Level 3 Safeguarding Training

1. L Level 3 Safeguarding Training Whole day training June 2017

2. Introductionsand Housekeeping Fire alarms Facilities Timings of the day Mobile phones Confidentiality /Respect

3. Trust Safeguarding Team Ruth Vines Head of Safeguarding 020 8702 3955 Nhamo Paz Celia Jeffreys Carolyn Sobers Safeguarding Adults Safeguarding Children’s Safeguarding Children’sLead Lead BEH Lead BEH Enfield Community Services 020 8702 3118 020 8702 4918 0208 702 5600 Safeguarding Nurses

4. Welcome • Level 3 Safeguarding children training • 6 or 12 hours required over 3 year period • Trust safeguarding (all details are on the Intranet) • Celia Jeffreys • Named Doctors • Enfield Community safeguarding team • Safeguarding training can be challenging at times, please feel welcome to leave and take some time out of you need to

5. What do the Safeguarding Team do ? • Expert resources • Support with complex safeguarding children concerns • Quality Assurance for Trust board regarding safeguarding children • Update staff members with legislative and policy changes (newsletter) • Work closely with Local Authority safeguarding Boards

6. Learning objectives • Recognise factors that can impact on the vulnerability of a families and their ability to safeguard their own children. • Have an understanding of how complex lifestyle choices can have adverse effects on parenting • Recognition of vulnerable groups of children • Demonstrate effective multi-agency working when safeguarding children is a concern

7. Subjects Covered • Vulnerability • Categories of child abuse • Parental mental health • Parental substance misuse • Parental domestic violence and abuse • Female genital mutilation (FGM) • Harmful cultural practices • Fabricated/induced illness • PREVENT • Child sexual exploitation (CSE) • Substance and alcohol misuse by young people • Trafficking/Modern slavery • Information sharing • Referring to children's social care • Case conferences

8. Principles of safeguarding • The child's welfare is paramount • Multi agency approach • A continued process, not a one off event • Focused on outcomes for children • Holistic in approach • Professional curiosity and recognising disguised compliance • You do not need to be certain to share without consent!

9. Definition of a child • Child: • Not yet reached their 18th birthday • Unborn baby • Children under 16 are not presumed to have capacity to make their own decisions • Children can have capacity in certain situations (Gillick/Fraser Competency) • Childs age and maturity • Childs level of cognitive and emotional development • The complexity and nature of the intervention • Mental disorder

10. Parental Responsibility • Parental responsibility usually lies with the parents – but not always. When taking decisions under the Mental Health Act, it is essential to be certain where parental responsibility lies. • Parental Responsibility: • Mother at birth • Father if married to mother at time of birth or on birth certificate • Others can acquire PR through court process • Local authority if there is a care or supervision order in place • It is essential to know if any of the following apply as they may affect parental responsibility: • Care Order • Residence or contact order • Appointment of a guardian • Parental responsibilities agreement or order under Section 4 of the Children Act

11. Private Fostering • Think Victoria Climbie • When a child or young person under 16 (or 18 if disabled) is living away from home for 28 days or more and is being cared for by someone who is not their: • Parent • Grandparent • Person with parental responsibility • Step parent (by marriage/civil partnership) • Aunt/Uncle • Sibling • Local authority must be informed if this comes to your attention and they will carry out a private fostering assessment

12. THINK CHILD, THINK PARENT, THINK FAMILY……. Group Work

13. What makes a child vulnerable • Age (0-1) • Poverty • Child with learning disability or physical disability • Social isolation • Family residing in an area of high crime, poor housing or high unemployment

14. Age as a risk factor for death or serious injury from abuse or neglect • Infancy is period of highest risk • There are further risks to young people during adolescence, including risks associated with child sexual exploitation and risks of suicide (Brandon et al 2016)

15. Parental factors contributing to a child's vulnerability • Parent with learning disability • Parent/s with mental illness • Domestic Violence in the family/difficult separation • Substance misuse (drugs and alcohol) • Adverse experiences as a child (parent was a looked after child (LAC)) • History of violent crime • History of animal abuse • Pattern of multiple consecutive partners

