SafeguardingMa-ers

DrKPuvanendranFRCP,FRCPCH,DCH.ConsultantPaediatrician

DesignatedDoctorforSafeguardingandChildDeathReview

SafeguardingChildren

Safeguardingchildreniseveryone’sresponsibility

‘All those who come into contact with children and

families in their everyday work, including

practitioners who do not have a specific role in

relation to child protection, have a duty to safeguard

and promote the welfare of children’.

(What To Do If You’re Worried A Child

is Being Abused; DOH 2003)

Children killed every

year as a result of

abuse

Live with known domestic

abuse in the home

Parents have mental

health problems

Parents have

problematic drug use

Live with parents thought to

misuse alcohol

11 million children in England

Facts&figures

SafeguardingandChildProtec7on•  Safeguarding’is:•  Protec7ngchildrenfrommaltreatment•  Preven7ngimpairmentofhealthordevelopment•  Ensuringchildrengrowupincircumstancesconsistentwith

theprovisionofsafeandeffec7vecare•  Enablingchildrentohaveop7mumlifechancesinadulthood•  ‘ChildProtec;on’is:•  Apartofsafeguardingandpromo7ngwelfare•  Referstotheac7vitythatisundertakentoprotectspecific

childrenwhoaresuffering,orarelikelytosuffer,significantharm

Defini;onsofAbuse

• Inflic;ngharm,orfailingtoacttopreventharm

• Childrenmaybeabused:– inafamily– inanins;tu;onalorcommunityseCng– bythoseknowntothechild– morerarely,byastranger

• Childrenmaybeabused– byanadultoradults– byanotherchild

CategoriesofAbuse

• Neglect

• Physicalabuse

• SexualAbuse

• Emo;onalAbuse

NeglectPersistentfailuretomeetachild’sbasicphysicaland/orpsychologicalneedslikelytoresultintheseriousimpairmentofthechild’shealthordevelopment,suchas:– Substancemisuseinpregnancy– Failingtoprovideadequatefood/shelter/clothing/protec;onfromdangerandabandonment

– Failingtoensureadequatesupervision– Failingtoprovideappropriatemedicalcare– Failingtorespondtochild’sbasicemo;onalneeds

PossibleindicatorsofNeglect

PhysicalIndicatorsBehaviouralIndicators

Dirty bedroom, no sheets on

bed, inappropriate sleeping

place

Being tired all the time

Being unkempt, dirty or smelly Frequently missing school or

being late

Loss of weight or constantly

being underweight

Failing to keep medical

appointments

Dressed inappropriately for the

weather conditions

A baby who never cries

Learning disabilities due to

poor brain development

Psycho-social development,

depression, psychiatric illnesses

& personality disorders

Untreated medical conditions Being left unsupervised regularly

PhysicalAbuse

• Shaking• Throwing• Poisoning• Burning/scalding• Drowning• HiCng• Suffoca;ng

• Otherwisecausingphysicalharm

• Whenacarerfabricatessymptomsordeliberatelyinducesillnessinachild

SexualAbuseForcingoren7cingachildtotakepartin:

– Sexualac7vi7es,includingpros7tu7on,whetherthechildisawareofwhatishappeningornot

– Physicalcontactincludingpenetra7veandnon-penetra7veacts

– Non-contactac7vi7esincludingchildrenlookingatorbeinginvolvedintheproduc7onofpornographicmaterial,watchingsexualac7vi7es,encouragedtobehaveinsexuallyinappropriateways,andverbalsexualabuse

PossibleindicatorsofSexualAbusePhysical Indicators Behavioural Indicators

Pain, itching, bruising or bleeding in

genital or anal areas

Sudden unexplained changes in

behaviour

Any sexually transmitted infection

(STI)

Apparent fear of someone

Recurrent genital discharge or

urinary tract infections without

apparent cause

Being sexually coercive with other

children

Stomach pains Nightmares or bedwetting

Discomfort when child is walking or

sitting down

Self-harm, self-mutilation, suicide

attempts, abuse of drugs/alcohol,

eating problems (anorexia /bulimia/

overeating)

Pregnancy Sexualised behaviour or knowledge,

drawings, language

Running away from home

Emo;onalAbuse•  Persistent emotional ill-treatment of a child causing severe

and persistent adverse effects on child’s emotional

development:

• Conveying that children are worthless/unloved

• Imposing age-inappropriate expectations on children

• (e.g., caring for an alcohol-addicted parent)

• Seeing/hearing the ill-treatment of another

•  (Domestic Violence)

• Serious bullying

• Exploiting & corrupting children

PossibleindicatorsofEmo;onalAbuse

Physical Indicators Behavioural Indicators Failure to grow or to thrive

(particularly if child thrives away

from home)

