Safeguarding Children Training Level One/Two August 2016

1. Safeguarding Children Training Level One/Two August 2016

2. the indicators of child maltreatment and who is at most risk the importance of the role of all colleagues in safeguarding the appropriate action to take if concerns are raised and who to seek advice from when to sharing appropriate information with other agencies how to refer to children’s social care The level of training that you require in safeguarding children: . The safeguarding children page of the intranet or your manager will advise you- training is available in via the Local Safeguarding Children Boards or the Trust. Additional Level Three training is mandatory for all clinical health professionals in CAMHS, Children’s ECS, substance misuse and all adult mental health (except those who work with just older adults). Please book onto training via the intranet. By the end of the session participants will know:

3. Principles - of the Trust, professional codes and statute • Safeguarding is everyone's business and part of every assessment process • Mental or physical illness does not preclude you from being a good parent/carer • We must adhere to the principle that “the welfare of the child is paramount” • If you have any concerns about a child, share them appropriately – there is support to guide you.

4. A Quiz- discuss the questions in pairs for 10 minutes We will give you the answers later….

5. What is Safeguarding Children? Safeguarding children - the action we take to promote the welfare of children and protect them from harm - is everyone’s responsibility. Everyone who comes into contact with children and their families has a role to playto • protect children from maltreatment; • prevent impairment of children's health or development; • ensuring that children grow up in circumstances consistent with the provision of safe and effective care; and • taking action to enable all children to have the best outcomes. Working Together to Safeguard Children March 2015

6. Who is a child? • A child is anyone who has not yet reached their 18th birthday. • The statutory guidance applies to an unborn baby (Working Together 2015) • All adult service users MUST be asked if they have contact with a children or are parent/carer and the safeguarding children form completed for each service user. • If the service user is a parent or carer, the children’s names and dates of birth should be recorded.

7. Legislation and Guidance – supports early help and child protection Clinical/operational guidelines for your area of work Trust Safeguarding Children Procedures Trust Domestic Violence and Abuse Protocol, 2015 Multi-agency Safeguarding Children where there are concerns about parental mental health London Safeguarding Children Board Procedures Children Act 1989 Children Act 2004 Working Together to Safeguard Children 2015 Nice Guidance on how to recognise child maltreatment These are available on the Trust intranet

8. What parents want We want help early on, before things get so bad we’re scared our children may be taken away • More understanding, less stigma and discrimination; • support in looking after their children; • practical support and services; • good quality services to meet the needs of their children; • parent support groups; • on-going support from services beyond periods of crisis; • continuity in key worker support; • freedom from fear that children will inevitably be removed from them. Think child, think parent, think family 2011 The Trust is committed to listening to parents and children and getting help early for them. Quotes from service users in 2010 and 2013 Earlier intervention would have helped – before problems became entrenched

9. What children and young people who are carers of parents with a mental health problem say….. It felt really good when i could talk to people because I felt like a bottle ready to explode and I didn't want that to happen Speak to the young people not (just) the adults. The adults might not see as much Don’t think I’m coping just by looking at me I dunno why but when mummy was sad I just felt bad all the time Get the family out on trips

10. Vulnerability factors for abuse and neglect Domestic Violence Where a parent/carer has a mental illness Substance misuse (drugs or alcohol) • Poverty • Children under 16 living in poverty (ChiMat March 2016 - for year 2012-13). • England 18.6%; London: 21.8% • Barnet: 15.8% (under 19 child population 96,900) • Enfield: 25.5% (under 19 child population 87,900) • Haringey: 24.4% (under 19 child population 66,300) • Learning Disability (parent/carer or child) or child disability • Social Isolation, areas of high crime, poor housing, high unemployment • Children in care

11. Frequency of occurrence of key factors within the family of children subject to a serious case review 2012-14 Number of families where domestic abuse, mental ill health or substance misuse existed (Out of a total of 139) Serious Case Reviews DfE2016

