Transfer of Children In and Out of Health Visiting, Family Nurse Partnership & School Nursing Teams Guideline

SH CP 69 Transfer of Children In and Out of Health Visiting, Family Nurse Partnership & School Nursing Teams Guideline Version 4 Summary: Keywords: Target Audience: This guideline outlines the process for the transfer of children in and out of Health Visiting and School Nursing Teams from 0-19 years. This includes the transfer of vulnerable, non-vulnerable children and children with additional needs. Also the transfer of Children from the Family Nurse Partnership team to the Health Visiting teams Transfer in, Transfer out, school entry, vulnerable children, children with additional needs, School Nursing, Health Visiting, Family Nurse Partnership. School Nursing, Health Visiting and Family Nurse Partnership teams in Southern Health NHS Foundation Trust. Next Review Date: June 2018 Approved & Ratified by: Children s Division Quality and Governance Forum Date of meeting: 20 Date issued: Author: Director: Sharon Hargreaves/Jane Levers/Lisa Privett Ginny Taylor, Head of Service, Children s Division 1

Version Control Change Record Date Author Version Page Reason for Change 18.6.12 Jane Levers 1 Review date for Transfer of children in and out of School Nursing teams guideline 31.7.12 Sharon Hargreaves To amalgamate the transfer process for Health Visiting/ School Nursing and Vulnerable children guideline. 10.09.12 Barbara Goff 2 5, 9,10 Amalgamation of the processes for vulnerable children 10.09.12 Fiona Gallagher 2 5, 9,10 Amalgamation of the processes for vulnerable children 03.09.14 Julia Baker 2 Amalgamation of the changes due to RiO SOP v1.2 20.04.15 Sharon Hargreaves 2 Update to process of transferring 0-5 external to Southern Health 24.11.15 Lisa Privett 3 Update to reflect retrieval of secondary record from filestore from CHIS 21.12.15 Sharon Hargreaves, 3 Update to reflect recent changes to process. Julie Hooper, Lisa Privett 20.4.16 Sharon Hargreaves/ Lisa Privett 4 8,15,17 To include the recommendations of NHS England for NBBSS results to be recorded within CHIS by 21 days 12/4/18 4 Review date extended from April to June 2018 Reviewers/contributors Name Position Version Reviewed & Date Jane Levers Professional Lead for School Nursing 18.6.12 Sharon Hargreaves Locality Clinical Manager 31.7.12 Julia Huggan Health Visitor & Practice Teacher 31.7.12 Irene Patience Nursery Nurse 31.7.12 Lisa Riddles Health Visitor Student 31.7.12 Janice Nichols Health Visitor Student 31.7.12 Kath Clark Locality Clinical Manager 19.2.13 Julie Hooper Locality Clinical Manager 19.2.13 HV Mentor Group 26.3.13 Jane Levers Professional Lead for School Nursing 30 09 14 v 2 Julia Baker Safeguarding Children Practitioner 30 09 14 v 2 Fiona Butt Specialist Nurse Safeguarding Children 30 09 14 v 2 Sam Fellows Specialist Nurse Safeguarding Children 30 09 14 v 2 Jane Mills Specialist Nurse Safeguarding Children 30 09 14 v 2 Chis O Dea Specialist Nurse Safeguarding Children 30 09 14 v 2 Jane McQuillan Specialist Nurse Safeguarding Children 30 09 14 v 2 Kate Walters Specialist Nurse Safeguarding Children 30 09 14 v 2 Frances Wallace-Watson Practitioner Nurse Safeguarding Children 30 09 14 v 2 Donna Burkhardt Practitioner Nurse Safeguarding Children 30 09 14 v 2 Carol Bralee Practitioner Nurse Safeguarding Children 30 09 14 v 2 Anita Lewis Practitioner Nurse Safeguarding Children 30 09 14 v 2 Naomi Black Designated Nurse Children in Care 30 09 14 v 2 Sharon Hargreaves Locality Clinical Manager 30 09 14 v 2 Sharon Hargreaves Area Manager 30 09 14 v 2 Kath Clark Area Manager 30 09 14 v 2 Jane Levers Professional Lead for School Nursing 30 09 14 v 2 Amanda Whelan Professional Practice Lead for Health Visiting 30 09 14 v 2 Liz Christie Professional Practice Lead for Health Visiting 30 09 14 v 2 Tina Scarborough Named Nurse for Safeguarding Children 30 09 14 v 2 Caz Maclean Interim Associate Director of Safeguarding 30 09 14 v 2 Ginny Taylor Operational Service Lead 30 09 14 v 2 Liz Taylor Clinical Service Lead 30 09 14 v 2 Jane Levers Professional Lead for School Nursing 13.04.15 v3 Sharon Hargreaves Area Manager 20.04.15 v3 The Policy Group Lisa Privett CHIS Manager 20.4.16 V4 2

