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Objectives Where children suffer significant harm resulting in serious and permanent damage or death, a Child Practice Review (CPR) provides the opportunity to understand issues and improve professional and organisational practice. This research presents key findings and recommendations from analysis of 33 CPRs. Recommendations within individual CPRs and national reviews repeatedly cite challenges and requirements for urgent action1–3 indicating barriers in moving recommendations into action. The key aim of this research is to minimise harms being perpetrated on children by understanding where challenges and barriers in multi-agency safeguarding (with focus on health) exist to facilitate a more effective safeguarding response. Methods As part of the process in analysing the CPR data, the analysis was divided into three key stages: Risk: Index Child and Family Characteristics within CPRs. Includes descriptive information to identify trends within child/family characteristics and risk indicators. Inferential analysis and PROXSCAL (multidimensional scaling technique) exploring the co-occurrence of risk indicators across the child/family. Response: Organisational and Agency Involvement. Includes descriptive information identifying which organisations and agencies were aware of the child and/or family prior to index incident. This includes thematic analysis of multi-agency learning and responses. Review: Quality of CPRs. Descriptive and thematic analysis examined information contained within CPRs regarding their ability to extract out key learning and action. Results Analysis of index children and parents/carers revealed a need for increased awareness and monitoring of key risk factors, particularly when these co-occur or accumulate (e. g. , ACEs, mental health issues). For practitioner/organisational responses, data identified safeguarding concerns across various agencies prior to index incident. Thematic analysis highlighted key challenges with applying whole-family approaches, professional curiosity, how to gather, record and share child's voice, information sharing and responses to missed health appointments. Examination of CPRs themselves showed variable quality limiting learning being implemented effectively and efficiently. Conclusion This research identifies key actionable recommendations for health professionals working with children and families in preventing the most tragic outcomes. We have developed several models to help more effectively respond to risks and challenges encountered for practitioners working with children. The 'Model of Multi-Agency Connections, Considerations and Complexities' (figure 1), along with a case study example (missed health appointments), illustrates these complexities. We unpick 'professional curiosity' and consider solutions using best practice to navigate these barriers, including The Collective Safeguarding Responsibility Model: 12Cs (Ball 20: 141–154. https: //onlinelibrary. wiley. com/doi/epdf/10. 1002/car. 2679 The child safeguarding practice review panel. (2022). Annual review of local child safeguarding practice reviews. Available from: https: //assets. publishing. service. gov. uk/government/uploads/system/uploads/attachmentdata/file/1123918/Annualᵣeviewₒfₗocalchildₛafeguardingₚracticeᵣeviews. pdf
McManus et al. (Tue,) studied this question.