standard operating procedure 4 (sop 4) cypf specialist

Version 2.0 January 2015 18

Standard Operating Procedure 4 (SOP 4) CYPF Specialist Mental Health Services

Did not attend / No access visit

Why we have a procedure?

To provide a clear process for managing non-attendance at health appointments and no access visits so there is early intervention and prevention when disengagement is a feature as this is the key to safeguarding children and young people. To work in partnership, both inter-agency and multi-agency, to raise awareness when missed appointments and no access visits occur. Every year children and young people miss appointments in healthcare settings and are not available at home to be seen by health staff for any number of reasons. In the majority of cases it should be the decision of parents/carers when to ask for help and advice on their children and young people’s care and upbringing. However, professionals do also need to engage parents/carers early in order to prevent problems or difficulties becoming worse. (Working Together to Safeguard Children DoH 2015). Serious case reviews, both locally and nationally have repeatedly identified parental non-engagement or disengagement with professionals as a factor which places children and young people at increased risk. Therefore, any failure of planned contact should be regarded as a potentially serious matter and should lead to an assessment of potential risk.

What overarching policy the procedure links to?

Did Not Attend (DNA) and Cancellation Policy

Which services of the Trust does this apply to? Where is it in operation?

Group Inpatients Community Locations

Children and Young People Services Sandwell and

Wolverhampton

Mental Health Services

Learning Disabilities Services

Who does the procedure apply to?

All clinical and non-clinical staff working within Child and Adolescent Mental Health Services (CAMHS) in Sandwell and Wolverhampton, Early Intervention Services and Eating Disorders Services in Sandwell and Wolverhampton.

When should the procedure be applied?

Did Not Attend/No Access Visit SOP - CYPF

Version 1.0 June 2018 of 12 CYPF Specialist Mental Health Services

For all missed appointments where the child or young person did not attend, was not brought to attend their appointment, or where there no access was possible to be seen for a pre-arranged visit in their own home.

How to carry out this procedure

1st DNA / No Access Visit (Leave calling card informing of

contact details and request contact to be made by

parent/carer by a specified date)

Assess possible risk

Attempt to contact family via telephone during appointment time &/or letter

RISK

IDENTIFIED

NO RISK

Recommended that 2nd visit be at home (practitioners to use

discretion but justify decision)

Arrange further

appointment at clinic

or home

2nd DNA / No Access Visit (leave calling card informing of

contact details and request contact to be made by parent/carer by a

Specified date)

Complete Lateral Checks Review:

Records and identify previous concerns and document

Contact: GP- request a ‘flag’ be

placed on GP record to inform practitioner of attendance/identify missed appointments etc.

Liaise with other professionals E.g.:

School Health /Education Health Visitor Children’s Centre Allied health

professionals Housing CAMHS Discuss with Children’s

Social Care and identify if there has been any recent intervention if known

NO RISK RISK

Send letter to parents (Appendix 2) informing them of your contact

details should they have any concerns

Consider further intervention required e.g.: CAF/ professionals meeting/referral to children’s social care

Ensure all information documented

Seek guidance as necessary from line manager or safeguarding children team


Version 1.0 July 2017 of 12 CYPF Specialist Mental Health Services

This Risk Assessment Flowchart is a visual aid designed to assist the practitioner in making decisions regarding missed appointments or No Access Visits with families. It is the responsibility of the Practitioner to decide on the level of need of the family prior to the first appointment, based on prior knowledge of the family and level of intervention from other agencies.

Procedure for First Missed Appointment

When a risk assessment of situation has not raised safeguarding concerns following a first missed appointment: . Address and GP details should be checked on relevant ICT systems or with Child

Health to prevent missed appointments from incorrect patient details. For No Access Visits, leave a written communication that you have called as

arranged, leave contact details requesting contact and record this in the child or young person’s health record.

Attempt to contact the parent/carer/young person to ascertain if appointment has been received or the reason for the missed appointment and where possible re-arrange a further appointment/visit.