16. 4 categories of child abuseDiscussion • Neglect https://www.youtube.com/watch?v=0MV136Qb68A • Sexual • Emotional • Physical Remember that a non mobile baby should not have bruises, if this is recognised you must ask questions and act

17. Parental factors that can cause harm to children

18. Parental Mental Health • Severe mental illness can adversely affect an individuals ability to parent their children BUT this doesn’t always happen and with correct treatment and support parenting can be good • Red flags Please consider: • Does the child feature as a part of the psychosis, delusional thinking or suicide plans? • Compliance with their treatment plan • Describe and identify the relationship with their child • Is the child a young carer? • If parental mental health concerns co-exist with other risk factors (DV, substance misuse etc.) the child must be considered at greater risk.

19. Impact of parental mental health issues • The impact of the parents mental health problems on the safety, wellbeing and development of the child: • Emotional availability and attachment • Day to day Supervision • Behavioural boundaries • Effects of a chaotic home life • Always consider liaising with the child’s health visitor/school nurse in these circumstances

20. Parental substance misuse • All illicit substances, legal highs, alcohol • Professionals often focus on the issues faced by parents who misuse substances without considering the impact on their children • Risks to children: • Sudden unexpected infant Death Syndrome associated with co-sleeping • Accidental ingestion of drugs • Accidents (fire, drowning) due to inadequate adult supervision • Parents deliberately giving children drugs

21. Assessment in substance misuse • Children and parenting capacity need to be included as part of every risk assessment • Assessments need to be child focused if there are children in the family • Risk assessment should be dynamic rather than static (one off) process, which reflect changes in circumstance • Consider other risk factors such as DV and mental health when risk assessing

22. Domestic violence and abuse (DVA) • Domestic violence and abuse can manifest as physical violence, controlling behaviour and coercive control within in a close relationship • DVA can affect men, women and same sex couples as well as teenagers and the elderly • However the severity of violence is worst against women • Seven women a month are killed are killed by a current or former partner in England and Wales • 85% of victims sought help at least 5 times from professionals in the year before they got effective help

23. Domestic Violence and Abuse and children • DVA is always harmful to children • It may be seen/heard or the child may live in a toxic household • 62% of children who live in an abusive home are directly physically or sexually abused themselves • Professionals should not rely on victims of abuse to act for their own or their children's protection • Controlling behaviour may continue to pose risks to victim and child even following separation, especially at child contact

24. If you become aware that a parent/carer/service user is experiencing DVA Follow the Trust DVA policy • Assess the immediate risk to the parent/child • Be aware that risk escalates around the time of parental separation • Never advise someone to leave their partner Always refer to children's social care if: • High risk DVA • Children are suffering from or at risk of suffering significant harm • A woman is pregnant • There is a baby under 1 year • A child is disabled

25. Group work Name the effects that harmful behaviours may have on children……. Describe what behaviours or signs that you may observe for a child that has experienced or lives with: • Parental MH or • Substance misuse or • DVA In the following ages • Baby 0-1 years or • Toddler 1-3 years or • Child 3-11 years or • Adolescent 11-18 years

26. Effect of early neglect on child’s brain development • Still face clip - https://www.youtube.com/watch?v=apzXGEbZht0 • Neglect can negatively affect the physical development of the child’s brain leading to: • Insecure attachment • Cognitive difficulties such as speech and language delay • Poor intellectual ability and inability to concentrate or express feelings

27. Female Genital MutilationWarning: diagram follows

28. Female Genital Mutilation

29. Female Genital Mutilation • FGM IS CHILD ABUSE • FGM can occur at anytime throughout a girls/women’s life from a few days of life to adulthood • FGM is a cultural and tradition practice, Communities believe that FGM should be carried out to keep a girl ‘clean’ and to ensue her honour pre marriage • FGM is carried out in over 32 Countries in the world and has travelled with migration into western countries • Usually carried out by a traditional cutter, often the traditional birth attendant in a community in non sterile conditions, however is becoming more medicalised in specific areas of the world • Women can be unaware that they have had FGM as a child • 30 million girls are at risk globally in the next decade

