Safeguarding children and young 31 Recommendations were made for people action by Dec 2014
• leadership, culture and values and executive accountability;
• patient-centred drivers and safeguarding;
• board and ward coherence;
• security and controls on the physical access to hospital premises;
• policy development and implementation; and
• fundraising.
A presentation by Jeff Barlow [email protected]
All health staff must have the competences to recognise child Definition maltreatment and to take effective action as appropriate to their role.
They must also clearly understand their responsibilities, and should be supported by their employing organisation to fulfil their duties. Chief Executive officers and ‘A child is anyone under the age of 18 independent contractors such as years.’ GPs, in particular have a (Children Act 1989, 2004) responsibility to ensure that all staff across the organisation have the knowledge and skills to be able to meet this requirement
4 Main Categories of Child Abuse
Neglect Physical Sexual Emotional (psychological)
1 Definition of Neglect That includes
Neglect is the persistent failure to Neglect may occur meet a child’s basic physical and/or psychological needs, likely during pregnancy as a to result in the serious result of maternal impairment of the child’s health or development. substance abuse.
(Working Together to Safeguard Children, 2013) (Working Together to Safeguard Children, 2013
That includes - And also
Denying access to appropriate medical care or treatment Definition of Physical Abuse
Physical Abuse may involve hitting, shaking, NICE GUIDELINE: consider neglect when parents or carers: throwing, poisoning, burning or scalding, drowning, suffocating or otherwise causing • fail to administer essential prescribed treatment physical harm to a child. • repeatedly fail to attend essential follow-up appointments necessary for child’s health & wellbeing
• persistently fail to engage with relevant child health promotion programmes which include: • immunisation • health and development reviews • screening
• have access to but persistently fail to obtain NHS treatment for child’s dental caries
• fail to seek medical advice for their child to the extent that child’s health and wellbeing is compromised, including if the child is in ongoing pain Physical harm may also be caused when a parent or carer fabricates the symptoms of, or deliberately induces, illness in a child. Working Together to Safeguard Children, 2013
Definition of Sexual Abuse
Sexual abuse involves forcing or enticing a child or young person to take part in Definition of Emotional Abuse sexual activities, not necessarily involving a high level of violence, whether or not the child is aware of what is happening. • Emotional abuse is the persistent emotional maltreatment of a child such as to cause severe The activities may involve physical contact, including assault by penetration and persistent adverse effects on the child’s emotional development. (for example, rape or oral sex) or non- penetrative acts such as masturbation, • It may involve conveying to children that they are worthless or unloved, inadequate, or valued only insofar as they meet the needs of another person. kissing, rubbing and touching outside of clothing. • It may include not giving the child opportunities to express their views, deliberately silencing them or ‘making fun’ of what they say or how they communicate. It may feature age or They may also include non-contact activities, such as involving developmentally inappropriate expectations being imposed on children. children in looking at, or in the production of, sexual images, watching sexual • These may include interactions that are beyond the child’s developmental capability, as well activities, encouraging children to behave in sexually inappropriate ways, or as overprotection and limitation of exploration and learning, or preventing the child grooming a child in preparation for abuse (including via the internet). participating in normal social interaction.
Sexual abuse is not solely perpetrated by adult males. Women can also commit • It may involve seeing or hearing the ill-treatment of another. acts of sexual abuse, as can other children. • It may involve serious bullying (including cyberbullying), causing children frequently to feel frightened or danger, or the exploitation or corruption of children. Some level of emotional abuse involved in all types of maltreatment of a child, though it may occur alone. Working Together to Safeguard Children 2013
Working Together to Safeguard Children, 2013
2 There are four main types of FGM: Other areas of concern Type 1 – clitoridectomy – removing part or all of the clitoris.
Type 2 – excision – removing part or all of the clitoris and the inner labia (lips that surround the vagina), with or without removal of the labia majora (larger outer lips).
