with a plan to slowly integrate him onto the ward. Early in his admission, Sam really struggled to manage his mental health, presenting as very aggressive towards staff and displayed high risk of self-harm behaviours which were frequently followed by shame and remorse. Sam was placed in long-term segregation for three different periods since his admission. The most significant episode of aggression involved hitting a member of staff over head with a pool cue without any warning or identifiable trigger. Sam described auditory hallucinations telling him to hurt himself and others, as well as flashbacks that caused him intense levels of distress. Working within an attachment and trauma model meant that the initial therapeutic task was to help Sam build stable, reliable relationships at Bluebird House in order to help him manage his emotions and distress. This was done by listening to Sam and involving him in his care, creating care plans with him, providing consistency and creating new skills as well as developing his existing ones. For example, Sam created a specific plan with the nursing team to help communicate when he was struggling. This involved developing a Zoning Care Plan, which has four different coloured zones to describe how a young person is feeling (red-




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crisis, orange-starting to struggle, green-ok, and blue-feeling low) and outlining early warning signs. Sam worked with the team to use coloured wristbands linked to the Zoning Care Plan in order to communicate with the ward team so they could support him when he needed it. This enabled Sam to not only start developing his knowledge and recognition of his emotions but helped create a sense of safety, knowing that we would know how to support his needs. Over time, Sam relied on these less because by creating this secure base with the nursing team, Sam was able to engage in different therapies to help him regulate his emotions and cope with the difficult thoughts he experienced. When Sam initially came to Bluebird House, he frequently involved himself in incidents on the ward but over the last few months of his admission he was able to disengage from these situations and deal with emotions of frustration, anger and elation. He became better able to recognise his triggers, understand what lead him to be in hospital as well as identifying positive ways of managing his mental health. Sam engaged well with education and therapy sessions as well as building positive relationships with staff and his peers. Sam’s presentation during his admission changed dramatically from high levels of assaults on staff and frequent incidents of self-harm to occasional incidents of self-harm and rare aggression towards others. As described above, Sam built skills managing his emotions and behaviours meaning he could work towards his goal of return to

the family home. He began a period of extended leave from Bluebird House (via section 17 of the Mental Health Act) to the family home, gaining a job as an apprentice chef in a local restaurant and was discharged from his section on 13 February 2018.




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Leigh House Introduction Leigh House is a 21 bed open general adolescent unit, commissioned by NHS England, and admits local young people as far as practicable or repatriates local young people that have had to go out of area for urgent care and treatment. Young people admitted are aged between 12 and 18 years and admission criteria include that they suffer from a mental disorder. Some children are detained under the Mental Health Act; this is an increasing percentage. 10 of the 21 beds are commissioned for young people with eating disorders. The treatment includes a structured eating programme with psychological support and nasogastric (NG) feeding if required. The median length of stay is between 58 and 110 days dependant on the young person’s presentation and diagnosis. Their discharge pathway is usually involves returning home to family or in some circumstances supported living. The occupancy has been 82.46% for the reporting year. Use of restrictive interventions Young people admitted to Leigh House pose mainly risks to themselves through self-harm or food/fluid restrictions, and as such, present with some challenging behaviours when staff intervene in preventing self-harm or support with NG feeding. This

sometimes requires the use of restrictive interventions such as restraint in order to manage the immediate risk, to keep that young person and staff members safe. All restraint is carried out in accordance with the legal framework as prescribed in the Mental Health Act Code of Practice, Trust policies and procedures. All incidents, including episodes of restraint, are reported on the Trust’s incident reporting system. This information is available to clinical teams in Leigh house to identify emerging trends, and to track the progress of individual young people.

There were 226 episodes of restraint in the reporting period 2017/18. The majority were to manage risk of harm to self, 11 were required to manage the risk of harm to others, two to stop patients from inflicting serious damage to property and in seven cases the incident forms did not specify the cause for use of restraint. This




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has been identified as a data entry issue to our governance team and should not reoccur in future reporting. The spikes in restraint are related to a small number of young people, between one and four of the occupied beds. The episodes of restraint are reported as preventing self-harm but also to prevent absconding as the unit is open. The use of prone restraint in Leigh House over the reporting period accounts for less than 0.5% of the overall restraint positons utilised by the team. Although the team work very hard to deescalate young people and prevent all types of restraint, prone restraint cannot currently be eliminated completely as there are no alternative restraint positions advised by Southern Health Foundation Trust to give intramuscular injection medication. In addition, in some cases prone restraint may be clinically more appropriate for individual young people, for example to prevent retriggering of past trauma associated with supine restraint. In these cases restraint position is specifically care-planned.

