3.1 Referrals (including Referral Pathway)

This chapter was revised in February 2009 to include the Referral Pathway and reference to the Multi Agency Referral Form

Duty to Refer
Urgent Medical Treatment
Ensuring Immediate Safety
Confidentiality
Listening to the Child
Parental Consultation
Making a Referral
How Referrals will be Received
Where a Crime against a Child may have been Committed
The Outcome of a Referral
Emergency Protective Action
Cross Boundary Referrals
Pre-birth Referrals
Recording

1. Duty to Refer

Professionals, employees, managers, helpers, carers and volunteers in all agencies must make a referral to Children, Young People and Families if it is believed or suspected that a child is suffering or is likely to suffer Significant Harm. Any such referral must be made as soon as possible when any concern of Significant Harm becomes known - the greater the level of perceived risk, the more urgent the action should be.

The suspicion or allegation may be based on information, which comes from different sources. It may arise in the context of the Common Assessment Framework. It may come from a member of the public, the child concerned, another child, a family member or professional staff. It may relate to a single incident or an accumulation of lower level concerns.

Further professional guidance is available from “What to do if you’re worried that a child is being abused” revised by the Department for Education and Skills in December 2006.

The information may also relate to harm caused by another child, in which case both children, i.e. the suspected perpetrator and the victim, must be referred. See also Children who Exhibit Harmful Sexual Behaviour Procedure.

The suspicion or allegation may relate to a parent or professional or volunteer caring for or working with the child. See also Allegations against Staff, Carers and Volunteers Procedure.

A referral must be made even if it is known that Children, Young People and Families are already involved with the child/family.

Advice may be sought about the appropriateness of the referral from the Designated Professional or Named Professional within any agency, the manager of the local Children, Young People and Families Assessment Team or, if the case is open, from the allocated social worker.

WHEN IN DOUBT, CONCERNS MUST BE SHARED.

2. Urgent Medical Treatment

If the child is suffering from a serious injury, medical attention must be sought immediately by calling an ambulance or taking the child to the Accident and Emergency Department of the local hospital. The on call Hospital Registrar for Children must be informed of the nature of the concerns and a referral made in accordance with this procedure as soon as practicably possible.

No child who is an inpatient in a hospital and about whom there are concerns about Significant Harm should be allowed to be taken home without a referral having been made to establish whether the home environment is safe, the concerns by medical staff are fully addressed and there is a plan in place for the ongoing promotion and safeguarding of the child’s welfare. Referrals concerning children on the John Radcliffe site should be referred to the Hospital Assessment Team.

3. Ensuring Immediate Safety

The safety of children is paramount in all decisions relating to their welfare. Any action taken by staff should ensure that no child is left in immediate danger.

When considering whether immediate action is required to protect a child, all agencies should also consider whether action is required to safeguard and protect the welfare of any other children in the same household or related to the household or the household of an alleged perpetrator or elsewhere e.g. a work environment such as a school.

The law empowers anyone who has care of a child to do all that is reasonable in the circumstances to safeguard her/his welfare. A teacher, foster carer, childminder or any professional should, for example, take all reasonable steps to offer a child immediate protection from an abusive parent.

4. Confidentiality

See also the Information Sharing Protocol.

The safety and welfare of the child overrides all other considerations including the following:

Confidentiality;
The gathering of evidence;
Commitment or loyalty to relatives, friends or colleagues

In deciding whether there is a need to share information, professionals must consider their legal obligations, including whether they have a legal duty of confidentiality towards the child.

Where there is such a duty, the professional may lawfully share information if the child consents or if there is a public interest to do so, for example the public interest in protecting the child from harm. This must be judged by the professional on the facts of each case.

Where there is clear risk of Significant Harm to a child, or serious harm to adults, the public interest test will almost certainly be satisfied (for further explanation of the public interest test, please refer to the Information Sharing Protocol.) However, there will be other cases where it is not so clear. In these cases, professionals will be justified in sharing some confidential information as part of their consultation with others, to enable them to make a decision about whether to make a referral and share fuller information. In these circumstances, the information shared should be proportionate and anonymised.

Further professional guidance is also available from "What to do if you’re worried that a child is being abused” revised by the Department for Education and Skills in December 2006.

The overriding consideration must be the best interests of the child - for this reason, absolute confidentiality cannot and should not be promised to anyone.

If suspicions or allegations are about relatives, friends or colleagues, professional or otherwise, the concerns must not be discussed with them before making the referral.

