Tavistock and Portman Safeguarding Children: Level 1, Camden CCG Dr Rob Senior, Named Doctor Sonia Appleby, Named Professional

The 3Rs in Safeguarding and Child Protection Recognizing Reporting Recording Context – the child or young person (<18s) should always be the primary focus)

Procedural Context Agency safeguarding procedures Local Safeguarding Policies, including the strategic direction of the LSCB: Camden Safeguarding Children Board Regional Safeguarding Procedures: Pan-London Children Procedures National Safeguarding Procedures e.g. Working Together to Safeguard Children

Legal Context All health services are required by section 11(2)(a) Children 2004 to ensure that safeguarding children is everyone’s responsibility and is therefore applicable to any NHS or private service user.

Training Context All health staff are required to receive safeguarding children training to ensure there is a level of assurance regarding competence, skills, attitudes and values. Source: Intercollegiate Document March 2014

Competence Know about child maltreatment in its different forms (physical including Fabricated and induced illness, emotional and sexual abuse, and neglect) including child trafficking, FGM and radicalisation including prevalence and impact Know about relevance of parental, family and carer factors such as domestic abuse, mental and physical ill-health, substance and alcohol misuse Know what to do if there are concerns about child maltreatment, including local policies and procedures around who to contact, where to obtain further advice and support, and have awareness of the referral process Know about the importance of sharing information (including the consequences of failing to do so)

Competence (con’t) Know what to do if they feel that their concerns are not being taken seriously or they experience any other barriers to referring a child/family Know the risks associated with the internet and online social networking Know what the term ‘Looked after child’ means

Domains of Safeguarding Need: identifying children who have specific needs Welfare: where there are concerns regarding the quality and/or consistency of parenting Child Protection: any child or unborn child who is at risk of, or has suffered ‘significant harm’ Child protection concerns are determined by the presence or likelihood of significant harm

Significant Harm No definitive or ‘absolute criteria’ Consideration of the following: Severity Duration and frequency Premeditation, threat, coercion, sadism Aggregated negative events both acute and chronic, which damage the child’s physical and psychological development

Prevalence of Child Abuse The sad truth is we do not know how many children are affected by child abuse. Child abuse is usually hidden and children may be too young, too scared, or too ashamed to tell anyone about what is happening to them

Incidence of Child Abuse 50,000 child and young people known to be in need of protection 29,000 child and young people talked to Child Line in 2014 NSPCC estimates that for every one child identified as being in need of protection, 8 children experiencing abuse are undetected Source: http://www.nspcc.org.uk/services-and-resources/research-and-resources/statistics/

Prevalence of Children Abuse 1: 14 children in the UK have been physically abused 1: 20 children in the UK are subject to sexual abuse 1:3 children in the UK will never tell an adult that they have been abused

Types of Abuse On-Line Abuse Any type of abuse that happens on the web whether through social networks, playing on-line games or using mobile phones Sexual Abuse A child is sexually abused when they are forced or persuaded to take part in sexual activities. This does not have to be physical contact and can happen on-line

Types of Abuse (con’t) Physical Abuse Deliberately hurting a child causing injuries such as bruises, broken bones, cuts, bites etc. Neglect On-going failure to meet a child’s basic needs Emotional Abuse Emotional abuse can involve deliberately trying to scare or humiliate a child or isolating or ignoring them.

Types of Abuse (con’t) Child Sexual Exploitation Children exploited for money, power and/or status FGM The partial or total removal of external female genitalia for non medical reasons Bullying and Cyberbullying Can happen in school, home or on-line

Types of Abuse (con’t) Domestic Abuse Witnessing domestic abuse is child abuse Child Trafficking Children are recruited, moved or transported exploited, forced to work or sold Grooming Can be groomed on-line or in the real world, by a stranger or by someone they know, for example, a family member, friend or professional Abuse linked to spiritual or religious beliefs

Types of Abuse (con’t) Harmful Sexual Behaviour Children and young people who develop harmful sexual behaviours causing harm to themselves or others Fabricated or Induced Illness Fabricated or induced illness (FII) is a rare form of child abuse. It occurs when a parent or carer, usually the child’s biological mother, exaggerates or deliberately causes symptoms of illness in the child.

Types of Abuse (con’t) Radicalisation Radicalisation is defined in the Prevent Strategy as “the process by which a person comes to support terrorism and forms of extremism leading to terrorism” Source: http://www.publications.parliament.uk/pa/cm201012/cmselect/cmhaff/1446/1446.pdf

Whose at Risk? Children are abused in any section of our society irrespective of class, ethnic or regional groups Children are abused by family members, family friends, professionals, carers and strangers

Factors that Help us to Predict Child Abuse Domestic Abuse No official numbers of children exposed to domestic abuse but it is estimated to be 1:5 Domestic Abuse is a factor in 60% of Serious Case Reviews Source: http://www.nspcc.org.uk/preventing-abuse/child-abuse-and-neglect/domestic-abuse/who-is-affected/

