Walsall Healthcare NHS Trust School Nursing Service

MESSAGING WITH YOUNG PEOPLE GUIDANCE AND STANDARD OPERATING PROCEDURE Walsall Healthcare NHS Trust School Nursing Service Leicestershire Partnership NHS Trust / Use of messaging with young people: guidance and SOP: LPT School Nurses / February 2014 / Page 1

CONTENTS 1.0 INTRODUCTION... 4 2.0 RISK OF HARM... 5 2.1 COMPETENCE TO MANAGE RISK... 5 2.2 MANAGING OUT OF HOURS RISK... 5 2.3 RESPONDING TO MESSAGES THAT INDICATE RISK OF SIGNIFICANT HARM... 5 2.3.1 Assess the level of harm... 5 2.3.2 Flowchart: responding to messages that indicate risk of significant harm... 7 2.3.3 Recording... 8 2.3.4 Further Actions... 8 2.3.5 Support... 8 3.0 GENERAL GUIDANCE... 9 3.1 SETTING UP AND MANAGING A MESSAGE SERVICE... 9 3.1.1 Advertising a messaging service... 9 3.1.2 Answering messages... 10 3.1.3 Consent... 10 3.1.4 Professional conduct... 10 3.2 INFORMATION MANAGEMENT AND CONFIDENTIALITY... 11 3.2.1 Record keeping... 11 3.2.2 Identity... 11 3.2.3 Preserving confidentiality... 12 4.0 ChatHealth MESSAGING SYSTEM GUIDANCE... 13 4.1 GUIDANCE FOR TEAM MEMBERS... 13 4.1.1 Managing conversations in the team inbox... 13 4.1.2 Getting a team inbox summary from Service Information... 13 4.1.3 Adding notes to a conversation... 14 4.1.4 Assigning attributes to a conversation... 14 4.1.5 Assignments and assigning a conversation... 14 4.1.6 Closing a conversation... 15 Leicestershire Partnership NHS Trust / Use of messaging with young people: guidance and SOP: LPT School Nurses / February 2014 / Page 2

4.1.7 Transcribing a conversation... 15 4.1.8 Retention and destruction of conversations and information... 16 4.1.9 Locking a conversation... 16 4.1.10 Editing your profile... 16 4.1.11 Notifications... 16 4.1.12 Managing your availability... 17 4.2 GUIDANCE FOR MANAGER / ADMINISTRATORS... 18 4.2.1 In Hours and Out of Hours Messages... 18 4.2.2 Opening Exceptions... 19 4.2.3 Message Templates... 20 4.2.4 Conversation Monitoring... 20 4.2.5 Conversation Policy... 20 4.2.6 Assignable Attributes... 21 5.0 ASSOCIATED READING... 22 6.0 APPENDIX 1: Assessment framework: competence to manage messaging risk... 23 Leicestershire Partnership NHS Trust / Use of messaging with young people: guidance and SOP: LPT School Nurses / February 2014 / Page 3

1.0 INTRODUCTION Communications culture is changing and we recognise the prolific growth in use of text messaging and instant messaging as an alternative to voice calls and other forms of communication. We are keen for our services to be accessible and for service users to be able to contact us in the most convenient and timely way. We recognise that service users and staff value messaging as a communications medium and that robust guidance is needed to ensure all communication happens safely and securely. There are a number of risks that we associate with use of messaging with young people. These risks occur when a member of staff shares their mobile phone number with a young person. This guidance explains how to approach the management of those risks. The guidance is in three parts: Guidance about managing imminent risk of significant harm General guidance for staff who use messaging with young people Specific guidance for staff who use ChatHealth messaging Leicestershire Partnership NHS Trust / Use of messaging with young people: guidance and SOP: LPT School Nurses / February 2014 / Page 4

