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Announcements and latest updates

Welcome to the Right Decision Service (RDS) newsletter for August 2024.

  1. Contingency planning for RDS outages

Following the recent RDS outages, Tactuum and the RDS team have been reviewing the learning from these incidents. We are committed to doing all we can to ensure a positive outcome by strengthening the RDS to make it fully robust and clinically resilient for the future.

We would like to invite you to a webinar on 26th September 3-4 pm on national and local contingency planning for future RDS outages.  Tactuum and the RDS team will speak about our business continuity plans and the national contingency arrangements we are putting in place. This will also be a space to share local contingency plans, ideas and existing good practice. We would also like to gather your views on who we should send communications to in the event of future outages.

I have sent a meeting request for this date to all editors – please accept or decline to indicate attendance, and please forward on to relevant contacts. You can also contact Olivia.graham@nhs.scot directly to register your interest in participating.

 

2.National  IV fluid prescribing  calculator

This UK CA marked calculator is now live at https://righdecisions.scot.nhs.uk/ivfluids  . It has been developed by a multiprofessional steering group of leads in IV fluids management, as part of the wider Modernising Patient Pathways Programme within the Centre for Sustainable Delivery.  It aims to address a known cause of clinical error in hospital settings, and we hope it will be especially useful to the new junior doctors who started in August.

Please do spread the word about this new calculator and get in touch with any questions.

 

  1. New toolkits

The following toolkits are now live;

  1. Updated guidance on current and future Medical Device Regulations

We have updated and simplified this guidance within our standard operating procedures. We have clarified the guidance on how to determine whether an RDS tool is a medical device, and have provided an interactive powerpoint slideset to steer you through the process.

 

  1. Guide to six stages of RDS toolkit development

We have developed a guide to support editors and toolkit leads through the process of scoping, designing, delivering, quality assuring and implementing a new RDS toolkit.  We hope this will help in project planning and in building shared understanding of responsibilities throughout the full development process.  The guide emphasises that the project does not end with launch of the new toolkit. Implementation, communication and evaluation are ongoing activities throughout the lifetime of the toolkit.

 

  1. Training sessions for new editors (also serve as refresher sessions for existing editors) will take place on the following dates:
  • Thursday 5 September 1-2 pm
  • Wednesday 24 September 4-5 pm
  • Friday 27 September 12-1 pm

To book a place, please contact Olivia.graham@nhs.scot, providing your name, organisation, job role, and level of experience with RDS editing (none, a little, moderate, extensive.)

7 Evaluation projects

Dr Stephen Biggart from NHS Lothian has kindly shared with us the results of a recent survey of use of the Edinburgh Royal Infirmary of Edinburgh Anaesthesia toolkit. This shows that the majority of consultants are using it weekly or monthly, mainly to access clinical protocols, with a secondary purpose being education and training purposes. They tend to find information by navigating by specialty rather than keyword searching, and had some useful recommendations for future development, such as access to quick reference guidance.

We’d really appreciate you sharing any other local evaluations of RDS in this way – it all helps to build the evidence base for impact.

If you have any questions about the content of this newsletter, please contact his.decisionsupport@nhs.scot  If you would prefer not to receive future newsletters, please email Olivia.graham@nhs.scot and ask to be removed from the circulation list.

 

With kind regards

 

Right Decision Service team

Healthcare Improvement Scotland

6 - 8   9 - 11   12 - 14   15 - 18   A - Z

Typical development 0 - 5 years old

Each child will be different and may not present as their chronological age because of past experiences or additional needs. (8) Therefore, you may need to use language and resources from other age/stage sections of this toolkit.

  • Children’s sexual development starts at birth.​ Babies are discovering their own bodies. They often touch themselves, sometimes their genitals, too. This happens by chance rather than intentionally.
  • Toddlers are becoming aware of themselves and their bodies. They also learn that they look different from other children and adults (they develop their identity). 
  • Children aged 2-4yrs learn that they are boys or girls (they develop their gender identity). 
  • Children start to pick up messages from the world around them about gender stereotypes; that some toys, clothes, behaviours and jobs are for boys and some are for girls. 
  • They become very interested in their own body and those of people around them. Often, they study their own body and genitalia in detail and sometimes show them to other children and adults.They start deliberately touching their genitals because it makes them feel good. 

