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The SUDI Scotland toolkit provides information to the professions who may be involved. Many organisations play a role in investigating SUDI. As SUDI occurs rarely, some professionals may be involved in only one case. This toolkit offers a support resource for an unfamiliar occurrence, guiding professionals as to their role in the process and thereby including support for bereaved families.

Resources

Professionals may download, print or email resources to collect the information required from individual guidance or look at an overview of the process timeline showing how the various professions interact. This toolkit may also be used to produce hard copies of this resource making information easily accessible in a variety of settings. Please note that if using hard copies, the information will be updated regularly and care should be taken to ensure that the SUDI guidance being followed is up to date. The principles in the SUDI toolkit guidance may be applied to sudden unexpected deaths in children. This toolkit is not appropriate for every SUDI.

The following sections will help social workers to respond appropriately to a SUDI. Other professionals involved may have addressed some of the issues, but you should not assume that they have. The information may also be useful to other professionals interacting with social workers through their involvement following a SUDI.

Interactive timeline and flow chart
When a SUDI occurs
Ongoing involvement
The role of Child Protection
Support during the next pregnancy
Staff Support
Steps and timelines around the investigation of a SUDI
The SUDI Review
Resources & External web links

Interactive timeline and flow chart

The interactive timeline demonstrates the role and responsibility of social workers in relation to other professionals involved, and in the subsequent SUDI Review meeting. The scenario illustrated in the flow chart highlights some of the key points but does not aim to show everything that may arise in what is a unique circumstance for each case of SUDI.

View example scenario (flow chart) »

When a SUDI occurs

1. Emergency Department staff will check whether there has been any previous involvement with social work, and if so in what capacity.

2. Social work will check relevant records, examining any previous concerns as to the well being of the infant / other child in the family and relay such information to the relevant Emergency Department staff in confidence.

3. A social worker will be assigned to the family if there is confirmation that the family has existing or recent dealings/contact with social work.

4. Primary support for the family will be given by health workers and the police if the family is not known to social work. However, if other agencies believe that support from social work would be of benefit then social work will continue to be involved.

5. Social work will liaise with relevant hospital and primary health colleagues, police and the child protection team as appropriate.

6. The parents/family will be made aware by staff in the Emergency Department that initial information taken regarding the circumstances of the death and previous medical history will be shared with social work as appropriate.

Ongoing involvement

1. You will be asked for background information about the infant and the mother/ father or carer.

2. You may be contacted at several stages of the process to share relevant information.

3. You may be asked to take part in a SUDI Review.

4. Make sure that information about SUDI and risk reduction is included in any information you provide for families with infants you are supporting.

The role of Child Protection

Child protection underpins all investigations following SUDI. It is standard practice for a child protection team to be contacted in all cases to make them aware of the infant’s death. The degree of involvement of a child protection team will vary for each SUDI, from maintaining a very peripheral role and concluding their part in the investigation as soon as the initial post-mortem examination findings are known, to providing ongoing support to the family and staff involved, if child protection issues are raised. Child protection teams include professionals from health care, social work and police.

Child protection staff collaborate with health care professionals, social workers and police to:

1. Initiate and maintain good communication between all agencies involved to ensure clarity of roles.

2. Gather relevant background information.

3. Provide support to primary care colleagues regarding access to medical notes, interviews with members of the police etc.

4. Support the management of a SUDI until post-mortem examination findings are known.

5. Advise as well as develop policies and practice in child protection.

6. Ensure that the bereaved family understands that child protection involvement is standard practice in all SUDIs.

7. Provide the necessary support packages available for the family should they be required.

Child Protection team involvement

1. The child protection health team in the hospital is notified by Emergency Department staff when a SUDI occurs.

2. There is interaction with relevant hospital and primary care colleagues, police and social work, as appropriate and an agreement on who makes contact with the following:

• lead paediatrician for the area
• clinical director for children’s services
• executive director with responsibility for child protection
• nurse consultant for vulnerable children
• designated doctor for vulnerable children
• the Child Health Commissioner
• chief nurse for the area
• family health visitor for pre-school children.

3. The advisor involved with the case will assess and decide on the level of engagement with maternity and child health services, background history including any previous child protection concerns.

4. The team will remain involved with the case until the outcome of the post-mortem examination is known.

5. The parents/family are informed by Emergency Department staff or a paediatrician it is standard practice that initial information gathered regarding the circumstances of the death will be shared with the local child protection team.

6. The parents/family should be reassured that this does not imply suspicion or criticism of their care of the deceased infant.

Support during the next pregnancy

If a family has previously experienced a SUDI, then the following actions may help provide support:

1. Acknowledge the previous death using the infant’s name.

2. Aim for continuity of support.

3. Ensure services such as addiction support are accessible from early on in the pregnancy.

4. Note anniversaries when the parents may need additional support.

5. Discuss with the health staff plans for providing extra support for the care of the next infant, such as provision of an apnoea monitor.

6. Whenever appropriate discuss risk factors such as sleep position and smoking.

Staff support

The professionals involved may require support. Some professionals may have prolonged involvement in the investigative process and will have no experience of SUDI. This toolkit provides information on staff support.

Steps and timelines around the investigation of SUDI

Each case has unique circumstances which require investigation so there is never an absolute timeline to follow. The following steps should occur:

1. The police will provide the Procurator Fiscal with a Sudden Death report the next lawful day (Monday if the death occurs over the weekend).

2. Original medical records will be requested by the police on behalf of the Procurator Fiscal, and given to the pathologist prior to the post-mortem examination.

3. A post-mortem examination will be requested and normally take place within 48 hours.

4. The paediatrician following up the case will offer to meet with the parents after 1-2 weeks to discuss the process to date and offer ensure appropriate support is available for the family

5. The final post-mortem examination report can take several months as further examinations of samples will need to be concluded.

6. The Procurator Fiscal will confirm with Healthcare Improvement Scotland that it is appropriate for the SUDI Review meeting to take place once the post-mortem examination report is available, assuming there is no suspicion of criminality. Healthcare Improvement Scotland will liaise with SUDI paediatrician for the NHS Board.

The SUDI Review

The SUDI Review is a multidisciplinary meeting at which the case is discussed. The meeting is held shortly after the final post-mortem examination report is available, which may be several months after the infant has died. The purpose is to discuss all aspects of the death, including possible causes or contributing factors, to see what lessons can be learned and to plan support for the family, in particular during and after any future pregnancies.

Participants may include:

• paediatrician
• pathologist
• general practitioner
• community health visitor
• community midwife
• social worker.

The meeting will be held at a suitably convenient time and place for all involved. The SUDI Review meeting will not take place if there is any suspicion of criminality or if a Significant Case Review has to take place through Child Protection.