Practitioner's Guide and Toolkit - Engaging with Families

Please note, this guidance should complement, not replace, any existing service or agency guidance.

Introduction

The Perth and Kinross Child Protection Committee has produced this practitioner guidance in partnership with first line practitioners and managers to assist all those working within services to engage more effectively with parents, carers, children and young people, within the context of child welfare and protection.  

This guidance aims to support practitioners to consider what may be getting in the way of engaging with parents, carers, children and young people, what actions they may need to take, and, at all times, to support them to keep their focus on the needs of the unborn baby, baby, child or young person for whom there may be care and protection concerns.

Why is engagement with families so important?

When we are speaking about engagement with families, we are really speaking about the quality of the working relationships we build with them and practice which is relationship-based. Understanding some of the barriers that children, young people and adults face when they are offered support from services or agencies, or there is a need for services or agencies to intervene in their family life, helps practitioners to work more effectively with them.  

A good working relationship, in which the person receiving services feels seen, safe and understood, which offers them both support and appropriate challenge, can support positive change. It can offer the scaffolding that people need to get back on track or to open a new chapter in their lives in terms of themselves and their child(ren). This can help to ensure that the care and protection needs of babies, children and young people are better met. By contrast, there is considerable evidence to demonstrate that risks for babies, children and young people can increase when services find it hard to engage with families.
 

Good practice in engaging with families

Within any given situation, risk assessment is key. There will be a very small number of situations in which urgent child protection concerns mean that there is an immediate need to ensure the baby, child or young person is safe and there is no time to gently promote engagement. In these situations, the lead professional (social worker) will take legal advice, consult with police colleagues, if appropriate, and determine the course of action to be taken. This may include applying for a Child Protection Order to remove the child to a place of safety in the most serious situations. Importantly, even within these fraught and tense situations, there are opportunities to engage effectively with families. The ways in which workers conduct themselves during urgent interventions is crucial for ongoing and future relationships with the parents or carers and the child or young person. Being transparent, respectful, offering choices where they are available, not making promises that cannot be kept and keeping parents and carers informed about what to expect in the days ahead can help provide a basis for meaningful future engagement.

Fortunately, most situations can be approached in a more planned and thoughtful manner. Effective engagement with parents, carers, children and young people can best be promoted by practitioners who: 

• Are clear with family members about their role, remit and the reason for their involvement with the family.

• Work in accordance with their codes of practice, treat all members of the family with respect and demonstrate a trauma-informed approach through empathy and kindness towards them.  

• Are committed to a rights-based approach, ensuring that the children, young people and adults they work with are given clear information about their rights and the choices that are available to them throughout any intervention.  

• Develop trusting relationships with family members through being reliable, transparent and accountable.

• Understand that ambivalence and resistance are normal human responses.  

Families can find it hard to share with services that they are having difficulties - they want to be able to manage things on their own and keep things private within their family. Parents and carers worry that they will be judged; that their children will be taken away from them and that their private matters may become public. If parents and carers have had adverse experiences of service involvement in their own childhoods or as adults, for example, their ability and willingness to work with services in the present is likely to be affected. 

Using a trauma-informed and responsive approach to working with families is essential in ensuring that practitioners' approaches to families are empathetic and compassionate. When individuals and families are under pressure, it is important to understand that it is normal for practitioners to be met with some ambivalence or active resistance. This is part of human nature and so it is important that workers recognise and respond appropriately when they encounter this. 

Naming these feelings, letting the family know that the practitioner understands that feeling ambivalent or resistant are normal reactions and providing reassurance that the practitioner will work with them over time to build up trust may help to move things along productively. Being patient, persistent and consistent can help to show families that practitioners are genuinely committed to supporting them.

What behaviours might practitioners notice when they are finding it harder to engage with families? 

All practitioners are likely to find it difficult to engage with or to reach some of the families with whom they work at some point in their working lives. It is important that practitioners are alert to the indicators, some subtle, some obvious, that they are struggling to gain effective engagement.