2.0 RISK OF HARM 2.1 COMPETENCE TO MANAGE RISK Staff who share their mobile phone number with a young person should have a certain level of competence to manage the associated risks. The expected competence level in school nursing is: on the NMC register as a registered nurse will be competency assessed 1 by their line manager; have attended the Trust s required mandatory safeguarding training; The only mobile phone number that should be given to young people by a school nurse is the ChatHealth Walsall messaging service s number. Staff should not give young people their work mobile number or personal mobile number. 2.2 MANAGING OUT OF HOURS RISK If you give a young person your mobile phone number it is important that they understand when you are and are not available to provide advice and support. Explain: Your working hours. Times when you are unlikely to respond to calls and texts. The length of time it usually takes for you to respond to a voicemail or messages which is normally within 24 hours of a normal working week. Alternative sources of help a young person can contact in your absence. Printed materials which provide your mobile phone number for use by young people (such as posters and leaflets which promote the service) should also explain the points covered above. 2.3 RESPONDING TO MESSAGES THAT INDICATE RISK OF SIGNIFICANT HARM This section of guidance explains what to do if you receive a text message or instant message indicating that there is a risk of significant harm. 2.3.1 Assess the level of harm 1 See APPENDIX 1: Assessment framework: competence to manage messaging risk Leicestershire Partnership NHS Trust / Use of messaging with young people: guidance and SOP: LPT School Nurses / February 2014 / Page 5

Based on the details in the message, assess whether the level of harm is significant. A disclosure of significant harm can include the threat of harm to self or others, the threat of harm from others, or a disclosure from one person about another. Leicestershire Partnership NHS Trust / Use of messaging with young people: guidance and SOP: LPT School Nurses / February 2014 / Page 6

2.3.2 Flowchart: responding to messages that indicate risk of significant harm Imminent risk is happening now. Non-imminent risk is characterised as planned intent. Overriding consent and breaching confidentiality: Unless seeking consent from a Young Person about sharing information with third parties would put them at greater risk then they should be informed. If you are considering overriding a Young Person s consent to share information with third parties then this is something that should be considered carefully and you may need to seek advice from your line manager or other colleagues. Walsall MASH 0300 555 2866 (Monday-Friday 09:00 16:30). When you do breach confidentiality without consent you should explain your actions to the young person as soon as you believe it is safe to do so. Ensure that you explain the steps you have taken and the rationale behind your decision. Contact with a Young Person at Risk of Significant Harm: Consider carefully how and when you make contact with a Young Person. Respond to a Young Person using the same method of communication they used to communicate with you. For example, if they message you, then use messaging back. If you wish to contact them via voice calling then message them for consent to do so. Messaging App Users: If a Young Person is a messaging app user a System Administrator may be able to gain further information about the Young Person from the system even if they are a hidden user. Timeframes: Unless the risk of significant harm is deemed imminent, then timeframes can be suggested to a Young Person to clearly explain when you hope for them to make contact with you and how this would affect next steps. Follow up with Social Care: If you have additional information to add to a referral made to social care by the police as a result of a referral you made to them, then please contact the Imminent DO NOT CONTACT THE YOUNG PERSON IF YOU THINK THIS WILL PUT THEM AT GREATER RISK. Report to Emergency Services by calling 999 with or without Young Person s consent. Please state that you would like a safe and well check to be carried out The Police are able to take a referral from you if all you have is a Young Persons telephone number. If appropriate continue communication with Young Person until Emergency Services take over care. Walsall Multi Agency Hub In office hours 0300 555 2866 Out of office hours: 0300 555 2866 police for a crime number or the young person s name. Walsall Healthcare NHS Trust / Use of messaging with young people: guidance and SOP: WHT School Nurses / January 2016 / Page 7 A message is received indicating risk of significant harm. Is the risk imminent or non-imminent? Non-imminent DO NOT CONTACT THE YOUNG PERSON IF YOU THINK THIS WILL PUT THEM AT GREATER RISK Can you contact the Young Person? No Yes Discuss consent with the Young Person in relation to notifying the emergency services and/or third parties and/or offer advice and support that could help reduce their level of risk. Consider reporting to the Social Care/Police with or without the Young Person s consent. The Police are able to take a referral from you if all you have is a telephone number of a Young Person. Police Non-Emergency Number 101 Please state that you would like a safe and well check to be carried out. Unsure DO NOT CONTACT THE YOUNG PERSON IF YOU THINK THIS WILL PUT THEM AT GREATER RISK Can you contact the Young Person? No Yes Contact the Young Person to establish a more detailed understanding of the situation. Re-assess Imminence.

