Referral to the lead statutory agencies

This section will support clinicians to take forward concerns that a child or young person may be at risk of, or suffering, maltreatment (abuse and neglect).

How do I know when to make a safeguarding referral to Children's Social Care

One of the challenges in safeguarding children and young people, is to know whether the situation necessitates a safeguarding referral to Children's Social Care or a different response. With thresholds to Children’s Social Care seemingly getting higher and higher, practitioners understandably can be unsure whether to make a referral and equally be frustrated when a referral is rejected. In all situations, it is important to view each case individually. Below is a guide to considering abuse and neglect in a child/young person and guidance on what action to take.

What can I do if I am still unsure what to do?

• Check your local children safeguarding board website for guidance - many have guidance on specific topics and advice on what to do if you have a safeguarding concern such as a 'threshold'or 'vulnerability checklist' or 'criteria for action' document.
• Refer to the NICE guideline Child maltreatment: When to suspect maltreatment in under 18s [CG89]
• Talk to your GP Practice Safeguarding Lead or Deputy Lead
• Talk to other safeguarding professionals such as Named GP, Designated Professionals or similar depending on country/area
• Talk to NSPCC or Children's Social Care

If at any time, you SUSPECT child maltreatment, you should refer the child or young person to children's social care, following Local Safeguarding Children Board Procedures  NICE Guideline CG89

GPs and practice staff, who have a statutory duty to make referrals, should ensure that they have access to their current local multi-agency safeguarding children partnership policies and procedures which set out how national guidance (see Section 5 of the toolkit) is translated into local protocols and practice. Some localities may have a 'threshold' or 'criteria for action' document, allied to the procedures, that indicate the level of need that may require statutory intervention. The document will also normally indicate when the provision of early help, or a single agency response may be a more appropriate course of action. Contact and referral details will be given within the document.

The General Medical Council states:

"In sharing concerns about possible abuse or neglect, you are not making the final decision about how best to protect a child or young person. That is the role of the local authority children's services and, ultimately, the courts. Even if it turns out that the child or young person is not at risk of, or suffering, abuse or neglect, sharing information will be justified as long as your concerns are honestly held and reasonable, you share the information with the appropriate agency, and you only share relevant information". (GMC: Protecting Children and Young People)

NICE Clinical Guidance (CG89) Child Maltreatment: when to suspect maltreatment in under 18's (published 2009, undated 2017)

NICE Clinical Guidance (CG89), which has been written for non-specialists in child maltreatment, helps practitioners to recognise and prioritise concerns about possible presentations:

• Suspect means a serious level of concern about the possibility of child maltreatment, but not proof of it;
• Consider means that maltreatment is one possible explanation for the alerting feature and so is included in the differential diagnosis;
• Exclude maltreatment if a suitable explanation is found for the alerting feature, which might be after discussions with colleagues.

Practitioners can access NICE evidence and explanations to help them identify possible child abuse and neglect in clinical presentations. You can also access clinical and practice guidance that informs practice. (NICE, 2009; NICE, 2017).

Other resources to help practitioners

A short guide for practitioners (in England): What to do if you are worried a child is being abused sets out the actions that should be taken when child safeguarding concerns are raised.

This guide includes an outline of the process of referral to the local authority Children's Social Care services and the steps that may follow a referral. It also provides details of what to do in an emergency, including the powers of Police Protection.

Early Help

Early help (may be called different names in different areas) means providing support as soon as a problem emerges; and details of local early help services will be available for your locality. This type of support is normally informed by an early help assessment (EHA) and is undertaken with the agreement and consent of the child, young person and/or parent(s). The lead professional co-ordinates a team around the child and family in ensuring the provision of appropriate support and help to prevent escalation of the issues.

Practitioners should, in particular, be alert to the potential need for early help for a child who:

• Is disabled and has specific additional needs
• Has special educational needs (whether or not they have a statutory Education, Health and Care Plan)
• Is a young carer
• Is showing signs of being drawn into anti-social or criminal behaviour, including gang involvement and association with organised crime groups
• Is frequently missing/goes missing from care or from home
• Is at risk of modern slavery, trafficking or exploitation
• Is at risk of being radicalised or exploited
• Is in a family circumstance presenting challenges for the child, such as drug and alcohol misuse, adult mental health issues and domestic abuse
• Is misusing drugs or alcohol themselves
• Has returned home to their family from care
• Is a privately fostered child

(Working Together to Safeguard Children, 2018)