Hampshire CAMHS Safeguarding Practice In the recent CQC inspection, the final report highlighted the care and compassion that staff show towards the children and young people within Hampshire CAMHS, leading to an outstanding judgement for caring. Safeguarding practice was considered by CQC to be effective and robust.

Individual safeguarding cases have illustrated high levels of staff sensitivity to the needs of the child, the recognition of abuse and neglect and the wider associated safeguarding risks. Hampshire CAMHS is committed to learning form significant events; serious case reviews, multi- agency reviews, serious incidents or learning from individual cases. Examples of learning include the completion of the Hampshire CAMHS child not brought non-engagement process (SCR learning), which has now been implemented in practice, and a self-harm reflective review. The child not brought process includes service-specific designed leaflets which have been developed and reviewed in consultation with parent/carers and former service users. In addition, posters have been produced to be displayed in waiting rooms within the clinics. These publications are also supported by traffic light guidance illustrating risk and letter templates to support the process. This is to ensure that children and young people receive an appropriate risk assessment if their health needs are not met through missed appointments. Following a disproportionate number of serious self-harm incidents in one geographical location within Hampshire CAMHS, a request was made to the local safeguarding children board to see if there was any significant learning to be gained from a multi-agency reflective audit. The cases concerned had previously been subject to scrutiny through the internal serious incident investigation process. The




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multi-agency self-harm audit highlighted some significant findings in relation to young people’s experience of domestic abuse, sexual abuse/exploitation and impact upon their own mental health. The findings will be widely disseminated across agencies and used to inform practice. Four internal safeguarding audits were conducted last year. Two Multi-agency Risk Assessments Conference (MARAC) audits as virtual engagement with MARAC was implemented across Hampshire CAMHS teams following the JTAI inspection for domestic abuse. The third audit related to child protection conference attendance and child protection report writing compliance. The fourth audit related to children in care record keeping and application of children in care alerts. Audit findings have been shared across the service. The monthly safeguarding digest continues to be written and produced on a monthly basis. The safeguarding digest details both Trust, local and national changes and disseminates learning in the form of serious incidents, serious case reviews, multi-agency reviews or critical learning. Findings from internal audits are also included within the newsletter. A safeguarding induction pack has been produced for both new and existing staff to support them to understand safeguarding practice and process.




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Specialist Safeguarding Children Level 3 training has been delivered with more sessions booked for later in the year. The training has been designed to be an interactive workshop using case studies to explore key safeguarding themes which are pertinent to CAMHS and current safeguarding priorities. Multiple Prevent workshops to raise awareness of the risks of radicalisation have also been delivered. Hampshire CAMHS proactively engaged with the joint targeted area inspection dry-run audit on the theme of neglect. As a service, CAMHS have an extremely diverse and complex caseload which requires consideration of not only the individual but the family and wider social context. Working alongside other agencies to meet the needs of the local population is a service priority for this year. As a service CAMHS receive a significant number of historical abuse disclosures. This can be further complicated if the young person/child has complex mental health needs. This issue was raised to the HSCB as it was felt further guidance in such situations would be beneficial. The named nurse and named doctor have been working in conjunction with a multi-agency group to produce county-wide guidance to inform practice in this sensitive area. The draft guidance will be finalised in 2018/19.




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Priority 5 – Stakeholder engagement During 2017/18, the HSCB has re-focussed elements of its stakeholder engagement programmes and delivered some events targeted at specific groups.

Multi-Agency Professionals HSCB has revised its approach to engaging frontline professionals across the county. Previously, engagement had operated through regional groups of managers. These groups focussed on disseminating information and providing a forum for professionals to feed into the Board’s quality assurance work. During 2017, the HSCB launched a new programme of Regional Practitioner Forums. The forums operate three times a year in a number of locations to ensure the Board reaches professionals from across the broad geographical area. The Regional Practitioner Forums are aimed at frontline professionals and provide an opportunity to brief staff on learning from reviews and audits, increase knowledge of updated policies and procedures and consult on new initiatives and resources such as the neglect toolkit. The forums also enable professionals to receive briefings from other agencies and areas of work (e.g. Multi-Agency Safeguarding Hubs, Multi-Agency Public Protection Arrangements). At each forum, attendees are asked for feedback on areas to escalate to the Board and/or its subgroups, as well as themes or agencies that they would like to learn more about at future forums.

The first round of practitioner forums were held during November and December 2017 with a follow-up session delivered in February 2018 due to high demand. These events were attended by approximately 100 professionals from across the partnership.

