This assignment will reflect on my public health role as a school nurse / health visitor by critiquing a local policy regarding safeguarding against national policies. This will be achieved by analysing the strengths of the policy and how it links with department of health policies. How the policy affects families will also be assessed. Evidenced based strategies will be used to reflect on how the policy can be developed further through collaborative working and involving users and families. The policy to be chosen will be disabled children in schools. This has been chosen because disabled children may be at a more disadvantage because of their disability and more in need of safeguarding procedures.

The reflection will be based on Rolfe et al (2001) which is a developmental model that will enable me to move from one level of knowledge to a higher one while developing my skill base in the nursing profession.

It is firstly important to discuss my role as a health practitioner (health visitor / school nurse) before assessing how I can use this to develop local policies on safeguarding children. School nurses are involved in the primary prevention of abuse and neglect. A key part of their remit is to develop, manage, and evaluate health action plans that facilitate proactive protection and effective intervention for children and families. My role as a school nurse will include educating and advising parents, carers and teachers on the management of disabled children, and ensuring partnership working is in place; reducing health inequalities and achievement of national and local health objectives, leading to the co-ordination of school health plans. In the policy of a local government I am working on, the public health role of the school nurse in family protection issues include: improving the health of children and young people; assisting in the development of services; identifying child protection issues and participating fully in their effective management in accordance with national and local child protection guidelines; participating in Clinical Supervision (Child Protection and Peer Group). The school nurse role will also include undertaking specialist assessments such as risk assessments / vulnerability assessments, for clients with complex needs, using appropriate assessment tools. These include school children with behavioural and cognitive difficulties. I found that one of the most challenging and difficult part of the job included managing challenging and aggressive behaviour in a sensitive and controlled manner as prescribed in local procedures, and giving evidence in court particularly in relation to child protection proceedings.


In 2004, there were 26,300 children on the child protection register in England (DfES, 2005). It is also noted that disabled children are “three times more likely to suffer child maltreatment than there able bodied peers” (DH / DfES, 2006 p21).  In my assessment this will be due to the disabled person’ lack of communicating abuse, frustration in managing the person particularly in cases of challenging behaviours and the extra vulnerability posed by disabled children. As a result of my skill and knowledge of child health and development I will have an important role to play in all stages of the child protection process which should have been well indicated in the local guidance. I can achieve this by being aware of potential indicators of abuse or neglect, and help colleagues be aware of them. For instance, if a child has bruising and is unable to explain how the bruising occurred, the matter should be investigated, reported to the school head and incident forms filled.


The school policy I will reflect on will be based on children with disabilities. The school’s policy states that the school will encourage a positive response to disability in the school and eliminate bullying, harassment or the less favourable treatment of people with disabilities wherever and whenever it is likely to occur. The school’s Anti-Bullying Policy is clear in how discrimination, bullying, harassment of all children and adults (disabled and able bodied) will be dealt with through school procedures. Incidents related to disability are logged and reported by the Head Teacher. Evidence based strategies already in progress in the school include accessibility planning,  to ensure that there is a rolling programme of improvements over the next three years in relation to access to the curriculum, access to information for both pupils and their parents and access to the school buildings, its facilities and amenities for all. The data will then be used to raise standards and ensure is as accessible as possible.


I will now compare the school’s policy with that of DCSF (2008) guidelines, which recognised that unacceptable variations in service provision exist between regions and within local areas. The final report, published on 18 November 2008, addressed the issue of access for all children, young people and families, including vulnerable groups such as those with learning difficulties or disabilities. The report recommended that children with behavioural, emotional and social difficulties should be confident that, for example, their mental health needs would be assessed alongside all their other needs, no matter where the need is initially identified. The Government has accepted this recommendation in principle. The work will be a priority for the new National Advisory Council for children’s mental health and psychological wellbeing to take forward.