2.3.3 Recording Remember to take the following actions to record how you have dealt with messages that indicate high risk of significant harm: 2.3.3.1 Manager Notification Notify your line manager or the on-call manager 2.3.3.2 Incident reporting Where appropriate complete a safeguard Trust incident report. If you do not know the identity of the young person with whom you have been communicating, select non-person incident in order to complete the online incident report without including service user details. 2.3.3.3 Electronic Patient Record If you know the identity of the young person with whom you have been communicating, record the incident in Careplus client notes.upload any related documentation e.g. letters to Careplus adhoc documents. 2.3.4 Further Actions Once the immediate risk is being managed and/or has been reduced, contact other agencies that are involved in the young person s care to share information where appropriate. Consider implementing any appropriate care pathways or refer to other policies and guidance. This will help give the young person access to appropriate care and help to continue reducing risk. 2.3.5 Support You can seek support in responding to messages which indicate risk of significant harm from your colleagues and managers or by contacting the named nurses for safeguarding on 01922 443917, Monday to Friday, 9:00am 5.00pm. 2.3.5.1 Staff wellbeing and supervision After any incident, be mindful of your own wellbeing and any impact the experience might have had on you. If necessary, access clinical or safeguarding supervision to discuss the case. Walsall Healthcare NHS Trust / Use of messaging with young people: guidance and SOP: WHT School Nurses / January 2016 / Page 8

3.0 GENERAL GUIDANCE 3.1 SETTING UP AND MANAGING A MESSAGE SERVICE 3.1.1 Advertising a messaging service 3.1.1.1 General considerations General considerations for setting up a message based service are outlined in the document, Use of text messaging services: Guidance for nurses working with children and young people, RCN 2006. 3.1.1.2 Advertising a messaging service Pertinent information to convey when advertising a service, including expectations around describing response times and confidentiality arrangements are outlined in the document, Use of text messaging services: Guidance for nurses working with children and young people, RCN 2006. 3.1.1.3 Non-delivery of messages due to technical error Message based conversations involve the risk of messages failing to arrive due to technical error. Your advertising should describe alternative sources of help that a young person can use if they don t receive a timely response to a sent message. 3.1.1.4 Accommodate school policy Engage with school staff and governors about their expectations of the service and their policy around mobile phone use in school. Encourage young people to abide to school rules around mobile phone use. 3.1.1.5 Cost Any costs which would be incurred to a young person as a result of messaging a school nurse should be explained. 3.1.1.6 Discretion Engage with young people to understand their expectations about the level of discretion required when advertising the service, e.g. they may prefer to pick-up a pocket sized calling card than be seen, by peers, reading a poster about the service. 3.1.1.7 Bullying Bullying is not tolerated and this should be explained in your marketing materials. Walsall Healthcare NHS Trust / Use of messaging with young people: guidance and SOP: WHT School Nurses / January 2016 / Page 9

