Integration of Interprofessional Simulation for Safeguarding Children and Families: A Mixed Methods Study

Integration of Interprofessional Simulation for Safeguarding Children and Families: A Mixed Methods Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF advancing-simulation-practice Integration of Interprofessional Simulation for Safeguarding Children and Families: A Mixed Methods Study Jen Menzies, Sophie Meller, Elaine Robinson, Chris Counihan, Emma Clark, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4762927/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The study aims to evaluate the effectiveness of translational and transformational simulation experience in building student confidence around complex safeguarding decisions. Methods The research was framed within an exploratory sequential mix method design [ 1 ]. A survey before and after the safeguarding simulation using an author-developed questionnaire ad Likert scale were entered into SPSS (statistical software version 29) for quantitative analysis. Qualitative - student responses directly following the simulation using Mentimeter – a digital technology that collects anonymous comments in real-time and a professional independently facilitated discussion two weeks after the simulation. Results The quantitative results revealed a positive correlation between the experience of simulated interprofessional education and their confidence in understanding complex collaborative decision-making. Qualitative findings revealed four categories: (1) Confidence, (2) Information sharing, (3) Communication and (4) interprofessional working, derived from students' expressions of learning. Conclusion Interprofessional education (IPE) and simulation can produce a positive learning experience in theory and practice increasing student confidence significantly in complex collaborative decision-making. Understanding the complexities of different roles, alongside the value of information each brings, is imperative for safeguarding children and families. Interprofessional transformative simulation safeguarding practice complex decision-making deliberate practice mastery transitional simulation simulation models confidence communication Figures Figure 1 Background This study is uniquely placed in transformative and translational simulation with five disciplines across Healthcare, Social work, and Education, challenging established perspectives, leading to new beliefs and ways of being [ 2 , 3 , 4 ]. Safeguarding children's welfare is integral to all professional roles involving contact with children, young people, and their families [ 5 ]. Students feel ill-equipped with the specialist skills required for complex decisions in safeguarding practice, focusing on preventive rather than crisis learning, when protecting children and adults from harms including those as-sociated with violence and abuse and to master skills in the classroom that can support safeguarding practice [ 6 ]. It is a challenging and complex area of practice in which professionals often need more preparation [ 7 , 8 ]. The World Health Organisation advocates interprofessional education within healthcare curricula to encourage students to understand their views and challenge the stereotypes of other professionals [ 9 ]. Effective safeguarding requires a child-centered and coordinated approach, and multi-disciplinary simulation supports the international recommendation that Interprofessional education should be extended beyond health education [ 10 , 11 ]. IPE interventions positively impact students’ attitudes, skills, behaviors, and knowledge related to collaborative competencies that address the gap in theory and practice experience in decision-making and safeguarding [ 12 , 13 ]. Consequently, an interprofessional simulation workshop was designed and delivered by academics and practitioners with extensive experience in safeguarding practice [ 7 ] and recognised nationally for engaging in the development of interprofessional simulation education [ 14 ]. Simulation is the 'reproduction of behavioral traits through the act of pretending, imitating, or enacting a situation' [ 15 , p.5], as it can facilitate risk-taking by promoting safe, structured, supportive environment, inherent in participatory learning, which could accommodate failure [ 16 , p.372], allowing them to explore complex issues such as safeguarding [ 17 ]. The primary aim of this project was to introduce translational and transformational simulated deliberate practice to the curricula through an interprofessional workshop to develop students' confidence, knowledge, and skills toward mastery of skills in collaborative deliberate practice decision-making in safeguarding [ 2 , 3 , 18 ]. Methods Simulation design Within priority areas translational simulation that promotes patient safety and spans cultural healthcare organisations and interprofessional care processes is essential [ 2 , 18 ]. IPE is differentiated from multidisciplinary/multi professional education, where shared content is taught to many professions without the intention of developing interaction [ 19 , 20 ]. The Interprofessional Education Collaborative (IPEC) released a set of core competencies [ 21 ]. the simulation and educational model design aimed to embrace this and incorporate pedagogical mastery and deliberate practice. Mastery learning approaches aim to ensure that all students have mastered key concepts before moving on to the next topic or stage in professional development [ 22 ]. Deliberate practice involves training or learning activities designed to improve performance by using skilled practitioners and educators to develop practical skills [ 23 ]. Combining deliberate practice with mastery learning is a viable concept for skill attainment, resulting in a more effective learning experience and reduces the cognitive load on student learners [ 24 ]. Both theoretical foundations of mastery and deliberate practice were the basis for the simulation model to bring practice and theory together within a safe environment to learn and encompass the goals of each education programme. Intervention The present study concerns students’ views before and after attending an interprofessional safeguarding simulation. Different programmes of Third-year undergraduate midwifery (MW), postgraduate specialist community public health nurses (SCPHN both health visitors and school nurses), n = 15; Postgraduate Primary Education (PGCE) trainees, n = 22 and master’s social work (SW), n = 9 were invited to attend a simulation event held over one day in March 2022. The event lasted five hours [ 25 ]. These groups of students were identified because decision-making within complex safeguarding will be a significant part of their role in their training and career pathway. One week before the IPE workshop, students were given pre-debrief and a reflective tool information to reduce anxiety and promote psychological safety in such an emotive topic. A link was sent to each student to a documentary outlining the experiences of a child subjected to emotional abuse and witnessed domestic abuse within the family. This set the scene for the students to consider the child's voice. Upon arriving at the workshop, the students were placed into pre-determined interprofessional teams of nine to twelve. IPE activities are perceived by students as more relevant and successful when participants are organised in groups of this size [ 26 , 27 ]. The simulation consisted of a complex case study formed from real safeguarding experiences. Each discipline had its information, which, when put together, gave an overview of the whole case. The students must make decisions collectively by measuring against safeguarding threshold documents [ 28 , 29 ]. Students were then asked to prepare a brief report from the information for their own profession given to present at the stimulated strategy meeting. Each group was allocated two facilitators, one from a practice area and one academic colleague. One of the facilitators chaired the simulated strategy meeting, and each professional group presented the information they had considered. In addition, police and probation reports were presented by the chairperson. The groups then had to collate all the information heard and discuss how to progress using a framework developed from the signs of safety model [ 30 ] and using simulated thresholds debating each other’s perspective to come to a collective decision in an interprofessional team facilitated by the staff members. Method and Procedure The research was framed within an exploratory sequential mix method design [ 1 ]. This included an initial quantitative phase to explore students’ self-reported levels of confidence before and after attendance at the interdisciplinary safeguarding simulation. This was followed by a qualitative phase, which included collecting student responses directly following the simulation using Mentimeter – a digital technology that collects anonymous comments in real-time. We asked them to reflect on two themes of the day: Identify three aspects of safeguarding practice that you feel more informed about at the end of your interprofessional day and share with us that you have learned about working interprofessionaly that you will take forward into your own practice. In addition, a focus group was held two weeks later to further understand simulation experiences informed by the patterns uncovered in the quantitative data. An independent facilitator was enlisted to lead the focus group and, therefore, reduce any researcher bias. Nine students responded with interest in forming the focus group. However, only two students attended so the focus group became a facilitated professional discussion which was held virtually using the university blackboard collaborate platform. This platform was identified as the most secure and convenient platform for student access. The project team was aware that safeguarding scenarios can often be emotive and raise unexpected anxieties. A strict pre- and post-debrief was given, and a distress protocol was formulated and disseminated to all facilitators in each team. This ensured that supportive pathways could be adhered to should any student demonstrate signs of distress throughout the day. On the day, no students required intervention due to distress, and programme leads were able to reflect with students on their programmes following the event. Experienced practitioners were signposted and available to the students before, after and during the event to support psychological safety. Data analysis The primary aim of the study was to determine if students’ self-confidence scores improved when taking part in a simulated interdisciplinary safeguarding experience. To achieve this aim, students were grouped by their profession (student teachers, health