Contents Section Title Page 1. Introduction 4 2. Scope 4 3. Definitions 4 4. Duties and responsibilities 5 5. Process 6 5.1 5.2 5.3 5.4 5.5 5.6 5.7 Process for the external transfer of children under 5 into the Health Visiting Team Process for the external transfer out of children under 5 from the Health Visiting Team Process for the internal transfer of non-vulnerable children within Southern Health NHS Foundation Trust Process for the transfer of children from the Family Nurse Partnership programme to the Health Visiting Team. Process for the transfer of children from Health Visiting team to School Nurse team at school entry Process for the transfer of children in and out of School Nursing Teams Additional process for the transfer of Vulnerable Children in and out of Health Visiting and School Nurse Teams 6 7 8 8 9 10 10 6. Training requirements 11 7. Monitoring compliance 11 8. Associated trust documents 11 1 2 3 4 5 6 7 Appendices Transfer in Form - Request for Records CHIS New Born Blood Spot Screening Process Transfer in Transfer out of Non Vulnerable Children 0-5 to External Trusts Transfer out of Vulnerable Children 0-5 to External Trusts School Entry Health Review Questionnaire Guidance on Adoption Record Process for Child Health Staff FNP Graduation Pathway 12 13 17 18 19 21 22 3

TRANSFER OF CHILDREN IN AND OUT OF HEALTH VISITING AND SCHOOL NURSE TEAMS GUIDELINE 1. Introduction 1.1 This guideline outlines the process for the transfer of children in and out of Health Visiting and School Nursing Teams. This includes the transfer of vulnerable children and children with additional needs. Also, the process of transfer from the Family Nurse Partnership programme to the Health Visiting Teams. It is important that this process is robust to: Ensure that clinical records of vulnerable/ non-vulnerable children are transferred safely and efficiently internally and externally. Promote the early identification of an individual child s health needs that may impact on their development, well-being and ability to access education. Ensure children, young people and families, continue to receive seamless access to the Healthy Child Programme 0-19 Southern Health NHS Foundation Trust [Southern Health] Enable professionals in the child s new health care organisation to provide continuity of care to a vulnerable child and their family 2. Scope 2.1 The contents of this document apply to all members of the Health Visiting, School Nursing and Family Nurse Partnership Teams within Southern Health. 3. Definitions 3.1 Healthy Child Programme 0-19 [HCP] [Southern Health] This document describes the service offered to all pre-school and school-age children and families by Health Visiting, School Nursing and Family Nurse Partnership Teams in Hampshire. 3.2 School Nursing and Health Visiting Teams A team of practitioners who work with a defined population to deliver services that promote the health and well-being of children, young people and their families. Team members will include all or some of the following practitioners: Health Visitor [HV] School Nurse [SN] Special School Nurse [SSN] Community Staff Nurse [CSN] Nursery Nurse [CNN] Health Care Support Worker/ School Nurse Assistant [HCSW/ SNA] Clerical Support Worker Student Health visitor Student School Nurse 3.3 Family Nurse Partnership Teams A team of Family Nurses who are trained to deliver the Family Nurse Partnership Programme (FNP). FNP is a voluntary, preventative programme for vulnerable young first time mothers. It offers intensive and structured home visiting, delivered by specially trained nurses, from early 4

pregnancy until age two. FNP has three aims: to improve pregnancy outcomes, improve child health and development and improve parents economic self-sufficiency 3.4 OpenRiO The electronic patient record system 3.5 Standard Operating Procedure (SOP) The standard operating procedure for the RiO Electronic Patient Record System defines the business rules around which the RiO Electronic Patient Record will be used with the Trust. It is designed to work with current policies and procedures and to be used as the guide for all RiO users within the organisation including seconded and temporary staff. 3.6 Movement of records The movement of clinical records must be tracked to ensure that it is recorded where any paper secondary records are held. The location and movement (tracking) of the Secondary RiO Record is to be recorded using progress notes on OpenRiO. The Initial Progress Note entry should indicate where Secondary RiO Record, (including historical volumes of secondary records), are held. When an HCP enters the first Progress Note for a client the standard sentence should be used: This is the SHFT [insert name of team] primary record. Paper records are a secondary record. Any paper information associated with this OpenRiO record (known as the Secondary RiO Record is located with the. (add name of the Service Team). If it is not known if a Secondary RiO Record exists use: This is the primary Record, there is no Secondary RiO Record held at [base]. The following conventions are to be followed when recording the movement of Secondary RiO Records. Heading: Secondary RiO Record Movement Colour of Record (e.g. blue or orange) Volume number/s Type (e.g. integrated, pre-rio, post RiO Delivery method (e.g. internal courier, Royal Mail, signed-for, hand-delivered, etc.) Destination The Progress Note must not be marked as a significant event When patients are subsequently transferred to other teams or moved in or out of SHFT services a Progress Note is to be recorded by both the sender and the receiver of the Secondary RiO Record to identify where it is located. 4. Duties and responsibilities 4.1 Southern Health NHS Foundation Trust Board Southern Health NHS Foundation Trust Board [Southern Health] has the responsibility to ensure that the health contribution to School Nursing Services is discharged across Southern Health through commissioning processes. 4.2 Director of Integrated Services West The Director of Integrated Services West has the overall strategic and operational accountability for delivery of the Health Visiting, School Nursing Service and Family Nurse Partnership. 4.3 The Senior Management Team The Senior Management team have the strategic and clinical lead in all aspects of the Health Visiting, School Nursing Service and Family Nurse Partnership and will ensure there is adherence to this guideline. Barriers to the compliance of this guideline will be escalated to the Integrated Director. 5