3.1.2 Answering messages 3.1.2.1 Response time For school nursing in this Trust, the maximum response time for any message received in is one working day, unless you make specific arrangements otherwise with a young person. 3.1.2.2 Checking for and assigning new conversations The duty each day will be responsible for reading and responding to all incoming messages. If the young person s identity has been verified then the duty nurse will check Lorenzo to ascertain whether they are known and open to another school nurse. If this is the case the conversation will be transferred to the nurse who holds the young persons case. If the incoming message indicates a risk of significant harm that requires immediate action then the process in 2.3.2 will be followed prior to transferring the conversation. 3.1.2.3 Unexpected colleague absence If the staff member assigned to duty on any given day is absent from work then the duty clinical team leaders will ensure that cover is provided in order that the messaging service continues as business as usual If a young person contacts the service and they are already open as an active case to another nurse who is absent from work (due to e.g. sickness or leave) then the duty clinical team leader should be consulted for advice about who is best place to respond to that young person. 3.1.3 Consent 3.1.3.1 Consent to respond to a message by message Consent to respond to a message by message is assumed if a young person has initiated contacted by message. 3.1.3.2 Consent to initiate a message conversation Consent to initiate message conversations must be sought when acquiring a young person s details. 3.1.4 Professional conduct 3.1.4.1 Professional distance Be aware that a young person s perception of a relationship may be different when it is being conducted by message conversation, as opposed to voice call or face to face contact. They may perceive the social rules of messaging to be different to Walsall Healthcare NHS Trust / Use of messaging with young people: guidance and SOP: WHT School Nurses / January 2016 / Page 10

other communications methods. Be aware of the increased potential for inappropriate relationships developing. 3.1.4.2 Professional language Use similar language and tone of voice that you would use for other forms of communication. Do not unnecessarily use text-speak. 3.2 INFORMATION MANAGEMENT AND CONFIDENTIALITY 3.2.1 Record keeping 3.2.1.1 Contemporaneous record keeping Record message conversations to the patient record in accordance with the expectations of the record keeping policy. Transcriptions of the conversation should be saved a PDF document and uploaded onto Careplus adhoc documents. If the child health paper record is available then the PDF should be printed out and filed in the record in addition to being uploaded to Careplus 3.2.1.2 Recording anonymous conversations A record should be kept of message conversations with service users who do not provide their name. A transcript of the closed conversation should be saved to the anonymous conversations shared folder which is titled with the ChatHealth Messaging. 3.2.1.3 Disclosure Explain to service users that your message conversations with them will be added to their health record where it may be seen by other healthcare professionals. 3.2.1.4 Safeguarding information Message conversations which contain information sensitive to safeguarding should be stored appropriately in accordance with the expectations of the record keeping policy. 3.2.2 Identity 3.2.2.1 Verifying identity Seek to verify identity regularly. It is not necessarily appropriate to identify a service user based on the phone number associated with their incoming SMS text message, particularly where time has passed between exchanges. Feedback suggests young people are more likely to change phone numbers or swap SIM cards and devices with a greater frequency than other service users. Your approach may be different if you know the service user to be using a form of messaging which requires them to register and establish a user profile, such as instant messaging from within the ChatHealth mobile messaging app. Walsall Healthcare NHS Trust / Use of messaging with young people: guidance and SOP: WHT School Nurses / January 2016 / Page 11

3.2.2.2 Habitually questioning identity When a service user provides their name in a message, this should be habitually treated with a degree of uncertainty. Using your professional judgement and taking into account the context of the conversation, consider whether the given name is likely to be a true statement of fact. When a service user provides a name in a message, it is at the practitioner s discretion whether or not the message should be recorded to that patient s record, e.g. they may choose not to record the conversation to that patient s record if they have reason to suspect the sender of the message may have provided a false identity. When assessing the validity of a name provided in a message, you should take into account the form of messaging that is being used. Instant messaging from within the ChatHealth mobile messaging app requires the user to establish and identity profile and provides a greater degree of handset security than SMS messaging. 3.2.2.3 Allowing anonymity Having a message conversation with a service user who does not want to give their name (i.e. casual contact ) is permissible if the nurse feels that identity is not essential to the nature of their enquiry. If you feel a conversation is unsuitable to continue without having further information about their identity, inform the service user clearly and help them to understand the options they have in order to access further help. 3.2.3 Preserving confidentiality 3.2.3.1 Security and encryption of SMS text messages SMS text messages are not encrypted, access to handsets is not secure and service users may be using cloud storage to backup information on their mobile device. The service user you are messaging may not be the only person who can access the mobile device which is being used to send and receive messages. The service user you are messaging may not be the only person who can view the information in messages. It is not appropriate to include sensitive and/or highly confidential information in a text message. Your approach may be slightly different if you know the service user to be using a form of messaging which requires them input a password to access their messages, such as instant messaging from within the ChatHealth mobile messaging app. 3.2.3.2 Shared access If messages are handled by staff on a team basis, as opposed to an individual practitioner basis, service users should be made aware that messages conversations may be seen by a number of team members. Walsall Healthcare NHS Trust / Use of messaging with young people: guidance and SOP: WHT School Nurses / January 2016 / Page 12