professionals and social workers) and surveyed before and after the safeguarding simulation using an author-developed questionnaire. Pre-simulation, students were asked to indicate their experience of working with other students across different disciplines (1 = no experience – 3 significant experience). They were then asked to rate their self-confidence (1 = not confident at all to 5 = extremely confident), as a professional, in a multidisciplinary simulation. Students were asked the same question following the simulation. Results from the questionnaire were entered into SPSS (statistical software version 29) for quantitative analysis. It was decided that non-parametric measurements would form the analytic strategy given the small sample and due to violating some of the conditions for parametric testing. The Kruskal-Wallis test was used to test for median differences between each professional group’s experience of working with other disciplines with a post-hoc follow-up. The analysis acknowledged Zar’s guidance [ 31 ] on interpreting differences between unequal groups when reporting results. Similarly, a Wilcoxon-signed rank test was selected to test for median differences across matched observations – in this case self-confidence scores before and after the simulation conference. Qualitative Data Analysis Qualitative data in addition to the quantitative, was generated by student responses directly following the simulation using Mentimeter – a digital technology that collects anonymous comments in real-time. This was to enable a context around the scores from the survey. Two students attended a professional discussion meeting which was held two weeks after the simulation day to elicit rich qualitative data. An independent facilitator was enlisted to lead the focus group and, therefore, reduce any researcher bias. The facilitator had yet to be part of the simulated experience, employed by the university, or known to any students or the research team. The facilitator had met with two research team members on three separate occasions in the week leading up to the professional discussion for information and training purposes (around the electronic platform) only. The facilitator was an experienced professional who had previously led such sessions and was recommended by an independent staff member. Professional discussion recordings were listened to by the research team, and themes were identified independently using thematic analysis. Following Glasser’s coding process [ 32 ] we gathered student responses from Mentimeter to feed into the professional discussion data. Four themes were identified: Confidence, Information Sharing, Communication, and Interprofessional working. Results The descriptive analysis below in Table 1 illustrates the experiences each student cohort had working across disciplines, as reported at the beginning of the interprofessional safeguarding simulation. Generally, student health workers reported having some experience of working with students from other disciplines, however this was not consistent with responses from student teachers and student social workers who reported having little to no experience. The descriptive findings generally indicate students feel they have had limited opportunities to work with students from other disciplines. Table 1 Students’ experiences of working with other professional disciplines Student Teachers (n = 22) Student Social Workers (n = 9) Student Health Workers (n = 15) Experience Levels No experience working alongside students from other disciplines 77.3% 66.7% 20% Some experience working alongside students from other disciplines. 22.7% 22.2% 66.7% Significant experience working alongside students from other disciplines. 0% 11.1% 13.3% Further analysis was conducted to determine if the differences in experiences from each student cohort were statistically different from each other. A Kruskal-Wallis test was conducted to test for median differences in experience levels between teachers (n = 22), social workers (n = 9) and health workers (n = 15). Distribution of experience levels scores were similar for all groups, as assessed by visual inspection of a boxplot, and following guidance by Vargha & Delaney [ 33 ]. Median experience levels scores were statistically significantly different between each student cohort (i.e. teachers, social workers, and health workers), χ2(2) = 12.228, p = .002. Further analysis using pairwise comparisons were performed using Dunn’s procedure [ 34 ] with a Bonferroni correction for multiple comparisons. Using the adjusted p -values, the post-hoc analysis finds a statistically significant difference in median experience levels between student health workers (mdn = 2) and student teachers (mdn = 1) ( p = 0.02), but not between any other combination (e.g. student health workers and student social workers). The results suggest that student health workers have had more experience of working across other disciplines when compared to student teachers only. Given the significance of finding ways for students to work across disciplines, results are now presented based on the attitudinal changes following attendance of a simulated interprofessional safeguarding conference. Table 2 illustrates the frequency count of responses from students indicating their levels of self-confidence as a professional before and after a simulated safeguarding conference. Descriptive analysis reveals changes in self-confidence from pre-simulation to post-simulation, where over 70% of the cohort are fairly-to-completely confident in their ability to work professionally with others. Table 2 Pre and post safeguarding simulation conference self-confidence survey scores Pre safeguarding simulation self-confidence Post safeguarding simulation self-confidence Level of Agreement N = 46 % N = 46 % Not confident at all 1 2.2% 0 0% Slightly confident 11 23.9% 1 2.2% Somewhat confident 25 54.3% 9 19.6% Fairly confident 8 17.4% 28 60.9% Completely confident 1 2.2% 8 17.4% Further analysis using the Wilcoxon signed-ranks test was run to test for statistical differences. Results are concerned with students reflecting on their own self-confidence before and after participating in the simulated safeguarding conference. The difference scores were symmetrically distributed, as assessed by a histogram with superimposed normal curve. This was inspected visually by two of the research team who concorded the level of symmetry across the values. The Wilcoxon’s signed rank test revealed that students’ self-perceptions of their own confidence statistically significantly improved after attending the simulated safeguarding conference (Mdn = 4, e.g., fairly confident) compared to their pre-self-confident scores (Mdn = 3, e.g., somewhat confident), z = 4.49, p < .001, where the effect size was observed to be moderate r = .46 according to estimates by Cohen [ 35 ]. Of the 46 students who participated in the study, the post simulation conference scores elicited an increase in confidence for 35 students compared to pre-conference confidence, whereas 8 students did not see any difference, and 3 students saw a decrease in confidence. We explored confidence levels qualitatively at focus groups... Confidence This study like others found a strong correlation between the use of simulation and students’ reported self-confidence [ 36 ]. The qualitative results identified an improvement in confidence towards safeguarding after the simulation day; the in-depth qualitative feedback from the focus group supported this (see Table 3 ). Previous studies where students identify no change or a slight decrease this can be attributed to previous experience [ 4 , 7 ]. Several health students previously worked within safeguarding environment whilst the no-confidence or no increase in confidence can be because they already felt confident in this arena. The slight decrease could be due to the complexity of safeguarding and their new roles with the responsibility of complex decision-making. Table 3 qualitative themes Theme Quotes confidence 'It was good to see how other professionals work together, a newness of information. So how midwives knew one thing, teachers something else, it was interesting to see how that picture formed’ (P1) 'I think confidence-wise, it probably made me realise I was quite confident with my assessment; if you had asked me beforehand, I would have said I do not know what I am doing (P1) ‘I felt confident in my view’(P2). Information sharing ‘How other people’s evidence changes your own opinions and decisions regarding care ‘P2) ‘Importance of information sharing offering different perspectives and considering different views’ (p2) and “all different parts of the jigsaw come together even if you think it is nothing, it might end up being something (P1) ‘It was a good day to see how other professionals work together (P1) ‘How that picture is really formed’(P2). Communication ‘It made us realise how important it is to share that information’ (P1). ‘We come into these meetings with so much information, and you presume you know most of it, but it makes you realise you don't actually know the half of it’(P1). “It is vital to communicate.” “Communication is key” Interprofessional working ‘Understanding the different agencies involved and how important communication and record keeping is for safeguarding decisions. 'The role of other agencies and the impact of sharing concerns to get the full picture. 'That there are many aspects to look at and many viewpoints to understand the full picture.' P2 commented, 'It was interesting to hear the different opinions of different people about sharing information and things.’ P1 shared this view, 'It was a good day to see how other professionals work together, a newness of information. So how midwives knew one thing, teachers something else, it was interesting to see how that picture formed.' ‘[I] Gained insight, as in our role we come into these meetings with so much information. You presume you know most of it, but this makes you realise you don't actually know the half of it (P1). 'The importance and context of information shared by other professionals. ‘How many people are involved and how different information can come to light from different disciplines. ‘The need for everyone to be there, in case of any missed information.’ Students felt their confidence and reported increased knowledge of the safeguarding procedures and regulations concerning child protection. They also reflected that participating in the simulation helped them appreciate each professional group's unique viewpoint and contribution. Information Sharing Understanding information and communication of risks and relationship dynamics in safeguarding cases is essential if interventions are to influence family and child outcomes. Information sharing and interprofessional communication are one-way practitioners can agree on clear goals and responsibilities based upon open and honest communication [ 37 ]. However, interprofessional information sharing brings its challenges. Each member brings their own professional and personal viewpoints to a case and situation, often increasing decision-making uncertainty among novice professionals [ 38 ]. Practitioners rely on their intuitive expertise while students acknowledge the importance of communication, which is so often omitted, and the downfall revealed in many serious case reviews [ 39 , 40 ]. Communication Recognising child neglect requires effective interprofessional liaison and the development of working relationships to reduce the risk of significant harm [ 41 ]. The Mentimeter (see Fig. 2 identified critical skills required for effective communication, such as listening to others’ views and contemporaneous record keeping, as vital to professional safeguarding responsibilities. the IPE day helped develop their skills in listening and communication. Indeed, through communication with other professionals, students learned that their views could be influenced by the viewpoint of others within the strategy. Students highlighted that the number of professionals involved and the bringing together multiple communication elements of information was essential in understanding the complete picture of a child’s life, allowing strengths and concerns to be identified. Interprofessional working. There was overwhelming evidence through students' comments on Mentimeter (see Fig. 1 ) that multi-agency working, and collaboration were key areas in which students felt they gained the most knowledge. Discussion Interprofessional working is a challenging area of practice that cannot simply be prescribed through protocols and procedures, nor acquired as a set of technical competences [ 7 ]. Translational simulation is simulation that offers a safe place to practice essential skills of decision making and teamwork without putting patients or students at risk. This has been recognised in studies [ 2 ] that identify this type of education can be on demand without relying on practice opportunistic events and ensure that all students are given the opportunity to develop these skills. The results of this study suggest that interprofessional safeguarding education using a transformational simulated learning approach improved confidence. The IPE also heightened the students’ awareness of different agency roles, information, and, ultimately, how collaborative decisions are made in this area of practice. Students identified through the focus group and Mentimeter (see Fig. 2) that attending the study day enhanced their confidence in potentially participating in an actual safeguarding strategy meeting. They reported increased knowledge of the safeguarding procedures and regulations concerning child protection, and participation in the simulation helped them appreciate each professional group's unique viewpoint and contribution. Interestingly, whilst all groups identified an overall increase in confidence of at least one point on the Likert scale (see Table 1 above), a correlation between lower student numbers from a specific discipline and higher confidence scores was noted. This could be attributed to the organisation of the disciplines, where the groups with a more significant number of participants from one discipline had one spokesperson. Not all members participated equally, thus diluting the experience, and reducing the overall confidence score. This was also reflected in the comments in the professional discussion, where students stated they preferred to be in smaller groups. Interprofessional working is essential for collaboration and teamwork, and effective communication enables practitioners to work across boundaries, share responsibility, and critically review collective decisions [ 42 , 7 ]. Working interprofessionally to safeguard children’s welfare requires expert practice and a higher level of communication. It depends on the ability and experience of the practitioner and is shaped by their role as well as the profession in which they have trained and worked [ 7 ]. The simulation highlighted the value and contribution of all the disciplines, identifying this promoted respect and a shared understanding of the differing roles. Although simulated learning is abundant within healthcare, it is evident that these experiences rarely combine more than two agencies and are mainly clinical skills focused. The day was incorporated into educational modules that addressed theoretical components of safeguarding practice, acknowledging that skill acquisition is not just a matter of intuitive understanding and experiential learning but also relies on formal knowledge and a critical understanding of research evidence [43, 44). Students highlighted that they communicated collectively throughout the day, enabling them to draw conclusions and employ decision-making regarding safeguarding thresholds. This method of IPE and simulation serves to transform practice and dispel the invisible walls that “create institutional and cultural barriers, which in child protection may be exacerbated by institutional anxiety about risk” [ 7 , p.493]. For future frontline practitioners, the complexity of safeguarding cases can often lead to conflict and confusion in unfamiliar interprofessional networks. This highlights the need for more IPE via simulation across health, education, and social care, not only in safeguarding but in all areas to transform outcomes and reduce risk for our populations. Interprofessional simulation exercises can be stressful and anxiety-inducing, and so could limit the capacity for learning as a factor related to the simulation process [ 45 ]. Psychological safety was deeply considered in terms of interprofessional education, but safeguarding and domestic abuse were contentious and emotive topics, with risk assessment and signposting identified for students at the start of the day. A culture of psychological safety helps teams engage in learning behaviours when not present results in constraints discussion and communication. [ 45 ]. The simulation day enabled such discussions to address the concept of developing interprofessional expertise to transform practitioners in becoming more proficient at working with others to manage complex child safeguarding issues. This level of discussion through enhanced interprofessional simulation experience improved the students’ communication and decision-making skills, attitudes, and perceptions of their own and others’ professional roles [ 46 , 47 ]. , identify that pre-or undergraduate education may not readily transfer to the postgraduate work context of specialist education. In preparation for new roles development is essential, for some this is a career change in an entirely different identity and for those students the understanding of others and their own role it essential to promote client safety and effective working within high pressure environment to make clinical decisions in safeguarding. Implications for Practice Research indicates that IPE is critical to developing student curricula across interprofessional programmes, even when timetabling constraints, cost, risk-averse departmental cultures, lecturer and practitioner attendance, and programme-specific requirements set by professional regulations are considered [ 48 ]. All require stringent and timely planning from teams to ensure the provision of a structured and effective IPE day. Enabling practitioners to be given time out to support IPE requires service managers to appreciate the importance and relevance to their work environment, facilitating protected time from practice for practitioners to be involved. Maintaining strong partnerships between university and practice areas is paramount in designing, developing, and implementing such simulated IPE activities, which will ultimately benefit practice by developing skills of knowledge of newly qualified students transitioning into their area of specialism. Descriptive analysis within this study reveals that over 70% of the cohort felt fairly to completely confident in their ability to work with other professionals following this exercise. We acknowledge that there is a difference at the beginning of the interprofessional simulation where some health workers have experience, but this is not consistent with the responses from education and social work students who report having little or no experience. Whilst previous experience may influence the confidence scores one qualitative results had identified that all students some degree of improvement in working practices from the exercise. Limitations As discussed earlier, the study's limitations concerning the quantitative data collected demonstrated that fewer participants responded to the post-survey (54 respondents) than completed the pre-survey (91 respondents). The implications of this were that the quantitative data from the post-survey could not yield results as reliable as the pre-survey data. As a group of researchers, this was reflected upon. A larger focus group for professional discussion would have also allowed a broader set of feedback and increased parity of responses across the programmes involved. Conclusion The development of this multi-agency simulation event as a learning experience for these students proved to be a positive and significant learning experience. Students across all four programmes commented that they would like this shared learning to occur more frequently. The interprofessional educational simulation has been recognised externally {49} as a strength of our provision .It was evident from both qualitative and quantitative results that student confidence in making complex safeguarding decisions increased as a direct result of this day. In such multiple professional and complex situations, IPE supports students to develop confidence and capability in many aspects of health and social care. Building on this study, future work should focus on interprofessional education's distinct nature, utilising the Menzies model of deliberate practice and mastery to formulate future sessions that contribute to further promote the development of conceptual models that future research could test and verify. In addition to this, a validated tools could be developed and utilised to measure qualitative data rather than Mentimeter, which may have differing results in this way, system-wide positive outcomes will be generated across education and practice. Declarations Declaration of generative AI (Artificial Intelligence) and AI-assisted technologies in the writing process While preparing this work, the author(s) used Grammarly to check for any grammatical errors. After using this tool/service, the author(s) reviewed and edited the content