Transcript Hertfordshire Safeguarding Children Board Topic Group 8

Serious Case Reviews
Local Lessons & Actions
www.hertsdirect.org/safeguardingchildren
Why do we undertake SCRs?
Regulation 5 of the LSCB Regulations 2006
states:
“(1)The functions of a LSCB in relation to its
objective ....are as follows(e) Undertaking reviews of serious cases
and advising the authority and their Board
partners on lessons to be learned.”
When do we undertake SCRs?
When a child dies and abuse or neglect is
known or suspected to be a factor in the death,
the LSCB should always conduct a SCR into
the involvement of the organisations and
professionals in the lives of the child and family.
(Working Together, 2010)
When do we consider undertaking
SCRs?
• When a child sustains a potentially life-threatening injury or
serious and permanent impairment of physical and/or mental
health and development through abuse; or
• A child has been seriously harmed as a result of being
subjected to sexual abuse; or
• A parent has been murdered and a domestic homicide review
is being initiated under the Domestic Violence Act 2004; or
• A child has been seriously harmed following a violent assault
perpetrated by another child or an adult;
AND
The case gives rise to concerns about the way local
professionals and services worked together to safeguard the
children.
What is the purpose of a SCR?
• To establish what lessons there are about the
way professionals and organisations worked
individually and together.
• To identify how theses lessons will be acted
on; in what timescale; and what is expected to
change
• To improve intra- and inter-agency working &
therefore better safeguard children.
Alternative methods of Learning
• Partnership Case Reviews – a systemic model
that is new to Hertfordshire building on the
experience of the police.
• Individual agency reviews – where one
agency/organisation would review its work or
involvement with a family.
• Working groups to address specific case
issues.
SCR in Hertfordshire
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5 SCR completed in past year
3 deaths and 2 serious injuries
3 under 5 years old
1 teenager
Parental mental health problem
Domestic Violence
Parent with learning disability
Substance misuse
Neglect
www.hertsdirect.org/safeguardingchildren
3 cases
4 cases
1 case
1 case
5 cases
What were the lessons in
Hertfordshire
• Keeping a focus on the child
– Can/are the parents meeting the child’s needs
• Working across adult and children's services
– Making best use of expertise
• Accessing and taking account of past history
– Start again syndrome & the rule of optimism
www.hertsdirect.org/safeguardingchildren
What were the lessons in
Hertfordshire
• Assessing the impact of cumulative risk
factors on parenting ability
– Working with complexity
• All significant adults should be included in
assessments
– The absence of fathers, male partners, relatives
• Critical and authoritative child protection
practice
– Family & professional accountability
Implementing the Learning
• SCR Panel has monitoring role
• Evidence of progress against the Multiagency and IMR plans
• HSCB Sub- groups cross reference actions
to ensure all actions taken forward
• Actions cross referenced business plan
Evidence of Learning
• 5 cases of Neglect – Pilot graded care profile
• Multi- agency conference November
• Updated Child Protection Procedures June
2010- Practice guidance
• Audit quality of assessments in cases of
neglect
Evidence of Learning
• Assessments/Domestic violence- keeping the
focus on the child
• Developing multi-agency assessment tool
• Reshaping front end of the service improve
quality of assessments – Targeted Advice
Service
• Adult Safeguarding Board
Evidence of Learning
• HSCB – Learning the Lessons programme
• Partnership News
• Social Care – Learning the lessons workshops
and monthly bulletins
• Evidence of good practice