GIRFEC
Getting it right for every child
In Scotland, Getting it right for every child (GIRFEC) is a national approach that involves practitioners and professionals across services working together to promote, support and safeguard the wellbeing of children and young people. When necessary, anyone who works with children and young people should take early, appropriate and proportionate action rather than waiting until a situation has reached crisis point. This requires working across organisational boundaries and professional disciplines to help ensure children and young people are given the best start in life.
GIRFEC is founded on the United Nations Convention on the Rights of the Child (UNCRC), an international treaty granting all children and young people a comprehensive set of rights that public authorities in Scotland are now legally required to promote (see Introduction).
As shown below, there are five key GIRFEC questions that all practitioners should ask themselves when working with a child or young person’s wellbeing needs, while maintaining a focus on the rights of the child or young person. The child or young person should fully participate in discussions when considering these questions.
GIRFEC: The Five Questions Practitioners Need to Ask
What is getting in the way of this child or young person’s wellbeing?
Do I have everything I need to help this child or young person?
What can I do now to help this child or young person?
What can my agency/profession do to help this child or young person?
What additional help, if any, may be needed from others?
GIRFEC and Child Protection and the Dental Team
The example below illustrates alignment of the five GIRFEC questions with the tiered approach to managing dental neglect recommended by the British Society of Paediatric Dentistry (BSPD), updated to support children’s rights in decisions about their care.
Gather information
Actions required:
- Gather a thorough social, medical and dental history.
- Complete a thorough clinical examination.
- Be aware of the rights of competent young people to refuse treatment/ appointments.
Suggested team members responsible: Dental receptionist, dental nurse, dentist
Keep accurate records
Actions required:
- Keep accurate clinical records.
Suggested team members responsible: Dentist and/or other team members
- Keep accurate administrative records of appointments and attendance.
Suggested team member responsible: Dental receptionist
Gather information
Actions required:
- Gather a thorough social, medical and dental history.
- Complete a thorough clinical examination.
- Be aware of the rights of competent young people to refuse treatment/ appointments.
Suggested team members responsible: Dental receptionist, dental nurse, dentist
Keep accurate records
Actions required:
- Keep accurate clinical records.
Suggested team members responsible: Dentist and/or other team members
- Keep accurate administrative records of appointments and attendance.
Suggested team member responsible: Dental receptionist
Raise concerns with child or young person and parent/carers
Action required:
- Explain clinical findings, the possible impact on the child and why you are concerned, using age-appropriate language.
Suggested team member responsible: Dentist
Explain what changes are required
Actions required:
- Explain treatment needed and expectation of attendance.
Suggested team member responsible: Dentist
- Give advice on changes needed in diet, fluoride use and oral hygiene.
Suggested team members responsible: Dentist, therapist, hygienist or dental nurse
Offer support
Actions required:
- Consider giving free fluoride toothpaste and a toothbrush, if available.
Suggested team members responsible: Dentist, therapist, hygienist or dental nurse
- Offer the parent/carer a choice of appointment times.
Suggested team member responsible: Dental receptionist
- Listen for indications of a breakdown in communication or parental worries about the planned care, and offer to discuss again or to arrange a second opinion.
Suggested team members responsible: All team members
Continue to liaise with parent/carers and
Maintain clinical relationship with the child or young person
Actions required:
- Keep up open communication with the parent/carer, reinforcing advice to help them understand what is expected of them.
- Keep up open communication with the child or young person. Reinforce advice to help them learn, or feel empowered, to maintain their oral health even in circumstances where their home support is lacking.
Suggested team members responsible: All team members
Monitor progress
Action required:
- Arrange a recall visit and keep accurate records of attempted contacts.
Suggested team members responsible: Dentist and dental receptionist
If necessary, involve other agencies
Actions required:
- Discuss and offer to arrange community/home based dental health support via the child’s Health Visitor, School Nurse, General Medical Practitioner or Childsmile Dental Health Support Worker.
- Agree and liaise with the child’s Health Visitor/School Nurse to ensure preventive advice is being reinforced in the community/home setting.
- If concerns for the child’s wellbeing continue or increase, consider a child protection referral.
- If at any stage there is concern for a child or young person’s immediate safety, or that the child is suffering significant harm, follow local procedures to make a child protection referral.
Suggested team members responsible: All team members