Learning from Serious Case Reviews Domestic Abuse In 50% of cases, domestic abuse continues even after their parents have separated. It can happen during contact visits (Stanley et al, 2009). Agencies must be aware of this when formulating their response or making decisions around arrangement orders.  Victims’ risks increase following disclosure

Factors that Help us to Predict Child Abuse (con’t) Parental Mental Ill-Health The stresses of parenting can exacerbate mental health problems which may impact on the welfare of the child. Not getting enough sleep or having to adapt to a baby’s routine can make it more difficult for parents to cope with a mental health problem such as anxiety or depression. Source: http://www.nspcc.org.uk/preventing-abuse/child-protection-system/case-reviews/learning/parents-mental-health-problem/

Learning from Serious Case Reviews Parental Mental Ill-Health Parents offered mental health services often failed to take them up or to keep appointments. Where a parent with mental health problems is reluctant to engage, health professionals sometimes step back from provision of a service. This loss of support to the adult may in turn impact on the wellbeing or safety of the child. When parents with mental health problems do not engage professionals should consider whether an assessment of the child’s needs is necessary. Source: http://www.nspcc.org.uk/preventing-abuse/child-protection-system/case-reviews/learning/parents-mental-health-problem/

Factors that Help us to Predict Child Abuse (con’t) Drugs and Alcohol Substance misuse by a parent or carer is widely recognised as one of the factors that puts children more at risk of harm. The biggest risk posed to children is that parents, when under the influence of drugs or alcohol, are unable to keep their child safe (including overlay through co-sleeping and accidents caused through lack of supervision).

Learning from Serious Case Reviews Drug and Alcohol Misuse sudden infant death syndrome associated with co-sleeping accidental ingestion of drugs accidents (fire, drowning) due to inadequate adult supervision parents deliberately giving children drugs.

Responding to Concerns Responding and managing suspicions and allegations of child abuse is demanding We need to recognise our society embraces a variety of child-rearing practices However, we must at the same time distinguish what constitutes acceptable child care and what does not

Effective Management Safeguarding and child protection requires a multi-disciplinary approach requiring: Sharing information in a timely manner Sharing information is a fundamental aspect of enabling a child’s safety and protection Staff should not seek to manage a child protection concern alone

Recording Any discussions with a child and parent Discussions with managers/supervisors Information provided to the Local Authority Children’s Services Decisions taken and by whom (time, date and signed) Retain a copy of written referral

Investigating Child Protection Concerns During a child protection investigation, discussion within the professional network has priority until it is clear there is no conflict between the interests of child and his parents/carer(s). The same principle of priority is applicable in circumstances where there are concerns/or allegations of child abuse involving a professional

Looked After Children A child who is being looked after the local authority is known as a child in care. They might be living: with foster parents at home with their parents under the supervision of social services in residential children's homes other residential settings like schools or secure units. Source: http://www.nspcc.org.uk/preventing-abuse/child-protection-system/children-in-care/

Looked After Children 93,000 LAC (UK,2014) 41,155 (62%) as a result of abuse and neglect in England and Wales Children in Care are 4 times more likely than their peers to have mental health difficulty Children in care are less likely to do well in school A small number of children in care experience further abuse and neglect whilst in care

You see a child and suspect abuse or neglect Is the child acutely sick, in pain, bleeding or has “medical” problems? Yes No Will the child be at immediate risk of abuse when he/she leaves the surgery? Discuss with Mon- Fri 9-5 Child Protection Team Hotline Tel. 020 3317 2403 Refer for assessment to the Safeguarding Children Clinic Child Protection Team, Crowndale H.C 59 Crowndale Road, London NW1 1TU Not Sure Mon-Fri 9-5 GP Child Protection Lead Claire Taylor 07736070327 clairetaylor5@nhs.net Designated Nurse for Safeguarding Children Jackie Dyer Tel 07768886258 Designated Doctor for Safeguarding Children Deborah Hodes Deborah.hodes @nhs.net Duty Social Worker Team Out of Hours On call Paediatric Registrar at acute trust Refer to Mon - Fri 9 -5 Duty Social Team at MSH Multi-Agency Safeguarding Hub 9am – 5pm Tel 020 7974 3317 Tel 020 7974 6600 Tel 020 7974 4094 Out of hours 020 7974 4444 Or dial 999 in emergency NB. All referrals to be followed in writing within 48hrs Contact the on-call Paediatric Registrar University College Hospital Tel. 08451 555 000 Whittington Hospital Tel. 020 7272 3070 Royal Free Hospital Tel. 020 7794 0500 You see a child and suspect abuse or neglect

Local Safeguarding Contacts Designated Nurse, Jackie Dyer Jackie.dyer@camdenccg.nhs.uk Designated Doctor, Deborah Hodes deborah.hodes@nhs.net Named General Practitioner Clairetaylor5@nhs.net Designated Doctor for Looked after Children (LAC) gitacroft@nhs.net Designated Nurse for LAC a.akamo@nhs.net Designated Doctor for CDOP blloyd@nhs.net Camden MASH Team Tel 020 7974 3317 Tel 020 7974 6600 Tel 020 7974 4094

Remember: most children are all right Remember: most children are all right! Image accessed 20th October 2015 via the internet