Death of a 15-year-old in early 2014, as a result of complications caused by a chronic health condition. Child BR was receiving care from a tertiary health centre, geographically remote from their home town. Child BR was made subject to a Child Protection plan on the grounds that Child BR was resisting medical intervention, concerns of parental neglect and parental inability to endorse attendance at medical appointments. A Child Protection plan and later a Child in Need plan were implemented, which maintained the same level of support from practitioners. Parents had agreed to a bespoke residential plan to improve Child BR's access to health care but Child BR died before the plan could be implemented. Uses the Welsh Child Practice Review model to identify learning points, including: scope for exploring joint working practices between tertiary and primary health services, including the role of the GP as the repository of all health information; when brief interventions are successful ways to maintain them should be explored; and commissioners of specialist health services should consider prompt access to psychological services for children and young people with chronic conditions.
      
 Title:  Concise child practice review: Case reference: Child BR. LSCB: Blackpool Safeguarding Children Board Author: Rachel Shaw Date of publication: 2014  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.                          Final November 2014                                                                                      Page 1 of 16    CASE REFERENCE: Child BR  Blackpool Safeguarding Children Board  Concise Child Practice Review  Review Process  Circumstances Resulting in the 12 month Review  The death of a child is always a tragedy.  Formal and effective systems are required to review what has happened and to learn from the experience so that inter-agency arrangements or services can be further improved where this is thought to be necessary.  At the beginning of 2014 Child BR age 15 years was found dead at the family home. The Home Office Pathologist concluded in the Post Mortem Report that Child BR’s cause of death was Methoxetamine (Synthetic Class B Drug) Toxicity, Chronic Renal Failure and Hypertensive Heart Disease.  Child BR was of Caucasian descent and lived at the family home with siblings.  Child BR suffered with a significant chronic health problem, which without medical intervention would be life limiting.  In addition there had been previous concerns about parental neglect which had led to a multiagency response by agencies.  Specialist health care services were being provided by a geographically remote tertiary health care provider to manage and treat the condition.  Following an early referral from the tertiary health care provider Child BR was being supported by social workers from the local Children’s Social Care Service.  Attempts to ensure Child BR accessed health care proved challenging initially when as a young dependent child who relied on parental compliance to attend and later as a teenager exerting self choice in refusing to consistently access health care.  Attempts to work with Child BR and family were intermittently successful.  Prior to Child BR’s death a bespoke residential placement had been identified and plans were in place to introduce this to Child BR. The aim was to offer Child BR intensive support in order to improve access to essential health care to maximise health outcomes.  Unfortunately Child BR died before this was implemented and it remains unknown if this intervention would have been successful or in fact provided further challenge.    Final November 2014                                                                                      Page 2 of 16  Background Information for the period prior to the 12 month Review:   Child BR was born with a health problem requiring immediate surgical treatment and follow up.  It appears that Child BR was lost to follow up due to Child BR and family moving house to another area.  Child BR next came to the attention of health services at the age of 11, which was 3 years 9 months prior to the review timeline, and was diagnosed with a life threatening illness which was a consequence of the original condition.  This acute episode of ill health necessitated health care provision from a tertiary centre which was geographically remote from Child BR’s home town.  The centre made an early assessment that if Child BR did not access appropriate treatment this would lead to deterioration in health and subsequent death.  This coupled with concerns that Child BR was resisting medical intervention and parental inability to endorse attendance resulted in an appropriate safeguarding referral from the tertiary centre to Social Services Child Care Team in April 2009.  The health care providers recognised that Child BR and family required additional support to meet health needs.  This resulted in Child BR being subject to a Child Protection Plan, the category of which was neglect, with intensive multi agency support.  Successful compliance with the Child Protection Plan resulted in both Child BR’s health and welfare needs being met more consistently and a Child in Need Plan was then implemented which maintained the same level of support from practitioners.   Child BR’s health condition required regular treatments each week which were delivered both at the tertiary centre and also at home, facilitated by a parent, following extensive training.  From August 2013 onwards home treatments were no longer appropriate and visits three times a week were required at the tertiary centre.  The family and Child BR required intensive family support from services.  Child BR was displaying challenging behaviour within and outside of the home including refusal to attend for health treatment and resistance to attend school.  