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Part 2A: Identification of abuse and neglect

Was not brought (children)

Children not being brought to health appointments can be a sign of neglect or other abuse or that a family might need additional support. The term ‘was not brought’ is now widely used across health regarding children rather than ‘did not attend’ as it more accurately conveys that children, in general, need to be brought to health appointments (there are exceptions to this such as older teenagers who may make appointments themselves).

There are many reasons why a child may not be brought to a health appointment e.g. a parent forgot the appointment, the child is now better, a parent got the wrong appointment time/date, they did not know about the appointment (especially secondary care appointments). Generally, in most cases, a one-off missed appointment would not be a concern. However, patterns and context are very important. For example, a child who is on a child protection plan for neglect who is not brought to one health appointment should raise the practitioner's level of concern and prompt action to ensure the welfare of the child. Practices should have a practice policy relating to children not being brought to appointments.

Children not brought to appointments should be coded 'was not brought' rather than 'did not attend'.

Secondary care and other health providers should have their own ‘was not brought’ policies that they follow.

Every time a child is not brought to a health appointment, the practitioner should consider what the impact on the welfare of the child could be, whether there are any other concerns within the family and take action if necessary. A checklist of issues to consider when a child is not brought to an appointment: (practices may consider doing this with the admin/reception team to aid the clinician):

  • What was the purpose of the appointment (may not be known)? If the purpose is known, what could the potential impact of the missed appointment be on the child's welfare?
  • Does the child have any ongoing physical or mental health problems?
  • Are there other health appointments that the child has not been brought to? Is there a pattern of missed appointments?
  • Are there a high volume of Emergency Department and GP out of hours attendances?
  • Is the child on a child protection plan or a looked-after child?
  • Are there any safeguarding concerns documented in the child's records?
  • Are there any siblings and if so, is there a pattern of health appointments that the children have not been brought to?
  • Are there any concerns about the parent/carer that could impact on their ability to bring the children to health appointments, for example physical or mental health problems, drug and alcohol issues, domestic abuse, safeguarding concerns.

If there is any concern about the child following the completion of the checklist, action needs to be taken proportionate to the level of concern. This could include:

  • asking the reception staff to contact the parents to arrange another appointment
  • contacting the parent/child yourself to discuss why the child has not been brought and make a further assessment
  • contacting other health professionals such as a health visitor, to share information and concerns to aid further decisions
  • contacting Children's Social Care (Health and Social Care Trust in Northern Ireland), especially if the missed appointments are adversely impacting the child’s health.

In all cases, it is important to document your actions and reasons for them.

The video ‘Rethinking Did Not Attend’ was developed in Nottingham to encourage practitioners to identify children as ‘Was Not Brought’ rather than ‘Did Not Attend’ when they are not presented at medical appointments.

References
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