Multiagency working to protect vulnerable children in the COVID era: What have we learnt? What should we do now?

Final project report (PDF). August 2022.

Authors

Project coordinators: Sharon Dixon and and Catherine Pope.

Sharon Dixon is a GP partner in Oxford and NIHR Doctoral Research Fellow at the University of Oxford. She is a practice safeguarding lead..

Catherine Pope is a Senior Research Fellow at Green Templeton College and Professor of Medical Sociology in the Nuffield Department of Primary Care Health Sciences, University of Oxford.

Green Templeton Student researchers

Jennifer Ginger, Yiwen Zhang, Chloe Mercer.

Introduction

Multi-agency working is the cornerstone of effective child safeguarding. This is embodied throughout safeguarding processes, from a policy and strategic level where safeguarding partnerships hold oversight of child safeguarding planning to the front-line delivery of safeguarding care (for example through multi-agency safeguarding hubs, multi-agency safeguarding meetings and inter-professional conversations).

Multi-agency working offers the possibility of bringing together perspectives and knowledge from across the different facets of families’ lives and interfaces with services, to develop a fuller and more nuanced contextual understanding of the child within their family and social circumstances. As well as having shared interests in the child’s welfare and wellbeing the agencies and individuals engaged in multi-agency collaborations typically have shared aims and goals about the safeguarding process.

However, each agency participating in a multi-agency process or activity will also have their own internal structures, guidelines, and processes. Agencies on the front-line may be considered or treated as a ‘single entity’ under an umbrella heading, for example ‘education’ or ‘health’ and there may be significant differences and layers of complexity within their structures and teams. For example, ‘education’ for one family could include several schools or pre-school settings which can each function as discrete relatively autonomous units, or ‘health’ could include health visiting, midwifery, primary and secondary care – all of whom may be working within different work protocols, professional guidance and/or boundaries. This can complicate multi-agency collaboration; we know from serious case reviews that the gaps in these multi-agency processes are implicated in failings of child safeguarding processes, sometimes with devastating impacts. There is an urgent need to understand how these gaps arise and therefore could be bridged.

The COVID pandemic in March 2020 generated significant challenges for safeguarding care. Legislative changes including societal lockdowns designed to support infection control necessitated rapid adaptations and transitions in how safeguarding care was delivered. In parallel with grappling with these rapid changes, professionals recognised that the risks for vulnerable children were increasing. The message to stay safe at home worked less well for children and families who may not be safe in domestic settings. Rates of domestic violence and abuse (DVA) increased, and there were concerns about rises in alcohol consumption and the negative sequelae associated with this. Despite the concerns about increased risks, rates of referral to social care and for DVA support went down. Most children were not in school and thus had fewer opportunities to seek support. Children known to be vulnerable were allowed to go to school, but many did not. In some regions, health staff who typically would have been available to support families, such as health visitors, were re-deployed into other services, reducing opportunities for proactive routine care and opportunistic identification of safeguarding vulnerabilities. Medical consultations shifted rapidly towards a total triage model, with most appointments conducted remotely1. These adaptations largely happened within agencies and inside individual organisations.

At the start of the pandemic, it became clear that safeguarding processes needed urgent attention. A number of organisations produced rapid pragmatic guidance for their teams. For example, in primary care, the Royal College of General Practitioners (RCGP) offered suggestions about how practices could maintain and consider safeguarding needs2. However, there was little evidence to inform this guidance, with no pre-existing research about how best to approach safeguarding using remote consulting.

Recognising this gap, two of the authors (CP and SD) conducted a qualitative interview study with GPs to explore their perspectives on managing safeguarding concerns in the pandemic, which has been reported elsewhere1. While conducting this work we became aware that research to explore safeguarding in the pandemic was also being conducted within social care3 and in relation to child protection4. CP and SD approached these researchers to explore shared learning about safeguarding and to consider how our collective research could inform better multi-agency working. These conversations led to the activity reported here.

Approach

The Sheila Kitzinger Programme provides financial and administrative support to researchers seeking to maximise the impact of their research and their influence on policy and practice. This Programme supported a series of learning meetings where we brought together academics and clinicians involved in safeguarding practice, policy, and research to share learning about safeguarding in the pandemic5. While this was not a research project per se and thus did not require ethical approval, the participants consented to the inclusion of their contributions in this final report for the funder.

The meeting participants across the programme included representation from primary care (both researchers and clinicians with expertise in domestic violence and abuse and safeguarding), social care (academics and practitioners including from fostering and adoption), paediatricians, child and adolescent psychiatry, police, multi-agency researchers and education workers. A full list of meeting participants is included in the appendix, within the meeting minutes (Appendix A+B).

