Responding to Missing Families & Unborn Babies for Whom There are Concerns

For the purposes of this policy, a missing family can be defined as a family who has disappeared from a known location within a Health Board area, there has been no response to attempts to see the child and for whom there may be concerns of significant harm for the children in respect of unmet need, vulnerability, abuse or neglect. This includes risks to an unborn child.

If health professionals are concerned that a child/YP/unborn may be at immediate risk of harm/danger then police should be contacted. A referral should also be made to Children and Families Duty Social Work.

The health professional raising the concern should remain active in seeking the whereabouts of the unborn baby, child/YP, and family and notify police or social work if they become aware of them being found.

If Health Professionals are concerned that an unborn, child/ren, or young person is ‘missing’ from their last known address and they have no forwarding information, they should ensure that all reasonable efforts have been made to locate the family and ascertain that they are safe.

If any health professional has significant concern and remain unable to locate the child/ren, or young person, consideration should be given to issuing an MFA/ROA by the Nurse Consultant for Public protection or Child/Public Protection Nurse.

The Nurse Consultant Public Protection and Child/Public Protection Nurses have delegated responsibility from the Executive Director of Nursing, Midwifery and AHP, and will make the final decision as to whether a national MFA/ROA requires to be shared across Scotland’s Health Boards. 

They will do this in collaboration with their NHS Board Caldicott Guardian as appropriate. Caldicott Guardians are appointed to ensure that personal information is processed legally, ethically, and appropriately in line with General Data Protection Regulation (GDPR).

Health Professional’s must carefully consider the need to process personal data fairly and lawfully and should only do so when the following conditions are met;

• A child protection concern where information can be lawfully shared without the need for consent to be given by the individual(s) to whom the information relates to. Health professionals have a professional duty to share information when a child/young person/unborn may be at risk of significant harm. This will always override a professional or agency requirement to keep information confidential in line with GDPR. This is further supported through Getting information sharing right for every Child (GIRFEC guidance 2022) – section 13.  Getting it Right for Every Child Practice Guidance 4: Information Sharing (2022).

Personal information disseminated by Health Boards/Trusts about missing families should be considered based on the individual case, and subject to scrutiny by the Caldicott Guardian.

Where NHS Borders health professionals (caseload holders) have concerns that a child/unborn baby may be at risk of significant harm, and the child/YP/unborn baby is missing from their last known address and they have no forwarding information, they should ensure that all reasonable and practical efforts are undertaken to locate the family. This should include:

• Discussion with other health professionals including GP/Health visitor & Midwife in other localities in Borders.
• Interrogation of IT systems such as Community Health Index (CHI), Standard Immunisation Recall (SIRS) and Trak.
• Contacts in other statutory agencies should also be considered e.g. housing, social work, police and education/early years/nurseries.
• Contact with family and/or friends as appropriate.
• Discussion with the NHSB Public Protection Team at the Public Protection Unit (01896 664580).
• Consider requirement for Child Protection Referral | Inter-agency Referral Discussion (IRD)
• Any actions taken and consultations should be documented within Child/YP community EMIS and Badgernet for unborn.

Health Professionals with responsibility or involvement with the unborn baby / child / young person’s wellbeing should be notified of their missing status.

Consideration for raising a Pregnancy at Risk of Absconding Alert

Where an unborn baby has been placed on the Child Protection Register pre-birth and/or there are Child Protection plans in place for a Compulsory Supervision Order / Child Protection Order to be placed at birth and the new-born removed from parental care, a Risk of Absconding Alert (ROA) should be completed if there are concerns that the pregnant woman may abscond to another area without informing professionals, to deliver in another area. 

In these circumstances, health professionals, as part of any multi agency child protection plan can request a ROA is cascaded to the health board areas where it is considered that the pregnant woman may be.  It is expected that the Midwife also links with any other health boards, where it is suspected a pregnant woman may be residing/may be intending to abscond to, to raise awareness of the ROA which will be circulated, they should also contact the parent’s GPs to request information is added to KIS.

Raising, Disseminating, tracing a Missing Family/ Pregnancy at Risk of Absconding Alert

• Once all efforts to locate a missing unborn baby, child/YP, and family have been exhausted, the Nurse Consultant Public Protection or Child / Public Protection should review actions taken by the referrer to recommend any other actions which may be required and where appropriate, authorise an MFA/ROA. The timing for this decision is dependent on the risk assessment.
  
  
• Once a decision has been made to raise a MFA/ROA, the Nurse Consultant Public Protection or Child/Public Protection Nurse is responsible for ensuring the Missing Family Alert template (MFA1) is completed and is securely disseminated to Scottish Health Boards/ Child Protection Leads (including SAS) via secure email (Appendix 2).
  
  
• The MFA 1 form should be filed in Child/YP EMIS record and Badgernet for Unborn.
  
  
• Details should be entered onto NHS Borders Missing Families Database with Secure Public Protection Drive.
  
  
• Alert to entered onto Patient management systems Trak and EMIS; ‘ Child/YP and their family are missing from their known address- If attends at health appointments/ED please contact 01896 664580.
  
  
• The health professional raising the MFA/ROA should inform the General Practitioner (GP) who can support the process by documenting the MFA/ROA on the Key Information Summary (KIS) with the necessary details on who to contact. This will allow NHS 24 Public Protection service to contact the relevant professional who submitted the MFA/ROA with details of the individual/s contacting NHS 24.
  
  
• If there is a clear link to an English Local Authority area a decision should be made whether it is appropriate to share the MFA/ROA with that authority.

Monitoring a Missing Unborn/Child/YP and family

If the family remain missing after a 3-month period, the Public Protection Team should consider re-issuing the Missing Family Alert or make a decision to close the alert. If the alert is closed, the Public Protection Team must formally notify other health boards and professionals involved in the initial distribution.

Missing Unborn/Child/YP and family traced

Where a Missing Family Alert has been raised from within NHSB and the Unborn/child/YP family is subsequently located, the Public Protection Team should:

• Advise all areas and services on the original distribution list that the family has now been found by completing the appropriate section on the original MFA1 and re-circulating it.
• Ensure that were missing child/family is located within the NHSB area, that appropriate health professionals and services are informed.
• The Health Professional involved in requesting the MFA/ROA should inform the GP Practice to remove the alert from KIS (Key Information Summary).

Until child/YP/family has been located, the responsibility continues to lie with the referrer/caseload holder to continually review the risks associated to the child and take further action as required.

The health record should remain with the case holder, who should continue to regularly make checks with other professionals involved with the family, the GP and child health service to determine whether a family has now registered in another area.  

The caseload holder/referrer should continue to maintain regular contact with the NHSB Public Protection team to support a continual review any risks. 

The NHSB Public Protection team will provide advice/support the referrer on any further measures which may be required, such as recommending a missing person referral to Police Scotland, at any time. 

NHSB Public Protection Team is the Single Point of Contact for Missing Family Alerts from other Local Authorities and UK wide.