12. Children can be hurt in many ways Physical Abuse Emotional Abuse Sexual Abuse Neglect There are NICE guidelines on how to recognise child maltreatment on the safeguarding children page of the Trust intranet

13. Recognising Abuse and Neglect Exercise Work in groups to briefly list the main indicators that you would see in either physical, sexual or emotional abuse, or neglect

14. Physical Abuse Includes Shaking Hitting Burning/scalding Female Genital Mutilation Fabricated or Induced Illness Drowning Suffocating/strangulation Force feeding Rituals and exorcism Possible signs Bruises (soft tissue areas or any in non-mobile babies) Grasp marks Bites Burns/scalds Fractures Large number of different aged marks Failure to seek medical help/opposite

15. Emotional Abuse Includes Overly critical parenting Causing child to feel unloved, worthless Inappropriate expectations Causing children to feel frightened Witnessing domestic violence or other forms of abuse Possible signs Very low self esteem High level of anxiety Overly compliant/eager to please Fearfulness/appearing withdrawn Behavioural issues Self harm

16. Neglect Includes Failure to meet physical needs Failure to meet psychological needs Failure to provide food, shelter, clothing Failure to protect from harm Failure to seek medical care Possible signs Malnutrition Dirty/cold environment Leaving young child unattended Failure to protect from physical danger Lack of supervision Lack of stimulation, social contact, education

17. Sexual Abuse Includes Forcing/enticing child to take part in sexual activity Contact, penetrative/non penetrative Non-contact e.g. watching sexual activity/pornography Encouraging inappropriate sexual behaviour Sexual exploitation Possible signs Pregnancy (where father’s identity concealed) Genital bruising STIs/ UTIs Inappropriate sexualised behaviour Child hinting of secrets Wide range of possible behaviours Staying out late/being secretive (sexual exploitation)

18. Sexual Abuse and Sexual Exploitation Facts • It is against the law for a child under the age of 16 to have sexual intercourse. Any under age sexual activity? Assess for possible exploitation. • Sexual intercourse under the age of 13 is statutory rape and must be reported to children’s services • Anyone can be an abuser regardless of age, occupation, sexuality, race etc. - this includes women and children who may either be the abusers or be part of it. • Most perpetrators are known to their victims, often includes highly skilled in grooming to gain trust, can commit the abuse and securing their silence through manipulation. • All children are at risk of exploitation but those who are vulnerable are more at risk. This includes those with a mental illness, those in care and those who are at being neglected as they may be less protected and more susceptible to grooming and to gang membership.

19. Child Sexual Exploitation (CSE) Is a form of sexual abuse that involves the manipulation and/or coercion of young people under the age of 18 into sexual activity in exchange for things such as money, gifts, accommodation, affection or status. The manipulation or `grooming` process involves befriending children, gaining their trust, and often feeding them drugs and alcohol, sometimes over a long period of time, before the abuse begins (Barnardos 2012)

20. Trafficked Children • Usually hidden but may come into contact with health providers because of physical and mental health problems. • Children under 18 years of age are always considered trafficked even if they appear to have consented to the arrangement. • They may be trafficked for sexual exploitation, fraud, domestic servitude or labour, from abroad or from within the UK. • After being identified there is a very high risk of a child returning to the trafficker and being exploited again- contact social care or the police quickly if you think a child may be trafficked.

21. Private Fostering Has been linked with harm to children. You, as a trust employee, have to report all privately fostered children to children’s services for an assessment. It is a criminal offence not to do so. Private fostering is defined in the Children Act 1989 as a child under the age of 16 years (or under 18 years if disabled) who is cared for, and provided with accommodation, for 28 days or more by someone other than a parent or legal guardian, or close relative. • Grandparents • Brother or Sister (Half or full) • Aunt or Uncle (relative or by marriage) • Step-parent

22. Child abuse linked to spirit possession • Spirit belief is quite widespread in many societies and is not abusive itself however it is neither usual nor acceptable to abuse a child in relation to this. • There may be a belief that an evil spirit has entered the child and is controlling him or her. It may be believed by the family, community and the child themselves. • Abuse may occur as part of exorcism- getting rid of the evil spirit - in the home or in a place of worship. • The signs of abuse may include the effects of cutting, burning, semi-strangulation, tying up and rubbing the genitals, eyes or mouth with substances such as chilli. • The action that you take should be the same as any other form of abuse.