as needed and took full responsibility for the content of the publication. This project gained ethical approval from Northumbria University at Newcastle (41092). All participants provided written consent using the institutional form approved. Consent for publication- has been given by all authors J Menzies, S Meller,C ,Coulihan, E Robinson, E Clark ,J Ogle and M Dorward. Availability of data and materials-The datasets generated and/or analysed during the current study are not publicly available due University restrictions but are available from the corresponding author on reasonable request. Competing interests-The authors declare that they have no competing interests. Funding -not applicable Authors contributions-see section Acknowledgements-not applicable. Authors information- all authors have considerable professional and academic experience in their discipline and the challenges interprofessional decision making brings and the complex nature of child safeguarding. Jen Menzies identified the issue after more than 30 years in Nursing and the last 16 in safeguarding casework supporting families in the community and students with life changing decisions and circumstances. Transformational simulation came from serious case reviews following significant harm, injury or death to clients where other decisions could have been made. This formed the basis of a model of simulation alongside deliberate practice and Mastery within the University environment. The contributions of other agencies to these decisions and knowledge of their roles and the information they have is imperative to promote client safety and support students in their roles. Author Contribution JM wrote main manuscript text,lead for project.SM and ER helped write conclusion and qualitative section and ethics.CC analysed and wrote quantitative section and assisted with references. MD,EC,JO were involved in the setting up of the project and delivery and assisted in initial literature review and article selection.all authors have read the manuscript. References Creswell JW. Research design: Qualitative, quantitative, and mixed methods approach. 2nd ed. Thousand Oaks, CA: Sage; 2003. Brazil V, Reedy G. Translational simulation revisited: an evolving conceptual model for the contribution of simulation to healthcare quality and safety. 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London: HM Government; 2018 Turnell, A., & Edwards, S. (1999). Signs of Safety: A Solution and Safety Oriented Approach to Child Protection Casework. New York: Norton. Zar, J.H. (2010). Biostatistical Analysis, 5th ed. Pearson Prentice Hall: Upper Saddle River, NJ. Glaser B. G. (1978). Theoretical sensitivity. Sociology Press. Vargha, A., & Delaney, H. D. (1998). Kruskal-Walli’s test and stochastic homogeneity. Journal of Educational and behavioral Statistics, 23(2), 170–192. Dunn OJ. Multiple comparisons using rank sums. Technometrics. 1964; 6:241–52. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988. Zapko, K. A., Ferranto, M. L. G., Blasiman, R., & Shelestak, D. (2018). Evaluating best educational practices, student satisfaction, and self-confidence in simulation: A descriptive study. Nurse Education Today, 60, 28–34. https://doi.org/10.1016/j.nedt.2017.09.006 Stewart, A., Petch, A., & Curtice, L. (2003). Moving towards integrated working in health and social care in Scotland: From maze to matrix. Journal of Interprofessional Care, 17(4), 335–350 Lash S. Risk Culture. In: Adam B, Beck U, Van Loon J, editors. The Risk Society and Beyond: Critical Issues for Social Theory. London: Sage; 2000. p. 47–62. Whittaker A & Taylor B (2018). Professional judgement and decision-making in social work, Journal of Social Work Practice, 32:2, 105–109. (“Professional Judgement and Decision Making in Social Work Current … Social Care Institute for Excellence. Learning from case reviews: interprofessional communication and decision-making [Internet]. 2015 [cited 2022 Oct 24]. Available from: https://www.scie.org.uk/files/safeguarding/children/case-reviews/learning-from-case-reviews/interprofessional-communication-decision-making.pdf Sharley V. Identifying and Responding to Child Neglect within Schools: Differing Perspectives and the Implications for Inter-Agency Practice. Child Indic Res. 2020; 13:555–71. Hewitt G, Sims S, Harris R. Evidence of communication, influence, and behavioural norms in interprofessional teams: a realist synthesis. J Interprof Care. 2015;29(2):100–5. Munro E. Effective child protection. London: SAGE Publication Ltd.; 2008. 176 p. Department for Education (DfE) (2023) Working together to safeguard children: a guide to multi-agency working to help, protect and promote the welfare of children. London HM goverment [Accessed 15/12/2023] Connolly F, De Brún A, McAuliffe E. A narrative synthesis of learners' experiences of barriers and facilitators related to effective interprofessional simulation. J Interprof Care. 2022;36(2):222–33. Machin AI and Pearson P (2013) Health visitors' interprofessional working experiences: Implications for their collaborative public health role Journal of Health Visiting 2013 1:1, 31–38 Domac S, Haider S. Interagency safeguarding adults training for protection and prevention. J Interprof Care. 2013;27(6):520–2. O'Keefe M, Ward H. Implementing interprofessional curriculum: how problems might also be answers. BMC Med Educ. 2018; 18:132 The Office for Standards in Education, Children’s Services and Skills (Ofsted) (2024) Initial teacher education report: University of Northumbria. [Online] Available at: http://www.reports.ofsted.gov.uk/ (Accessed 19 July 2024). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4762927","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"advancing-simulation-practice","associatedPublications":[],"authors":[{"id":332718725,"identity":"c4e53745-f97d-4b2a-a2be-f50e8029857d","order_by":0,"name":"Jen Menzies","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABR0lEQVRIie2RMUvDQBSAXxDiEuwmFwL6F54UomJJf4jLhYPr0lBXwSFSSJfYOZt/oZPa7cpBplTXgg4tgpNDRSgZxJpQYhNanB3uG4733t3He48DUCj+IZqfHbRRpAhQK8q4uswwtii8pJh5ZfSHsoKXYhS/SkFV2endxNMpbXRgX8az9KLRrD9348+PB3l+bMnrOVw5gImoDBY+tpBSfupbvIUEuXv3ErNolEhv2He7BGIGOPYrStS2iZtKBCsLECW1J+06jALpDRLNJ6ALwKfq+rfvNqF0mSmdBaG4bNajtdJN4XtTiYxcEXkXnQgU2oCslYBogdgYLGznCkPd4rbpI3OjCWcwDlreMNSCE7fPDLO6/lEvsc2UOliz2JuZfjnNWsQkXAZn3r2x+zqZL5yDvYRWlKKnDluhmx95uP2lQqFQKEr8ABbfe41biEWvAAAAAElFTkSuQmCC","orcid":"","institution":"Northumbria University","correspondingAuthor":true,"prefix":"","firstName":"Jen","middleName":"","lastName":"Menzies","suffix":""},{"id":332718726,"identity":"a18d6e29-d452-4de6-a097-62e08a54e593","order_by":1,"name":"Sophie Meller","email":"","orcid":"","institution":"Northumbria University","correspondingAuthor":false,"prefix":"","firstName":"Sophie","middleName":"","lastName":"Meller","suffix":""},{"id":332718727,"identity":"7f5015c3-c9e5-426d-8737-88a50136b931","order_by":2,"name":"Elaine Robinson","email":"","orcid":"","institution":"Northumbria University","correspondingAuthor":false,"prefix":"","firstName":"Elaine","middleName":"","lastName":"Robinson","suffix":""},{"id":332718728,"identity":"ffbf17d1-441d-4c7a-92bd-7438dbe658d2","order_by":3,"name":"Chris Counihan","email":"","orcid":"","institution":"Northumbria University","correspondingAuthor":false,"prefix":"","firstName":"Chris","middleName":"","lastName":"Counihan","suffix":""},{"id":332718729,"identity":"2ae54f50-d71f-4e38-bce2-28e5490ef930","order_by":4,"name":"Emma Clark","email":"","orcid":"","institution":"University of York","correspondingAuthor":false,"prefix":"","firstName":"Emma","middleName":"","lastName":"Clark","suffix":""},{"id":332718730,"identity":"fa3a5a2b-4531-4c1b-b5f2-1ec0b32117d2","order_by":5,"name":"Justine Ogle","email":"","orcid":"","institution":"Northumbria University","correspondingAuthor":false,"prefix":"","firstName":"Justine","middleName":"","lastName":"Ogle","suffix":""},{"id":332718731,"identity":"049ee031-9c1f-4342-ae89-eab5041c3784","order_by":6,"name":"Margaret Dorward","email":"","orcid":"","institution":"newcastle health care trust","correspondingAuthor":false,"prefix":"","firstName":"Margaret","middleName":"","lastName":"Dorward","suffix":""}],"badges":[],"createdAt":"2024-07-18 13:22:55","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4762927/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4762927/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":63279772,"identity":"df6ef0d5-fe40-4cbb-8000-363ce1fb1cfe","added_by":"auto","created_at":"2024-08-26 12:46:17","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":127185,"visible":true,"origin":"","legend":"\u003cp\u003eMentimeter results\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4762927/v1/ab61fa496ebad1b20cba1c79.jpg"},{"id":70317374,"identity":"b80d2354-5925-4b99-8f0c-ddea96df91f2","added_by":"auto","created_at":"2024-12-02 06:03:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":957195,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4762927/v1/86ccc25f-302d-4074-be26-d4e2477f7db5.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Integration of Interprofessional Simulation for Safeguarding Children and Families: A Mixed Methods Study","fulltext":[{"header":"Background","content":"\u003cp\u003eThis study is uniquely placed in transformative and translational simulation with five disciplines across Healthcare, Social work, and Education, challenging established perspectives, leading to new beliefs and ways of being [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Safeguarding children's welfare is integral to all professional roles involving contact with children, young people, and their families [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Students feel ill-equipped with the specialist skills required for complex decisions in safeguarding practice, focusing on preventive rather than crisis learning, when protecting children and adults from harms including those as-sociated with violence and abuse and to master skills in the classroom that can support safeguarding practice [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. It is a challenging and complex area of practice in which professionals often need more preparation [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The World Health Organisation advocates interprofessional education within healthcare curricula to encourage students to understand their views and challenge the stereotypes of other professionals [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Effective safeguarding requires a child-centered and coordinated approach, and multi-disciplinary simulation supports the international recommendation that Interprofessional education should be extended beyond health education [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. IPE interventions positively impact