CHAPTER 5: Recognition & Response |
AMENDMENTS
This chapter was revised in August 2010 to take account of the changes in Working Together to Safeguard Children 2010. The specific changes are in paragraphs 3.3, 3.5, 5.6, 6.3 and 6.4 and are shown in italics. In Section 5.4 a link has also been added to the CAF page on the Children's Trust website.
RELEVANT GUIDANCE
Please also refer to the NICE Guidelines for Health Professionals: When to Suspect Child Maltreatment
Contents
1. Introduction
| 1.1 | This chapter provides:
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| 1.2 | The Recognising Vulnerability of Children in Particular Circumstances Procedure provides information of circumstances where children may be particularly vulnerable to abuse and/or neglect. |
| 1.3 | The Referral and Assessment Procedure provides procedures once the referral is made to Children's Social Care. |
2. Key Concepts
Significant Harm |
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| 2.1 | The Children Act 1989 provides the legal framework for defining the situations in which local authorities have a duty to make enquiries about what, if any, action they should take to safeguard or promote the welfare of a child. |
| 2.2 | Section 47 of the Act requires that if a local authority has 'reasonable cause to suspect that a child who lives or is found in their area is suffering or is likely to suffer Significant Harm' the authority shall make, or cause to be made, such enquiries as they consider necessary.....' |
| 2.3 | Under s.31 (9) of the Children Act 1989 as amended by the Adoption and Children Act 2002:
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| 2.4 | Under s.31 (10) of the Act, where the question of whether harm suffered by the child is significant turns on the child's health and development, his/her health and development must be compared with that which could reasonably be expected of a similar child. |
| 2.5 | There are no absolute criteria on which to rely when judging what constitutes significant harm. It is the responsibility of Children's Social Care to make a judgement if a referral about abuse and / or neglect of a child satisfies the criteria for a Section 47 Enquiry (see Section 3, Threshold for Section 47 Enquiries, of the Section 47 Enquiries Procedure. |
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| 2.6 | 'Child abuse and neglect' are forms of maltreatment of a child. These terms include serious physical and sexual assaults as well as cases where the standard of care does not adequately support the child's health or development. |
| 2.7 | Children may be abused or neglected through the infliction of harm, or through the failure to act to prevent harm. |
| 2.8 | Abuse can occur within the family or in an institution or community setting. Abuse can occur within all social groups regardless of religion, culture, social class or financial position. |
| 2.9 | Children may be abused by those known to them or, more rarely, by a stranger. They may be abused by an adult /s or another child/ren. |
| 2.10 | Working Together to Safeguard Children 2010 sets out definitions and examples of the 4 broad categories of abuse and neglect which are used to determine if a child protection plan is required:
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| 2.11 | These categories overlap and an abused child does frequently suffer more than one type of abuse. This chapter provides:
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3. Categories of Abuse and Neglect
Physical Abuse |
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| 3.1 | Physical abuse may involve hitting, shaking, throwing, poisoning, burning or scalding, drowning, suffocating or otherwise causing physical harm to a child. |
| 3.2 | It may also be caused when a parent or carer fabricates the symptoms of, or deliberately induces illness in a child (see Fabricated or Induced Illness Procedure). |
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| 3.3 | Emotional abuse is a form of Significant Harm which involves the persistent emotional maltreatment 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 include not giving the child opportunities to express their views, deliberately silencing them or "making fun" of what they say or how they communicate. It may feature age or developmentally inappropriate expectations being imposed on children. These may include interactions that are beyond the child's developmental capability, as well as overprotection 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 (including cyberbullying) 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. |
| 3.4 | Some level of emotional abuse is involved in most types of ill treatment of children, though emotional abuse may occur alone. |
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| 3.5 | Sexual abuse is a form of Significant Harm which involves forcing or enticing a child or young person to take part in sexual activities, not necessarily involving a high level of violence, whether or not the child is aware of what is happening. The activities may involve physical contact, including assault by penetration (for example rape or oral sex) or non-penetrative acts such as masturbation, kissing, rubbing and touching outside of clothing.. They may also include non-contact activities, such as involving children in looking at, or in the production of, sexual images, watching sexual activities, encouraging children to behave in sexually inappropriate ways, or grooming a child in preparation for abuse (including via the Internet). Sexual abuse is not solely perpetrated by adult males. Women can also commit acts of sexual abuse, as can other children. |