4.4 Clinical Team Leaders Clinical Team Leaders have the daily operational management of the Health Visiting and School Nursing Service and are required to ensure all staff are suitably trained and competent to deliver this role and that relevant policies are adhered to. Compliance to the guideline will be audited annually and exceptions to service delivery will be raised to Area Managers. 4.5 School Nurse, Health Visiting and Family Nurse Partnership Teams School Nurse, Health Visiting and Family Nurse Partnership Teams are responsible for complying with this guideline, and raising any exceptions of service delivery to their managers. 5. Process 5.1 Process for the external transfer of children under 5 into the Health Visiting team All Health Visitors have a responsibility to ensure that systems are in place for the Team to offer the Healthy Child Programme to all families with children under 5 years of age who transfer into their area. This includes all children resident in Hampshire who may not be registered with a GP. 5.1.1 The Health Visitor has responsibility to review previous health visiting records upon receipt and determine level of need according to The Assessment of Children and Families Vulnerability Criteria. See 5.6 for the transfer of vulnerable children. 5.1.2 The Health Visitor will ensure that the Children in Care Nurses are informed when Children in Care transfer into or out of the Team. See 5.5.4 and 5.6 Each team has a robust process for requesting records from their Child Health Information Services (CHIS), formerly known as Child Health Records Department (CHRD): As soon as CHIS are aware that a child has transferred into SHFT they will notify teams via the RIO Monthly team planner (MTP). The comment box on the MTP will read Transfer in Where a transfer in is initially identified by the HV team, the team will inform CHIS and confirm if it is a Transfer in of child over 4 weeks of age (birth visit does not have to be done) or Midwifery transfer in under 4 weeks (new birth visit required). Urgent transfer in requests to CHIS are by telephone but the team will also need to request the secondary records using the Transfer in Form - Request for Records (Appendix 1) and non-urgent are notified to CHIS by email and include the Request for Records form. The request for secondary records should be actioned as a priority by the team to enable the HCP to gain a full clinical picture. On receipt of the request form CHIS will action within 5 working days. The date of request for records is documented in the progress note of the electronic record. The child should remain on the MTP until receipt of records with the comment Awaiting secondary record. The status of the request for records is checked weekly prior to allocation and the child will be removed from the MTP on receipt of secondary records. If records are not received after 4 weeks, a second request is sent by admin and documented on the progress note If a family has transferred in from abroad or is a service family there may not be any previous records. 6

At 8 weeks if no records are available, contact the previous Health Visiting Team for further information. Consider liaison with other professionals for information; GP, Social Care, Midwifery Services, Armed Forces Family Liaison and Police. An assessment based on professional judgement can then be made from the information received and should be documented in the electronic record. Discuss with Safeguarding Team and Clinical Team Lead to see if a Ulysses Safeguard report needs to be submitted. In the case of no records and insufficient information being received within 2 weeks, then face to face contact with the family should be made adopting all lone working measures. Working in partnership with the family, discuss and use the Framework of Assessment and the Vulnerability Criteria to determine level of need and future contact Families with children under 1 year or identified as vulnerable should be offered a face to face contact by a Health Visitor. This contact should be within 10 working days of when the family are made known to the HV teams whether by monthly team planner or by other professionals. If contact cannot be made liaison should take place with the relevant agencies i.e. GP and the Safeguarding Team. 5.1.5 During this contact, the Health Visitor, working in partnership with the family, will: Discuss and assess the level of vulnerability in order to determine level of need and future contact Record in the RiO Vulnerable Child Assessment Form and the progress notes Enquire into the Infant s status re Newborn Blood Spot Screening, immunisation and neonatal hearing screening and document on the transfer-in form and send to CHIS. It is the responsibility of the Health Visitor to ensure a conclusive screen is recorded by CHIS within 21 days (see appendix 1 and 2) 5.1.6 Families with children over the age of 1 and not identified as vulnerable will be contacted within 15 working days using the RiO editable letter. The letter will include contact details for the Health Visiting Team, Child Health Clinic times and local Children s Centre information. On receipt of the records from the previous Health Visiting team, the records will be reviewed by the named health visitor for any vulnerabilities. If vulnerabilities are identified or suspected, a face to face contact will be offered by the named health visitor and the process for the transfer in of a child under 1 and transfer in of a vulnerable child (5.1.5 & 5.7.8 ) will be followed 5.1.7 The Health Visiting Team will record all contacts in accordance with the Clinical Information Assurance [Record Keeping] Policy (Southern Health). The movement of records should be recorded in the progress note of the Rio record as per the SOP 5.2 Process for the external transfer out of children 0-5 from the Health Visiting team (See Appendix 3) 5.2.1 The records for any child 0-5 years should not be transferred out without a formal request from CHIS via the MTP. CHIS can request secondary records from Filestore and will inform the team if this happens. 5.2.2 The Health Visitor has the responsibility to check all records for children transferring out of their teams. The Health Visitor must inform CHIS if there are any relevant forms/letters that also need to be printed and sent. The movement of records should be recorded in the progress note of the RiO record as in section 3.4 7

