How to Find Your Way Around… SEPT - MANDATORY TRAINING 1. You can play the PowerPoint, and find the Test here EXAMPLE COURSE

SEPT - MANDATORY TRAINING 2. You can minimise this column and make the main page bigger by clicking this icon. Click it again to bring it back. EXAMPLE COURSE

SEPT - MANDATORY TRAINING 3. Always click this ‘Home’ icon to save your progress and log off. This is very important! EXAMPLE COURSE

SAFEGUARDING CHILDREN & ADULTS (CLINICAL STAFF) SEPT - MANDATORY TRAINING

Safeguarding Level 2 - Learning Objectives This Level 2 course also incorporates Level 1 and on completion you will have an understanding of: the Trust Safeguarding arrangements for children and adults; your professional responsibility in relation to safeguarding children and adults; the definition of child/adult abuse; what to do if you are concerned for a child or adults welfare; the impact that parental mental health and drug & alcohol misuse can have on children's welfare; safeguarding adult investigation process how to access further information. Definition of Child Abuse The fact that we have all been children means that we will often have different opinions of what constitutes abuse. The Government document Working Together to Safeguard Children 2010,applies the term ‘child’ to those up to their eighteenth birthday. Abuse is the maltreatment of a child, by causing harm or failing to prevent harm to the child, which results in, or is likely to result in 'Significant Harm'. This includes the impairment suffered from seeing or hearing the ill- treatment of another for example, in circumstances involving Domestic Violence ALL Staff have a statutory duty to respond to concerns,allegations or direct disclosures of significant harm of to a child. Reports of concerns may come from other staff, professionals or by direct disclosure or information from the child family, friends or neighbours.

SEPT - MANDATORY TRAINING This is reflected in Working Together to Safeguard Children 2010 which states that; ''Staff working in Mental Health Services, including those providing general adult and community, forensic, psychotherapy, alcohol and substance misuse and learning disability services, have a responsibility in safeguarding children when they become aware of or identify a child suffering or likely to suffer significant harm. This may be as a result of service’s direct work with those who may be mentally ill, a parent, a parent-to-be, or a non-related abuser, or in response to a request for the assessment of an adult perceived to represent a potential or actual risk to a child or young person '' Concerns should be discussed with the Line Manager or Safeguarding Team. Further information can be accessed via the Trust Safeguarding Policy Categories of Abuse Abuse can occur within the family, an institution or community setting. Abuse can occur in all social groups regardless of religion, culture, social class or financial position. Children may be abused by those known to them or more rarely a stranger. They may be abused by an adult(s) or another child(ren). Child abuse can take many forms, but is usually divided into four categories. Physical Abuse Physical abuse may involve, hitting, shaking, throwing, poisoning, burning, scalding, drowning or suffocating a child. Physical harm may also be caused when a parent or carer fabricates the symptoms of, or deliberately induces, illness in a child. (FII - Fabricated or Induced Illness) The following is not a comprehensive or definitive list but provides a guide to the more common non- accidental injuries.

SEPT - MANDATORY TRAINING Any injury which the child, parent, carer tries to hide or give several diffferent or unlikely explanations, should raise concerns. In these circumstances advice should always be sought. Bruising on uncommon sites for example, buttocks, mouth, cheeks, under the arm, genital area or neck etc may indicate physical abuse. Indicators that should also cause concern are; Bruises on a non-mobile child Multiple bruises or bruises in clusters Bruises on any non-bony part of the body or face including the eyes, ears and buttocks On the neck i.e.attempted strangulation, or ankles and wrists that resemble ligature marks Bites can leave a clear impression and abuse should be considered as a possibility; especially when it is thought that the mark is unlikely to have been caused by a young child. An animal bite on a child may indicate inadequate supervision of the child or neglect. Sexual Abuse Sexual abuse 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. Signs which could indicate sexual abuse including: Children displaying sexualised behaviour or language

