This document has been created to ensure that each agency provides a consistent response to undertaking checks on individual cases within the MASH. If a case meets Level 4 and Practice Managers make the decision that multi agency checks are required then specific agencies will be ‘ragged in’ to undertake these checks.
There have been some challenges in the past about how much information is required from each agency and that Practice Managers in Social Care were not specific enough in terms what they were asking for. These Practice Standards provide guidance for each partner agency on what to check for and ask in relation to the concerns in the enquiry. For example, the information required for a child who is being neglected may be different from the information required about someone who may be having contact with a risky adult. This means that ‘rag’s completed by Practice Managers will not be specific, as each partner agency is required to use their practice standards as a baseline for those checks. If there are specific pieces of information required that are not covered in the practice standards this will be written into the ‘rag’ and therefore the partners do still need to read the rag to ensure that nothing is missed. To assist partner agencies within MASH, Social Care staff within MASH must comply with the Practice Standard of gaining consent and recording this clearly and where consent is not sought or given again this requires recording correctly. The impact of Social Care staff not recording consent correctly will impact on where partner agencies record their information on MASH Protect. The different examples of how these impacts upon recording practices are noted below:
1) Section 47 Enquiries – all partner information is available in Care First Most of these cases would not have parental consent at the point of referral; therefore agencies record their information onto the ‘sensitive’ section of MASH Protect. It is worth noting, that MASH promotes good practice and when possible adheres to the seven rules of Information Sharing (it is better to share information with informed consent rather than not) by requesting the MASH Officers to make contact with carers/parents and seek their consent for information sharing. If consent is not sought the completion of the Record of Strategy Discussion that contains all multi- agency information, rationale for the decision and plan of actions. This record is available in Care First.
2) Single Assessments In cases where consent was provided by parent/carer directly to referrer, the information gathered by the Children’s Services MASH Officers is recorded in the ‘Disclosed’ section of the MASH Protect and transferred in Care First. MASH partners continue recording all their information in the sensitive section of MASH Protect and this prevents any transfer of data between the two systems. Consequently, the MASH Records available in Care First are very sparse and contain incomplete information.
A number of cases are referred to the MASH without parental consent being secured by the referrer (i.e. NSPCC/anonymous/ family members’ referrals). It is therefore the responsibility of MASH Officer to make contact with parent/carer in order to gain consent for multi-agency checks. Due to the fact that consent was not secured at the point of the RAG, partner agencies record their information in the sensitive section of MASH Protect.
3) Cases without parental consent The MASH information sharing Agreement states that “If a case does not meet this (significant harm) threshold and is referred for early help or child in need services, documented consent will be required from the parents or carers if information is to be shared.” (Northamptonshire Multi-Agency Safeguarding Hub (MASH) Information Sharing Agreement Version 6.5 (Updated September 2014)). Therefore, if consent has not been secured at the point of MARF or during the MASH Enquiry all information will be recorded in the sensitive section of MASH protect and will not be transferred to Care First. Once parental written consent has been gained by the allocated Social worker undertaking a Section 17 assessment, MASH can disclose all the relevant information. Finally, these practice standards are a baseline for all multi agency checks and if you are going to deviate from them, you must record why you are not undertaken a particular check. Social Care MASH Officers are required to get a Practice Manager of Team Manager’s permission before deviating from the practice standards.
Practice Standards for Social Care checks in MASH
The following points are good practice on every case:
Check each adult and each child using name, address and date of birth.
Follow the prompt sheet for MASH officers Regardless of the RAG, MASH officers should consult this document when undertaking MASH checks and follow the practice guidelines. If in doubt consult the NSCB and Children’s Services Procedures.
Sexual abuse
If there are concerns raised about a current sexual abuse allegation – check with a senior and organise a strategy meeting.
Call the paediatrician to see if a medical is required, this will have to take place through Serenity.
When collating the history check for history of sexual abuse/or exploitation.
Clarify where the child is now and if they are safe.