4.0 ChatHealth MESSAGING SYSTEM GUIDANCE 4.1 GUIDANCE FOR TEAM MEMBERS 4.1.1 Managing conversations in the team inbox 4.1.1.1 Checking for and assigning new conversations The team protocol/rota for checking for and assigning new conversations should specifically explain who has responsibility for monitoring Unassigned Conversations at any given time. It should specifically identify who is responsible for receiving system notifications about conversations in Unassigned Conversations. 4.1.1.2 Unexpected colleague absence The team protocol for dealing with unexpected colleague absence should specifically explain how this relates to checking for and assigning un-read messages in All Conversations. 4.1.1.3 Using the inbox tabs to show only un-read conversations Sort by un-read to see conversations with un-read messages in your caseload or in the team caseload. Excessive numbers of un-read messages may indicate that expected response times are not being met. 4.1.1.4 Using the inbox tabs to show only closed conversations Sort by closed conversations to see closed conversations in your caseload or in the team caseload. Excessive numbers of closed conversations may indicate that closed conversations are not being completely transcribed. 4.1.2 Getting a team inbox summary from Service Information 4.1.2.1 Protocol for checking service performance Agree a team protocol for monitoring levels of message activity in order to identify whether problems could be arising with conversation management. Your protocol should explain specifically who is responsible at any given time for monitoring numbers of open conversations, closed conversations, un-transcribed conversations, un-read messages and un-responded messages. The Service Information feature is intended to support this. Walsall Healthcare NHS Trust / Use of messaging with young people: guidance and SOP: WHT School Nurses / January 2016 / Page 13

4.1.3 Adding notes to a conversation 4.1.3.1 Adding a service user s name in the identity tab Add the service user s name to the identity tab if it has been provided during the SMS conversation. This helps distinguish them from service users who wish to remain anonymous. This can be a useful aide to record keeping as anonymous conversations are treated differently in the record keeping process. Service user names associated with instant messaging conversation sent from the ChatHealth messaging app will automatically be included in the identity tab, if the user has not chosen to hide their identity. 4.1.3.2 Information that is appropriate to be added as conversation notes Do not add information as conversation notes which would be better placed in the patient record. The ChatHealth system is not a record keeping system. 4.1.3.3 Deleting conversation notes made by colleagues Ask for consent from a colleague before deleting conversation notes they have made. Information deleted from conversation notes will not be recorded on the full transcript. 4.1.4 Assigning attributes to a conversation 4.1.4.1 Recording a NHS number If you have cross checked a service user s identity against the patient record and wish to record their NHS number against a conversation with them, use the assignable attributes feature. 4.1.4.2 Information that is safe to be added as assignable attributes Do not add information as assignable attributes which would be better placed in the patient record. The ChatHealth system is not a record keeping system. 4.1.5 Assignments and assigning a conversation 4.1.5.1 Workload management Agree a team protocol for communicating regularly about conversation assigning to help ensure that tasks and workloads are shared appropriately. 4.1.5.2 Taking a conversation from a colleague s workload without consent Agree a team protocol defining when it is appropriate to assign conversations from a colleagues caseload to your own without their consent, e.g. if they are unexpectedly absent. Walsall Healthcare NHS Trust / Use of messaging with young people: guidance and SOP: WHT School Nurses / January 2016 / Page 14