30. Effects of FGM

31. FGM and The Law • It is an offence to carry out FGM in the UK • Legislation: Prohibition of Female Circumcision Act 1985 Female Genital Mutilation Act 2003 Serious Crime Act 2015 • Mandatory REPORTING duty – Call police on 101 • Under 18 • Disclosure from the child directly to the practitioner • Visual confirmation of having been undertaken • Mandatory RECORDING duty requires the acute trust, GP’s and Mental Health trust to report quarterly if a woman affected by FGM presents to their clinical area • For the MHT this is taken from the RIO system (please record on RIO if you know that a woman is affected by FGM)

32. Harmful Cultural practices- effects on children All are abusive to children • Child Abuse linked to faith or belief • Breast flattening/ironing • Traditionally thought of as a means to safeguard children from unwanted sexual advances • https://youtu.be/imCmlG3_3tc • https://youtu.be/jUsP3ZjFrU8 • So called ‘Honour’ based violence • Ultimately can lead to child death • Forced/child marriages • Against the rights of the child • Children with LD and physical disabilities are the most vulnerable group

33. Child Abuse Linked to Faith or Belief (CALFB): • The National Action Plan  includes the below when referring to Child Abuse Linked to Faith or Belief (CALFB): • witchcraft and spirit possession, demons or the devil acting through children or leading them astray (traditionally seen in some Christian beliefs), • the evil eye or djinns (traditionally known in some Islamic faith contexts) and • dakini(in the Hindu context); • ritual or murders where the killing of children is believed to bring supernatural benefits or the use of their body parts is believed to produce potent magical remedies; • use of belief in magic or witchcraft to create fear in children to make them more compliant when they are being trafficked for domestic slavery or sexual exploitation.

34. Health implications of Abuse linked to faith or belief • Physical: This can involve beating, burning, cutting, stabbing, semi-strangulating, tying up the child, or rubbing chilli peppers or other substances on the child’s genitals or eyes. • Emotional: Emotional abuse can occur in the form of isolation. A child may not be allowed near or to share a room with family members, and threatened with abandonment. The child may also be persuaded that they are possessed. The act of telling a child that they are possessed by an evil spirit or told that they are a witch can be emotionally abusive. • Neglect: In situations of neglect, the child’s family and community may have failed to ensure appropriate medical care, supervision, education, good hygiene, nourishment, clothing or warmth. • Sexual: Children who have been singled out in this way can be particularly vulnerable to sexual abusers within the family, community or faith organisation. These people exploit the belief as a form of control or threat.  Children could also be subject to practices through the deliverance process that are sexually abusive e.g. having to be bathed undress in the presence of others. Trafficked children from some countries have been known to be subjected to practices designed to control them. Some of these practices involve using their pubic hair and undergarments in rituals.

35. Justifications for Abuse linked to Faith or Belief • Evil Spirits: Belief in evil spirits that can ‘possess’ children is often accompanied by a belief that a possessed child can ‘infect’ others with the condition. This could be through contact with shared food, or simply being in the presence of the child. • Scapegoating: A child could be singled out as the cause of misfortune within the home, such as financial difficulties, divorce, infidelity, illness or death. • Bad Behaviour: Sometimes bad or abnormal behaviour is attributed to spiritual forces. Examples include a child being disobedient, rebellious, overly independent, wetting the bed, having nightmares or falling ill. • Physical Difference/Disability: A child could be singled out for having a physical difference or disability. Documented cases included children with learning disabilities, mental health issues, epilepsy, autism, stammers and deafness. • Gifts and uncommon characteristics: If a child has a particular skill or talent, this can sometimes be rationalised as the result of possession or witchcraft. This can also be the case if the child is from a multiple or difficult pregnancy. • Complex family structure: Research suggests that a child living with extended family, non biological parents, or foster parents is more at risk. In these situations they are more likely to have been subject to trafficking and made to work in servitude

