First Case Scenario: (Words Count: 1153)

First Case Scenario: (Words Count: 1153)

1. First of all, it is important to know where their parents are. Attending to the dental clinic with his sister who is a young teen is a big question mark.

Second, staying out playing with his friends at this age until late (11 pm).

Third, attending dental clinic one week after getting the trauma.

Fourth, the patient attended the clinic with dirty and unsuitable clothes as it is cold, and he presented with just a t-shirt and no jacket as he has none.

Fifth, untreated and noticeable head lice.

All the points mentioned above are referred to as NEGLECT. According to British Society of Paediatric Dentistry 2009, neglect is “the persistent failure to meet a child’s basic physical and/or psychological needs, likely to result in the serious impairment of the child’s health or development.” His parents did not fulfil his basic needs such as inadequate clothing, lack of supervision and failure to seek medical and dental care.

To roll out abuse, I need to ask Sam nonleading questions about whether he has any other injuries.

2. I want to know about their parents. If the patient and his sister are living with their parents or one of them? Who is taking care of them? Who is fulfilling their needs? Why Sam took a week until he came for the dental treatment? Especially the tooth is causing further harm to the tongue and the tooth itself is painful while he drinks cold drinks. Is he seeing any GP for his head lice? How often he is taking a shower? Does Sam have any other injuries?

I could contact his parents to further details, or I can call his schoolteacher or his school nurse.

3. Referrals should be made according to the child or family residential area. For Manchester, we refer to Manchester Children’s services or Trafford Children’s Services. First of all, I need to be aware of consent and caution which means I need to obtain consent from parents or carers and inform them about the action I am going to take to make sure I fulfil the best interest of the child. In the case of the child’s abuse, I can make the referral without informing parents or carers. Examples of abuse according to NHS Safeguarding Children and Young People Policy 2020 are:
   1. Sexual abuse is suspected
   2. Fabricated/Factitious Illness is suspected
   3. Honour Based Violence or Forced Marriage is suspected
   4. The situation may place the child at further risks such as fleeing or violence
   5. You would be at risk personally by sharing the information

In case I make a referral without taking consent, I need to justify the reason of doing so otherwise, I need to share information only with Children’s Social Care with consent taken from one of the parents.

Process of Referral to The Social Services:

According to NHS Safeguarding Children and Young People Policy 2020

• With being aware of the cautions, I must talk with the child and the parent and explain to them the reason for making the referral; then, I take a consent.
• Give Children’s Social services a call and explain to them my concerns and outcomes for the referral.
• Write to The Local Authorities a letter within 24 hours after the call to The Social Services.
• The following information must be included in the referral form. Referral must continue even if some information is missing to protect the child. These details are:
  • Full name, any aliases, date of birth and gender of child/children;
  • Full family address and any known previous addresses;
  • Identity of those with parental responsibilities;
  • Names, date of birth and information about all household members, including other children in the family, and other significant adults who frequent the household;
  • Ethnicity, first language and religion of children and parents/carers;
  • Any need for language interpreter, sign interpreter or other communication aid;
  • Any special needs for the child(ren);
  • Is the child registered at a school or regularly attending a school? If so, identify the school.
  • Any significant/important recent or historical events/incidents in the child or family’s life;
  • Has the child recently spent time abroad or recently arrived in the area?
  • Specific details of your concerns including allegations, their sources, timing and location;
  • Identity and current whereabouts of the suspected/alleged perpetrator;
  • The child’s current location and emotional and physical condition;
  • If the child currently safe or needs of immediate protection because of any approaching deadlines (such as with abuse cases);
  • Known current or previous involvement of other agencies/professionals;
  • Information regarding parental knowledge of, and agreement to, the referral.
• If harm is suspected and the safety of the child or siblings is jeopardised, contact the police.

I need to keep full records for all the details explained to the child and parents/carers and send a copy to the Safeguarding Team including my name, title and contact details.

4. In England, following a child protection referral and investigation, a case conference is called when a child is suspected to be at significant risk of harm. The conference is attended by the child or their representatives, family members, the social worker linked to the child, and other relevant professionals who have been involved in the assessment process. One outcome from the case conference is that the child is at risk of further significant harm, and a child protection plan is developed. Every plan should identify specific risks to the child and describe how these risks will be reduced. Regular meetings are held to monitor compliance with the plan. Where changes have not been implemented, the child may be taken into foster care following court proceedings.

If a child is referred to child protection and is thought to be at risk of harm, a case conference then undertaken. Members such as the child or a representative, family members, the responsible social worker assigned to the child and any other member or professionals who got involved in the assessment process should attend the conference (Keene et al., 2015). The purpose of the conference is to decide whether the child is at risk of further harm. If so, a protection plan is developed. Risks will be discussed and how to reduce them. Following that, if the child’s needs are not fulfilled then foster care will be responsible for the child (Keene et al., 2015).

5. It is important to know who has parental responsibility for a child before starting any dental treatment. Doing so to make the dentist get valid consent from the right person and to prevent any illegal acts. Always ask the social worker about who has the parental responsibility for the child attending the clinic. If the child is subjected to placement order, consent must be signed from parents and the local authority. Section 33 Children Act 1989 enables the local authority to make the final decision rather than the parents. In the other hand, if the child is not subjected to placement order and still accommodated by a local authority for more than 24 hours, the child will under section 20 Children Act 1989. This means the local authority cannot share parental responsibility and the child still to be considered as Looked After Child.

6. According to (Keene et al., 2015), they stated that “seventy-nine children were examined in each group. Children with child protection plans had statistically higher levels of primary tooth decay than controls”. Moreover, they stated children under the protection plan have poorer care and dental attendance with almost double untreated dental caries affecting the primary teeth than the controlled group (Keene et al., 2015).

Second Case Scenario:

References:

1. Keene, E. J., Skelton, R., Day, P. F., Munyombwe, T. & Balmer, R. C. (2015). ‘The dental health of children subject to a child protection plan’, Int J Paediatr Dent,25(6), pp. 428-35.
2. Harris, J. and Whittington, A. (2016). ‘Dental neglect in children’. Paediatrics and Child Health, 26(11), pp.478-484.