Safeguarding – is it time for your check up?
Take the Child Protection Company’s test to see if you are up to speed with best practice
The aim of this article is to reinforce how important it is that everyone in the dental practice knows what to do with regards to safeguarding their patients, their colleagues and themselves.
Through four simple exercises you can test yourself on your current safeguarding knowledge (and that of your colleagues if you tackle the exercises as a team).
- To ensure that good practice in regard to safeguarding and child protection is embedded within your practice
- To understand your responsibility to report concerns
- To increase your vigilance around children, young people and adults visiting your practice
- To underline the need to observe confidentiality with family and friends
- To reinforce how important that everyone in the practice keeps their safeguarding training up to date.
With dental teams having contact with millions of children and adults at risk each year, it is not surprising that they are seen as being ideally placed to recognise the signs of abuse and neglect and to take appropriate steps to report concerns. Indeed, in the current pandemic dental staff maybe one of the few professionals with safeguarding training a child or adult at risk comes into contact with.
Dental teams are in a position where they may hear something concerning, observe signs and indicators of abuse and neglect and are highly likely to identify injuries to the head, face, neck, mouth and teeth.
Members of the dental team may be asked to provide information and reports, give evidence in court and to assist by assessing the dental needs of children and adults at risk. However, it is not their responsibility to investigate possible abuse or neglect. Their key role is to highlight concerns about those issues.
Each practice should have an identified Safeguarding Practice Lead (SPL), and ideally also a deputy to ensure sufficient support to staff. The SPL is not expected to be an expert in safeguarding or deal with all safeguarding issues, but rather a central person with oversight of safeguarding matters. The SPL and deputy maybe practice managers, senior practitioners or colleagues.
Children’s Social Care Services have a legal duty to investigate all suspicions that a child is suffering or is likely to suffer significant harm. However, where there is suspicion of a crime having been committed, the Police must always be informed immediately and will take the lead role in all criminal investigations.
Dental practices should have clear child safeguarding policies and procedures in place in line with those from their local Safeguarding Partners. These should clearly define the roles and responsibilities of staff at all levels and the procedures that they must follow. They should include the details of the Safeguarding Practice Lead to whom staff are to contact with any concerns or suspicions of child abuse or neglect.
Discuss as a team: when responding to a disclosure of child abuse, it’s important that you:
A. Ask or make children, young people or adults at risk write statements about abuse that may have happened to them.
B. Make notes of the main points carefully
C. Take photographs of any injury.
D. Contact the alleged ‘perpetrator’ or alleged ‘victim’.
Let’s take these points in turn:
- Never ask or make children and young people write statements about abuse that may have happened to them. This is inappropriate.
- Don’t take photographs of any injury, as this can compromise enquiries. Instead, use a body/face/mouth map to record the details.
- Don’t contact the alleged ‘perpetrator’ or alleged ‘victim’ (unless you have no choice because they make contact with you).
So, the correct answer is B.
It’s also important to:
- Remain calm, be available to listen carefully to what you are being told and try not to show any shock or disbelief.
- Listen with the utmost care to what the child is saying.
- Always inform the child, young person or adult at risk that this information will have to be passed on but only to people who need to know and who will help protect their safety and welfare.
- Always offer reassurance. Let them know that they were right to inform you, that the abuse isn’t their fault, that they’ve done the right thing and that you are listening to them and treating the information seriously.
- Do not rush them into giving details of the abuse. Your role is to listen to what they want to tell you and not to conduct an investigation.
- Question normally without pressurising and only using open questions.
- Always inform the Safeguarding Practice Lead or their deputy in your practice immediately, unless the disclosure implicates them in any way. If you’re unable to make contact with these people, then contact Children’s Social Care Services.
- A full written record of the disclosure should be made as soon as possible on the same day and stored in a secure location until passed to the relevant agency.
- Ensure all records are clearly signed and dated and include: the time the conversation with the child took place, the time the record was written, a clear factual outline of what was said, details of the individual’s body language, etc and always attach any initial notes made, body maps and so on.
All referral information and decisions, phone calls, discussions and actions should also be recorded and kept with the full record. This should also include a record of any decisions made not to refer the incident, along with the reasons.
You may use any type of paper or incident form for your recordings but try not to use personal diaries and notebooks, as they could become evidence in the future.
What not to do if someone discloses abuse to you:
- Don’t make any promises to keep secrets, that you can make everything better etc.
- Don’t use leading questions or investigate. This may cause unnecessary stress and repetition for the person concerned. It may also invalidate any evidence if required for a prosecution.
- Don’t put words in the child’s mouth.
- Don’t stop someone who is freely recalling significant events; allow them to share whatever is important to them.
- Don’t be judgemental (e.g. ‘Why didn’t you try and stop them?’).
- Don’t break the confidentiality agreed between the person disclosing the information, yourself and your Safeguarding Practice Lead, their deputy or your manager.
Kane is a five-year-old, who has recently learnt to ride his bike without stabilisers.
He’s very proud of his achievement and has been telling everyone.
When he comes into the practice, he has grazes on his forehead, chin and down both shins, in addition to a bruised right knee and elbow.
His mother tells you he’s fallen off his bike. When asked what happened, Kane tells you he stopped too quickly and went right over the handlebars.
What action would you take?
A. Report (by following your safeguarding procedures).
B. Using a body map note down all of Kane’s injuries.
C. Record your observation and continue to monitor.
D. Take no action.
The nature of the injuries appears consistent with the explanations provided by both the child and the mother. They are both quite open about how the injuries occurred and are not trying to conceal them in any way. There are no other indicators to cause further concern.
