Auckland District PATIENTS, CLIENTS, RESIDENTS Starship Children s Health National Women s Health Health Board (Section 4) Policy & Procedure Manual FROM POSSIBLE CHILD ABUSE OR NEGLECT Overview This Document This document covers the following topics relating to the provision of an inpatient watch in situations where a child is or may be at risk, in the context of concerns about possible child abuse or neglect Topic See Page Overview... 1 Introduction... 2 Principles... 3 National Women s Hospital... 4 Starship Hospital... 5 Child Youth and Family... 6 Ward Management Plan... 7 Appendix: process for billing CYF... 8 Supervision of At Risk Inpatient Children Page: 1 of 8
Starship Children s Health National Womens Health PATIENTS, CLIENTS, RESIDENTS Auckland District Policy & Procedure Manual (Section 4) Health Board FROM POSSIBLE ABUSE OR NEGLECT Introduction Purpose To provide clear guidelines about the management of the 24 hour watch, in the context of concerns about child abuse and neglect. Scope This policy applies to all staff, contractors and students within Auckland District Health Board, who are involved in the admission of a baby, child or young person to an inpatient service, where there are concerns about child abuse or neglect Associated Documents The table below indicates documents associated with this one Type Board Policy Manual Document Title(s) Bicultural responsibilities under Te Tiriti O Te Waitangi Tikanga RBP Child Abuse, Neglect, Care & Protection Code of Rights and Responsibilities Legal issues relating to children Trespass Notice - ADHB Legislation Children Young Persons and their Families Act 1989 (and Amendments 1994) Privacy Act 1993 (and Health Information Privacy Code 1994) Other Aotearoa New Zealand Association of Social Work [ANZASW] Code of Ethics and Core Competencies Memorandum of Understanding between ADHB and CYF MoH Whanau Ora Puawaitahi Operational Guidelines Safety of Children in Hospital. Office of the Children s Commissioner, January 2006 Starship Children s Health Clinical Guidelines for Abuse and Neglect Page: 2 of 8 Supervision of At Risk Inpatient Children
Auckland District PATIENTS, CLIENTS, RESIDENTS Starship Children s Health National Women s Health Health Board (Section 4) Policy & Procedure Manual FROM POSSIBLE CHILD ABUSE OR NEGLECT Principles Principles New born babies and children/young people are frequently admitted to National Women s Hospital or Starship Children s Health, who are believed to be at risk due to care and protection concerns. Steps must be taken to ensure the safety of these children while in hospital. It cannot be assumed that admission guarantees safety. Once child protection concerns have been identified (refer to pages 4 and 5 of this policy), ADHB takes the view that, in most cases, the best way to ensure safety is to provide a 24 hour watch. This process needs to be transparent for all concerned. In both National Women s and Starship Hospital, ADHB will provide and pay for the 24 hour watch until a referral to CYF has been made. Once a referral to CYF has been made, ADHB will continue to provide and pay for the 24 hour watch for up to 24 hours, after which time CYF will pay for the 24 hour watch. The implementation of these guidelines will: Assist staff to maximise the safety of the baby, child or young person. Assist hospital staff in the management of these situations and increase the support available to them. Ensure the parents and/or guardians are aware of the reasons for the 24 hour watch. Clarify the funding responsibilities of ADHB and CYF Supervision of At Risk Inpatient Children Page: 3 of 8
Starship Children s Health National Womens Health PATIENTS, CLIENTS, RESIDENTS Auckland District Policy & Procedure Manual (Section 4) Health Board FROM POSSIBLE ABUSE OR NEGLECT National Women s Hospital Process This page outlines the process to be followed when planning for and implementing a 24 hour watch for a newborn baby at risk from child protection concerns in National Women s Hospital Step Action 1 During pregnancy, an unborn baby is recognized to be at risk from child protection concerns that will arise after delivery 2 The midwife discusses their concerns with the mother, and a Women s Health Social Worker 3 The midwife or social worker completes a Mother and Baby Safety Plan [hyper-link]. This outlines the agencies involved, risks and child protection concerns for baby, and a comprehensive Action Plan, clearly stating if a 24 hour watch is required 4 The Mother and Baby Safety Plan is placed in the mother s antenatal record. 5 If the matter has been referred to CYF prior to delivery, a Child Protection Alert is placed 6 During delivery, the midwife accesses the Mother and Baby Safety Plan, initiates the Watch and informs a social worker 7 The midwife or social worker informs CYF of the delivery and the placement of the Watch Page: 4 of 8 Supervision of At Risk Inpatient Children