Where practitioners are working with situations where risks appear lower and may be less clear-cut, it can be more difficult for them to recognise these indicators and, therefore what action they may need to take to ensure the baby, child or young person's safety. The National Guidance for Child Protection in Scotland (2021, updated 2023) provides some helpful context about when services find it hard to engage.

Here are some examples of the behaviours that practitioners might notice in their attempts to engage with families, which can roughly be separated into three main groups:

Avoiding behaviours

As the name suggests, avoiding behaviours are those in which actions are taken, or not taken, to prevent things like visits from taking place or planned work from being completed. Avoiding behaviours may be part of a strategy to prevent services from seeing the child or the home conditions, for example, through to a symptom of wider disorganisation in the person's life or may reflect the stage that the person is at in terms of being able to recognise and respond to professional concerns. Some examples of avoiding behaviours include the parent or carer:

• Not responding to repeated attempts to contact them

• Not being in for or not answering the door to practitioners at pre-arranged visits 

• Cancelling appointments at short notice on a regular basis 

• Not bringing babies, children or young people to health or other appointments

• Seeking support only in times of crisis - e.g.: financial assistance - but not engaging with routine or planned support to address the underlying issues.  

• Use of diversions throughout home visits or meetings - examples of include leaving the television on at a loud volume, taking or making phone calls, texting throughout or having visitors come into the home during the allotted time.  

• Planned work is regularly overtaken by an issue that the person says they need to address immediately but which could clearly have waited until the end of the session.

• Repeatedly raising issues about others within the community or issues within the news that detract from the work that needs to be undertaken with them. For example, they may point to others in their street who they believe are using drugs and whose children are at more risk than their own, suggesting that the practitioner should go elsewhere.

Aggressive, hostile or violent behaviours

These behaviours are usually the most obvious kind that workers notice and record when working with families. Feeling threatened may be a subjective experience and first-line practitioners may develop higher tolerance to threatening or hostile behaviour over their time in practice. However, a person does not have to shout or explicitly make threats for a worker to feel threatened, the physical signs of a person barely controlling rage can create an environment in which the worker does not feel safe to continue the discussion. This could be clenched fists, gritted teeth and slamming things down. Some other examples of aggressive, hostile or threatening behaviours include the parent or carer:

• Being verbally abusive to the practitioner such as shouting or swearing at them.

• Being aggressive or threatening towards the practitioner - this could be through coming into the professional's personal space, adopting aggressive body language such as pointing at the practitioner, making fists with their hands etc. 

• Seeking to demean or humiliate the practitioner through negative comments about their looks, their level of intelligence or their professional competence.  

• Making veiled or explicit threats of harm.

• Explicitly saying or implying that they know where the practitioner lives/details of the practitioner's own personal life/children and may use this information to cause harm. 

• Physically attacking or causing harm to the practitioner. 

• Being abusive to practitioners with respect to protected characteristics under the Equality Act (2010).

• Making vexatious complaints about practitioner (see below)

Disguised non-compliance behaviours

Previously known as 'disguised compliance' but more accurately referred to as 'disguised non-compliance,' these are behaviours which are used so that it appears that the parent or carers are doing what is asked of them and are making progress. However, in reality, despite agreeing to take action or agreeing with professional concerns, the person does not take action, perhaps giving what seem to be reasonable excuses in isolation, but it becomes clear over time that they do not accept professional concerns. This could be termed as the person saying what they think the practitioner wants to hear as a means to avoid escalation. This could be an unconscious or conscious strategy and at its core, is another type of avoiding behaviour. Practitioners can sometimes find this more difficult to address than the parent or carer directly saying no or being hostile towards them.

Some examples of disguised non-compliance would be parents or carers:

• Agreeing with the practitioner that they will take action to make changes but repeatedly not following through with what they said they would do.

• Appearing to engage with work to help improve the situation but not actually doing what needs to be done.  

• Agreeing with professional concerns verbally but showing their disagreement through their actions.  

• An example may be appearing keen to arrange appointments but then repeatedly cancelling them when the appointment comes around (please see the section 'Did Not Attend or Was Not Brought? When children do not attend medical appointments' for further guidance around this issue.)

