Working with the people of Camden to achieve the best health for all

1. Working with the people of Camden to achieve the best health for all Level 1 Safeguarding Children Training For Practice Managers & Admin Staff Jackie Dyer -Designated Nurse July 2015

2. Aim of the session Working with the people of Camden to achieve the best health for all To develop an awareness of and the ability to act on concerns about the safety and the welfare of children & young people

3. Scope of session Working with the people of Camden to achieve the best health for all Recognise signs & potential indicators of child maltreatment Understand impact of parent/carer physical and mental health on the well-being and development of a child & young person What to do if they have concerns about children , in order to safeguard and promote the welfare of children, including those who are suffering or at risk of suffering significant harm Knowledge of the relevant legislation Children Acts 1989 , 2004 & Sexual Offences Act 2003

4. Definition of Safeguarding Working with the people of Camden to achieve the best health for all The process of protecting children from abuse, neglect, preventing impairment of their health and development, and ensuring they are growing up in circumstances consistent with the provision of safe and effective care which is undertaken so as to enable children to have optimum life chances and enter adulthood successfully. (Working Together to Safeguard Children 2015)

5. Safeguarding Children Working with the people of Camden to achieve the best health for all A duty to protect children from maltreatment A duty to prevent impairment

6. Definition of Child Protection Working with the people of Camden to achieve the best health for all Child protection is the process of protecting children who have been identified as either suffering, or likely to suffer significant harm as a result of abuse. The categories of abuse are; Neglect Physical Emotional Sexual

7. Definition of Physical Abuse Working with the people of Camden to achieve the best health for all may involve hitting, shaking, throwing, poisoning, burning or scalding, drowning, suffocating, or otherwise causing physical harm to a child. Physical harm may also be caused when a parent fabricates the symptoms of, or deliberately induces illness in a child

8. Definition of Emotional Abuse Working with the people of Camden to achieve the best health for all is the persistent emotional maltreatment of a child such as to cause severe and persistent effects on the child's emotional development, and may involve: Conveying to children that they are worthless or unloved, inadequate, or valued only insofar as they meet the needs of another person; Imposing age or developmentally inappropriate expectations on children. These may include interactions that are beyond the child's developmental capability, as well as overprotection and limitation of exploration and learning, or preventing the child participating in normal social interaction;

9. Definition of Emotional Abuse Working with the people of Camden to achieve the best health for all Seeing or hearing the ill-treatment of another e.g. where there is domestic violence and abuse; Serious bullying, causing children frequently to feel frightened or in danger; Exploiting and corrupting children. Some level of emotional abuse is involved in all types of maltreatment of a child, though it may occur alone

10. Definition of Neglect Working with the people of Camden to achieve the best health for all 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, such as failing to provide adequate food, shelter and clothing, failing to protect a child from physical harm or danger, or the failure to ensure access to appropriate medical care or treatment. It may also include neglect of or unresponsiveness to a child’s basic emotional needs.

11. Definition of Sexual Abuse Working with the people of Camden to achieve the best health for all Forcing or enticing a child or young person to take part in sexual activities, whether or not the child is aware of what is happening. The activities may involve physical contact, including penetrative (e.g. rape or buggery) or non-penetrative acts. They may include non-contact activities, such as involving children in looking at pornographic material or watching sexual activities, or encouraging children to behave in sexually inappropriate ways.

12. Signs of Child Maltreatment Working with the people of Camden to achieve the best health for all Child Sexual Exploitation (CSE) FGM Trafficking Exploitation by radicalization Fabricated Illness Potential Signs Understanding potential impact of parents/carers mental health, Domestic Abuse Risks associated with Intranet & Social Media

13. What is Child Sexual Exploitation CSE Working with the people of Camden to achieve the best health for all Child Sexual Exploitation (CSE) FGM Trafficking Exploitation by radicalization Fabricated Illness Potential Signs Understanding potential impact of parents/carers mental health, Domestic Abuse Risks associated with Intranet & Social Media

14. Trends in Child Sexual Exploitation CSE Working with the people of Camden to achieve the best health for all Gangs & groups Older ‘boyfriend’ Trafficked Child Sexual Exploitation Sexual Bullying Online Opportunistic Familial Trends in CSE

15. Definition of Domestic Abuse Working with the people of Camden to achieve the best health for all Any incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse between those aged 16 or over who are or have been intimate partners or family members regardless of gender or sexuality. This can encompass but is not limited to the following types of abuse: psychological physical sexual financial emotional Controlling behaviour is: a range of acts designed to make a person subordinate and/or dependent by isolating them from sources of support, exploiting their resources and capacities for personal gain, depriving them of the means needed for independence, resistance and escape and regulating their everyday behaviour. Coercive behaviour is: an act or a pattern of acts of assault, threats, humiliation and intimidation or other abuse that is used to harm, punish, or frighten their victim.”* *This definition includes so called ‘honour’ based violence, female genital mutilation (FGM) and forced marriage, and is clear that victims are not confined to one gender or ethnic group.“ ( Home Office 2013 )

