Child Protection, Public Health and Nursing by Jane Appleton & Sue Peckover

Author:Jane Appleton & Sue Peckover [Appleton, Jane & Peckover, Sue]
Language: eng
Format: epub
Tags: Medical, Public Policy, Family & Relationships, Child Rearing, Social Services & Welfare, Political Science, Parenting, Public Health, General, Nursing
ISBN: 9781780460451
Google: gVxwDwAAQBAJ
Goodreads: 27038749
Publisher: Dunedin Academic Press
Published: 2015-10-29T00:00:00+00:00

CHAPTER 6

Small signs, big risks: The importance of early detection

Caroline Bradbury-Jones, University of Birmingham

Julie Taylor, University of Birmingham

Introduction

The role of public health nurses in identifying and responding to children where safeguarding is an issue is well recognised. Also the importance of early detection and intervention is widely accepted. In most instances however the alerting factors are not clear or sudden, but vague, cumulative and insidious. This makes detection and early intervention problematic. In this chapter we use two examples from our own research to show the complexities associated with public health nurses’ safeguarding decision-making. We illuminate some of the barriers and challenges associated with their assessments, and the tentative steps they take in weighing up the small signs and big risks.

There is no doubt about the longer-term consequences of child abuse and neglect and living with domestic abuse experience. The importance of early intervention has been emphasised in both research and policy, and it is a key aspect in the role of the public health nurse. Such early intervention is often thought of as being early as possible in a child’s life (Allen, 2011b), and given the development needs, vulnerability and reliance on adults of infants this is compelling. Indeed those first 1,001 days, from conception to age two, are seen as critical (Leadsom et al., 2013). However early intervention as soon as risks are identified and early intervention to minimise the effects of harm are very important too.

Safeguarding decision-making would be so much easier if the manifestations of maltreatment were more clear-cut. We know however that, in most situations when making safeguarding assessments regarding families and children, public health nurses are faced with vague, cumulative and insidious alerting risk factors (Appleton, 2011). They are called upon to make tough safeguarding judgements and on the basis of these formulate appropriate responses. Using the mantra ‘the safety of the child is paramount’ as a yardstick, any concern should be enough to prompt action. But even that is not straightforward. We know from our own practice and from a raft of empirical evidence that in reality thresholds vary and decision-making is complex (Flaherty et al., 2008; Gillingham, 2011; LeBlanc et al., 2012; Mummery, 2002; Stokes and Schmidt, 2012). The purpose of this chapter is to unpick these complexities and to illuminate the relationship between the shifting polymorphic ‘small signs’ of child maltreatment and their associated ‘big risks’ in terms of consequences.

We take two of our own studies and use these as case examples to illustrate the challenges that public health nurses face in relation to safeguarding decisionmaking. Where relevant, we have used data from the studies to enliven the discussion and highlight how public health nurses talk about such issues. We have chosen these particular studies because they not only focused on the role of public health nurses but also explored different safeguarding angles. Combined, they reflect different contexts and possibilities with which it is hoped most public health nurses can identify. The studies are: Dental neglect study (Bradbury-Jones et al., 2013); and Domestic abuse study (Bradbury-Jones et al.

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