Individual members of the public who make a referral may prefer not to give their name or alternatively they may disclose their identity, but may not wish for it to be revealed to the parents/carers of the child concerned.

Wherever possible, Children, Young People and Families workers receiving referrals should respect the referrer’s request for anonymity. However, referrers should not be given any guarantees of confidentiality, as there are certain limited circumstances in which the identity of a referrer may have to be given e.g. the criminal or family court arena.

5. Listening to the Child

If the child makes an allegation or discloses information which raises concern about Significant Harm, the initial response should be limited to listening carefully to what the child says so as to:

Clarify the concerns
Offer reassurance about how s/he will be kept safe and
Explain that the information will be passed to Children, Young People and Families and/or the Police

No promises should be given to the child that any information he or she gives will be treated confidentially; it must be explained that any information by a child that indicates that he/she or any other child may have been abused must be referred to Children, Young People and Families.

If a child is freely recalling events, the response should be to listen, rather than stop the child; however, it is important that the child should not be asked to repeat the information to a colleague or asked to write the information down.

If the child has an injury but no explanation is volunteered, it is acceptable to enquire how the injury was sustained.

However, the child must not be pressed for information, led or cross-examined or given false assurances of absolute confidentiality. Such well-intentioned actions could prejudice police investigations, especially in cases of Sexual Abuse.

A record of all conversations, (including the timings, the setting, those present, as well as what was said by all parties) and actions must be kept.

No enquiries or investigations may be initiated without the authority of Children, Young People and Families or the Police.

If the child can understand the significance and consequences of making a referral, he/she should be asked her/his views by the referring professional.

Whilst the child’s views should be considered, it remains the responsibility of the professional to take whatever action is required to ensure the safety of that child and any other children.

6. Parental Consultation

Professionals should seek, in general, to discuss concerns with the family and, where possible seek the family’s agreement to making a referral unless this may, either by delay or the behavioural response it prompts or for any other reason, place the child at increased risk of Significant Harm.

See also the Information Sharing Protocol.

A decision by any professional not to seek parental permission before making a referral to Children, Young People and Families must be recorded and the reasons given.

Where a parent has agreed to a referral, this must be recorded and confirmed in writing using the Common Assessment Framework if appropriate.

Where the parent is consulted and refuses to give permission for the referral, further advice should be sought from a manager or the Designated Professional or Named Professional, unless to do so would cause undue delay. The outcome of the consultation and any further advice should be fully recorded.

If, having taken full account of the parent’s wishes, it is still considered that there is a need for a referral:

The reason for proceeding without parental agreement must be recorded
Children, Young People and Families should be told that the parent has withheld her/his permission
Unless to do so would place the child at greater risk of Significant Harm or prejudice the enquiry, the parent should be contacted by the referring professional to inform her/him that after considering their wishes, a referral has been made

7. Making a Referral

8. How Referrals will be Received

Children, Young People and Families will ensure that a duty worker is available to receive referrals; outside normal working hours, the Emergency Duty Team will receive referrals.

Children, Young People and Families will acknowledge receipt of a written referral within ONE working day.

Children Young People and Families will deal with the referral in accordance with the Framework for the Assessment of Children in Need and Their Families and determine whether a referral should be responded to on the basis that the child is in need of support under section 17 of the Children Act 1989 or in need of protection under section 47 of the Children Act 1989.

The worker receiving a referral will establish:

The nature of the concern
How and why it has arisen
What the child’s and family’s needs appear to be
Whether the concern involves Significant Harm
Whether there is any need for any urgent action to protect the child, any other child in the same household or any child in contact with an alleged perpetrator

To do so, the worker receiving the referral will usually discuss the case with the referrer and in doing so, will:

Give their name and designation
Help the referrer to give as much relevant information as possible and repeat back to the referrer the key points using the checklist indicated above (Section 7, Making a Referral)
Clarify information that the referrer is reporting directly and information that has been obtained from a third party
Discuss whether there are concerns about maltreatment/neglect and if so, what is their foundation
Clarify who has and who has not been told about the referral
Clarify the whereabouts of the child
Discuss whether it may be necessary to consider taking urgent action to ensure the safety of the child or any other child in the same household or who is in contact with an alleged perpetrator
Agree how to re-contact the referrer if further clarification is required
Clarify the extent to which the referrer’s anonymity can be maintained (if this is an issue in the case of a non-professional referrer)
Clarify expectations about how and when feedback is to be given

At the end of any discussion or dialogue about a child, the referrer (whether a professional or a member of the public or family) and Children, Young People and Families should be clear about who will be taking what action or that no further action will be taken. The outcome of any such discussion should be recorded by Children, Young People and Families, and by the referrer (if a professional).