5.2.3 Following notification from CHIS via the MTP the HV team should discharge and close down any outstanding appointments The HV then needs to check if there are any alerts. If alerts are present the HV must allocate to a Named HV who will make an urgent assessment of need within 5 days If you aware of a child transferring out of Southern Health but CHIS have not requested the records please refer to Appendix 3/4. 5.3 Process for the internal transfer of non-vulnerable children HV Team 1 to HV Team 2 or SN Team 1 to SN Team 2 within Southern Health NHS Foundation Trust. 5.3.1 Rio referrals/client records can ONLY be transferred between teams within the same specialty e.g. SN Team 1 to SN Team 2 when teams are the same speciality AND are within the SOUTHERN HEALTH Trust area. A RiO referral cannot be transferred to a different specialty, for example from HV to SN. The referral MUST be discharged and a new referral created by the receiving speciality 5.3.2 The transferring team needs to inform the new team of the transfer and send any paper secondary records via the internal courier service. 5.3.3 The receiving team needs to record the receipt of the paper secondary records in a Progress Note as in 3.4. 5.3.4 When Referrals are transferred, any appointment booked for that client is removed automatically from the HCP Diary. It is the responsibility of the receiving team to ensure appointments are re- booked as required. 5.4 Process for the transfer of children and families from the Family Nurse Partnership programme to the Health Visiting Teams with Southern Health NHS Foundation Trust. 5.4.1. When Child reaches 18 months Family Nurse agrees with client plan for agreed work over the final six months of the programme 5.4.2 When Child is 21 months old Family Nurse will discuss at supervision recommendations for transfer to the Health Visiting service (Universal, Universal Plus or Universal Partnership plus) and requirements for an Early Help assessment of other service involvement post FNP. Family Nurse will contact the relevant Health Visiting team and commence plans for a joint introductory visit. 5.4.3 When Child is between 22-23 months old Family Nurse to complete FNP summary of progress information in order to provide a comprehensive summary of family progress with FNP, analysis of current situation, including assessment of need and recommendations for Health Visiting service and other professional input. Family Nurse to ensure this is recorded appropriately in the electronic patient record. If client not already engaged in Children Centre activities, Family Nurse to provide client with materials, accompanied visit etc. as required to facilitate access to Children Centre. 5.4.4 When Child is 23.5 months old Family Nurse will present client at supervision for the final time. Family Nurse will ensure that: the client graduation has been communicated in writing to all involved agencies (including GP); records have been updated, including a copy of testimonial. QSO will notify CHIS and the Health Visiting team of client transfer. 5.4.5 The process of record transfer will be that of process 5.3 of this document. 8

5.5 Process for the transfer of children from Health Visiting team to School Nurse team at school entry 5.5.1 From 1st May each year Health Visiting team admin will generate a list from Data Warehouse of all vulnerable/ partnership plus children due to start school the following September. To include a list of children on a child protection plan, children in care, children in need and vulnerable children with alerts and children with a care plan. The Health Visitor and School Nurse will arrange a face to face contact to update on all vulnerable children due to start school the following school year. Dates for handover of children from Health Visiting to School Nursing should be completed by the end of July prior to the child starting school. When a child reaches the month of their 5th birthday the HV team will discharge the referral as per the RiO SOP [Southern Health 2015] and the child s secondary record [if non-vulnerable] will be archived as per the Trust archiving process. 5.5.2 Secondary records for vulnerable children and for children attending special school should be transferred to the School Nursing team. All other records will remain with the Health Visiting team until the child reaches their 5th birthday and will then be archived if not already Please also refer to 5.510 regarding children attending special school 5.5.3 Using professional judgement the Health Visitor will review all alerts and care plans to ascertain which children need to be verbally handed over to the SN team. Where there is no longer a need for ongoing support or a role for the SN team care plans should be closed and vulnerable child alerts removed. All children with a complex or additional health need should be discussed 5.5.4 A progress note should be added by the Health Visitor to the child s Electronic Patient Record for any child who will be verbally handed over to the SN team with relevant School entry handover information to include the current issue and current plan. The progress note can be printed off if necessary and used as an aide memoire at handover. All printouts should be shredded after the verbal handover. Best practice would be for the School Nurse and Health Visitor to be able to handover with a laptop/ PC so that progress notes can be updated with any new information, alerts added or removed if necessary and the future plan added. The School Nurse/ CSN has a responsibility to review the information available about the child in accordance with the Vulnerability guideline 0-19 years [Southern Health 2013]. The School Nurse/ CSN will develop and record an action plan in the RiO progress notes if School Nursing input is required, an alert added if necessary, RiO referral created and the child s name added to the Monthly Team Planner. Following the review of records, if no school nursing input is required, then the alert must be removed. 5.5.5 If a vulnerable child is being transferred out of area by the HV, handover to the School Nurse/ CSN must take place over the telephone prior to forwarding the record as per the transfer out process. 5.5.6. If the child is attending Special School provision (full time or part time) from age 2 due to their complex health needs the child will need handing over to the Special School Nurse, [if there is one linked to that school] at school entry. Although the Health Visitor will remain involved with the child and family until the child reaches age 5 the secondary record should be forwarded to the Special School Nurse [SHFT only]. There should be appropriate liaison and information sharing between the Special School Nurse and Health Visitor to ensure both services are aware of the needs of the child. When letters are received about the child by the HV Team they should be documented in the progress notes and forwarded for filing in the secondary record. Please note that there may be secondary records sitting within other services. 9

