Competency framework: Level 4

Job roles – professionals who deliver a senior leadership role within providers for safeguarding children and young people or children and young people in care. An understanding of ‘typical’ health, development, mental health, and behaviour, and how this is impacted in safeguarding children and young people and children and young people in care situations is needed. Although some roles have different titles across the four nations of the UK, the expectation of competence and expertise is the same, for example:

• Level 4 senior/named doctors and nurses

• Level 4 senior/named midwives (in organisations delivering maternity services)

• Specialist child psychologists  and specialist child psychiatrists (in mental health trusts/providers)

• Level 4 senior/named health professionals in ambulance organisations

• Specialist nurses (in residential homes, secure children’s homes)
• Named GPs (supporting a health system)

UK nation-specific job role titles

England and Northern Ireland: level 4 senior/named doctors, level 4 senior/named nurses, level 4 senior/named midwives, medical adviser to adoption agency

Scotland: lead nurse for child protection, lead paediatrician for child protection

Wales: level 4 senior/named doctors, level 4 senior/named nurses, level 4 senior/named midwife or lead midwife for safeguarding, heads of safeguarding, level 4 senior/named doctor for children and young people in care  and adoption, medical advisers for adoption

Legislation

NB: UK and home nation specific legislation content will be completed after the SME review

Overview of level 4 core competencies

Competency at this level is about individuals being able to:

• use knowledge and skills in safeguarding children and young people and what it means to be a children and young people in care, or care leaver to support and advise other health professionals; to offer expertise and resolve escalations for individual situations
• know their role and responsibility to demonstrate leadership and work together with other professionals to ensure the local system meets the needs of vulnerable children and young people
• take a role in trust/provider assurance, governance and training relating to safeguarding children and children and young people in care
• offer a supervisory and supportive role to staff members, recognising the emotional impact of this work; which may include debrief meetings, clinical and restorative supervision
• promote to frontline staff, senior staff, and executives, the vital importance of up-to-date competency, training, and processes to keep children safe and reduce health inequalities for children and young people in care.

Professionals (role titles may be different across four nations) who undertake statutory IHAs and other relevant health assessments for children and young people in care  need a higher level of knowledge and understanding to deliver a thorough, trauma-informed assessment taking into account the impact of prenatal factors, family health, environment and abuse/trauma on development, physical and emotional health. Level 4 senior/named professionals for children and young people in care  need appropriate expertise to advise and support individual situations.

Level 4 core competencies

The same competency can be described for level 4 safeguarding children professionals and level 4 children in care professionals in some areas with the understanding that the knowledge and expertise required to meet that competence is different. When distinct competencies are required these are listed in separate sections.

Health care staff at this level should:

