Working Together to Safeguard Children | Policy Analysis

Working Together to Safeguard Children | Policy Analysis This paper will consider the impact of the â€Å"Working Together To Safeguard Children† child protection policy on the clinical practice of the nursing profession in a general community clinic. The current legislative framework for child protection will be considered with regard to the 1989 Children’s Act, with special reference to the obligations of health professionals working with vulnerable children and their families. Research evidence on the role of nurses in the detection of child abuse will be considered. Furthermore, the paper will discuss the implications of developing existing general practice child protection procedures to include a more active and explicit role for child protection by medical and nursing staff. As Stower (2000) has argued, â€Å"Child protection is the term used by all agencies when there is a suspicion that a child or children (all or some of the children in a family) are at risk of being abused by any adult, family member or non-family member† (p 48). The 1989 Children’s Act was introduced to improve inter-agency cooperation between social services, health and education agencies in the provision of assessment and intervention with vulnerable children. One category of vulnerable children addressed by the legislation were children that have been subject to abuse. The central aim of the 1989 Children’s Act was to emphasis that the welfare of the child is of paramount importance at all times, and that professionals working with vulnerable families should promote cooperation and partnership where-ever possible. It afforded children the right to protection from abuse and the right to have inquiries made about their individual circumstances to safeguard them from harm. The Children’s Act 1989 raised the controversial issue of parental rights, patient confidentiality and a duty of health professionals to protect children and share information with appropriate other agencies with a view to protecting a child. In 1991, Working Together under the Children’s Act was published and it updated guidance on child protection, with an emphasis on different professional groups â€Å"working together† towards the interests of the child. This was replaced by Working Together to Safeguard Children in 1999. This policy document made it very clear that protecting the child was a higher priority than maintaining confidentiality. However, it recommended that parents should be informed when a professional was going to make a referral to social services, unless asking for permission from parents was likely to place the child ‘at risk’ of significant harm. The â€Å"Working Together To Safeguard Children† (WTSC) polic y was based on the legislative framework of the Children’s Act 1989. It outlined the specific roles and responsibilities of community nurses where child protection concerns had been experienced in their clinical practice. It stated that where child abuse was suspected by nursing staff, careful records of parental attitudes and behaviours should be made. This might include reference to the grounds for suspicion, such as a delay in seeking treatment for an injury, unexplained injuries on a child or variation in parental account of how an injury occurred over time, or between parents (Benger and Pearce, 2002). WTSC recommends a non-confrontational, information gathering approach to early investigations of child abuse by community nurses staff, with a strong emphasis on discussing concerns with the child’s GP, who may have detailed knowledge on the circumstances of the child and their family. Where there are concerns that the child maybe at â€Å"at risk of significant ha rm†, nursing and medical staff may contact the social services department to make an official referral. It is standard practice for the GP to make a child protection referral, but â€Å"when there are conflicting opinion, either by medical, managerial or senior colleagues, if the nurse is still convinced that there is a child protection issues, she or he is individually accountable and should refer it to social services† (p 51). However, under the current legislative framework, social services personnel may wish to contact the referral agency for further information on the child’s health and to undertake â€Å"network checks† with all the agencies involved. The GP or nurse maybe invited to an inter-agency strategy meeting attended by social services staff, the police and other relevant staff to discuss their child protection concerns and decide upon a plan of action. Furthermore, the GP or nurse maybe invited to a child protection conference that may lead to the decision to record the child on the Child Protection Register. The Child Protection Register is available to appointed child protection staff within health organisations, to check if a child is known to social services for reasons of emotional, sexual and/ or physical abuse, or neglect (WTSC, 1999). General guidelines on child protection are provided as part of the policy document. It is stated in section 1.13 that â€Å"For those chil dren who are suffering, or at risk of suffering significant harm, joint working is essential, to safeguard the child/ ren and where necessary – to help bring to justice the perpetrators of crimes against children† (p 3). It recommends that health professionals should be vigilant to the possibility of child abuse amongst patients and â€Å"be