Safeguarding Children & the Pharmacy Team

1. Safeguarding Children & the Pharmacy Team CQC Level Two session

2. Agenda for the session • Dispelling some myths and some key messages • Implications for pharmacists and pharmacies • An awareness of the types of harm • What to do if you suspect abuse or neglect • Information sharing • Where to get advice and support

3. Some Key Principles • The interests of the child are always paramount • Child protection is everyone’s responsibility • Always listen to and believe the child or young person • Report your concerns and make a record

4. Dispelling some myths • Child abuse happens in all sorts of families, don’t think that it couldn’t happen to ‘nice’ families or people that you know • Child abuse occurs in a variety of circumstances and across all social groups.

5. Facts and figures about child abuse • Most child abuse takes place in the home or other ‘safe’ place and in at least 75% of sexual abuse cases, the abuser is well known to the child • 16% of children experience serious maltreatment by parents, of whom one third experience more than one type of maltreatment. • 7% of children experience serious physical abuse at hands of parents/carers • 15% experience sexual abuse • 1% by parent/carer • 3% by another relative • 11% by people known but unrelated to them (NB 5% of children experience sexual abuse by an adult stranger or someone they had just met.) • 6% of children experience serious absence of care at home during childhood. • 6% of children experience frequent and severe emotional maltreatment during childhood.

6. Children may be more vulnerable if there is a history of • family violence or abuse • drug and alcohol misuse • mental health problems • learning difficulties • socio-economic problems (e.g. poverty and unemployment) or • when a child is premature, disabled or unplanned/unwanted • Cumulation of features increases vulnerability

7. Dispelling more myths • Women and Men are involved in abuse • Boys and girls are abused • Child abuse can happen to children of any age and can go unnoticed by experts • Child abuse is never the child’s fault

8. How many children are affected? • Latest available figures show that there are nearly 46709 children subject to child protection plans in the UK as at 31 March 2010 • 39,100 England • 2,730 Wales • 2,518 Scotland • 2,361 Northern Ireland • Nearly 88,000 children were looked after by local authorities in UK • 64,400 England (31.3.10) • 5,160 Wales (31.3.10) • 15,892 Scotland (31.7.10) • 2,463 Northern Ireland(31.3.09)

9. Deaths • Every week in England and Wales one to two children will die following cruelty. • There are on average 80 child homicides recorded in England and Wales each year. • 35 at the hands of a parent/carer • 34 at the hands of a person unrelated but well known to the child or family. • Only 11 at the hands of a stranger/less well known • The people most likely to die a violent death are babies under 1 year old, who are four times more likely to be killed than the average person in England and Wales.

10. Other sources of harm • Over a quarter of all rapes recorded by the police are committed against children under 16 years of age. • 43% of children experience bullying by their peers • 31% physical • 7% discriminated against • 14% were made to feel different/an outsider.

11. Implications for Pharmacists • Pharmacists and pharmacy staff regularly come into contact with children and their families in the course of their work and may come across families who are experiencing difficulties in looking after their children. • Child protection legislation places a statutory duty on organisations and professionals to work together in the interests of vulnerable children. • All healthcare professionals, including those who do not have a role specifically related to child protection, have a duty to safeguard and support the welfare of children. • This means actively promoting the health and well-being of children and also protecting vulnerable children in collaboration with other organisations and authorities.

12. Implications for Pharmacists • The changing nature of pharmacy practice means that the profession is likely to have an increased role in child protection. As a pharmacist or registered pharmacy technician you may be involved in: • identifying concerns about a child and referring these concerns to Social Services or the Police • responding to a request from Social Services for information about a child or their family. • providing a professional pharmaceutical service to a child or family as part of an agreed child protection plan. • You will need to be • alert to potential indicators of abuse and neglect, • familiar with local procedures for promoting and safeguarding the welfare of children, and understand the principles of patient confidentiality and information sharing.

13. What is Child Abuse • No legal definition • Fundamentally it is anything that individuals do which directly harms children or damages their prospects of a safe and happy development into adulthood • Includes acts of ‘commission’ or ‘omission’

14. Significant Harm • The threshold for a formal child protection inquiry • Defined under Children Act 1989 • HARM: ill-treatment or the impairment of health or development • Includes seeing or hearing the ill-treatment of another; • ’development’: physical, intellectual, emotional, social or behavioural development • ’health’: physical or mental health • ’ill-treatment’ includes sexual abuse and forms of ill-treatment which are not physical • a single traumatic event may constitute significant harm (e.g. violent assault or poisoning), significant harm is more often a cumulative pattern of events which interrupt, change or damage a child’s development.

