Child Not Brought to Appointments
The following animation is aimed at raising awareness about the consequences of missing appointments and to ensure that children and adults get the medical care that they need. This is a powerful reminder that children do not take themselves to appointments, and for practitioners to reflect on the impact of missed appointments on a child's wellbeing. With thanks to Nottingham City CCG & Safeguarding Children Board.
Child Not Brought (CNB): Child was not brought to the appointment without cancellation.
Did Not Attend (DNA): Did not attend appointment without cancellation
No Access Visit (NAV): Not available at home to be seen for appointment.
It is recognised that many children miss appointments in hospital and community settings, and are not available at home to be seen by staff working in different agencies.
Many Serious Child Safeguarding Practice Reviews (Serious Case Reviews) / Homicide Reviews both nationally and regionally have featured CNB, DNA and NAV as a precursor to serious child abuse and child death.
Key principles for Practice
- All agencies should have a policy and local guidance for managing CNB, DNA and NAVs which underpins both process and practice and reflects the differing needs of children and their families.
- Services provided should be child and young person friendly and work in partnership with parents and other practitioners.
- Practitioners should be child focussed and consider children and young people even when the CNB / DNA / NAV relates to the parent/carer, particularly when mental health or problematic substance misuse is featured.
- Practitioners should ensure they are appropriately trained in the identification of child maltreatment to ensure effective judgements are made as to whether the child or young person’s health and development are subject to impairment.
- Develop robust communication links with parents and other professionals or agencies working with the child and ensure that any outcome or consequence for the child or young person is explained.
- Know when and with whom to share information when there are concerns about a child or young person’s welfare and where to get advice.
- Document assessments, analysis, communications and actions taken in the child / young person or parent / carer record as relevant.
- Parents / Carers may disengage with any agencies caring for themselves or their children.
- Remember disengagement is a key risk factor for children and families and may be a precursor to something more serious happening.
- Following CNB / DNA / NAV the responsibility for any assessment of the situation rests with the practitioner to whom the child has been referred in conjunction with the referrer (Laming 2003).
- Consider the needs of the child and the parents / carers capacity to meet those needs.
- Consider environmental context of the child’s situation.
- Identify whether intervention is required to secure a child’s welfare.
- Verbal / written communication with the parents / referrer needs to outline consequence of CNB / DNA / NAV on the child.
- Where there are clear child protection concerns, discuss these with your line manager and make a referral to the Multi-Agency Safeguarding Hub (MASH) firstname.lastname@example.org in accordance with Lewisham’s procedures.
- Where there are concerns relating to children, information should be shared with the Line Manager, Named or Designated Safeguarding Lead / Lead Professional or other agency working with the family who can add to the information sharing process.
- The content of discussions should be clearly documented along with any actions and outcomes in the child or parent / carer record.
- Analysis and conclusion should also be documented ensuring that any referral letters and context of previous records have been considered.
- Consider arranging another appointment, check addresses and other details for accuracy.
- Ensure parents / carers are informed about the consequence(s) of further non-attendance for the child / young person and with whom information will be shared with should there be further CNB / DNA / NAV.
- Repeated CNB / DNA / NAV should result in a Team Around the Family (TAF) meeting to agree the best course of action.
- Unless there is a concern that a child / young person is likely to suffer significant harm then a referral should not be made to MASH until it is established the TAF has not worked. The referral will need to show what work has been attempted, by whom, and what is expected a referral to MASH will achieve.
- An immediate referral to MASH should be made if it is established urgent medical attention has not been sought or delayed for a child or young person by a parent / carer.
- Agencies should find ways to collect information in respect of CNB / DNA / NAV to increase the uptake of services in order to safeguard children and young people and improve their outcomes.
- Number of services CNB / DNA / NAVs under the age of 18 and include the outcome.
- Number of service CNB / DNA for mental health, drug and alcohol services including outcomes of the CNB / DNA.
- Number of NAVs including outcome of no access (all services).
- GP’s should audit outcomes of CNB / DNA / NAV and consider the consequence of non-engagement in order to work with families to improve engagement.
L&G NHS Trust – Child Not Brought Policy