If an adult in the household is a registered sex offender, liaise with Police MASH to see who will liaise with MOSOVO re their involvement with the adult. Sexual exploitation Complete the CSE toolkit with parents and professionals. Liaise with RISE to see if they are involved. Check with a senior if a strategy discussion is required – this will generally by when it is high risk, or we have clear evidence of exploitation. Domestic abuse
Check with IDVA/Police the DASH score. If it is high risk check with a senior if a strategy meeting is required.
Phone/ email Sunflower Centre to alert them of the case so they can pin in and attend the strategy meeting if able to.
Speak to both parents, unless it is unsafe to do so. When talking to victims ensure that they are safe to speak to you. If they feel unsafe consider if Refuge would be an option. Explain the impact of domestic abuse on children to both parents. Clarify what their plans are for the relationship. When collating the history – look for previous incidents of domestic abuse, have they separated and got back to together. Did we close the case agreeing that they could live together?
Neglect
If concerns are about neglect check the history for previous concerns about the same issues. Look for situations where children were left home alone, or found alone in the street, poor home conditions, persistent head lice, poor hygiene, lack of food and clothing. Use the neglect assessment tool as an aide memoir to do this. Speak to professionals about the impact on the child of the neglect. Is one child more neglected than others? Speak to parents about the neglect and consider if they have financial issues, if they have learning needs or mental health issues or drug/alcohol abuse issues.
Children who have been found in seriously neglectful environments may also need paediatric assessments, so call the paediatrician and checks.
Significant injuries occur because of poor supervision; this are classed as neglect but still requires a paediatric assessment. If a child has suffered a significant injury due to neglect or poor supervision please contact the paediatrician. Injuries/bruising to a baby under 6 months or a non mobile child under 2 years old These children must have a paediatric assessment. Call the paediatrician immediately and book this in, speak to senior about arranging a strategy meeting. Injuries to children under 3 years old If a child less than two years old has an injury which meets tier 4 (MASH) we must contact the paediatrician and discuss the concerns and if they advise a medical, please organise. Do not advise parents to send them to the GP. 45% of all serious case reviews where children have died are children under 1 year old. We need to be mindful that this is an age where children are more likely to be abused and therefore we cannot just rely on what parents say.
Physical abuse If a child has a bruise and has made a disclosure of being physically harmed, we must call the paediatrician and book a medical and then organise a strategy meeting. Please contact both parents and with permission anyone else who has cared for the child when the injury may have occurred and get an explanation. Check the history for previous incidents of physical abuse and domestic abuse. Be mindful of the fact that when there is domestic abuse there is a higher likelihood of physical abuse. If there is no disclosure but there are concerning injuries please call the paediatrician.
Drug/alcohol abuse If drug/abuse, please look for previous issues in relation to alcohol misuse or drug misuse. Be mindful that if parents are not attending appointments arranged with services that this could be because they are using illicit drugs and therefore want to avoid testing. Look for concerns about neglect in these cases. Other indicators of people using drugs/alcohol are shoplifting, sex working, and handling stolen goods.
Homelessness
If teenager is homeless call the parents and the teenager, see if they can go home, or if there is somewhere else they can stay, if not this will require an assessment. Get consent from the teenager and their parents for checks. If the teenager is ‘sofa surfing’ or not staying at parents get the all the details of where they are living and add to relationships, as Police will need to do checks on them. If they are living with someone who has CYPS input already, speak to the relevant social worker. If a family is homeless liaise with housing, are they intentionally homeless, do they have no recourse to public funds. Check if they can find themselves somewhere else to stay, it is the parents’ responsibility to find somewhere to stay, but this could require assessment.
Female Genital Mutilation Speak to Northampton Flower and ask for advice. Speak to a senior before contacting the family. Look for confirmation about the family being out of the country for a significant amount of time and changes to the child’s behaviour. If there is intelligence that a child has had the procedure a medical is likely to be required through Serenity.