SEPT - MANDATORY TRAINING Wetting/Soiling/Self Harm Withdrawn behaviour Running away Child/Young person that has money or gifts that they cannot account for or want to discuss Pregnancy in a young person or a concealed pregnancy Staff who are aware of a child that has contact with an adult with prior allegations or convictions of sexual abuse should report this to the line manager or Safeguarding team Emotional Abuse Persistent emotional ill treatment which causes severe and persistent effects on the child’s emotional development. This can occur where there is persistent emotional unavailability and unresponsiveness from the parent or carer towards a child and in particular towards a baby. Emotional abuse may include: Conveying to children they are worthless or unloved Causing children to feel frightened or in danger, e.g. witnessing domestic violence. Negativity or hostility towards a child or young person Rejection or scapegoating of a child or young person. Using the child for the fulfilment of the adult’s needs for example, children being used in marital disputes Emotional abuse may result in children and young people exhibiting self harm and / or suicidal ideation Neglect Is the persistent failure to meet the child’s basic physical and or psychological needs, likely to result in serious impairment of health and development. Neglect may occur during pregnancy as a result of maternal substance abuse. Once a child is born, neglect may involve a parent or carer failing to:

SEPT - MANDATORY TRAINING provide adequate food, clothing and shelter (including exclusion from home or abandonment); protect a child from physical and emotional harm or danger; ensure adequate supervision (including the use of inadequate care-givers); or ensure access to appropriate medical care or treatment. These categories overlap and an abused child frequently suffers more than a single type of abuse. Risk Factors Those working primarily within adult services must be mindful of the following factors affecting parents, that will have an impact on children’s welfare: Previous History This may occur where a known abuser or person who is a ‘Risk to a Child’ (formerly known as a Schedule 1 Offender) has access to children through a new relationship or at work. Where a client is pregnant or a new child is born to a family, where there were previous Safeguarding concerns or children have been removed into local authority care due to abuse or risk of significant harm Domestic Violence / Abuse Two women are killed each week in England and Wales by a partner or former partner and 90% of children are in the same or next room when violence occurs(Home Office, 2007). Staff must consider the risk of Domestic Abuse and the effects on children in all assessments, CPA process and Risk profiles for clients. CAMHS services should give priority to those referred where there are issues of domestic abuse/violence

SEPT - MANDATORY TRAINING The government defines Domestic Abuse as; ''Any incident of threatening behaviour, violence or abuse (psychological, physical, sexual, financial or emotional) between adults who are or have been intimate partners or family members, regardless of gender or sexuality." This includes issues of concern to black and minority ethnic (BME) communities such as so called 'honour based violence', female genital mutilation (FGM) and forced marriage. Domestic Abuse can have serious long term damage to children through living in ahousehold where domestic violence and abuse is taking place, even though they have neverthemselves been directly harmed. These effects can include: anxiety, panic attacks, nightmares and bedwetting. For young people there are increased risks of self-harm, drug and alcohol misuse and running away from home (Mullender and Morley, 19963). Women living in households where there is Domestic Abuse are at an increased risk when pregnant. Domestic Abuse can affect the unborn child through physical injury, (kicks/punches to the abdomen) stress and anxiety to the mother and a failure to attend ante natal appointments. Drug and Alcohol Misuse Misuse of drugs (prescribed or illegal) and or alcohol is strongly associated with significant harm to children (and the unborn during pregnancy) especially when combined with other features such as domestic violence, mental illness. (See DoH Hidden Harm and Hidden Harm - 3 years on Mental Health The majority of parents who suffer mental illness are able to care for and safeguard their children. However nationally 25% of children who are subject to a Safeguarding Conference have a parent with mental health problems A recent report in 2009 by the National Patient Safety Agency reported that 30 murder convictions a year result from children killed by a parent or step parent. A third had a mental disorder