alert† to the potential risk that abusers â€Å"may pose to children†, and â€Å"share and help to analyse information as that an informed assessment can be made of the child’s needs and circumstances† (p 3). The WTSC policy stated that it was important that every organisation that came into contact with children had a child protection policy in place, but gave little guidance on what the child protection policy should be. It can be argued that the child protection policy should be revised regularly to take into consideration new developments within general practice, such as the introduction of electroni c patient record systems, or change of staff or clinical services. Changes to policy should be undertaken collaboratively between GP’s, nurses and administrative staff that have contact with children. The importance of health care systems in the protection of children has been made clear in recent years, and lead to legislative changes that are presently being implemented as part of the 2004 Children’s Bill. Victoria Climbie died in February 2000 as a result of severe and repeated physical abuse and neglect by her caregivers that amounted to 128 separate physical injuries being recorded at the time of her death. The appauling circumstances of her death trigged a public inquiry, led by Lord Laming (2003), who identified 12 opportunities by health, police and social services agencies to protect this eight year old girl from many months of brutal abuse and neglect. One source of criticism in the Climbie report was directed at the health care system, in particular Accident and Emergency departments, that had misdiagnosed her physical injuries of scratches and bruises as being the result of scabies in June 1999. Social services were not notified of any child abuse concerns by do ctors at this time. In July 1999, Victoria Climbie was readmitted to hospital for treatment of burns, but due to poor communication between health professionals, social services and the police no full assessment of the child was ever made (Hall, 2003). The Lord Laming report recommended that agencies work more closely together, with better training and interagency cooperation to prevent child abuse. As Hall (2003) argues, â€Å"Amid the justifiable horror at the death of Victoria Climbià © and the focus on violent physical abuse, we must not neglect the opportunities for prevention. This too is the responsibility of all who work with children, but in the health service it particularly falls on primary care staff, including midwives, health visitors, school nurses, and on those working with mentally ill adults and drug misusers† (p 294). Lord Lamings recommendations were reflected in the 2004 Children’s Bill that aims to set up a central electronic record for every chi ld in the country that would contain sensitive information on professionals who were involved with them. It is believed that such a system would make it easier for appropriate professionals to make ‘informed judgements’ about the safety of children, based on information gathered from other agencies with an interest in the child. However, the new legislation is controversial because of concerns about civil rights, and the Government are currently in consultation with local education authorities with a view to piloting the electronic record system. In the UK, four types of child abuse are currently recognised under the legislative framework. These can be classified as neglect, physical injury, emotional abuse and sexual abuse. Physical abuse and neglect maybe the most often encountered type of child protection problem in community practice, but it is easy to mistake physical abuse for accidental injury (Breslin and Evans, 2004). The estimated burden of physical child abuse in the UK population is 2.7 children per 1000 per year, according to the NSPCC (Breslin and Evans, 2004). This means that every general practice in the country could include a sizeable minority of families registered with them where physical child abuse is occurring at home. When children attending Accident and Emergency departments for treatment, it is standard practice to send a notification of attendance and reason for attendance to the GP. When medical staff have suspicion of child abuse, a careful examination of the medical records may show that a child has a history of injury. Shrivasta (1988) found that 22 out of 108 children (20.4%) had one or more admission to hospital for non-accidental injuries over the 5 year period of the study. Furthermore, Fryer and Miyoshi (1994) have shown that abused children are ‘at risk’ of being re-abused over a relatively short period of time. In their study, 69.2% of children that suffered from a reoccurrence of abuse, did so within 360 days of the prior abuse event. Furthermore, in their study 9.34% of children were re-abused in the four year period of the study, and the risk of multiple reoccurrences increased after every abuse event. Therefore, it is not possible for health professionals to discount evidence of child abuse as being a ‘one off’ episode that is unlikely to happen again, without a full investigation of the child’s needs. It is possible to check if a child is registered with social services on the Child Protection Register. However, this is a poor measure of risk because only the most serious cases of child abuse will ever be registered, and children rarely stay on the Child Protection Register for more than two years due to current social services