PRACTICE REVIEW POLICY AND TOOLKIT Case Discussion Tool (V8

practice review policy and toolkit case discussion tool (v8 aug 2019) there are a range of methodologies for undertaking reviews

PRACTICE REVIEW POLICY AND TOOLKIT
Case Discussion Tool
(V8 Aug 2019)
There are a range of methodologies for undertaking reviews.1 The
methodology should ensure that correct information is gathered and
analysed in a proportionate, timely and robust manner when reviewing
individual cases, with a focus on impact of the presenting issue on
the child and their family. This should lead to actions and learning
for the system that are child-centred and as effective as they can be.
This case discussion tool was developed by Carole Brooks Associates
and Salford Safeguarding Children Partnership to provide a
proportionate and accessible way to do this. It is based on bringing
together elements of effective methodologies such as the Problem Tree
(or situational analysis), Signs of Safety, and Kolb’s reflective
learning cycle. References to these are provided below.
Purpose:
The tool provides a structure for practice discussions about
individual cases once initial facts are known, for example for a rapid
review meeting, practice review discussions or reflective sessions.
The purpose of the tool is to guide discussion about specific cases or
themes through five stages in a strengths-based way. It aims to get
from the facts, initial thoughts and feelings, to generating
hypotheses and a simple root cause analysis to what needs to happen
next, in a structured way. It can be used with groups of
professionals, and/or service users.
Materials required:
Flipchart pages for each step visible side by side on a wall or
stands, or an interactive board or laptop and large screen divided
into five sections is required to capture analysis from the case
discussion. Whilst immediate recording is not essential, having a
continuous write up on flipchart, or interactive method is helpful, to
keep a visual ‘flow’ of information and allow reference back from one
part to the other, and so all parts are in view at the same time. This
helps participants to think critically. Ensuring participants have the
blank case discussion tool in advance with the case documents, and
during discussion, to make their own notes and organise their thoughts
may be helpful.
Chairs/tables should all be facing the flipcharts or board to
facilitate discussion.
Facilitator:
The facilitator must be able to listen to discussion and absorb the
information to convert this accurately onto the flipchart/board in the
appropriate section. This dynamic of parallel discussion/recording is
an essential element of this method. It is unlikely the facilitator
will be such an active part of the discussion themselves, and they
should not be someone directly involved in the case.
Their role is to keep the discussion focussed, provide challenge where
required and summarise during the discussion to test out
understanding, gather differing views and ensure everyone who wants to
has an opportunity to participate in discussion. The facilitator
should be confident and experienced in applying theory and research
into practice to support reflective and evidence based discussion.
Time:
A minimum of 45-60 minutes is recommended for the case discussion
itself, and time to write up the results. Timing may be set depending
on the complexity of the case and the number of participants. For
example, if the case involves a number of professionals and siblings,
longer may be required. It is also good practice to arrange time for
longer than you think you will need to ensure that the discussion is
finalised with clear actions and everyone feels they have had an
opportunity to participate.
Prompts and assurance questions for facilitators:
*
Writing the evidence sources for ‘basic facts’ (Step 1) and ‘about
the child’ (Step 2) sections in advance if they are not clear in
the referral form will save time in the meeting. The facilitator
can recap these briefly and launch into ‘immediate thoughts’ as
the first part of discussion (Step 3).
*
If people have not attended a case discussion using this
methodology before, it may be useful to describe the process, and
expected behaviours and assumptions as outlined in the Practice
Review Policy (see appendix A)
*
Are key people from the right agencies present for the discussion?
Having a gap in the knowledge and viewpoints in the discussion can
result in flawed hypotheses and outcomes. It can be helpful at the
beginning of the meeting to reflect on what gaps in knowledge
there are as part of the ‘immediate thoughts’. Ways to mitigate
include perhaps including someone via phone/conference call, or if
there is someone present who understands the missing area, to
‘wear two hats’.
*
There is likely to be a resulting list of ‘what we don’t know and
need to find out’. Bear this in mind in concluding and it is ok to
say we don’t have all the information yet. Have a clear plan about
timescales for getting information and next steps, but be
proportionate about what additional information is needed.
