SAFEGUARDING CHILDREN Pharmacy Training

SAFEGUARDING CHILDREN Pharmacy Training Facilitators: Justine Yearwood, Named Nurse for Safeguarding Children and Rose Regan, Nurse Advisor for GP’s

Safeguarding Team • Carmelita Street, Clinical Service Manager • Justine Yearwood, Named Nurse for Safeguarding Children • Keri Clay – Child Death Overview Co-ordinator • Rose Regan – GP Nurse Advisor • Annette Wilkin / Anne Martin – Paediatric Liaison Nurse Advisor • Anne Martin / Deborah Lateef, Nurse Advisor for Initial Assessment Team (Based within Children’s Services) • Beverley Wilson, Named Nurse for Looked After Children • Laura Mpansi, Nurse for Looked After Children • Admin, Pat Weeks, Karleen Steward, Claire Young and Shimila Azam

Aim To equip Pharmacists with the appropriate Safeguarding knowledge to effectively identify suspected cases of significant harm to Children and young People. Learning Outcomes • At the end of the session participants will be able to state their roles, duties and responsibilities to safeguard and protect children. • Develop an increased awareness of definitions, signs and symptoms of abuse, relevant to their role. • Demonstrate knowledge of the pathway they should follow and who to contact for support and advice when there is a concern about the welfare of a child.

Safeguarding Is Everyone’s Responsibility • Whoever comes into contact with children in a professional capacity has a duty of care to that child. • The Children’s Act 2004 reinforced the message that all organisations that work with children and families. Share a commitment to safeguard and promote the welfare of children. • ALL NHS agencies and those commissioned by the NHS have a statutory duty towards safeguarding children.

What is Safeguarding? • Protecting children from maltreatment. • Preventing impairment of children‘s health or development. • Ensuring that children grow up in circumstances consistent with the provision of safe and effective care. • Enabling those children to have optimum life chances and enter adulthood life successfully.

Children: The Five Outcomes • Stay Safe. • Healthy. • Achieve Economic Wellbeing. • Positive Contribution. • Enjoy & Achieve.

Key Policies and Legislation LEGISLATION • Children’s Act 1989 • Adoption and Children Act 2002 • Education Act 2002 • Sexual Offences Act 2003 • Children’s Act 2004 • Adoption and Children Act 2006 • Safeguarding Vulnerable Groups Act 2006 GUIDANCE • Every Child Matters. Change for Children 2003 • Working together to safeguard children 2006 • London Child Protection Procedures (3rd Edition 2007) • Local Safeguarding child manual/guidance • The right to choose. Multi agency statutory guidance for dealing with forced marriage 2008, both children and adults

Child Safeguarding Statistics • On average 1-2 children die each week as a result of abuse or neglect. • Every 10 days in England and Wales one child is killed at the hands of their parent. In half of all cases of children killed at the hands of another person, the parent is the principal suspect. • 1 child in 1000 under 4 years old suffer severe physical abuse. • In 2008 a total of 2268 referrals were made to B&D Children’s Services, of which 197 (8.69%) were deemed a child protection issue. • There are between 70 – 120 referrals a day to B&D Children’s Services

Local Safeguarding Children’s Board (LSCB) • Children’s Act 2004. • Statutory body made up of Partner agencies. • Objective to co-ordinate and to ensure the effectiveness of their member agencies in safeguarding and promoting the welfare of children. • Safeguarding Leads of all agencies. • London LCSB Procedures 2007. www.londonlscb.gov.uk

Definitions of Abuse • Abuse is a violation of an individuals human and civil rights by any other person or persons. • Every Child and Young Person has a right to life free from abuse (Article 19 UN Convention on he rights of the child.) • Legal Definition Children’s Act 1989. • The child is suffering or likely to suffer, significant harm and the harm is attributable to lack of adequate parental care or control.

Neglect • Neglect is the persistent failure to meet a child’s basic physical and/or psychological needs, likely to result in the serious impairment of the child’s health and development. • Neglect can occur during pregnancy as a result of maternal substance abuse. • An inability to provide adequate food, clothing and shelter. • An inability to protect a child from physical and emotional harm and danger. • Neglect can be lack of adequate supervision. • Failing to access appropriate medical care.