5.6 Process for the transfer of children in and out of School Nursing Teams 5.6.1 When a child transfers into a new school/ area, the School Nurse/ CSN has responsibility to review any previous HV/ School Nursing records upon receipt. [Appendix 5] Using their professional judgement and the information available to them, they should assess levels of vulnerability and any unmet health needs according to the Identification of Vulnerability in School-age Children guideline [HCHC 2011]. If School Nursing input is required an action plan will be developed and recorded in the RiO progress notes. 5.6.2 Families with school-age children under 6 years of age transferring in will be sent a School Entry Health Review Questionnaire [Appendix 5] to complete for their child, with the contact details of the School Nurse Team. If necessary [e.g. for school entry review screening], and with parental consent, a member of the School Nursing Team will see the child in school as per the Healthy Child Programme. 5.6.3 Records for a non-vulnerable child will only be transferred out of area on request from CHIS. Otherwise records will be archived in accordance with trust policy. 5.6.4 If a vulnerable child transfers out of area to a known address, a handover to a School Nurse in the new area must take place over the telephone. 5.6.5 If a vulnerable child transfers out of area and the address is unknown and unobtainable from colleagues in other services, please seek advice of the Safeguarding Single Point of Contact Tel: 02392 372780 as a missing child/ren alert may need to be circulated, either locally or through custodian of the list of children who are subject of a child protection plan. This information should be documented in the records as per 5.7 5.7 Additional process for the transfer of Vulnerable Children, including Children in Care 0-19 years out of Southern Health Visiting and School Nursing teams 5.7.1 The lead HCP for the child should Inform Children s Services (Social Care) and other professionals involved, of the change of address. 5.7.2 Liaise with the Health Visitor or School Nurse who will provide future care [by telephone]. This information should be documented in the child s RiO record as per the RiO SOP [Southern Health 2012] and the Access, Movement and Storage of Clinical Records Procedure [Southern Health 2012]. 5.7.3 If a child s address has been S-Flagged (sensitive records); see current version of the SOP, Sensitive Records) the new practitioner and area need to be made aware and they will need to link with Children s Services about the current status and then with the GP for reviewing. 5.7.4 Inform Southern Health s Specialist Nurse for Children in Care (CiC) in your area when a child moves out of the area. 5.7.5 If a Health visitor or School nurse is aware that a family has moved out of Southern Health s area and they have the new address and contact details of the Professional, they need to ask the receiving professional to inform their CHIS to request the Southern Health records. 5.7.6 For children who are being placed for adoption the records will not be cleansed before being sent. Please follow the process above. Please note that records should only be sent for cleansing once requested via the teams MTP [Appendix 6] 10

5.7.7 No records will come through the Safeguarding or Children in Care Team. 5.7.8 The School Nurse or Health Visitor should liaise with professionals previously involved as appropriate. A Health Visitor will visit the family within 10 working days of notification of transfer or receipt of the notes for a child under 5 years of age. The School Nurse will use professional judgement regarding contact following liaison with previously and newly involved professionals. 5.7.9 If a Child s address was S-Flagged (sensitive records) in their previous area, review status and inform Children s Services about the current status and then with the GP for reviewing. 5.7.10 Other elements of the transfer-in process should be completed in the usual way. 6. Training requirements 6.1 All staff in Health Visiting and School Nursing Teams will be given instructions on applying the Guideline for Transfer In and Out of Health Visiting and School Nursing Teams at team meetings and local induction. All Family Nurses within the FNP team will receive training during team meetings and from the national unit regarding transfer/graduation of clients from the programme to the health visiting teams. 7. Monitoring compliance 7.1 Compliance will be monitored during the annual quality audit of clinical record keeping. 8. Associated trust documents SH CP 08 Vulnerability Guideline Healthy Child Programme 0-19 SH IG 1 Clinical Information Assurance (Record Keeping) Policy SH IG 02 Access, Movement and Storage of Clinical Records Procedure SH IG 3 Mislaid or Lost Clinical Records Procedure Family Nurse Partnership programme NHS newborn blood spot (NBS) screening programme V1.1 (DOH February 2015) Public Health England (2015) Health visiting and school nursing partnership pathways for supporting health visitor and school nurse interface and improved partnership working 11

