WELCOME TO SAFEGUARDING CHILDREN Level 2 Training for Frontline Practitioners

1. WELCOME TO SAFEGUARDING CHILDRENLevel 2 Training for Frontline Practitioners FACILITATED BY A MEMBER OF THE CHILD PROTECTION TEAM

2. Aim ‘To provide professionals with the knowledge, skills and support to recognise and know how to act upon, indicators that a child’s welfare or safety may be at risk.’

3. Learning Objectives • To define child abuse and to recognise the signs and indicators of vulnerability of children in need / in need of protection. • To apply knowledge of vulnerability to make a comprehensive assessment of vulnerable children. • To be able to complete a referral following LSCB guidelines for children in need / protection. • To be able to evaluate when further action is required to challenge the outcome of referrals made under LSCB guidelines. • To know who / how to access support when escalation and challenges to practice concerning vulnerable children is required.

4. WHO’S RESPONSIBILITY IS CHILD PROTECTION? All health professionals working with children will commonly complete CAFs, which should be the responsibility of all concerned with child welfare. This includes GPs, health visitors, school nurses and other community health professionals and should not be dependent on grade or position, but rather on competence and degree of involvement with, and knowledge of, the child or young person. Working together 2010

5. Victoria Climbié 2001

6. Baby Peter 2009

7. Key Current Legislation

8. Health Professionals Responsibility Working Together 2010 • All health professionals working directly with children should ensure that safeguarding and promoting their welfare forms an integral part of all stages of the care they offer. • Other health professionals who come into contact with children, parents and carers in the course of their work also need to be aware of their responsibility to safeguard and promote the welfare of children and young people. • This is important even when the health professionals do not work directly with a child, but may be seeing their parent, carer or other significant adult.

9. CONFIDENTIALITY AND SAFE INFORMATION SHARING In deciding whether there is a need to share information you need to consider your legal obligations including: • Whether the information is confidential • If it is confidential, whether there is a public interest sufficient to justify sharing • Where there is a clear risk of significant harm to a child the public interest test will almost certainly be satisfied. Information Sharing: Practitioners Guide 2006

10. Every Child Matters

11. What is Child Protection? • Activity which is undertaken to protect specific children who are suffering or at risk of suffering significant harm. • Effective child protection is essential as part of wider work to safeguard and promote the welfare of children. • All agencies should proactively safeguard and promote the welfare of children so that the need for action to protect children from harm is reduced Working Together 2010

12. What is Safeguarding and Promoting Welfare of Children? • Protecting children from maltreatment • Preventing impairment of children’s health or development • Ensuring that children are growing up in circumstances consistent with the provision of safe and effective care. • Undertaking a role so as to enable those children to have optimum life chances and to enter adulthood successfully Working Together 2010

13. WHAT IS “SIGNIFICANT HARM”? • “Harm” means ill-treatment or the impairment of health or development, including, for example, impairment suffered from seeing or hearing the ill treatment of another. • The question whether the harm suffered by a child is “significant” depends on his health or development being compared with that which could reasonably be expected of a similar child S31 Children Act 1989

14. What is a Child In Need? (Working Together 2010) Children who are defined as being “in need” under S17 of Children Act 1989, are those whose vulnerability is such that they are unlikely to reach or maintain a satisfactory level of health or development, or their health or development will be significantly impaired without the provision of services; plus those who are disabled.

15. Children In Need (Working Together 2010) Critical factors to be taken into account are: • What will happen to a child’s health or development without services being provided. • The likely effect the services will have on the child’s standard of health and development. • Local Authorities have a duty to safeguard and promote the welfare of children in need.

16. Categories Of Abuse • Physical Abuse • Sexual Abuse • Emotional Abuse • Neglect

17. Physical Abuse • Physical abuse may involve hitting, shaking throwing poisoning, burning or scalding, drowning or suffocating or otherwise causing physical harm to a child. • Physical harm may also be caused when a parent or carer fabricates the symptoms of, or deliberately induces illness in a child. Working Together 2010

18. Physical Abuse Recognition • Delay in presentation for treatment or advice, avoidance or non-attendance • Story is vague and may vary • Account of injury is not compatible with actual injury • Parent’s behaviour is cause for concern or abnormal • Child’s appearance and interaction with the parent is abnormal e.g. frozen watchfulness, failure to thrive • Child may say something

19. Common Injury Sites

20. Non accidental v’s accidental injuries

21. Babies are Precious and Fragile – Never Shake a Baby Some parents or carers may lose control and shake their baby in a moment of anger or frustration especially if the baby cries a lot or has problems feeding. Shaking can cause serious injuries including: • Fractures (limbs, ribs and skull) • Cerebral haemorrhage • Retinal haemorrhage • Brain damage or even death • Bruises on babies must be taken seriously - babies do not bruise easily • Pre mobile children do not get bruises or other injuries without good explanation. • Identify vulnerability in children and carers. Adapted from NSPCC leaflet “A cry for children” (1995)