Recognition of Neglect • Evidence of neglect builds up over time. • When professionals work in areas of high poverty and deprivation they can become desensitised to some of the indicators of neglect. • Children can fail to grow within normal limits or lose weight. • Child thrives away from home environment. • Child frequently absent from school. • Child left with inappropriate carers. • Child left with adults who are drunk or violent. • Child left alone for excessive periods.

Sexual Abuse Sexual abuse involves forcing or enticing a child or young person to take part in sexual activities, including prostitution, whether or not the child is aware of what is happening. The activities may involve physical contact, including penetrative (e.g. rape, buggery or oral) or non-penetrative acts. They may include non-contact activities, such as involving children in looking at, or in production of, sexual online images, watching sexual activities or encouraging children to behave in sexually inappropriate ways.

Hitting Shaking Throwing Poisoning Burning Drowning Suffocating Strangling Biting Hair Pulling Licking Slapping Or otherwise causing physical harm to a child Physical harm can also be caused when a parent fabricates the symptoms or deliberately induces illness in a child Physical Abuse

Developmental Delay. Abnormal attachment between a child and parent. Aggressive behaviour towards others. Scapegoat within the family. Low self esteem and lack of confidence. Withdrawn or seen as a loner. Playing on community and cultural fears. Overcritical . Shouting / Swearing. Humiliation. Emotional Abuse • Emotional Abuse can be difficult to recognise, as the signs are usually behavioural rather then physical. • The indicators are often associated with other forms of abuse. Indicators can be:

Common Sites For Accidental Injury FOREHEAD NOSE BONY SPINE CHIN FOREARM ELBOWS HIP KNEES SHINS

Concerning Injuries SKULL - fracture or bleeding under skull (from shaking) EYES - bruising, black (particularly both eyes) EARS - Pinch or slap marks, bruising CHEEK/SIDE OF FACE - bruising, finger marks NECK -bruising, grasp marks UPPER & INNER ARM - bruising, grasp marks MOUTH - torn frenulum CHEST - bruising, grasp marks SHOULDERS - bruising, grasp marks Linear bruising. Outline of belt/buckles. Scalds/burns BACK } BUTTOCKS } THIGHS } GENITALS - bruising KNEES - grasp marks

Sexual Offences Act 2004 • Aim of Act • To protect children and families from Sexual Abuse. • Key Points of the Act • Tougher sentences for adults. • Closer monitoring of Sex Offenders. • New and updated offences. • Clarification regarding sexual activity in the under 16’s.

Consent and the Under 16’s • The legal age for consent to sex is still 16. • (Whether straight, gay or bisexual) • Specific laws protect children under 13, who cannot legally give their consent to any form of sexual activity. There is no defence of mistaken belief about the age of the child as there is in cases involving 13 -15 year olds.

Home Office Guidance • ‘The Law is not intended to prosecute mutually agreed teenage sexual activity . . .unless it involves abuse or exploitation’ • ‘Young people still have the right to confidential advice on contraception, condoms, pregnancy and abortion, even if they are under 16’

LCPC Protocol on Disclosure If a young person under the age of 13 years discloses that they have engaged in or intend to engage in a penetrative sexual act or other intimate sexual activity there should be a presumption (within the constraints of Professional Codes of Conduct), that the case will be reported to Children’s Services P&A Team.

LCPC Protocol A comprehensive Risk Assessment for under 16’s engaged in Sexual Activity includes . . . • Confidentiality assessed using the Fraser Guidelines. • Sexual partners of 13-16 year olds checked with the Police as part of the risk assessment. • The presumption of reporting to the Police and Children’s Services any under 13’s engaged in sexual activity. Frazer Guideline • The young person understands the advice and has sufficient maturity to understand what is involved. • The young person would be very likely to begin, or continue to have sexual intercourse with or without contraception treatment.