Fabricated induced illness Refer to the FII procedure and do not tell parents that professionals have concerns about them fabricating or inducing illness. Check with a senior about what to share. The procedure states that you need to talk to the referrer to make a plan about what to share. Also contact the paediatrician as they need to look at the information and consider if a strategy meeting should be held.
Mental health/suicide attempt With teenagers/children check to see if there been previous suicide or self harm attempts. Serious self harm episodes, like jumping off a bridge, taking a large amount of tablets (in excess of 50) etc need a strategy meeting. Check if CAMHS are involved. With parents who have mental health issues consider if there is a safe adult in the household to care for the children. Is the parent suggesting that they have thoughts of harming the child? If so we need to consider a strategy meeting. Ask parents what support they have, do they have a diagnosis and a mental health worker involved. If so ask permission to contact their worker.
Children Missing Look for patterns and dates of missing periods, check for any intelligence around CSE and consider undertaking the CSE toolkit. Check that parents are reporting them as missing on each occasion. Read the return interviews and see if there are any other concerns. Specifically comment on when reported missing and when child found. Children missing for more than 24 hours need a strategy meeting.
Radicalisation Check if Prevent team has been involved and liaise with them about any concerns raised. Andy Blaize or Jody Williams are the points of contact there. Dog Bites See who the dog belongs to and if there are children in the household. How have the adults responded to the concerns? Any child under 2 years old with a dog bite needs consideration for a strategy meeting.
Families in Crisis Look for parents are not coping, is the behaviour of a child impacting on siblings. Has the child or any family member picked up a weapon? Speak to parents about what support they have. Consider EHA or EHPT.
Unaccompanied asylum seekers If you are made aware of an unaccompanied asylum seeker in custody please let a senior know and First Response Team so that they can do the age assessment. Be aware that these are vulnerable children who have often travelled long distances to get here.
Unborn babies We only take referrals for women who are 12 weeks and above gestation. This is because prior to this the baby is not deemed as viable. If the pregnancy is more than 22 weeks we will need to consider a strategy meeting if the concerns meet the threshold for s47 enquiry. When speaking to mothers, try to ascertain who the father is, name, and date of birth etc and how involved he will be. Then speak to the father about the concerns. Speak to the mother about preparation for the baby and how she feels about the pregnancy, as well as the concerns that lead to the referral. If the mother is looked after, or leaving care, (or an open case) please ensure that we contact the allocated social worker. If we ascertain that the pregnancy is not yet viable please share the concerns with the relevant hospital via email so they and the midwife can record it and refer when appropriate.
Concealed pregnancy There are two types of concealed pregnancy, ‘denied’ where a person does not know, or denies the symptoms to them, or ‘concealed’ where a person does not but has chosen to not tell professionals. Not accessing antenatal care is a choice and has to be respected; however, there could be significant consequences for the baby if they do not. If you get a concealed pregnancy you need to consider the same questions as ‘unborn babies’, but also try to ascertain why they have not sought treatment or told professionals. The risks are heightened if they have had children removed previously, have concealed a previous pregnancy or have a medical condition that could harm the unborn if they do not seek treatment. We should consult the procedure in these scenarios to consider if it meets the threshold for a strategy meeting.
Practice Standards for Police checks in MASH
On each case please read the referral:
If the concerns are historical sexual abuse/exploitation, look for specific previous concerns of this nature. If sex offender, liaise with ________ re their involvement, check with Social Care.
Look for intelligence about adults in household.
(If sex working person managed by probation – contact them for update)
Check each adult and each child using name, address and date of birth.
If several adults involved check with SC that they want all checks and the extent of them.
Collate a history of involvement this should include any arrests for violence, drug/alcohol, sexual offences and anything else relevant to referral.
For victims of domestic abuse please collate history and be specific about dates and names of perpetrators and level of risk on each occasion, what is DASH.
Probation involved and why.
If concerns about neglect, look for call outs regarding concerns re ASBO, poor home and absent parents, children home alone etc.