23. Female Genital Mutilation (FGM) • Global Estimation: 100 to 140 million women and girls have undergone FGMC • Africa: A further 3 million girls undergo this every year • Middle East & Asia: in some parts • Unicef survey in 2013 showed in half the countries the girls were under 5 and in the rest aged 5-15 years • Source: Tackling FGM in the UK Intercollegiate recommendations for identifying and reporting (2013) www.rcn.org.uk • In 2013 the NSPCC FGMC helpline reportedly received 102 calls in three months 38 of those were referred to the police • Women who have undergone FGMC are more likely to have poor obstetric outcomes with approx. two perinatal deaths per 100 • Women who have had FGMC may also suffer from post traumatic stress disorder or depression

24. FGM – Your Responsibilities responsibilitie Mandatory reporting Mandatory recording Where FGM is identified in NHS patients, it is now mandatory to record this in the patient’s health record USE THE NEW FGM section on Rio. If the patient has undergone FGM, referral to a specialist FGM clinic should always be considered. If a patient is identified as being at risk of FGM, then this information must be shared with the GP and health visitor, as part of safeguarding actions. • Section 5B of the 2003 Act1 introduces a mandatory reporting duty which requires regulated health and social care professionalsand teachers in England and Wales to report ‘known’ cases of FGM in under 18s which they identify in the course of their professional work to the police. The duty applies from 31 October 2015 onwards. • There is a requirement to report to the Police using the 101 Line (in addition to any referral to Children’s Services)

25. What else increases risk?

26. Parental mental illness A serious mental illness can adversely affect the ability to parent but if given adequate support, many individuals with a serious mental health problem are able to successfully care for their children (Reupert and Mayberry 2007 p 365) Children who are caring for adults with a mental illness need support and meet the criteria as a child in need. Parents with a mental illness (or learning disability) have an increased vulnerability to exploitation/domestic violence/drug and alcohol use that increases the risk to the child from others

27. Links between Domestic Violence and Child Abuse • Nearly 75% of children subject of a CP plan lived in households where DV occurs . • The category of abuse is usually emotional as there is good evidence that witnessing violence is a risk factor for psychological disorders in children & young people, educational problems and risk taking behaviour( ESRC violence research programme 2002) • The Adoption & Children Act 2002 definition of harm clarified that this includes “impairment suffered from seeing or hearing the ill treatment of another” • Domestic violence is present in the homes of 54% of children who are the subjects of Serious case Reviews. • The risks to children living with DV include direct physical or sexual abuse of the child in around 55- 60% of cases. The severity of the violence against the mother is predictive of the severity of abuse to the children

28. Domestic Violence and Abuse (DVA) • Children are affected by witnessing DVA, living in a controlled household or becoming involved in violence and abuse • The risk to children should be assessed whether the person experiencing domestic violence and abuse is living with the perpetrator or not and /or whether the child experiencing domestic violence and abuse themselves • It must be recognised and taken into account that children do form attachments, even with abusive parents

29. If you become aware that a parent or carer is experiencing DV • You should follow the Trust DVA protocol for the adult • Be aware that risk escalates around the time or following parental separation so you need help from other agencies. • You must always refer to Children’s Services Social Care as a child protection concern where there is: • A high risk to the person experiencing domestic violence and abuse • Any indication the children have suffered or are t risk of suffering significant harm • Where there is any level of risk and: A pregnant woman A baby under one year of age A child who is disabled • In other cases you should refer to the SPA/MASH/SPOE for multi-agency assessment of risk

