Last updated: 14/04/2023

Guidance

Responding to non-accidental injuries – multi-agency safety planning

We work collaboratively with professionals and whānau or family to secure the safety of tamariki with a suspected non-accidental injury.

Upcoming changes for this guidance

This content will be strengthened so it more completely reflects our commitment to practice framed by te Tiriti o Waitangi, based on a mana-enhancing paradigm for practice, and drawing from Te Ao Māori principles of oranga to support mana tamaiti, whakapapa and whanaungatanga. We each need to consider how we can apply these principles to our practice when reading this guidance. The following resources provide support:
Practice for working effectively with Māori
Our practice approach

What is a non-accidental injury

A non-accidental injury (NAI) results when a person does something that physically harms or injures te tamaiti.

Physical abuse

Neglect

When we become aware of a non-accidental injury

We are likely to become aware of an actual or suspected non-accidental injury through a report of concern. Anyone can make a report of concern, including a hospital or another medical professional, another professional like a teacher or lawyer, a whānau or family member or friend, or a member of the public.

All reports of concern follow the normal intake pathway.

Intake decision response tool

Intake and early assessment

If the concerns are very serious, we should notify emergency services or encourage the notifier to do so.

Start the collaborative and multi-disciplinary process for decision-making and planning

When we receive a report of concern about te tamaiti experiencing a suspected non-accidental injury, we need to:

ensure their immediate needs are met
work collaboratively to keep them safe from further harm.

We work with the notifier to understand the concerns and gather information to inform safety planning.

We work together with te tamaiti, their parents and whānau or family, and professionals to discuss the concerns and develop a safety plan.

Practice standard: Work closely in partnership with others

Protect and support the development of tamariki and rangatahi within healthy whānau and families

All cases that require an investigation response are worked in consultation with Police following the Child Protection Protocol.

Child Protection Protocol (CPP)

Working collaboratively achieves better outcomes by:

ensuring robust and safe decision-making
reducing stress and worry for te tamaiti and their whānau or family.

If professionals disagree, we make sure that everyone is heard and their concerns are considered. If agreement can’t be reached, it is Oranga Tamariki that has the statutory responsibility for taking steps to ensure the care and protection of tamariki.

We start the collaborative and multi-disciplinary process for decision-making and planning as soon as te tamaiti is identified as being at risk – preferably within 24 hours of their admittance to hospital.

Because different hospitals have different requirements, we need to be clear about when and where the planning will occur and who needs to be involved in the discussions to ensure a plan is in place well before the discharge date.

We need to involve all the people who have been caring for te tamaiti, making decisions and planning since they were admitted to hospital. These people might include:

nursing staff
the paediatrician or other medical specialists
the hospital child protection worker
the Oranga Tamariki hospital liaison social worker
the investigating police officer
other agencies or professionals working with the whānau or family
counsel for te tamaiti if one has been appointed.

If there are multiple health professionals and complex interfaces or issues to manage, we might include a senior Oranga Tamariki person (such as a supervisor or practice leader) or use a meeting facilitator.

The social worker should be easily accessible and make sure everyone has their contact details and their supervisor’s contact details.

Policy: Assessment – when te tamaiti is in hospital with a suspected non-accidental injury

Staff resource: Schedule 1 — Children admitted to hospital with suspected or confirmed abuse or neglect

Be very clear about the roles of the local co-worker and the key 'home site' social worker. A video conference between the social workers and their supervisors can help. The key worker needs to make sure that proposed services and supports have been approached and agreed before te tamaiti returns home.

Allocating a key worker and co-worker

When tamariki from outside the Auckland metropolitan area are admitted to Starship Children's Hospital, Grey Lynn social workers co-work the case while te tamaiti is in hospital. The ‘home site’ manager or practice leader contacts Grey Lynn's duty supervisor or practice leader as soon as possible to ensure good communication, planning and follow up with everyone.

Policy: Assessment – when te tamaiti is in hospital with a suspected non-accidental injury

Staff resource: Schedule 1 — Children admitted to hospital with suspected or confirmed abuse or neglect

Engage with te tamaiti and their whānau or family as early as possible

Parents, whānau or family and te tamaiti should be involved in the safety planning either in person or by phone or videoconference.

We need to:

know and consider the wishes of te tamaiti and their whānau or family
talk with the whānau or family about harm and danger, so they’re aware of the issues that will be raised in developing the safety plan.

Hui ā-whānau

If the parents or usual caregivers are unwilling to take part in developing the safety plan for te tamaiti, or if there is an unacceptable risk that the plan will not be followed by the whānau or family, consider what further action might be needed to ensure the safety of te tamaiti. If we’re thinking about court proceedings, we talk with our supervisor and Legal Services.

We need to keep the safety of te tamaiti at the forefront of planning. While we should build safety in collaboration with whānau or family, in situations where it is unclear how te tamaiti has been harmed we also need to consider whether we should immediately apply for a Place of Safety warrant or other legal order to secure the safety of te tamaiti. If we’re thinking about legal orders, we talk with our supervisor or practice leader, Legal Services and the appropriate health representative.

Develop a safety plan

The safety plan should be straightforward, SMART and written in plain language.

Undertake safety planning (step 5) – Core assessment phase

SMART planning

Practice standard: Ensure safety and wellbeing

It needs to outline:

what the safety issues are for te tamaiti, how they will be addressed, and what safety arrangements are already in place
who will care for te tamaiti, and where they will live
who in the whānau or family will have contact with te tamaiti, when this contact will occur and if required, who will supervise it
how any risks to siblings and other tamariki in the home will be addressed
how the emotional needs of te tamaiti will be addressed
how the health and rehabilitation needs of te tamaiti will be addressed
what support the whānau or family needs, who will provide this and when
what financial support is available to those caring for te tamaiti, and who is responsible for providing or accessing this
the roles and responsibilities of professionals
how the plan will be monitored, who will be responsible for monitoring and how people will be kept informed.

Ensure everyone involved has a copy of the safety plan.

Multi-agency safety planning template (DOC 145 KB)

Table the safety plan at the discharge meeting. The discharge meeting is run by the hospital to ensure that:

post-hospital health care is organised by health professionals (such as hospital staff or homecare agencies)
the whānau or family of te tamaiti understands and can provide any in-home procedures, care or medication necessary.

We table the safety plan for te tamaiti at the discharge meeting so everyone is clear about the way forward.

Resources

Multi-agency safety plan template.

(DOC 145 KB)

Every tamaiti or rangatahi admitted to hospital with a suspected non-accidental injury will have a…

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