Auckland District PATIENTS, CLIENTS, RESIDENTS Starship Children s Health National Women s Health Health Board (Section 4) Policy & Procedure Manual FROM POSSIBLE CHILD ABUSE OR NEGLECT Starship Hospital Process This page outlines the process to be followed when planning for and implementing a 24 hour watch for a child or young person at risk from child protection concerns in Starship Hospital More comprehensive guidance on the details of child protection processes in Starship is provided in the Starship Clinical Guidelines Step Action 1 A child or young person presents to Starship, and the staff are concerned about child abuse 2 After consultation within the primary team, staff discuss the child or young person with Te Puaruruhau, and refer to Te Puaruruhau 3 Staff discuss with Te Puaruruhau whether a Watch is required. Occasionally, after reviewing the case, the Te Puaruruhau team may decide that a Watch is not required 4 The primary team inform the family of the referral to Te Puaruruhau, and the need for the 24 hour watch. 5 In discussion with Te Puaruruhau, a decision is made whether the child should be referred immediately to CYF, or after review by Te Puaruruhau 6 A social worker completes a Ward Safety Plan 7 When referral to CYF is made, ADHB will inform CYF of the placement of the Watch Supervision of At Risk Inpatient Children Page: 5 of 8
Starship Children s Health National Womens Health PATIENTS, CLIENTS, RESIDENTS Auckland District Policy & Procedure Manual (Section 4) Health Board FROM POSSIBLE ABUSE OR NEGLECT Child Youth and Family Process This page outlines the agreed process that will be followed by the Department of Child Youth and Family Services, when they are informed that a 24 hour watch has been implemented for a child or young person at risk from child protection concerns in National Women s or Starship Hospitals. A situation may arise where a baby or child is already in the custody of CYF at the time of their admission. If ADHB and/or CYF staff are aware of this, they must consult with each other as to whether any care and protection concerns exist with regard to family members or caregivers, for whom a Watch should be provided. In this situation, CYF will be financially responsible for any Watch required, or will provide supervision of access through alternative arrangements. Step Action 1 CYF is informed by ADHB that care and protection concerns exist, and that a 24 hour watch has been implemented 2 CYF will treat this as a critical referral 3 CYF will assess the safety of the child or young person in hospital 4 CYF will ensure that other children or young people linked to the child in hospital are not at risk 5 In the case of admissions to Starship with non-accidental injury, CYF will attend an urgent case conference within 24 hours of referral 6 In the case of newborn babies in National Women s, CYF will act according to the plan agreed in the Mother and Baby Safety Plan. 6 CYF staff in hospital will complete CYF information sheet CR1250 7 In consultation with ADHB, CYF will decide whether the 24 hour watch must continue. Where required, continuation of the Watch more than 24 hours past referral to CYF, will be funded by CYF. 8 The CYF social worker will supply the Charge Nurse or Charge Midwife with an Order Number, to facilitate payment by CYF (see flowchart in Appendix) 9 CYF may request the Watch notes under Section 66, CYPFA 1989. 10 If CYF have custody, they can determine who can visit the child and for how long, Page: 6 of 8 Supervision of At Risk Inpatient Children
Auckland District PATIENTS, CLIENTS, RESIDENTS Starship Children s Health National Women s Health Health Board (Section 4) Policy & Procedure Manual FROM POSSIBLE CHILD ABUSE OR NEGLECT Ward Management Plan Recommended Best Practice Follow the steps below to provide a ward management plan for children and young people who need a 24 hour watch Step Action 1. Admitting staff inform the Charge Nurse, Charge Midwife or Shift Co-ordinator of the need for a Watch 2. The Charge Nurse, Charge Midwife or Shift Co-ordinator contacts the Duty Manager 3. The Duty Manager contacts the nursing bureau and completes paper work required for the bureau 4. For each shift, the Charge Nurse, Charge Midwife, Duty Manager or Shift Co-ordinator ensures that: The Watch is orientated to the Ward on arrival The Watch is aware of his/her role and the requirements for the documentation The Watch is provided with the appropriate forms : CR1003 and CR1002 The Watch receives a handover (including diagnosis, condition, what to look for, who can visit and how to get help), and is introduced to the nurse caring for the child. The Watch is introduced to the child and family The Watch gets breaks in a timely manner 5. The Watch will remain with the child during the entire duration of their shift and will: Ensure that they are in the same room as the child and in sight of the child at all times Notify the Registered Nurse (RN) or Midwife if he/she has concerns Document visitors and alert RN or midwife if visitors arrive who are not permitted to have access to the child Complete hourly recording on report form CR1003 Supervision of At Risk Inpatient Children Page: 7 of 8
Starship Children s Health National Womens Health PATIENTS, CLIENTS, RESIDENTS Auckland District Policy & Procedure Manual (Section 4) Health Board FROM POSSIBLE ABUSE OR NEGLECT Appendix: process for billing CYF Child identified as needing CYF Watch Duty Manager orders Watch CYF Social Worker comes to ward and gives CN/CM an Order Number CYF Social Worker also gives the Order Number to the CYF / ADHB Liaison Practice Leader CN/CM completes Watch form daily, including Order Number. Faxes form to ADHB Bureau ADHB Bureau sends summation of Watches including Order Number to ADHB Accounts Receivable Watch in attendance ADHB Accounts Receivable raises invoice, quoting Order Number Invoices sent to CYF National Accounting Centre for processing Page: 8 of 8 Supervision of At Risk Inpatient Children