16. Definition of Domestic Abuse Working with the people of Camden to achieve the best health for all 1in 4 women will experience abuse 12.9 million incidents recorded by British Crime Survey against women, 2.5 million against men 1 call a minute to police Children living DV represent 2/3 cases CP conference 2 women are killed UK each week DV is a feature of most CP cases worst outcomes. Feature in 56% of SCR’s in London Feature in 62% of child sexual abuse referrals included DV Hester and Pearson 1998 30% of DV starts or escalates during pregnancy, women are at greater risk after they have given birth

17. Definition of FGM Working with the people of Camden to achieve the best health for all Female genital mutilation (FGM) form of child abuse, devastating physical & psychological consequences for girls and women. The World Health Organisation describes it as: "procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons" (WHO, 2013). Since 1985 it’s been a serious criminal offence under the Prohibition of Female Circumcision Act to perform FGM or to assist a girl to perform FGM on herself. The Female Genital Mutilation Act 2003 tightened this law to criminalise FGM being carried out on UK citizens over An estimated 66,000 women with FGM in UK >20,000 girls under 15 yrs are potentially at risk of FGM (England and Wales) ref: “A Statistical Study to Estimate the Prevalence of Female

18. Camden’s FGM Program Working with the people of Camden to achieve the best health for all • To raise awareness of FGM in training • Develop a process for sharing information in health (midwife/health visitor/school nurse/GP/paediatrician • Make referrals into tertiary local clinics, centralising expertise and services • Liaise with multi-agency groups Police /Social Care

19. BROACHING THE TOPIC • Using the term mutilation may be upsetting to some patients • Be sensitiveand use value-neutral terms • Have you been cut down there? • Were you circumcised? • Have you been closed? Safeguarding women with FGM and girls at risk of undergoing FGM is everyone’s responsibility

20. What you should do Working with the people of Camden to achieve the best health for all Identify FGM in women and girls from affected communities Give information to empower and support affected women and girls Referto specialist services and support organisations Consider child protection issues – treat as child abuse and inform social services of concerns Document information and share as appropriate Consider getting involved in awareness campaigns

21. Parental Mental Illness & Safeguarding Children Working with the people of Camden to achieve the best health for all Approximately 30% of adults with mental ill health have dependent children. The majority of parents with a history of mental ill health do not present a risk to their children. A wide range of mental ill health can affect parents & their families. High risk if parents illness incorporates delusional beliefs about the child or include them in suicidal planning Review of SCR’s show where children had died or been harmed found in 2/3 of cases parents had a current or past history of mental illness

23. Private Fostering Working with the people of Camden to achieve the best health for all

24. You see a child and suspect abuse or neglect Is the child acutely sick, in pain, bleeding or has “medical” problems? Yes No Contact the on-call Paediatric Registrar University College Hospital Tel. 08451 555 000 Whittington Hospital Tel. 020 7272 3070 Royal Free Hospital Tel. 020 7794 0500 Will the child be at immediate risk of abuse when he/she leaves the surgery? Yes Not Sure No Refer to Mon - Fri 9 -5 Duty Social Team at MSH Multi-Agency Safeguarding Hub 9am – 5pm Tel 020 7974 3317 Tel 020 7974 6600 Tel 020 7974 4094 Out of hours 020 7974 4444 Or dial 999 in emergency NB. All referrals to be followed in writing within 48hrs • Discuss with • Mon-Fri 9-5 • Child Protection Team Hotline • Tel. 020 3317 2403 • GP Child ProtectionLead • Claire Taylor 07736070327 clairetaylor5@nhs.net • Designated Nurse for Safeguarding Children Jackie Dyer • Tel 07768886258 • Designated Doctor for Safeguarding Children Deborah Hodes • Deborah.hodes @nhs.net • Duty Social Worker Team • Out of Hours • On call Paediatric Registrar at acute trust • Discuss with • Mon- Fri 9-5 • Child Protection Team Hotline • Tel. 020 3317 2403 • Refer for assessment to the Safeguarding Children Clinic • Child Protection Team, Crowndale H.C • 59 Crowndale Road, London NW1 1TU Child Protection Guidelines for General Practitioners in Camden

25. National context Working with the people of Camden to achieve the best health for all Children Acts 1989 & 2004 London Child Protection Procedures 2011 Working Together to Safeguard Children 2015 Munro review of Child Protection 2010/11 Health & Social Care Act 2012 NHS Commissioning Board – Safeguarding Vulnerable People in the Reformed NHS Accountability and Assurance Framework – March 2013

26. Local Safeguarding Contacts Working with the people of Camden to achieve the best health for all Designated Nurse Jackie Dyer Jackie.dyer@camdenccg.nhs.uk Designated Doctor Deborah Hodes deborah.hodes@nhs.net Named General Practitioner Clairetaylor5@nhs.net Designated Doctor for Looked after Children (LAC) gitacroft@nhs.net Designated Nurse for LAC a.akamo@nhs.net Designated Doctor for CDOP blloyd@nhs.net Camden’s MASH Team Tel 020 7974 3317 Tel 020 7974 6600 Tel 020 7974 4094

27. Further Training Working with the people of Camden to achieve the best health for all Camden Safeguarding Children Board Training details can be found at: www.cscb.org.uk www.camdentds.co.uk