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Comprehensive Medical Assessments
This document describes the comprehensive medical assessment (CMA) process in NHS Greater Glasgow and Clyde for children at risk of neglect. Key points: - The CMA aims to identify unmet health needs, coordinate ongoing care, and provide an opinion on neglect. It involves a holistic medical exam, dental exam, and report. - Referrals come from the central child protection unit for children with concerns of neglect. Medical history is collected from various sources. - Exams are locally delivered and include growth, development, physical exam, and interaction observation. Feedback is provided to social work and a detailed report is written. - Developments include peer review, collaboration with dentistry, and a document
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Comprehensive Medical Assessments
- 1. Baspcan Comprehensive medical assessments NHSGGC DrLaura Somerville 15/4/15
- 2. Glasgow • Population in2012 of 595,080 • 25% 0-15year olds • 1/3 live in 10% most deprived areas of Scotland • Lowest life expectancy in UK =73 years • Largest ethnic mix in Scotland • April 2014 502 children on cpr, 392(78%) neglect a concern
- 4. Background • HMIE inspection2009 • Need for improved medical assessments of children where neglect is a concern • Comprehensive medical assessments(CMA) introduced NHSGGC(vision of Professor Jean Herbison/Marie Valente,CPU)
- 5. Aim • Describe CMAprocess • CMA examination • Service developments • Dental component(2nd presentation) • Illustrative cases(3rd presentation)
- 6. CMA-who,why,how,what • Who? Children atrisk or suffering from chronic neglect • Why? Vulnerable children where interpretation of range of health presentations is required Identify unmet health needs
- 7. How? • Locally delivered holisticmedical assessments by paediatricians • Dental assessment
- 8.
- 9. Greater Glasgow andClyde Map
- 10. The CMA • Aimsto identify unmet health needs • Coordinate ongoing health issues • Comprehensive report with an opinion regarding neglect
- 11. The CMA process •Referral via central child protection unit • Discussion ?CMA- not NAI/CSA/LAAC • Information requested - A+E,hospital admissions,outpatient clinics - Gp visits - Health visitor/school nurse information inc %school attendance - Developmental screening and immunisations - GIRFEC assessment
- 12. The CMA • Child,parent(consent),socialworker • Medical examination • Growth • Development • Interaction observed • Physical examination • Dental examination • Verbal feedback to social work • Report-social work/gp/referrals
- 13. The CMA report •Collation and interpretation of information • Health concerns and health needs • Opinion on neglect • The citations....The challenges..
- 14. Report writing • “Neglectis the persistent failure to meet a child’s basic physical and/or psychological needs likely to result in serious impairment of the child’s health or development” Scottish Government 2010
- 15. Developments • Peer review–paediatricians,nurse advisors ,dental colleagues and reporter • Collaborative working with dental colleagues including joint symposium • Personal practice document most commonly encountered medical and educational issues
- 16. Personal practice document •11 most commonly encountered issues including • Obesity • Constipation • Amblyopia • Nocturnal enuresis • Developmental impairment • School attendance • Dental caries
- 17. cont Questions to consider: 1.Hasthe parent responded to or sought appropriate care and medical attention? 2. For treatable conditions-have they participated in treatment? 3.Would not doing so cause significant harm/serious impairment?
- 18. Next challenges • Caseconferences • Opinion • Linking with Scottish Children Reporters System • Audit including outcomes
- 19. Emotional abuse/emotional neglect •Describe interaction but only 1 assessment • This is often our main concern • Child and adolescent mental health(CAMHS) involvement planned
- 20. Conclusion • Comprehensive medicalassessments have challenged and changed the way paediatricians assess children with neglect in Glasgow(NHSGGC) • Service developments have been positive with joint working with dental colleagues, SCRA,CAMHS colleagues • Developments continue
- 21. Thanks • Professor JeanHerbison • Dr Alison Rennie • Marie Valente • Professor Charlotte Wright • All CMA colleagues • Child protection Unit ,RHSC,Yorkhill