What to do next • Where (in line with NMC,BMA or GMC Codes of Professional Conduct) that there is reasonable cause to suspect that a child is suffering or likely to suffer significant harm, the Duty Social Worker should be contacted via a Multi Agency Referral Form (MARF). • If the young person already has a Social Worker the referral should go to them. Children’s Services will arrange a Strategy Meeting/Discussion with you as the referrer, and the Police. • In deciding whether to make a referral, the child’s best interests must be the overriding consideration. • All cases involving under 13’s must be fully documented, including giving reasons where a decision is taken not to share information.

Purpose of the Strategy Meeting • The purpose of the Strategy Meeting/Discussion will be to: • Review the nature of the incident; • Share background Information; • Determine future actions; • Consider whether the information /evidence indicates that a crime might have been committed.

The Age of Consent for Heterosexual SexEngland and Wales The age of consent to any form of sexual activity is 16 for both men and women. The Sexual Offences Act 2003 introduced a new series of laws to protect children under 16 from sexual abuse. However, the law is not intended to prosecute mutually agreed teenage sexual activity between two young people of a similar age, unless it involves abuse or exploitation. Specific laws protect children under 13, who cannot legally give their consent to any form of sexual activity. There is a maximum sentence of life imprisonment for rape, assault by penetration, and causing or inciting a child to engage in sexual activity. There is no defence of mistaken belief about age of the child, as there is in cases involving 13-15 year olds.

Under 16’s:Consent and confidentiality in sexual health services Any competent young person in the United Kingdom can consent to medical, surgical or nursing treatment, including contraception and sexual and reproductive health. Young people are owed the same duties of care and confidentiality as adults. Confidentiality may only be broken when the health, safety or welfare of the young person, or others, would otherwise be at grave risk.

Contraception and Under 16’s Health professionals in the UK may provide contraceptive advice and treatment to young people under 16 if, in their clinical judgement, they believe it is in the young person’s best medical interests and they are able to give what is considered to be informed consent.

Every Child Matters: Change For Children (2004) • Pharmacists and pharmacy technicians can help to improve all five outcomes by providing good quality information, advice, support and signposting to appropriate services when a need is identified. Working Together to Safeguard Children (2006) • Those professionals who work directly with children should ensure the safeguarding and promoting their welfare forms an integral part of all stages of the care they offer. • Those professionals who come into contact with children, parents and carers in the course of their work also need to be aware of their safeguarding responsibilities.

Hidden Harm Parental mental illness does not necessarily have an adverse effect on a child but it is essential to always assess its implications for each child in the family. Where a parent has a enduring and/or severe mental illness, children in the household are more likely to be at risk of, or experiencing significant harm. A pregnant woman may have previous severe mental disorders e.g. schizophrenia or personality disorder involving risk of harm to self or others.

Fabricated Illness / Induced Illness Parent/carer reports signs/symptoms not explained by a medical condition. Poor response o prescribed medication and/or treatment. New symptoms are reported on resolution of previous ones. Child’s normal activities are restricted by parent due to the perceived illness. Repeated presentations to a variety of doctors with a variety of problems Further information on www.doh.gov.uk

Barriers to Safeguarding • Concerns about relationship with family. • Fear of getting it wrong. • Lack of experience. • Pressure of workload. • Familiarity with service user. • Fear of reprisal / complaint. • Unresolved personal feelings.

Information Sharing Guidance Sharing information is essential to enable early intervention for people who need additional services to achieve positive outcomes. It is vital for providing effective and efficient services that are coordinated around the needs of the individual and for safeguarding and protecting the welfare of individuals. It is important that practitioners understand why,when,and how they should share information, so they can do so confidently and appropriately as part of their day-to-day practice.

Information Sharing Practitioners Guide (2006) • This was the first cross-government guidance for practitioners across the whole of the children’s workforce. • Most decisions to share information require professional judgement. • The guidance seeks to provide clarity on the legal framework for information sharing at the front line and to develop practitioners understanding and confidence in sharing information professionally and lawfully.