See also: WHO guidance (1)

Support and learning required from carers and staff

All children need help from adults to distinguish between appropriate and inappropriate behaviour. Past trauma may mean that a child or young person displays inappropriate and sometimes sexualised behaviour. Be clear with everyone in the house or care setting about what is acceptable and about the need for personal privacy. (8)

At this stage, there is a lot of personal care involved in looking after children and this provides daily opportunities to teach social rules that are protective. You will already be experienced at teaching other social rules, for example saying ‘please’ and ‘thank you’ teaching children to take turns in games, how to eat meals together, share toys etc. 

Children aged 2-4yrs exploring their bodies and being interested in other children’s bodies is typical behaviour, but they need to be taught protective social rules about this: 

  • "We don't show each other our pants or what's inside them because that’s private” The NSPCC Pants Campaign made this video to help explain this to young children - The Pantosaurus Song (duration 2 minutes 30):

 

  • "You don't touch/rub that part of your body in front of other people"  
  • “You don’t touch someone else’s penis/vulva or bottom and no-one should touch yours”. There will be situations when this will be required e.g. helping to wipe clean after using the toilet or as part of a medical examination. It’s important that we teach children that these are exceptions. This story book is a helpful way to get this across - Your body belongs to you by Cornelia Spelman (duration 3 minutes 03):

  • Children need to be taught the accurate names for the private parts of their body – penis or vulva and bottom. They may use a range of other words e.g. flower, wee man etc. It’s ok if they use these, as long as they are also taught the correct words. 
  • Staff and carers should demonstrate that they respect children's right to ownership/ autonomy of their body. As with teaching social rules, this can done as part of everyday situations, for example, saying goodbye at nursery, asking ‘would you like a hug?’ instead of automatically hugging them.  
  • Children need adults to help them learn how to assert and articulate their right​ to bodily autonomy. For example, if another child picks them up or hugs them without asking, the adult can intervene: ‘I’m not sure that x wanted to be picked up/a hug. You need to ask them first’ This short video explains it well - Consent for kids (duration 2 minutes 43):

 

 

Gender stereotyping

Gender stereotyping can limit children’s expectations for themselves and they need the adults in their lives to challenge this. It is important that staff and carers help them learn that girls and boys are not limited by their gender. This can be done as part of day to day care by encouraging children to play with a range of toys, dressing up outfits etc and sharing stories about people that challenge gender stereotypes.

This video shows the impact of gender stereotypes on children’s ideas - Redraw the Balance (duration 2 minutes 07):

 

 

 

 

This story book, William's doll by Charlotte Zolotow, is about a boy who wants a doll (duration 5 minutes 58):

 

Brain development

Children will benefit from activities that help brain development, both at this stage and as a part of laying the foundations for adolescent brain development. This video from the NSPCC - Building a strong brain architecture - is a helpful overview (duration 3 minutes 12):

 

What children should be learning at school and how to back it up at home

Children attending Early Years services/nursery should be benefitting from the Early Protective Messages approach used by staff. This approach promotes gender equality, bodily autonomy and child protection through situational learning/teachable moments. Workshops for kinship carers and foster carers are also available to help build this approach into day to day care.

All children in Scotland should be getting Relationships Sexual Health and Parenthood (RSHP) lessons at school as part of the Health and Wellbeing curriculum. Individual schools can choose what resources to use but most will now use Go to website: rshp.scot, as it is the most up to date resource. All the content on this website is available for anyone to view and use.

These links take you to an overview of what children are learning at school and what you can do in the home setting to back this up.

Go to website: Early Level information from rshp.scot

Go to website: Information from rshp.scot 

Behaviours that are not developmentally typical and how to respond

This tool has been developed by Stop it Now for parents, but is suitable for carers and staff to use. It describes behaviours that are developmentally expected and behaviours that are not healthy or safe.

Carers who are concerned about a child’s behaviour should share their concerns with the team around the child as a first action.

Staff should refer to their locality guidance and protocols.

Stop It Now traffic light tool for under 5s