Compulsive nervous behaviours

such as hair twisting or rocking

Sudden speech disorders An unwillingness or inability to play

Delayed development, either

physical or emotional

Excessive fear of making mistakes

Self-harm or mutilation

Excessive deference towards

others, especially adults

Excessive lack of confidence, and

need for approval, attention and

affection

Inability to cope with praise

Specifictypesofviolencetowardschildren

• Honourbasedviolence• Forcedmarriage• Trafficking• Pros7tu7on• Domes7cservitude• Spiritpossession• Femalegenitalmu7la7on

OtherFactorsthatraiseConcern•  Parent(andorchild)misusingalcoholordrugs•  Domes;cabusewithinthehousehold•  Parentswithlearningdifficul;esandormentalhealth

problems•  Childrenwithdisabili;es•  Grooming&Sexualexploita;on(includingonline)•  Teenagepregnancy&parenthood•  ChildTrafficking•  Highlymobilefamilies&familieswithoutrecoursetopublic

funds•  Bullying(includingonline)•  FemaleGenitalMu;la;on•  Self-harmingbehaviours

Toxictrio

Mul;pleriskfactors• Parentalsubstancemisuse• Parentalmentalhealthproblems• Domes;cabuse

Adultservicesnotconsideringriskstochildrenorparen;ngcapacity

AbuseofDisabledChildren

!  Abusers think it is safer to victimise a disabled child.

!  Abusers are attracted to immature behaviour

!  Disabled children may have compromised

communication.

!  Disabled children may be socially isolated.

!  Disabled children receive less information about

abuse.

!  May be less able to understand that behaviour is

inappropriate.

!  More dependent – need extra care.

Child Safeguarding

and promoting welfare

Family and environmental Factors Family History and functioning

Wider Family

Housing

Employment

Income

Family’s Social Integration

Community Resources

Health

Education

Emotional & Behavioural Development

Identity

Family and Social Relationships

Social Presentation

Basic Care

Ensuring Safety

Emotional Warmth

Stimulation

Guidance & Boundaries

Stability

TheAssessmentFramework

The Voice of the Child

• What is the Common

Assessment

Framework?

•  In what circumstances

would a CAF be

used and by whom?

•  An assessment of the child and family’s needs

when the child has additional needs in relation

to one or more of the 5 priority outcomes from

Every Child Matters but does not meet the

threshold for intervention from Children’s Social

Care

•  A CAF is an assessment that can be undertaken

by any professional in “Universal Services” who

is concerned that a child or young person may

not be meeting one or more of the 5 priority

outcomes from Every Child Matters (Be healthy,

Stay Safe, Enjoy and Achieve, Make a Positive

Contribution, Economic Well Being)

Children with Additional Needs

ThresholdofNeeds

Level One

Universal

Children with no

additional needs

Level Two

Vulnerable

Children with

additional

needs

Level

Three

Complex

Children

with

complex

needs

Level Four

Acute

Children whose

needs

are complex,

prolonged

or critical

Key Legislation and Guidance good to :

1.  Children Act 1989 and 2004

2.  United Nations Convention on the Rights of the Child 1990

3.  Human Rights Act 1998

4.  What To Do If You’re Worried A Child Is Being Abused (2006)

5.  Information Sharing: Guidance for practitioners and managers (2008)

6.  NICE Guidelines when to suspect child maltreatment (2009)

7.  London Child Protection Procedures (2010, 4th Edt)(Local policies)

8.  Working Together to Safeguard Children (2013)

9.  Safeguarding children and young people: roles and competencies for health care staff - Intercollegiate Document March 2014

FindingsfromNa;onalSCRsVoiceofthechild–OfstedReportApril2011

•  the child was not seen frequently enough by the professionals involved, or was not asked about their views and feelings

• agencies did not listen to adults who tried to speak on behalf of the child and who had important information to contribute

• parents and carers prevented professionals from seeing and listening to the child

• practitioners focused too much on the needs of the parents, especially on vulnerable parents, and overlooked the implications for the child

• Agencies did not interpret their findings well enough to protect the child.

BiennialSeriousCaseReviewReport:2003-2005Brandon,Metal,DCSF(Jan2008)

•  161seriouscasereviewincludedinthestudy.Ofwhich:•  12%wereonthechildprotec7onregister•  55%wereknowntosocialservices•  16%relatedtoheadinjuriestobabies•  21%featuredneglect(strictdefini7onofneglectusedforthestudy)•  30%werelivinginpoorlivingcondi7ons•  Inrela;ontoagebreakdownforthe161:•  47%wereunder1•  20%wereage1-5•  7%wereage6-10(significantlyunderrepresented,giventhisisoneofthehighestgroupspresentedto

hospitalA&Edepartments•  !5%wereage11-15•  9%were16plus(mainlysuicides)•  Outofthe161,47werelookedatinmoredetail.Inthesecases:•  Domes7cviolencewaspresentin66%•  Mentalhealthwaspresentin55%•  Substancemisusewaspresentin57%•  Inaddi7onthereportfoundthatin1in3casesofthe47detailedcases,allthreeofthesefactorswere

present.