A further kind of avoiding and/or hostile behaviour can be that sometimes used by parents and carers who may have been or are currently working as professionals who may seek to use their connections, knowledge and expertise of their field to undermine services trying to work with or intervene with their child or children. Examples of this may include parents and carers:

• With a medical background who may use terminology that others may not understand and imply that the practitioner is ignorant for not being aware of its meaning.  

• With a social work background who may use their professional knowledge as a basis to demand specific resources or changes to the child's plan.  

• With a legal or law enforcement background who may use their knowledge of the law to suggest that the practitioner or the service could be sued or note that they have powerful connections which could make life difficult for the practitioner.  

• May make it known to the practitioner that they have friends or connections within the management structure of the organisation the practitioner works for and suggest that this could have negative consequences for them.  

It is, of course, natural that someone who has expertise and experience in a specific area will draw upon this knowledge in given situations. However, the behaviours noted above are those in which the intent is to intimidate the practitioner. These behaviours could stem from a place of fear or anxiety or could be deliberately used with the intention to keep services from uncovering potential harm to the child or young person. These kinds of behaviours may be difficult to address as they are nuanced, although the implications of them will be made clear to the worker.

In the next section, the reasons underpinning the kinds of behaviours described above are discussed, as are the ways in which practitioners can seek to understand and respond to them.
 

Making sense of behaviours which affect engagement

First and foremost, practitioners need the tools and skills to help them recognise patterns of behaviour. This is where recording and assessment tools such as chronologies are so helpful as, when properly maintained, they will show patterns of missed or cancelled appointments, for example.

Having a clear focus for recording notes also supports pattern recognition - when reading a case note, the reader should be able to quickly identify what the purpose of the visit or contact was on a given day, whether the practitioner was able to achieve the purpose of the contact and if not, why not.  Taking a few minutes to read back one's notes, to notice, to be professionally curious and to identify potential patterns of behaviour is an essential part of effective work with families.

For all of the behaviours listed in the section above, practitioners need to carefully reflect on what may be behind the presenting behaviours. Here are some key questions to consider:

• Does or could the person have a history of involvement with services perhaps as a result of their own trauma as children or younger adults? Could this be affecting their willingness and ability to be reached by services now?

• Does or could the person have a Speech, Communication or Language Need (SCLN)? This could be affecting how able they are to understand what needs to happen and why.  

• Does or could the person have a learning disability or difficulty? 

• Does the person have the necessary literacy skills to be able to read letters and keep a calendar to help them attend important appointments etc? 

• Does or could the person be neurodivergent and struggling to manage their time and attend appointments? 

• Does or could the person have a problematic substance use issue which means that they may be focused on addressing their need for the substance at the cost of other issues? 

• Does or could the person have a mental health issue such as depression or anxiety which is affecting their capacity to engage, retain information or have the motivation they need for change?

• Does or could the person have an acquired brain injury which affects their capacity to regulate their emotions and/or their understanding of issues? 

• Is it possible/likely, that the person's behaviour towards the practitioner may be being controlled by another person, such as in domestic abuse, cuckooing or other exploitation?  

• Could there be a cultural explanation which needs further attention? 

It may be that several of these factors and/or others than those mentioned above are relevant for one person. Understanding these issues and the impact on the person can help practitioners respond more effectively to the person's needs and to build a relationship. It is important to seek advice on these issues highlighted above from people with expertise, to make sure that practitioners are communicating and connecting with individuals in ways that best suit them and meet their needs.

It can also be the case that one or more of these factors are relevant but that the practitioner may still be dealing with a person from the very small proportion of adults who may deliberately and purposefully use a range of behaviours to keep services at bay to hide the neglect, abuse or exploitation of a baby, child or young person in their care. It is important to always ensure that practitioners allow themselves to 'think the unthinkable' as is discussed in Learning from Research and Learning Reviews towards the end of this guide.
 