students\u0026rsquo; attitudes, skills, behaviors, and knowledge related to collaborative competencies that address the gap in theory and practice experience in decision-making and safeguarding [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Consequently, an interprofessional simulation workshop was designed and delivered by academics and practitioners with extensive experience in safeguarding practice [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] and recognised nationally for engaging in the development of interprofessional simulation education [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Simulation is the 'reproduction of behavioral traits through the act of pretending, imitating, or enacting a situation' [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, p.5], as it can facilitate risk-taking by promoting safe, structured, supportive environment, inherent in participatory learning, which could accommodate failure [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, p.372], allowing them to explore complex issues such as safeguarding [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe primary aim of this project was to introduce translational and transformational simulated deliberate practice to the curricula through an interprofessional workshop to develop students' confidence, knowledge, and skills toward mastery of skills in collaborative deliberate practice decision-making in safeguarding [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSimulation design\u003c/h2\u003e \u003cp\u003eWithin priority areas translational simulation that promotes patient safety and spans cultural healthcare organisations and interprofessional care processes is essential [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. IPE is differentiated from multidisciplinary/multi professional education, where shared content is taught to many professions without the intention of developing interaction [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe Interprofessional Education Collaborative (IPEC) released a set of core competencies [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. the simulation and educational model design aimed to embrace this and incorporate pedagogical mastery and deliberate practice. Mastery learning approaches aim to ensure that all students have mastered key concepts before moving on to the next topic or stage in professional development [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Deliberate practice involves training or learning activities designed to improve performance by using skilled practitioners and educators to develop practical skills [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Combining deliberate practice with mastery learning is a viable concept for skill attainment, resulting in a more effective learning experience and reduces the cognitive load on student learners [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBoth theoretical foundations of mastery and deliberate practice were the basis for the simulation model to bring practice and theory together within a safe environment to learn and encompass the goals of each education programme.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eIntervention\u003c/h2\u003e \u003cp\u003eThe present study concerns students\u0026rsquo; views before and after attending an interprofessional safeguarding simulation. Different programmes of Third-year undergraduate midwifery (MW), postgraduate specialist community public health nurses (SCPHN both health visitors and school nurses), \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;15; Postgraduate Primary Education (PGCE) trainees, \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;22 and master\u0026rsquo;s social work (SW), \u003cem\u003en\u0026thinsp;=\u003c/em\u003e\u0026thinsp;9 were invited to attend a simulation event held over one day in March 2022. The event lasted five hours [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. These groups of students were identified because decision-making within complex safeguarding will be a significant part of their role in their training and career pathway.\u003c/p\u003e \u003cp\u003eOne week before the IPE workshop, students were given pre-debrief and a reflective tool information to reduce anxiety and promote psychological safety in such an emotive topic. A link was sent to each student to a documentary outlining the experiences of a child subjected to emotional abuse and witnessed domestic abuse within the family. This set the scene for the students to consider the child's voice. Upon arriving at the workshop, the students were placed into pre-determined interprofessional teams of nine to twelve. IPE activities are perceived by students as more relevant and successful when participants are organised in groups of this size [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe simulation consisted of a complex case study formed from real safeguarding experiences. Each discipline had its information, which, when put together, gave an overview of the whole case. The students must make decisions collectively by measuring against safeguarding threshold documents [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Students were then asked to prepare a brief report from the information for their own profession given to present at the stimulated strategy meeting.\u003c/p\u003e \u003cp\u003eEach group was allocated two facilitators, one from a practice area and one academic colleague. One of the facilitators chaired the simulated strategy meeting, and each professional group presented the information they had considered. In addition, police and probation reports were presented by the chairperson.\u003c/p\u003e \u003cp\u003eThe groups then had to collate all the information heard and discuss how to progress using a framework developed from the signs of safety model [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] and using simulated thresholds debating each other\u0026rsquo;s perspective to come to a collective decision in an interprofessional team facilitated by the staff members.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eMethod and Procedure\u003c/h2\u003e \u003cp\u003eThe research was framed within an exploratory sequential mix method design [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. This included an initial quantitative phase to explore students\u0026rsquo; self-reported levels of confidence before and after attendance at the interdisciplinary safeguarding simulation. This was followed by a qualitative phase, which included collecting student responses directly following the simulation using Mentimeter \u0026ndash; a digital technology that collects anonymous comments in real-time. We asked them to reflect on two themes of the day: Identify three aspects of safeguarding practice that you feel more informed about at the end of your interprofessional day and share with us that you have learned about working interprofessionaly that you will take forward into your own practice.\u003c/p\u003e \u003cp\u003eIn addition, a focus group was held two weeks later to further understand simulation experiences informed by the patterns uncovered in the quantitative data. An independent facilitator was enlisted to lead the focus group and, therefore, reduce any researcher bias.\u003c/p\u003e \u003cp\u003eNine students responded with interest in forming the focus group. However, only two students attended so the focus group became a facilitated professional discussion which was held virtually using the university blackboard collaborate platform. This platform was identified as the most secure and convenient platform for student access.\u003c/p\u003e \u003cp\u003eThe project team was aware that safeguarding scenarios can often be emotive and raise unexpected anxieties. A strict pre- and post-debrief was given, and a distress protocol was formulated and disseminated to all facilitators in each team. This ensured that supportive pathways could be adhered to should any student demonstrate signs of distress throughout the day. On the day, no students required intervention due to distress, and programme leads were able to reflect with students on their programmes following the event. Experienced practitioners were signposted and available to the students before, after and during the event to support psychological safety.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eThe primary aim of the study was to determine if students\u0026rsquo; self-confidence scores improved when taking part in a simulated interdisciplinary safeguarding experience. To achieve this aim, students were grouped by their profession (student teachers, health professionals and social workers) and surveyed before and after the safeguarding simulation using an author-developed questionnaire. Pre-simulation, students were asked to indicate their experience of working with other students across different disciplines (1\u0026thinsp;=\u0026thinsp;no experience \u0026ndash; 3 significant experience). They were then asked to rate their self-confidence (1\u0026thinsp;=\u0026thinsp;not confident at all to 5\u0026thinsp;=\u0026thinsp;extremely confident), as a professional, in a multidisciplinary simulation. Students were asked the same question following the simulation.\u003c/p\u003e \u003cp\u003eResults from the questionnaire were entered into SPSS (statistical software version 29) for quantitative analysis. It was decided that non-parametric measurements would form the analytic strategy given the small sample and due to violating some of the conditions for parametric testing. The Kruskal-Wallis test was used to test for median differences between each professional group\u0026rsquo;s experience of working with other disciplines with a post-hoc follow-up. The analysis acknowledged Zar\u0026rsquo;s guidance [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] on interpreting differences between unequal groups when reporting results. Similarly, a Wilcoxon-signed rank test was selected to test for median differences across matched observations \u0026ndash; in this case self-confidence scores before and after the simulation conference.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eQualitative Data Analysis\u003c/h2\u003e \u003cp\u003eQualitative data in addition to the quantitative, was generated by student responses directly following the simulation using Mentimeter \u0026ndash; a digital technology that collects anonymous comments in real-time. This was to enable a context around the scores from the survey. Two students attended a professional discussion meeting which was held two weeks after the simulation day to elicit rich qualitative data. An independent facilitator was enlisted to lead the focus group and, therefore, reduce any researcher bias. The facilitator had yet to be part of the simulated experience, employed by the university, or known to any students or the research team. The facilitator had met with two research team members on three separate occasions in the week leading up to the professional discussion for information and training purposes (around the electronic platform) only. The facilitator was an experienced professional who had previously led such sessions and was recommended by an independent staff member.