Safeguarding Children with Disabilities

1. Safeguarding Children with Disabilities Children’s Safeguarding Board Septe November 2018 Guy Van Dichele

2. Introduction Croydon Children’s Safeguarding Board have a responsibility to ensure they have a system in place to safeguard all disabled children from emotional, physical and sexual abuse and neglect. The specific needs of children with disabilities are addressed in children protocols, in line with current legislation and guidance. The exam question: Have we an adequate system in Croydon or can more be done to protect children and young people with disabilities?

3. Are children with disabilities more at risk? Working together to Safeguard Children states that “The available evidence on the extent of abuse among disabled children suggests that disabled children are at increased risk of abuse, and the presence of multiple disabilities appears to increase the risks of both abuse and neglect” (Paragraph 11.28) This is further supported by DfE and NSPCC Reports.

4. London Safeguarding Children Board : Protection Procedures Any child with a disability is by definition a ‘child in need’ under Section 17 of the Children Act 1989. Since the Disability Discrimination Act 1995 was repealed in 2011 by the Equality Act 2010, it remains unlawful to discriminate against a disabled person in relation to the provision of services. This includes making a service more difficult for a disabled person to access or providing them with a different standard of service. The Disability Discrimination Act 2005 (DDA) and the Equality Act 2010, define a disabled person as someone who has: “a physical or mental impairment which has a substantial and long term adverse effect on his or her ability to carry out normal day to day activities” This means that the needs of children and young people with long term illnesses such as leukaemia, diabetes, cystic fibrosis or sickle cell are addressed. In Croydon, we also have examples of children with rare conditions such as Pradi-Willi syndrome. The key issue is the impact of abuse or neglect on a child or young persons health and development and how best to support them and safeguard their welfare. Research suggests that children with a disability may be generally more vulnerable to significant harm through physical, sexual, emotional abuse and/or neglect than children who do not have a disability. (See Responding to concerns of abuse and neglect procedure) The national guidance Safeguarding Disabled Children – Practice Guidance (DCSF 2009) provides a framework for collaborative multi agency responses to safeguard disabled children.

5. What evidence suggests and the reasons: • Disabled children may be especially vulnerable to abuse for a number of reasons: • Many disabled children are at an increased likelihood of being socially isolated with fewer outside contacts than non disabled children • Their dependency on parents and carers for practical assistance in daily living, including intimate personal care, increases their risk of exposure to abusive behaviour • They have an impaired capacity to resist or avoid abuse • They may have speech, language and communication needs which may make it difficult to tell others what is happening • They often do not have access to someone they can trust to disclose that they have been abused; and/or • They are especially vulnerable to bullying and intimidation

6. Looked After Children • 25 Children with disabilities are known to the Councils All Age Disability Service (September 2018). • Looked after disabled children are not only vulnerable to the same factors that exist for all children living away from home, but are particularly susceptible to possible abuse because of their additional dependency on residential and hospital staff for day to day physical care needs. • Force feeding • Unjustified or excessive physical restraint • Rough handling • Extreme behaviour modification, including the deprivation of liquid, medication, food or clothing • Misuse of medication, sedation, heavy tranquillisation • Invasive procedures against the child’s will • Deliberate failure to follow medically recommended regimes • Misapplication of programmes or regimes • Ill fitting equipment (e.g. callipers, sleep board that may cause injury or pain, inappropriate splinting) • Undignified age or culturally inappropriate intimate care practices

7. So what is the difference for safeguarding children with disabilities • Safeguards for children with disabilities are essentially the same as non disabled children. Particular attention should be paid to promoting a high level of awareness of the risks of harm and high standards of practice, and strengthening the capacity of children and families to help themselves. Measures should include: • Making it common practice to help disabled children make their wishes and feelings known in respect of their care and treatment • Ensure that disabled children receive appropriate personal, health and social education (including sex education) • Making sure that all disabled children know how to raise concerns, and giving them access to a range of adults with whom they can communicate. Those children with communication impairments should have available to them, at all times, a means of being heard • An explicit commitment to, and understanding of, disabled children’s safety; and • Welfare among providers of services used by children with disabilities • Close contact with families, and a culture of openness on the part of services • Guidelines and training for staff on good practice in intimate care; working with children of the opposite sex; handling difficult behaviour, consent and treatment • Anti-bullying strategies; sexuality and sexual behaviour among young people; especially those living away from home; and • Guidelines and training for staff working with 16 and over to ensure that decisions about children with disabilities who lack capacity will be governed by the Mental Capacity Act once they reach the age of 16. • Where there are concerns about the welfare of a child with disabilities, they should be acted upon in accordance with safeguarding procedures and the law, in the same way as with any child. Expertise in both safeguarding and promoting the welfare of child and disability has to be brought together to ensure children with disabilities receive the same level of protection from harm as other children.