If concerns relate to physical abuse look for previous incidents where this child or stresses in household have been physically assaulted. There may also be domestic abuse as well. If during checks you learn an offender has been currently arrested please ascertain if they have been charged, if they have bail conditions, say if still in custody. If drug/abuse, please look for previous arrests of unveil about drugs or alcohol abuse. Look for related crimes, for e.g. shoplifting, sex working, handling stolen goods. Homelessness If teenager is homeless check with SC if checks required. If a family is homeless check with SC if checks required.
FGM Look for trips out of the country and anything relevant in relation to immigration.
Trafficking Look for immigration status and unusual intelligence information regarding trips out of country etc.
Fabricated induced illness, treat this like neglect/physical abuse cases.
Mental health/suicide attempt look for call outs re previous attempts either adult of child look for other concerns regarding child abuse as this could be a trigger.
Children Missing Look for patterns and dates of missing periods check compacts there is intelligence information around CSE, or who they are associating. Specifically comment on when reported missing and when child found.
Radicalisation Check if prevent team has been involved. Trips in or out arrested/Intel, in relation to this (Put your own DS expectations on, try to summarise where possible if appropriate)
Dog Bite Look for arrest/intel re danger with dogs. Consider if necessary to do all checks on adult for checks if the dog does not belong to the family.
Families in Crisis Look for call outs re parents not coping, suggesting giving child up, anti social behaviour, incidents involving weapons. Be specific about who is offender in this scenario.
Practice Standards for Health in MASH
For all referrals please use the template below (In bold). When collecting the information think about the child’s journey so far in life.
The information gathered will be appropriate to age of the children and the reason for referral.
Information gathered from system one Northamptonshire/ Name DOB NHS
Registered at surgery?
Immunisations are
S/N, H/V level at surgery Ethnicity / UK entry
Last seen by GP
Risks and concerns
If possible consider:
Check family details, addresses, who is living in household, sibling, DOB are any missing?
Childs Birth, where how, birth weight, prematurity, complications.
Neonatal screening results.
Developmental checks- looking at parental interaction, environment, voice of the child.
Child hood illnesses- ? normal, attended appropriately,
School checks- Primary School, Year 6, attended, weight checks normal, etc?
Diagnosis of illnesses- referrals to services, attended, follows ups?
Accident and Emergency (A/E) admissions- why, when, is there a mode of injury?
Did not attends (DNA’s) - who brings them, to appointment? Multiple attendances, lack of attendances.
Parental interaction?
Emotional responses?
What agencies are involved?
Does child have additional needs, disabilities? Do they need extra support?
Any parental risk factors if known?
Any concerns raised by professional before relevant to enquiry?
Children and Adults – mental health/LD information gathered.
Date of attendance. Who referred them to the service?
Diagnosis, medication, what professional do they see, name and contact numbers
What services are they open to?
What is engagement like?
Date of discharge from service
Strategy meeting
Please ensure case are handed over verbally to the person attending to ensure the
Information, risks and concerns are shared.
All information gathered will need to be printed off for the meeting.
Also rag the case where possible before attending strategy so it does not time out.
Record outcome of Strategy on Strategy sheet to share outcome with professionals. Mental health- EPEX/System One
Check system One and EPEX for the information Template to use Is not known/known to SMHS for NHFT in Northamptonshire Adult name in full, DOB NHS (If you have this)
Points to consider when collecting the MH information
Commencement of treatment with services
Diagnosis of condition, and when
Admission to hospital and discharge date
Services currently involved with and contact numbers of professionals, or have accessed
Assessments undertaken and care plans
When last seen Check children in the family to see if known to SMHS on EPEX. The following points are good practise on every case: (See template sheet to use for recording of each case.) Please consult this document when reviewing health records and also use the Northamptonshire Safeguarding Children’s Board and children’s procedures.