22. Sexual Abuse Sexual abuse involves forcing or enticing a child or young person to take part in sexual activities, not necessarily involving a high level of violence, whether or not the child is aware of what is happening. The activities may involve physical contact, including assault by penetration (for example, rape or oral sex) or non-penetrative acts such as masturbation, kissing, rubbing and touching outside of clothing. They may also include non-contact activities, such as involving children in looking at, or in the production of, sexual images, watching sexual activities, encouraging children to behave in sexually inappropriate ways, or grooming a child in preparation for abuse (including via the internet). Sexual abuse is not solely perpetrated by adult males. Women can also commit acts of sexual abuse, as can other children. Working Together 2010

23. Sudden changes in behaviour / school performance Displays of affection in a sexual way, inappropriate to age Regression to younger behaviour Genital itching / pain Chronic illnesses/ infections STD’s Eating disorders Unexplained pregnancy Fear of undressing for PE Unexplained abdominal pain Distrust of familiar adult Anxiety at being left with particular carer Unexplained gifts/money Apparent secrecy Wetting day/ night Sleep disturbances/ nightmares Phobias / panic attacks Self harm / attempted suicide Physical / mental / emotional developmental delay Indicators of Sexual Abuse

24. Convictions In The UK • Approximately 1% of convicted adult sex offenders are women. • April 2009 56 women were in prison for sexual offences, compared with 31 in June 2005 (MOJ) • In 2008, 84 women were under supervision in the community (MOJ)

25. Callers To Child Line 2008/9 • 2,142 children calling about sexual abuse said their perpetrators were female (17% calls) – and increase of 132% over 04/05 • Mothers were the perpetrators for 4% of girls and 20% boys • Other female perpetrators included female aquaintance, aunt, sister, step mother and grand mother (1% each)

26. No ongoing mutual play relationship Different ages or development Use of force bribery, manipulation or threats Not balanced with other aspects of child’s life Adult sexual knowledge and behaviours Behaviours significantly different from same age children Continue despite consistent requests to stop Complaints from other children Behaviours to adults Distorted ideas about the rights of others Progression in frequency or intensity over time Feelings of fear, anxiety, shame or intense guilt PSB with animals Sexualises objects Causing physical / emotional harm Rob Tucker Lucy Faithful Foundation 2010 Young children: when sexual behaviours raise concern

27. EMOTIONAL ABUSE Emotional abuse is the persistent emotional maltreatment of a child such as to cause severe and persistent adverse effects on the child’s emotional development. It may involve conveying to children that they are worthless or unloved, inadequate, or valued only insofar as they meet the needs of another person. It may include not giving the child opportunities to express their views, deliberately silencing them or ‘making fun’ of what they say or how they communicate. It may feature age or developmentally inappropriate expectations being imposed 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. It may involve seeing or hearing the ill-treatment of another. It may involve serious bullying (including cyber bullying), causing children frequently to feel frightened or in danger, or the exploitation or corruption of children. Some level of emotional abuse is involved in all types of maltreatment of a child, though it may occur alone. Working Together 2010

28. INDICATORS OF POSSIBLE EMOTIONAL ABUSE • Severe behavioural problems • Inability to play • Excessive withdrawal or timidity • Excessive sadness • Indiscriminate attachment • Non-organic failure to thrive

29. EMOTIONAL ABUSE -PARENTAL/CARER BEHAVIOURS: • Marked age-inappropriate expectations of the child • Persistent rejection, failure to respond or negative attitudes • The parent/carer makes their love for the child conditional • The child is scapegoated • The parenting style is one of ‘high criticism and low warmth’ or • Parent/carer responses to the child are inconsistent and provoke insecurity • Extreme discipline is used or threatened • Threats and fear are used to control the child

30. EMOTIONAL ABUSE PARENTAL/CARER BEHAVIOURS: • The child is affected by domestic violence • The child is used to meet adults’ needs • The child takes on age-inappropriate responsibilities and ‘parents the adults’ • Parent fails to recognise the child’s individuality and psychological boundaries Emotional abuse is difficult to assess, and requires multi-disciplinary (including child psychiatric) assessment.

31. 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 or development. Neglect may occur during pregnancy as a result of maternal substance abuse. Once a child is born, neglect may involve a parent or carer failing to: ●● provide adequate food, clothing and shelter (including exclusion from home or abandonment); ●● protect a child from physical and emotional harm or danger; ●● ensure adequate supervision (including the use of inadequate care-givers); or ●● ensure access to appropriate medical care or treatment. It may also include neglect of, or unresponsiveness to, a child’s basic emotional needs. Working Together 2010

32. Recognising Neglect Indicators of possible neglect • Medical treatment not sought for a child’s injury or illness • A child who is not attending school • A child being left unsupervised (inappropriate to age and ability) • A child left to care for other children • A child who has to meet his or her own basic needs • A child who is persistently hungry