4.1.5.3 Assignment notes Always explain why you have assigned a conversation to a colleague. assignment notes feature is intended to support this. The 4.1.6 Closing a conversation 4.1.6.1 Closing conversations Conversations should be closed when an episode of care is thought to be ended, in order to minimise the residual build-up of open conversations and to ensure that notes attached to a conversation are current and accurate. 4.1.6.2 You will receive a prompt to close if inactive School nurses will be prompted to close a conversation if it has been inactive a period is two weeks. 4.1.7 Transcribing a conversation 4.1.7.1 Transcribe all closed conversations Closed conversations must be transcribed by downloading the full transcript PDF or transcribed in full using the partial transcribe feature (and all transcribed elements marked as transcribed) in order that the system will automatically delete a conversation. Conversations that have not been closed but require recording in the child health record should be cut and pasted and uploaded as a client note on careplus and where available printed out and added to the child health paper record. 4.1.7.2 Uploaded to adhoc documents on Careplus Transcripts of conversations should be uploaded, as a PDF onto adhoc documents on Careplus 4.1.7.3 Checking cut and paste information When cutting and pasting from the ChatHealth system to the patient record, check that the text you are pasting relates to the conversation you are intending to record keep and that it is not older text previously captured to the cut and paste clipboard. 4.1.7.4 Mark transcribed Use the mark transcribed feature in partial transcribe to avoid accidentally duplicating record keeping. 4.1.7.5 Saving full transcripts of anonymous conversations Full transcripts of conversations with anonymous service users should be stored in the ChatHealth folder on the shared drive created specifically for this purpose. Access should be limited to staff within the service area. Records should be organised in sub folders named as anonymous chats and filed by month/year. Walsall Healthcare NHS Trust / Use of messaging with young people: guidance and SOP: WHT School Nurses / January 2016 / Page 15

4.1.7.6 Auditable Information Every aspect of your conversations including messages, notes, history of assignments and assigned attributes will be recorded and auditable. 4.1.8 Retention and destruction of conversations and information 4.1.8.1 Deleted closed and transcribed conversations Records should not be stored in the ChatHealth system. transcribed conversations will be automatically deleted. All closed and 4.1.8.2 Retention of closed transcribed conversations Closed and transcribed conversations will be retained for a period 4 days by the ChatHealth system before automatic deletion. 4.1.8.3 Retention of full transcripts of anonymous conversations Transcripts of anonymous conversations saved in the shared folder should be retained in line with the record keeping policy. In line with Trust policy for retention period is 15 years (until the youngest service users would be 26 years old). 4.1.9 Locking a conversation 4.1.9.1 Loss/corruption of a full transcript In the event of a lost or corrupt full transcript, lock the relevant conversation in order that a further transcript can be safely obtained before the conversation is deleted. 4.1.9.2 Protection against re-assignment Lock a conversation if there is a reason why you would not what it to be reassigned by a colleague. 4.1.9.3 Lock notes Use lock notes to explain your reasons for locking a conversation. 4.1.9.4 Long term locking of conversations Conversations must not be locked indefinitely 4.1.10 Editing your profile 4.1.10.1 Adding our name Add your name and job title to your user profile in order to prevent your email address being made available to service users. 4.1.11 Notifications Walsall Healthcare NHS Trust / Use of messaging with young people: guidance and SOP: WHT School Nurses / January 2016 / Page 16

4.1.11.1 Delivery method Notifications should be delivered to you via email. 4.1.11.2 Team member notifications Notifications will be sent to you if: You receive a new message to a conversation assigned to you. A message in a conversation assigned to you remains un-read for 24 hours. This notification will be sent every 24 hours until the message is read. A conversation is assigned to you by a colleague A conversation assigned to you has been inactive for one week and you should consider closing it. This notification will be sent every 24 hours until the message is closed. 4.1.11.3 Team notifications All members of the team will receive notifications relating to Unassigned Conversations. Notifications will be sent if: A new message is received to Unassigned Conversations. A message in Unassigned Conversations remains un-read for 24 hours. This notification will be sent every 24 hours until the message is read. A conversation is assigned to Unassigned Conversations by a colleague. A conversation in Unassigned Conversations has been inactive for one week and you should consider closing it. This notification will be sent every 24 hours until the message is closed. 4.1.11.4 Notification frequency The notification frequency for school nurses is immediately, the frequency setting never for should not be used. 4.1.12 Managing your availability 4.1.12.1 Availability Set your availability accordingly if you are unavailable to respond to messages for a period of time which is longer than expected response times. 4.1.12.2 Reassign and respond The availability action setting for school nurses is reassign conversation and reply with a message. 4.1.12.3 Personal availability outside of normal office hours Your personal availability does not need to be set to unavailable outside of your team s normal working hours when the team s automated out of hours message will be effective. Walsall Healthcare NHS Trust / Use of messaging with young people: guidance and SOP: WHT School Nurses / January 2016 / Page 17