| 3.6 | Children under 16 years of age cannot lawfully consent to any sexual activity occurring, although in practice young people may be involved in sexual contact to which, as individuals, they may have agreed (see Sexual Exploitation Procedure and Sexually Active Children Procedure). |
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| 3.9 | Neglect involves 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 and development. |
| 3.10 | Neglect may occur during pregnancy as a result of maternal substance misuse (see Recognising Vulnerability of Children in Particular Circumstances Procedure, Parental Substance Misuse). |
| 3.11 | Once the child is born, neglect may involve failure to:
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4. Recognising Abuse and Neglect
Please also see the NICE Guidelines for Health Professionals: When to Suspect Child Maltreatment
| 4.1 | The factors described in this section are frequently found in cases of child abuse. Their presence is not proof that abuse has occurred, but:
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| 4.2 | Generally, in an abusive relationship the child may:
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| 4.3 | Staff should be aware of the potential risk to children when individuals, previously known or suspected to have abused children, move into or have contact with the household (see Management of Those Presenting a Risk to Children Procedure.) |
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| 4.4 | This section provides information about the sites and characteristics of physical injuries which may be observed in abused children. It is intended primarily to assist non medical staff in the recognition of bruises, burns and bites which should be referred to Children's Social Care and / or require medical assessment. Further information for medical staff can be found on the Core Info website. |
| 4.5 | The following may be indicators of concern:
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Bruising |
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| 4.6 | Children can have accidental bruising, but the following must be considered as highly suspicious of a non accidental injury unless there is an adequate explanation provided and experienced medical opinion sought:
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| 4.7 | Bruising may not be easily noticeable or distinguishable when children have darker skins (black / ethnic groups). Greater vigilance is required in noticing other possible indicators of injury e.g. wincing or demeanour of the child. |
| 4.8 | 'Mongolian blue spots' closely resemble bruising. They are typically grey / blue pigmented areas over the lower back, trunk and limbs, which may be extensive. There is no over-lying damage or palpable swelling. They remain essentially unchanged in the first year of life and progressively disappear in childhood. |
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| 4.9 | Bite marks can leave clear impressions of the teeth. Human bite marks are oval or crescent shaped. Those over 3cm in diameter are more likely to have been caused by an adult or older child. |
| 4.10 | A medical opinion from a forensic dentist / odontologist should be sought where there is any doubt over the origin of a bite. The police will have contact details. |
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| 4.11 | It can be difficult to distinguish between accidental and non- accidental burns and scalds, and will always require experienced medical opinion. |
| 4.12 | Accidental scalds usually involve the upper front part of the body and have splash marks. Any burn with a clear outline may be suspicious e.g.:
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| 4.13 | Scalds to the buttocks of a small child, particularly in the absence of burns to the feet, are indicative of dipping into a hot liquid or bath. |
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| 4.14 | Fractures may cause pain, swelling and discolouration over a bone or joint. |
| 4.15 | Non-mobile children rarely sustain fractures accidentally. |
| 4.16 | There are grounds for concern if:
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Scars |
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| 4.17 | A large number of scars or scars of different sizes or ages, or on different parts of the body, may suggest abuse. |
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| 4.18 | Emotional abuse may be difficult to recognise, as the signs are usually behavioural rather than physical. Manifestations of emotional abuse may also indicate the presence of other kinds of abuse. |
| 4.19 | The indicators of emotional abuse are often also associated with other forms of abuse. |
| 4.20 | Recognition of emotional abuse is usually based on observations over time and the following offer some associated indicators: |
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| 4.21 | Boys and girls of all ages may be sexually abused and are frequently scared to say anything due to guilt and/or fear. The child may fear s/he will not be believed and/or fear repercussions due to possible threats that may have been made. |
| 4.22 | This form of abuse is particularly difficult for a child to talk about and full account should be taken of cultural sensitivities of individual child / family. |
| 4.23 | Recognition of sexual abuse can be difficult, unless the child tells others of the abuse, their account is believed and the suspected abuse referred to Children's Social Care and/or the police. There may be no physical signs and indications of sexual abuse are most likely to be emotional / behavioural. |
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| 4.24 | Behavioural indicators of sexual abuse may include:
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| 4.25 | Evidence of neglect is built up over a period of time and can cover different aspects of parenting e.g. neglect of the child's physical needs possibly causing non-organic failure to thrive; neglect of the child's developmental emotional needs which may contribute to cognitive delay; neglect of the child's emotional needs resulting in behavioural markers. |
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5. Professional Response
Being Alert to Children's Welfare |
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| 5.1 | Everybody who works or has contact with children (or pregnant women) should be able to recognise, and know how to act upon, evidence that a child's health or development (or that of the unborn baby) is or may be being impaired and especially when they are suffering or likely to suffer Significant Harm. Useful information for practitioners about what to expect of children's development at different ages is available in Chapter 5 of 'Birth to Five'. |
| 5.2 | Whenever practitioners are concerned about the welfare or safety of a child they should follow these procedures. These concerns may arise during:
If the member of staff who has made the referral to Children's Social Care does not feel the response has been appropriate and concerns remain, then the member of staff should share this view with Children's Social Care Managers and, if problems persist, discuss with their line manager about escalating the issue through their management line - see Complaints, Non-Compliance and Conflict Resolution Procedure |
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| 5.3 | The Common Assessment Framework (CAF) is a nationally standardised approach to conducting an assessment of the needs of a child or young person and deciding how those should be met. |
| 5.4 | CAF, developed for use by practitioners across all agencies is intended to facilitate communication and more effective work. The CAF enables contribution by children and parents/carers to the assessment, planning and review processes. For further information about the CAF process in Milton Keynes, please refer to the CAF page on the Children's Trust website. |
| 5.5 | Those working with children and those working with adults who are parents/carers need to be aware of their duties to share information (with informed consent) about children with additional needs, and need to be aware how they can complete or contribute to a Common Assessment. |
| 5.6 | Use of CAF should not delay referral to Children's Social Care if there are concerns that a child is at risk of being abused or neglected (see Quick Referral flowchart). The CAF Form is not a referral form although it may be used to support a referral or a specialist assessment. |
| 5.7 | If a Common Assessment has already been completed (or is in progress) when child protection concerns are identified, it should inform the assessment completed by Children's Social Care (see Quick Referral flowchart.) |
| 5.8 | If, following an assessment by Children's Social Care, a child does not meet the criteria for services, undertaking a Common Assessment to respond to the child's additional needs may be recommended. |
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| 5.9 | Professionals in most agencies should have internal procedures, which identify child protection designated / named managers /staff able to offer advice and decide upon the necessity for a referral. |
| 5.10 | Consultation, without giving case details, may also be accomplished directly with Children's Social Care via the child protection co-ordinators or in her/his absence the Referral and Assessment team. There should be no delay in obtaining advice e.g. by waiting to speak to the co-ordinator, so that any decision to refer can be followed up immediately. |
| 5.11 | A formal referral or any urgent medical treatment must not be delayed by the need for consultation. |
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| 5.12 | Responsibility for making enquiries and investigating allegations rests with Children's Social Care and Police Child Abuse Investigation Units (CAIUs), along with other relevant agencies (see Referral and Assessment Procedure and Section 47 Enquiries Procedure.) |
| 5.13 | Where abuse is alleged, the initial response by professionals should be limited to listening carefully to what the child says so as to:
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| 5.14 | The child must not be pressed for information, led, cross-examined or given false assurances of absolute confidentiality. Such well-intentioned actions could prejudice police investigations, especially in cases of sexual abuse. |
| 5.15 | If the child can understand the significance and consequences of making a referral to Children's Social Care, s/he should be informed that the referral is being made. |
| 5.16 | Regardless of the child's view, it remains the responsibility of the professional to take whatever action is required to ensure the safety of that child and any other children. |
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| 5.17 | Where practicable, concerns should be discussed with the family and agreement sought for a referral to Children's Social Care unless this may:
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| 5.18 | Professional consultation (see Section 5.9, Professional Consultation) should be sought if in doubt about the advisability of informing the parents of the concerns or if there are concerns about the safety of any member of staff. |
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| 5.19 | A decision by any professional not to seek parental permission before making a referral to Children's Social Care must be recorded and the reasons given. |
