4 Vulnerability in Children and Young People
59. Defining vulnerability in children and young people is challenging. Further definitions may be obtained from Scottish Executive guidance on the implementation of Health for all Children report ( HALL 4) 26. The outcomes from the consultation on Getting it Right for Every Child will help to strengthen the identification of vulnerable children and young people. However we need to recognise that in the emergency care context some children may be at particular risk of injury or harm because of personal, family or social factors. In terms of emergency healthcare provision, indicators of vulnerability can include:
- Non-accidental injury
- Neglect by parents or carers
- Recurring accidental injury
- Alcohol, drug or solvent misuse
- Sexual abuse
- Self harm or reckless behaviour
The areas that we focus on in this section include:
- Child protection
- Self-harm
- Emergency care records
- Recurring attendance by children and young people
Child Protection
60. It is important that health care practitioners are skilled and knowledgeable in child protection in order to identify vulnerability indicators in children and young people. Some practitioners will also need more specialist knowledge and skills including inter-agency training. In addition to having trained staff, all emergency care sites must know what to do when there are concerns about risk to a child or young person. This will include who to consult and inform, the information that should be recorded and the correct way to do this. Staff should have access at all times to specialist advice and support to help manage complex child protection cases and in all cases, there must be appropriate management and onward referral.
61. The survey questionnaire responses indicated that 93% of emergency care sites have written child protection policies. However only 61% of emergency care sites have staff specifically trained to deal with child protection issues and only 46% of sites have trained staff available at all times.
Self-Harm
62. Self-harm is an area of vulnerability that gives particular concern. Children and young people presenting with possible/actual self-harm have complex needs. Staff must be empathetic to their needs and have the competencies to recognise their vulnerability. Their treatment is more complex than with adults and there must be appropriate referral mechanisms in place to refer on to Child and Adolescent Mental Health Services ( CAMHS).
63. The survey questionnaire responses indicated that only 28% of emergency care sites have protocols for dealing with self-harm, alcohol and/or drug misuse in children and young people. While the majority of responses indicated emergency care sites have access to CAMH services, a number noted that access to these services was not available at all times.
64. When staff are unable to determine personal details for a child or young person there should be a guideline for staff to follow to ensure the ongoing safety of the child or young person. This should apply in any situation involving a potentially vulnerable child or young person and it is particularly important in the case of self-harm.
Emergency Care Records
65. Children and young people may access health care and advice from a number of emergency care sites across Scotland. Contacts with these emergency care sites should be recorded and notified to the appropriate primary care team.
66. Primary care teams are best placed to build up a complete picture of a child or young person and their family/care environment and can help ensure identification and follow up of possible vulnerability.
67. It is recognised that at times a child or young person seeking emergency medical advice and/or treatment may be unable to provide details of their primary care provider. There will also be occasions where a child or young person is not registered with a primary care team.
68. In these situations, emergency care staff must understand the procedures to follow to ensure that an attendance by a child or young person is documented. This protocol may involve contacting local primary care providers to initiate registration of the child or young person.
Recurring Attendance by Children and Young People
69. Recurring attendance of children and young people for emergency care or advice may indicate particular vulnerability. Therefore all emergency care sites must be able to identify recurring attendance.
70. The questionnaire responses for this review indicated that overall 53% of emergency care facilities in Scotland can identify repeat attendances by children and young people (70% for large hospitals and children's hospitals and 41% for community hospitals, minor injury facilities and medical centres).
71. The difficulty in identifying recurring attendance can be attributed in part to the existence of paper based record systems which do not easily lend themselves to data collation. There are plans for new electronic record systems within A&E Departments which will facilitate improved information flow between hospitals, primary care providers and out-of-hours services. However this is a long term aim and all emergency care sites need to act now to ensure that they have a system in place which helps safeguard children and young people. This should include a mechanism to detect attendance by children and young people on a local child protection register.
72. Where recurring attendance gives cause for concern, emergency care staff should know what action they should take, who needs to be informed and consulted and details of the appropriate referral network.
73. Primary care have a key role in this process and their record collation should include all notifications of contact by NHS 24, out-of-hours services and the Scottish Ambulance Service.