SAFER communication guidelines

These are guidelines for communications between health and local authority children’s social care teams using the SAFER process when a child may be suffering or is likely to suffer significant harm. All verbal communications can be carried out using the SAFER process. The use of SAFER will ensure a uniform approach to communicating the level of risk to a child/children.

Section A: Prior to referral, ask yourself these questions:

  • Have I assessed the child and documented my findings?
  • Have I documented existing risk factors or issues?
  • Is there any evidence of substance abuse, domestic abuse, mental illness, a chaotic lifestyle or missed appointments?
  • Has a Common Assessment Framework (CAF) been followed?
  • Has the situation been discussed with the child’s parent(s)?
  • Who else is in the household?
  • Has the situation been discussed with the child’s GP?
  • Have I updated myself on the child’s recent health history?
  • Do I have knowledge of any siblings? May they be at risk of harm too?
  • Is there a social worker already allocated? Have I discussed this referral with that social worker?
  • Has the situation been discussed with a named nurse/senior colleague for safeguarding?
Prior to making a call, have the following available:
  • the child’s health record
  • a list of recent events
  • the evidence triggering the call.

Section B: Aide-memoire to support efficient and appropriate telephone referrals of children who may be suffering, or are likely to suffer, significant harm.


  • This is the health visitor (give name) for (give your area). I am calling about … (child’s name(s) and address).
  • I am calling because I believe this child is at risk of significant harm.
  • The parents are/aren’t aware of the referral.

Assessment and actions

  • I have assessed the child personally (and done a CAF) and the specific concerns are … (provide specific factual evidence, ensuring the points in Section A are covered).
  • Or: I fear for the child’s safety because … (provide specific facts – what you have seen, heard and/or been told and when you last saw the child and parents).
  • A CAF has/hasn’t been followed.
  • This is a change since I last saw him/her (give no. of) days/weeks/months ago.
  • The child is now … (describe current condition and whereabouts).
  • I have not been able to assess the child but I am concerned because … .
  • I have … (actions taken to make the child safe).

Family factors

  • Specific family factors making this child at risk of significant harm are … (base on the Assessment of Need Framework and cover specific points in Section A).
  • Additional factors creating vulnerability are … .
  • Although not enough to make this child safe now, the strengths in the family situation are … .

Expected response

  • In line with Working together to safeguard children, NICE guidance and Section 17 and/or Section 47 of the Children
  • Act I recommend that a specialist social care assessment is undertaken (urgently?).
  • Other recommendations.
  • Ask: Do you need me to do anything now?

Referral and recording

  • I will follow up with a written referral and would appreciate it if you would get back to me as soon as you have decided your course of action.
  • Exchange names and contact details with the person taking the referral.
  • Now refer in writing as per these procedures and record details and time and outcomes of telephone referral.

(NB: The intention is to make reasons for referral factual and informative to assist the duty team in taking appropriate action.)

If a child is at risk of immediate, significant harm, the priority remains to move them to a place of safety. The police have the powers to remove a child to a place of safety without parental consent.

The Redcar and Cleveland adaptation of the SAFER tool can be found here.


The SAFER tool was developed from a communication toolkit called SBAR (Situation; Background; Assessment; Recommendation) that was originally created by the US Navy for use on nuclear submarines. It was adapted for use in healthcare by Dr M Leonard and colleagues from Kaiser Permanente, Colorado, USA.

PGF 15/11/2011