\u003c/p\u003e \u003cp\u003eProfessional discussion recordings were listened to by the research team, and themes were identified independently using thematic analysis. Following Glasser\u0026rsquo;s coding process [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] we gathered student responses from Mentimeter to feed into the professional discussion data. Four themes were identified: Confidence, Information Sharing, Communication, and Interprofessional working.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe descriptive analysis below in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e illustrates the experiences each student cohort had working across disciplines, as reported at the beginning of the interprofessional safeguarding simulation. Generally, student health workers reported having some experience of working with students from other disciplines, however this was not consistent with responses from student teachers and student social workers who reported having little to no experience. The descriptive findings generally indicate students feel they have had limited opportunities to work with students from other disciplines.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStudents\u0026rsquo; experiences of working with other professional disciplines\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudent\u003c/p\u003e \u003cp\u003eTeachers\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;22)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStudent Social Workers (n\u0026thinsp;=\u0026thinsp;9)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStudent Health Workers\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExperience Levels\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo experience working alongside students from other disciplines\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e77.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSome experience working alongside students from other disciplines.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSignificant experience working alongside students from other disciplines.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003cp\u003eFurther analysis was conducted to determine if the differences in experiences from each student cohort were statistically different from each other. A Kruskal-Wallis test was conducted to test for median differences in experience levels between teachers (n\u0026thinsp;=\u0026thinsp;22), social workers (n\u0026thinsp;=\u0026thinsp;9) and health workers (n\u0026thinsp;=\u0026thinsp;15). Distribution of experience levels scores were similar for all groups, as assessed by visual inspection of a boxplot, and following guidance by Vargha \u0026amp; Delaney [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Median experience levels scores were statistically significantly different between each student cohort (i.e. teachers, social workers, and health workers), χ2(2)\u0026thinsp;=\u0026thinsp;12.228, p\u0026thinsp;=\u0026thinsp;.002. Further analysis using pairwise comparisons were performed using Dunn\u0026rsquo;s procedure [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] with a Bonferroni correction for multiple comparisons. Using the adjusted \u003cem\u003ep\u003c/em\u003e-values, the post-hoc analysis finds a statistically significant difference in median experience levels between student health workers (mdn\u0026thinsp;=\u0026thinsp;2) and student teachers (mdn\u0026thinsp;=\u0026thinsp;1) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.02), but not between any other combination (e.g. student health workers and student social workers). The results suggest that student health workers have had more experience of working across other disciplines when compared to student teachers only.\u003c/p\u003e \u003cp\u003eGiven the significance of finding ways for students to work across disciplines, results are now presented based on the attitudinal changes following attendance of a simulated interprofessional safeguarding conference. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e illustrates the frequency count of responses from students indicating their levels of self-confidence as a professional before and after a simulated safeguarding conference. Descriptive analysis reveals changes in self-confidence from pre-simulation to post-simulation, where over 70% of the cohort are fairly-to-completely confident in their ability to work professionally with others.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePre and post safeguarding simulation conference self-confidence survey scores\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePre safeguarding simulation self-confidence\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePost safeguarding simulation self-confidence\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLevel of Agreement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot confident at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSlightly confident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSomewhat confident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFairly confident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e60.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCompletely confident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e\u003c/h2\u003e \u003cp\u003eFurther analysis using the Wilcoxon signed-ranks test was run to test for statistical differences. Results are concerned with students reflecting on their own self-confidence before and after participating in the simulated safeguarding conference. The difference scores were symmetrically distributed, as assessed by a histogram with superimposed normal curve. This was inspected visually by two of the research team who concorded the level of symmetry across the values. The Wilcoxon\u0026rsquo;s signed rank test revealed that students\u0026rsquo; self-perceptions of their own confidence statistically significantly improved after attending the simulated safeguarding conference (Mdn\u0026thinsp;=\u0026thinsp;4, e.g., fairly confident) compared to their pre-self-confident scores (Mdn\u0026thinsp;=\u0026thinsp;3, e.g., somewhat confident), \u003cem\u003ez\u0026thinsp;=\u003c/em\u003e\u0026thinsp;4.49, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001, where the effect size was observed to be moderate \u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.46 according to estimates by Cohen [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Of the 46 students who participated in the study, the post simulation conference scores elicited an increase in confidence for 35 students compared to pre-conference confidence, whereas 8 students did not see any difference, and 3 students saw a decrease in confidence. We explored confidence levels qualitatively at focus groups...\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eConfidence\u003c/h2\u003e \u003cp\u003eThis study like others found a strong correlation between the use of simulation and students\u0026rsquo; reported self-confidence [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. The qualitative results identified an improvement in confidence towards safeguarding after the simulation day; the in-depth qualitative feedback from the focus group supported this (see Table \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Previous studies where students identify no change or a slight decrease this can be attributed to previous experience [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Several health students previously worked within safeguarding environment whilst the no-confidence or no increase in confidence can be because they already felt confident in this arena. The slight decrease could be due to the complexity of safeguarding and their new roles with the responsibility of complex decision-making.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003equalitative themes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTheme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQuotes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003econfidence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e'It was good to see how other professionals work together, a newness of information. So how midwives knew one thing, teachers something else, it was interesting to see how that picture formed\u0026rsquo; (P1)\u003c/p\u003e \u003cp\u003e'I think confidence-wise, it probably made me realise I was quite confident with my assessment; if you had asked me beforehand, I would have said I do not know what I am doing (P1)\u003c/p\u003e \u003cp\u003e\u0026lsquo;I felt confident in my view\u0026rsquo;(P2).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInformation sharing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lsquo;How other people\u0026rsquo;s evidence changes your own opinions and decisions regarding care \u0026lsquo;P2)\u003c/p\u003e \u003cp\u003e\u0026lsquo;Importance of information sharing offering different perspectives and considering different views\u0026rsquo; (p2)\u003c/p\u003e \u003cp\u003eand \u0026ldquo;all different parts of the jigsaw come together even if you think it is nothing, it might end up being something (P1)\u003c/p\u003e \u003cp\u003e\u0026lsquo;It was a good day to see how other professionals work together (P1)\u003c/p\u003e \u003cp\u003e\u0026lsquo;How that picture is really formed\u0026rsquo;(P2).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommunication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lsquo;It made us realise how important it is to share that information\u0026rsquo; (P1).\u003c/p\u003e \u003cp\u003e\u0026lsquo;We come into these meetings with so much information, and you presume you know most of it, but it makes you realise you don't actually know the half of it\u0026rsquo;(P1).\u003c/p\u003e \u003cp\u003e\u0026ldquo;It is vital to communicate.\u0026rdquo; \u0026ldquo;Communication is key\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInterprofessional working\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lsquo;Understanding the different agencies involved and how important communication and record keeping is for safeguarding decisions.\u003c/p\u003e \u003cp\u003e'The role of other agencies and the impact of sharing concerns to get the full picture.\u003c/p\u003e \u003cp\u003e'That there are many aspects to look at and many viewpoints to understand the full picture.'