Adult Services Practitioner s Guidance Chronologies

Table of Contents Why are Chronologies Essential? What is a Chronology? What it is not Using Chronologies What Might Constitute a Significant Event? Appendix 1 Chronology Template of Significant Events Appendix 2a Single Agency Chronology Example of Significant Events Appendix 2b Integrated Chronology Example of Significant Events Appendix 3 Significant Events Page 3 Page 4 Page 4 Page 5 Page 6 Page 7 Page 8 Page 10 Page 14 2

Why are Chronologies Essential? All adults have the right to be safe and protected. They should get the support they need, when they need it, for as long as they need it and their wellbeing should always be paramount. This is a shared responsibility for all practitioners and managers working in the public, private and voluntary/third sectors. This guidance has been produced to provide practitioners working with adults and their families with clear practice guidance on the use of chronologies. It incorporates the key aspects of the Social Work Inspection Agency Practice Guide for Chronologies (2010) and is intended to provide minimum standards, aimed at ensuring a consistent approach to collating, sharing and exchanging information for both single agency and integrated chronologies. An accurate chronology can assist the process of assessment and review. A chronology is not an assessment, nor is it an end in itself. It is a tool that professionals from a range of disciplines can use to help them understand what is happening in the life of an adult. Many inquiries into the care of adults at risk have concluded that a chronology could have helped towards earlier identification of risk and earlier, more effective intervention. The key purpose of the chronology is early indication of an emerging pattern of risk and concern. This may be evident for example by the gradual and persistent withdrawal from protective factors such as non-attendance at health appointments or refusal to engage with support workers. A good quality chronology can be used as an analytical tool to help understand the impact of immediate, cumulative and historical events and changes that affect the adult and their family members. Chronologies are essential documents in the legal process. The purpose of the chronology submitted to the court is to assist in understanding the case history by identifying and dating key events. A good chronology can help reduce the need for the filing of statements and reduce delay in the legal process. The courts recognise the importance of chronology in robust decision making. A chronology will assist in NHS adverse incident processes. 3

What is a Chronology? Chronologies are a critical tool in adult care and/or protection practice and allow for the collation and management of key information relating to the adult s wellbeing. Chronologies: Are a method of identifying and recording significant events Enable practitioners to gain a more accurate picture of the adult Highlight gaps and missing details that require further assessment Assist practitioners to identify patterns of behaviour which will contribute to an assessment and a multiagency approach Inform risk assessment, decision making and care planning What it is not? A chronology is not a replacement for:- Practitioners professional judgment, knowledge, skills and instinct Direct discussion between practitioners and agencies Multi-agency working Early identification, intervention and support Case file recording Assessment and planning 4

Using Chronologies Chronologies can be single agency or integrated. Every adult should have in place an up-to-date single agency chronology. It is the responsibility of the case holder to ensure that this is in place and maintained. A single agency chronology provides a brief description and summarised account of events in date order where information known to the agency and shared by other professionals and the family will be collated and recorded. It will not draw together comprehensive information held by all of agencies nonetheless it will be an analytical tool to assist in the understanding of the impact of life events and to inform decision making. An integrated chronology is produced as part of a specific multi-agency intervention and will bring together information extracted from single agency chronologies that is relevant and proportionate to the adult. Professionals working with a complex case should consider bringing their single agency chronologies together to assist with analysis and decision making. Some information held in single agency chronologies may not be relevant to an integrated chronology and professional judgement will be required to decide what is appropriate and relevant. Care must be taken not to produce unmanageable lists of events that make it impossible to identify risks, resilience and patterns of behaviour. See appendix 1 for the form to be used for both single agency and integrated chronologies. When preparing a chronology; Information should be factual, accurate and evidence-based Must be up-to-date Include the source of information 5

Include information that is relevant, necessary, legitimate, appropriate and proportionate for sharing with the adult and other professionals Will not replace case notes or records which will be comprehensive Each entry will have an action/outcome Will be written using clear language, suitable for all professionals, adults and family Will be presented in time and date order Will be typed The adult and/or family members should be involved in the process of compiling a chronology. Chronologies will be reviewed a minimum of annually to ensure they are current. What Might Constitute a Significant Event? A significant event is one that has had an impact, or continues to have an impact on the adult s wellbeing. Appendix 3 contains guidance for practitioners regarding what may constitute a significant event. The examples provided are for guidance purposes only and the list is not exhaustive. The purpose of the chronology is to record the significant events (positive and negative) and the practitioner must determine the impact these events have had on the adults wellbeing. Appendix 1 provides the template for recording chronologies. Appendices 2a and 2b provide examples of a single agency and integrated chronology. Appendix 3 provides guidance on what constitutes a significant event. Please note that this list is not exhaustive. 6

