1. PROBLEMS Adeela, PJ, Sheila, Prabh

2. Today… Introduction Small group discussion Overview Quiz

3. Why challenging? Deteriorate quickly Pressurised setting Child protection Parents… Teenagers… Contraception Confidentiality, consent, capacity

4. Case discussions Small groups

5. Confidentiality Duty of confidentiality to under 16’s Breech confidentiality if risk to welfare of child Justifiable disclosure Preferably consult young person re disclosure

6. When to disclose? (GMC guidelines) 1. Too immature 2. Big age/maturity difference 3. Partner has position of trust 4. Force (emotional/physical/money) 5. Alcohol/drugs involved 6. Person known to police/child protection

7. Fraser Guidelines Understands advice Can’t persuade to inform parents Likely to continue having SI Physical/mental health will suffer if don’t provide contraception Best interests

8. Clinical issues Consultations with children and their families are a big part of our workload. Difficult because symptoms can be vague, presumed, interpreted by parents Often multiple problems- poor feeding, coryzal symptoms, vomiting, fever. Signs in children may be minimal and could point to a wide range of pathology.

9. NICE GUIDELINE FEVERISH ILLNESS IN CHILDREN: ASSESSMENT AND INITIAL MANAGEMENT IN CHILDREN YOUNGER THEN 5 YEARS

12. NICE GUIDELINE Urinary tract infection in children Diarrhoea and Vomiting in children under 5

13. Child Protection SHROPSHIRE’S SAFEGUARDING CHLIDREN BOARD Stay Safe team 03456789008, Emergency social work duty team 03456789040 TELFORD & WREKIN SAFEGUARDING CHILDREN BOARD 01952 385700, 01952676500

14. Integrated services for children and young people Telford is divided into 5 clusters, each has its own ISM In Shropshire they are called Multi-agency teams, and MAT manager or duty social worker can be contacted for consultation and advice.

15. Every Child matters Be healthy Stay safe Enjoy and achieve Make a positive contribution Achieve economic well being

17. Continuum of needs The ‘windscreen’ model shows how a child’s needs may move backwards and forwards through universal, vulnerable, complex and acute needs. All children access universal services and will develop to their full potential with help of parents,carers

18. ‘Vulnerable’ Early identification of children as vulnerable is critical in making sure targeted services can intervene early. If ignored these issues could develop and lead to poorer life chances or the need for more intrusive intervention

19. ‘COMPLEX’ NEEDS Chronic health problems, concerns about development Child appears withdrawn, isolated, experiences discrimination, poor hygiene, provocative Parents-antisocial, difficult employment, erratic, inconsistent care, domestic violence Poor housing, poor school attendance, difficulty in peer and family relationships

20. ‘ ACUTE’ NEEDS Children with disability, abuse, rejection by their families, serious difficulties in school or severe mental health problems All children on the child protection register All children under the local authority or children with a court order Privately fostered children

21. Where a child is not at immediate risk or significant harm : check the CHILD INDEX for other services involved, previous common assessments or LEAD PROFESSIONALS

22. COMMON ASSESSMENT FRAMEWORK(CAF) Services engage with child and their family and complete CAF Identify needs of child Single agency plan and review action set up

23. TEAM AROUND CHILD (TAC) If the child has complex needs then multi- agency teams get involved and for have Team around the child meeting