Children and Young People During 2017/18, HSCB has engaged with children and young people on a number of different areas of work. HSCB have a proactive relationship with the Police and Crime Commissioner’s Youth Commission. HSCB’s Partnership Support Team meets with the Youth Commission a number of times a year to consult with them and receive feedback on different themes. In this reporting period, the Youth Commission have reviewed the infographic version of the HSCB annual report and provided suggestions as to how it could be made more accessible and attractive for children. They also reviewed the ‘children and young people’ section of the HSCB website and provided feedback on the content and layout. They have also reviewed the content of the neglect toolkit and provided additional information to include in the ‘life of a teenager’ section. In addition, members of the Youth Commission attended and presented at the first joint HSCB/HSAB annual conference in 2017 on the theme of a family approach to domestic abuse. Youth Commission Members addressed the conference and gave views on the service provided to children affected by domestic abuse.




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Students from local colleges also attended both the Family Approach to Domestic Abuse and the county lines conferences and provided positive feedback via their tutors. HSCB has developed links with the children and young people’s forums of Hampshire CAMHS. Members from this group have also provided feedback on the infographic annual report as well as on the content of the neglect toolkit.

Early Years Sector The HSCB Partnership Support Team has been working closely with the Hampshire County Council Services for Young People team to develop a programme of safeguarding briefings for Early Years providers including nurseries, pre-schools, childminders and nannies. The support team have also developed briefings on a range of safeguarding topics including neglect, unidentified adults, abusive head trauma and non-accidental injuries in babies. The briefings, which also include updates from the Board as well as local and national guidance changes, provide the opportunity for the Early Years sector to inform the work of the Board and request themes for future safeguarding events. The briefings are delivered to early years professionals at 11 different sessions across the county on a termly basis. During 2017/18, the briefings were attended by 325 professionals. In addition, video footage of the training was made available for childminders and nannies who could not attend the briefings in person.

Voluntary Sector HSCB has a positive relationship with the Hampshire Voluntary Alliance. The Alliance is open to any charity/voluntary organisation working with children and young people in the local authority area of Hampshire. Through this relationship, HSCB has gained voluntary sector representation on the Board and a number of subgroups. In early 2018, HSCB held a safeguarding workshop with members of the Voluntary Alliance. This provided an opportunity to engage specifically with the voluntary and community sector and hear directly from them on safeguarding issues. The workshop included briefings from the Willow Team on child exploitation, the Multi-Agency Safeguarding Hub (MASH), the Neglect Toolkit and a question and answer session on safeguarding issues and Board priorities.

HSCB Website HSCB further developed its website during 2017/18. Following the positive response to the online neglect toolkit, and professionals’ feedback on its accessibility and ease of use, the Partnership Support Team developed other ‘toolkit’ style resources for partners. The website now hosts an ‘unidentified adults’ toolkit providing information and resources to support professionals in their work to identify adults and family support networks for children.




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During 2017/18, there were a total of 35,150 visits to the HSCB website by 23,224 unique users.

Communication from the Board Newsletters are produced after each Board meeting for dissemination across the HSCB network. They provide an overview of decisions made by the Board, signpost to any new policies or resources and give notice of upcoming events and training. The 4LSCBs across Hampshire & Isle of Wight have also produced regular briefing documents to highlight changes and promote awareness and understanding of key 4LSCB policies. These briefings summarise key learning points from the full protocols and in 2017/18, topics included 4LSCB Procedures and the 4LSCB Unborn/New-born Baby Safeguarding Protocol.

Hampshire’s 5CCGs The voice of the child and their carers remains a fundamental tenet of the CCGs’ vision to inform service provision and delivery. Ensuring that all Looked After Children (LAC) have the facility to communicate what they perceive they need, as well as their carers, continues to be a priority as part of the Locally Commissioned Service (LCS) for initial health assessments. The LCS, as reported last year, is built around hearing clearly the commentary and concerns of LAC and their carers.

Building on the success of the 2016 Safeguarding Annual Conference, where a care leaver addressed the delegation on what it felt like for them accessing health services, the 2017 conference asked care leavers if they would like to have an information stand about what they thought about health, what they struggle with and what they would like to see. This opportunity was taken up readily by some care leavers. During the conference, they spoke directly to delegates at the stand and then approached the organisers to speak from the platform which they did eloquently. This was very well received by those in attendance. The comments from young people have been incorporated into a poster and moving forward will form the basis of the strategy to address the health of care leavers.