In accordance with the DCSF (2008) guidelines risk assessments are already used by the local authority and their value depends on the skills of those using it. What these tools do demonstrate is that certain factors can increase the probability of future harm. Once risk level is assessed this will inform consideration of the level of intervention needed and the development of a risk management plan. The local policy uses the Framework for Assessment model (DH, 2000) to base its risk assessment procedures, which it keeps under regular review, so that any change in circumstances which may impact on risk can be identified. To improve the skills of practitioners it is important to bear in mind that though risk assessments can help to reduce the likelihood of future harm, care must be taken not to rely on any `predictive formula.’

To add to this, the Home Office is currently rolling out Multi-Agency Risk Assessment Conferences (MARACs) nationally. These bring together key agencies likely to come into contact with victims, and enable them to obtain the most complete assessment possible of the circumstances of the abuse and the risks faced by victims and their children. This information should be used to develop a safety plan that combines individual agency actions into a comprehensive multi-agency response aiming to reduce further victimisation. As Working Together to Safeguard Children makes clear, safeguarding and promoting the welfare of children depends on effective joint working between agencies and professionals that have different roles and expertise (DfES, 2006).


The Children’s Plan, Every Child Matters reforms, the Children Act 2004 and a range of other initiatives have provided a much needed impetus for change. But the report also highlights continuing concerns that some children are not well served. The report rightly challenges the Government, local authorities and all those working with young people to do more to safeguard our most vulnerable children. However, it also raised a number of significant concerns, including the level of priority given to safeguarding within some agencies. The Government defines the term ‘safeguarding and promoting the welfare of children’ as: ‘The process of protecting children from abuse or neglect, preventing impairment of their health and development, and ensuring they are growing up in circumstances consistent with the provision of safe and effective care that enables children to have optimum life chances and enter adulthood successfully’ (DfES, 2006).


Since the 1990s there has been more emphasis on family support policies and creating better life opportunities for children. There are implications for this for children living in highly disadvantaged families (Corby, 2009).


I have learnt that there are some preventative measures I can adopt to safeguard children particularly those with disabilities in schools. Lord Laming (2003) stated after the Gloria Climbie case that it was possible for children to fall through the child protection net, despite going through a number of agencies. This then led to a series of strategies laid down in Every child matters (DfES, 2003) and the children act 2004(DfES, 2004). An early identification statement of children in need of protection and support must be done through collaborative practice and integrative service provision. Early intervention can include poverty issues in the family problems in school. Filling out a Common Assessment Framework at the initial stage will help identify any early intervention needs (DfES, 2005).


The local authority is responsible for co-ordinating the assessment of the child’s needs, of the parents’ capacity to keep the child safe and promote his or her welfare and of the wider family circumstances. The local policy I have reviewed for school nurses in partnership working with children and their families supports the notion of developing care plans agreed with individual/family and partnership agencies. The Common Assessment Framework (CAF) provides a bridge to communication for collaborative working (DfES, 2005). This would promote support for vulnerable children/ families, co-ordinate and contribute to programmes of parent education and information, targeting vulnerable families and priority health needs. For instance, I could support with dietary information to help a disabled person not to suffer neglect through malnutrition. When working with families, carers and people with disabilities I must be sensitive, understanding and respectful in dealing with disabilities, skilful in responding and adapting to different needs and knowledgeable about differences and their impact about attitudes and behaviours. The local policy being reviewed expects School Nurses to communicate complex and sometimes distressing/ sensitive information to patients’ carers whilst exhibiting empathy and reassurance.


Agencies should seek every opportunity at establishing partnerships (Tunstill and Allnock, 2007). The local policy being reviewed expects School Nurses to work closely with the local Public Health Team supporting the integrated community schools and the local implementation of Health for all Children. Collaboration will include confidence in information sharing, shared understanding of aims and objectives, regular contact with family members, and a developed central  Information sharing database, which is supported in  Mason et al (2005). This will provide effective communication channels with the multi-disciplinary/multi-agency workforce. I will also participate at meetings and case conferences in order to contribute to the achievement of comprehensive, confidential and client centred case management such as at Children’s Panel Hearings and Records of Needs meeting, and report to the Children’s Panel and Education Department.