At the first meeting (July 2021), participants shared their research, and professional experiences of child safeguarding policy during the pandemic. These were typically focussed on experiences and roles in context specific settings, for example police practices in the pandemic directed to responding to DVA, social workers management of children known to be ‘at risk’. Together the group identified areas for further reflection:
1. Advantages and disadvantages of remote working
2. Consideration of how (and when) there are opportunities to break down professional silos in multi-agency working to safeguard children.
3. How to identify and develop practices that fostered positive working and interactions during the pandemic (we gave this the shorthand term ‘professional kindness’)
4. What practices we would want to keep from our learning and working in the pandemic – and what we would like to leave behind.
To inform our deliberations on these topics, with support from three student researchers (JG, YZ, CM), we explored published research, policy, and guidance about child safeguarding during the pandemic. We re-convened the group in October 2021, to share the reviews of literature and reflect further on what we had learnt (summary slides included as appendix C).
This final project report represents a summary of the meeting processes and conversations, focussed on the key questions identified in our first meeting.

Discussion

The advantages and disadvantages of remote working

Participants’ experiences of working and researching child safeguarding in the pandemic afforded a lens to explore and share our work. Across the reports from health, education, and social care, we identified many commonalities, including adaptations to processes of assessment, learning to navigate remote consulting with those we were supporting, and managing an evolving interface of professional and multi-agency interactions.

There were shared concerns about the potential limitations of remote assessments, including the lack of non-verbal and visual clues, the safety and privacy of electronic encounters, challenges in developing rapport and establishing trust, and impacts on those who were disadvantaged through digital contacts (for example excluded because of a lack of equipment, data, literacy, or language).

There were shared concerns that these transitions risked creating new and exacerbating existing health inequalities. Professionals in health, social care and education had a shared awareness that those who were just about managing before the pandemic may have become rapidly more vulnerable because of the stresses of COVID and the associated societal responses such as lockdowns (including physical, emotional, social, and financial impacts). These could be harder to evaluate and support, representing a source of unease and distress for professionals across disciplines. Many of these stressors could also be relevant to professionals themselves, as they held both professional and personal uncertainty and vulnerabilities as they worked.

Professional isolation and vulnerability could be compounded by staff illness and staffing shortages, meaning simultaneously increased workloads and reduced opportunities for respite or time off. The experience of the possibility of ill health (or death) as a potential ‘occupational hazard’ was new for some and magnified for all. In the initial phases of the pandemic, this was compounded by conflicting messages, and a lack of (consistent or adequate) access to PPE.

In sharing our work, we heard how the transition to remote consulting represented a profound change in practice across health, social care, and education. There were pervasive concerns about the challenges of delivering safeguarding care by remote consultations, with concerns about how safe the conversations were, and what might be missed. Knowing how to safely and effectively navigate to be able to hear the ‘voice of the child’, the heart of safeguarding, was hard, and a source of concern.

We discussed how remote working could create opportunities for some individuals and some safeguarding encounters. For example, in the study about remote working with GPs, they identified potential opportunities for utilising the flexibility of telephone triage and remote encounters to create spaces for those in need; adapting to increase the equity of what they offered and suggested that this could be actively recognised and nurtured in policy and practice. In social care, working remotely could facilitate shorter but more frequent check in calls, or enable sharing of material by email with rapid follow up in a video call. Changes in bureaucracy meant that navigating access to material benefits such as food banks could be easier. Home school link workers told us how they had worked flexibly, using their local knowledge to individualise offerings and support. Safeguarding partnerships enabled local agencies to find solutions and work together. Many of these adaptations were enabled, at least in part, by a sense of relative professional autonomy, under-pinned by a professional commitment to compassion and kindness.

At the same time we consistently heard, across and between disciplines, that remote working impacted on personal and professional wellbeing. These included effects on worker welfare, on stress and isolation, personal and professional vulnerabilities, and in navigating the blurred boundaries between work and home. Working from home could lead to a sense of relative professional isolation, and holding these stresses without access to peer support or de-briefing was hard.

How (and when) there are opportunities to break down professional silos in multi-agency working to safeguard children

We heard how the experience of increased isolation and stress whilst delivering or researching safeguarding care during the pandemic had been expressed by social workers, primary and secondary care clinicians, police, academics working in safeguarding and domestic violence and abuse (DVA), education workers and adoption workers. With the exception of research with a multi-agency focus (eg Driscoll et al., 2021), this work was typically documented in different role specific literature or meetings, with fewer opportunities for sharing between disciplines, resulting in less awareness of the challenges other professional groups were experiencing. For example, the research in primary care had been presented at a national RCGP conference, but there was no mechanism to communicate this to secondary care or social work research. Likewise, the research into social care remote consulting was not shared directly within health meetings or forums. Participants described an initial ‘tsunami’ of training, but again, we heard how in our participants experience, that this was typically developed and delivered within professional groups.