policy. Greenfields and Statham (2004) have shown that the decision of health agencies to act on suspicious injuries is affected by knowledge of whether they are registered on the Child Protection Register or not and social/ circumstantial factors related to the child and their family, as opposed to the clinical characteristics of the case. Indeed, a third of child protection register custodians felt that health professionals gained a false sense of security from knowing a child was on the register, and did not intervene as much as where the child was not already known to social services. Research has shown that abused children who live with the perpetrator are sixteen times less likely to receive medical care for their injuries, as opposed to abused children where the perpetrator is not resident (Ezzell, Swenson and Faldowski, 1999). Furthermore, retrospective studies of adults reporting that they were abused as children are much higher than official statistics would suggest (Cawson et al, 2000). This suggests that a considerable degree of child abuse is ‘hidden from view’ and community nurses may be in a unique position to befriend families through the delivery of standard health care, such as immunisation, and be vigilant to child protection issues at this time. Furthermore, since research has shown that children at risk of abuse and neglect may not be registered with a GP (Taylor, 2004), the provision of general health checks such as the cervical smear clinic or diabetic annual review provide an opportunity for nurses to enquire after any children in the home that may not be registered at the practice. As the WTSC policy emphasises inter-agency partnership, it is possible for community nurses to contact duty social workers, health visitors and youth workers to facilitate information exchange about vulnerable young people in the area. This also provides an opportunity for information and training about the respective professional disciplines. Nurses in community settings have a potentially high level of contact with abused children and the opportunity to form ‘trusting relationships’ with children and families (Nayda, 2002). It is necessary to formulate general practice child protection policies that make best use of nursing expertise, and facilitate ‘working together’ ideals within practice between nurses, GP’s and other professionals as much as ‘working together’ with external organisations. This means that any child protection policy should include time at a weekly practice meeting where staff can exchange information about children thought to be ‘at risk’, and discuss best child protection practice. Opportunities for information exchange and inter-agency cooperation in child protection enquiries are particularly important since nurses, in one study, felt that other professionals were keen to ‘pass the buck’ rather than engaging in equal profession al consultation (Nayda, 2002). Furthermore, the nurses in this study suspected child abuse on a regular basis, but only reported it when there were no repercussions of reporting; â€Å"Their concerns were not only for the children and their families but also for themselves. One nurse stated that if her own safety was uncertain she would not report a situation where a child was at risk. However, most were concerned about the consequences of reporting for the family† (p 172). Furthermore, the decision to report about child abuse was partly informed by past experience of dealing with the child protection welfare system. As such, â€Å"some of the nurses did not report all cases of suspected abuse, knowing that reporting their suspicions did not necessarily result in action† (p 176). The nurses reported that they were reluctant to report families for child abuse because they felt it destroyed the relationship that they had developed with the families, and reporting child a buse was very much identified as a last resort when all other intervention options had failed. Through this study, it is clear that the ‘ideological’ values underpinning the WTSC policy may not be applied in practice due to difficulties contacting other professionals, and personal confidence and sense of security when making a decision about child protection. As Stower (1999) argues, there is some confusion amongst the nursing profession about their responsibilities under the Children’s Act 1989. The area of parental responsibility is not clearly defined in the legislation, and the term ‘at risk of significant harm’ is open to subjective interpretation. However, Stower (1999) suggests â€Å"This will depend on the degree of the type of abuse, the effect on the child and the circumstances surrounding the event. It must be remembered that single bruises in certain circumstances, for example, a disabled child or very young baby, could be significant an d should not be disregarded† (p 49) In conclusion, research has shown that child abuse is a common problem and one that nurses may encounter as part of their clinical practice. Research shows that community nurses are in a good position to build relationships with families, and to detect child abuse as part of their routine health screening duties. Furthermore, the new child protection policies insist that nurses report child protection concerns, and exchange information with other relevant agencies. However, in a Scottish study of training and supervision in child protection for nurses, it was observed that there was a lack of uniform availability of training