787 Emergency department attendances by children thought to be at high risk of exploitation

Background Safeguarding children is an essential part of clinical care provision. As part of normal practice staff refer to guidance on identifying children at risk. Electronic Patient Records often have flags which highlight children who have had concerns raised. Separately, organisations such as the police maintain their own matrices for identifying those at risk. For example, our local Police Authority keep a list of children who score highly for proven risk factors for exploitation. This list is shared with the Trust Safeguarding Children team under an information sharing agreement, approved by our Caldicott guardian. Objectives To retrospectively review whether children identified as high risk of exploitation by the local Police Authority are attending our Trust’s Emergency Departments, and for what reason. Additionally, to determine whether these attendances resulted in appropriate safeguarding actions. Methods All Emergency Department attendances between 1/12/19–10/09/20 were reviewed for the 44 children with the highest risk scores on the local Police authority Exploitation risk matrix. We assessed reason for attendance, whether the child had a safeguarding flag on EPR prior to their attendance, whether safeguarding concerns were raised, what actions were taken and whether these actions were appropriate. Results 25 children attended the ED during the date range reviewed, 13 had a safeguarding flag, and 9 had multiple attendances. The most common reasons for attendance were self-harm (12), traumatic injury (9) and violence (7). Guidelines were followed appropriately and completely in two thirds of attendances (29/41). The patient was not referred to the safeguarding team when they should have been in nine attendances. Additionally, in three instances where referral to the safeguarding team was made, it is not clear that appropriate ongoing actions were taken. All attendances where there was a lack of, or incomplete, appropriate safeguarding action involved children aged 15 years or over. Conclusions Children identified as high risk by our local Police’s exploitation risk matrix attend ED frequently, and some are recurrent attenders. Most are older teenagers. Although detailed guidelines and a robust system of flagging exist, front line ED staff require further guidance on identifying those children at risk of exploitation as appropriate actions were not taken in all cases. One possible consideration is that older children presenting following violence are not being distinguished appropriately from adults on presentation as they are not seen by staff who primarily work with children. This presentation will highlight some of the proposed guidance.