SEPT - MANDATORY TRAINING (Preventing Harm to Children from Parents with Mental Health Needs) npsa.nhs.uk/patient safety/alerts- and-directives. It is essential that staff working with adults consider the implications of mental health on children's welfare and parenting capacity. Those suffering from the following may justify a referral to social care for an assessment of the child’s needs and must be discussed with Team managers or the Trust Safeguarding Team: Severe post natal illness; Delusional thinking especially when involving the child; Self harming behaviour and suicide attempts; Altered states of consciousness; Mental illness combined with domestic violence and/or substance misuse; Unsupported and/or isolated mentally ill patients. Note: Where there is both parental mental illness and domestic violence and / or substance misuse, staff must make a referral to Social Care unless they can evidence why there is no risk to a child. Consultant Psychiatrists must be involved in all decision making (i.e home leave or discharge) arrangements for parents/carers where there are safeguarding concerns. Children's health can also suffer if the domestic abuse reduces the ability of the non-abusing parent to parent effectively and may impair the parent/child relationship impact on a child’s development and emotional well being.

SEPT - MANDATORY TRAINING Children & Young people: Thoughts on parental mental health Children with a parent with mental illness often receive little help in dealing with the effects of the parent’s illness. They often worry about their parents, blame themselves for the illness, fear they will ‘catch’ the illness and feel unsupported. These children need to be seen and heard. The following videos contains clips of children of different ages talking about their experiences of mental illness and how professionals can help. The aim of the video clips is to: Raise awareness of the effects that parental mental illness can have on young people; Consider the needs of these young people; Consider how you or your department can address these needs.

SEPT - MANDATORY TRAINING Think Family You should consider the following questions whenever you see clients: Are there children in the family; Is there someone looking after them; How is the parent’s illness affecting the children; Are the children safe; Do the children have someone to talk to. We cannot assume that someone else is talking with children and young people, and we should ensure that we communicate and work with other professionals where appropriate in order that children and young people can make sense of their parent’s illness and feel supported. Other professionals that can help with this includes: Child & Adolescent Mental Health Service; Health Visitors & School Nurses; Children’s Social Services; School Counsellors; Voluntary Sector. Click to view Patients as Parents addressing the needs, including the safety, of children whos parents have mental illness.

SEPT - MANDATORY TRAINING Definition of Adult Abuse Safeguarding Adults refers to any person aged 18 or over who: "...is or may be in need of community care services by reason of mental, physical or learning disability, age or illness and who is or may be unable to take care of himself or unable to protect himself against significant harm or serious exploitation which may be occasioned by actions or inactions of other people." No Secrets 2000 Abuse is defined as, 'a violation of an individual's human and civil rights by any other person or persons. It may involve a single or repeated act or omisson, occurring within a personal or close relationship where there is an expectation of trust, which causes harm to a vulnerable adult see Trust Safeguarding Policy & Procedures and Department of Health No Secrets 2000) Message from Research Victims Those most vulnerable to abuse include: People dependant on others for assistance, especially with finances and personal care Those with mental incapacity or fluctuating capacity Those with communication difficulties and or decreased mobility Those living in isolation or in a home, residence but without visitors Those subject to hate crime Perpetrators Research on abuse to adults, suggests that the following people can abuse others; Adult children

SEPT - MANDATORY TRAINING Carers Husband/wife/partner Doctor/Nurse Social Worker/Carer Other professionals or people with access to the vulnerable person Friends/Neighbours Messages from Research The findings from the research carried out by Action on Elder Abuse (Hidden Voices) in 2005 demonstrated that 1 in 10 over 65 experience abuse; 1 in 5 with a disability experience abuse; Only 1 in 8 situations are reported; 99% of vulnerable adults reporting abuse know the abuser; Categories of Abuse Categories of abuse are similar to those of children but include, Financial, Institutional and Discriminatory Abuse. Physical Many of the descriptors for children also apply to adults such as hitting,shaking, kicking, biting. The following may also apply to adult abuse Misuse of medication Restraint or inappropriate handling Bruising not consistent with explanation given Unexplained injuries such as fractures. Repeated falls Pressure sores Discriminatory Racist or sexist remarks or abuse related to the persons age, illness, disability or culture, are all indicators of discriminatory abuse. Indicators may include: Forced marriage Incitement of others to commit abuse based on difference Lack of equal access to healthcare, etc.