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Spotlight on Fitfest This year’s health and wellbeing event encouraged young people in Hampshire to ‘Get Fit, Get Happy and Get Healthy’. A range of workshops were delivered by clinicians, artists and sports people. Young people had the opportunity to learn:

How to identify, express and manage their emotions.

The ingredients of the food they were eating.

How to improve body image and self-esteem. Additionally, various sports and creative activities were available including: street dance, martial arts, pottery, decoupage, drama and storytelling. This gave people the opportunity to experience a new activity and understand the connection, and positive impact, these activities can have on emotional wellbeing. Opportunities to access relevant information and learn skills in a fun and non-stigmatising environment are vital and the right of all young people in Hampshire. Between April 2017 and April 2018, there have been two mobile fit fests in schools in Aldershot, one in the New forest and three Hampshire-wide Fit Fest events in Havant and Winchester. This has involved approximately 455 young people and their teachers.

Hampshire CAMHS Campaigns

The 2017 Hampshire CAMHS campaign focussed on raising awareness around youth suicide and on the issues facing young people that can lead them to consider ending their lives by suicide. The projects worked directly with young people and focussed on building their emotional resilience. In addition, there were outreach projects that made the general public more aware of the pertinent issues and the role they can play in supporting a young person.

In 2018, Hampshire CAMHS have launched the EVERYBODY campaign with a focus on eating disorders. The intention is to use this opportunity to address the related issues of confidence and self-esteem which are integral to young people’s mental and emotional health and how they manage with the modern day challenges that face them. Hampshire CAMHS are seeking to inspire and empower young people with positive ways of coping and genuine confidence and happiness, and allow them to reach their potential.

Hampshire CAMHS will be seeking to run this campaign in creative and innovative ways that enable young people, parents/carers and the general public to hear and understand the information, working collaboratively with partner agencies. Many of the plans will also build relationships and confidence between CAMHS and young people, families and relevant professionals.




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Workforce Development HSCB continues to support agencies in meeting their responsibility to ensure professionals working with children and families receive safeguarding training by providing a multi-agency training programme. The development of the 2017/18 programme was based on themes from the HSCB annual training needs analysis, HSCB business plan priorities and national and local learning from Serious Case Reviews. A total of 43 learning interventions were delivered between April 2017 and March 2018 and were attended by 1,018 people from multi-agency settings and the voluntary sector. Key training provided by the HSCB The top five interventions attended based on the total number of bookings comprised:

HSCB/HSAB Conference – Adopting a Family Approach (97%).

Missing, Exploited and Trafficked Children (MET) (90%).

Learning Lessons Workshops (88%).

Working with Hostile Families & Disguised Compliance (88%).

Safeguarding Disabled Children (85%).

Group/Sector Attended

District/Borough/City Councils 71

Childrens Services 284

Education 55

Health 240

Housing 7

Others (incl. YOT) 55

Police 99

Pre-school/nursery 6

Probation 19

Schools 99

Voluntary 83

Total 1,018

Summary of Impact and Evaluation Reports HSCB, as part of its statutory role, should ‘monitor and evaluate the effectiveness of training, including multi-agency training, to promote and safeguard the welfare of children’. It is within this context that course evaluation is undertaken by the Children’s Services Workforce Development Team (WDT), supported by direct observations of training events by members of the HSCB and WDT colleagues. The methodology used is Guskey’s model of training evaluation and is designed to incorporate multiple sources of information to provide more reliable results. All HSCB courses delivered within 2017/18 were subject to Level 1 Learning Transfer–Reaction Level.




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This included self-reports from course participants of the level they were engaged with and enjoyed the training. Longitudinal evaluation The WDT plan for longitudinal evaluation includes more in depth evaluation of agreed training events. Specifically, data is collected from the trainer, trainees and their managers at different stages including pre-course, immediately post-course and at internals after the training (i.e. three or six months). This information is collated and analysed, conclusions determined, and shared with HSCB. Any actions are identified, implemented and reviewed. This remains a work in progress to build on for 2018/2019. In this context, two courses were subject to longitudinal evaluation during the 2017/18 and separate reports have been provided to HSCB. In summary, a re-commissioned course ‘Missing, Exploited and Trafficked Children’ was delivered for the first time in January 2018 and was subject to longitudinal evaluation. This course has been positively received and an observation from the HSCB and WFD team noted. The second longitudinal evaluation completed was for the ‘Introduction to Neglect’ course. The following are some of the positive comments from delegates:

Missing, Exploited and Trafficked Children

‘A good robust course which covered all learning outcomes and highlighted the importance of professional curiosity, the importance of the context and bigger picture as well as the “online lives” and impact of this being a pathway to potential harm’. ‘Really useful sessions – highly informative – would be interested in attending other relevant training by the same group’. ‘Fantastic course that I will be able to share with colleagues, and I will ensure additional consideration when meeting with children and young people’.