Participants described feeling alone in carrying the burden of safeguarding during the pandemic, which potentially undermines the shared trust and accord that needs to underpin effective multi-agency collaboration. Sharing the burden by understanding others’ stresses was helpful in creating space for collaboration and professional kindness.

These meetings offered a space for the shared reflection that is perhaps under-recognised or under-valued component of safeguarding work: listening and witnessing trauma and distress as a compassionate professional companion – ‘standing witness’. Being able to do this represented a core value for safeguarding professionals, but it can carry an emotional impact. Sharing these experiences and developing spaces for mutual support could represent another opportunity for inter-disciplinary solidarity and compassionate cooperation and enhance joint working. Spaces for mentorship, peer support, and spaces for reflection and supportive listening represent best practice and do exist, – but this could be further nurtured. These structures are largely within single agencies, but could be developed at a multi-agency level, for all frontline safeguarding workers. This could support nurturing practitioners new to safeguarding.

We also heard that ‘Silos’ in safeguarding were experienced not only between professional groups, but also between different types of safeguarding need. All these potential divisions warrant reflection and attention, to promote an understanding of how this intersectionality interfaces with multi-agency working and safeguarding care.

As we considered the gains made by coming together to share learning we identified the need for shared language and a shared understanding of what the language means, and how this is understood and operationalised within different agencies. One example focussed on the complex area of information sharing to support child safeguarding. This emerged as a potential source of tension between agencies, as agency-specific guidance and disciplinary practices tended to simplify information sharing, leading to expectations that this is a binary and straightforward process. ‘Rules’ for information sharing could sometimes seemingly pit individual agencies against each other, which could hamper effective safeguarding. Many serious case reviews have identified that information sharing has been a failing, yet simply imploring professionals to do better, without developing a mutual understanding of the challenges and complexities each agency faces may not improve matters.

Even within the single agency ‘health’, where all practitioners are held within the supportive framework of professional guidance such as the GMC for doctors, differences in the challenges experienced between primary and secondary care were noted. Primary care often holds the records for many family members. This is part of the strength and value of primary care’s contributions to safeguarding but can add tensions and complicate processes of communication about what information needs to be shared and when or whether consent is needed. If there is immediate concern, then this is relatively straightforward, as consent is not needed, however situations may be less clear and more nuanced requiring a shared understanding of processes and meanings of consent. An example discussed in the meeting was when a social worker has asked the family for consent to approach primary care; what does that mean for the GP? As data guardians who know what is in the record, GPs are obliged to establish consent (unless consent is not needed) and this process could be uncertain and nuanced. Together, we reflected on what could it be helpful for social care, primary, and secondary care professionals to understand about consent to facilitate information sharing.

How to support ‘professional kindness’

One of the social care participants reflected that, in over thirty years of social work, this was the first time they had ever had a conversation about these questions with three GPs – with the converse being equally true! The need for better cross-agency working was seen as vital. While remote working may have complicated case-load care, it also enabled and improved some professional communication. For example, GPs found it easier to attend multi-agency meetings when these are on-line. While this could facilitate meetings, as with casework, understanding what this might mean for developing professional trust and rapport was important to be considered, including how this might both help and hinder network development. The group felt that more attention was needed to develop spaces for effective relationship building between teams. This was seen as an important step towards meaningful and beneficial multi-agency working.

Partnership working is the essence of safeguarding care and is embodied within formal safeguarding partnership structures. Yet this needs to percolate to the front line. While it is positive that 56% of respondents to a large multi-agency working survey (Driscoll et al., 2022) felt that working relationships among partners and relevant agencies had strengthened as a result of the pandemic adaptations, we need to ensure that we invest in this and nurture collaboration and relationships.

Compassionate leadership, shared learning and training could support these aims.

What we would want to keep from our learning and working in the pandemic – and what we would want to leave behind

The pandemic rapidly transitioned how safeguarding care was delivered and experienced for front-line practitioners across disciplines. It represented a time of rapid learning and adaptation. The opportunity to pause, reflect and take stock in the learning meetings was valued, as was the chance to share this experience across disciplines. Remote working created risks and opportunities which need to be used to inform how services re-configure as the pandemic recedes and to ensure learning is available should it be needed again in a time of crisis.

