Safeguarding Children? Child records in Accident and Emergency: the perspectives of staff

This case study of the use of hospital accident and emergency records to safeguard children was triggered by Lord Laming’s inquiry into the care of Victoria Climbié, his follow up report, and government legislation since 1948. Research on the use of documentation for safeguarding children is limited, although serious case reviews consistently indicate, that across agencies, record keeping, and the sharing of pertinent information to identify patterns of maltreatment is poor. The social constructed meaning people place on hospital documentation relating to children’s safety and the perceived intentions of conveying that information within and between social environments are the focus of this research. A hermeneutic framework was used to identify how staff in A&E and other agencies perceive the use of A&E child records (birth -16 years). The investigation was in three stages (a) analysis of a purposive sample of 378 A&E children’s records, (b) a focus group with twelve A&E staff on the case study site and (c) another group with twelve members of the Local Operational Child Protection group. Colaizzi’s approach and the hermeneutic circle were the methods utilised to provide a rich description of the essential structure of the phenomenon. The results reveal that although written records are good tools for communication, records are not sufficiently child focused and risks factors are not always recognised. Consequently, the ability of the professional to provide information to safeguard children is limited. The data also highlights professional communication as the central theme, because this seemed to describe and unify the participants’ practices in a way that made sense. The findings of this study indicate that the behaviour of staff plays a crucial role in recording information. They are influenced by factors that are multi-faceted with the complexities of meanings that include social, economic, emotional, cultural, political and technical elements. A new theoretical framework to understand the complex interaction of professional perspectives within the varied situations that occur in clinical practice is proposed. This is underpinned by a constructivist epistemology. This provides an efficient method for evaluating the overall behaviour of the major components that affect documentation and communication, and highlights the recurring problems that arise from these areas when safeguarding children. Hence, this study provides an original contribution to knowledge concerning information sharing in the field of child protection. As a result of the findings of this study A&E records have been redesigned locally.