Protocol for Management of Non Attendance
for Mid-West Spina Bifida and Hydrocephalus Association
1.0 Policy
It is the policy of Mid-West Spina Bifida and Hydrocephalus Association that the following procedure is followed in relation to non-attendance at scheduled physiotherapy appointments.
2.0 Purpose
The purpose of this policy is to identify the actions that should be taken when a member does not attend for an appointment (DNA).
2.1 Objectives
2.1.1 To minimise the risk to children and young people if a parent/guardian chooses not to attend or fails to attend an appointment with the child or young person.
2.1.2 To support families where children have been identified as vulnerable by facilitating attendance and helping to co-ordinate appointments on their behalf.
2.1.3 To identify reasons for non attendance, for example, change of address, literacy issues, timing of appointments, travel issues etc.
2.1.4 To improve the management of non attendance and reduce non – attendance rates.
2.1.5 To ensure effective communication and sharing of information between professionals when children/young people do not attend and there may be child protection concerns.
2.2 Background
In most circumstances our members rely on their parents/guardians and carers to meet their needs by attending appointments to ensure that their health needs are met. Research has repeatedly shown that missed appointments are a feature in Serious Case Reviews where children have died or suffered abuse or neglect (DfES (UK) (2008), H.S.E. (2010)).
Pearson (2008) found that:
· Lack of follow up for children who had recurrently failed to attend health appointments was associated with negative outcomes.
· It is rarely the child or young person’s fault that an appointment is missed. Failure to issue further appointments as a consequence of departmental policy unfairly disadvantaged the child.
The report recommended that Health Services should proactively follow up and assess the potential risk for children who do not attend appointments.
It is acknowledged that parents have the right to make decisions in respect of their child’s health, including health related interventions. Parental responsibility allows a parent to accept or decline a health service or treatment on behalf of their child (for example immunisation). However, if by declining a health service or treatment this may be detrimental to a child or young person’s health, growth or development, an assessment should be made to assess the risk this poses to the child or young person.
3.0 Scope
This policy applies to all service users and staff members of the Mid-West Spina Bifida and Hydrocephalus Association.
4.0 Legislation/other related policies
National Consent Policy, QPSD-D-026-1, V. 1, HSE, 2013
Children First, National Guidance on the Protection and Welfare of Children, Dept of Children and Youth Affairs, 2011
5.0 Glossary of Terms and Definitions
Did not attend (DNA): failure to attend without prior notification.
Could not attend (CNA): failure to attend with prior notification.
Designated Liaison Person or Deputy: a person designated by the organization to act as a liaison with TUSLA and a resource person to any staff member or volunteer who has child protection concerns. The designated liaison person is responsible for ensuring that the standard reporting procedure is followed, so that suspected cases of child neglect or abuse are referred promptly to the Duty Social Worker in TUSLA or in the event of an emergency and the unavailability of the HSE, to An Garda Síochána.
6.0 Roles and Responsibilities
Chairperson/General Manager
It is the responsibility of the Chairperson to ensure this guideline is implemented within the service.
Team
It is the responsibility of all staff involved in the delivery of the service to comply with this policy.
It is the responsibility of the Team to co-ordinate appointments and to communicate clearly with parents/guardians/members to facilitate attendance.
It is the responsibility of the Teams to validate family’s/member’s contact details and issue appointment letters and/or text messages.
It is the responsibility of the Teams to inform the member or a parent/guardian of the child/young person, as part of the first appointment letter, of the attendance policy.
Members/Parents/Guardians
It is the responsibility of the member or parents/guardians of children/young persons to inform the relevant service provider(s) if they are unable to attend for their appointment(s) 48 hours prior to appointment where possible.(in the case of an emergency arising they should notify the service as soon as possible)
It is the responsibility of the member or parents/guardians of children/young persons to inform the relevant service provider(s) of any change of address or contact details.
7.0 Procedure
7.1 Non Attendance Procedure for a member newly referred to the service:
7.1.1 Initial appointments will be issued by standard letter, with the Attendance Information Flyer attached to the letter. (Appendix III)
7.1.2 Where a first appointment has been issued and the family does not attend without prior notification a team member will attempt to contact the parent(s)/guardian(s) by phone.
7.1.3 If contact cannot be made by phone, a letter will be sent asking the parent to contact the Team to arrange another appointment. This letter will be copied to the referral source. This letter will state that as they have failed to attend an appointment without prior notice they must contact the service within 14 days to arrange a further appointment. (Appendix IV)
7.1.4 Admin will put the child’s name on the agenda of the relevant team meeting under ‘DNA’ for monitoring purposes.
7.1.5 If no contact is made with the service within the 10 WORKING days the child will be discharged and a discharge letter will be sent to the family and copied to the GP and referrer. A new referral would then need to be made in order to access the service. The new referral date would apply in terms of the child’s position on the waiting list if applicable. (Appendix V)
7.1.6 If phone contact is made and the parent/guardian requests a rescheduled appointment, an appointment LETTER IS SENT to the MEMBER/parent/guardian from the Team.
7.1.7 If a MEMBER/parent/guardian contacts the Team and advises that they do not wish to avail of the service, the child will be discharged, and a letter recording this decision will be sent to the MEMBER/parent/guardian, the referrer and GP. A new referral would then need to be made in order to access the service in the future. The new referral date would apply in terms of the child’s position on the waiting list if applicable.