33. Recognising Neglect • A child who appears underweight or overweight or small of stature (no organic reason) • A child who suffers frequent minor injuries and illnesses • A child who is given no stimulation from parents/carers (little communication and play) • A child who is persistently dirty, smelly or inadequately dressed • A child who shows indiscriminate affection or is withdrawn and frightened • Assessment of neglect needs to be a multi-disciplinary assessment

34. All classes, cultures & age groups Domestic violence Parental expectation Poor parenting skills Under 20 years old Abused parents Partner not biological parent Poverty/financial stress Alcohol/drug abuse Mental Health problems History of Criminal Assault Isolation/poor support Poor Housing/Accommodation Unemployment Pornography Person in household who has been identified as presenting a risk or potential risk to children ABUSE / VULNERABILITYFACTORS – FAMILY UNIT

35. ABUSE / VULNERABILITYFACTORS –THE CHILD • Previous history of abuse or neglect • Under 5 years old • Babies who are premature, under weight, feeding difficulties, crying baby • Disabled, special needs • Birth defect • Wrong Sex • Poor development and growth INCREASED FACTORS = INCREASED VULNERABILITY

36. Health Basic Care Education Ensuring Safety Emotional & Behavioural Development Emotional Warmth CHILD Safeguarding & promoting welfare PA R E N T I N G C A P A C I T Y Identity Stimulation CHILD'S DEVELOPMENTAL NEEDS Family & Social Relationships Guidance & Boundaries Social Presentation Stability Selfcare Skills FAMILY & ENVIRONMENTAL FACTORS Family History & Functioning Wider Family Community Resources Family's Social Integration Income Employment Housing The Assessment Framework

37. Threshold Of Intervention

38. Referrals THE PROTECTION OF THE CHILD MUST IN ALL CASES OVERRIDE REQUESTS FROM THIRD PARTIES FOR INFORMATION TO BE KEPT CONFIDENTIAL

39. WHAT HAPPENS AT POINT OF REFERRAL

40. The LSCB Code of Practice states: • If somebody believes that a child may be suffering, or may be at risk of suffering significant harm, then s/he should always refer his or her concerns to Children’s Social Care and/or the Police. Section 3.1 LSCB Code of Practice - June 2008

41. Suspicions or Allegations Made to You Any suspicions or allegations made to you concerning the welfare of a child including those by a close relative, friends, neighbours by children or parents, or anonymously should be regarded as serious and an immediate referral made to Children’s Services or the Police.

42. Referrals It is good practice for professionals to discuss any concerns they have with the family where possible. However there are exceptional circumstances where such discussion would place the child at increased risk of significant harm. Cont’d.

43. Where allegations are made to a professional and they do not know the family involved. Issues of staff safety. The risk of destroying evidence e.g. disclosure of sexual abuse, factitious illness by proxy. The likelihood of children or other family members being intimidated. The possibility of an increased risk of domestic violence. The possibility of the family moving to avoid professional scrutiny. Referrals Other factors relevant to the decision whether to refer without prior discussion with the family include:-

44. The Content of the Referral Family Details - Names, Dates of Birth, Address. • Reason for making the referral; • the nature of your concerns • how and why they have arisen. • What appear to be the needs of the child and family, including special needs arising from cultural, physical, psychological, medical or other factors (based on Assessment Framework) • Identify clearly whether there are concerns about abuse or neglect, what is their foundation and whether the child/ren may need urgent action to make them safe from harm. • Any other agency known to the family - GP, School, Health Visitor. • Clarify actions which will be taken by both the agency receiving the referral and the referrer.

45. How to Refer 1. Telephone the CSC (Customer Services Centre ) or Police. 2. Interrogate the Child Protection Reviewing Unit. 3. All referrals to them must be confirmed in writing within 24 hours. 4. This should include all the relevant information and agreed actions. • A copy to Children’s Services /Police. • A copy to your Manager. • A copy to be retained in the child’s records. ALWAYS

46. Children’s Services Customer Service Centre Telephone 01522 782111 – Specific to Children • Your call will be taken by an experienced operator • Your information will be relayed electronically to either the FAST team in your area • Document the time and whom you speak to in the notes • Complete the CAF form as normal practice • Follow up your referral, ask for feedback from CSC within 3 working days

47. The Child Protection Reviewing Unit Day Time (01522) 554061 Out of Hours Day - (01522) 782333 You should log your information with the reviewing unit if you harbour CONCERN, SUSPICION, KNOWLEDGE regarding a child’s safety. Your call will be returned. LSCB website: www.lincolnshire.gov.uk

48. The Child Protection Reviewing unit The Custodian will advise the enquirer of: • The child’s current child protection plan status. • Any previous enquiries regarding the child within the last 5 years. • Any past child protection plan status if different from the present (within the last 5 years). The Custodian: • Notifies the relevant Children’s Services office when more than one enquiry is received

49. Recap • Refer through the CSC • Interrogate the Child Protection Reviewing Unit. • Confirm the referral in writing • keep a copy for records. • send a copy to Manager or Child Protection Department. ALWAYS Don’t Forget the LSCB website www.lincolnshire.gov.uk

50. Escalation Policy LSCB - 2010