Themesfromseriouscasereviews•  Needtoensureanawarenessinadultservicesoftheneedsof

childrenandtheimpactofparentsbehaviourontheirhealthanddevelopment

•  Needforgreaterunderstandingoftheroleofinforma7onsharingwithinandbetweenagencies

•  Needtoassessallfamilymembersandinpar7cularfathersandpartnerswithafocusontheirhistoryandpossibleriskstochildren

•  Needforallservicestoberealis7cabouttheimpactonchildrenofadultneedsandbehaviourssuchassubstancemisuse

•  Needtobeawareofriskfactorse.g.domes7cviolenceandthecumula7venatureofriskforbothadultsandchildren

•  Needtopromoteevidencedbasedprac7ceandchallengeparentswhenappropriate

Child In Need

Children Act 1989 (Section 17)

They are unlikely to achieve or maintain, a

satisfactory level of health or development without the provision of services by a local authority

Their health or development will be significantly impaired without the provision of such services

They are disabled – children automatically defined as Children In Need (CIN)

Children are defined as being “in need” when their

vulnerability is such that :

ChildrenAct1989SignificantHarm(Sec;on47)

• The Children Act 1989 introduced the concept of significant harm as the threshold that justifies compulsory intervention in family life, in the best interests of children.

• Significant harm is any physical, sexual or

emotional abuse, neglect, accident or injury that is sufficiently serious to adversely affect progress and enjoyment of life. Harm is defined as the ill treatment or impairment of health and development.

SignificantHarmChildrenAct1989(Sec;on47)

• The Local Authority has a duty to make enquiries when they have reasonable cause to suspect that a child who lives, or is found, in their area is suffering or likely to suffer significant harm to enable them to decide whether they should take action to safeguard or promote the child’s welfare

• Professionals’ Meetings

• Child in need/ partnership/ network meetings

• Strategy Meetings

• Child Protection Conference(s)

• Core Groups

• MARAC

• MAPPA

• MASH

•  SCR panel

• Child Death Overview Panel/ Rapid Response Meeting

• Discharge Planning meeting

Mul7-agencymee7ngstoshareinforma7on

TheSevenGoldenRules

"  RememberthattheDataProtec7onActisnotabarriertosharinginforma7on

"  Beopenandhonest"  Seekadvice"  Sharewithconsentwhereappropriate"  Considersafetyandwellbeing"  Necessary,propor7onate,relevant,accurate,

7melyandsecure"  Keeparecord"  Informa;onSharing:PocketGuide(DCSF2008)

ProfessionalResponseinChildProtec;on

"  NICE guidance (2009) suggests 5 key steps

"  Listen and observe

"  Seek an explanation

"  Record what is observed and heard and why this is a concern

"  Either consider, suspect or exclude child maltreatment

"  Record actions taken and the outcome

"  (And then get advice and support, follow CP procedures, and refer to social care)

NICEGuidelines–KeyPoints

"  Stress the need for good communication between health professionals and the child/young person as well as their families and carers is essential

"  Confidentiality – when can we share information without consent?

"  Emphasis on the difference between when we should consider child maltreatment and when we should suspect it

ProfessionalResponse2.Sharingourconcerns

!  By discussing concerns with your manager,

named or designated health professional.

!  By discussing your concerns (without

necessarily identifying the child) with your

colleagues or senior colleagues in other

agencies.

!  By making a formal referral to Social Services

or the Police in accordance with child

protection procedures.

Usefulwebresourceshttps://www.education.gov.uk/aboutdfe/statutory/g00213160/working-together-to-safeguard-children Please note that

within this document there are many further web sources of information in Appendix C.

Children Act 1989

Children Act 2004

Learning Lessons from Serious Case Reviews 2009-10

https://www.gov.uk/government/publications/new-learning-from-serious-case-reviews-a-2-year-report-for-2009-to-2011-

brief New learning from serious case reviews 2009-2011

https://www.nspcc.org.uk/

http://www.londoncp.co.uk/ London Child Protection Procedures 2010 4th Edt

NICE Guide: When to Suspect Child Maltreatment

http://www.education.gov.uk/b00219296/munro Munro Report 2011

http://www.rcn.org.uk/__data/assets/pdf_file/0004/78583/004542.pdf

FemalegenitalMu7la7on(FGM)–www.gov.uk/government/publica7ons/female-genital-mu7la7on-guidelines

ChildSexualExploita7on(CSE)-www.nspcc.org.uk/sexualabuse/cse/homepage

www.nspcc.org.uk/inform/resourcesforprofessionals/childtrafficking