Type 3 – infibulation – narrowing of the vaginal opening by creating a seal, formed by cutting and repositioning the labia. Other harmful procedures to the female genitals, which include pricking, piercing, cutting, scraping and burning the area. Other harmful procedures to the female genitals, which include pricking, piercing, cutting, scraping and burning the area.
Multi-agency Guidelines on female genital Mutilation
• Does the person appear disconnected from family, friends, community organisations, or houses of worship? • Has a child stopped attending school? • Has the person had a sudden or dramatic change in behavior? • Is a child engaged in commercial sex acts? • Is the person disoriented or confused, or showing signs of mental or physical abuse? • Does the person have bruises in various stages of healing? • Is the person fearful, timid, or submissive? • Does the person show signs of having been denied food, water, sleep, or medical care? • Is the person often in the company of someone to whom he or she defers? Or someone who seems to be in control of the situation, e.g., where they go or who they talk to?
Parental Well Being
• Mental Health issues
• Drug/Alcohol misuse
3 Legal Framework - Children at Risk
• Balance between two principles
1. Parents ought to be able to bring up their children as they think best 2. The state must have adequate power to protect children at risk
• Framework to enable fair and reasonable decisions to be made
Section 17 & Section 47 What is a Serious Case Review? Definitions • Section 17 – A risk of significant impairment to • It’s an analysis of what happened? and the reasons health & development of the child or young why? person. • Involves each organisation who has been involved with the child or family undertaking an Individual Management Review. • Section 47 – A risk of significant harm to the • Scrutinising records and individual involvement. child or young person. • Submitting a report to SCR overview author. • Evaluated by Ofsted
When is a SCR undertaken? Why do a Serious Case Review?
The LSCB should conduct a Serious Case Review • Establish whether there are lessons to be learned from the (SCR) when case about the way in which local professionals and abuse or neglect of a child is known or suspected; and organisations work together to safeguard and promote the either – welfare of children (i) the child has died; or • Identify clearly what those lessons are both within and (ii) the child has been seriously harmed between agencies, how and within what timescales they will be acted on, and what is expected to change as a and there is cause for concern as to the way in which the authority, their Board partners or other relevant persons result and have worked together to safeguard the child. • Improve inter-agency working and better safeguard and Working Together to Safeguard Children, (2013) promote the welfare of children’ Working Together to Safeguard Children. (2013)
4 Victoria Climbié Findings from Biennial Analysis of SCR
Died 25th February 2000 SCR 2005-07 of 189 children’s cases revealed • The highest risk of maltreatment related deaths & serious injury are in the first 5 yrs of life Working Together 2006 • 17% of children were subject to a child protection plan. The major category of concern was neglect. • A third of the 40 children studied in depth had a history of missed health Baby Peter appointments. • 45% of families were highly mobile & were living in poor conditions. Half of the parents/carers had criminal convictions . Died 3rd August 2007 • There was a failure to take into account the dearth of information about fathers and other men connected to the family. (Brandon, 2009 p 36-37) Working Together 2010
Children Act 2004 .Working Together to Safeguard Children (HM Government 2013) • Sets out new duties to ensure that child welfare is • This guidance covers the legislative requirements and highlighted in the work of all relevant agencies and in the expectations on individual services to safeguard and way they work together promote the welfare of children; and • provides a framework for Local Safeguarding Children Boards (LSCBs) to monitor the effectiveness of local • Provides a framework to improve information sharing services. (databases)
• Places a duty on key agencies to co-operate
Every Child Matters: Change for Children The Safeguarding Adults Framework in (DfES 2004) Leeds Five key outcomes for children and (West Yorkshire Multi-Agency Safeguarding Procedures) young people
• Being healthy
• Staying safe
• Enjoying and achieving The Safeguarding Children’s Framework in • Making a positive contribution Leeds (West Yorkshire Consortium Procedures) • Achieving economic well-being