• contribute as a member of the safeguarding children and young people and children and young people in care teams to develop strong internal policies, guidelines, protocols, and procedures
• facilitate and contribute (at an appropriate level) to own organisation’s quality assurance activities and multi-agency meetings for effective safeguarding of children and young people and services for children and young people in care; this will involve multi-agency work and recognises the importance of individual organisation and service contribution, and also will include internal governance, learning events, statutory reviews, and inspections
• advise on local safeguarding of children and young people, and services for children and young people in care using knowledge, research and learning from audits, training, learning from poor and exemplary practice, and addresses areas where there is an identified training/development opportunity
• work effectively and collaboratively with safeguarding children and young people teams, children and young people in care teams, and partners in other agencies, to conduct safeguarding and children and young people in care  training needs analysis, and to commission, plan, design, deliver and evaluate single and multi-agency training and teaching for staff in the organisations covered
• contribute to the implementation of learning national reviews; children in care leaders should lead on creation and implementation of action plans and learning where they refer specifically to children in care:
  • Child Safeguarding Practice Reviews (England), Child Practice Reviews or Single Unified Safeguarding Reviews (SUSR) (Wales), Learning Reviews (Scotland), Case Management Reviews (Northern Ireland)
  • domestic abuse related death reviews involving 16-18 years old and/or children and young people e.g. domestic homicide reviews or domestic homicide & suicide reviews in Scotland
  • individual management or agency reviews, and child death reviews, where requested
• be aware of cross-border/jurisdiction differences in legislation, guidance and practice throughout the United Kingdom and Ireland where appropriate
• advise and contribute to the development of Specific, Measurable, Achievable, Relevant, and Time-bound (SMART) action plans, in relation to above reviews, using a root cause analysis approach where appropriate or other locally approved methodologies; these reviews may also consider safeguarding children and young people or children and young people in care practice
• understand the oversight and quality assurance process following the reviews detailed above with safeguarding children and young people and children and young people in care teams, and in addition, be able to hold leaders and organisations to account
• escalate effectively, supporting colleagues from other organisations, providing advice as appropriate, and be able to support resolution of professional differences using multi-agency guidance to raise concerns through a formal process
• possess sufficient expertise and experience to provide up to date, evidence-based advice and information about safeguarding children and young people or children and young people in care to the employing body including senior managers, executive directors, and the Board, and should have the confidence to deliver oversight and assurance with a proactive and reactive approach
• provide specialist advice to practitioners, both actively and reactively, including clarification on national and local organisational policies, legal issues, e.g. relating to care orders or criminal investigations, and the management of complex safeguarding of children and young people situations
• possess expertise and communication skills to enable provision of supervision in safeguarding children and young people and children and young people in care , and engagement in peer supervision, and leads or ensures appropriate reflective practice is embedded in local organisations, including peer review for safeguarding children and young people
• possess expertise and ability to participate with a trauma-informed approach in sub-groups, as required in national guidance, of the Safeguarding Children Partnership (LSP)/the safeguarding panel of the health and social care trust/the Child (or Public) Protection Committee in Scotland/the safeguarding committee of the Health Board or trust in Wales
• lead/engage with risk management of the organisation’s ability to safeguard all children and young people recognising additional needs of children and young people in care
• ability to understand and apply the Mental Capacity Act 2005 (c.9), Adults with Incapacity (Scotland) Act 2000 (asp 4) and Liberty Protection Safeguards (formerly Deprivation of Liberty Safeguards) (England and Wales only) and how this might apply to all 16-18 year olds.

Level 4 core competencies applicable to health care staff for safeguarding children and young people

Health care staff at this level should:

• possess clinical expertise and knowledge to support and lead peer review in relation to child protection medical examinations
• possess clinical expertise and knowledge to offer clinical advice in complex cases
• be able to elicit, understand and consider the views of a child or young person and how these should be included in the service providing child protection medical examinations
• provide expertise and support, and escalation if needed to enable child protection medical examinations and reports to be completed appropriately
• enable trauma informed care embedded in practice acknowledging consequences of adverse childhood experiences and impact of child safeguarding
• support partnership working with social care and offer constructive challenge where safeguarding needs are not being met
• liaise and escalate as needed where processes are not working effectively and child safeguarding not being met
• support professional colleagues where they have been instructed by Court or are involved in legal process
• act as an expert resource and source of support for those working at level 3
• possess expertise and ability to participate with a trauma-informed approach in sub-groups, as required in national guidance, of the Safeguarding Children Partnership (LSP)/the safeguarding panel of the health and social care trust/the Child (or Public) Protection Committee in Scotland/the safeguarding committee of the Health Board or trust in Wales

Level 4 core competencies applicable to health care staff for children and young people in care

Health care staff at this level should:

• possess clinical expertise and knowledge to be able to clinically support staff, offer quality assurance/peer review, clinically support in complex cases
• ensure staff working with children and young people can elicit, understand, and consider the views of a child or young person and how these should be included in the health assessment
• demonstrate oversight and quality assurance, and escalate if needed to enable health assessments to be completed within statutory requirements for children and young people in care
• support adequate service development and liaison with other health teams
• initiate interventions to facilitate and support child resilience and reduce risk of emotional harm, ensuring trauma-informed care is embedded in organisations and services
• act as a key conduit and contact for social worker, key worker at residential units, families, and Local Authorities, where there are challenges accessing health services.
• possess the ability to support networks of carers and families to deliver appropriate care and support, offering constructive challenge where health needs are not being met
• liaise with other agencies and escalates as needed regarding the health management of individual children and young people in care
• support professionals to contribute to Court reports or information used in other legal processes related to children and young people in care
• act as a resource and source of support for those working at level 3 and/or supervise staff working with children and young people in care
• have confidence and expertise to provide safeguarding advice from a health perspective for children and young people in care where safeguarding issues arise within the care system
• interpret regional, national, and local policy documents/reports and their implications for children and young people in care’s health and service provision
• work creatively with other specialist areas to deliver high quality services specific to the needs of children and young people in care