SAFEGUARDING CHILDREN Shirley Robinson Named Nurse Safeguarding Children

1. SAFEGUARDING CHILDREN Shirley Robinson Named Nurse Safeguarding Children

2. Objectives Understand the legal framework for safeguarding children Discuss types of abuse Signs and Indicators Know how to act on concerns Sharing Information Identify and overcome the obstacles Issues for the Primary Health Care Team

3. When we have to deal with abuse we may feel a mixture of some or all of the following: Denial - difficult to accept abuse takes place Guilt - because we all make mistakes Fear - that we won�t know what to do Anger - that people can do such things to children Pain - at the recognition of abuse in our own lives Jealousy- if we have to let another professional take over

4. OBLIVION What? �There�s no such thing as child abuse� � Abuse doesn�t happen amongst people I know� �Too much is made of abuse � it isn�t that common� OBSESSION � Everyone abuses children � Abuse is very common in some types of family� �Any single person who works with children is an abuser� Professional awareness and responsibility

5. Facts and Figures 31% bullied during childhood 7 % seriously physically abused by parents or carers during childhood 1% sexually abused by a parent or carer during childhood 3% sexually abused by another relative during childhood On average 1 child is killed by their parent or carer every week in England and Wales Ref: NSPCC

7. Legislation and Guidance Children Acts 1989 and 2004 Working Together to Safeguard Children 2006 Framework for Assessment of Children in Need Kent County Council Child in Need / Child Protection procedure What to do if you�re worried a child is being abused Information Sharing: practitioners guide 2008

8. Principles of the Children Act 1989 The welfare of the child is paramount Partnership between the state and parents Parental responsibility for the child Prevention of abuse Protection of the child

9. Framework For Assessment Of Children In Need

10. Professional Responsibility To identify children in need, or suffering, or at risk of suffering significant harm Refer to statutory agency when appropriate Contribute to assessment Participate in action plans Record concerns

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16. The Non Accidental Injury Inconsistent story Story does not fit injury Story does not correspond to development of the child Injuries not witnessed Frequent A&E attendances Failure to attend for treatment early enough or not at all Injuries in areas of body protected by clothes Families where Domestic Violence exists Parents who demonstrate aggression

19. Parents Behaviour as Indicators for Emotional Abuse Fail to provide consistent love and nurture Habitual verbal harassment Exert overt hostility Reject children Highly critical of their children Frequently ridicule children Have excessively high expectations Language used is always negative �High criticism, low warmth

20. Vulnerability Factors Families living in poverty Domestic Violence Where a parent has a mental illness Substance misuse (drugs or alcohol) Learning Disability (parent or child) Social Isolation Areas of high crime, poor housing, high unemployment

22. Significant Harm Significant harm is the threshold that justifies compulsory intervention in family life in the best interests of the child The local authority has a duty to make enquiries where they consider, or have reasonable cause to suspect, a child is suffering or likely to suffer significant harm

24. Significant Harm �A compilation of significant events, both acute and long-standing, which interact with the child�s ongoing development and interrupt, alter or impair physical and psychological development. � Significant harm represents a major symptom of failure of adaptation by parents to their role, and also involves both the family and society�. (Bentovim � Significant Harm in Context 1988 p57)

25. Acting on Concerns Kent Safeguarding Children Board (KSCB) Procedures

27. Consultation Lead professionals within PCT Social Services (Duty) Police � Child Abuse Investigation Unit (CAIU) �If in doubt ask�

28. Referral How �urgent� or �grave� is the situation? Most situations are not �urgent and grave�. If you are in any doubt seek advice from the Duty Team � SSD of from the Police (SIU). Does the referral involve concerns about �significant harm�? Has a crime been committed against a child (or an adult)?

29. Information Sharing Legal Restrictions Common law duty of confidence Human Rights Act 1998 Data Protection Act 1998

31. Consent & Confidentiality In general it is and has always been good practice to obtain parent�s�/carers consent to make a referral to the SSD or to obtain further information from another agency. Seeking consent should be the �norm�. Exceptions are: Where you (the referrer) make a professional judgement that seeking consent would place the child(ren) and/or other people at increased risk.

32. Information Sharing In Child Protection it is vital to consider the following: It may not be safe for the child or children to seek consent (that is � seeking consent may place a child at greater risk of harm). A crime may have been committed � seeking consent could well undermine its detection There is a legal basis for sharing information without seeking consent.

33. Consent & Confidentiality Exceptions are: Where the child has made an allegation or disclosure of sexual abuse/assault. Where a crime has clearly been committed. Most situations will not involve exceptions! If you are in any doubt seek advice from the Duty Team � SSD, Named Nurse or from the Police (CAIU).

35. Disclosure in the Absence of Consent Need to know� basis What is the purpose of the disclosure? What are the nature and extent of the information to be disclosed? To whom is the disclosure to be made? Is the disclosure proportionate response to the need to protect the welfare of a child

40. Activity Considering the case scenarios What is the potential impact on a child What action, if any, would you take? What are the dilemmas faced for you as a professional worker? Are you able to maintain confidentiality if requested?

41. GP�s Role in Child Protection: Tensions Family Medicine Family Support Confidentiality Professional autonomy Child Protection Paramount principle Information sharing Interagency collaboration

42. Difficulties Facing the PHCT What to do and say when abuse was suspected during the course of a consultation Awareness of local Child Protection guidelines Strategies for their implementation at practice level How to maintain working relationships with families during and after the child abuse investigative process Attendance at Child Protection case conference and preparation of relevant reports

43. Serious Case Review C/2003 Primary Care Trust�s are to consider and recommend an appropriate means of highlighting the medical records of adults who may present risks to children, particularly highlighting information that may indicate Child Protection risks.

44. Serious Case Review D/2003 Where there are concerns regarding the welfare of an adult within a household, consideration should be given to children in the same household and the possibility of Child Protection issues raised sooner rather than later.

45. Serious Case Review D/2003 General Practitioners should be made aware of the possibility of severe neglect where parents persistently refuse medical advise for their children and do not attend hospital appointments.

46. Serious Case Review A2005 A child with bruising and not cruising should be referred to a paediatrician General Practices to review procedures to ensure domestic violence is discussed with all women presenting with symptoms suggestive of domestic violence. Critical incident analysis should be encouraged as good practice. General Practices to ensure all staff have appropriate training in child protection and domestic violence

47. Serious Case Review A/2006 Midwives and Health Visitors should have access to GP records relating to children and their families.