4.2 GUIDANCE FOR MANAGER / ADMINISTRATORS 4.2.1 In Hours and Out of Hours Messages 4.2.1.1 In hours message - mainstream schools The in hours bounce-back message for school nursing teams is the following standard agreed message. The message should read: Thanks for texting the School Nurse. Your nurse is currently on duty and your message will be seen soon. We respond most quickly to messages that need urgent attention and we aim to respond to all messages within 24 hours, Monday to Friday. If you need to contact us Monday to Friday 8.30 until 4.30pm call 01922 423349. If you need help in the meantime contact your doctor, visit a NHS walk-in centre or call NHS 111. If it is an emergency, dial 999 or visit A&E. For our safety and yours we store your messages on electronic records. Records can be seen by other healthcare professionals but we all follow strict confidentiality rules and your School Nurse will explain more about this. 4.2.1.2 In hours message - special schools The in hours message for special schools is the following agreed standard. Thank you for your message. The School Nurse will text you back soon but remember we only work Monday to Friday from 8.30am until 4.30pm. If you need help urgently then please speak to a teacher, parent/carer or your doctor. If it is an emergency then please go to the hospital or ring 999. 4.2.1.3 Out of hours message - mainstream schools The out-of- hours bounce-back message for school nursing teams is the following standard agreed message. Alternative daytime contact information can be changed to suit local arrangements. The message should read: Thanks for texting the School Nurse. Your nurse is not here at the moment. Our working hours are Monday to Friday (from 8:30am to 4:30pm). Your message will be seen during those hours after which we respond most quickly to messages that need urgent attention and we aim to respond to all messages within 24 hours, Monday to Friday. If you need urgent help in the meantime, contact your doctor, visit a NHS walk-in centre or call NHS 111. If it is an emergency, dial 999 or visit A&E. For our safety and yours we store your messages on electronic records. Records can be seen by other healthcare professionals but we all follow strict confidentiality rules and your School Nurse will explain more about this. Walsall Healthcare NHS Trust / Use of messaging with young people: guidance and SOP: WHT School Nurses / January 2016 / Page 18

4.2.1.4 Out of hours message special schools The out of hours message for special schools is the following agreed standard. Thank you for your message. The School Nurse is not here. The School Nurses work Monday to Friday from 8.30am until 4.30pm. If you need help urgently then please speak to your parent/carer or your doctor. If it is an emergency then please go to the hospital or ring 999. 4.2.1.5 Critical information in an unavailable message mainstream schools Standard information from your team s out of hours bounce-back, describing alternative sources of help, should be included in personal unavailable bounceback messages by adding it as an assignee unavailable footer. The footer should read: We respond most quickly to messages that need urgent attention and we aim to respond to all messages within 24 hours, Monday to Friday. If you need to contact us Monday to Friday 8.30am until 4.30pm call 01922 423349. If you need help in the meantime contact a member of school staff or your doctor, visit a NHS walk-in centre or call NHS 111. If it is an emergency, dial 999 or visit A&E. For our safety and yours we store your messages on electronic records. Records can be seen by other healthcare professionals but we all follow strict confidentiality rules and your School Nurse will explain more about this. 4.2.1.6 Critical information in an unavailable message special schools Standard information from your team s out of hours bounce-back, describing alternative sources of help, should be included in personal unavailable bounceback messages by adding it as an assignee unavailable footer. The footer should read: The School Nurses work Monday to Friday from 8.30am until 4.30pm. If you need help urgently then please speak to your parent/carer or your doctor. If it is an emergency then please go to the hospital or ring 999. 4.2.2 Opening Exceptions 4.2.2.1 Set an exception for extraordinary openings and closures An exception must be created for all extraordinary closures or openings of the service beyond the normal opening hours defined in general settings. Bank holidays are automatically understood by the system to constitute an exceptional closure. School holidays and other school closures are not automatically recognised by the system and must be manually added. Walsall Healthcare NHS Trust / Use of messaging with young people: guidance and SOP: WHT School Nurses / January 2016 / Page 19