Neglect

‘I found the session very rewarding and well presented’. ‘The course was really helpful and the trainer was engaging’. ‘The course has strengthened my knowledge, as yet I have not needed to use the Neglect Toolkit but it will be useful in the future’.




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Course Development For the past 18 months the WDT have been working closely with HSCB to support the implementation and delivery of new courses, including securing suppliers for the delivery of the following:

Missing, Exploited and Trafficked Children (MET).

Introduction to Child Neglect.

Supervising and Managing Staff who have a responsibility for Safeguarding Children.

Additionally, the HSCB have worked jointly with HSAB to develop and deliver training on:

Adopting a Family Approach to tackling Substance/Alcohol Misuse, Mental Health and Domestic Abuse.

Virtual College eLearning

HSCB, in partnership with Children Service’s Workforce Development Team, utilises the Virtual College which offers an alternative to classroom based learning. Virtual College courses now comprise part of a blended approach to learning, with eLearning taking place as part of pre-course learning on a number of face-to-face interventions. Legal Masterclass Training Following a health review, which the Designated Doctor and Designated Nurse (West and North Hampshire CCGs) completed, a ‘Legal Masterclass’ was conducted in July 2017. 76 multi-agency professionals attended the masterclass. 76% of these delegates stated that the masterclass would change the way that they work. Delegates identified: ‘Always clearly differentiate (and quote evidence if possible) what is

fact and what opinion is’.

‘Recognising what needs to be written that may be obvious to one agency that is not to another agency. It is OK to say that you cannot

give an opinion/answer if you are unable/outside of expertise’. Following the positive feedback, and the request from delegates for more training, the Legal Masterclass will be repeated in 2018/19.




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Priorities for 2018/19 The HSCB Business Plan 2018/19 is focused on strategic priorities that form the basis of the work of the Board over the coming year. These priorities support the statutory functions of the HSCB and the partnership response to protecting vulnerable children, preventing harm and promoting their welfare. The structure of the Business Plan allows the Board to remain flexible to respond to the emerging areas of work and also to refine existing programmes of activity in line with feedback received from children, their families and professionals. To support the delivery of the Business Plan, the HSCB have produced more detailed work plans, aligned to the Board’s priorities, which will be delivered by each subgroup and associated work-streams. HSCB will take a leadership role in the delivery and quality assurance of partnership work in these areas. Progress against this plan will be reviewed and monitored by the Board’s Executive Group with chairs of the relevant subgroups reporting on progress against their actions. Where necessary and appropriate, the Executive Group will highlight areas of concern to the full HSCB Board meetings for further action. HSCB will also identify and promote good practice across its partner agencies.

The Board’s priorities for 2018/19 are as follows: Adopting a Family Approach

That both the child and the adult are ‘seen’ by members of the children’s and adults’ workforce and that there is a common understanding of how their needs are interdependent.

That staff working with children at risk from factors relating to adults, and professionals working with adults within the family, understand what it is like to be a child living in that environment.

Strengthening our Assurance Programmes

HSCB is assured that the services provided to children and their families in Hampshire are timely, appropriate and effective.

Engagement

The Board engages with children, their families, and professionals to receive feedback on its work and to gain assurance that services to support children in Hampshire are fit for purpose.




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Leadership and Transformation

The HSCB leads the safeguarding agenda, challenges the work of partner organisations, and commits to an approach that learns lessons, embeds good practice and is continually influenced by children, young people and their families.

Working with the Police and Board Partners to embed a ‘Trauma Informed Approach to early intervention and prevention’. This approach will be explored further and opportunities for multi-agency programmes of work agreed during the coming year.

Key Threads that Run Through all Priorities

The voice and lived experience of the Child - to ensure that our work is child-centred and we continually seek to engage and involve children and young people.

Multi-agency partnership working - including the voluntary, faith and community sectors.

Lessons are identified and learned from case reviews and multi-agency audits undertaken, and the monitoring of the implementation of recommendations.

All of our work is underpinned by a focus on making sure that basic practice (as prescribed within statutory guidance and local procedures) is effective, timely and of high quality.




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ADOBE STOCK Certain photographs used in this report have been licensed from Adobe Stock.

These photographs are protected by copyright law. Resale or use of any photos used in this report is prohibited. Photographs © / Adobe Stock



hampshire safeguarding children board annual report 2017/18 · hampshire safeguarding children...

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