Practice Guidance for Management of Survivors of Non-Recent Abuse in Childhood
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Derbyshire and Derby City Practice Guidance for management of survivors of non-recent abuse in childhood There is a separate Strategy for survivors of non-recent abuse in childhood Final version – March 2018 Sign off by Derby and Derbyshire Safeguarding Children Board Policy and Procedures group Review January 2019 Page | 1 Derbyshire and Derby City Practice Guidance for survivors of non-recent abuse in childhood – (There is a separate Strategy for survivors of non-recent abuse in childhood) This guidance should be read in conjunction with Derby and Derbyshire Safeguarding Children Board policies and procedures. https://www.derbyshirescb.org.uk/ http://www.derbyscb.org.uk/ Rationale These practice guidelines have been developed to provide a framework for the safeguarding partnership across Derby and Derbyshire to follow in situations where a person makes an allegation of non-recent childhood abuse. There is a growing recognition that a disclosure of non-recent abuse may reveal current risks to others from an alleged perpetrator. Some high profile cases e.g. Savile, show the potential extent of abuse by one individual. All front line public servants and their management have a duty of care to their clients, and in the safeguarding of others. This may place them in complex positions when trying to negotiate and balance their duties and responsibilities. The practice guidelines have been developed to help to address some of these dilemmas. It will outline options for responding to disclosure and help front line staff to be clearly accountable for the decisions they make. It is hoped that this framework will enable any response to be as effective as possible in supporting adults at risk, as well as in ensuring they meet their duty to safeguard children and young people or adults who may be at risk now. At the time of writing this strategy, an Independent Inquiry into Child Sexual Abuse (IICSA) is currently underway investigating whether public bodies and other non-state institutions have taken seriously their duty of care to protect children from sexual abuse in England and Wales. It is expected that this will take some time to be completed and may result in further guidance and possible legislative changes. Safeguarding Adults guidance started with ‘No Secrets’ (2000) which provided a code of practice for the protection of vulnerable adults although there was no statutory requirement to implement this. The Care Act 2014 has replaced ‘No Secrets’ and for the first time, sets out a clear legal framework for how local authorities and other parts of the health and care system should safeguard adults at risk of abuse or neglect. In accordance with The Care Act (2014) the focus is on making safeguarding personal and where possible, facilitating the individual to make decisions regarding their safety and well-being, for them to be an integral part of the safeguarding process. Page | 2 Context and Background The National Society for the Prevention of Cruelty to Children (NSPCC) defines non-recent abuse (also known as historical abuse) as an allegation of neglect, physical, sexual or emotional abuse made by or on behalf of someone who is now 18 years or over, relating to an incident which took place when the alleged victim was under 18 years old. It is also important to recognise that a young person, less than 18 years old, may disclose non recent abuse, although this would be addressed in accordance with Safeguarding Children’s Board policies and procedures. Language in this area can be complex, so for clarity the following definitions are used: Trauma - This term is widely used but in this context refers to a ‘stressful event or situation (either short or long lasting) of exceptionally threatening or catastrophic nature, which is likely to cause pervasive distress in almost everyone’ (ICD-10 1994). This is usually subdivided into two types of adverse and abusive life events (Terr 1991). o Type 1 trauma: Single-incident trauma, e.g. sudden and unexpected events which are experienced as isolated incidents such as road traffic accidents, rapes or terrorist attacks. This can happen in childhood or adulthood. o Type 2 or Complex trauma: This is often defined as traumatic events which are repeated/ long-term, interpersonal abuse, occurring on multiple occasions and often (although not always) beginning early in life (Herman, 1997). Complex Trauma includes all forms of childhood abuse which is chronic and cumulative such as childhood sexual abuse, childhood physical abuse, witnessing domestic abuse and neglect. Domestic abuse is the most common experience of complex trauma in adulthood. Abuse - Abuse can take a number of forms; emotional/verbal, physical and sexual but is always something that happens within a relationship, usually with someone who you know. Examples include childhood sexual abuse, childhood physical abuse, and neglect. In the last few years, there has been increasing