Sexual abuse
Voice of the child
Repeated Urinary tract infection (UTI), vaginal infections
Termination of pregnancy, contraception
Sexualised behaviour/ behavioural response
Current or historical abuse
Child Sexual Exploitation (CSE)
Look for push and pull factors within the records/family
Voice of the child
Domestic abuse in family
Absences/ truancy /exclusion from school
Drugs/Alcohol/smoking habits
Referral to Children Adolescents Mental Health Service (CAMHS) for behavioural issues
Repeated UTIs, vaginal infections, Termination of pregnancy,, contraception
Bereavement
Attending appointments with older adults who are not carers/parents
Domestic abuse
Physical injuries for the children
Emotional response for children
Behavioural changes
Multi Agency Risk Assessment Committee (MARAC) dates, who was victim, who was perpetrator and Domestic Abuse Stalking and Harassment (DASH) score.
Domestic Abuse police notifications
Neglect
History of neglect previously
Poor engagement with services
A/E admissions
Parental factors mental health, Alcohol and drugs
Disguised compliance
Poor home environment
Children not meeting developmental milestones
Significant weight loss or weight gain
Injuries/bruising to a baby under 6 months or non-mobile child under 2 years old
Speak to Health Visitor (H/V) and community midwife (C/M) for previous and current history and concerns
Need Datix/ 24 hour report from professional in Northamptonshire Healthcare Foundation Trust (NHFT) working with the family?
Speak to hospital A/E and Named professional to gain more information about injuries
Need to consider what injuries could occur if baby is non mobile?
Physical abuse
Attendances to A/E explanation given for injuries and do they match the story?
Are they visible to health?
Supervision of children by parents, boundaries in place for the children by parents
Voice of child
History of Domestic Abuse ( D/A)
Accessing different services e.g. A/E, Out Of Hours, Minor injuries, Northampton General Hospital, Kettering General Hospital, or other A/E around the county
D/A notifications and D/A in the household
Drug/Alcohol abuse
Previous history of drug and alcohol and D/A
Concerns around neglect of the children
Mental health information on the parents and input from services in NHFT.
Homelessness
The impact on the children lives from being homeless
Teenagers what’s life like for them?
Referral to CAMHS for behavioural problems
Ethnicity if no recourse to public funds
Consider the vulnerabilities if the children have learning Disability within the family? Female Genital Mutilation (FGM)
Speak to hospital to establish if mother has had FGM
Have family had travel vaccination to travel for extended period?
Establish if had long period out of the country.
Fabricated Induced Illness
If this is suspect and the record is showing multiple concerns about attendance, then a full chronology may need to be completed by another professional who is dealing with the family.
Review the attendances to professional, why, diagnosis and treatments given.
Who they attended with?
What hospitals have been involved with them for treatments?
Mental health and suicide attempts
What is the engagement with mental health services?
Previous admission and assessments
Are they safe, what protective factors/family is there?
Children missing
Is there any push and pull factors
Drug and alcohol misuse
D/A
CSE
What is their sexual health?
Radicalisation
Are they or have they converted their religion?
Have they been abroad for period of time/ travel vaccinations?
Mental health history
Dog Bites
Type of dog, is it dangerous dog
History of dog bites previously
History of dogs in the family or extended family
Boundaries/protection of children from Dogs e.g. Stair gates Families in Crisis
Look for parents not coping at home.
Mental health history.
Extended family support
Behavioural problems with children and referral to CAMHS. Unaccompanied asylum seekers
Health information will not be required in these situations. Unborn babies
Need to be over 12 weeks, ring community midwife or H/V for information.
Obtain history of pregnancy, DNAs, consultant appointments, scans, blood taken, confirm Estimated Date of Delivery (EDD).
If the Father Vulnerabilities?
What preparation has been made for pregnancy?
Planned pregnancy?
Consensual sex?
Concealed pregnancy
Ring hospital asks for health of baby and what was delivery if concealment found out at delivery.
Who was present at delivery?
Age of the mother
Details of father, was this a consensual relationship?
Whether any antenatal care given and what this care consisted of?
Ragging of cases
Use in conjunction with Thresholds and Pathways document for NSCB
RED -LEVEL 4
AMBER - LEVEL 3
Green LEVEL 2