If services would normally be accessed in a clinic, primary care surgery or school setting, consideration should be given to a home visit to meet with the child or young person.

A missed appointment may entail sending a letter to the parent/carer (Appendix 1/ Appendix 2).

Further appointments should be made for the child or young person and a copy of the letter/details of the home visit recorded in the child or young person’s health record.

NB: CAMHS / substance misuse services - if the child or young person’s family default then efforts are made to engage/re-engage according to risk. If disengagement continues and risk/need is low refer back to referrer. For CAMHS refer to local Case Management Protocol (Appendix 3).

Where CYP have been referred to a specialist children’s service (i.e. Physiotherapy / Speech and Language Therapy / Occupational Therapy) it is the referrer’s responsibility to alert the service to any safeguarding concern. The specialist service to which the child or young person has been referred is responsible for alerting the referrer to DNA / defaulted appointments and responsibility for following up child or young person who fail to attend rests with the referrer. The health visitor and school health advisor must also be informed as they are the lead health professional, regardless of whether they were the referrer. The referrer will then be accountable for contacting the family/young person further if indicated. A letter will be sent to parent/carer advising of the above. A sample letter or similar wording to be used is outlined (Appendix 4).

Repeated /Persistent DNAs / No Access Visits

Liaise with the referrer and other professionals e.g.: Health visitor and school health advisor who have knowledge of the family. In this way more information can be obtained to make an informed estimation / risk assessment of the possible impact to the CYP’s non-attendance / access.



Inform the CYP’s GP if the parent / carer / young person is persistently not attending

appointments or disengaging from services. Refer to your Local Safeguarding Children Board Multi-agency Thresholds (Dudley

LSCB / Wolverhampton LSCB / Sandwell LSCB) for safeguarding children in order to aid decision making regarding the level of intervention required. A referral to Children’s Social Care (CSC) may be indicated.

Practitioner’s should discuss emerging concerns with their immediate line manager and where necessary escalate this to the Named Safeguarding professionals in their area in order to agree a forward plan for the CYP / family.

Managing DNA / No Access Visit for CYP subject to a Child Protection Plan

The practitioner must inform the CYP’s social worker of any missed appointments. In the event the CYP’s allocated social worker is unavailable then the duty social worker must be informed.

Record all discussion with CSC in the CYP’s health file, ensuring copies of appointment letters are filed in the patient/clients records and a copy sent to social worker.

Managing Disengagement

In order to safeguard and protect the welfare of the CYP, practitioners should be aware of the risks and damaging impact disengagement from health care services can pose. This also applies in cases where the service user is a parent: particularly where mental health and problematic substance misuse is a feature.

Disengagement is a strong feature in domestic abuse and in serious neglect and physical abuse of children. They may suffer significant harm in terms of their physical, mental health or development where disengagement exists. Children have a right to healthcare and for adults to act in their best interest (UN Convention Rights of the Child 1989).

Practitioner’s should ask adult service users when they are being seen in any health setting whether there are CYP in the home, and they must consider the impact of adult disengagement on CYP.

It is important to keep lines of communication open with the family as much as possible and where there have been disagreement with the current worker it may be appropriate to offer an alternative worker. However, practitioners’ must guard against collusion with the family.

A chronology must be started for families where there is disengagement. All CYP must be registered with a GP to ensure their care is co- ordinated and

information is drawn together to inform assessment. Parents /carers must be encouraged to register their CYP with a GP. If parents / carers do not do so, the service must continue to work with the CYP whilst continually encouraging registration. Refusal to register with a GP must be discussed with your Safeguarding Named professionals.

Practitioners must analyse / risk assess situations where disengagement is a feature. The Trust NHS governance and Children Safeguarding Team will assist in decision making about the level of intervention required and whether a referral to CSC is needed.

Practitioners must consider convening a professional meeting to share information and agree a way forward.



Any assessment must focus on the needs of the CYP and the parents / carers to meet those needs.