The correct answer is C.
Always remember to:
- Monitor by carefully observing the child when you have contact
- Record your concerns factually, non-judgementally and as soon as possible
- Consult with your Safeguarding Practice Lead or their deputy.
- If the child is at imminent risk you must not delay. Contact Children’s Social Care Services immediately, or the police in an emergency.
Janice has worked for the practice for four years. She returned to work part time (five mornings a week) after her children started school.
She is interested in becoming the practice Safeguarding Lead or deputy driven by her concern for children and the potential for perpetrators of abuse being at large. She often talks in staff meetings about child abuse cases in the media and what she would like to happen to child abusers.
Would Janice make a good Safeguarding Practice Lead or deputy?
C. Maybe, with some provisos.
Potentially, if Janice acknowledges her personal views, then she may be suitable. Janice’s motivation is laudable but safeguarding children is about ensuring all children achieve positive outcomes.
Whilst we need to be vigilant to the possibilities of child abuse, it is important not to allow our own beliefs and attitudes to influence our responses to children and families at risk of harm. Janice needs to be encouraged to consider her attitudes and values to avoid making judgements about families before considering becoming a Safeguarding Practice Lead.
The correct answer is C.
Who would be ideal to take the Safeguarding Practice Lead role?
- Whilst it is not vital that the nominated person is in a senior role, they should hold authority to make decisions. The Safeguarding Practice Lead would ideally be a person who has:
- An interest in making a difference in the practice.
- A good basic knowledge of safeguarding children and adults.
- The ability to be child- and person-centred.
- The support of management to undertake the role.
- Status and authority to make decisions.
- Excellent rapport with children, families and staff.
- Ability to communicate to a high standard, both verbally and in writing.
To be confident and knowledgeable within a safeguarding role, it is important to continue to build on knowledge beyond an introductory standard.
Mr and Mrs Jones, an elderly couple, arrive at the dental surgery. Mrs Jones speaks to the receptionist and tells her that Mr Jones needs to have his remaining teeth removed as they are causing him lots of trouble.
The receptionist asks them to take a seat and goes to speak to the dentist. A few minutes later, Mr Singh, the dentist, asks Mr Jones to come through to the treatment room alone.
Mrs Jones protests and says: 'He won’t understand what you are saying to him’.
Mr Singh assures her that her husband is in safe hands and he will ensure he gets the help he needs. Once in the treatment room, Mr Singh makes sure Mr Jones is sat comfortably on an upright chair and he sits directly in front of him, leaning forward and asks what he can do to help.
It is apparent Mr Jones is hard of hearing but could clearly see what Mr Singh was asking.
Mr Jones said he only had a few teeth left and he wanted to hold onto them for as long as possible but said that sometimes he had difficulty chewing food his wife had cooked as she was getting forgetful and often over cooked meat.
Mr Singh and Mr Jones agreed what the next steps would be and Mrs Jones was invited into the treatment room.
Mr Singh spoke to Mrs Jones and said after examination of Mr Jones's teeth, it was his professional opinion that it would not be the best option to remove them. His teeth and gums were sound, but his sensitivity required him to eat softer foods such as soups and casseroles.
What are the key issues in this case study about being person centred? Please answer the following question.
Choose which one of the following is NOT a key issue in being person centred for this case study?
A. Keeping Mr Jones in control
B. Understanding his communication needs
C. Exercising your professional status
D. Being sensitive to both Mr and Mrs Joneses’ situation
Being familiar with and having a rapport with people you come across in your dental practice will help you understand their needs. Although it is always important not to assume what those needs are.
In this case study, there is an example of good teamwork and communication between the staff at the surgery. Sensitivity to both individuals resulted in the best outcome for the patient.
Always be clear that if a person is in immediate danger from harm you should contact Adult Social Care Services or the police without delay.
The correct answer is C.
The ‘Seven Golden Rules of Information Sharing’ were published in the H M Government document ‘Information Sharing: Guidance for practitioners 2018 and provides a useful guide for all staff.
Which of the following is not a ‘Golden Rule’?
A. The Data Protection Act 2018 and GDPR do not allow information sharing without consent
B. Seek advice
C. Consider safety and wellbeing
D. Keep a record
Many dental practitioners have concerns about patient confidentiality. So let’s be clear, you have a duty to share information regarding any concerns which you may have about a child or adult at risk but only with the relevant people, organisations and agencies, not with family, friends or colleagues who don’t need to know.
Where concerns are raised you should share the information immediately. Early sharing of information is the key to providing effective early help where there are emerging problems. No individual should assume that someone else will pass on information which they think may be critical to keeping a child safe. Fears about sharing information cannot be allowed to stand in the way of the need to promote the welfare and protect the safety of children and adults at risk.
The Data Protection Act 2018 and the General Data Protection Regulation (GDPR) allows practitioners to store and share information for safeguarding purposes, including sensitive and personal information and this information should be treated as ‘special category personal data’. This includes allowing practitioners to share information, regarding ‘safeguarding of children and individuals at risk’, without consent if it is not possible or reasonable to gain consent.
The correct answer is A.
So, don’t forget to report your concerns, it may be vital in preventing abuse occurring or reoccurring. Where a referral is required, it should be made within 24 hours.
The safety and welfare of a child or adult at risk is paramount and the sharing of information with the relevant individuals, organisations and agencies is absolutely essential.
Author: Lisa Dunbar