Harassment, aggression, threats and/or vexatious complaints

When practitioners encounter harassment, aggressive, violent or threatening behaviour or vexatious complaints in the course of undertaking child welfare protection work, it is important to seek support from their line managers for their own wellbeing and safety. It can be at these times that support is most needed to enable the practitioner to retain their focus on the care and protection of the unborn baby, baby, child or young person.

 What do we mean by these terms?

Harassment can take a range of forms from phoning/emailing the practitioner extremely frequently, threatening them with complaints, through to stalking behaviours such as following the person or waiting for them outside their work. However, it is important to note that people who are very anxious or dysregulated may also phone or email many times without any intent to harass the practitioner - this is not harassment as such, and a regular communication protocol could be put in place to support the person to feel less anxious through predictable contact with services.

Aggressive and threatening behaviour may include shouting, threats of violence, deliberately entering into a worker's personal space to physically intimidate, punching the wall or deliberately knocking something over. Violent behaviour includes any kind of physical attack by a person using their body or an implement to cause physical harm. It is important to recognise that service users can feel angry or emotional due to the context of the work and although they may struggle to self-regulate, it may not be their intention to be threatening to practitioners in any way. However, professional boundaries regarding acceptable behaviour are important and require to be implemented and maintained.

Vexatious complaints are complaints that are persistent, repetitive and not made based on genuine issues. They are complaints that appear to be made specifically to harass or denigrate an individual. Clearly, complaints processes are an important part of any service and have a valuable role in enabling service users to raise issues and concerns so that matters can be addressed. It is the right of any service user to complain about the service they receive, and they should always be supported to do so. However, when the complaint process is being used to cause harassment to a practitioner and affect their capacity to undertake their duties, agencies and services need to act to prevent further harm.

Organisations have their own policies to support their staff in these situations. For Perth and Kinross Council employees, we have Lone Working, Violence and Aggression and Managing Unreasonable Demands policies in place.

Practitioners who are the subject of these kinds of behaviours may find it difficult and distressing to manage and this is discussed further below. They may feel intimidated and fearful of continuing to undertake their professional duties. It is important that practitioners and their line managers are aware of the impact of these behaviours may have on them both as individuals and professionally. This is particularly the case if the practitioner begins to change how they would normally practice, finding themselves reluctant to engage with the family; potentially avoiding contact with them, for example. When this happens, the risks for unborn babies, babies, children and young people increase significantly. In these circumstances, attuned support from line managers and supervisors is vitally important, as is robust supervision of staff.

In all circumstances, ensuring the care and protection of the baby, child or young person is the primary goal of intervention and so their welfare must always be the paramount consideration in any decisions made about how best to proceed.

The importance of effective multi-agency working

The safety of babies, children and young people in need and at risk relies on the practitioners in the team around them working effectively together, communicating well and sharing information appropriately. It is natural that some parents, carers, children and young people may prefer one practitioner to another. We all have preferences. However, sometimes parents or carers who are trying to deflect attention from what may be happening in their home, may try to 'split' the professionals who are working with them. This can involve the parent or carer appearing to strongly favour one worker over others, perhaps through telling the worker that they are the only professional that understands them and appearing to follow their advice whilst strongly not listening to others. By contrast, the practitioner or practitioners who are not shown favour may be actively criticised, undermined or be subjected to hostility.  

Creating division in the team around the child can be an effective strategy to deflect attention away from the child or young person and the presenting issues. This is where it is critical that practitioners are self-aware and stay alert to this possibility. Reflection through supervision, discussions with colleagues or, if necessary and possible, as a team around the child can help to address this issue. As practitioners, it is important to be aware of our own biases which can vary from over-identifying with individual service users to finding it more difficult to engage with others. Practitioners must be alert to these possibilities and continuously work to address them.
 

What about when children and young people themselves are harder to reach?

There are many reasons that practitioners may find children and young people harder to reach, or why a child or young person may openly say that they will not engage with the practitioner.

