Developing an integrated care pathway for vulnerable children means Calderdale and Huddersfield NHS Trust can ensure child protection is top priority. Steve Lui explains.

Last year, a three-year-old child came into the accident and emergencydepartment of a district general hospital in West Yorkshire with a scaldon his upper right arm. Staff decided to use the recently launchedintegrated care pathway for safeguarding children to monitor his case asthey felt that the explanation given by his father did not match theinjury.

As a result, the child was admitted to the paediatric ward forobservation and, after further discussions with social services, itemerged that he was already on the child protection register. Five dayslater, the boy was transferred to a specialist burns unit for intensivetreatment of the scald.

Pulling in professionals

During his time on the ward, all those involved in the child's care,such as the paediatric and nursing team, social care and community childprotection teams and a health visitor, were contacted and an emergencycase meeting took place. It was decided that once the child was ready tobe discharged, he should be placed with foster carers. While this is astandard procedure in accordance with the local area child protectioncommittee guidelines, the safeguarding pathway had improved the qualityand speed of internal and external communications.

According to Sue Smith, formerly nurse consultant for safeguardingchildren at Calderdale Primary Care Trust and the University ofHuddersfield and now a lecturer in child protection at the university:"Developing the pathway has helped professionals clearly identify who isinvolved in the child's care and who's responsible for each action. Thisacts as a prompt to staff and helps to ensure all the recommendedactions have been completed or can be followed up if required.Furthermore, using the pathway helps facilitate clearer communicationbetween the departments like accident and emergency and the wards."

Both Lord Laming, in his inquiry into the death of Victoria Climbie, andthe chief nursing officer, in her review of the contribution that healthprofessionals can make to vulnerable children and young people,identified that further work was required to strengthen the role ofnurses, midwives and health visitors in caring for such children.

In fact, one of the main themes that emerged from the chief nursingofficer's review was the need to develop a common assessment frameworkfor vulnerable youngsters. As a result, Calderdale and Huddersfield NHSTrust, the three local primary care trusts, and the council's children'ssocial care team set up a Climbie steering group, which aimed to developan integrated care pathway for children across a number ofmulti-disciplinary teams.

"Since September 2004, the safeguarding children integrated care pathwayhas been used in the paediatric in-patient, outpatient and communitymidwifery team at Calderdale and Huddersfield NHS Trust," explainsKirsty Akroyd, the trust's integrated care pathway facilitator. "Thepathway is a tool that allows health and social care professionals tofocus on child protection by assessing a family's situation and takingsteps if they think a child is at risk. It's also used as commonprotocol by health and social care professionals for communication andinformation sharing.

"The pathway consists of demographic details," continues Akroyd. "It's alist of key professionals involved with the child and their contactdetails, body maps, a chronology of events and a good-practice checklistbased on the Laming recommendations."

A communication revolution

As the pathway has to be completed in depth prior to a child'sdischarge, staff involved in the child's care are aware of all theprofessionals who need to be informed, which has improved communicationbetween the acute sector and community services. And, if a child istransferred to another hospital, the universal care record makes iteasier to ensure the receiving hospital has the necessary social andmedical information to enable them to continue with the child's care.Prior to the development of the pathway, the information passed on couldbe lacking in consistency and detail.

For Alison Edwards, paediatric practice development nurse at Calderdaleand Huddersfield NHS Trust, the pathway enables information,observations and actions from both medical and nursing teams to bedocumented in one record. "There is consistency of information withinthe care record, which helps the team work more closely together andprevents information being missed or unavailable," concludes Edwards."As all the information is in one document and is filed in the medicalnotes, staff are aware of key contacts if the child is readmitted in thefuture, alerting them to further concerns."

Further information Contact Steve Lui, Calderdale and Huddersfield NHSTrust's critical appraisal reviewer, at steve.lui@cht.nhs.uk or ClinicalGovernance Support Unit, Integrated Pathway Facilitator, Old Ward 3,Calderdale Royal Hospital, Calderdale and Huddersfield NHS Trust.