Alternative education provision was made at two or more different specialist educational establishments in an attempt to meet Child BR’s educational requirements whilst maintaining regular health care interventions.  The Police and local council worked together to assist the family in improving their home environment by clearing the house and garden and agreeing ground rules for interaction with neighbours following disputes.  Legal Context:  A Serious Case Review was commissioned by Blackpool Safeguarding Children Board (BSCB), in accordance with Working Together to Safeguard Children (Department of Education 2013).  Regulation 5 of the Local Safeguarding Children Boards Regulation 2006 sets out the functions for LSCBs.  This includes the requirement for LSCBs to undertake reviews of serious cases in specified circumstances.  Regulation 5 (1) (e) and (2) set out an LSCBs function in relation to serious case reviews, namely:  5. (1) (e) undertaking reviews of serious cases and advising the authority and their Board partners on lessons to be learned. Final November 2014                                                                                      Page 3 of 16   (2)  For the purposes of paragraph (1)(e) a serious case is one where:   (a) abuse or neglect of a child is known or suspected; and   (b) either (i) the child has died; or (ii) the child has been seriously harmed and there is cause for concern as to the way in which the authority, their Board partners or other relevant persons have worked together to safeguard the child.  BSCB considered that the death of BR met the criteria for undertaking the SCR because there had been concerns that neglect had been a feature over a number of years prior to death.  This review was undertaken in line with the principles of learning and improvement set out in Section 9 of Working Together to Safeguard Children (Department of Education March 2013).  The methodology used was the Child Practice Review process (Protecting Children in Wales, Guidance for Arrangements for Multi-Agency Child Practice Reviews, Welsh Government, 2012).  The Child Practice Review process was introduced in Wales in January 2013 to replace the Serious Case Review Process.  This is an innovative formal process that allows practitioners to reflect on cases in an informed and supportive way.  Documenting the history of the child and family is not the primary purpose of the review.  Instead it is an effective learning tool for Local Safeguarding Children Boards to use where it is more important to consider how agencies worked together.  The detail of the analysis undertaken of the case is not the focus of the reports which are succinct and centre on learning and improving practice. However, because a review has been held, it does not mean that practice has been wrong and it may be concluded that there is no need for change in either operational policy or practice.  The role of Safeguarding Boards is to engage and contribute to the analysis of case issues, to provide appropriate challenge and to ensure that the learning from the review can be used to inform systems and practice development.  In so doing the Board may identify additional learning issues or actions of strategic importance.  These may be included in the final child practice report or in the action plan as appropriate.  Methodology:  Following notification of the tragic death of Child BR and agreement by the chair of BSCB to undertake a Child Practice Review, a Review Panel was established in accordance with guidance.  This was Chaired by a member of Blackpool Safeguarding Children Board, an NSPCC Service Manager, and included representation from relevant organisations from Health, Police, Education and Social Care.  Rachel Shaw, Designated Nurse, Safeguarding Children Service, was commissioned from Public Health Wales NHS Trust to work with the panel and to undertake the review.  The time period for this review is between the 1 January 2012 and 1 January 2013 also taking into account the services provided prior to this 12 month timeline.   Full Terms of Reference are included in Annex 1.  Final November 2014                                                                                      Page 4 of 16  All agencies reviewed all their records and provided timelines of significant events and a brief analysis of their involvement for the 12 month period of the review and the preceding years.  These were considered by the Reviewer and Review Panel and provided opportunity for panel members to raise questions, clarify understanding of the circumstances of the case, services provided and identify good practice and areas for improvement.  The agency timelines were merged and used to produce an interagency timeline.  This was carefully analysed by the Reviewer with the Review Panel to identify the areas that required further exploration and consideration.  The process also identified key practitioners to be invited to attend a learning event, the purpose of which was to understand the involvement of services with BR and family.    The 12 month summary timeline is attached as Annex 2.  The Chair of the Panel and reviewing officer met with Child BR’s family to gain an understanding of their experiences of the services offered.  This was shared with the panel and with practitioners attending the learning event held on the 10 July 2014, facilitated by the Reviewer and attended by the Chair of the Panel and Business Manager of the LSCB.  The learning event was organised in line with Welsh Government guidance (Child Practice Reviews Organising and Facilitating Learning Events, December 2012).  Following the learning event, the reviewer collated and synthesised the learning to date for discussion with the review panel, the panel gave consideration about what could be done differently to further improve future practice.  