| 5.20 | Formal referrals from named professionals cannot be treated as anonymous, so the parent will ultimately become aware of the identity of the referrer. |
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| 5.21 | Where a parent has agreed to a referral, this must be recorded and confirmed in the referral to Children's Social Care. |
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| 5.22 | Where the parent refuses to give permission for the referral, further advice should, unless this would cause undue delay, be sought from a manager or the nominated child protection officer and the outcome fully recorded. |
| 5.23 | If, having taken full account of the parent's wishes, it is still considered that there is a need for a referral:
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| 5.24 | For a full discussion about information sharing and confidentiality, see Information Sharing and Confidentiality Procedure. |
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| 5.25 | If the child is suffering from a serious injury, medical attention must be sought immediately from Accident & Emergency (A&E). |
| 5.26 | If abuse is suspected, Children's Social Care and the duty consultant paediatrician must be informed. |
| 5.27 | Except in cases where emergency treatment is needed, Children's Social Care and the CAIU are responsible for ensuring any medical examinations required are initiated as part of a Section 47 Enquiry. |
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| 5.28 | In all cases of injury presented at A & E or walk in service, the emergency service must inform the GP, health visitor and/or school nurse. |
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| 5.29 | Staff in LSCB member agencies and contracted service providers must make a referral to Children's Social Care if there are signs that a child under the age of 18 years or an unborn baby:
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| 5.30 | The timing of such referrals must reflect the level of perceived risk, but should usually be within 1 working day of the recognition of risk. |
| 5.31 | In urgent situations, out of office hours, the referral should be made to the emergency duty team (see 01908 265545). |
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| 5.32 | Referrals should be made to the Children's Social Care office where the child is living or is found. |
| 5.33 | If the child is known to have an allocated social worker, referrals should be made to her/him, or, in her/his absence to the manager or a duty officer. In other circumstances referrals should be made to the duty officer (01908 235169 or 235170). |
| 5.34 | Where available, the following information should be provided with the referral (but absence of information must not delay referral):
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| 5.35 | The referrer must confirm verbal and telephone referrals in writing, within 48 hours, using a multi-agency referral form. Any CAF that has been undertaken should be attached to the referral. |
| 5.36 | Children's Social Care must acknowledge referrals, in writing, within 1 working day of receipt. Where no acknowledgement is received within 3 working days, the referrer must contact Children's Social Care again. |
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| 5.37 | The safety of children is paramount in all decisions relating to their welfare. Any action taken by members of staff from an LSCB agency should ensure that no child is left in immediate danger. |
| 5.38 | The law (s.3 (5) Children Act 1989) empowers anyone who has actual care of a child to do all that is reasonable in the circumstances to safeguard her/his welfare. |
| 5.39 | A teacher, foster carer, childminder or any professional should for example, take all reasonable steps to offer a child immediate protection from an aggressive parent. |
| 5.40 | Where abuse is alleged, suspected or confirmed in a child presented at A & E / admitted to hospital, s/he must not be discharged until:
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| 5.41 | The referrer should keep a written record of:
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6. Referral by Members of the Public
| 6.1 | When members of the public are concerned about the welfare of a child or an unborn baby, they should contact the local Children's Social Care of the area in which the child lives / is found or in the case of an unborn baby, where the mother lives. |
| 6.2 | Any professional from another agency receiving a child protection referral from a member of the public must:
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| 6.3 | Referrers should have an opportunity to discuss their concerns with a qualified social worker. |
| 6.4 | Referrers should be asked specifically if they hold any information about difficulties being experienced by the family/household due to domestic abuse, mental illness, substance misuse, criminal behaviour/convictions and/or learning difficulties. |
| 6.4 | The NSPCC help line offers an alternative means of reporting concerns. |
| 6.5 | Individuals may prefer not to give their name to Children's Social Care or NSPCC. Alternatively they may disclose their identity, but not wish for it to be revealed to the parents / carers of the child concerned. |
| 6.6 | Where possible, staff should respect a referrer's request for anonymity. There are however, certain limited circumstances in which her/his identity may have to be given e.g. to a court. |
| 6.7 | Local publicity material should make the above position clear to potential referrers. |
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