Professional concerns regarding an 11-year-old boy admitted to hospital in April 2020. Liam's presentation at hospital was due to an accidental injury, but his appearance and history of previous medical presentations raised concerns about his care and resulted in the instigation of care proceedings. Learning includes: practitioners should take into account the impact of parental anxiety on a child's overall welfare; practitioners learn strategies for working with parents who are highly anxious; children cannot always easily articulate their day-to-day life experience, particularly when they have no ongoing relationship with an adult outside of the home; the need for practitioners to be professionally curious about information provided by parents and how that impacts upon the care provided; the challenges of working with families where there is partial engagement and disguised compliance. No recommendations, but notes that learning has been incorporated into the local safeguarding partnership's workstreams, including multi-agency training, planned audits and professional guides.
      
 Title:  Learning review report: Liam. LSCB: Hampshire Safeguarding Children Partnership Author: Hampshire Safeguarding Children Partnership Date of publication: 2022  This case review report was deposited by the publishing LSCB(s) with the national SCR repository, a partnership between the Association of Independent LSCB Chairs and the NSPCC.  This report is available online via the NSPCC Library Catalogue. Copyright of this report remains with the publishing LSCB(s) listed above.                            1    Learning Review Report  Liam  This review has been undertaken on behalf of the Hampshire Safeguarding Children Partnership (HSCP) by the Learning and Inquiry Group. The review of Liam’s case is taking place in conjunction with the review a of another child, where some similar characteristics of the case were identified, and it was considered that learning in the two cases were likely to have similarities.    A summary of the case: Liam was referred to Childrens Services at the end of April 2020, aged 11, following admission to hospital a fortnight earlier. His initial presentation at hospital was due to an accidental injury, but his appearance (thin and pale), a detailed history of his previous medical presentations and observations of his progress in hospital raised concerns about the care he was receiving at home.  A multi-agency assessment of his circumstances resulted in his case being put before the court in public proceedings.  History:  Liam lives with his mother, father, and older half sibling. There is a history of his parents seeking medical advice from an early age, due to reported concerns about mobility, pain and discomfort and eating difficulties in particular. He was also described as highly anxious, with some social and communication difficulties.   Parents were concerned about his health and were anxious about what his reported conditions meant. In particular, they were keen to know if Liam was autistic. At aged 6, Liam’s family decided to home educate him and notified the school and the Local Authority Elective Home Education service of this decision.  Liam was seen by various health professionals over the following years during which time he was also waiting to be assessed for autistic spectrum disorder (ASD). Adaptations were carried out in the family home to assist with mobility and Liam was noted to use a wheelchair at times. He was referred to a paediatrician, paediatric orthopaedic surgeon, paediatric physiotherapist, and to the paediatric pain service. A referral was made to Children’s Services via the Multi Agency Safeguarding Hub (MASH) in February 2019, with concerns expressed about his social isolation and the appropriateness of the educational input he was receiving. A Child and Family Assessment was completed which concluded that the family should be offered support at Early Help level, but this was not taken up by the family.   Liam was seen and assessed by a commissioned service on behalf of Hampshire Child and Adolescent Mental Health Service (CAMHs) in April 2019, which confirmed his diagnosis of ASD.  Matters came to a head in late April 2020 when his family, having sought medical advice and help to treat an injury which seemed not to be healing, took Liam to A&E.  It became apparent that Liam  2  was severely underweight and that his diet had become significantly restricted over the previous weeks (particularly since the COVID-19 lockdown on 23 March 2020).  Learning points for managers: • Ensure that practitioners take into account the impact of parental anxiety on a child’s overall welfare. • Children will not always easily be able to articulate their day-to-day life experience particularly where they have no ongoing relationship with an adult outside of the home. Practitioners may need to go back to see the child more than once.   Learning points for practitioners: • To be 'professionally curious' about information provided by parents and how that impacts upon the care provided. • Copying multiple people into a letter does not guarantee that anyone is acting on the information.  Learning points for HSCP: • Help practitioners to engage with parents who are highly anxious.  Themes in common with other reviews in Hampshire: • The challenges of working with families where there is partial engagement and disguised compliance. • Children will not always easily be able to articulate their day-to-day life experience, particularly where they have no ongoing relationship with an adult outside of the home.  If you do one thing, take the time to…. • Consider the impact of parental anxiety on child development and learn strategies for working with parents who are highly anxious.  How was learning achieved:   A multi-agency review was commissioned by the Learning and Inquiry Group of Hampshire Safeguarding Children Partnership. Hampshire agencies provided written reports. These were reviewed by two senior managers, independent of the case and where required, additional information sought from professionals involved in the case.  HSCP response:  The learning in this Learning Review Report has been incorporated into HSCP workstreams. This has included multi-agency training, planned audits, scrutiny work, professional guides, and featured newsletter items.   Training and resources:  ▪ HSCP Training - HSCP offers training on a variety of safeguarding themes. ▪ HSCP Training 2020/21 ▪ HIPS Procedures  ▪ HSCP and IOWSCP Neglect Strategy and Toolkit ▪ HSCP AND IOWSCP Safeguarding Adolescents Toolkit – Strategy Guide on Neglect  ▪ Neglect Multi-agency Training ▪ Child and Family Engagement Guidance for Primary Care  3  ▪ Child and Family Engagement Guidance for Secondary and Tertiary Care ▪ Spotlight on Disguised Compliance ▪ Published SCR/LCSPR reports and learning summaries can be found in the Learning and Reviews section of the HSCP website. Published Reviews  Publication date: 24 January 2022  