Appendix 1 Chronology Template of Significant Events Name: DOB: The purpose of this chronology is to record the significant events (positive and negative) that have had, or continue to have, significance to the adult s wellbeing. The impact column primarily focuses on the impact of each event on the adult s wellbeing; however, an event may have an impact on others and these should be recorded in this column. Event Significant Event Source Impact Outcome Entered By Name & Agency Entry 7

Appendix 2a Single Agency Chronology Example of Significant Events Name: Ethel Scott DOB: 12/04/1919 The purpose of this chronology is to record the significant events (positive and negative) that have had, or continue to have, significance to the adult s wellbeing. The impact column primarily focuses on the impact of each event on the adult s wellbeing; however, an event may have an impact on others and these should be recorded in this column. Event Significant Event Source Impact Outcome Entered By Name & Agency Entry 23/04/2014 Ethel has had a fall and broken her hip 23/05/2015 Single Shared Assessment 1(referral) received from Arbroath Infirmary 30/05/2014 Ethel returns home with Social care officer support x 2 daily as highlighted in assessment process. Cares respite will also be introduced as Ethel s husband is struggling with caring role Fax received from Ninewells hospital Ward 2 Arbroath infirmary Homecare assessor Peasiehill Officer Negative affect on overall wellbeing Positive assessment of need undertaken Positive support plan and services in place Information passed to Primary Worker Home Care Assessor allocated to complete assessment as Ethel will require assistance to return home Case to be transferred to Care Manager for respite application Duty Worker Peasiehill office Angus council Team Manager Peasiehill Angus council S Brown Home Care Assessor Peasiehill office Angus Council 23/04/2014 23/05/2014 30/05/2014 8

Appendix 2a Single Agency Chronology Example of Significant Events. Ethel Scott continued Event Significant Event Source Impact Outcome Entered By Name & Agency Entry 20/07/2014 Ethel has been diagnosed as having Vascular Dementia Letter received from Old Age Psychiatry Negative impact on well-being Positive formal diagnosis and access to appropriate support Information put on observations S Smith Care Manager Peasiehill Office Angus Council 21/07/2014 12/12/2014 Ethel s husband Fred died last night Community alarm control. Negative impact on well-being Positive access to Emergency Respite to be found as Ethel is not safe to remain at home on her appropriate support own without supervision. Ethel is transferred to Seaton Grove care home for respite, as she has already had two stays there. S Smith Care Manager Peasiehill Office Angus Council 13/12/2014 9

Appendix 2b Integrated Chronology Example of Significant Events Name: Daisy Mae DOB: 19/06/1991 The purpose of this chronology is to record the significant events (positive and negative) that have had, or continue to have, significance to the adult s wellbeing. The impact column primarily focuses on the impact of each event on the adult s wellbeing; however, an event may have an impact on others and these should be recorded in this column. Event Significant Event Source Impact Outcome Entered By Name & Agency Entry 29/05/2013 Daisy Mae was referred to the Community Mental Health Team. GP of Peek Practice Positive will receive an assessment of her mental health Worker allocated and letter sent advising of initial appointment J Bloggs, Case Manager Community Mental Health Team (CMHT), Arbroath. Angus Council. 29/05/2013 30/05/2013 Adult Concern report due to concerns regarding Daisy Mae s mental health and putting herself at risk. Police Scotland Positive worker will assess risk and appropriate safeguards Home visit arranged for 02/06/2013 F Smith, Duty Worker, CMHT, Arbroath. Angus Council. 30/05/2013 31/05/2013 Call received by the Out Of Hours Service regarding concerns for Daisy Mae s behaviour while in a public place. Concerned member of the general public Negative unable to undertake further assessment due to no answer Visit undertaken by Out Of Hours Service. No answer. Information fax to CMHT Arbroath J Black, Out Of Hours Service Co-ordinator 31/05/2013 10

Appendix 2b Integrated Chronology Example of Significant Events. Daisy Mae continued Event Significant Event Source Impact Outcome Entered By Name & Agency Entry 31/05/2013 Home visit undertaking by Case Worker. Due to concerns regarding mental health follow up visit by Mental Health Officer and GP. J Bloggs Case Manager CMHT Arbroath Positive now placed in a safe environment and will have her mental health fully assessed Emergency detention S36 of the Mental Health (Care & Treatment) (Scotland) Act 2003 used S Smith, Mental Health Officer, Angus Council 31/05/2013 03/06/2013 Detained under Mental Health (Care & Treatment) (Scotland) Act 2003 S44 Short term detention. S Smith Mental Health Officer Positive receiving appropriate and treatment for her mental illness In receipt of appropriate care and treatment S Smith, Mental Health Officer, Angus Council 04/06/2013 10/06/2013 Assault on fellow patient (tried to put a pillow over face). Patient (victim of assault) Negative demonstrates that Daisy continues to be mentally unwell. (Negative impact on the patient who was the victim of the assault). Risk assessment carried out by ward Multidisciplinary team Senior Charge Nurse, Brodie Ward 11/06/2013 11

