Objectives. Understand the legal framework for safeguarding childrenDiscuss types of abuseSigns and IndicatorsKnow how to act on concernsSharing InformationIdentify and overcome the obstaclesIssues for the Primary Health Care Team. When we have to deal with abuse we may feel a mixture of some
Named Nurse Safeguarding Children
2. Objectives Understand the legal framework for safeguarding children
Discuss types of abuse
Signs and Indicators
Know how to act on concerns
Identify and overcome the obstacles
Issues for the Primary Health Care Team
3. When we have to deal with abuse we may feel a mixture of some or all of the following:
Denial - difficult to accept abuse takes place
Guilt - because we all make mistakes
Fear - that we won’t know what to do
Anger - that people can do such things to children
Pain - at the recognition of abuse in our own lives
Jealousy- if we have to let another professional take over
“There’s no such
thing as child
“ Abuse doesn’t
people I know”
“Too much is made
of abuse – it isn’t
that common” OBSESSION
“ Everyone abuses children
“ Abuse is very
common in some
types of family”
“Any single person
who works with
children is an
abuser” Professional awareness and responsibility
5. Facts and Figures 31% bullied during childhood
7 % seriously physically abused by parents or carers during childhood
1% sexually abused by a parent or carer during childhood
3% sexually abused by another relative during childhood
On average 1 child is killed by their parent or carer every week in England and Wales
7. Legislation and Guidance Children Acts 1989 and 2004
Working Together to Safeguard Children 2006
Framework for Assessment of Children in Need
Kent County Council Child in Need / Child Protection procedure
What to do if you’re worried a child is being abused
Information Sharing: practitioners guide 2008
8. Principles of the Children Act 1989
The welfare of the child is paramount
Partnership between the state and parents
Parental responsibility for the child
Prevention of abuse
Protection of the child
9. Framework For Assessment Of Children In Need
10. Professional Responsibility To identify children in need, or suffering, or at risk of suffering significant harm
Refer to statutory agency when appropriate
Contribute to assessment
Participate in action plans
16. The Non Accidental Injury Inconsistent story
Story does not fit injury
Story does not correspond to development of the child
Injuries not witnessed
Frequent A&E attendances
Failure to attend for treatment early enough or not at all
Injuries in areas of body protected by clothes
Families where Domestic Violence exists
Parents who demonstrate aggression
19. Parents Behaviour as Indicators for Emotional Abuse
Fail to provide consistent love and nurture
Habitual verbal harassment
Exert overt hostility
Highly critical of their children
Frequently ridicule children
Have excessively high expectations
Language used is always negative
“High criticism, low warmth
20. Vulnerability Factors Families living in poverty
Where a parent has a mental illness
Substance misuse (drugs or alcohol)
Learning Disability (parent or child)
Areas of high crime, poor housing, high unemployment
22. Significant Harm Significant harm is the threshold that justifies compulsory intervention in family life in the best interests of the child
The local authority has a duty to make enquiries where they consider, or have reasonable cause to suspect, a child is suffering or likely to suffer significant harm
24. Significant Harm ‘A compilation of significant events, both acute
and long-standing, which interact with the child’s
ongoing development and interrupt, alter or
impair physical and psychological development. …
Significant harm represents a major symptom of
failure of adaptation by parents to their role,
and also involves both the family and society’.
(Bentovim – Significant Harm in Context 1988 p57)
25. Acting on Concerns
Kent Safeguarding Children Board (KSCB) Procedures
27. Consultation Lead professionals within PCT
Social Services (Duty)
Police – Child Abuse Investigation Unit (CAIU)
“If in doubt ask”
28. Referral How ‘urgent’ or ‘grave’ is the situation?
Most situations are not ‘urgent and grave’. If you are in any doubt seek advice from the Duty Team – SSD of from the Police (SIU).
Does the referral involve concerns about ‘significant harm’?
Has a crime been committed against a child (or an adult)?
29. Information Sharing Legal Restrictions
Common law duty of confidence
Human Rights Act 1998
Data Protection Act 1998
31. Consent & Confidentiality In general it is and has always been good practice to obtain parent’s’/carers consent to make a referral to the SSD or to obtain further information from another agency. Seeking consent should be the ‘norm’.
Where you (the referrer) make a professional
judgement that seeking consent would place the
child(ren) and/or other people at increased risk.
32. Information Sharing In Child Protection it is vital to consider the following:
It may not be safe for the child or children to seek consent (that is – seeking consent may place a child at greater risk of harm).
A crime may have been committed – seeking consent could well undermine its detection
There is a legal basis for sharing information without seeking consent.
33. Consent & Confidentiality Exceptions are:
Where the child has made an allegation or
disclosure of sexual abuse/assault.
Where a crime has clearly been committed.
Most situations will not involve exceptions! If you are
in any doubt seek advice from the Duty Team – SSD, Named Nurse or from the Police (CAIU).
35. Disclosure in the Absence of Consent Need to know’ basis
What is the purpose of the disclosure?
What are the nature and extent of the information to be disclosed?
To whom is the disclosure to be made?
Is the disclosure proportionate response to the need to protect the welfare of a child
40. Activity Considering the case scenarios
What is the potential impact on a child
What action, if any, would you take?
What are the dilemmas faced for you as a professional worker?
Are you able to maintain confidentiality if requested?
41. GP’s Role in Child Protection: Tensions Family Medicine
Professional autonomy Child Protection
42. Difficulties Facing the PHCT What to do and say when abuse was suspected during the course of a consultation
Awareness of local Child Protection guidelines
Strategies for their implementation at practice level
How to maintain working relationships with families during and after the child abuse investigative process
Attendance at Child Protection case conference and preparation of relevant reports
43. Serious Case Review C/2003
Primary Care Trust’s are to consider and recommend an appropriate means of highlighting the medical records of adults who may present risks to children, particularly highlighting information that may indicate Child Protection risks.
44. Serious Case Review D/2003
Where there are concerns regarding the welfare of an adult within a household, consideration should be given to children in the same household and the possibility of Child Protection issues raised sooner rather than later.
45. Serious Case Review D/2003
General Practitioners should be made aware of the possibility of severe neglect where parents persistently refuse medical advise for their children and do not attend hospital appointments.
46. Serious Case Review A2005 A child with bruising and not cruising should be referred to a paediatrician
General Practices to review procedures to ensure domestic violence is discussed with all women presenting with symptoms suggestive of domestic violence.
Critical incident analysis should be encouraged as good practice.
General Practices to ensure all staff have appropriate training in child protection and domestic violence
47. Serious Case Review A/2006
Midwives and Health Visitors should have access to GP records relating to children and their families.