Appendix 1 REQUEST FOR RECORDS This form is for used for all children who move into the SHFT area To: Child Health Information Service Basingstoke: hp-tr.chrdbasingstoke@nhs.net Pre-school Health : hp-tr.childhealthrecords@nhs.net School Health hptr.childhealthdepartmentsouthernhealth@nhs.net From: [HV or SN Name] Please request records from the previous Trust for the following child or children Family Child s Full Name NHS Number Date of Birth Sex M / F M / F M / F M / F Full Name: Parent / Main care giver Date of birth: Parent / Main care giver Family s new address & postcode Family s previous address & postcode CHIS Action Checklist Date request for records email received Date Referral & MTP entry entered on RiO Name of family s previous Trust Date letter sent to previous Trust Other action taken / Comments 12

Appendix 2 - CHIS New Born Blood Spot Screening Process Transfer in CHIS receive new born- blood spot screening results daily from the labs and record results on RiO on the day of receipt. If all nine results are 04, i.e. conditions not suspected, CHIS notifies parent/guardian(s) by letter. If a baby has abnormal results CHIS will notify the HV via the monthly team planner and will send all paperwork to the HV when they have a completed result. Please note communicating results to parents of babies who do not have a normal screening results is the responsibility of the Health Visitor. All results are available in the screening link on the demographic page. CHIS also will complete a progress note for abnormal results. If a baby under one year of age transfers from abroad with no information about blood spot, CHIS will alert the HV team to request the information from the parent/guardian and arrange testing if necessary. It is the responsibility of the HV to inform CHIS of a conclusive screen to be recorded in CHIS within 21 days. 13

Procedures for newborn blood spot (NBS) screening of babies under a year of age, for whom screening results are not available This procedure applies equally to all infants resident in England, whether born in England, other countries of the UK, or born abroad. Babies born outside England may have been screened as part of routine screening in their country of birth for the five conditions screened for in England before the expansion of the programme. For some infants, NBS screening is inadvertently not carried out or the results are missing. If for a child under a year of age, there are no documented results (or declines) for all five conditions screened for in England before the expansion of the programme (sickle cell disease (SCD), cystic fibrosis (CF), congenital hypothyroidism (CHT), phenylketonuria (PKU) and medium-chain acyl-coa dehydrogenase deficiency (MCADD)), screening should be offered and carried out for all the untested conditions that will include the four additional inherited metabolic diseases (maple syrup urine disease (MSUD), isovaleric acidaemia (IVA), glutaric aciduria type 1 (GA1) and homocystinuria (HCU)). For babies older than 8 weeks, the routine screening test for cystic fibrosis (IRT) is no longer reliable and so this test will not be done in babies over 8 weeks of age. If for a child under a year of age, there are documented results (or declines) for all five conditions screened for in England before the expansion of the programme (SCD, CF, CHT, PKU and MCADD), screening should not be offered for the four additional inherited metabolic diseases (MSUD, IVA, GA1 and HCU). The expectation is that a sample should be taken from a baby with incomplete results for SCD, CF, CHT, PKU and MCADD and the results of this sample (that will now be screened for all nine conditions) be recorded on the child health information system equal to or less than 21 calendar days of movement in being recorded on the child health information system. See referral pathway Seeking results for SCD, CF, CHT, PKU and MCADD In most cases where there is no documented result, the child has probably been tested, with a normal result, but for one reason or another, this is not available. Only written confirmation of results should be accepted. All reasonable attempts should be made to find the results, however this should not unduly delay screening. When the results of NBS screening are not immediately available, there are a number of places they can be sought. If the mother does not have the results, ideally recorded in the personal child health record (PCHR), the first place to start should be the previous health visitor and/or child health records department (CHRD). If they do not have the results, at least they will know which midwifery department would have been responsible for taking the sample and therefore the relevant screening laboratory. It is unlikely the GP will have the results if the mother doesn t. 14