The worker receiving the referral must consider whether there are other children in the same household, the household of an alleged perpetrator or elsewhere, who should be considered as part of the referral.

The worker receiving the referral will also:

Check whether the child is subject to a Child Protection Plan and whether there is a record of any current or previous involvement with Children, Young People and Families in relation to the child or children concerned and any other members of the household
Identify other agencies or persons who may hold relevant information (including the Child Index, once established).
Consult other agencies as appropriate (including the Police if any offence has been or is suspected to have been committed – see Section 9, Where a Crime against a Child may have been Committed)
Where it becomes apparent that a child of school age is not registered or regularly attending school, follow the procedure set out in the Children Missing Education Procedure

Parents should be informed of the referral and their permission sought to share information with other agencies unless to do so would:

Be prejudicial to the child’s welfare
Cause concern about the behaviour of the adult concerned with the child
Cause concern that the child would be at risk of further Significant Harm

(See also the Information Sharing Protocol for further guidance.)

In these circumstances, a manager from Children, Young People and Families may decide to consult other relevant agencies without seeking parental consent. Any such decision must be recorded with reasons.

A decision about the outcome must be made within one working day of the referral (see Section 10, The Outcome of a Referral).

9. Where a Crime against a Child may have been Committed

If the referral relates to a situation in which a crime has or may have been committed, including sexual or physical assault or physical injury caused by neglect, the Children, Young People and Families Assessment Team worker receiving the referral must consult with the Police at the earliest opportunity.

The Police and Children, Young People and Families, in consultation with any other agencies involved with the child, must consider whether there should be a criminal investigation and/or a Children, Young People and Families-led intervention. A decision on how to proceed will be made jointly by managers in the Police and Children, Young People and Families. This will need to be discussed carefully and a decision made at a Strategy Discussion - see Section 7, Single Agency or Joint Enquiry/Investigation - Criteria and Thresholds of Child Protection Assessments and Core Assessments Procedure.

10. The Outcome of a Referral

All professionals who make referrals about children should be aware that the referral will not automatically result in a Child Protection Assessment and some situations that are potentially harmful to a child may be dealt with, initially, by offering support to the child and family.

Children, Young People and Families will decide upon and record their next steps of action within one working day of receiving a referral.

The decision about future action will take account of the discussion with the referrer, consideration of information held in existing records and discussion with any other professionals or services as necessary (including the Police – see above Section 9, Where a Crime against a Child may have been Committed).

The outcome of the referral will be:

That the child appears to be a Child in Need and there are concerns about the child’s health and development which justify an Initial Assessment but there are no present concerns about Significant Harm or
That the child appears to be a Child in Need and there are concerns about actual or potential Significant Harm which justify an Initial Assessment and will probably lead to a Strategy Discussion, which may lead to a Child Protection Assessment and/or
That emergency protective action should be taken to safeguard the child or children (this will usually be determined by an immediate Strategy Discussion) or
Where the child is already known and new information suggests that the child is or may be suffering Significant Harm, that a Child Protection Assessment and/or a new or updated Core Assessment is required or
That a referral to another agency is made and/or the provision of advice and information is acted on or
That no further action is required

Feedback on the outcome of a referral should be provided to the referrer in writing, including where no further action is to be taken.

In the event that an agency does not agree with the response and decisions about the referral by Children, Young People and Families, the referring agency should discuss their concerns directly with the line manager of the social worker, in the first instance to seek resolution. (See also the Resolving Professional Disagreement in Individual Cases Procedure).

In the case of a referral by a member of the public, feedback should be provided in a way which will respect the confidentiality of the child.

11. Emergency Protective Action

Where there is a risk to the life of a child or the possibility of immediate harm, the Police officer or social worker must act with urgency to secure the safety of the child.

Immediate protection may be achieved by:

An alleged abuser agreeing to leave the home
A voluntary agreement for the child to move to a safer place
Application for an Emergency Protection Order
Removal of the child to Police Protection
The removal of the alleged abuser, for example through the enforcement by the Police of a Court Order (Sexual Offences Prevention Order or Risk of Sexual Harm Order) made under the Sexual Offences Act 2003 or an Exclusion Requirement attached to an Emergency Protection Order or an Interim Care Order
Gaining entry to the household under Police powers

The agency taking protective action must always consider whether action is also required to safeguard other children in the same household or in the household of/in contact with an alleged perpetrator or elsewhere.