*
Keep a focus on the lived experiences of the child(ren)/adult(s).
What is/was it like for them? Are you clear what the impact has
been, not just on the child or close family member but also other
family members and siblings.
Step Guide
Frame1 ﾧ
The Facts:
As per Practice Review Policy, gather agency summary information and
circulate to attendees prior to the discussion. Those attending should
take responsibility for having read the papers beforehand. If for some
reason these have not been available before the meeting, time at the
beginning should be allocated for reading these.
What else do we need to know? Who else do we need to involve?
Frame2
About the child and their lived experiences:
This can be completed before the discussion and is focussed wholly on
understanding about the child, their characteristics, who their family
is, what we think life is like for them.
Frame3
Immediate Thoughts:
Kolb refers to this as ‘reflective observation’. Spending no more than
5 minutes, reflection on immediate thoughts about the case, what we
have done and experienced. This may feel unstructured but is a good
way for participants to ‘get things off their chest’, kick around
initial hypotheses and most importantly bring in the lived experience
of the child and impact on them, to ensure they are at the centre of
further discussions. Some people are naturally good at this, but the
facilitator will need to get the most out of participants. It is
important to be clear which is fact, and which is feelings.
Frame4
The Analysis Tree:
This is sometimes called situational analysis and creates a structural
analysis of the causes and effects of an issue or problem to get to
the initial/primary root causes. Firstly, it is important to agree the
focal point (presenting issue) of the reason for the case discussion
in simple words from the point of view of the child. This is the event
or issue which has generated the referral. Once this is agreed, the
facilitator should direct discussion about
a.
Effects: the subsequent events and outcomes that has, or could
result from the presenting issue (written in boxes above the
presenting issue). This could be short term or longer term effects
including those into adulthood. They could be effects for the
child, communities or services.
b.
Root Causes: what the potential causes could have been, drilling
down until the hypotheses of root cause(s) are reached. It is
likely there will be more than one cause and further testing of
hypotheses about the causes.
Frame5
What are we worried about:
Concurrent with all previous steps, participants may express things
they are worried about. It is helpful if these are clear and
participants use this phrase so that the facilitator can capture this
during the whole discussion.
Frame6
What is working well:
Participants may identify what has worked at any step and it is
helpful participants are clear so that the facilitator can capture
this during the whole discussion.
Frame7
What needs to happen next?:
Sufficient time should be protected at the end of the discussion to
capture actions. These should be SMART: What is the action, who by,
when, how will we know it is done, what difference will it make? It is
helpful to reflect around the room whether the majority of
participants are happy with the outcome. Be aware that not everyone
may be comfortable with the outcome and want to say more. Colleagues
in the room, and the facilitator should be sensitive to this.
Frame8
Follow Up:
After the discussion, the notes should be in the same format as the
headings and circulated to participants for correction of any factual
errors (See Appendix B). The write up of the session will also form a
major part of the case review report and will include the SSCP action
log. Single agency learning will be captured in single agency action
plans, which should be submitted to the SSCP within 10 working days of
the case review taking place.
Further Reading:
Kolb: Kolb D (1984) Experiential Learning: Experience as a source of
learning and development. New Jersey: Prentice Hall
Signs of Safety: https://www.signsofsafety.net/signs-of-safety/
Problem Tree: http://www.mspguide.org/tool/problem-tree
Ruch, G. ‘Thoughtful’ practice: child care social work and the role of
case discussion’ Child and Family Social Work 2007, 12, pp 370–379
Appendix A: Principles, Values and Assumptions excerpt from Practice
Review Policy
Our new safeguarding children partnership arrangements outline how our
vision, values and six principles drive our approach. Reviews should
also reflect the following principles, values and assumptions:
1.1Principles
-------------
*
Child and family centred: The individual (where able) and their
families should be invited to contribute to reviews. They should
understand how they are going to be involved and their
expectations should be managed appropriately and sensitively
*
The framework must result in providing learning back into the
system – its core purpose is to improve service provision not
simply describe or challenge it
*
There should be a culture of continuous learning and improvement
across agencies that work together to safeguard and promote the
wellbeing of children, identifying opportunities to draw on what
works and promote good practice
*
We support the principle of identifying issues and addressing them
early, and individual agencies should be pro-active and
pre-emptive in analysing and learning from individual cases. The
approach taken to reviews should be proportionate according to the
scale and level of complexity of the issues being examined
*
The Safeguarding Children Partnership is responsible for the
review and must assure themselves that it takes place in a timely
manner and that appropriate action is taken to secure improvements
in practice
*
Any reviews should be led by individuals who are independent (i.e.