If the results cannot be found after recourse to all these possible sources. Parents should be offered screening for all nine conditions and referred to the appropriate screening centre as documented in the referral pathway. Families can decline individual conditions (CHT, SCD, CF) or ALL the inherited metabolic diseases (PKU, MCADD, MSUD, IVA GA1 and HCU). The laboratory will test the sample and report the results to the child health records department. The laboratory will test for all nine conditions (eight if over 8 weeks old), irrespective of which of the following have already been tested for SCD, CF, CHT, PKU and MCADD. The results should be recorded in PCHR and all other relevant records. If the parents decline the offer of testing, this should be recorded in PCHR and all other relevant records It is the responsibility of the HV to inform CHIS within 21 days of the screening results including if results are unknown due to lack of evidence and/or parents refuse screening of their child. If the child is over 12 months old, note should be made of the missing results and that the parents have been given the appropriate advice. Advice to parents The exact details need to be phrased in the light of the individual circumstances, but the following points need to be made to parents. If the baby is over twelve months old, the parents should be told that we do not know if their baby has been tested for all conditions, and that we do not recommend testing after 12 months for the reasons above. This will be recorded in the child s clinical notes and on the child health information system. All babies up to a year old should be offered screening for the conditions we routinely screen for at 5-8 days old in England if they do not have documented results for SCD, CF, CHT, PKU and MCADD. However, not all the tests are as reliable as when carried out at 5-8 days of age. The test for sickle cell disease can be carried out at any age and is equally reliable in older children. The screening test for cystic fibrosis is unreliable after a baby is 8 weeks old. Older babies with cystic fibrosis may have normal results. If a child has repeated chest infections or diarrhoea, medical advice should be sought and a test for cystic fibrosis may be arranged. This test is more complicated than the screening test and so it is not carried out on all babies. The screening test for congenital hypothyroidism (CHT) becomes less reliable in older babies. This means that some older babies with CHT may not be picked up. An alternative test can be done on babies who have symptoms suggestive of CHT, e.g. prolonged jaundice, developmental delay, etc. The test for phenylketonuria can be carried out at any age and is equally reliable in older children. This is also applicable to the four additional inherited metabolic diseases (MSUD, IVA, GA1 and HCU) in most cases. 15

The screening test for medium-chain acyl-coa dehydrogenase deficiency (MCADD) becomes less reliable in older babies. This means that some older babies with MCADD may not be picked up. If parents decide not to accept the offer of screening, or the baby is over twelve months old, this should be recorded in clinical notes and on the Child Health information system. Parents should be asked to seek medical advice and remind staff that their baby has not been tested if their baby has signs of chronic health problems such as developmental delay, chronic diarrhoea or repeated lower respiratory tract infections. 16

CHIS request Appendix 3: Transfer out of Non Vulnerable Children 0-5 to External Trusts Please note that Electronic Patient Record (EPR) should be the primary record and must contain the most up to date details in the progress notes; detailing recent care and address of where the secondary records have been archived. When records are requested for transfer CHIS will request through the Team MTP for secondary records. Any archived records can be recalled by CHIS as required however if the Rio record is complete the clinician can decide if the secondary record is required or if a printout will suffice. Baby moved abroad Baby transferred out of SHFT to another trust Address Known Baby transferred out of SHFT Within UK Address unknown HV to complete progress note recording that baby transferred abroad, detailing if address unknown Admin to archive secondary records and record archiving number in progress notes HV contacts new HV Team (Contact details may be obtained from CHIS) and informs of new address of child transferring in Complete progress note recording that baby transferred out, new address and that new HV team informed (name of HCP informed) Admin to check National Spine to see if new address available Address known Admin to discharge from caseload Address still unknown HV completes progress note stating address unknown 17

Appendix 4 Transfer out of VULNERABLE Children 0-5 to External Trusts Please note that Electronic Patient Record (EPR) should be the primary record and must contain the most up to date details in the progress notes; detailing recent care and address of where the secondary records have been archived. CHIS REQUEST When records are requested for transfer CHIS will request through the Team MTP for secondary records. Any archived records can be recalled by CHIS as required however if the Rio record is complete the clinician can decide if the secondary record is required or if a printout will suffice. Baby moved abroad Baby transferred out of SHFT to another trust Address Known Baby transferred out of SHFT Within UK Address unknown HV to complete progress note recording that baby transferred abroad, detailing if address unknown HV contacts new HV Team (Contact details may be obtained from CHIS) and informs of new address of child transferring in Admin to check National Spine to see if new address available Inform any relevant agencies including GP, Local Authority, Children s Centres that child has transferred out HV to contact SPOC For further advice Dependent on advice from SPOC admin to archive secondary records and record archiving number in progress notes Admin to discharge from caseload If child s address has been S- Flagged, the new HCP should be aware and may need to link with GP/Children s Services re: current status Inform New HV that they need their CHIS department to request the records from our CHIS Complete progress note recording that baby transferred out, new address and that new HV team informed (name of HCP informed) Place on MTP and check every 2 weeks if records have been requested and transferred out. Contact NEW HV again to Chase up request status and check Contact has been made Address known Address still unknown HV completes progress note stating address unknown Inform any relevant agencies including GP, Local Authority, Children s Centres that child has transferred out 18

Appendix 5: SCHOOL ENTRY HEALTH REVIEW QUESTIONNAIRE Please complete the consent form and questionnaire and return it to the School Nursing Team via your child s school. The School Nursing Team works in partnership with children, young people and families to ensure that children are supported within their school and their community to remain healthy. The team offers confidential advice and support in all areas of health, which may affect your child during their school years. At school entry [age 4-5 years] your child will be offered a health review in school. Parents/Carers are not routinely invited to attend, however if either you or the school identify a concern or request to consult with the School Nurse, a member of the School Nursing Team will contact you. All results from the health review will be forwarded to parent/carers and can be added to your child s parent held record. The health review will consist of: A vision screening test. This vision test is to find out how much your child can see when naming or matching letters using separate eyes. The test is designed for children and whilst it will detect the majority of eye problems it is not a full examination. If your child has difficulty seeing the letters, their eyes will need to be checked by an optician or orthoptist [eye specialist] for a further assessment. You will be contacted by the School Nursing Team should a possible concern be identified. A hearing screening test. This test provides an indication of the level at which your child can hear. If a possible hearing problem is identified, you will be contacted. Please note that colds can have an effect on a child s hearing. Height and weight measurement. As the parent/carer with parental responsibility, I give consent for vision, hearing, height & weight checks as detailed above Child s name Parent/Carer s Name.. Mother/ Father/ Carer with parental responsibility [Please delete as appropriate] Signature Date: Name of child School. Previous School attended [if relevant]... Male / Female NHS No Date of Birth. Home Address... Postcode Telephone Number... Childs first language. Ethnicity.... GP Name, address and phone number.... Mother s height Father s height 19