Here are several reasons that children and young people have described about what gets in the way of engaging with services:

Loyalty and love

Children and young people tend to be very loyal towards their parents or carers because they love them, and they may not wish to engage with someone who they see as upsetting their parent or carer. For example, if the practitioner has had to have a difficult conversation with the parent or carer and they have become angry or distressed as a result, the child or young person may see the practitioner as the reason for the person they love being upset or angry. It can be quite understandable that they may not wish to speak to the practitioner under those circumstances. They may also be scared of getting their parent or carer into trouble if they disclose that they are worried about things too, so it may feel easier not to say anything at all. 
 

Fear and threats

When children and young people are living in situations in which domestic abuse is ongoing, or they are being physically, sexually and/or emotionally abused or coercively controlled, the abusive person will have made it very clear to that child or young person that there will be negative consequences for talking to practitioners.  Children and young people may be threatened with harm against themselves, the non-abusive parent, a sibling, a family pet or someone or something else that the child or young person loves. Practitioners must always be alert to this possibility, ensure that the child or young person has opportunities to talk with them away from family members, wherever possible, and ensure that children and young people are not unwittingly placed at higher risk through their actions.
 

Trust

Like any of us, children and young people need time to get to know someone and trust them before they feel comfortable in speaking or spending time with them. It is important to think about the individual experiences of the child or young person - if you are their new school nurse, social worker or support worker, how many people in that role have they known before you? Were those workers reliable? Did they move on just as the child or young person was starting to open up to them?

Children may have had traumatic experiences with social work in the past - a loss through a brother, sister or sibling becoming looked after away from home, or they may have become looked after away from home and been separated from their parents themselves in the past. Think about what your role may mean or represent to the child or young person and acknowledge this with them.

As practitioners, we need to recognise that trust takes time to build but can be lost in a heartbeat. Being persistent and consistent, acknowledging with the child or young person that it is understandable that they might not wish to speak to you, is key. It is important to keep showing up and being present for the child or young person so they have opportunities to speak with you - children and young people can and do change their minds over time.

Social stories and life story work can support children and young people in understanding events in their lives and why decisions were made, where these are identified as a barrier to building relationships. 
 

Making use of existing relationships with the child or young person

The most important thing is that the child or young person has someone, in the team around them, that they can speak to about what is happening in their lives. Respecting the choices of children and young people is important, if they do not wish to speak to one particular practitioner, it is important not to be precious and to find someone that they feel comfortable engaging with, respecting their rights and choices. School staff often have a key role to play here, as the people that often see children and young people more than any other practitioner and who may already be trusted and known adults. Children and young people should be made aware that adults in the team around them will speak with each other to make sure that they are helping the child or young person as best they can. The child or young person's consent should be sought wherever possible about what information can be shared with other practitioners. As always, child protection concerns do not require consent and should be shared without delay.
 

Resources to engage with children and young people

Asking open-ended questions, engaging in play or activities, can be non-threatening ways to engage with children and young people.  

Children and young people, just like many adults, may find it easier to talk and engage with practitioners if involved in an activity such as baking, playing or going for a walk.  

Drawing pictures with children can help to gain their views or playing with figurines.  

There are lots of resources such as Wellbeing Webs and Signs of Safety Activity sheets which can be used to engage with children. Talking Mats is an excellent visual communication system to use with children and young people. 

Doing a genogram or an ecomap with children and young people can also be useful ways to get to know them.  

Practitioners being persistent and consistent in their approaches to children and young people is key, it is important that they keep showing up and giving opportunities to engage. Practitioners must always leave the door open for children and young people  in case they change their mind.
 

Maintaining a professional approach - practical advice

When practitioners have concerns about the behaviours they have observed or noticed when trying to engage with a family, it is important that they discuss their concerns with their line managers and, where safe and appropriate, address the observed behaviours with the parent or carer directly. It may be that the parent or carer is unaware of how their behaviour is coming across to others and it is important to give people a chance to make changes.  

When meeting with parents, carers, children and young people, practitioners should try to:

• Present themselves calmly, use open body language and speak plainly and clearly. 

• Use empathy and actively listen to families' concerns, providing reassurance that it is normal that they may feel upset and angry during parts of the process.  

• Nonetheless, ensure that professional boundaries are established early and clearly state, when faced with challenging behaviours, what behaviour is acceptable and what is not.  

