Multi-agency safety planning
Updated: 01 April 2017
What's Important To Us
At the forefront of our concerns is the safety and welfare of children and young people. We support multi-disciplinary practice as a means of securing safe care for children and young people. Concurrently important is involvement with family/whānau in planning and decision making to allow for flexible practice with family-led solutions. For children and young people admitted to hospital with a suspected non-accidental injury, multi-agency planning around how they will be kept safe from further harm happens prior to their discharge.
This key information will assist you when planning safety for children and young people leaving hospital.
A collaborative approach and multi-disciplinary process involving professional colleagues and the family/whānau is needed if we are to secure safety for children and young people.
You might also find Building safety around children and young people helpful as you work through this planning process.
Building relationships and engagement
Working collaboratively with other professionals and the family/whānau is critical to securing safety for children and young people. The multi-disciplinary process for decision making and planning begins when the child or young person is first identified as being at risk and continues during the child or young person's hospital stay. Working closely with our health and Police colleagues right from the beginning of the case is critical if robust and safe decision making is to occur. This will be a time of exceptional stress and worry for the family/whānau and the injured child or young person. The social worker, hospital staff and other professionals involved need to work closely with the family/whānau to ensure safety is achieved.
It is important that the social worker engages positively, is easily accessible and communicates clearly with everyone involved. Make sure that everyone knows the contact details of the social worker and their supervisor. Additional stress and pressure is experienced when a hospitalised child or young person attracts media or political attention.
Being clear about roles and responsibilities
If the child or young person is hospitalised away from their home site be very clear about the roles of the local co-worker and the 'home site' social worker. When children or young people from outside the Auckland metropolitan area are admitted to Starship Children's Hospital, Grey Lynn social workers will co-work the case while the child or young person is in hospital. The ‘home’ site manager or practice leader will contact Grey Lynn's duty supervisor or practice leader as soon as possible to ensure good communication, planning and follow up with all parties.
Working collaboratively across disciplines provides the opportunity for workers to have robust discussions relating to the child or young person's care and safety. Whilst everyone is working together for the safety and wellbeing of the child or young person, sometimes opinion on how this should be achieved can differ. Although you will need to make sure that everyone is heard and their concerns considered, it is Oranga Tamariki who have the statutory responsibility for taking steps to ensure the care and protection of children and young people.
How planning should occur
When a child or young person is hospitalised because of a suspected non-accidental injury safety needs to be built around the child or young person prior to their discharge so that upon their release they are protected from the possibility of future harm.
Discharge planning may occur in the discharge meeting or at a separate multi-disciplinary meeting and shared during the discharge meeting.
Because different hospitals have different requirements, be clear about when and where the planning will occur and who needs to be involved in the discussions well before the discharge date.
Who should be involved in the planning process?
While regions and hospitals manage processes around children and young people in hospital differently, the one consistent thing that needs to occur iare arrangements made prior to the child or young person leaving hospital about how they will be kept safe in the future.
The people who have been involved in the child or young person's care, decision making and planning since they were admitted to hospital need to be involved in these discussions. These people might include:
- relevant 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 family/whānau
- counsel for the child if one has been appointed
- the Oranga Tamariki social worker.
Sometimes it is useful to have a senior Oranga Tamariki person (e.g. supervisor and/or practice leader) involved in the planning process, particularly at meetings where there are multiple health professionals and complex interfaces to manage.
If the child or young person is hospitalised away from their home, the ‘home site’ social worker and supervisor will need to be involved by telephone or videoconference if they are unable to attend in person.
Wherever possible the parents, family/whānau and (if age appropriate) the child or young person should be involved in the planning along with agencies providing services and supports either in person, by telephone or videoconference.
Practical things to think about for meetings
- A comfortable room for the number of people attending
- A whiteboard and pens
- A person appointed to keep and distribute accurate minutes of the meeting
- A phone or televideo link, if necessary
- Consider using a facilitator for the multi-disciplinary safety planning meetings particularly if there are a large number of people or complex issues to consider.
Developing the child or young person's plan
Every child or young person admitted to hospital with a suspected non-accidental injury (and/or with whom we are working in an intervention phase) will have a plan that guides our current and future work with them.
The plan must be robust and unambiguous, give primacy to ensuring the safety of the child or young person, provide for the child or young person’s ongoing health and the wellbeing needs of the family/whānau.
Keep your plan simple and straight-forward and use language that the family/whānau and child or young person can understand. You will have had ongoing conversations with the family/whānau about harm and danger and so the issues you raise in putting the plan together should not come as a surprise to anyone.
Use the SMART plan format when agreeing and writing up the child or young person’s plan: make sure it is Specific, Measurable, Achievable, Relevant and Time framed.
The process of building and maintaining safety around a child or young person will be a key feature in their plan – the plan can’t work if it doesn’t also address safety – and for children and young people who are due to be discharged from hospital, consider the following questions in the development of their plan:
- Where will the child or young person will live?
- Who will the child or young person live with and for how long?
- Who in the family/whānau will have contact with the child or young person?
- When will this contact occur and who will supervise this?
- What health services do the child or young person need and who will provide them?
- Who will ensure that the child or young person gets to their appointments?
- What support does the family/whānau need, who will provide this and by when?
- How will the plan be monitored (meeting, phone calls, written reports?)
- Who is responsible for monitoring and how will people be kept informed?
Other important things to remember
Working collaboratively is important and needs to begin as soon as the child or young person is admitted to hospital. Don’t wait until discharge before getting the family/whānau and professionals together. The sooner we start working on the issues, the sooner we can build safety around the child or young person.
It is important that the wishes of the child and family are known and considered in pre-discharge planning, particularly if they are not able to attend the meeting.
The availability and commitment of any agency nominated in the plan should be determined before the pre-discharge meeting and wherever possible that agency should attend the pre-discharge meeting.
Meet with your supervisor and other involved site staff before the discharge planning meeting to talk through the safety and care issues for the child. If this is an 'out of site' situation, the key and co-social workers and their supervisors should have a video conference. The site to which the child or young person returns will need to make sure that proposed services and supports have been approached and agreed before the child or young person returns to the home district.
If the parents/usual caregivers are unwilling to engage in developing the child or young person’s plan, or you consider that there is an unacceptable risk that the plan will not be followed by the family/whānau, consider what further action might be needed to ensure the child or young person's safety. This may involve initiating court proceedings - discuss this with your supervisor and lawyer if you think this is necessary.
In most circumstances when a child or young person has been hospitalised because of illness or accidental injury, the hospital will call a discharge meeting shortly before the child is discharged.
Tabling the plan for the child or young person at the discharge meeting will help to ensure that everyone involved is clear about the way forward.
The discharge meeting will involve relevant hospital staff, any home care agencies providing post hospital care and the family of the child. The purpose of a discharge meeting is to ensure that post hospital health care is organised by health professionals and that the family/whānau understand and can provide any in-home procedures, care or medication necessary.