Dental - Was Not Brought - Children & Young People (Age 0-18 years) & Vulnerable Adults

Summary flowchart available in Appendix A.

1. If the CYP is not brought for any dental appointment, a member of the dental team will attempt to make contact with their parent/guardian by telephone the same day.  The responsible clinician must ensure this task is delegated.
2. If telephone contact is successful, another appointment will be offered.  This will be followed up with an appointment letter.   
3. If telephone contact is unsuccessful, a CNB text message must be sent that day, (or another phone call must be undertaken within the next 2 working days).
4. If contact is made by the parent/guardian within 2 working days of the text message, then the CYP will be appointed and no further WNB action will be taken at this stage.  This will be followed up with an appointment letter.
5. If within 2 working days there has been no response to the text message, a CNB letter will be sent. (See Appendix G & Appendix H for age-appropriate letter).
6. If contact is made by the parent/guardian within 2 weeks of this letter, then the CYP will be appointed and no further WNB action will be taken at this stage.  A follow up appointment letter will be sent.
7. If there is no response to the letter within two weeks, a Childsmile referral is required (see referral form in Appendix D).  . 
8. All correspondence including telephone communication must be documented within the CYP R4 comms.
9. If a child does not attend for 2 appointments within a rolling 18-month period (whether consecutive or not), a Childsmile referral must be submitted via the appropriate referral pathway (further information on the Childsmile referral pathway is available in Appendix C)..  The responsible clinician must be copied into all referral correspondence.
   1. If significant barriers to attendance or suspicion of disguised compliance is identified at any stage, regardless of appointment status, a referral must be made to Childsmile.
   2. The Childsmile team will investigate why the CYP has not been brought and will offer assistance to overcome any barriers identified.  It must be noted that the responsibility of the clinician remains throughout.  They will be fed back all information gained by the Childsmile team and must use this to make a professional judgement on any next steps to safeguard a CYP’s welfare.

The Duty Team are also available to advise any staff on any concerns they have about an individual.

If you consider a child or young person to be in immediate danger, call the police on 999 without delay. If you need advice, information or to report a concern contact the Children & Young Persons Social Work Duty Team on 01896 662787.

Summary flowchart available in Appendix B.

1. Note: Many VA rely on a care team to assist them in making and attending appointments. In these circumstances, the care team should be contacted, as well as the welfare guardian (or relevant other), if known.
2. If a VA is not brought for any dental appointment, a member of the dental team will attempt to make contact with them or their welfare guardian (or relevant other) the same day.  The responsible clinician must ensure this task is delegated.
3. If telephone contact is successful, another appointment will be offered. This will be followed up with an appointment letter.       
4. If telephone contact is unsuccessful, a VA text message must be sent that day, (or another phone call must be undertaken within the next 2 working days).
5. If contact is made by the patient or their welfare guardian (or relevant other), within 2 working days of the text message, then the patient will be appointed and no further WNB action will be taken at this stage.  This will be followed up with an appointment letter.
6. If within 2 working days there has been no response to the text message, a ‘VA letter’ will be sent.
7. If contact is made by the patient or their welfare guardian (or relevant other), within 2 weeks of this letter, then the patient will be appointed and no further WNB action will be taken at this stage.  A follow up appointment letter will be sent.
8. If there is no response to the letter within two weeks, a Priority Groups referral is required.  
9. All correspondence including telephone communication must be documented within the patient’s R4 comms.
   1. If a VA does not attend for 2 appointments within a rolling 18-month period (whether consecutive or not), a Priority Groups referral must be submitted via the appropriate referral pathway.  The responsible clinician must be copied into all referral correspondence.
   2. If significant barriers to attendance or suspicion of disguised compliance is identified at any stage, regardless of appointment status, a referral must be made to the Priority Groups team within Oral Health.
   3. The Priority Groups team will investigate why the VA was not brought and will offer assistance to overcome any barriers identified.  It must be noted that the responsibility of the clinician remains throughout.  They will be fed back all information gained by the Priority Groups team and must use this to make a professional judgement on any next steps to safeguard a VA’s welfare.

The Duty Team are also available to advise any staff on any concerns they have about an individual. If you consider a vulnerable adult to be in immediate danger, call the police on 999 without delay.

If you need advice, information or to report a concern contact the Adult Protection Support Service on 0300 100 1800

• CYP – children and young people (aged 0 to 18^th birthday).
• Disguised compliance – where there is the appearance of engagement from a parent/guardian, but appointments are still frequently missed/cancelled. Or, after periods of non-engagement may attend appointments to reduce professional’s concerns.
• DNA – did not attend. The term used to describe a missed appointment for an individual who does not rely on a third party to support their attendance (i.e., not a CYP or VA).
• Responsible clinician – the Dentist or Dental Care Professional whom the patient has missed their appointment with.
• Significant Case Review – this is a multi-agency process for establishing the facts of and learning lessons from a situation where a vulnerable individual has died or been significantly harmed.
• VA – vulnerable adult.
• Vulnerability – in need of special care, support or protection because of age, disability, risk of abuse or neglect.
• WNB – was not brought. CYP or VAs who require the support of a parent/guardian/care giver to attend appointments and do not attend them are classified as WNB. This term replaces ‘did not attend (DNA)’ as it more accurately reflects the reliance on a third party to enable the CYP or VA to attend.

• NHS Borders Oral Health Improvement
  • Newstead Office: 01896 824512
  • Childsmile: bord-uhb.childsmile@borders.scot.nhs.uk
  • Priority Groups: bord-uhb.caring4smiles@borders.scot.nhs.uk       
• Adult Protection Contacts NHS Borders Intranet, Adult Support & Protection
• Child Protection Contacts NHS Borders Intranet, Children & Young People's Health Network
• Children & Families Long Term Team East
  • Duns: 01361 886115
  • Hawick: 01450 364777
• Children and Families Long Term Team West
  • Galashiels: 01896 664158
  • Peebles: 01721 726310
• Reporter To Children’s Panel
  • 1 Fountainhall Road, Edinburgh, EH9 2NL
  • 0300 200 1989

Oral Health Improvement Childsmile Referral Pathway

Public Dental Service Childsmile Referral

Oral Health Improvement Priority Groups Referral Pathway

Dental Services Priority Groups Referral

CNB 0-15 Letter

CNB 16-18 Letter

Vulnerable Adult letter