opportunities; a situation aggravated by a professional resistance to clinical supervision by nurses who ‘avoided it like the plague’ and a resistance to child protection training that was perceived as not relevant to some nurses practice. â€Å"However, it is important to recognise that supervisors of these nurses may have little or no expertise in child protection issues, therefore the ability to access a specialist child protection worker in relation to specific pieces of work may be critical† (Lister and Crisp, 2005, p 67). Therefore, effective training and clinical supervision programmes, that meet nurses’ needs, may be central to their increased involvement in child protection screening and referral in general practice. References Benger J and Pearce A (2002) Quality improvement report: Simple intervention to improve detection of child abuse in emergency departments. BMJ 324, pp 780 – 782 Breslin R and Evans H (2004) Key child protection statistics. Retrived from: http://www.nspcc.org.uk/inform/Statistics/KeyCPstats/1.asp : 16th June 2005 Cawson P, Wattam C, Brooker S and Kelly G (2000) Child maltreatment in the United Kingdom (NSPCC, London) Department of Health (1999) Working Together to Safeguard Children (HMSO, London) Ezzell C, Swenson C, Faldowski R (1999) Child, family and case characteristics. Child and Family Studies 8.3 (pp 271- 284) Fluke J; Yuan Y; Edwards M (2005) Recurrence of maltreatment. Child Abuse Neglect 23.7 (pp 633 – 650) Greenfields M and Statham J (2004) The use of child protection registers (Thomas Coran Research Unit, Institute of Education) Hall D (2003) Child protection. BMJ 326: 293 – 294 Keshavarz R, Kawashima R and Low C (2002) Child abuse and neglect presentations to a pediatric emergency department. Journal of Emergency Medicine 23.4, pp 341-345 Lister P and Crisp B (2005) Clinical supervision in child protection for community nurses. Child Abuse Review 14, pp 57 – 72 Lord Laming (2003). Inquiry into the death of Victoria Climbià ©. London: Stationery Office, 2003. Retrieved from: www.victoria-climbie-inquiry.org.uk :18 June 2005 Nayda (2003) Influences on Registered Nurses’ decision making in cases of suspected child abuse. Child abuse review 11, pp 168 – 178 Prescott A, Bank L, Reid J, Knutson J, Burraston B and Eddy J (2000) The veridicality of punitive childhood experiences reported by adolescents and young adults. Child Abuse Neglect 24.3, pp 411-423 Shrivastava R (1988) Non-accidental injuries (Unpublished thesis at University of Liverpool) Stower S (2000) The principles and practice of child protection. Nursing Standard 14, pp 48 55 Taylor (2004) Integrating community child health and hospital information for communication and early warning (Royal Free Hospital Report, London) The Children’s Act 1989 http://www.opsi.gov.uk/acts/acts1989/Ukpga_19890041_en_1.htm

Nicotine as a Means for Weight Control Essay -- Smoking Tobacco Diet P

Nicotine as a Means for Weight Control: Tobacco drieth the brain, dimmeth the sight, vitiateth the smell, hurteth the stomach, destroyeth the concoction, disturbeth the humours and spirits, corrupteth the breath, induceth a trembling of the limbs, exsiccateth the windpipe, lungs, and liver, annoyeth the milt, scorcheth the heart, and causeth the blood to be adjusted." Tobias Venner Via pecta ad vitam Longam, 1693 (Fielding, 1992) Introduction: Since around the 1950's-60's, smoking has been a target of attack for the scientific community and rightly so. Smoking, as well as other forms of tobacco use, has been proven to be linked with serious health problems and diseases such as lung cancer and emphysema. Research has become so extensive that actual causal and not simply correlational relationships have been proven. Yet, smoking remains the number one preventable cause of premature death and disability in theunited States (390,000 death per year.) (gopher:flminerva.acc.Virginia:70/00/p ... ubstancetfacts/substance/drucl/tobacco.txt.) So after all the negative evidence of smoking and other uses of tobacco products, why do people insist on continuing? The presence of a substance called nicotine partly answers this question, Nicotine effects in tobacco products are associated with addiction, tolerance, and motivation reasons for use. One motivation less focused on but none the less very important is the use of nicotine as an ap petite suppressant. Many people, especially young women, associate nicotine with weight loss and dietary control. Two questions arise: Is the claim that nicotine as a means to control weight grounded in factual evidence, or rather the product of an image portrayed by the tobacco industry?... ...nce Abuse, 5, 391-400. Richmond RL- Kehoe L-, & Webster IW. Weight change after smoking cessation in general practice. Medical Journal of Australia, 158, 821-2. Schwid SR., Hirvonen MD., & Keesey 13E. (1992). Nicotine effects on body weight a regulatory perspective. American Journal of Clinical Nutrition, 55, 878-84. Seah Mi., Raygada M., & Grunberg NE. (1994). Effects of nicotine on body weight and plasma insulin in female and male rats. Life Sciences. 55, 925-31. Winders SE., Dykstra T., Coday MC., Amos JC., Wilson MR>, & Wilkins DR. Use of phenylpropanolamine to reduce nicotine cessation induced weight gain in rats. Psychopharmacology, 108, 501-6. Winders SE., Wilkins DR. 2d, Rushing PA., & Dean JE. (1993) Effects of nicotine cycling on weight loss and regain in male rats. Pharmacology, Biochemistry & Behavior, 46, 209-13.