Further information should be sought from other professionals working with the family and other professionals / agencies informed of disengagement of a family / CYP.

Cases of disengagement (where there are concerns for a CYP’s welfare) must be discussed with Named Safeguarding Professionals which may include an action plan and agreement detailing a referral to CSC.



Sample Letter- No Access

Clinic contact Details/Telephone Number. No Access Date: Name / Address of Parent / Carer / Young Person: Dear Parent / Carer of: Child / Young Person name / DOB Health appointments and developmental reviews for your child or young person are important for their wellbeing. They also provide you with an opportunity to discuss any concerns around their health which you may have. The following contacts were attempted on: 1……………………………………………………………… 2…………………………………………………………….. The health professional was not able to make contact on these occasions. Please telephone the above number before …………Insert Date …..to arrange a further appointment. If you do not respond to this letter it may be necessary for information on your child/family to be discussed with other Professionals. Kind Regards Signed……………………… Name of Health Professional

Appendix 1



Sample Letter-DNA

Clinic contact Details / Telephone Number. Did Not Attend (DNA) Date: Name / Address of Parent / Carer / Young Person: Dear Parent / Carer of: Child / Young Person name / DOB Health appointments and developmental reviews for your child or young person are important for their wellbeing. They also provide you with an opportunity to discuss any concerns around their health which you may have. The following appointments were made on: 1……………………………………………………………… 2…………………………………………………………….. Neither appointment was attended. You will not be offered any further appointments at this time. However, should you wish to discuss this further please do not hesitate to contact me on the number above, Kind Regards Signed……………………… Name of Health Professional

Appendix 2



1 Case Management Protocol - CAMHS The purpose of the protocol is to guide clinicians in relation to their administrative case management. Not all cases will fit or follow the protocol, however in these cases it is expected that the clinician will document their reason(s) for diverting away from the protocol. Choice Appointment 1. A letter explaining the purpose, function and time available for a Choice appointment is

sent to families with a registration form, ethnicity sheet and SDQ outcome measures to be returned at the Choice appointment.

2. At the Choice appointment the purpose, function and time available for the appointment is reiterated. The assessment takes place and risk assessment completed.

3. At the end of the Choice appointment a way forward is agreed with the family i.e. further screening needed; refer to more appropriate service; advice given and discharge or agree appropriate core CAMHS intervention and recorded in a co-produced care plan. Consent recorded.

4. Forward copies of Care Plan to relevant professionals and family. 5. Score SDQ and HoNOSCA measures and record on Oasis along with other relevant

clinical information. 6. If Choice appointment is not attended the clinician must consider risk and vulnerability of

the child / family and attempt to re-engage or discharge accordingly. Intervention 1. At first appointment agree the focus of the work and sign Care Plan with client / family. 2. Undertake appropriate and relevant assessment in accordance with the therapeutic

approach. 3. Forward a copy of the Care Plan to the referrer outlining the focus of the work to be

undertaken. 4. Update / add to information on Oasis. 5. Remember to outcome every appointment on Oasis within Trust timescales, i.e. 3 days. 6. Review risk assessment / plan and add to / change accordingly. Review 1. Review Care Plan as clinically indicated. A decision will be made as to whether a new

care plan is negotiated or whether discharge is appropriate. 2. Repeat outcome measures every six weeks and record on Oasis. 3. Review risk assessment every six weeks or more frequently if deemed necessary. Supervision 1. After each care plan review take care plan to supervision to agree justification for

continued involvement. 2. Supervisor and supervisee to record case discussion in preferred format. Any case

discussed in supervision should be noted on the case note contact sheet. Managing Risk 1. Discuss all safeguarding issues in supervision and ensure discussion is recorded in case

notes. 2. Cases that score high risk or where there is any cause for major concern or safeguarding

issues must be brought to the attention of the Service Manager and / or discussed in the team meeting and care plan minuted.