30. What to do if you are worried that child or young person may have unmet needs or be suffering abuse or neglect? Assess the risks and discuss the level of need Record full information and your analysis, decisions and action. Make sure you share your concerns/get supervision- speak to your manager/ safeguarding champion/ an experienced colleague or one of the safeguarding team. Consider discussing with the health visitor/GP or referral for family support through Multi Agency Safeguarding Hubs (MASH, SPA or SPOE) services if appropriate or for child protection

31. What about confidentiality? Duty to safeguard confidentiality of information Agreement to share information to another agency should always be sought from child/parent at the early help or child in need level But Can be overridden if child may be at risk of harm and/or in public interest. You do not need to be certain to share without consent. Child’s welfare paramount Disclosure on need to know basis and should be proportionate.

32. What sort of help is available? – the continuum of need helps Child Protection or a Looked After Child Early help Child in Need or Vulnerable child

33. EARLY HELP • Providing early help is more effective in promoting the welfare of children than reacting later • Early help means providing support as soon as a problem emerges, at any point in a child`s life, from the foundation years through to the teenage years (Working Together 2015)

34. Thresholds of harm No absolute criteria to decide if a child is a child is vulnerable or in need of protection Assess protective and risk factors Degree/duration/frequency of any abuse or neglect A child being at risk of “significant harm” justifies compulsory intervention in family life (S47 Children Act) by Children’s Services

35. Threshold guidance to help us

36. Making a child protection referral Obtain consent but if unsure whether this would increase risks or delay referral - agree with the recipient of the referral what the family, child and parents will be told and by whom Ask for support from the safeguarding team if needed Refer to social care in the area that the child lives Send a copy of the referral into the safeguarding inbox at: safeguarding@beh-mht.nhs.uk Confirm a phone referral in writing within in 48 hours (Forms on intranet) If you have not heard back within 3 working days -contact them again. Always discuss with your manager and a safeguarding lead if you do not consider the response adequate to protect the child.

37. Referrals For early help, vulnerable children in need and child protection: Enfield 02083795555(SPOE) Barnet 020 8359 4066 (MASH) Haringey 020 8489 4470 (SPA) Always send a copy to safeguarding team’s inbox: safeguarding@beh-mht.nhs.uk

38. Diverted to CAF/Child in Need An outline of the most likely case pathways Child in Need/Team around the Child Meeting No further action No further action Child in Need Plan Legal Proceedings Legal Proceedings No further action No further action Child Protection Conference Child Protection Conference

39. Lessons from SeriousCase Reviews • “Health” is the agency most consistently involved with the family and there is: • Often a failure to share information and communicate • Often workers work in silos- not across agencies to help or build a picture of what life is like for the child. • Often too much of a focus on the needs presented by the adult • We are too willing to believe what we are told, too optimistic- we need to maintain “respectful uncertainty.”

40. Lessons learnt in this Trust? We need • To know who the adults and children are in the family and record it on Rio • To record our contact with other professionals on Rio • to challenge social care more and escalate our concerns if we remain concerned • to be actively involved in the safeguarding processes- our knowledge, skills and analysis are vital • to be aware of disguised compliance.

41. Allegations against staff The response to allegation made against a member of staff or a volunteer who works with children should be made in line with the Trust’s Child Protection and Serious Incident Procedures. When there is an allegation or concern that any person who works with children, in connection with their employment or voluntary activity, has: • Behaved in a way that has harmed a child, or may have harmed a child; • Possibly committed a criminal offence against or related to a child; • Behaved towards a child or children in a way that indicates they are unsuitable to work with children. You should listen to the child but not interview them. Support the staff member Follow the advice in the procedures. Escalate through your manager The Local Authority Designated Officer will be informed and offer advice to the Trust.

42. Key messages Be alert to the possibility of potential abuse - even if you do not work with children directly Early intervention works best. Always do something if you are worried Families eager to conceal problems and professionals too readily accept explanations and are reluctant to challenge families or other professionals (Brandon et al 2012). Doing the simple things right in safeguarding is vital but isn’t always easy. Your manager/champion/safeguarding team will support and supervise you.

43. Answers to the quiz………… Any different now?