Wirral LSCB Logo


Top of page

Size: View this website with small text View this website with medium text View this website with large text View this website with high visibility

4.11 Management of Children and Young People in Need who are Medically Fit for Discharge

SCOPE OF THIS CHAPTER

This chapter identifies the procedure and protocol with regard to children who are in hospital and defined as Children in Need within the meaning of the Children Act 1989 and where safeguarding becomes a consideration.

RELEVANT CHAPTERS

Recognition of Significant Harm Procedure

Thresholds for Services to Children

RELEVANT GUIDANCE

Managing Self-Harm in Young People (Royal College of Psychiatrists)

AMENDMENT

In February 2015, a link was added to the Royal College of Psychiatrists’ Managing Self-Harm in Young People guidance located above in Relevant Guidance.


Contents

  1. Introduction
  2. Corporate Responsibility for Children in Need
  3. Children to Whom This Protocol Applies
  4. Initial Contacts
  5. Who Should Call a Discharge Meeting 
  6. When Should a Discharge Meeting be Called 
  7. The Purpose of a Discharge Meeting for Children in Need
  8. What Information Will Be Required for a Discharge Planning Meeting
  9. Power to Detain Children in Hospital


1. Introduction

This protocol has been produced primarily for the use of professionals who will be involved in the undertaking of assessments of Children In Need and their families under the Children Act 1989, which includes children in need of protection. It builds on the national guidance for children: Working Together to Safeguard Children (2015), Framework for the Assessment of Children in Need and their Families (2000) and includes the Laming Report Recommendations (2003) following the death of Victoria Climbie and the progress report The Protection of Children in England (2009).


2. Corporate Responsibility for Children in Need

Delivering services to children in need in our communities is a corporate responsibility, which falls on all local authority departments, health authorities and community services. The Children and Young People’s Department has lead responsibility for establishing whether a child is in need and ensuring that a Social Work Assessment of Needs and Strengths are carried out. This means planning, preparation, co-ordination and communication with professionals in other agencies, which includes ensuring that the health and educational dimension to children’s needs are included as central to the Social Work Assessment of Needs and Strengths.


3. Children to Whom This Protocol Applies

This protocol applies to all children in need.

There has been growing concern about the extent of mental health of children in recent years through improved assessment and recognition of early symptoms and behaviour of children and young people.

The types of behaviour concerned are:

  • Self harm;
  • Self neglect;
  • Severe challenging behaviour where they are a risk to themselves.

Often these children and young people are medically fit for discharge but are not co-operating with treatment or rehabilitation plans.

The Child and Family Service provide a risk assessment for young people and this protocol emphasises existing arrangements between Child and Family Services and other services.

Many of these young people may be at risk and require Child Protection procedures to be applied and this protocol would not replace the LSCB arrangements where abuse is suspected or an allegation has been made. What it does require for each child in need is for a discharge planning meeting to take place before the child or young person is discharged home following a referral to the Children and Young Peoples Department.


4. Initial Contacts

All contacts to Wirral Children and Young Peoples Department must be made to the Integrated Front Door (Telephone number 0151 606 2008). If the contact concerns harm or potential harm then the staff/professional concerned must detail their concern verbally and in writing to IFD, through the means of completing the Multi agency request for services (MARS) form All contacts by professionals must be confirmed in writing within 48 hours of contact.

IFD are not an assessment service – the service will forward details of the contact to the assessment team in the child’s District who will acknowledge the contact within 24 hours by sending a feedback form to the referrer. The Assessment Principal/Practice/Team Manager will then decide, within one working day, what action is necessary, including any discharge arrangements. (Where the contact concerns harm or potential harm the contact will be forwarded to the appropriate assessment team within one hour).

All children in need and those in need of protection will be subject to a Social Work Assessment of Needs and Strengths, which has a maximum timescale of 10 days from the point of referral being accepted. For children where it has been deemed necessary by the Children and Young People’s Department to conduct an investigation (section 47) the timescale will be moved into 35 days in order to conduct a Social Work Assessment of Needs and Strengths following consultation with the Key partner agencies such as Police, Health, Education, the child and relevant family members and any other agencies involved.

For those children and young people where harm is not immediate or apparent but there is concern about their wellbeing a Social Work Assessment of Needs and Strengths would be used as a framework to conduct the multi-agency assessment. The decision to undertake a Social Work Assessment of Needs and Strengths is made by the relevant district Practice/Team manager.


5. Who Should Call a Discharge Meeting 

Any agency can call a Discharge Planning Meeting but as the child or young person is residing in hospital then it is generally expected that the staff, including hospital paediatrics, would host and Chair the meeting.

Hospital Trusts will have their own local procedures which should be followed for deciding whether it is appropriate to call a Discharge Planning Meeting. This protocol should be placed in the context of local NHS procedures.

If the meeting were called under WSCB procedures it would become a strategy meeting Chaired by a Children's Specialist Services Principal/Practice/Team Manager with Police in attendance. The attendance and participation of hospital staff at the strategy meeting is vital.


6. When Should a Discharge Meeting be Called 

The meeting should be held within 24 hours of the need being identified and assessed. The Child and Family Services will have completed a risk assessment and will present this to the discharge planning meeting at which an appropriate representative will attend from Children's Specialist Services.


7. The Purpose of a Discharge Meeting for Children in Need

The purpose of a discharge planning meeting is to bring professionals and those working with the child or young person and their family together to consider:

  • What services are needed to promote a plan for improvement in their welfare;
  • Who and which agency should contribute to the assessment and production of this plan;
  • What are the likely outcomes;
  • Any shared financial responsibilities to be agreed; and
  • When the plan is to be reviewed.


8. What Information Will Be Required for a Discharge Planning Meeting

Under the Assessment Framework the social worker conducting the Social Work Assessment of Needs and Strengths will need to have spoken with the child or young person alone and their family with a view to ascertaining their wishes and feelings as well as conducting information gathering and assessment. A child’s living environment will need to have been assessed which will mean home visiting with parents/carers before a discharge plan has been agreed.

Ward staff will be expected to contribute by assessing the child’s routines and reaction to hospital environment and have an assessment of any family visits. All professionals will be expected to contribute from their own professional discipline and be able to inform the meeting of services that can be expected to be provided.

Issues that may need to be considered are:

  • Any immediate safeguarding measures that are required;
  • The need for any Risk Management Plans agreed with the Child and family service – this may include any strategies that are agreed between parents and school staff in specific relation as to how any risk taking behaviour can be monitored and managed within the school/college environment;
  • What assessments are required and by whom they are to be completed;
  • Any other agreed actions for referring to relevant supportive agencies in the Voluntary, Community and Faith sectors, including any services that may be required for interpretation or translation.
This list is not exclusive of any other arising issues


9. Power to Detain Children in Hospital

The granting of an Emergency Protection Order would authorise the prevention of the child’s removal from hospital (Section 44 Children Act 1989). As an ‘authorised’ person a hospital worker can make an application to the Court for an Emergency Protection Order.

Equally the Children and Young People’s Department may apply for an order where they are making enquiries under Section 47.

End