Organisations should also develop the culture of creating an evidence based strategy that protects and safeguards children and families at risk. This enables them to become accountable for achieving the goals and principles set out within it. The strategy should then be backed by a steering group with members from all levels of the organisation represented. Various team action plans with key action points, can help with implementation of aims and objectives set out in the overall strategy, and assist in maintaining the momentum for evidence based practice (Newman et al, 2005). The local safeguarding children board, LSCB is an example of a local area setting up an evidence based steering group that develops strategies for its own local area (Leicester, Leicestershire and Rutland, 2008). I could be involved in a steering group to develop a policy in my area of expertise or review an existing policy such as the one on safeguarding disabled children in schools, working collaboratively with other relevant professionals from a multidisciplinary set up. It is also relevant in these meetings to involve family representatives in order to develop person centred approaches.


A major area of work with families and children – (which has not been fully developed in the local policy guidelines of the joint PCT and local government I am reflecting on) – is developing Health Action Plans (HAP). HAP will include details of the need for the health interventions such as in oral health, fitness, continence details of medication taken side effects etc. (DoH, 2001). HAP is an important instrument to safeguard children from health inequalities and neglect, and can be done in conjunction with the family and children.  I will develop and manage the HAP which can be used as part of a protection plan where abuse has been identified and the abuse affected the person’s health.


As the first point of contact primary care is the place where important decisions are made.  But for many people with disabilities, encounter with the primary care team can be both frustrating and difficult.  Therefore, the School Nurse will play a key role in supporting people with disabilities access the health care they need from primary care and other NHS services (DoH, 2001).


The process of planning requires the development of goals or health action (DoH, 2002). This should be specific, reflecting a time frame, measurable, achievable, based on patient partnership and stating who and how.  This is called the STAMPS model (Heath, 1995).


However, a multidisciplinary approach to the health meetings could recommend re allocating staffing commitments to enable all the health action goals to be achieved.  The final stage of the HAP would be to review its effectiveness in improving the person’s health status, and check that the required action is implemented and assistance given (DoH, 2002).


The process of health facilitation and HAP supports the active and central involvement of the person with learning disabilities in decision-making (Redworth and Phillips, 1997).  The rights of the individual in choosing who is involved in their care is one that should be agreed throughout the planning process, and these should be in collaboration with a wide ranging multidisciplinary networks.


In situations where the disabled person is unable to give consent a multidisciplinary team approach, including the family can be adopted as the balance between satisfying the best interest of the person and the person’s wishes (Ware, 2000). It has been argued that a failure to acknowledge the views of a client on what constitutes good or bad health may lead to ineffective health care practices and a lack of commitment on the part of the individual (Kerns, 2003).  Expertise and professional judgement would therefore not be enough to justify action.  (Bunton and Macdonald, 2002).


In conclusion, this is a reflective essay based on my health visiting and school nursing practice experiences of intervention which are planned and managed in order to protect vulnerable children and families. I mainly used the policy for disabled children in schools to reflect on and generally compared the local policy with theories and national guidelines to protect vulnerable children and families in my practice. I analysed its effectiveness in protecting the health and well being of vulnerable children and families, working in partnership with children, the family and the multidisciplinary team. I assessed evidence based strategies as part of my involvement in working collaboratively. An example of the work I did is the HAP which can be used proactively to prevent health inequalities or as part of a protection plan where health issues have been affected.

Important areas of learning include: not relying on any `predictive formula’ for assessing risk assessments; secondly, working effectively between agencies and professionals that have different roles and expertise for .safeguarding and promoting the welfare of children; finally, completing an early identification statement of children in need of protection and support. This is done through collaborative practice and integrative service provision.



















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