Baspcan

Comprehensive medical assessmentsNHSGGC

Dr Laura Somerville15/4/15

Glasgow

• Population in 2012 of 595,080 • 25% 0-15year olds• 1/3 live in 10% most deprived areas of

Scotland• Lowest life expectancy in UK =73 years• Largest ethnic mix in Scotland• April 2014 502 children on cpr,

392(78%) neglect a concern

Background

• HMIE inspection 2009• Need for improved medical

assessments of children where neglect is a concern

• Comprehensive medical assessments(CMA) introduced NHSGGC(vision of Professor Jean Herbison/Marie Valente,CPU)

Aim

• Describe CMA process• CMA examination• Service developments

• Dental component(2nd presentation)• Illustrative cases(3rd presentation)

CMA-who,why,how,what

• Who?

Children at risk or suffering from chronic neglect

• Why?

Vulnerable children where interpretation of range of health presentations is required

Identify unmet health needs

How?

• Locally delivered holistic medical assessments by paediatricians

• Dental assessment

The West Centre,Drumchapel

Greater Glasgow and Clyde Map

The CMA

• Aims to identify unmet health needs • Coordinate ongoing health issues• Comprehensive report with an opinion

regarding neglect

The CMA process

• Referral via central child protection unit• Discussion ?CMA- not NAI/CSA/LAAC• Information requested- A+E,hospital admissions,outpatient clinics- Gp visits- Health visitor/school nurse information inc

%school attendance- Developmental screening and

immunisations- GIRFEC assessment

The CMA

• Child,parent(consent),social worker• Medical examination• Growth• Development• Interaction observed• Physical examination• Dental examination

• Verbal feedback to social work• Report-social work/gp/referrals

The CMA report

• Collation and interpretation of information

• Health concerns and health needs• Opinion on neglect

• The citations....The challenges..

Report writing

• “Neglect is the persistent failure to meet a child’s basic physical and/or psychological needs likely to result in serious impairment of the child’s health or development”

Scottish Government 2010

Developments

• Peer review –paediatricians,nurse advisors ,dental colleagues and reporter

• Collaborative working with dental colleagues including joint symposium

• Personal practice document most commonly encountered medical and educational issues

Personal practice document

• 11 most commonly encountered issues including

• Obesity• Constipation• Amblyopia• Nocturnal enuresis• Developmental impairment• School attendance• Dental caries

cont

Questions to consider:

1.Has the parent responded to or sought appropriate care and medical attention?

2. For treatable conditions-have they participated in treatment?

3.Would not doing so cause significant harm/serious impairment?

Next challenges

• Case conferences• Opinion

• Linking with Scottish Children Reporters System

• Audit including outcomes

Emotional abuse/emotional neglect

• Describe interaction but only 1 assessment

• This is often our main concern

• Child and adolescent mental health(CAMHS) involvement planned

Conclusion

• Comprehensive medical assessments have challenged and changed the way paediatricians assess children with neglect in Glasgow(NHSGGC)

• Service developments have been positive with joint working with dental colleagues, SCRA,CAMHS colleagues

• Developments continue

Thanks

• Professor Jean Herbison• Dr Alison Rennie• Marie Valente• Professor Charlotte Wright• All CMA colleagues • Child protection Unit ,RHSC,Yorkhill