\u003c/p\u003e \u003cp\u003eP2 commented, 'It was interesting to hear the different opinions of different people about sharing information and things.\u0026rsquo;\u003c/p\u003e \u003cp\u003eP1 shared this view, 'It was a good day to see how other professionals work together, a newness of information. So how midwives knew one thing, teachers something else, it was interesting to see how that picture formed.' \u0026lsquo;[I] Gained insight, as in our role we come into these meetings with so much information. You presume you know most of it, but this makes you realise you don't actually know the half of it (P1).\u003c/p\u003e \u003cp\u003e'The importance and context of information shared by other professionals.\u003c/p\u003e \u003cp\u003e\u0026lsquo;How many people are involved and how different information can come to light from different disciplines.\u003c/p\u003e \u003cp\u003e\u0026lsquo;The need for everyone to be there, in case of any missed information.\u0026rsquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eStudents felt their confidence and reported increased knowledge of the safeguarding procedures and regulations concerning child protection. They also reflected that participating in the simulation helped them appreciate each professional group's unique viewpoint and contribution.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eInformation Sharing\u003c/h2\u003e \u003cp\u003eUnderstanding information and communication of risks and relationship dynamics in safeguarding cases is essential if interventions are to influence family and child outcomes. Information sharing and interprofessional communication are one-way practitioners can agree on clear goals and responsibilities based upon open and honest communication [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. However, interprofessional information sharing brings its challenges. Each member brings their own professional and personal viewpoints to a case and situation, often increasing decision-making uncertainty among novice professionals [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Practitioners rely on their intuitive expertise while students acknowledge the importance of communication, which is so often omitted, and the downfall revealed in many serious case reviews [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eCommunication\u003c/h2\u003e \u003cp\u003eRecognising child neglect requires effective interprofessional liaison and the development of working relationships to reduce the risk of significant harm [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. The Mentimeter (see Fig.\u0026nbsp;2 identified critical skills required for effective communication, such as listening to others\u0026rsquo; views and contemporaneous record keeping, as vital to professional safeguarding responsibilities. the IPE day helped develop their skills in listening and communication.\u003c/p\u003e \u003cp\u003eIndeed, through communication with other professionals, students learned that their views could be influenced by the viewpoint of others within the strategy.\u003c/p\u003e \u003cp\u003eStudents highlighted that the number of professionals involved and the bringing together multiple communication elements of information was essential in understanding the complete picture of a child\u0026rsquo;s life, allowing strengths and concerns to be identified.\u003c/p\u003e \u003cp\u003e \u003cb\u003eInterprofessional working.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThere was overwhelming evidence through students' comments on Mentimeter (see Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) that multi-agency working, and collaboration were key areas in which students felt they gained the most knowledge.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eInterprofessional working is a challenging area of practice that cannot simply be prescribed through protocols and procedures, nor acquired as a set of technical competences [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTranslational simulation is simulation that offers a safe place to practice essential skills of decision making and teamwork without putting patients or students at risk. This has been recognised in studies [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] that identify this type of education can be on demand without relying on practice opportunistic events and ensure that all students are given the opportunity to develop these skills.\u003c/p\u003e \u003cp\u003eThe results of this study suggest that interprofessional safeguarding education using a transformational simulated learning approach improved confidence. The IPE also heightened the students\u0026rsquo; awareness of different agency roles, information, and, ultimately, how collaborative decisions are made in this area of practice. Students identified through the focus group and Mentimeter (see Fig.\u0026nbsp;2) that attending the study day enhanced their confidence in potentially participating in an actual safeguarding strategy meeting. They reported increased knowledge of the safeguarding procedures and regulations concerning child protection, and participation in the simulation helped them appreciate each professional group's unique viewpoint and contribution.\u003c/p\u003e \u003cp\u003eInterestingly, whilst all groups identified an overall increase in confidence of at least one point on the Likert scale (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e above), a correlation between lower student numbers from a specific discipline and higher confidence scores was noted. This could be attributed to the organisation of the disciplines, where the groups with a more significant number of participants from one discipline had one spokesperson. Not all members participated equally, thus diluting the experience, and reducing the overall confidence score. This was also reflected in the comments in the professional discussion, where students stated they preferred to be in smaller groups.\u003c/p\u003e \u003cp\u003eInterprofessional working is essential for collaboration and teamwork, and effective communication enables practitioners to work across boundaries, share responsibility, and critically review collective decisions [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Working interprofessionally to safeguard children\u0026rsquo;s welfare requires expert practice and a higher level of communication. It depends on the ability and experience of the practitioner and is shaped by their role as well as the profession in which they have trained and worked [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The simulation highlighted the value and contribution of all the disciplines, identifying this promoted respect and a shared understanding of the differing roles. Although simulated learning is abundant within healthcare, it is evident that these experiences rarely combine more than two agencies and are mainly clinical skills focused.\u003c/p\u003e \u003cp\u003eThe day was incorporated into educational modules that addressed theoretical components of safeguarding practice, acknowledging that skill acquisition is not just a matter of intuitive understanding and experiential learning but also relies on formal knowledge and a critical understanding of research evidence [43, 44).\u003c/p\u003e \u003cp\u003eStudents highlighted that they communicated collectively throughout the day, enabling them to draw conclusions and employ decision-making regarding safeguarding thresholds.\u003c/p\u003e \u003cp\u003eThis method of IPE and simulation serves to transform practice and dispel the invisible walls that \u0026ldquo;create institutional and cultural barriers, which in child protection may be exacerbated by institutional anxiety about risk\u0026rdquo; [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, p.493]. For future frontline practitioners, the complexity of safeguarding cases can often lead to conflict and confusion in unfamiliar interprofessional networks. This highlights the need for more IPE via simulation across health, education, and social care, not only in safeguarding but in all areas to transform outcomes and reduce risk for our populations.\u003c/p\u003e \u003cp\u003eInterprofessional simulation exercises can be stressful and anxiety-inducing, and so could limit the capacity for learning as a factor related to the simulation process [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. Psychological safety was deeply considered in terms of interprofessional education, but safeguarding and domestic abuse were contentious and emotive topics, with risk assessment and signposting identified for students at the start of the day. A culture of psychological safety helps teams engage in learning behaviours when not present results in constraints discussion and communication. [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. The simulation day enabled such discussions to address the concept of developing interprofessional expertise to transform practitioners in becoming more proficient at working with others to manage complex child safeguarding issues. This level of discussion through enhanced interprofessional simulation experience improved the students\u0026rsquo; communication and decision-making skills, attitudes, and perceptions of their own and others\u0026rsquo; professional roles [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e, identify that pre-or undergraduate education may not readily transfer to the postgraduate work context of specialist education. In preparation for new roles development is essential, for some this is a career change in an entirely different identity and for those students the understanding of others and their own role it essential to promote client safety and effective working within high pressure environment to make clinical decisions in safeguarding.\u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eImplications for Practice\u003c/h2\u003e \u003cp\u003eResearch indicates that IPE is critical to developing student curricula across interprofessional programmes, even when timetabling constraints, cost, risk-averse departmental cultures, lecturer and practitioner attendance, and programme-specific requirements set by professional regulations are considered [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. All require stringent and timely planning from teams to ensure the provision of a structured and effective IPE day.