Children, Young People and Families Services should only seek the assistance of the police to use their powers of Police Protection in exceptional circumstances where there is insufficient time to seek an Emergency Protection Order or other reasons relating to the child’s immediate safety.

Planned immediate protection will normally take place following a Strategy Discussion/Meeting.

Where a child is afforded immediate protection by an Emergency Protection Order or Police Protection the local authority has a duty to initiate a Child Protection Assessment.

12. Cross Boundary Referrals

If the referral relates to a child whose home is in Oxfordshire, but who is temporarily visiting the area of another local authority or in a hospital in the area of another authority, the local authority for the area where the child actually is at the time have prime responsibility for acting upon the referral.

The referral should be passed to that authority immediately for them to follow the necessary procedures and to undertake a Child Protection Assessment and/or take any immediate protective action that is necessary.

Similarly, it is the responsibility of Oxfordshire Children, Young People and Families to make initial enquiries where a referral relates to a child temporarily in Oxfordshire but normally resident elsewhere.

Before undertaking such enquiries, the child’s home authority must be consulted and agreement sought on who is best placed to undertake the enquiries. For those children from other local authority areas, who are the subject of Child Protection Plans, there must be consultation with the responsible Keyworker.

Where this is consistent with the child’s immediate protection needs, it may be agreed that the child’s home authority will respond to the referral.

All discussions/agreements should be confirmed in writing.

For further detail, see Children Moving Across Boundaries Procedure

13. Pre-birth Referrals

13.1 Making a Referral

Where agencies or individuals anticipate that prospective parents may need support services to care for their baby or that the baby may be at risk of Significant Harm, a referral to the relevant Children, Young People and Families Assessment Team must be made as soon as the concerns are recognised. The Assessment Team based at the John Radcliffe Hospital specialises in pre-birth assessments and can advise even if the child is not expected to born at the hospital.

Where the concerns centre around a category of parenting behaviour, for example substance misuse, the referrer must make clear how this is likely to impact on the baby and what risks are predicted.

Delay must be avoided when making referrals in order to:

Provide sufficient time to make adequate plans for the baby’s protection
Provide sufficient time for a full and informed assessment
Avoid initial approaches to parents in the last stages of pregnancy, at what is already an emotionally charged time
Enable parents to have more time to contribute their own ideas and solutions to concerns and increase the likelihood of a positive outcome to assessments
Enable the early provision of support services so as to facilitate optimum home circumstances prior to the birth

Concerns should be shared with prospective parent/s and consent obtained to refer to Children, Young People and Families unless this action in itself may place the welfare of the unborn child at risk e.g. if there are concerns that the parent/s may move to avoid contact with social workers or other professionals.

13.2 The Outcome of Referrals

A pre-birth Initial Assessment should be undertaken and a Strategy Meeting held on all pre-birth referrals where:

There has been a previous unexplained death of a child whilst in the care of either parent
A parent or other adult in the household has a relevant conviction for violence or there are significant concerns about the risks posed by him/her
A sibling in the household is subject to a Child Protection Plan
A sibling has previously been removed from the household by court order or Accommodated as a result of concerns regarding Significant Harm
The mother is under the age of sixteen and there are concerns about her or the expected child.
Domestic abuse is known to have occurred
The degree of parental substance misuse is likely to significantly impact on the baby’s safety or development
The degree of parental mental illness/impairment is likely to significantly impact on the baby’s safety or development
There are concerns about the prospective parents’ ability to care for themselves and/or to care for the child, for example where the parent has no support or learning disabilities
Any other concern exists that the baby may be at risk of Significant Harm, including a parent previously suspected of fabricating or inducing illness in a child or a prospective parent who has been the subject of fabricated or induced illness as a child themselves – for more information on this, see Fabricated or Induced Illness Procedure.

14. Recording

The referrer should keep a written record of:

Discussions with the child
Discussions with the parent
Discussions with managers
Information provided to the duty social worker
Decisions taken (clearly timed, dated and signed)
Records should be reviewed at regular intervals to ensure that decisions taken are followed through

The referrer should confirm verbal and telephone referrals in writing, within 48 hours, using the Common Assessment Framework if appropriate.

The duty social worker receiving the referral should keep a written record of:

Discussions with the referrer
Discussions with any other professionals or agencies involved (including the Police where a crime against a child may have been committed)
Any other relevant information which was taken into account
Discussions with managers
Decisions taken (clearly timed, dated and signed)
Records should be reviewed at regular intervals to ensure that decisions are followed through.