Abstract
Introduction Children and young people's (CYP) missed healthcare appointments may be an indicator of neglect. Healthcare providers are encouraged to consider the child as 'was not brought' (WNB) and to assess the need for early multidisciplinary information sharing to safeguard and promote welfare.
Method A new WNB-CYP pathway (flowchart, template patient notes, template letters) for missed appointments was developed. After piloting at one community dental service (CDS) clinic for eight months, a service evaluation was conducted via retrospective review of records and semi-structured interviews with staff.
Results Of 1,238 appointments for CYP, 134 were missed (WNB rate 10.8%) by 91 children. The WNB-CYP pathway was followed consistently 113 times (84.3%) and, when used, three quarters of WNBs were rebooked after communication with parents within three weeks. Written information was shared in 25 cases with general medical practitioners and other health and social care professionals. Staff reported high levels of engagement and pathway acceptability; it relieved uncertainty and supported decision-making, teamwork and inter-professional communication without increasing daily workload. Following minor amendments, the pathway was rolled out service-wide with similar success.
Conclusion A new WNB-CYP pathway facilitated early and consistent sharing of safeguarding information with other professionals about missed CDS dental appointments and improved dental team confidence.
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References
Office of the High Commissioner for Human Rights. United Nations Convention on the Rights of the Child. 1989. Available at https://downloads.unicef.org.uk/wp-content/uploads/2010/05/UNCRC_united_nations_convention_on_the_rights_of_the_child.pdf (accessed July 2019).
Harris J C, Balmer R C, Sidebotham P D. British Society of Paediatric Dentistry: a policy document on dental neglect in children. Int J Paediatr Dent 2018; 28: e14-e21 (first published 14 May 2009).
National Institute for Health and Care Excellence. Child maltreatment: when to suspect maltreatment in under 18s. 2009. Available at https://www.nice.org.uk/guidance/cg89 (accessed July 2019).
Office of the Chief Dental Officer England. Commissioning Standard for Dental Specialties - Paediatric Dentistry. London: NHS England, 2018. Available at https://www.england.nhs.uk/wp-content/uploads/2018/04/commissioning-standard-for-dental-specialties-paediatric-dentristry.pdf (accessed July 2019).
Woodman J, Brandon M, Bailey S, Belderson P, Sidebotham P, Gilbert R. Healthcare use by children fatally or seriously harmed by child maltreatment: analysis of a national case series 2005-2007. Arch Dis Child 2011; 96: 270-275.
Powell C, Appleton J V. Children and young people's missed health care appointments: reconceptualising 'Did Not Attend' to 'Was Not Brought' - a review of the evidence for practice. J Res Nurs 2012; 17: 181-192.
Roe M F E, Appleton J V, Powell C. Why was this child not brought? Arch Dis Child 2015; 100: 511-512.
Harris J C, Elcock C, Sidebotham P D, Welbury R R. Safeguarding children in dentistry: 1. Child protection training, experience and practice of dental professionals with an interest in paediatric dentistry. Br Dent J 2009; 206: 409-414.
Harris J, Sidebotham P, Welbury R. Child protection and the dental team: an introduction to safeguarding children in dental practice. Sheffield: COPDEND, 2006. Updated 2013. Available at https://bda.org/childprotection (accessed July 2019).
Harris J, C M, Welbury R, Cairns A M. The Scottish dental practitioner's role in managing child abuse and neglect. Br Dent J 2013; 214: E24.
Harris J C, Firth L M, Chadwick B L. Clinical audit of children's missed dental appointments in a city-wide salaried community dental service in relation to guidance on when to suspect child maltreatment. Child Abuse Rev 2017; 26: 172-183.
Sidebotham P, Brandon M, Bailey S et al. Pathways to harm, pathways to protection: a triennial analysis of serious case reviews 2011 to 2014. London: Department for Education, 2016, pp143-145, p195.
Royal College of Paediatrics and Child Health. Safeguarding Children and Young People: Roles and competences for healthcare staff. Available at https://www.rcpch.ac.uk/resources/safeguarding-children-young-people-roles-competencies-healthcare-staff (accessed July 2019).
Appleton J, Powell C, Coombes L. Children's missed healthcare appointments: professional and organizational responses. Arch Dis Child 2016; 101: 814-818.
Simons D, Pearson N, Dittu A. Why are vulnerable children not brought to their dental appointments? Br Dent J 2015; 219: 61-65.
Roe M. WNB versus DNA: why children cannot "not attend." BMJ 2010; 341: 1052.
Arai L, Stephenson T, Roberts H. The unseen child and safeguarding: 'Did not attend' guidelines in the NHS. Arch Dis Child 2015; 100: 517-520.
Harris J C, Elcock C, Sidebotham P D, Welbury R R. Safeguarding children in dentistry: 2. Do paediatric dentists neglect child dental neglect? Br Dent J 2009; 206: 465-470.
Kvist T, Cocozza M, Annerbäck E M, Dahllöf G. Child maltreatment - prevalence and characteristics of mandatory reports from dental professionals to the social services. Int J Paediatr Dent 2017; 27: 3-10.
Department of Health and Social Care. National service framework: children, young people and maternity services. 2004. Available at https://www.gov.uk/government/publications/national-service-framework-children-young-people-and-maternity-services (accessed July 2019).
French L R, Turner K M, Morley H, Goldsworthy L, Sharp D J, Hamilton-Shield J. Characteristics of children who do not attend their hospital appointments, and GPs' response: a mixed methods study in primary and secondary care. Br J Gen Pract 2017; 67: e483-e489.
Department for Education. Working together to safeguard children. 2015. Available at https://www.gov.uk/government/publications/working-together-to-safeguard-children--2 (accessed July 2019).
Rodd H D, Clark E L, Stern M R, Baker S R. Failed attendances at hospital dental clinics among young patients with cleft lip and palate. Cleft Palate Craniofac J 2007; 44: 92-94.
Acknowledgements and Contributor statement
Acknowledgements
JK completed the evaluation while a Leadership Fellow in Paediatric Dentistry (Safeguarding Children) funded by Health Education England working across Yorkshire and the Humber.
The authors would like to thank: Yorkshire and the Humber Regional Clinical Network of Consultants and Specialists in Paediatric Dentistry for sharing missed appointment policies and procedures at the outset, local Safeguarding Children Designated and Named Professionals for comments and support, and the Sheffield Community & Special Care Dentistry team, with special thanks to Lucy Middleton, Clair Jenkinson, Sara Thomas and our anonymous interviewees.
Contributor statement
JCH conceived, developed and implemented the initial pathway. JK and JCH together designed the evaluation, analysed and interpreted the data, formulated the action plan and drafted and critically revised the manuscript. JK conducted the data collection including interviews, further data analysis and implemented the action plan.
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Kirby, J., Harris, J. Development and evaluation of a 'was not brought' pathway: a team approach to managing children's missed dental appointments. Br Dent J 227, 291–297 (2019). https://doi.org/10.1038/s41415-019-0621-z
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DOI: https://doi.org/10.1038/s41415-019-0621-z
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