World Environment Day

World Environment Day is celebrated each year on 5th June. The United Nations established in 1972 to mark the opening of the Stockholm Conference on Human Environment. World Environment Day is used by the United Nations to encourage awareness of the environment. The first World Environment Day held at Stockholm, was the first time political, social and economic problems of the global environment were discussed at great length in view of taking some definitive action.World Environment Day is celebrated in many ways. Street rallies, parades, street plays create awareness about world environment. In many cities contests like poster contests, essay contests, poetry contests, slogan contests and debates are held to celebrate this event further. The main objective always is to get the people involved with the environment. Some cities have art exhibitions with art made from recycled materials. Banners are put all across the street promoting the message of World Environment Day.Tree planting is also held in some cities. Awards are given out to those neighborhoods that have made a significant effort to take care of the environment. Broadcast of public service announcements on TV and radio help to renew people’s efforts to saving the environment. Conferences are held to educate people about the efforts that can be made to preserve the environment. The World Environment Day’s agenda is to give importance to environmental issues. It hopes to empower people to become active agents promoting the cause of the environment. Change can happen only if it is affected at the community level; hence programs are held on World Environment Day that creates community consciousness.Heads of Government and Ministers of Environment deliver speeches’ advising the people of what has already been achieved and what still needs to be achieved. Some even go a step further and set up permanent government bodies that will look specifically into environmental issues. Each World Environment Day has a special topic that related to the environment that it addresses. The topic for World Environment Day for 2007 was â€Å"Melting Ice – a good Topic?† It discussed the affects the climate change was having on the  polar ecosystems and communities and the resulting global impacts of these changes.The topic for World Environment Day 2006 was Deserts and Desertification and the slogan was â€Å"Don’t desert dry lands† World Environment Day is a day for us to inspect the state of our environment. It calls for us to stop in our tracks one day in the year and examine our surroundings. It asks us to pledge, in a small way at least, to do something for the environment. The young and the old can contribute to the saving of the environment.Not everyone needs to make hefty contributions to world environment organizations. The little things, the ones that really matter are things like recycling our waste, using paper and products made of wood d iscriminately and these can be done by anybody and everybody. Children can also contribute to this cause by not wasting water, by switching off the lights and fans in the house when not in use. There is something each of us can do to preserve the environment. So let us all pledge to do something, at least one thing.

The Death Penalty and Punishment for Crimes - 795 Words

The purpose of punishment is to keep an incident from reoccurring. While punishment doesn’t keep it from happening again, it helps. Execution and the death penalty have been used in most societies since the beginning of history. Penalties back then included boiling to death, flaying, slow slicing, crucification, impalement, crushing, stoning, decapitation, etc. The death penalty was used for reasons today that would go under cruel and unusual punishment. Today in the United States, execution is used mainly for murder, espionage, and treason. In some states in the US, death by firing squad is still used. (â€Å"Criminal Justice: Capital Punishment Focus†). 35 states, the U.S military, and the U.S government today use lethal injection as the main method of execution. (â€Å"Methods of Execution†) I believe that the death penalty is not the right way to punish people who have been convicted of murder. 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