1 Working Together : A multidisciplinary response to Child Abuse and Working Together : A multidisciplinary response to Child Abuse and Neglect Prof Margaret Lynch Emeritus Professor of Community Paediatrics Kings College, London

2 Session Content why child abuse and neglect needs a multidisciplinary and cross sector response; meeting the challenge of multidisciplinary working; how a multidisciplinary response will protect the best interests of the child; developing a child protection system that will facilitate multidisciplinary working; the role of organisations in supporting a CP system and multidisciplinary working; examples of multidisciplinary team work

3 What is Child Abuse and Neglect (CAN)?

4 General definition - WHO (1999) Child abuse or maltreatment constitutes all forms of physical and/or emotional ill- treatment, sexual abuse, neglect or negligent treatment or commercial or other exploitation, resulting in actual or potential harm to the child’s health, survival, development or dignity in the context of a relationship of responsibility, trust or power.

5 Types of abuse recognized internationally Care giver acts & omissions Physical – acts which result (or could result) in physical harm Emotional – failure to provide a developmentally appropriate & supportive environment or acts that directly effect emotional health & development Sexual – acts in which a caregiver uses a child for sexual gratification Neglect – failure to provide for child in health, education, nutrition, emotional development, shelter & safe living conditions Exploitation - Commercial or other exploitation of child refers to use of the child in work or other activities for the benefit of others.

6 Recognition of CAN Physical evidence of injury or neglect Poor health and/or growth Delayed development Disturbed behaviour Via concerns about parents –Mental Health –Substance abuse –Domestic violence

7 Responding to CAN includes: Recognition Investigation Assessment (Court Action) Provision of Services Follow Up

8 Why Child Abuse & Neglect requires a multidisciplinary response Anyone working with children, families & adults with access to children might suspect abuse & neglect Child Abuse & Neglect can effect a child’s health, growth, development & behaviour Making decisions about the best interests of the child requires a thorough assessment of a child and family Intervention may include input from a range of services (including some adult services)

9 Challenges of working together

10 Challenges of working together Difference in Priorities Vocabulary & Interpretation of Terms Inappropriate Expectations of Others Stereotyping / Prejudices Management Structures (Including differing supervision arrangements) Budgets Human Resources

11 “ We do not see things as they are, but as we are.” (Kant)

12 Priorities Children’s NGOChildren’s rights Social WorkerFamily support / child rescue Teacher Helping children learn Doctor/Nurse Curing illness PolicemanCatching criminals JudgeSeeing justice is done PoliticianWinning elections AllTo be valued & rewarded MajorityTo have conflict free life

13 Challenges of working together Difference in Priorities Vocabulary & Interpretation of Terms Inappropriate Expectations of Others Stereotyping / Prejudices Management Structures (Including differing supervision arrangements) Budgets Human Resources

14 How can we work together?

15 Multidisciplinary working Helped by shared: Objectives Values Attitudes Vocabulary Identity Base Power Training Competencies Sense of Humour

16 Example of a shared philosophy Example of a shared philosophy (Department Of Health, England) The welfare of the child must be of first importance. The overriding principal is to secure the best outcome for the child.

17 True multidisciplinary working Acknowledges RESPECTS Preserves Uses Different Skills & Perspectives

18 Developing a Child Protection System to facilitate multidisciplinary working

19 Why do we need a system? So everyone knows how to proceed in cases of actual or suspected CAN To develop joint understanding of definitions & terminology To agree and formalize the co-operation between sectors, including a referral/reporting system To agree the steps to be taken in individual cases & each profession’s or sector’s roles & responsibilities To provide a framework for preventative strategies To ensure both professionals & the public are protected when reporting suspected CAN

20 Foundations of a child protection system Convention on the Rights of the Child National laws Understanding & Support from the Community Organisations Committed to Safeguarding Children Competent, confident & well supervised staff

21 An effective system will have: People from different organisations and professional background able & willing to work together Adequate training and support for all staff Thorough and co-ordinated assessments of the child’s needs and the carers’ ability to meet those needs within their societal / community context

22 An effective system will have: A range of resources, provided by different stakeholders and community groups Children and family members involved in making decisions about what resources they receive A Monitoring mechanism to ensure the system is effective Data collection

23 A child protection system should help all staff to: Accept their responsibility Be able & willing to identify abuse Respond appropriately & with confidence Be willing to contribute to assessment of child & family Put the best interests of the child first Have knowledge of legal frame-work Understand & respect role of others Contribute to safeguarding the welfare of children and their families (prevention)

24 When building a system (National or Local) Ensure local "ownership" Use local expertise Put in local context Build on existing systems Identify existing networks Use CRC & national legislation Integrate training into project

25 How can organisations play their role in protecting children?

26 All organizations should have: Staff recruitment policy (include volunteers) Procedure to consider allegations against staff (including outside work) Duty to protect staff from threats A stated commitment to child protection

27 In a committed organization child protection is: Recognized as a priority at the top Seen as everybody’s responsibility Acknowledged as complex & “difficult” Accepted as needing: –Policy & Procedures –Training –Supervision –Support –Time –Multi- agency/disciplinary Approach

28 Working Together Needs Managers who: Are committed to child protection Expect staff to be child focused Put safeguarding high on agenda Build up trust & lines of communication with managers from other services Are willing to address concerns Are honest about pressures

29 Examples of multi-disciplinary Examples of multi-disciplinary team work

30 The Case Conference An example of a team approach to working with individual cases

31 Case Conferences Objectives Brings together Information available on child & family Decides if additional information/assessment is needed Makes informed decision about future risks to child Decides on future action needed to protect child & support family (CHILD PROTECTION PLAN) –Who will do what –Who is responsible for co-ordinating actions of different sectors (Key Worker for family) Sets date for follow up conference

32 Case Conference may be a ttended by: Professionals who already know the child & family Representatives for each sector that could have role to play in assessment and service provision (a core team –known to everyone) Other key persons who know child & family or who might provide advice & support (e.g. NGO) Members of the family (as appropriate – may occasionally include child)

33 Case Conference information discussed includes: Evidence of suspected/actual abuse & neglect Details of child’s: –health, –development – functioning Information on the family including: –structure –strengths and difficulties –capacity to protect child – ability to promote child’s health and development Alternative ways of responding to child & family needs

34 Case Conferences Case Conferences General principles: CONFIDENTIALITY MUST BE RESPCTED Should have experienced “independent” chair Ideally professional participants prepare written reports Summary of discussion and decisions made should be kept and agreed by participants Activity data collected in a systematic & an anonymous way

35 An example of a “ strategic” team..

36 Area Child Protection Committees (UK) (Now known as Safeguarding Boards) Responsibilities include: Local Policy& Procedures Agreeing Definitions & Thresholds Encouraging Working Together Undertaking Serious Case Reviews Identifying Training Needs & Delivering Training Identifying Practice Implications of Research

37 ACPC Way of working (Variable - left to local arrangements) Chair who is respected by all agencies Meetings (monthly to quarterly) Working or Sub Groups Executive Committee Administrator & or Training Co-ordinator Annual Business Plan and Work Plan Production of Annual Report

38 UK ACPC What it is not A provider of services Funding body Concerned with individual cases (unless they go very wrong) An Open Forum for any one interested Successful (with some exceptions) in engaging the Community

39 ACPC Problems Time Money Administrative Support Perception of Social Services by Others Ability of Members to “speak” on behalf of their agency Ownership / Commitment

40 It’s all about building bridges:

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