Introduction to Safeguarding Children Training
Safeguarding Children – A Beginner’s Guide (with acknowledgements to Wessex LMCs)
Although the intercollegiate document “Safeguarding Children and Young people: roles and competences for health care staff” (September 2010) guidance is not yet enshrined in regulations the LMC view is that as the GMC, NMC and CQC begin to apply their standards it would be better to be ahead of the game and be prepared. Therefore all practices should have an education and training programme and comprehensive annual record for each staff member and all GPs will be expected to be trained to level 3.
Level 1: All non-clinical staff must have some training about safeguarding children – this must include all staff that work in a practice. It concerns the recognition of the various forms of abuse: physical, emotional & sexual and understanding and:
- the impact on the child when a parent has physical or mental health problems;
- the risks of the internet, social networking and understanding children’s rights;
- how to take appropriate actions or where to seek advice if they have concerns, and,
- what the term Looked After Child means, that is, a child who is looked after by the State.
Level 2: All non-clinical and clinical staff that come into contact with children and young people. The competencies for level one plus awareness of:
- normal child development and the impact that abuse or neglect has on this.
- the additional needs of Looked After Children, young offenders and also the increased risk of their further maltreatment.
- the questions surrounding data sharing both in terms of legal and ethical duties.
- how to document concerns.
Level 3: All GPs will now need to be trained and have the skills and competencies for level one and two together with training in:
- documenting reports and concerns, taking a history and examining a child in a manner that is appropriate for safeguarding, child protection and the legal process;
- contributing to the inter-agency collecting of information and assessment of risk;
- undertaking regular review of their own safeguarding practice as appropriate to their role;
- the role of the Local Safeguarding Children’s Board (LSCB) and how they work;
- having a core knowledge of the court and criminal justice system, the roles of different courts, the burden of proof, and the role of expert witnesses;
- the role of multi-agency audits and the role of the GP in this process;
- the assessment of risk and harm;
- the risks of misdiagnosis in safeguarding and the effective management of diagnostic uncertainty and risk;
- understanding fabricated or induced illness;
- the emerging evidence in child sexual exploitation and female genital mutilation, and,
- the procedures for actively following up children who do not attend outpatient appointments including cases of parents with mental health problems who do not attend follow up appointments.
Education and Training Requirements
As stated at the outset it is to be expected that the GMC and the Nursing and Midwifery Council will require evidence of training to the expected level and the continuing refreshment and updating of core skills through revalidation
It will then be expected that all staff have training every three years as a minimum requirement but this should be tailored to the role they fulfil. E-Learning is appropriate training for level 1 and 2 and can be used for level 3 but at level 3 there should also be some team-based learning.
In addition safeguarding leads should circulate regular updates in a written format (probably by e-mail), for example, concerning changes in legislation or local procedures or personnel.
Clinicians should be involved in case-based discussions, significant event reviews and experiential learning where relevant to children and young people.
Further recommendations from the national guidance:
- A mandatory 30 minute session should be included in the induction of all new staff to take place within the first 6 weeks of their employment to include the various aspects of abuse, broad principles of safeguarding and how and where to seek help.
- Level 1 – over a 3 year period all staff should have two hours training as a minimum. This should include the types of abuse and maltreatment, and appropriate action to take.
- Level 2 – over a 3 year period all staff should have three-four hours training as a minimum. This should include multi-disciplinary training and scenario based discussions.
- Level 3 – over a 3 year period all staff should have six hours of training as a minimum or two hours per year. This should include multi-agency training and can be internal or external to the practice. Any GP who has passed the MRCGP is already considered to have baseline training suitable for level 3 training.
- The named safeguarding GP should work with the practice manager to ensure all clinical and non-clinical staff are appropriately trained and have regular updates;
- The safeguarding GP should attend a half day update at least every three years and this should be preferably inter-agency and multi professional;
- All staff should have as part of their annual training an update on safeguarding. This could be delivered via the safeguarding lead GP by e-mail, using e-learning or from an external trainer.
Regular staff training should therefore include updates on safeguarding and an individual rolling annual record kept. This could be by using an e-learning module individually or as a resource used to help group discussion. Furthermore practices should have a regular clinical meeting (minimum of six monthly and preferably quarterly) to discuss Children At Risk, Looked After Children, etc. and as part of this meeting the opportunity should be taken to cascade information and update skills and knowledge. This could be done simply by the named GP meeting with health visitors and disseminating information to other attached staff.
The e-learning for healthcare has a number of safeguarding modules available on the e-LfH website. There are good modules on the BMA and RCGP websites too.
Regarding GP training the LMC believes that the rigid “two hours over three years” is not consistent with the five year revalidation cycle. We have received advice from the GPC which advises that there is no requirement for a formal update at an educational meeting. However GPs would be wise to be able to show equivalent learning of approximately two hours annually. Most GPs can do this evidencing cases they have dealt with, personal study, summary of cascaded information and any dealings they have had with HVs or other agencies regarding safeguarding concerns along with suitable reflections.
Further Guidance & Helpful Links
The latest government guidance is contained in the document Working Together To Safeguard Children (2015)
Appendix 3 contains a comprehensive list of links including to the “Safeguarding Children and Young people: roles and competences for health care staff” intercollegiate document (September 2010) which gives details of the three levels referred to above.