\u003c/p\u003e \u003cp\u003eEnabling practitioners to be given time out to support IPE requires service managers to appreciate the importance and relevance to their work environment, facilitating protected time from practice for practitioners to be involved. Maintaining strong partnerships between university and practice areas is paramount in designing, developing, and implementing such simulated IPE activities, which will ultimately benefit practice by developing skills of knowledge of newly qualified students transitioning into their area of specialism. Descriptive analysis within this study reveals that over 70% of the cohort felt fairly to completely confident in their ability to work with other professionals following this exercise. We acknowledge that there is a difference at the beginning of the interprofessional simulation where some health workers have experience, but this is not consistent with the responses from education and social work students who report having little or no experience. Whilst previous experience may influence the confidence scores one qualitative results had identified that all students some degree of improvement in working practices from the exercise.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eAs discussed earlier, the study's limitations concerning the quantitative data collected demonstrated that fewer participants responded to the post-survey (54 respondents) than completed the pre-survey (91 respondents). The implications of this were that the quantitative data from the post-survey could not yield results as reliable as the pre-survey data. As a group of researchers, this was reflected upon.\u003c/p\u003e \u003cp\u003eA larger focus group for professional discussion would have also allowed a broader set of feedback and increased parity of responses across the programmes involved.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe development of this multi-agency simulation event as a learning experience for these students proved to be a positive and significant learning experience. Students across all four programmes commented that they would like this shared learning to occur more frequently. The interprofessional educational simulation has been recognised externally {49} as a strength of our provision .It was evident from both qualitative and quantitative results that student confidence in making complex safeguarding decisions increased as a direct result of this day. In such multiple professional and complex situations, IPE supports students to develop confidence and capability in many aspects of health and social care.\u003c/p\u003e \u003cp\u003eBuilding on this study, future work should focus on interprofessional education's distinct nature, utilising the Menzies model of deliberate practice and mastery to formulate future sessions that contribute to further promote the development of conceptual models that future research could test and verify. In addition to this, a validated tools could be developed and utilised to measure qualitative data rather than Mentimeter, which may have differing results in this way, system-wide positive outcomes will be generated across education and practice.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eDeclaration of generative AI (Artificial Intelligence) and AI-assisted technologies in the writing process\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhile preparing this work, the author(s) used Grammarly to check for any grammatical errors. After using this tool/service, the author(s) reviewed and edited the content as needed and took full responsibility for the content of the publication.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eThis project gained ethical approval from Northumbria University at Newcastle (41092).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAll participants provided written consent using the institutional form approved.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication- has been given by all authors J Menzies, S Meller,C ,Coulihan, E Robinson, E Clark ,J Ogle and M Dorward.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials-The datasets generated and/or analysed during the current study are not publicly available due University restrictions but are available from the corresponding author on reasonable request.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests-The authors declare that they have no competing interests.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding -not applicable\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors contributions-see section\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements-not applicable.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors information- all authors have considerable professional and academic experience in their discipline and the challenges interprofessional decision making brings and the complex nature of child safeguarding. Jen Menzies identified the issue after more than 30 years in Nursing and the last 16 in safeguarding casework supporting families in the community and students with life changing decisions and circumstances. Transformational simulation came from serious case reviews following significant harm, injury or death to clients where other decisions could have been made. This formed the basis of a model of simulation alongside deliberate practice and Mastery within the University environment. The contributions of other agencies to these decisions and knowledge of their roles and the information they have is imperative to promote client safety and support students in their roles.\u003c/strong\u003e\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eJM wrote main manuscript text,lead for project.SM and ER helped write conclusion and qualitative section and ethics.CC analysed and wrote quantitative section and assisted with references. 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Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.scie.org.uk/files/safeguarding/children/case-reviews/learning-from-case-reviews/interprofessional-communication-decision-making.pdf\u003c/span\u003e\u003cspan address=\"https://www.scie.org.uk/files/safeguarding/children/case-reviews/learning-from-case-reviews/interprofessional-communication-decision-making.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSharley V. Identifying and Responding to Child Neglect within Schools: Differing Perspectives and the Implications for Inter-Agency Practice. Child Indic Res. 2020; 13:555\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHewitt G, Sims S, Harris R. Evidence of communication, influence, and behavioural norms in interprofessional teams: a realist synthesis. J Interprof Care. 2015;29(2):100\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMunro E. Effective child protection. London: SAGE Publication Ltd.; 2008. 176 p.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDepartment for Education (DfE) (2023) Working together to safeguard children: a guide to multi-agency working to help, protect and promote the welfare of children. London HM goverment [Accessed 15/12/2023]\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eConnolly F, De Br\u0026uacute;n A, McAuliffe E. A narrative synthesis of learners' experiences of barriers and facilitators related to effective interprofessional simulation. J Interprof Care. 2022;36(2):222\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMachin AI and Pearson P (2013) Health visitors' interprofessional working experiences: Implications for their collaborative public health role Journal of Health Visiting 2013 1:1, 31\u0026ndash;38\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDomac S, Haider S. Interagency safeguarding adults training for protection and prevention. J Interprof Care. 2013;27(6):520\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eO'Keefe M, Ward H. Implementing interprofessional curriculum: how problems might also be answers. BMC Med Educ. 2018; 18:132\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThe Office for Standards in Education, Children\u0026rsquo;s Services and Skills (Ofsted) (2024) \u003cem\u003eInitial teacher education report: University of Northumbria.\u003c/em\u003e [Online] Available at: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.reports.ofsted.gov.uk/\u003c/span\u003e\u003cspan address=\"http://www.reports.ofsted.gov.uk/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (Accessed 19 July 2024).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Interprofessional, transformative simulation, safeguarding practice, complex decision-making, deliberate practice, mastery, transitional simulation, simulation models, confidence, communication","lastPublishedDoi":"10.21203/rs.3.rs-4762927/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4762927/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe study aims to evaluate the effectiveness of translational and transformational simulation experience in building student confidence around complex safeguarding decisions.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe research was framed within an exploratory sequential mix method design [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. A survey before and after the safeguarding simulation using an author-developed questionnaire ad Likert scale were entered into SPSS (statistical software version 29) for quantitative analysis. Qualitative - student responses directly following the simulation using Mentimeter \u0026ndash; a digital technology that collects anonymous comments in real-time and a professional independently facilitated discussion two weeks after the simulation.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe quantitative results revealed a positive correlation between the experience of simulated interprofessional education and their confidence in understanding complex collaborative decision-making. Qualitative findings revealed four categories: (1) Confidence, (2) Information sharing, (3) Communication and (4) interprofessional working, derived from students' expressions of learning.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eInterprofessional education (IPE) and simulation can produce a positive learning experience in theory and practice increasing student confidence significantly in complex collaborative decision-making. Understanding the complexities of different roles, alongside the value of information each brings, is imperative for safeguarding children and families.\u003c/p\u003e","manuscriptTitle":"Integration of Interprofessional Simulation for Safeguarding Children and Families: A Mixed Methods Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-26 12:46:12","doi":"10.21203/rs.3.rs-4762927/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fe60c69b-1d32-4d63-b298-27d1cfbdd811","owner":[],"postedDate":"August 26th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-12-02T05:54:09+00:00","versionOfRecord":[],"versionCreatedAt":"2024-08-26 12:46:12","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4762927","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4762927","identity":"rs-4762927","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}