SAFEGAURDING CHILDREN ONE DAY IN HOUSE AWARENESS TRAINING

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SAFEGAURDING CHILDRENONE DAY IN HOUSE AWARENESS
TRAINING
Child Protection and Children in Need for new
staff within NHS Lincolnshire
Presentation title here
Presentation title here

• Presented by a member of the Child Protection
  Team

Lincolnshire Primary Care Trust
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SAFEGAURDING CHILDRENONE DAY IN HOUSE AWARENESS
TRAINING

• Training Aim
• To provide professionals with the knowledge,
  skills and support to recognise and know how to
  act upon, indicators that a childs welfare or
  safety may be at risk.

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Learning Outcomes

• By the end of this course, delegates will be
  able to
• what to do if they have concerns about children,
  in order to safeguard and promote the welfare of
  children, including those who are suffering or at
  risk of suffering significant harm
• what will happen once they have informed someone
  about those concerns what further contribution
  they may be asked or expected to make to the
  processes described in What To Do If Youre
  Worried A Child Is Being Abused, including how to
  share information
• some basic information and background about the
  legislative framework within which childrens
  welfare is safeguarded and promoted

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Health Professionals Responsibility (Working
Together 2006)

• 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.

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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

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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 2006

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What is Safeguarding and Promoting Welfare of
Children?

• Protecting children from maltreatment
• Preventing impairment of childrens 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 2006

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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

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What is a Child In Need? (Working Together 2006)

• 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.

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Children In Need (Working Together 2006)

• Critical factors to be taken into account are
• What will happen to a childs health or
  development without services being provided.
• The likely effect the services will have on the
  childs standard of health and development.
• Local Authorities have a duty to safeguard and
  promote the welfare of children in need.

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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 2006

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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
• Parents behaviour is cause for concern or
  abnormal
• Childs appearance and interaction with the
  parent is abnormal e.g. frozen watchfulness,
  failure to thrive
• Child may say something

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Common injury sites
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Non accidental vs accidental injuries
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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)

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Sexual Abuse

• Sexual abuse involves forcing or enticing a child
  or young person to take part in sexual
  activities, including prostitution, whether or
  not the child is aware of what is happening.
• The activities may involve physical contact,
  including penetrative (e.g. rape, buggery or oral
  sex) or non-penetrative acts. They may include
  non-contact activities such as involving children
  in looking at, or in the production of,
  pornographic material or watching sexual
  activities, or encouraging children to behave in
  sexually inappropriate ways
• Working Together 2006

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EMOTIONAL ABUSE

• Emotional abuse is the persistent emotional
  maltreatment of a child such as to cause severe
  and persistent adverse effects on the childs
  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.
• Working Together 2006

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EMOTIONAL ABUSE continued

• These may include interactions that are beyond
  the childs developmental capability, as well as
  over protection 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 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 2006

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INDICATORS OF POSSIBLE EMOTIONAL ABUSE

• Severe behavioural problems
• Inability to play
• Excessive withdrawal or timidity
• Excessive sadness
• Indiscriminate attachment
• Non-organic failure to thrive

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EMOTIONAL ABUSE -PARENTAL/CARER BEHAVIOURS (1)

• 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

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EMOTIONAL ABUSE PARENTAL/CARER BEHAVIOURS (2)

• 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 childs
  individuality and psychological boundaries
• Emotional abuse is difficult to assess, and
  requires multi-disciplinary (including child
  psychiatric) assessment.

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Neglect

• Neglect is the persistent failure to meet a
  childs basic physical and/or psychological
  needs, likely to result in the serious impairment
  of the childs health or development
• Neglect may occur during pregnancy as a result of
  substance use.
• Once a child is born, neglect may involve a
  parent or carer failing to provide adequate food
  and clothing, shelter including exclusion from
  home or abandonment, failing to protect a child
  fro, physical and emotional harm or danger,
  failure to ensure adequate supervision including
  the use of inadequate care-takers, or the failure
  to ensure access to appropriate medical care or
  treatment.
• It may also include neglect of, or
  unresponsiveness to, a childs basic emotional
  needs.
• Working Together 2006

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Recognising Neglect (1)

• Indicators of possible neglect
• Medical treatment not sought for a childs 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

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Recognising Neglect (2)

• 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

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ABUSE VULNERABILITYFACTORS FAMILY UNIT

• 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

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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
• PLURALITY IS THE KEY

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The Assessment Framework
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Threshold Of Intervention
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Referrals

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

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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 Social Services or the Police.

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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.
• Contd.

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Referrals

• Other factors relevant to the decision whether to
  refer without prior discussion with the family
  include-
• 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.

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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.

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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 Social Services/Police.
• A copy to your Manager.
• A copy to be retained in the childs records.
• ALWAYS

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Childrens Services Customer Service Centre

• Telephone [phone] 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 if the
  referral is accepted
• 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

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The Child Protection Reviewing Unit

• Day Time [phone]
• Out of Hours Day - [phone]
• You should log your information with the
  register if you harbour CONCERN, SUSPICION,
  KNOWLEDGE regarding a childs safety. Your call
  will be returned.
• LSCB website www.lincolnshire.gov.uk

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The Custodian of the Child Protection Reviewing
Unit

• The Custodian will advise the enquirer of
• The childs current child protection plan status.
• Any previous enquiries regarding the child within
  the last 5 years.
• Any past child protection plans if different from
  the present (within the last 5 years).
• The Custodian
• Sends copies of enquiries to the relevant
  Childrens Services office.
• Notifies the relevant Childrens Services office
  when more than one enquiry is received

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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
• Dont Forget the LSCB website
• www.lincolnshire.gov.uk

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Why We Need Records

• ACCURATE up to date records are never more vital
  than in child protection.
• Inquiries have in the past highlighted
  poor record keeping as a factor in situations
  where a child has been harmed.
• Records constitute
• A contract between practitioner and family
• A rationale for care
• An accurate reflection of practice (practice
  should always reflect the records)
• A focus point for standard setting, quality
  assessment and audit
• A baseline against which to measure progress or
  deterioration
• An indication of the way forward

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Record Keeping

• Information contained
• Assists you with completing CAF forms and
  contributing to the Assessment process with
  partner agencies.
• Is crucial to procedures to protect
• forms basis for your contribution to child
  protection conferences
• forms basis for your evidence in court
• The records themselves may be subpoenaed by the
  court

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Body Maps 1
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Body map 2
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Record Keeping

• Should be
• accurate
• indelible and in black ink
• unambiguous - distinguishing between fact and
  opinion
• maintained in chronological order
• completed within 24 hours of contact/incident
• altered only within professional guidelines
• signed - not initialled. Your first signature
  must have your name and title printed alongside
  it
• dated and timed
• confidential

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Key References/ literature

• Every child maters (DOH 2004)
• Working together safeguarding Children (2006)
• Lincolnshire Safegaurding board (2007) Policy on
  undertaking section 47 of the childrens act 1989.
• What to do if you are worried a child is being
  abused.(DOH 2003)
• Lincolnshire PCT (2007) child protection policies
  and procedures
• The Childrens and Young Persons Plan (2007)
• NMC (2005) Guidance on record keeping
• NMC (2004) code of conduct