Has your child received the following routine Immunisations in the table below? YES NO If you are unsure that your child has had all the recommended immunisations please discuss this further with your GP or Practice Nurse. Further information can be found at www.immunisation.nhs.uk or from your GP Practice. 2 months old Diphtheria, Tetanus, Pertussis, Polio, Hib and Pneumococcal infection 3 months old Diphtheria, Tetanus, Pertussis, Polio, Hib and Men C 4 months old Diphtheria, Tetanus, Pertussis, Polio, Hib, Pneumococcal and Men C Around 1 year Hib and Men C Around 13 months MMR and Pneumococcal 3 5 years old Diphtheria, Tetanus, Pertussis, Polio and MMR Does your child currently see a dentist? YES NO It is recommended that all pre-school and school-age children should see a dentist at least annually. For help with finding an NHS dentist please phone the Hampshire Dental Helpline on 0845 050 8345 or visit www.hampshiredentalhelpline.nhs.uk Does your child have any health problems? [Please tick all those that are relevant to your child] Asthma Severe allergies Epilepsy Diabetes Physical disability Learning disability Eczema Constipation Bedwetting Please supply details; Daytime wetting Soiling Other Health concern For more information visit www.southernhealth.nhs.uk/schoolnursing Does your child take any medication/ use an inhaler/ Epipen? If yes please give details: YES NO Has your child been assessed by any other health professional in the last year e.g. Paediatrician, optician, orthoptist [eye specialist], audiologist [hearing specialist]? If yes please give details: YES NO Does your child live in a smoking household? YES NO If you would like support with stopping smoking please contact Quit4Life on 0845 602 4663 or visit http://www.quit4life.nhs.uk/ If you have any other concerns about your child s health that you wish to discuss with a health professional, please contact your GP or the School Nurse team whose details can be found on the front of this questionnaire. 20

Appendix 6 Adoption Process CHIS & HV Systems support team email the adoption team a report listing children without an NHS number. Adoption team confirms the adoption and sends the list to CHIS CHIS pull new nhs number record onto local Rio CHIS progress note old record: CHIS Adoption process completed. HV/SN advised to cleanse records via MTP CHIS add entry to HV/SN MTP. Comment Adoption - Please cleanse secondary records as per new adoption process. Activity is Review CHIS print off discharge summary from logically deleted Record CHIS update new records using transfer in process including referral if under 5 and destroy the discharge summary. Do not enter any information about birth mother CHIS notifies the adoption team that they have completed their process and provide them with the new NHS number if necessary. Should CHIS come across or are notified of an adoption, providing they have both the Old and New NHS number the above process can be implemented without a report. Please also inform Children in Care Team SPOC 02392 372 780 email: hp-tr.admin-childrenincare@nhs.net 21

Appendix 7 FNP GRADUATION PATHWAY Child 18 Months Old Visit T41 FN supports client to complete facilitators Planning for your goals and where are we at? FN presents client in supervision for penultimate review. To include reflection on, and analysis of: progress with meeting the programme outcomes, priorities for the last 4-6 months of programme delivery, identification of unmet needs for child (children) and mother. Plans agreed for FN work over final 6 months, to be shared and agenda matched with client. Child 21 Months Old Supervision progress review to include decisions regarding; recommendations for transfer to HV service (Universal, universal plus or universal partnership plus?) and requirement for a CAF or other service involvement post FNP. FN contacts HCP HV team and commences plans for joint introductory visit. Child 22-23 Months Old Family nurse prepares your strengths and your achievements testimonial in readiness for client. Family Nurse to commence FNP Summary of progress document (or locally agreed alternative) in order to provide a comprehensive summary of family progress with FNP, analysis of current situation, including assessment of need and recommendations for HV or other professional input If client not already engaged in children s centre activities, FN to provide client with materials, accompanied visit etc. as required, to facilitate access to CC. FN presents client for final review in supervision. Child 23.5 Months Old Reflection on, and analysis of; FN feelings regarding preparations for graduation, review joint visit, any new information or assessment which may affect the recommended level of need and consequent referrals. Final checks to ensure that; the client graduation has been communicated in writing to all involved agencies, including GP, records are updated, including copy of testimonial; child health system, named nurse and health visiting service are notified of client transfer. 22