no direct line management) of the case under review and of the
organisations whose actions are being reviewed
*
All types of practice reviews should be completed in a timely
manner unless there is a reason for a longer period e.g. on-going
criminal proceedings.
1.2Values and Behaviours
------------------------
*
Participative and collaborative – Staff from all levels should
participate and feel they are making a difference and a
consultative approach provides richer narrative, encourages
awareness of quality issues and ownership of the findings. It
encourages the view that measuring quality and impact is something
done with and by staff rather than done to them. We include the
voice and experience of families, children and young people
wherever possible
*
Transparent – delivering clear messages about the purpose of
performance and quality assurance activity, with honest
constructive feedback regarding how these benefit the organisation
and individuals. The aim is to encourage openness and engagement
with the process and achieving goals
*
Strengths Based: High challenge, high support - we are committed
to a culture of improvement and learning which is relationship
based and focuses on strengths within agencies, individuals,
families and communities. It is a culture which delivers high
levels of challenge and high levels of support and we expect this
to underpin our performance and quality assurance framework
*
Outcome Focussed: consistently focussing on the lived experiences
of children and the impact of what we do on outcomes for them
*
Respectful: Each child and family’s record belongs to them. We
must demonstrate our respect in the manner in which we share and
record information and provide feedback to staff. We have a duty
to report with accuracy, and inaccurate recording of information
in any form is detrimental to outcomes for children and families.
1.3Assumptions
--------------
*
We can’t always stop children from being harmed, but we can always
learn to increase our ability to achieve this. We will never be
perfect and constant scrutiny is required to ensure the right
standards are met and exceeded and continuous improvement is
evident across the system
*
Professionals generally act from good intentions and try to act in
the best interests of their clients. Organisations’ systems,
process, culture and other factors can lead to poor decision
making and practice and these elements should also be the focus
for review and improvement. For example, out-dated or unclear
procedures, resources not available where needed
*
Where possible, information relating to children and families will
be based on reports drawn from case management systems and we
expect individual agencies to ensure this remains accurate and
relevant, with appropriate controls.
*
Every agency has a responsibility for identifying and implementing
its own learning in addition to multi-agency learning.
*
Measures of outcomes for children are clearly the most important
ones to assess, measuring the effectiveness of the system also
requires a focus on both what we do and the impact of what we do
in improving outcomes
Appendix B: Case Discussion Tool
Before
During Case Discussion
1.
Gather Facts
3.
Immediate thoughts
3.
Analysis Tree
3.
What are we worried about?
3.
What worked well?
3.
Missing Information
3.
What needs to happen? (SMART)
Effects = Impact of the focal problem on the child and system now and
in the future

Causes = why has the focal problem happened?
2. About the Child
WHAT ELSE DO WE NEED TO KNOW? WHO ELSE DO WE NEED TO INVOLVE?

Appendix C
Case Discussion Notes
Child Name:
Date of Referral:
Date of Case Discussion:
Professionals Present:
Name
Agency
Facilitator:
1.
Facts: Documentation available for case discussion
*
Referral Form
2.
About the child
3.
Immediate Thoughts
*
4.
Left Brace 19 Left Brace 20 Analysis Tree
EFFECTS:
FOCAL POINT:
ROOT CAUSES:
5.
What are we worried about?
*
6.
What worked well?
*
7.
Missing information?
*
8.
What needs to happen?
Action
Who By and When
What difference will it make?
ACTIONS FOR THIS CHILD
1.
2.
ACTIONS FOR THE SYSTEM
3.
4.
5.
6.
1 see review methodology options document for details
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