2. Case Reviews With thanks to Stuart Smith, CAIU Essex Police

3. What is a Case Review SERIOUS CASE REVIEW -When a child dies and abuse/neglect known or suspected or -Where there are concerns about inter- gency working to protect children from harm or -Child sustained potentially life-threatening injury/serious permanent impairment or serious sexual abuse

4. Reviews The R case 1999 7 yr old alleging sexual assault by her father The NG Case 1999 Child with disabilities suffered bruising incidents and a spiral fracture

5. Reviews The S Case 1999 Child placed with father who had previous convictions for sexual offences against children The 1-4 Case 2002 Convicted offender in family – continued abuse whilst assessment and child protection process failed to protect children

6. Reviews The Childs Case SCR 2002 Teacher previously investigated for sexual abuse abused number of children within school and social group The Needs of Children First SCR 2003 Long term issues in family involving number of professionals. Child admitted to hospital with insulin overdose. Concern medical equipment tampered with

7. Reviews RE Case SCR 2004 Death of 7 week old child – evidence of shaking & fractures to both legs Missing Records Case SCR 2004 Child of asylum seeking family known to number of agencies – physically assaulted by female carer who was not mother

8. Reviews KB Case SCR 2005 Baby suffered brain haemorrhaging and retinal damage. Long history professional involvement DE Case SCR 2005 Death of baby following history of multi-agency involvement

9. Reviews LU Case (Sec. 111 LGA 1972) 2005 Death of teenager who had been looked after child, living independently in supported accommodation Two current LSCB Reviews

10. Main areas of concern Identify needs of children first – 6 reviews Risk factors/assessments – 4 reviews Supervision – 4 reviews Basic training – 4 reviews Full checks & recording – 3 reviews Transfer of cases – 3 reviews Recording of entries – 3 reviews Interviewing children alone – 3 reviews

11. Recommendations Supervisors must be alive to need for assessments to be child centred Risk assessment training Supervisory review of cases prior to closing Review of training given to professionals – is it fit for purpose?

12. Recommendations Details obtained at referral. All necessary checks completed Chronology/summary sheet at beginning of all agency files Written record of transfer when a case is reallocated Child seen and spoken to alone Reinforcement of policies and procedures surrounding post natal depression

13. LSCB Recommendations All reviews are retained by a designated person All review recommendations are subject to action plans All action plans are subject to LSCB scrutiny and agencies are accountable for own recommendations Results of action plans are published and retained with the relevant reviews All future reviews are compared to this research to identify any further duplication of bad practice. Any remedial action is then made subject of review recommendation and action plan

14. Duplicate recommendations Identifying needs of child first Recognition of risk factors/assessments Full checks and recording Dating and signing of entries Chronologies Children interviewed alone Basic training and awareness Supervision of staff Referral deficiencies Referrals re: Domestic Violence Assessment postnatal and general depression Procedures fit for purpose

15. What Next?

16. MONITORING FRAMEWORK -Quarterly monitoring: -% of case review recommendations that have been implemented by each agency within timescale -Safeguarding performance and activity of each agency -Including training of new/existing staff