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

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

3. 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

4. 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.

5. 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

6. 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)

7. 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

8. 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

9. 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

10. 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

11. 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:

12. 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

13. 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

14. 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.

15. 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

16. 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

17. 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.

18. 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:

19. 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

20. 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:

21. 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

22. 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:

23. 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:

24. 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).

25. 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.

26. 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

27. 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

28. 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

29. 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

30. 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:

31. 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

32. 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
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
Designated Nurse for Safeguarding Children Jackie Dyer
Tel
Designated Doctor for Safeguarding Children Deborah Hodes
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
Tel
Tel
Out of hours
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
Whittington Hospital
Tel
Royal Free Hospital
Tel
You see a child and suspect abuse or neglect

33. Local Safeguarding Contacts
Designated Nurse, Jackie Dyer
Designated Doctor, Deborah Hodes
Named General Practitioner
Designated Doctor for Looked after Children (LAC)
Designated Nurse for LAC
Designated Doctor for CDOP
Camden MASH Team
Tel
Tel
Tel

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