Appendix 2b Integrated Chronology Example of Significant Events. Daisy Mae continued Event Significant Event Source Impact Outcome Entered By Name & Agency Entry 12/06/2013 Serious assault on nursing staff (use of pool cue). Police attended, no charges brought against Daisy Mae. M.Berry, Charge Nurse Negative demonstrates that Daisy continues to be mentally unwell. (Negative impact on the patient who was the victim of the assault). Risk assessment update patient on 1:1 observations Senior Charge Nurse, Brodie Ward 13/06/2013 29/06/2013 Multi-disciplinary ward meeting held. Decision made to revoke Short term detention. Dr Tim Responsible Medical Officer Positive demonstrates an improvement in Daisy s mental health and no longer under legislation Pre-discharge meeting arranged for 2nd July 2013 Senior Charge Nurse, Brodie Ward 01/07/2013 02/07/2013 Multi-disciplinary predischarge meeting held. Daisy Mae to be discharged on 5 July 2013. Dr Tim Responsible Medical Officer Positive plan identified for discharge from hospital Referral to tenancy support worker, CPN and welfare rights worker Senior Charge Nurse, Brodie Ward 04/07/2013 12

Appendix 2b Integrated Chronology Example of Significant Events. Daisy Mae continued Event Significant Event Source Impact Outcome Entered By Name & Agency 05/08/2013 Report received suggesting that Daisy Mae is residing with a known drug dealer (Mr Mitchell). Anonymous caller (member of public) Negative suggests that she is putting her wellbeing at risk Information discussed with Daisy Mae who denied being in a relationship. No further action taken P.Richards, Duty Worker, CMHT, Arbroath. Entry 06/08/2013 10/08/2013 Call received anonymously to ACCESSLine to advise that Daisy is residing with Mr Mitchell (see entry 05/08/2013). Member of public concerned as they report that Mr Mitchell is physically harming Daisy. Anonymous caller (member of public) Negative information suggests that Daisy is putting herself at risk of harm Information discussed with Daisy who continues to deny relationship. Professional network arranged for 15 August 2013 M.Baggs, Angus Council ACCESSLine 10/08/2013 15/08/2013 Professional network meeting held regarding the concerns about Daisy residing in a house with Mr Mitchell. J Bloggs Case Manager CMHT Arbroath. Positive all professionals able to share relevant information and plan safeguards Referral made to primary worker to carry out Adult Support and Protection investigation J Bloggs, Case Manager, CMHT, Arbroath. 28/08/2013 28/08/2013 Adult Support and Protection case conference held. J Bloggs Case Manager CMHT Arbroath. Positive risk management plan put in place Deemed to be an adult at risk under Adult Support and Protection Act 2007. Risk management plan put in place J Bloggs, Case Manager, CMHT, Arbroath. 13

Appendix 3 Significant Events A Chronology is not a record of a service and/or agencies involvement with an adult service user. It is a record of significant events in an adult s life. The following list provides some guidance for practitioners regarding what may constitute a significant event. Please note that the examples below are for guidance purposes only and the list is not exhaustive. NHS staff can also refer to the NHS Adverse Management Policy for examples and definition of adverse events. A significant event may include: Diagnosis of a long term condition. Change in family circumstances including the immediate family structure and/or significant adults. Change in domestic and/or living arrangements and/or environment. Positive or negative changes in the adult s physical health, health prognosis, mental health and/or emotional wellbeing including acute admissions, discharges, failed and/or missed appointments. Positive or negative changes in family/carers physical and/or mental health and wellbeing, health prognosis, hospital admissions and discharges. Incidences of abuse. Change in service and/or agency supports, including changes of key workers, gradual or sudden withdrawal from service and/or agency support. Adult concern referrals. Adult protection status including legal status and application of orders. Outcome of adult protection referrals/enquiries/investigations. Initial referral discussions (IRD s), network meetings, Care Programme Approach (CPA) meetings, Multi Agency Public Protection Arrangements (MAPPA) meetings, Multi Agency Risk assessment Conference (MARAC) meetings. A conviction and/or prison sentence held by the adult or others that might impact on the wellbeing of the adult. 14

Appendix 3 Significant Events continued Significant events where an adult service user is victim of or witness to a serious crime. Non-accidental injury and significant injury or neglect events. Key dates of birth, transitions, moves, life events and changes. A key professional intervention eg reviews, hearings, tribunals. Threats or actual incidents of violence. Significant home visits, refused visits, refused entry, lack of engagement. Incidents of suspected financial or other abuse. Repeated police contact. Evidence of suspected drug dealing, drug taking or excessive alcohol use. Civil proceedings. Any other relevant concerns or positive improvements. 15