There was a huge amount of positive and innovative work done during the pandemic, for example, school workers developing new relationships and outreach work with families and within their communities. Likewise, we heard about experiences of transition and compassion in family courts, (albeit alongside some challenges around access and digital transition). We need to appraise and evaluate transitions, recognise and value innovation and changes which worked well, and learn how to keep and build on this. This needs to include asking about and taking notice of what resources are needed to maintain both service structures and wellbeing of staff delivering and interacting with services.

Access to timely services that meet the needs identified in assessments was identified as integral to both effective safeguarding work and staff well-being. Early help access was singled out as an area for service development and focus. Ensuring that there was something available and meaningful to offer facilitated exploring support needs for families and promotes the development of trust. Lacking access to this risks moral injury for safeguarding workers alongside potential adverse impacts on families.

Framing safeguarding within a public health lens, and as a social determinant of health could keep a policy focus on recognising the need to invest services and resources into the care of vulnerable young people. This needs to be accompanied by support, resources, and training for those who deliver safeguarding. Ten years of austerity have had a palpable impact on frontline services, for both those who deliver them and those who depend on them.

While there were many commonalities, there was also much that could be learned from this cross-agency learning process. We need to be mindful about what has worked well and what has been less effective. This could differ between roles and disciplines, and taking a multi-agency lens to this reflection will help evolve multi-agency collaboration. There was a strong sense that post-pandemic practitioners should not simply revert to ‘what we did before’ or jettison all the new ways of working, including remote practice. There had been much learning about what could work well (and when, and for whom). But it was equally important to reflect on where things had been difficult, so that as practice evolved towards a likely hybrid model, that this was done ‘mindfully’ and with open eyes. As one of our participants reminded, with the words of St Benedict ‘Be careful to be gentle, lest in removing the rust you break the whole instrument’6.

Conclusion

We are beginning to read about some of the devastating cases when safeguarding care during the pandemic was not able to protect vulnerable children. Our learning meetings have reinforced the idea that to deliver effective safeguarding we need to understand and consider what processes and structural factors underpin points of divergence as well as points of alignment for multi-agency working. Suggesting that there should not be points of divergence, or that cohesion should be straightforward, without accounting for the culture and working practices of individual agencies, will not enhance multi-agency working. We need to work collaboratively, and collectively understand how to enhance the capacity and capabilities of multi-agency safeguarding teams, through from frontline practice to strategic policy. Sharing learning, practice, and research between agencies could form part of this process.

Key messages

1. Remote communication with families and between professionals became routine in safeguarding work during the pandemic.
2. Remote communication offers opportunities for fostering inter-agency communication and working, and can promote access for some, but is not without significant risks.
3. Pandemic learning and agency adaptations to remote working largely occurred within single agencies or institutions, and we need to urgently consider and evaluate the impacts of these on multi-agency working.

Next steps

We have been able to collaborate on a grant application, and on a personal view submission, which has been published on BJGPLife7 and will form a BJGP editorial.

References:

1. Dixon S, Frost L, Feder G, et al. Challenges of safeguarding via remote consulting during the COVID-19 pandemic: a qualitative interview study. Br J Gen Pract 2022; DOI: https://doi. org/10.3399/BJGP.2021.0396
2. RCGP guidance on managing safeguarding in COVID. COVID-19 and Safeguarding (rcgp.org.uk) Accessed 3.8.22
3. Ferguson H, Kelly L, Pink S. Social work and child protection for a post-pandemic world: the re-making of practice during COVID-19 and its renewal beyond it. Journal of Social Work Practice 2022; 36(1): 5–24
4. Driscoll J, Lorek A, Kinnear E, Hutchinson A. Multi-agency safeguarding arrangements: overcoming the challenges of Covid-19 measures. Journal of Children’s Services. 2020 Nov 2.
5. The Sheila Kitzinger Programme: Sheila Kitzinger Programme – Green Templeton College (ox.ac.uk), accessed 3.8.22
6. 10 helpful quotes from St. Benedict of Norcia (aleteia.org) accessed 3.8.22
7. Supporting the ‘Multi’ in Multi-agency working for child safeguarding – BJGP Life accessed 3.8.22

About the Sheila Kitzinger Programme

The Sheila Kitzinger Programme honours the life and builds on the work of the social anthropologist Sheila Kitzinger (1929-2015).

Sheila’s comparative research blended intense immersion in different communities, participant fieldwork and strong clinical knowledge to advocate evidence-based decisions on medical, legal and social change.