Defining child abuse Judging significant harm

1. Defining child abuseJudging significant harm Patrick Ayre Department of Applied Social Studies University of Luton Park Square, Luton email: pga@patrickayre.co.uk web: http://patrickayre.co.uk

2. Plus ça change • Every child matters & Keeping children safe • Jasmine Beckford, Kimberley Carlile, Tyra Henry & Victoria Climbié, Lauren Wright and Ainlee Walker, • Doing the simple things well

3. The research: how we started • Significant harm had become central to decisions in child protection • No definition of whole phrase in the Children Act or guidance • No comprehensive guidance about how to be apply in practice • Not much in literature

4. Significant harm Harm is defined by Children Act 1989: • ill-treatment (including sexual abuse and, by implication, physical abuse) • impairment of health (physical or mental) or development (physical, intellectual, emotional, social or behavioural)

5. MEANING OF CHILD ABUSE • 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. It may involve a parent or carer 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.

6. MEANING OF CHILD ABUSE • 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. It may involve a parent or carer 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.

7. MEANING OF CHILD ABUSE • Emotionalabuse • Emotional abuse is the persistent emotional ill-treatment 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 feature age or developmentally inappropriate expectations being imposed on children. It may involve 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 ill-treatment of a child, though it may occur alone.

8. MEANING OF CHILD ABUSE • Emotionalabuse • Emotional abuse is the persistent emotional ill-treatment 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 feature age or developmentally inappropriate expectations being imposed on children. It may involve 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 ill-treatment of a child, though it may occur alone.

9. MEANING OF CHILD ABUSE • Physicalabuse • Physical abuse 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 or carer feigns the symptoms of, or deliberately causes ill health to a child whom they are looking after. This situation is commonly described using terms such as factitious illness by proxy or Munchausen syndrome by proxy

10. MEANING OF CHILD ABUSE • Sexualabuse • Sexual abuse involves 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 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.

11. MEANING OF CHILD ABUSE • Sexualabuse • Sexual abuse involves 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 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. MEANING OF CHILD ABUSE • Sexualabuse • Sexual abuse involves 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 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.

13. Methods • Examine systematically the way phrase used by experts in practice • Approach derived from Critical Incident Technique (Flanagan, 1954) • Explore real practice incidents, collect real practice factors, not values and principles

14. What we did • We interviewed 25 experienced practitioners about how they made judgements about significant harm • Each had at least seven years experience • We looked at what they actually did in real cases, rather than what they thought they should do

15. First level in our framework • Observations concerning the individual parents  • Observations concerning the family as whole and relationships within it • Observations concerning the child • Further broken into subcategories resulting in four grids

16. Observations Concerning the Individual Parent Types of Indicator Direct evidence of Anger, abuse, over-chastisement Physically abusive behaviour Emotionally abusive behaviour Rejection, low warmth, high criticism Fails to meet basic needs Fails to provide supervision/exposes to danger Provide stimulation, guidance Exposes to filthy living conditions Neglectful behaviour Sexually abusive behaviour

17. Observations Concerning the Individual Parent Behaviour and attitude indicative of abuse Types of indicator Fails to believe child Fails to accept responsibility Fails to protect Fails to compensate for partner Coerces child to withdraw allegations Un-protective Violent, aggressive Fails to recognise problems Doesn’t follow advice Hostile Unwilling/unable to work in partnership towards change Un-cooperative Unskilled in parenting

18. Observations Concerning the Individual Parent Behaviour and attitude Indicative of abuse Types of indicator Not reliable, truthful Unable to give account an injury or gives conflicting inconsistent account Untrustworthy or behaviour suspicious Lacking in knowledge of children • Lacks characteristics associated with • parenthood e.g. • puts own needs first • fails to display empathy, patience or • understanding Un-parental Unsettled/unstable

19. Observations Concerning the Individual Parent Personal characteristics and history Types of indicator Drug and alcohol abuse Mental illness Learning disability Poor health Children have been removed from home Children have been on the child protection register Brought up in an abusive situation Former child subject of concern re abuse Was looked after by the local authority

20. Observations concerning the familyas a whole and relationships within it Types of indicator Family structure Rigid Step-parent or other main carer not a birth parent Reconstituted Unstructured Chaotic, lacking boundaries

21. Observations concerning the familyas a whole and relationships within it Environmental circumstances and stresses Types of indicator Poverty/unemployment Area deprived of resources Other severe stresses including scrutiny by the child protection system Other stresses on the family

22. Observations concerning the familyas a whole and relationships within it History Relationships Social and familynetwork Entrenched pattern Not a one-off Marital/carers Unsupportive/antagonistic Little progress in responses to input Parent/children attachments Un-protective/abusive Former history of relevant problems Between siblings Other problems Stability over time

23. Observations Concerning the Child Types of Indicator Category of Concern Direct evidence of Physical Abuse Any evidence indicating directly that the child or children is/are being abused. Evidence may be directly observed or contained in referrals, statements or reports. Sexual abuse Direct evidence of abuse (including allegations or disclosure) Emotional abuse Neglect

24. Observations Concerning the Child (cont.) Types of Indicator Category of Concern Direct evidence of Physical Weight, height, centile charts, physical milestones Developmental delay/problems indicative of abuse Speech Cognitive milestones Cognitive/language Ability to play,form relationships, social milestones. Performing an adult role whilst still a child Social/emotional

25. Observations Concerning the Child (cont.) Category of Concern Types of Indicator Indicators of Physical abuse Behaviour indicative of abuse Standard signs and symptoms of abuse Sexual abuse Emotional abuse Neglect

26. Observations Concerning the Child (cont.) Types of Indicator Category of Concern Indicators of Behaviour challenging or in some way associated with abuse Capacity for self protection History of abuse Need for special care (age and health) Personal characteristics and history Vulnerability Many changes of carer

27. Using the framework: making a judgement • Aid to assembling factors • Decision remains matter of informed professional judgement • Normally conducted on an inter-disciplinary basis.

28. What we found • Losing sight of the child • Accentuating the negative • Chronic abuse and the principle of cumulativeness

29. What we would hope to find

30. What we found

31. What we found • Chronic abuse and the principle of cumulativeness • Incidents scattered through files • The problem of proportionality • Acclimatisation

32. What we found • Making the case • Underpinning theory

33. Recommendations: Case review The accumulation of three referrals or expressions of concern will lead to interagency consultation and review • Any agency identifying serious concern will be responsible for ensuring that an appropriate review takes place • As a minimum, a review will be initiated after three referrals or expressions of substantial concern

34. Case review A fresh pair of eyes will be used to review regularly all cases characterised by long term poor parenting • All cases characterised by long-term poor parenting will be reviewed regularly by someone not working with the family • Peer and interagency review will often have distinct advantages • All agencies involved have a responsibility to ensure that review takes place • Reviews should include a full assessment of living conditions throughout the house where relevant

35. Case Recording, Assessment and Reporting Cumulative front sheets will be maintained on the files of all relevant agencies • Chronological list of relevant occurrences, each entry two or three lines in length • Shared at all formal and less formal interagency meetings, including child protection conferences • Part of all case reviews • Monitored within the supervision process

36. Case Recording, Assessment and Reporting • Formats and proformas used for recording, report writing, planning, reviewing and supervision should direct proper attention to the children, their needs, views and experiences • Practice guidance, training and report formats should ensure appropriate assessment of strengths as well as weaknesses