public awareness of the extent of historic child abuse, particularly sexual abuse. There has been high profile media coverage about non-recent abuse allegations by adults who have come forward about maltreatment in children’s Local Authority Residential Care Homes and other statutory care establishments. Allegations have also been made within the English and Irish churches, and there have been a number of high-profile cases involving ‘celebrities’ as alleged perpetrators. People often delay disclosure of abuse into adulthood (Read et al., 2006), however, publicity around these cases may make it more likely that people will disclose information that they may have previously felt too frightened or ashamed to share. The NSPCC reported an 84 per Page | 3 cent increase in disclosures of abuse to its helpline, with 600 cases referred to the Police and social services after the Savile scandal (Ramesh, 2013). Adverse Childhood Events (Key Points) Adverse Childhood Experiences (ACE) - This is an increasingly used term which describes the experience of range of adversity in childhood including abuse, neglect but also parental substance misuse, parental separation or incarceration, parental mental illness and living in care. How common is this? Living through abuse and trauma is more common than often previously recognised. The World Health Organisation reports that 20% of girls and up to 10% of boys experience sexual abuse in their childhood. In some specialist services, prevalence rates are often much higher, for instance 75% of women and men in substance misuse services report abuse and trauma in their lives (WH0 2014). It is now a well-researched and robust finding that survivors of trauma and complex trauma are at higher risk of a range of health, mental health and social difficulties (e.g. WHO 2014, Scot PHN 2016). It is important to stress; this does not mean any particular individual survivors will develop these difficulties but that they are at a higher risk and that the more trauma and complex trauma that is experienced by individuals, the higher the risk becomes. It is now well recognised that there is a common pattern of mental health difficulties which has been called Complex Post Traumatic Stress Disorder. Following many years of research this is to be included in the International Classification of Diseases (ISD-11) which is due to be published in 2017. A recent survey in Wales (2015 Public Health Wales NHS trust), replicated the international research and found that those with 4 or more experiences of adversity and abuse in childhood were 4x more likely to be a high risk drinker 6x more likely to have had or caused an unintended teenage pregnancy 6x more likely to smoke 14x more likely to be a victim of violence 15x more likely to be a perpetrator of violence 16x more likely to have used heroin 20x more likely to be incarcerated The development of these high risk health behaviours is easier to understand when viewed through the lens of being a survivor. For individuals affected this is likely to be complex and unique but overall we can start to think about these risky behaviours being a result of the impact of trauma or an attempt to cope with this impact. Why is this relevant to my work? Survivors experience two significant areas of difficulty in relation to their health Page | 4 1. Increased risk of health and social difficulties because of the direct and indirect consequences of their experience. Direct impacts might include; difficulties in developing safe and trusting relationships, post- traumatic stress difficulties, disruptions to education, lack of capacity to develop skills in managing distress and emotional reactions (due to being subjected to ‘insurmountable challenges’ which overwhelm survivors coping strategies, particularly for those effected in childhood). Indirect impacts can include; unsafe coping strategies developed to manage their distress, this can include reliance on alcohol or drugs, self-harm and an impact on their eating patterns and all of these can have long term health and mental health harming consequences. Poorer relationships with others is crucial as we know that safe and supportive relationships are a key predictor of resilience in the face of difficulties that is turning insurmountable challenges into manageable ones (Couper and Mackie 2016). 2. Difficulties accessing services or maintaining access with services This is again a complex area, but some elements which might be important include difficulties with trusting staff, difficulties with procedures that involve touch, not feeling understood by services and frequent disengagement for instance difficulties attending appointments. Practice Guidance Having someone disclose historical abuse to you can feel unsettling, and can raise a number of questions for us as professionals. This practice guidance aims to support people in the workforce of Derby City and Derbyshire, to offer a consistent approach to survivors of non- recent abuse with an underlying approach of treating people with dignity and respect.