15. Types of Abuse • Physical • Emotional • Neglect • Sexual

16. Physical Abuse • may involve hitting, shaking, throwing, poisoning, burning or scalding, drowning, suffocating, or otherwise causing physical harm to a child • can also be caused when a parent or carer fabricates the symptoms of, or deliberately induces illness in a child • Injuries caused may be as a result of action which is • Sudden & uncontrolled • Premeditated & controlled

17. Is it Abuse? • Accidental v Non Accidental • Age and Development of Child • Delay in presentation or failure to seek medical advice • Injuries of various ages and types • Incompatibility of the injury/injuries with the history • Conflicting and/or changing explanations

18. Emotional abuse • Persistent emotional ill treatment such as to cause severe and persistent adverse effects on the child’s emotional development. • conveying worthlessness • Silencing child • Making fun • Age inappropriate expectations/limitations • Bullying – cyberbullying • Seeing/hearing maltreatment • All harm has emotional element

19. Neglect • Persistent failure to meet a child’s basic physical and/or psychological needs, leading to impairment in health/development • Physical • Safety • Medical • Educational • Emotional

20. Sexual Abuse • Forcing or enticing Child or YP to take part in sexual activities irrespective of • Violence • Knowledge/understanding by child • Contact • Penetrative • Touching/rubbing/kissing • Non contact • Production/viewing images • Watching activity • Grooming • Perpetrators: Men, women & other children

21. Child abuse and neglect • An abused child may be subjected to more than one type of abuse and neglect.

22. Areas of specific concern for pharmacy services • Sexual health services • Substitute prescribing • Other • Self Protection • Weekend concerns • Failure to seek/follow advice

23. Sexual Health Services • Patient Group Directions for EHC • Children under 13 are of insufficient age to consent to sexual intercourse • All sexual activity with children under 13 should be considered as constituting significant harm and should always be considered for referral to Children’s Social Care. • All cases involving under 13s should be discussed with named professionals and presumption they will be referred

24. Sexual Health Services • For young people 13-15, Fraser Guidelines should be utilised • The young person understands the advice that is being given • The young person cannot be persuaded to inform or seek support from, or allow worker to inform their parents that contraceptive/protection, is being given • The young person is likely to begin or continue to have sexual intercourse without contraception or protection by a barrier method • The young person’s physical or mental health is likely to suffer unless they receive contraceptive advice or treatment • It is in the young person’s best interest to receive contraceptive/safe sex advice and treatment without parental consent

25. Sexual Health Services • For young people aged 13+ including vulnerable adults • Competence to understand and consent to the sexual activity they are involved in • Nature of the relationship between those involved, particularly if age or power imbalances. • Use of overt aggression, coercion or bribery including misuse of substances/alcohol as a disinhibitor • Young person’s own behaviour, e.g.misuse of substances/alcohol, places them in a position where they are unable to make an informed choice about the activity • Any attempts to secure secrecy by the sexual partner beyond what would be considered usual in a teenage relationship • ….

26. Sexual Health Services • … • Whether the sexual partner is known by the agency as having other concerning relationships with similar young people • If accompanied by an adult, does that relationship give any cause for concern? • Whether the young person denies, minimises or accepts concerns • Whether methods used to secure compliance and/or secrecy by the sexual partner are consistent with behaviours considered to be ‘grooming’ • Whether sex has been used to gain favours ( eg swap sex for cigarettes, clothes, cds, trainers, alcohol, drugs etc.) • The young person has a lot of money or other valuable things which cannot be accounted for.

27. Substitute Prescribing • Children of parents who use substances are at increased risk of • Neglect • Emotional Harm • Physical Harm • Risks reduced if parents are in Substitute Prescribing programme • However, there is continued need for vigilance • Children of all ages affected

28. Key issues/considerations • ? Continued illicit use • Impact of legal/illicit usage on parental health/ behaviour/ mood • Physical availability to child • Emotional availability to child • Priorities – drugs or child? • Strategies to protect child from impact of drugs/ culture • Role of drugs within parental relationship/ partnership • Messages to child about drug use and offending behaviour • Impact of “friends” / users • Witnessing use by others • Continued access to paraphernalia • Witnessing/becoming involved in violence/aggression

29. Other • Self Protection • Weekend Concerns • Failure to Follow Advice

30. Disclosure of Abuse • Always believe the child • Stay calm and be reassuring • Listen carefully and patiently to the child, do not press for further information • Never promise to keep a secret no matter how insistent the child may be • Tell the child that you are pleased that he/she has told you and explain that you are going to have to report the disclosure • Report the disclosure as soon as possible

31. What Should You Do If You Have Concerns? • Meet any urgent treatment needs • NICE Guidelines 2009

33. Sharing information with other professionals • Is there a legitimate reason for sharing information? • Do you have consent? • Is there a Court Order? • Is it in the public interest? • If this information is not shared would the risk to the child increase? • If not sure always seek advice from professional advisors, Caldecott lead or safeguarding specialists • Doing nothing may not be an option

34. Sources of Support • Designated Doctor • NL – Dr Suresh Nelapatla • 01724 282282 • NEL – Dr Bukar Wobi • 01472 874111 • Designated Nurse • NL & NEL – Sarah Glossop • 07789 615434

35. North Lincolnshire • Named GP – Dr Robert Jaggs-Fowler • Community Health Services • Named Nurse – Jane Westoby/Lisa Robinson • Specialist Nurse – Mandy Irvine • 01724 290609 • NLaG Team • Named Nurse – Sue Kidger • Specialist Nurse – Richard Painter • 01724 387887 • RDaSH • Named Nurse – Julie Wilburn • 01724 275945

36. North East Lincolnshire • Named GP – Dr Marcia Pathak • Community Health Services • Named Nurse – Julie Choudry • Specialist Nurse – Yvonne Tofts • 01472 326133/ 323404 • NLaG Team • Named Nurse – Lynn Benefer • Specialist Nurse – Richard Painter • 01472 875215

37. Questions?