36. The Law for Abuse Linked to Faith and Belief • There are a number of laws in the UK that allow the prosecution of those responsible for abuse linked to faith or belief. One of the biggest challenges is raising awareness and encouraging victims and witnesses to come forward.(Source: MET Police, Online) • The Children in Need Census 2016/7 identified 1,460 cases where the assessment of the child’s needs showed child abuse linked to faith or belief as a possible factor. (Department for Education, 2017 • http://nationalfgmcentre.org.uk/calfb/

37. Fabricated and induced illness (FII) • Previously known as Munchausen's by proxy • Usually perpetrated by women • FII involves a well child being presented by a carer as ill or disabled • Deliberately inducing symptoms by administering medication or substances • Falsifying test results e.g. blood in urine • Unverifiable or exaggerated symptom • Fulfils a need of the perpetrator rather than a true need of the child

38. Child Sexual Exploitation (CSE) • Child sexual exploitation is a form of child sexual abuse • It occurs where an individual or group takes advantage of an imbalance of power to coerce, manipulate or deceive a child or young person under the age of 18 into sexual activity • in exchange for something the victim needs or wants and/or (b) for the financial advantage or increased status of the perpetrator or facilitator • The victim may have been sexually exploited even if the sexual activity appears consensual. • Child sexual exploitation does not always involve physical contact; it can also occur through the use of technology Boys are at as much risk as girls

39. Children at risk of CSE • Looked after Children • Children with learning disabilities • Children coming from chaotic families • Children with mental health issues • Children with substance misuse issues • Missing children

40. Health Education England Video https://www.youtube.com/watch?v=sC4Nn_mYKu0

41. PREVENT • The Prevent Agenda. Prevent is one of four work strands which make up the government‘s counter-terrorism strategy – CONTEST. The aim of CONTEST is to reduce the risk to the UK and its interests overseas from terrorism. Pursue – focuses on detecting, investigating and disrupting terrorist threats to the UK and our interests overseas • Channel is part of the Prevent strategy. The process is a multi-agency approach to identify and provide support to individuals who are at risk of being drawn into terrorism. • This is in the pre-crime space and is a preventative tool

42. Substance and alcohol misuse by young people • Children at highest risk • LAC • Gang involvement • Parental Substance misuse • Children groomed for CSE • Mental health issues/low self esteem • Peer pressure • An assessment should be made of the whole family and the parents ability to keep the child safe

43. Gangs • A gang see themselves and are seen by others as a noticeable group who engage in a range of criminal activity and violence • Boys may be involved in drug selling/movement, theft, violence and recruitment • Many girls in gangs may be subject to CSE and can be used to carry drugs, weapons or are used as ‘bait’ to provoke rival gangs • Criminal activity can include fighting, drug use, initiation ceremonies, theft, stabbings and shootings • Children involved in gangs, including their family members (siblings) have safeguarding needs that should be addressed by practitioners

44. Contd • https://www.youtube.com/watch?v=dhOzM_HVqjY

45. Trafficking/Modern Slavery • Is well explained in the following NHS video • https://www.youtube.com/watch?v=Jv1H_fAoOG4

46. What to do if you have a concern that a child is suffering harm or is at risk of harm

47. Think Family Approach • Think child, think parent, think family in order to improve outcomes for parents with mental health problems and their families • Take a multi-agency approach, to implement a think family approach • Ensure screening systems in adult mental health and children’s services routinely and reliably identify and record information about adults with mental health problems who are also parents. • Listen to parents and children – most want support that is flexible, based on a relationship with a key worker and takes account of their practical priorities. • Build resilience and manage risk and consider an early help approach to keeping children safe. Escalate to specialist mental health and children’s safeguarding services when needed. • Staff to have an understanding of multi-agency practitioners roles and responsibilities. • Increase every family member’s understanding of a parent’s mental health problem – this can strengthen their ability to cope

48. Think family in practice • Document all children associated with adult service users on the RIO system (this could include step children, siblings, any child resident in or in association with the home) • Documentation should be completed in Client Demographics > Family details. • Add alert to RIO system to indicate safeguarding risks.

49. Social Care Thresholds Discussion • Why do we refer to children's social care ? • What do we hope to get from the referral ? • How do you feel if your referral is not accepted?

50. Social care Thresholds Child Protection or a Looked After Child Early help Child in Need or Vulnerable child