• Offer support to the person to regulate their behaviour - this could be through acknowledging the person is finding it difficult, suggesting a short break or offering to meet again at another time.

• Be clear about consequences of continued unacceptable behaviour - such as that the phone call/visit/appointment will need to be brought to a close if the person is unable to behave appropriately.  

• When working as part of a multi-agency team around a family, it can be helpful to undertake joint visits or office appointments with practitioners who have a more positive relationship with the person to help facilitate conversation. 

Impact on Practitioners - Advice and Support

It is natural that practitioners may find being subjected to threatening and abusive behaviours difficult to manage. Practitioners are people too and many may have had their own experiences of trauma. They may therefore find some behaviours particularly distressing for them on several levels, personally and professionally. Practitioners need to be mindful of looking after their own emotional wellbeing and their managers need to be alert to the signs that a practitioner may need extra support.  

Practitioners who have been subjected to abuse and harassment in the course of the work have described experiencing: 

• Embarrassment and humiliation, particularly if verbal abuse is targeted at their personal characteristics. 

• Feelings of stress and anxiety 

• Emotional exhaustion or feelings of being 'burnt out.'  

• Trying to hide their feelings of distress - especially early career practitioners who may feel that they 'should' be able to manage.

• Guilt and low self-esteem - professionally and personally. Practitioners can feel that they are no good at their jobs, affecting their sense of professional and personal worth. They may feel guilty if they believe that they are letting children and young people down through not being able to do their job properly because they are distressed or afraid. 

• Fear of confrontation which has led them to change their practice and behaviour, including avoiding challenging the person.  

• A lack of enjoyment and/or satisfaction in their role and deciding to look for other employment.

If you are experiencing these feelings as a practitioner, please reach out to your line manager or supervisor for support. Every practitioner has, or will at some point in their career, encounter a difficult situation like this. You are not alone, and your manager and your organisation are there to support you.  

Line Managers and Supervisors

Line managers and supervisors must remain aware of their duty to ensure that their staff members are safe and protected in undertaking their duties. They should also be aware that research indicates that: 

"...heightened stress reduces the capacity of parents and workers to keep at-risk children in mind and in focus" (Howe 2010). 

It is important that line managers and supervisors model behaviours which promote and create a safe space for workers to which to return and share their worries. This is more complex with the advent of hybrid working and it is important that managers and supervisors ensure that they regularly see staff in person, if possible, to enable them to see how their workers are. MS Teams, whilst very useful as a means to stay connected to staff, does not give the whole view of the person and can mean that important cues as to how the person may actually be feeling can be lost, such as body language, as only the face is seen.  

Whilst any kind of harassment or abuse can be distressing, practitioners who experience harassment due to a protected characteristic such as race, sexual orientation, sex, age, disability or gender reassignment are likely to need extra support and abuse of this kind should be addressed robustly by their managers and may necessitate police involvement.  

Line managers have a responsibility to ensure practitioners have access to management and supervision support when required, along with time to debrief with colleagues and to talk through difficult cases. It may help to link the practitioner with someone who has been through a similar experience to reassure them that they are not alone or unusual in coping with these kinds of issues. A personalised approach to support workers is essential as individuals all have different reactions and coping mechanisms for stress, and ways in which they prefer to be supported. Some may appreciate their colleagues being made aware of the situation whilst others may feel exposed by this. It is always important to ask what is preferred by the individual rather than make assumptions.

Line managers and supervisors, whilst attending to the support needs of their staff, must always retain focus on ensuring that the child or young person's need for care and protection remain central, contacts with the adult whose behaviour is causing harm are planned for and contingency arrangements are made to ensure that the baby, child or young person is physically seen.

Learning from Research and Learning Reviews

Messages from research and from Learning Reviews are clear - practitioners who do not adequately address behaviours from parents and carers such as disguised non-compliance, aggression or hostility may be leaving unborn babies, babies, children and young people at increased risk of harm. This has been a theme in Learning Reviews for decades. In the last 5 years alone, there has been a series of Learning Reviews of children who have been murdered by parents or carers who went to great lengths to keep professionals from finding out the abuse and neglect that the children were being subjected to by those who were meant to care and protect them. These reviews included the deaths of Abiyah Yasharahyalah (discussed in more detail below), Star Hobson and Arthur Labinjo-Hughes - the latter two of which you can read more about here. 