Draft reports were provided to the Review Panel and a Final report was agreed on the 17 September 2014.  The Reviewer and Chair of the Review Panel arranged to meet again with the family to share the learning identified from the Review. Once agreed by Blackpool Safeguarding Children Board the full report will be made publically available by the Board.  Analysis, Practice & Organisational Issues Identified  Analysis:    The challenge for practitioners and managers was that of a young person presenting with a serious health problem who was resisting regular specialised health treatment coupled with parental inability to enforce attendance.  Despite attempts by practitioners Child BR persisted in accessing health care on an intermittent and unpredictable basis often displaying verbally aggressive and disruptive behaviour towards health care staff, other patients and parents when attending.  The challenge of managing a young person living in crisis who is insistent on not accessing life saving treatment is an unusual scenario.   The age of Child BR during the 3+ years leading up to the time period of the review provided practitioners with additional challenge.  Initial engagement was with a young person reliant on those with parental responsibility for ensuring Child BR was presented for treatment.  As Child BR advanced in years and Final November 2014                                                                                      Page 5 of 16  became competent to make self choices about accessing health care the challenge of ensuring access to that health care was further compromised.   Child BR was supported via a Child in Need Plan for an extensive period.  During this time there were periods of improvement when there was intensive support and then issues arose again as professionals stepped back.  Legal options were considered by Children’s Social Care including making Child BR a ward of court. However, managers in Children’s Social Care did not think that this would have provided the method to enforce attendance for treatment and it was not pursued despite practitioners challenging the decision making of their managers.  Leading up to the time of death there was a decision to pursue a Residential Placement.  There had been previous parental refusal for a Residential Placement utilising voluntary arrangements under Section 20 Children Act 1989 but parental agreement was forthcoming in the weeks before Child BR’s death and a bespoke residential placement had been located.  The next steps would have been to discuss with Child BR.  It will remain unknown if this would have elicited any change in BR accessing essential health care.   Evidence of consideration for a ‘half way house’ between being supported at home and being accommodated under Section 20 was not apparent during the review.  This may have been achieved through innovative ways of maintaining intensive support to the family which had proved successful via the Child in Need Plan.   This review identified some key learning points and areas of effective practice which focussed on the following main areas:  Communication:  There was excellent communication between all practitioners involved in supporting Child BR including social workers, social work support workers, education workers, Consultant and Specialist Nurse from the tertiary centre and the Police.  Staff worked well together and shared information appropriately.  Staff should be commended on their tenacity in seeking to develop and maintain communication and a relationship with Child BR who was displaying very challenging behaviour towards staff visiting at home and when accessing health care provision.  Their passion to work together to secure positive outcomes for Child BR was undeterred.  A gender appropriate Social Worker was introduced at one stage in an attempt to provide a gender specific role model to improve outcomes but unfortunately this made no impact on the situation.  All practitioners who worked with Child BR and family remained constant throughout the time period from diagnosis to death which provided continuity of care to BR and family.  While health care was very specialised and being managed by the tertiary centre it was noted that there was little or no input from the local primary and community health services.  Although this is unlikely to have impacted on the outcome there may be learning for BSCB to explore this issue further.  Woodman J et al (2014) state because general practice is a universal service which can take a longitudinal view of families, GP’s are well placed to enact direct response to the children and families they see as well as participate in existing systems to Final November 2014                                                                                      Page 6 of 16  safeguard and protect children.    Learning Point 1:  Scope and improve, as appropriate, the current joint working between tertiary centres and local primary/community health services for children/young people with chronic health conditions.  To include:  • Local community health support to the child/young person/family (Community Nursing/School Nursing • GP health support to the child/young person/family • Information sharing between health services including electronic information sharing • Accessing GP resource as the repository for all health information In relation to GP input this may be assisted by reference to a recent publication The GP’s role in responding to child maltreatment: London: NSPCC   Interagency working:  There was evidence of excellent interagency working between all professionals. Successful implementation of a Child Protection Plan (which predates the review period) and then a Child in Need Plan which maintained the same level of intervention to Child BR leading to improved access to health care.  