5 Assessment of the child and family needs
Quality Committee
Leeds Safeguarding Children Board
www.leedslscb.org.uk/
Multi-Agency Safeguarding Hub Sexual Offences Act 2003
• This act strengthens the protection of children. • Any sexual intercourse with a child aged less than 13 years - statutory rape • Able to tackle inappropriate sexual activity with children – observation, images, touching etc • Includes preparatory offences – sexual exploitation/Grooming/ both internet and off line • non discriminate – male/female
6 Disclosure and Barring Service
Holly Wells and Jessica Chapman Ian Huntley Allegations Against Professionals • Any allegation against a professional who works with children. • Set up following Soham Murders enquiry – Previously known separately as CRB and ISA • Investigation by Named Person Local – Legislation (Safeguarding Vulnerable Groups Act 2006) – CRB checks not enough Safeguarding Children Board – Duty to report – it is a legal requirement – HR processes – Regulatory activity
REFERRAL Child Protection Procedures
West Yorkshire Consortium Procedures 2009 • Anyone who has concerns about the safety or Leeds Health pathways- wellbeing of a child, young person or unborn child • Missing children protocol - can make a referral • Child protection Manual • Case conferences - Giving evidence - Legal report writing • Each agency has detailed procedures • Repeat attendance at ED • Pre birth assessment • Child abduction • Removal at birth • Forensic Medical Examination • Allegations against staff
Why Refer? Child Protection Process • Children and have a right to be safe • Referral to Social Services • We have a responsibility to protect children • Verbal referrals should be followed up in • Abuse is damaging writing within 48hrs • Abuse exists in a world of secrecy and silence – the cycle of abuse has to be broken • Initial assessment – No further action/Child in need/Child suspected of significant harm • You only have one small piece of a jigsaw • Children rarely lie about child abuse • Strategy meeting • An abuser of children may well abuse many other • Initial Child Protection Conference children who also have a right to protection
7 Why Practitioners do not Refer? Confidentiality (children)
• Personal safety • Sharing of information amongst practitioners • Stress working with children and their families is essential • Poor Support • In general the law will not prevent sharing of • Inadequate Supervision information if it is: • Under-staffing In the child’s best interest • Confidentiality & consent Relevant • Assuming another agency is dealing with the Shared with those who need to know problem • Being persuaded by the person’s retraction
Information Sharing Seeking consent (children)
“No inquiry into a child’s death or serious injury has ever questioned why information was shared. It has • Seek consent unless this would be contrary to always asked the opposite” the child’s welfare
Georgina Nunney, Solicitor, Lewisham Children &Young People Now, April 16, 2008
Alerting Features
Two categories/levels of concern
Clinical Guideline on • CONSIDER - Maltreatment one possible When to Suspect explanation Child Maltreatment
• SUSPECT - Serious level of concern (proof not needed)
NICE Clinical Guideline 89 (2009)
8 Which Groups of children may be Summary of Roles and Responsibilities particularly vulnerable?
• Disabled Child • Be alert to signs and symptoms of child abuse • Child or parent with Mental or physical health difficulties • Know how to refer concerns • Looked After Children • Be aware of your responsibility to keep records up to date • Children who are in transition with relevant information • Children & Young People initiated into gangs • Work Together to safeguard children • Children living away from home • Contribute when required to Child protection process • Child with poor school attendance • Keep child focussed • Child living in environment with Domestic Violence • Participation with families • Migrant, Unaccompanied Asylum seeking children
• Children living in temporary accommodation • Safeguarding Supervision
• Children of parents who misuse substances • Further Safeguarding Training. • Families refusal/disengage from services. E.g. non - attendance
Practitioners must……….
‘Always do the simple things well…..’ • Be constantly vigilant (Lord Laming 2003) • Have an open and inquisitive approach, regardless of any assumptions arising from previous assessments
• Be aware of the need to re-assess following new and cumulative incidents and changes in circumstances (check basic information household composition)
• Challenge colleagues within partner agencies if required.
(Haringey LSCB 2008)
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