SEPT - MANDATORY TRAINING Sexual Including rape, sexual assault and sexual acts to which the person has not consented to or where pressure was applied to secure their consent. This may include the promise of,money, rewards or gifts in return for sex Sexual abuse also includes inappropriate touching and coercion of the person to look at sexual acts or images via the internet, photographs etc Psychological / Emotional Including verbal abuse, deprivation of contact, intimidation, isolation and withdrawal of services. Emotional Abuse also includes threats of Abandonment Institutional Care Deprivation or control of access to room, phone, post, visitors Financial / Material Including theft, fraud, exploitation and pressure in connection with wills, property, bank accounts, inheritance or benefits. Financial abuse also includes deception and the threat of deprivation in order to obtain money or material gain

SEPT - MANDATORY TRAINING Institutional Institutional abuse includes a rigid and fixed regime, the inappropriate use of medical or nursing procedures to make clients easier to manage rather than for their health needs. Examples of institutional abuse can include the use of : catheterisation sleeping tablets unauthorised use of control or restraint oppressive atmosphere lack of dignity and privacy dirty, unsafe environment Complaints made by ex-staff, visitors and or residents of a home or institution may be indicative of institutional abuse and should be reported to your line manager or the Trust Safeguarding Team Categories of abuse are similar to those of children but include financial, Institutional and discriminatory abuse. Signs and symptoms are also similar but involve the following: Neglect Issues of neglect include acts of ommissions, such as: Withholding or inadequate provision of ‘necessaries’, e.g. nutrition, heating, medication, healthcare, social stimulation. Withholding assistance to use toilet, keep clean, warm and comfortable. Failure to allow access to services e.g. health, social services, police etc Failure to safeguard and protect from harm and abuse

SEPT - MANDATORY TRAINING Allegations of Adult Abuse All allegations, concerns or reports of abuse must be discussed with Line Manager or Safeguarding Team as soon as possible. Staff must consider the client's immediate safety. This may involve the emergency services e.g. ambulance / police. The care and safety of other family members (including young children) should also be considered. Clients must be involved in all decisions and plans throughout the Safeguarding process, where appropriate. Staff must consult with the Line Manager and complete a Safeguarding Referral Form and send to the Trust Safeguarding team. The service manager will appoint a member of staff to co-ordinate the Safeguarding process, usually the Care Co-ordinator. A Safeguarding meeting may be arranged in order to Discuss concerns and assess risks Gather additional information Develop a safeguarding plan Clients should always be invited to meetings and may bring a family member, friend or advocate where appropriate. A client’s mental capacity must always be considered and a capacity assessment may be required in accordance with the Trust Mental Capacity Policy (MCPG1)

SEPT - MANDATORY TRAINING If a person with mental capacity does not want allegations of abuse to be investigated their wishes must be respected. These rights can be overridden if it is in the public interest such as: The abuse involves a paid employee of an organisation providing services to the person. The abuser involves someone who has access to other vulnerable adults. If a person does not want allegations investigated, this should not stop staff offering advice, information and support to the client. The appropriate safeguarding forms must be used to document the Safeguarding process and stored in the Safeguarding divider within the clients records. Copies off all forms should be sent to the Safeguarding team. Consent & Confidentiality No child or adult can be offered a confidential service. Whilst every effort should be made to ensure confidentiality is preserved, the disclosure of information which may assist in the prevention or detection of abuse is permissible. This applies both to information about third parties, e.g. adults who may pose a risk of harm to children or about those who may be the subject of abuse. Staff should consult the Trust Safeguarding Policies or the Trust policy on Confidentiality CPG9. Staff should contact their line manager for advice if there are concerns about sharing information.