8. What have we done to produce this report? • A task and finish group across Education, Health and Social Care, with additional input from colleagues in commissioning and advice from Eleanor Brazil Independent Consultant • Desktop research into what was available at a national, regional and local level • Gathered data and performance on the current prevalence of recorded abuse in Croydon • Identified key themes to be considered by the Board • Made recommendations to improve safeguarding of children with disabilities who are the responsibility of Croydon

9. Principles • Children with disabilities should be seen as children first and foremost and to have access to the same support as their non disabled counterparts • The needs of children with disabilities and their families should be understood in both generic and specialist services • Children with disabilities have the right to enjoy a full and decent life and protected from abuse • Service providers should have a positive and proactive duty to make reasonable adjustments to ensure that disabled children can use and receive services to the same standard as non-disabled children • Agencies should work together to ensure children are protected and in the best interests of the child and family • Cultural change is needed to ensure children with disabilities are not a Cinderella service to wider children’s services

10. What did we find? • Individual agencies had some good practice as a single agency but this was too often found to diminish when working across agencies • Cross agency working and understanding of thresholds for referral for disabled children need to be better understood. • Lack of foster carers with skills to care for disabled children or sometimes disabled children are removed from abusive parents but no consideration is given to whether they are caring appropriately for the siblings who remain. • Multi disciplinary conversations were too centered around money rather than the outcomes for children. • Greater attention is needed to the impact on siblings who become young carers and miss out on education/recreation due to their caring role. • Inadequate housing available so that disabled children are being cared for in an suitable environment and to prevent children remaining in hospital longer than necessary when ready for discharge. • JSNA needs to reflect wider determinants of children with disabilities and their families. • The percentage of children with disabilities on child protection plans was lower than expected and suggested a difficulty in reporting and responding to abuse for these children Children and their families were not offered the same level of support at a universal or early intervention / prevention stage thus allowing families to receive support at a much higher threshold • Specialist social work support was over relied on making capacity to support families adequately near impossible • Over reliance on specialist provision making the resources available tighter on the wider cohort who would benefit from early help and support

11. What did we find • Over reliance on out of borough placements • Lack of multi disciplinary commissioning for children with complex needs • Limited training and development available to practitioners and management • A range of data was available including forward planning data but a lack of robust action planning was in place particularly at a multi agency level • There was a lack of ambition for those children living in specialist care settings and an acceptance of such arrangements without due consideration to best outcomes for children • Evidence suggested practitioners struggled to have difficult conversations with parents • Thresholds were less understood where complex family situations occurred, often not recognising the parental contribution to abuse • The voice of the child and their families was limited in the safeguarding processes although improving The fragility of agencies working together, prioritising children with disabilities and understanding their additional vulnerabilities, alongside a workforce struggling to have difficult conversations with families, on top of already difficult situations with low numbers reported, concluded that the system for protecting children with disabilities was not adequate and in need of improvement.

12. What is suggested going forward? • A greater commitment to the voice of the child and their families should be embedded into practice • The task and finish group was just the start to get us to today. A Children with Disabilities Group (or similar) should be set up to take forward the work of the task and finish group and actions agreed by the CSB. • The new Early Help Strategy and Care Leavers Strategy and any other new strategies in Children’s services should give due consideration to Children with Disabilities and their families • Guidance for staff should be developed to enable a greater universal offer of support to families (complemented by the new Local Offer) • Training and learning opportunities should be reviewed in full and enhanced to enable a confidence in the workforces to prevent referral to specialist services where these are unnecessary. • Commissioning should identify a work plan that reduces over reliance on out of borough and specialist provision • The JSNA should be completed and used to develop commissioning going forward • The CSB should continue to receive updates on developments in this area and ensure children with disabilities are afforded the same appropriate Board time as other key priority areas