Common Assessment Framework(CAF) • Is a key part in delivering frontline services that are integrated and focused around the needs of the child. • It is a key component in the Every Child Matters :change for children programme • It is a standardised tool used to conduct an assessment of a child’s additional needs and help practitioners decide how these needs should be met.

For Discussion • What information is classed as confidential in you work as a Pharmacist ? • What is normally required before disclosing confidential information? • Describe as many types of circumstances you can think of where you either must or could disclose confidential information without consent.

Common Law • Common Law is the basis for civil Rights Law and Human Rights Laws. • Because there is a professional obligation to respect confidentiality this becomes part of the ‘duty of care’expected of Pharmacists under common law. • The pharmacist who discloses confidential information because he or she believes a child is at risk of significant harm is very unlikely to be challenged in court. • You are more likely to be challenged for NOT sharing information in the case of a child.

What to you have concerns • Speak to other health care professionals e.g. health visitor or GP • Seek advice from Children’s Services 0208 227 3852 • Seek advice from Safeguarding Team CHS 0208 522 9640 • NSPCC will give advice 0808 800 5000

Take the allegation seriously. Seek advice and support. Actively listen but DO NOT press for information. Inform them what you will do next. Record Keeping. Refer to Social Services. Think of your safety and the safety of the child. Follow policy and procedure. Don’t manage the disclosure on your own. Don’t ignore the allegation. Don’t promise to keep a secret. Don’t ask leading questions. Don’t investigate yourself. Don’t panic Managing a Disclosure of Abuse

If you suspect What Should YOU Do? • If safe to do so, ask the individual the direct question. (Unless Child Sexual abuse) • If possible, get consent to share information. • Inform the designated member of staff about your concerns immediately. • Document what is said accurately – be specific about what you’ve seen; what the victim said – using the victim’s words; what you said; note the context – time and date on your record; and sign it; avoid judgments and opinions. • Refer. • Be professional – do not discuss the matter with people who do not need to know. • Ensure that records are held securely and in accordance with data protection. • Take responsibility for following up progress.

It’s all in here!

Accountability for Practitioners • Accountability is an integral part of practice, as in the course of practice you have to make judgements in a wide variety of circumstances. • Whatever decision / judgement you make you must be able to justify your action and always remember that the “welfare of the child is paramount.” Children Act 1989

Professional Accountability “You are professionally accountable for your practice. This means that you are answerable for your actions and omissions, regardless of advice or directions from another professional.”NMC Code of Professional Conduct, 2002

Decision Making • Is an integral part of practice • Weighing up the best interests of the child • Using professional knowledge, judgement and skills top decide • What interventions will achieve the desired outcomes?

Information Sharing Information Sharing is vital to safeguarding and promoting the welfare of children & young people It is important that practitioners understand the circumstances when, why and how they should share information.

Case Reviews / Inquires • A key factor in many serious case reviews has been a failure to record information • To take appropriate action in relation to known or suspected abuse or neglect • To make a referral to social services and to share information appropriately • To understand the significance of the information shared

Confidentiality & Consent • The Data Protection Act is not a barrier to sharing information • It is in place to ensure that personal information is shared appropriately Information Sharing: Practitioners’ Guide Dfes 2006

Record Keeping • Good record keeping is an integral part of good practice. • The quality of your record keeping is also a reflection of the standard or your practice. • Good record keeping is a mark of the skilled and safe practitioner, whilst careless or incomplete record keeping often highlights wider problems with the individual’s practice

Content & Style • Be factual, consistent and accurate • Contemporaneous, be written as soon as possible after the event • Written clearly and legibly • No jargon or abbreviations • Accurately dated, timed and signed • Signature – print name

Human Rights Act 1998 • Strengthens the rights of the individual to expect confidentiality and privacy in matters in which regard as private. • However these rights are not absolute and can be overriden by either the public interest or the prevention of a crime, for the protection of health or for the protection of rights and freedom of others. • Therefore in situations of abuse , the rights of the child override those of the adult in respect of the private family life

Continuum of Needs and Services Statutory or specialist assessment from this point I = Identification and action T = Transition N = Needs met

SAFEGUARDING CHILDREN Pharmacy Training