The Consultant and Clinical Nurse Specialist from the tertiary centre attended Child Protection and Child in Need meetings and an extraordinary meeting with the Head of Children’s Services due to levels of concern for Child BR.   There were periods when brief but intensive interventions from specialist services within children’s social care were mobilised for time limited periods which resulted in improved outcomes for Child BR.  There may have been an opportunity to maintain these interventions and thus sustain this change over a longer period of time. Learning Point 2:  When brief interventions from specialist services are successful explore ways to maintain these interventions over a longer/permanent period of time.  There were however also periods where there was no progress in accessing health and education services.  This was the source of anxiety for practitioners who were concerned with the decision of managers within Children’s Social Care not to pursue a legal route to make Child BR a ward of court.  Managers based this decision on their view that this would not have been an effective method to enforce treatment or act as a stabilising factor in BR’s life.  Although practitioners felt confident to challenge the manager’s decision, which is good practice, they were left feeling anxious and vulnerable in being asked to continue to manage Child BR in the same way.  Practitioners would have benefitted from additional support from their managers at this time. Final November 2014                                                                                      Page 7 of 16   Learning Point 3: All agencies to ensure that staff are supported appropriately particularly at periods of increased anxiety eg when a child/young person dies, or at particularly challenging periods for a caseload holder. Learning Point 4: Blackpool LSCB to ensure there are arrangements in place to facilitate locally for multi agency professional forums for ‘stuck cases’.  The Consultant and Specialist Nurse considered whether discharging Child BR to adult services would be beneficial because the specialist health care services required could be delivered more locally.  However, it was concluded that the follow up for non attendance would not have been so rigorous and that this would have been a more risky option for Child BR.   Education partners worked together with other agencies well and responded to Child BR’s needs and sought to provide education in a variety of settings to suit need at the time.  This included education provision in specialist educational establishments and home education and although Child BR only accessed such provision intermittently education staff persisted in trying to engage the young person to engage.  Assessment:  It was noted that the Core Assessment undertaken by Children’s Services for Child BR would have benefitted from being updated regularly as new events/challenges arose.  This would have provided opportunities to assess his changing needs over time and analysis of risk.  Learning Point 5:  Children’s Social Care to ensure that Core Assessments for long term cases are reviewed following new events in that child/young person life.  Child BR displayed challenging behaviour towards professionals and was also challenging for parents.  Examples of this were refusing to attend school, refusing to attend for health treatment being verbally abusive towards staff and other patients and causing disruption in health settings.  Despite attempts from family to support sensible decision making Child BR continued to make poor decisions about access to both health and education provision which was being offered.   Parenting children can make many demands on adult carers but staff working together with this family tried endlessly to suggest positive parenting techniques to parents who in reality had lost parental authority.  Specific input from a Child Psychologist may have helped Child BR come to terms with a chronic life threatening disease which in turn may have influenced decision Final November 2014                                                                                      Page 8 of 16  making.  Psychological services for children and young people with chronic health needs is intrinsic to helping children/young people and their families deal with such enormous health issues and is often part of an in house service provision  aligned with specialist health services.  It will remain unknown if this would have helped in the case of Child BR as such services were not available as part of the tertiary health service provision.  Learning Point 6:  Commissioners of Specialist Tertiary Health Care Services consider prompt access to psychological services for children/young people and their families for children/young people with chronic long term life limiting health conditions.  Consent issues for young people making decisions about accessing health and other services:  The crux of the analysis of this case surrounds the ongoing dilemma facing families and professionals when children/young people are perceived as competent in making choices about whether they access services but make decisions which adults and professionals consider poor choices.  It is not possible to force children/young people to access services against their will and there is no legal route which would enforce this.  The tertiary health provider did seek legal advice in managing Child BR’s non compliance but the advice was unforthcoming perhaps because there were no legal solutions available.    In the case of Child BR it was hoped that the option of becoming accommodated would have provided some additional support and stability to encourage better decision making and secure Child BR’s agreement to treatment.  