CYSCP
7 Point Briefing: Local Multi-Agency Review - Billy
Billy
Background
Billy’s family are a private family with no extended family support. Until the time of the incident, Billy was living with his parents. Billy had little contact with people outside of his immediate family and initially stopped attending school in 2020. He commenced a new school placement Autumn Term 2021 but stopped attending school within six months.
Billy has a diagnosis of autistic spectrum disorder and obsessive-compulsive disorder. Billy described himself as feeling down most of the time throughout the last couple of years. Billy has spoken about ‘loneliness’, wanting friends and feeling anxious if he does not complete rituals related to his obsessive-compulsive disorder such as washing his hands. Billy has previously taken medication to support the management of his mental health. The medications were stopped either by his mum, as she felt they were making her son worse, due to side effects, despite these being changed to manage his symptoms.
Billy's case was referred to the Case Review Subgroup of the Safeguarding Children Partnership by Children’s Social Care following a significant assault to a person known to him.
What areas of good practice was highlighted?
Multi-agency working: Throughout this review good multi-agency co-operation and liaison was identified. School, Children’s Social Care, Police and Children and Adolescents Mental Health Services worked together to support Billy and his family to address Billy’s behaviours and risks to himself and others. Following the significant assault, agencies worked together to address Billy’s needs and these were co-ordinated through daily multi agency meetings.
Agencies understanding of Billy’s specific needs: Professionals involved in the care of Billy worked hard to develop a therapeutic relationship with Billy. The Family Intervention Rapid Support Team (a specialist team within Children and Adolescents Mental Health Services) were central in providing support to parents and other agencies to understand Billy’s specific needs. School made specific provision to address his needs through an Educational Health Care Plan. Police noted on their systems Billy’s specific needs in order that officers could best engage with him and offer support.
Engagement with family: Professionals did work with Billy’s mother particularly. When Billy is said to have not wished to engage with the Family Intervention Rapid Support Team, after a change to the lead clinician, work was undertaken through Billy’s mum. Safety plans noted to have been discussed with the family.
Voice of Billy: It is evident that significant attempts were made by agencies to obtain Billy’s voice and lived experiences in order for practitioners working with Billy to be able to support him and his family.
Referral to Youth Justice service: It is noted as good practice that following the significant incidences, Billy was referred to the Youth Justice service. Work was undertaken with him to reduce his risk of serious harm to himself or others.
Key Learning Points
Learning Point 1: Escalating risks and responses
At times Billy’s behaviours were of significant concern and there was an escalation of risk to himself and others. Although safety plans were undertaken the review concluded that some of these incidences particularly in relation to specific threats to harm teachers and his parents should have instigated a multi-agency response. It is recommended that partner agencies seek assurance that practitioners are aware of when and how to request a strategy discussion when there are escalating concerns.
Learning Point 2: Parental adherence to Safety plans
The review concluded that professionals may not have fully understood or explored the reasons why safety plans were not fully effective. It is recommended that when it is evident that a safety plan is not being effective, professionals involved should fully explore with the family the reasons for this. This review should consider the families views on the plan, the difficulties of adhering to this plan and the support required in order to effectively manage it.
Learning Point 3: Professionals understanding of Billys voice and lived experience
It is not clear in this case as to whether sufficient consideration was given to Billys learning difficulties and Autism impacting on his ability to fully articulate his concerns regarding his parents and lived experience. Did all professionals give due consideration to the concerns Billy was expressing? It is recommended that when professionals seek to obtain the views and lived experiences of children or young people with learning difficulties, they need to consider the impact of such a learning need on the child’s ability to articulate their concerns. In such cases professionals may need to seek advice from specialist
learning disability practitioners in order that additional support methods of communication can be considered.
Learning Point 4: Engaging with Fathers
It is not clear from the records reviewed if agencies worked equally with both Billy’s parents. Much of the records relate to work professionals undertook with Billy’s mother. It is recommended that professionals should actively seek to work with both parents as a routine.
Learning Point 5: Strategy meeting attendance
The initial strategy meeting held after the incident did not include a Children and Adolescents Mental Health Services worker despite their significant involvement in the case. The lack of Children and Adolescents Mental Health Services involvement at the strategy contributed to confusion regarding who would complete the initial mental health assessment on Billy. Delays in the mental health assessment were further complicated by Billy requiring medical treatment out of area. The routine invitation of a Children and Adolescents Mental Health Services practitioner at all initial strategy meetings has been adopted by Children’s Social Care as a result of this case. It is recommended that Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV) provide guidance with appropriate teams responsible for undertaking mental health assessments when a young person is in Police custody, this should include what happens if that young person requires medical treatment or admission.
Learning Point 6: Operation Divan
Operation Divan is a Police-led partnership initiative to challenge and discourage the carrying of knives by young people in North Yorkshire. It involves a focused discussion with the young person and their parents, to share concerns and offer positive support. Although Operation Divan was not considered suitable in this case, it is recommended that awareness raising with regards to Operation Divan is undertaken within the Safeguarding Children Partnership.
Learning Point 7
Outside the scope of this review concerns were raised about the management and accommodation of Billy following the incident. These concerns included a delay in a mental health assessment been undertaken, difficulties securing suitable accommodation, and lack of access to prescribed medication. It is recommended that in order to understand these concerns thoroughly, the City of York Safeguarding Children Partnership will explore with the practitioners involved in the care and decision making with regards to Billy at this time, to understand the challenges faced and develop processes that will ensure that every child and/or young person receives the right care at the right time.