SEPT - MANDATORY TRAINING Your Role What do you do if you are concerned about the welfare of a child or adult: Ensure clients immediate safety. Access emergency assistance if necessary; Inform your line manager or Safeguarding Team. For outside normal working hours contact the manager on call via switchboard; Child Protection referrals to relevant Children’s Social Care via the telephone, must be followed up with a written referral within 48 hours using the appropriate forms. (A copy should be sent to the Safeguarding Team); Inform clients of all decisions and actions unless doing so would put the client or member of staff at further risk; Record all information and actions in client’s record immediately. Children Policies The following policies will give further information and guidance. Trust policies can also be accessed from the intranet. Policy on Safeguarding Children (CLP37) Procedural Guidelines for Child Protection (CLPG37) Safeguarding Children Contact Details (CLPG37#1) Training Strategy for Safeguarding Children & Adults (CLPG37#2) Guidelines for the Visiting of Psychiatric Patients by Children (CLPG37#3) Child Protection Case Conference Report (CLPG37#4) Working Together to Safeguarding Children 2010 (DoH Guidelines) Southend Essex Thurrock (SET) Child Protection Procedures 2006 Bedford Luton and Central Bedfordshire LSCB Safeguarding Interagency Procedures 2008

SEPT - MANDATORY TRAINING Referral Forms Southend Thurrock and Essex Referral Forms (Child) Referral Form - Essex - Notes of Guidance Referral Form - Essex Referral Form - Southend Only Referral Form - Thurrock Only Pre-Assessment Checklist or Referral Forms Bedfordshire and Luton Referral Forms (Child) Referral Forms Additional Information Child Exploitation and Online Protection Centre (CEOP) – / 2629 Provides a 24/7 single point of contact for law enforcement, industry, non government organisations and the public for reporting instances of child abuse or potential abuse in the UK. Childline - Freephone (24 hours) Fostering Network or at 87 Blackfriars Road, London, SE1 8HA. Telephone: Internet Watch Foundation – Acts as a focal point for removing illegal materials from the internet.

SEPT - MANDATORY TRAINING Adult Policies Policy for the Protection of Adults from Abuse (CLP39) Procedural Guidelines for Safeguarding Adults (CLPG39) South Essex, SET Safeguarding Adults Guidelines: SET SAF1 - Adult Concern / Alert Form SET SAF2 - Record of Adult Safeguards Process SET SAF3 - Meeting Record SET SAF4 - Closure Form SET SAF RISK Bedfordshire and Luton Forms Additional Information This page provides links to sites that contain useful information about protecting vulnerable adults from abuse. Age Concern England – Offers information and advice, on a wide range of issues. Local groups are listed in the telephone directory under Age Concern. Some offer advocacy services. Help the Aged – A UK based charity which provides practical support to help older people live independent lives, particularly those who are frail, isolated or poor.

SEPT - MANDATORY TRAINING Public Concern at Work – Is the leading authority on public interest whistle blowing. Their charitable objectives are to promote compliance with the law and good practice in organisations across all sectors. In practical terms, they focus on the responsibility of workers to raise concerns about malpractice, and the responsibility of those in charge to investigate and remedy such issues. Respond – Organisation providing services to people with a learning disability who have experienced sexual abuse. Victim Support – Is the independent charity that helps people to cope with the effects of crime. It provides free and confidential support and information to help people deals with their experiences. Voice UK – National charity supporting people with learning disabilities who have experienced crime or abuse. Also support families, carers and professional workers. Women’s Aid – A national domestic violence charity also runs a domestic violence helpline. Action on Elder Abuse – A leading voluntary organisations focussing on the abuse of older people.

SEPT - MANDATORY TRAINING Support for Children and Families Staff have a duty to Safeguard children. This includes identifying where a child or family requires additional support and knowing how to access that support in order to prevent child protection issues occurring. Children in Need Section 17 Children Act Common Assessment Framework Partnership Meeting Professional Disagreements

Now You need to take the Test. SEPT - MANDATORY TRAINING Please click the ‘Test’ icon in the left column, and then click for Questions. EXAMPLE COURSE Remember to click the ‘Home’ icon when you finish the Test to save your results