3. All safeguarding concerns must be reported through local safeguarding procedures. 4. The key worker is responsible for arranging and co-ordinating necessary multi-agency /

multi-professional meetings for high risk cases.

Appendix 3



5. Where there is more than one clinician / clinic working with a child / young person / family in the service regular reviews with all clinicians involved should be arranged by the key worker as required.

6. If child / young person / family DNA then efforts must be made to re-engage according to risk and need either by a telephone call or sending an opt in letter.

7. If disengagement continues and risk/need is low refer back to referrer. 8. If disengagement continues and risk/need is high contact referrer as soon as possible

with concerns and request referrer to facilitate re-engagement. 9. When a child / young person has been identified as very high risk but wishes to

disengage, these children / young people and their families need to be offered 2 weekly contacts, even by phone call, and reviewed after following 3 months. Keep detailed notes of all contacts made and reasons for contacts not made.

10. Throughout disengagement refer to / update risk assessment and consider the necessity for implementing safeguarding if deemed necessary.

11. Discuss all disengagement concerns in supervision. 12. Continue to update Oasis. Discharge 1. When reviewing care plans and discharge is appropriate repeat outcome measures SDQ

and HoNOSCA and Service User Satisfaction Questionnaire. 2. If SDQ, HoNOSCA and Service User Satisfaction Questionnaires cannot be completed or

the young person / parent / carer decline decision / explanation must be recorded in the notes.

3. Send discharge letter to referrer copied to parent / carer and other necessary agreed agencies / practitioners within 10 days of discharge. If GP is not the referrer the discharge letter must be copied to the GP.

4. Record discharge information on Oasis and check all information has been recorded throughout the history of the case including ethnicity, HoNOSCA and diagnosis before discharging off the system.



2 Sample Letter- Specialist Services DNA

Date: Name / Address of Parent / Carer Dear Parent / Carer of: Child Name / DOB We are sorry that you / your child were unable to attend the appointment (or did not respond to the invite letter) we recently sent you. We would like to offer you a further appointment to ensure your child’s health needs are met. Date ………………………………….. Venue …………………………………. However, if your child’s health needs have changed and the appointment is no longer required would you please contact us so that we can update our records. If we do not hear from you or you fail to attend the further appointment offered we will share this information with your GP / referrer and in order to access the service again a re-referral to the service will be required. Signed……………………… Name of Health Professional Designation

Appendix 4



Where do I go for further advice or information?

- CAMHS / CFS Service Managers - CYPF Specialist Mental Health Service Manager - CYPF Head of Nursing - CYPF Clinical Director Training Staff will receive training in relation to this procedure, where it is identified in their appraisal as part of the specific development needs for their role and responsibilities. Please refer to the Trust’s Mandatory & Risk Management Training Needs Analysis for further details on training requirements, target audiences and update frequencies. Monitoring / Review of this Procedure In the event of planned change in the process(es) described within this document or an incident involving the described process(es) within the review cycle, this SOP will be reviewed and revised as necessary to maintain its accuracy and effectiveness. Equality Impact Assessment Please refer to overarching policy. Data Protection Act and Freedom of Information Act Please refer to overarching policy.



Standard Operating Procedure Details

Review and Amendment History - to be completed by Corporate Governance

Version Date Description of Change

1.0 June 2018 New SOP for BCPFT

Unique Identifier for this SOP is BCPFT-CYPF-SOP-10-4

State if SOP is New or Revised New

Policy Category CYPF Specialist Mental Health Services

Executive Director whose portfolio this SOP comes under

Executive Director of Nursing, AHPs and Governance

Policy Lead/Author Job titles only

CYPF Specialist Mental Health Services Manager

Committee/Group Responsible for Approval of this SOP

CYPF Quality and Safety Group

Month/year consultation process completed

April 2018

Month/year SOP was approved June 2018

Next review due July 2021

Disclosure Status ‘B’ can be disclosed to patients and the public

standard operating procedure 4 (sop 4) cypf specialist

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