In Significant Case Reviews, Safeguarding Reviews and Learning Reviews, an absence of Professional Curiosity from practitioners has often been identified. This is an approach which is about being open-minded to different possibilities and explanations, not simply accepting things at face value and asking questions, consistent with the authority invested in your professional role, to find out more about what may be happening in a given situation. It is an important part of helping keep unborn babies, babies, children and young people safe. As outlined in the sections above, there are many valid reasons that engagement between practitioners and families may be difficult to achieve but practitioners must, at all times, critically engage with the behaviours they observe from parents and carers. This will help them understand what may be giving rise to them and plan how to approach engagement with the individual in ways that suit them better. It will also help to identify when parents and carers are trying to hide neglect and abuse.  

Closely allied to the concept of Professional Curiosity is what Lord Laming termed 'Respectful Uncertainty' ( The Victoria Climbie Inquiry, 2003). The quotation below from P.205 of the report, sets this out very clearly, and applies equally to all practitioners involved in the care and protection of children:  

"While I accept that social workers are not detectives, I do not consider that they should simply serve as the passive recipients of information, unquestioningly accepting all that they are told by the carers of children about whom there are concerns. The concept of "respectful uncertainty" should lie at the heart of the relationship between the social worker and the family. It does not require social workers constantly to interrogate their clients, but it does involve the critical evaluation of information that they are given. People who abuse their children are unlikely to inform social workers of the fact. For this reason, at least, social workers must keep an open mind". 

Practitioners have a responsibility to be open and upfront with parents and carers and their need to be 'respectfully uncertain' in their approach and a duty to ensure that they make every effort to triangulate information which is pertinent to how harm has come to a child. So, behaviour which, after careful deliberation, is purposefully aimed at preventing professionals from seeing and interacting with a baby, child or young person for whom there are child protection concerns should be taken very seriously.

Practice Example: "You Lost Sight Of Me" - Birmingham Safeguarding Children Partnership Learning Review (2025)

Abiyah Yasharahyalah was a 3-year-old boy who died in 2020 and was buried in his family's back garden in Birmingham by his parents. Abiyah's death and burial only became known in 2022, when his parents admitted to workers involved with their new baby in another area what had happened to him. It was not possible to determine Abiyah's cause of death due to the time between his burial and his body being discovered. However, Abiyah, although nearly 4 years old at the time of his death, was the size of an average 14-month-old baby. He had severely stunted growth, 'appalling' dental health, rickets, anaemia, vitamin deficiencies and insufficiency fractures to his shins, ribs and radius.  

Abiyah's parents had very strict religious beliefs, following the practices of the lgbo people in Nigeria and those of the Royal Ahayah Witnesses, leading them to follow an extreme vegan diet which could not meet the nutritional needs of a baby or toddler. Abiyah's parents were resistant to engagement with health and other services, and his father could be extremely hostile to services when challenged. The Learning Review into Abiyah's death considered that services had lost sight of Abiyah with a focus on his parents and their right not to engage with services rather than keeping Abiyah's needs central. Both parents received long custodial sentences for causing or allowing his death. However, social workers who engaged with Abiyah's parents around their new baby were able to build a relationship with them, to the extent that they disclosed what had happened to Abiyah. His mother reflected that the social workers had a 'more personal, understanding and caring approach' than other professionals they had struggled to engage with previously. You can read more about Abiyah's case here.

We have created a speed learning session regarding Abiyah which you can watch below, with accompanying resources:


'You Lost Sight of Me' - CPC Speed Learning Session resources (Word doc, 49 KB)

Did Not Attend or Was Not Brought? When children do not attend medical appointments

All NHS staff who regularly come into contact with children/young people during the course of their work should ensure that they are acting in accordance with the NHS Tayside Child Protection Policy and the Guidance for when children/young people are not brought to health or medical clinic appointments. Further advice can be provided by Line Managers or by calling NHS Tayside Child Protection Advice Line on 07817 062977. 