4.2.3 Message Templates 4.2.3.1 Disclosure Statement The disclosure statement message template is a standard agreed template and should read: Before we get into any further details I thought it would be a good time to explain to about confidentiality. Unless you give permission, a School Nurse will not pass on anything you say to anyone else, like parents, teachers, or other students except in extreme circumstances like if the health, safety or welfare of you or someone else is at significant risk. If we did need to tell someone about something you had told us, we would always try to speak with you first. For our safety and yours we hold information that you tell us on electronic records that can be seen by other healthcare professionals who all follow the same confidentiality rules - this can include your doctor. Records are kept for future use. 4.2.4 Conversation Monitoring 4.2.4.1 On/Off Conversation monitoring should be set to on for school nursing service. 4.2.4.2 Settings Un-read conversation policy should be set to Prompt assigned user after specified time for school nursing in this Trust. Specified time should be 24 hours ( prompt assigned user after hours ). Prompt the assigned user to close the conversation after (hours) and allow the assigned user to defer close prompt messages for (hours) should both be 168 hours. 4.2.4.3 Local changes Conversation monitoring settings should be consistent across school nursing and not amended locally. 4.2.5 Conversation Policy 4.2.5.1 Settings for automatic deletion The conversation policy for school nursing should be Conversations will be automatically deleted on or after 96 hours of being closed AND transcribed and that Locked conversations cannot be deleted. Walsall Healthcare NHS Trust / Use of messaging with young people: guidance and SOP: WHT School Nurses / January 2016 / Page 20

4.2.5.2 Local changes Conversation policy settings should be consistent across the service and not amended locally. 4.2.6 Assignable Attributes 4.2.6.1 Information that is appropriate to be added as assignable attributes Assignable attributes should not be created to record information which would be better recorded in the patient record. Walsall Healthcare NHS Trust / Use of messaging with young people: guidance and SOP: WHT School Nurses / January 2016 / Page 21

5.0 ASSOCIATED READING Use of text messaging services Guidance for nurses working with children and young people RCN 2006 ChatHealth Messaging System: User Guide LPT 2013 Walsall Healthcare NHS Trust / Use of messaging with young people: guidance and SOP: WHT School Nurses / January 2016 / Page 22

6.0 APPENDIX 1: Assessment framework: competence to manage messaging risk Date: Name of Practitioner Role of Practitioner Locality Assessor Trainee initials Trainer initials Have you: Attended training for the ChatHealth messaging system? Read Use of messaging with young people: guidance for school nurses? Read ChatHealth messaging system: user guide (if you are being assessed for access to the ChatHealth system). Have you attended safeguarding training in accordance with WHT policies and guidelines? Can you accurately assess the level of harm and describe an appropriate response in these scenarios? You received a text stating I m going to kill myself? You received a text stating I m worried about going home tonight Describe an appropriate response to Imminent risk of significant harm Non-imminent risk of significant harm Describe how you would Notify your line manager or on call manager Complete an online incident form Can you demonstrate transcribing a message onto careplus from the ChatHealth app. Walsall Healthcare NHS Trust / Use of messaging with young people: guidance and SOP: WHT School Nurses / January 2016 / Page 23