A real and difficult ethical dilemma arises for professionals when a young person, who is informed and understands about health care treatment and the consequences of not accepting treatment, continues to refuse.  Professionals can only continue to guide and advise the young person in question and need to be supported by their managers in so doing.  This appropriate support will be different in each organisation ranging from manager’s support, multi agency professional forums for ‘stuck cases’, supervision from safeguarding teams within health settings etc.  Conclusion:  From the analysis it is apparent that professionals and family worked tirelessly to try to influence Child BR to make appropriate choices about accessing health care.  The process of the review has identified some learning points for BSCB to consider but the application of these is unlikely to have altered the outcome for Child BR.  The view of the family was that there was nothing else that professionals could have done to change anything and the family considered that all professionals involved went that extra mile to support them.   The challenge to professionals and families alike in supporting children/young people who make poor health/education decisions is likely to persist and there is no quick fix.  Final November 2014                                                                                      Page 9 of 16   Improving Systems & Practice  In order to promote the learning from this case the review identified the following actions for Blackpool Safeguarding Children Board and its member agencies:  Communication:  1.  Scope and improve, as appropriate, the current joint working between tertiary centres and local primary/community health services for children/young people with chronic health conditions.  To include: • Local community health support to the child/young person/family (Community Nursing/School Nursing) • GP health support to the child/young person/family • Information sharing between health services including electronic information sharing • Accessing GP resource as the repository for all health information In relation to GP input this may be assisted by reference to a recent publication The GP’s role in responding to child maltreatment: London: NSPCC  Interagency working: 2.  When brief interventions from specialist services are successful explore ways to maintain these interventions over a longer/permanent period of time. 3.  All agencies to ensure that staff are supported appropriately particularly at periods of increased anxiety eg; when a child/young person dies, or at particularly challenging periods for a caseload holder. 4.   Blackpool LSCB to ensure there are arrangements in place to facilitate locally for multi agency professional forums for ‘stuck cases’.  Assessment  5.  Children’s Social Care to ensure that Core Assessments for long term cases are reviewed following new events in that child/young person life.  6.  Commissioners of Specialist Tertiary Health care services consider prompt access to psychological services for children/young people and their families for children/young people with chronic long term life limiting health conditions. References: Protecting Children in Wales: Guidance for Arrangements for Multi- Agency Child Practice Reviews. Welsh Government 2012. Woodman J, Hodson D, Gardner R, Cuthbert C, Wooley A, Allister J, Rafi I, de Lusignan S, Gilbert R ( 2014) The GP’s role in responding to child Final November 2014                                                                                      Page 10 of 16  maltreatment. London. NSPCC Statement by Reviewer REVIEWER  Statement of independence from the case Quality Assurance statement of qualification  I make the following statement that prior to my involvement with this learning review:-   • I have not been directly concerned with the child or family, or have given professional advice on the case. • I have had no immediate line management of the practitioner(s) involved.  • I have the appropriate recognised qualifications, knowledge and experience and training to undertake the review. • The review was conducted appropriately and was rigorous in its analysis and evaluation of the issues as set out in the Terms of Reference.  Reviewer 1 (Signature)    Name     Rachel Shaw    Date  20  November  2014  Chair of Review Panel   ( signature)  Name  Linda Evans Date                   20  November  2014          Final November 2014                                                                                      Page 11 of 16     Annex 1: Terms of Reference  Final November 2014                                                                                      Page 12 of 16      TERMS OF REFERENCE FOR CHILD PRACTICE REVIEW Child BR  Introduction  • This Serious Case Review has been commissioned by Pauline Newman, Chair of Blackpool SCB on the recommendation the Case Review Sub-group of BSCB.  It is in accordance with ‘Working Together to Safeguard Children’ March 2013 which has been adopted by BSCB and underpins it’s Learning and Improvement Framework  • A multi-agency Review Panel and Review Panel Chair has been identified and an External Reviewer has been commissioned to undertake the review.  The Chair of the Review Panel will regularly report progress to the BSCB.  • Review Panel Members:  (Chair) Service Manager NSPCC  Designated Doctor for Child Protection Blackpool Teaching Hospitals  Designated Nurse for Child Protection Blackpool CCG  Principal Social Worker Children’s Social Care  Review Officer Lancashire Constabulary  Named Nurse Central Manchester University Hospital  Named Nurse Safeguarding Blackpool Teaching Hospitals  Head of Access and Inclusion Children’s Services   Purpose  Final November 2014                                                                                      Page 13 of 16  • Establish whether there are lessons to be learned about the way in which local professionals and agencies work together to safeguard children.  • Identify clearly what those lessons are, how they can be acted upon and what is expected to change as a result.  • As a consequence, improve inter agency working and better safeguard children.  • Identify examples of good practice. Terms of Reference  The terms of reference agreed for this review are:  1. The following services will produce a 12 month timeline of actions taken by each agency going back 12 months from the date of Child SB’s death • Blackpool Children’s Social Care • Blackpool Teaching Hospital NHS Trust • Blackpool Children’s Services – Education • Royal Manchester Children’s Hospital • Lancashire Constabulary • Blackpool Clinical Commissioning Group  2. A summary/analysis of each services involvement will also be produced by the above services.  This will include additional background information from outside the timescale for the review as well as initial analysis of the key issues involved, an indication of further issues for consideration by the Reviewer and any recommendations if appropriate. This should be brief (no more than 2 sides of A4)  3. Other services may be asked to provide a timeline following review of the information provided.  4. Determine whether decisions and action taken in the case comply with local and national  policies and procedures   5. To examine inter-agency working and service provision for the Child   6. To determine the extent to which decisions and actions were child focussed.  Final November 2014                                                                                      Page 14 of 16  7. The Reviewer will meet with the family to seek contributions to the review and keep them informed of key aspects of progress.  8. Identify any features of the case, which indicate that any part of the review process should involve, or be conducted by an independent party.  9. Identify any parallel investigations of practice and determine if a co-ordinated approach will address all the relevant questions.  10. To hold a learning event for practitioners.  11. The Reviewer will produce a succinct Review Report with recommendations which will constitute the Overview Report and Executive Summary under the current regulations in accordance with Working Together to Safeguard Children March 2013.  The Reviewer will share the Review Report with the family.  12. The review panel will agree an BSCB action plan from the recommendations  13. The Review Report will be presented by the reviewer and Chair of the Review Panel to the BSCB and it will then be made available to the public on the BSCB website.  14. The Chair of Blackpool SCB will be responsible for making all public comment, and responses to media interest concerning the review until the process is completed.  It is anticipated that there will be no public disclosure of information other than the Review Report.  A media statement will be prepared and approved by the BSCB Chair for use at publication of the Review Report, if required.  She will be assisted in this role by Blackpool Council Communications Team.  15. The BSCB and Panel will seek legal advice on all matters relating to the review.  In particular this will include advice on:  o Terms of Reference o Disclosure of Information Final November 2014                                                                                      Page 15 of 16  Appendix 2: Summary Timeline  Blackpool Local Safeguarding Children Board  Summary Timeline Re: Child BR Type of activity 2013      Jan Feb March April May June July Aug Sept Oct Nov Dec Local Health Services from DGH/Community Paediatricians  Admitted to DGH with Pneumonia            Health Visitor/School Nursing Service             Tertiary Health Centre Attended for treatment(2) Attended for treatment(1) Attended for treatment(2) Attended for treatment(2) Attended for treatment(1) Attended for treatment(1) Attended for treatment (4) Absconded during visit  Hospital Safeguarding team contacted for advice CAMHS referral advised Attended for treatment(3)  DNA 1 Attended for treatment(4)  DNA 1  Behaviour abusive and aggressive   Attended for treatment  Behaviour abusive and aggressive   Attended (5) for some  treatment   DNA 1   Behaviour abusive and aggressive  Attended (2) for some  treatment   DNA 1  Police             GP             Social Services       Legal advice sought by team manager. Wardship advised.  HOS advises not to pursue wardship  CIN Meeting  Permission sought to seek a residential placement under Section 20 Children Act 89 Refused by parent   CIN Meeting  Meeting between Team Managers over recent deterioration  Revisit section 20 accommodation with parent  CIN Meeting  SW to discuss Section 20 accommodation with parent Parent informed a residential Placement had been found  SW visits but parent unable to attend Final November 2014                                                                                      Page 16 of 16  Type of activity 2013      Jan Feb March April May June July Aug Sept Oct Nov Dec  Housing               Education    Education provided from different centre   Education meeting to discuss attendance issues   Home Visit – no reply  Several attempts made to contact home for tuition   Contextual issues              Detailed timelines were produced by the relevant services for the purposes of the review to assist the understanding of the complex interactions between events and services in this case.   This summary and partial timeline contains limited and annonymised details and is provided to supplement the outline of circumstances in the Child Practice Review report.  