Any parent or carer may forget to take a child to a routine medical appointment such as a dental check-up at one time or another. These things happen. However, when parents and carers are not taking children to their routine medical appointments or specific medical appointments for their conditions, such as asthma, mental health conditions or epilepsy, and this starts to become a pattern, professionals need to be aware of the possibility of medical neglect. A related issue is when parents or carers do not provide the child or young person with the medications they need for their health conditions which can also constitute medical neglect.  

When a baby, child or young person has not been brought to an appointment, It is important that practitioners ensure that the appointment letter was sent to the correct address for the family and verify the home address prior to a further appointment being sent out. It may be appropriate to offer an appointment reminder such as a text message or telephone call. Practitioners can also review the baby, child or young person's electronic health records to confirm if there is a non-disclosure of address in place and, if so, health practitioners can follow the Guidance on the Management of Non-Disclosure of Place of Residence or Whereabouts (Children and Young People) on NHS Tayside's Child Protection Staff Net. 

When a baby, child or young person has not been brought for an appointment, enquiries should be made with the parent or carer in the first instance regarding what may behind the non-attendance. For example, is there a practical barrier such as childcare commitments for siblings, or is the person in the Highland area of Perth and Kinross and the appointment is in Ninewells Hospital at 9am, for example? This may be impossible for parents or carers who do not have a car to attend due to public transport constraints. Some parents may not be able to problem solve or have no-one to ask for help. They may not have enough credit on their phone to call and ask for a later appointment in the day. So, before arriving at any negative conclusions, try to find out what is getting in the way and who or what might be able to help the family attend the appointment.

However, if there does not appear to be any presenting reasons behind the non-attendance at appointments and/or the child is in discomfort or pain, such as with a toothache that has not been treated, or may face poor outcomes if not taken for treatment, it is time to consider whether the child is being subjected to medical neglect.  

Non-attendance at health or medical appointments may be regarded as medical neglect if the child is not getting the treatment and care they need. It may also be considered under the wider heading of a lack of parental care as the parent or carer has not adequately met their child's health and well-being needs. 

Therefore, action should be taken if the child or young person's health or development is likely to be significantly impaired by not attending the appointment. Sharing this information means that services can discuss with the parent or carer, offering support or guidance as appropriate. If the child or young person is currently known to social work, is or has been on the Child Protection Register, is looked after or care experienced baby, child or young person, the relevant Health Visitor, Family Nurse, School Nurse, Care Experienced Young Person Service Nurse and allocated Social Worker should be informed.

To recognise that children need to be taken to health appointments, Health services have moved away from the use of Did Not Attend for missed appointments to using Was Not Brought to describe this within child health records and chronologies. This video explains why this is a much more appropriate term to describe what has happened when appointments for children are not attended.

So, whenever a child is not brought to an appointment, health professionals must be professionally curious and ask why this has happened. 

All Health Boards provide guidance to assist staff to act as early as possible in the best interest of the child in line with national child protection policy through: 

• Early identification of concerns

• Sharing of relevant, proportionate information to support wellbeing and safeguarding 

• Avoiding the risk of 'drift' setting in before non-engagement is identified and action taken. 

• Recognition that missed health appointments, including those without explanation or missed consistently should be followed up by exercising professional curiosity as repeat non-attendance can be potentially harmful and possibly be a feature of disguised non-compliance.

The use of these guidelines facilitates a standardised approach across NHS Tayside to the appropriate management of children who are not brought for health or medical appointments. This guidance is used alongside the NHS Tayside Child Protection Policy, and all staff have a responsibility to act to ensure that children are protected from harm. Everyone working with children must make every effort to act in their best interests.  

Practitioners have a responsibility to try and engage with families as the welfare of the child is paramount.
 

Resources

Engaging parents and families - a toolkit for practitioners: Education Scotland
 

Glossary of Terms