7.1.8 If there is failure to attend or cancel the rescheduled appointment, a discharge letter will be forwarded to the family and copied to the referrer and GP outlining reason for discharge. A new referral would then need to be made in order to access the service. The new referral date would apply in terms of the child’s position on the waiting list if applicable. (Appendix V)
7.2 Non Attendance Procedure for a member on the Active Caseload of the service:
7.2.1 Where an appointment has been issued and the family does not attend without prior notification, a team member will attempt to contact the MEMBER/parent(s) /guardian(s) by phone to establish the reason for nonattendance. Reason to be recorded on child’s file. IF MEMBER/PARENT/GUARDIAN CONTACT THE OFFICE AFTER THE SCHEDULED APPT IT IS STILL RECORDER AS DNA AND NEW APPT IS SENT and THE DNA/CNA flyer.
7.2.2 If phone contact is made and the parent/guardian requests a rescheduled appointment, an appointment LETTER is SENT to the MEMBER/parent/guardian from the Team and a DNA/CNA flyer.
7.2.3 If phone contact is made and the MEMBER/parent/guardian advises a Team Member that they do not wish to schedule further appointments for THEM/their child, the Team member will bring this information to the next Team Meeting.
7.2.4 If contact cannot be made by phone, a letter will be sent asking the MEMBER/parent/guardian to contact the Team to arrange another appointment. This letter will state that as they have failed to attend an appointment without prior notice they must contact the service within 10 WORKING days to arrange a further appointment. (Appendix IV) Admin to put the child’s name on the relevant team’s meeting agenda under DNA/CNA for monitoring.
7.2.5 Rolling DNA item on meeting agenda to monitor DNAs and follow up those who do not make contact.
7.2.6 If no contact is made after 10 WORKING days, the case will be discussed at team meeting, and a team member assigned to contact the family to discuss. If the team is unable to contact the family by phone, a letter will be sent (Appendix(VI) and risk assessment carried out by the team. (Appendix VII)
Risk Assessment
7.2.7 A risk assessment in relation to non-attendance/non-engagement is initiated when:
· A pattern of repeated non attendance/non engagement has been identified as a cause of concern
· A member or parent/guardian has advised the Team of their wish to withdraw from engagement with the service.
· A member or parent/guardian has failed to respond to phone contact and letter asking them to contact the service to schedule further appointments.
7.2.8 The team should assess any potential risk to the child’s health and wellbeing by reviewing the child’s file, liaising with other professionals who may have knowledge of the family, completing the Risk Assessment form (Appendix VII)
Details of the outcome of the Team’s discussions must be recorded on the child’s file under a Risk Assessment Appt type.
7.2.8 If following this risk assessment there is no risk to the child’s health/development identified, the child will be discharged from the service. A letter will be sent to MEMBER/parent(s)/guardian(s), referrer and GP outlining the reason for discharge. A new referral would then need to be made in order to access the service in the future. The new referral date would apply in terms of the child’s position on the waiting list if applicable.
7.2.9 If a risk to the child’s welfare has been identified, the Team Social Worker or Designated Liaison Person or Deputy will link with MEMBER/parents/guardians & other professionals in relation to facilitating attendance/engagement.
7.2.10 If concerns remain the designated Team member (decided at the team meeting) will liaise with Child Protection and Welfare Services for advice and a referral to Child Protection and Welfare Services may follow.
8.0 Revision and Audit
This protocol will be reviewed 6-12 months following implementation.
Appendix I: Attendance Information Flyer
 |
IF YOU CANNOT ATTEND, PLEASE LET US KNOW 48 HOURS AHEAD IF POSSIBLE Missed appointments may result in:
|
|
If there is anything we can do to help you attend appointments please talk to a member of the team |
Phone number: 061 439990 / 087 7378875 |
|
Or send us an email on: |
Appendix II: DNA, Request to contact service to arrange another appt
|
Address 1 Address2 Address3 Address 4 [Insert date] Dear [Insert name of member/parent(s)/guardian(s)] An appointment for you/your child to attend on [Insert date] was sent to you by post. However, we note from our records that you did not attend/ bring [Insert name of child] to this appointment and did not cancel in advance. To date we have not been able to contact you by phone. Please phone me within the next 10 working to reschedule this appointment. Failure to make contact with the service within this time may result in you/your child being discharged. I enclose a copy of our Non Attendance policy for your information.
Yours sincerely ___________________ Administrator CC Referral source If you are experiencing any difficulties coming to appointments please get in touch and let us know. We would like to work in partnership with you. |
Appendix III Discharge letter following non-attendance and no further contact
|
Address 1 Address2 Address3 Address 4 [Insert date] Dear [Insert name of member/parent(s)/guardian(s)] You have not contacted us as we requested in our letter to you dated [Insert date] regarding you/your child’s missed appointment. In keeping with our Non Attendance Policy we are now discharging you/your child from this service and a copy of this letter has been sent to the person who referred you/your child for services and your GP. When you wish to engage with the service please arrange to have a new referral sent. We wish you all the best for the future.
Yours sincerely ___________________ Administrator cc GP |
Appendix IV: DNA, 2nd Request to contact service to arrange another appt
|
Address 1 Address2 Address3 Address 4 [Insert date] Dear [Insert name of member/parent(s)/guardian(s)] We wrote to you on [Insert date] regarding you/your child’s missed appointment with us on [Insert date]. Our records show that to date you have not made contact with us to make a new appointment. Please contact me within the next 10 working days to reschedule this appointment. Failure to do so may result in you/your child being discharged from the service in accordance with our Non Attendance policy which has already been sent to you.
Yours sincerely ___________________ Administrator If you are experiencing any difficulties coming to appointments please get in touch and let us know. We would like to work in partnership with you. |
Appendix V Risk Assessment
|
|
||||||||||||||||||
CNA Policy Graph
DNA Policy – Active Caseload Graph
DNA Policy – Newly Referred Graph
