A focus on chronologies has been core to our ASP workstream this year. We’ve been working closely with the Chronologies Implementation Subgroup. This is one of four subgroups in support of the ASP National Implementation Group, formed to support both national and local implementation of the revisions of the Adult Support and Protection (Scotland) Act 2007 Code of Practice.
The subgroup brings together passionate practitioners and managers, committed to improving chronology practice in ASP across sectors. Part of our work, and building on our recent research, is to capture what’s happening around improving chronology practice. We’re interested in what people are trying and the impact this is having.
These four case studies highlight that changes in different parts of the system (recording, training, guidance, analysis, risk assessment) can be levers to affect change. We hope sharing these examples and building more over time, will inspire others to try different approaches to this complex issue.
Got an example or case study to share? Contact ellen.daly@iriss.org.uk
Moray HSCP
"In Moray we are taking a proactive approach to changing the culture and practice around chronologies and we already ensure that chronologies for ASP investigations are carried out from a multiagency perspective."
Risk, analysis and involving the adult
"When looking at risks in order to support chronology analysis we have included a ‘chronologies discussion’ in our ASP Case Conference (ASPCC) and Review Case Conference (RASPCC) agendas. Practitioners are being encouraged to involve individuals in the development of the chronology and to support them to look at any emerging patterns and how this information can be used to improve outcomes. We also make sure updated chronologies are shared at all review ASPCC’s and that this information is again analysed by those attending. Our Investigation paperwork also asks Council Officers to analyse chronology findings."
Impact
"Since these changes have been made we have noticed an improvement in the quality of discussion around chronologies and practitioners are no longer just seeing this as a paperwork exercise. They are experiencing the value of this being completed from a multiagency perspective and the clarity it can bring for professionals and the individual."
North Lanarkshire HSCP
Recording
"We are in the very early stages of implementing changes to our system and practice. We are currently building in additional prompts at various stages within Mosaic (case management system) to support practitioners to remember chronologies when updating the system."
Risk assessment and analysis
"Regarding the risk assessment (AP2), we are developing a new form where we are asking Council Officers to send out information requests to relevant partner agencies regarding their involvement and view of risks. This also includes a single-agency chronology with analysis. We would then ask the Council Officer to collate the chronologies to a multi-agency chronology and consider it as part of the risk assessment."
Anticipated impact
"We are hopeful that this will support practice and ultimately support the assessment of the risk to adults, identifying strengths and the support/protection needs for the adult at risk of harm."
NHS Dumfries and Galloway
Recording
"We are currently going through some exciting changes for the chronology implementation in NHS Dumfries and Galloway. We have a new tab on our clinical portal called ‘Chronology’ where practitioners can find chronology entries if, for example, an adult has attended Accident and Emergency, and or been the subject of a Multi Agency Public Protection Arrangement (MAPPA), Multi-Agency Risk Assessment Conference (MARAC) and or Multi-Agency Safeguarding Hub (MASH) meeting."
Implementation planning
"We are aware we are at the early stages of this and are currently meeting with leads from the different health areas, who are all working on their own implementation plan for training and implementing the use of chronologies in their practice. Each area will have a strategic lead. Once their implementation plan is in place, they will be linked with a Public Protection Advisor as their linked support person, and training will be rolled out to those working with the most vulnerable first, and then others in the team. We are planning on evaluating how this is working so that we can support people in making a real change in their practice in relation to chronologies."
Supervision
"We also support Chronology discussion within our Supervision sessions and have a heading within our Initial Referral Discussion about what the Multiagency chronology looks like for that person, for example if all agencies have a chronology of worsening mental health."
Guidance and training
"We are just completing our Chronology guidance, and we have our training ready for when teams have completed their chronology implementation plans. The training consists of e-learning and then face-to-face training to practice and discuss in person. For Multiagency, we are trying to understand how best to benefit from one another's chronologies and understand where best to keep a Multiagency chronology. This is an area of development we’re working on. "
Anticipated impact
"We really are at the early stages, but sure this will make a positive impact on practice and on the patient's experience."
Scottish Borders HSCP
A different approach
"Improving chronologies is a national challenge and features on most Joint Inspection reports across Scotland in relation to both adults and children’s services. Following the Scottish Borders Inspections for Adult Support & Protection and for Children at Risk of Harm, improved chronologies are encompassed in both post inspection Improvement plans. In response to this, we developed a Chronology, Analytical writing and Professional curiosity working group (CAP) in Autumn 2023."
CAP Purpose
"The overall purpose of the CAP is to review and develop understanding and practice around the importance and use of Chronologies including the role of Analysis and Professional Curiosity:
- Identifying, supporting and linking with priorities identified in a range of other relevant working groups thereby improving communication.
- Providing information on and increasing the quality and diversity of operational practice to enhance the lives of service users through access to existing research, benchmarking and identifying best practice.
- Establishing robust mechanisms for recommending and evaluating an improvement plan for use of chronologies, analysis and professional curiosity.
- Producing and presenting highlight and/or business reports to other relevant working groups.
- Developing new standards and revising current guidance in the practices of chronology and analytical writing.
- Developing audit and QA functions linked to chronologies, analysis and professional curiosity.
- Considering the need to implement chronologies across partner agencies who currently do not have these in place and formulating a multi-agency shared chronology system."
Involving the adult
"The aspiration of the group is to fully and fairly represent the views of service users and consider a range of methodology such as:
- Direct and indirect feedback from individuals.
- Feedback from Service User Reference Groups and organisations.
- Feedback from staff and organisations committed to promoting the rights of service users."
Anticipated impact
"The inclusion of analytical writing and professional curiosity is a different way of reframing chronologies, and it is hoped that this will assist in making sustainable and meaningful improvements.
This approach and working group have been positively received by the Scottish Borders Care Inspectorate Link Inspector as an innovative method of reviewing and developing current thinking."
