Child Protection

1. Level 2 2014 Child Protection For health staff who have any contact with children, young people and parents

2. Aim • To develop participants’ awareness of the key aspects of child abuse and maltreatment.

3. Learning Outcomes • By the end of the course participants will be able to: • Understand what constitutes child maltreatment. • Identify the key Safeguarding Children guidance and legislation. • Know how and when to refer to Social Care. • Demonstrate an understanding of the potential impact of parental physical and mental health on the wellbeing of a child. • Understand the importance of acting as an advocate for the child. • Identify your professional role in a multidisciplinary team. • Document appropriate safeguarding/child protection concerns. • Be aware of the risks of Female Genital Mutilation (FGM) radicalisation trafficking, sexual exploitation and Prevent agenda.

4. Learning Agreement • Treat everyone with equal value and respect • Don’t be afraid to ask questions – avoid side discussions • Sensitivity – feelings, issues and experience • Have respect for diversity – identity, culture and role • Confidentiality - personally & professionally • Listen to each other – one voice at a time • Time Keeping – joint responsibility • Certificates will only be given for a full attendance • Participants are requested not to use mobile devices during the session

5. Useful Documents • Working Together to Safeguard Children (HM GOV 2013) • What to do if you’re worried a child is being abused (dfes 2006) • Children Act (1989 and 2004) • Nice Guideline CG89. When to suspect maltreatment. • UN Convention on the Rights of a Child (2006) • Human Rights Act (1989)

6. Voice of the child • It is important to look at and listen to children. • It is important to understand the child's journey. • It is important to ensure the feelings of children and young people are taken into consideration, represented and recorded.

7. Pause For Thought • Daniel Pelka - born15.07.2007 died 03.03.2012 (RIP) • Serious Case Review – • “In this case, professionals needed to “think the unthinkable” and to believe and act upon what they saw in front of them, rather than accept parental versions of what was happening at home without robust challenge. • Much of the detail which emerged from later witness statements and the criminal trial about the level of abuse which Daniel suffered was completely unknown to the professionals who were in contact with the family at the time.”

8. Missed Opportunities • In Daniel’s case missed opportunities in health settings were: • His broken arm was too readily accepted by professionals as having been caused accidentally. • Daniel’s weight loss was not recognised, and child abuse was not considered as a diagnosis. • Daniel appeared to have been "invisible" as a needy child against the backdrop of his mother's controlling behaviour. • His poor language skills and isolated situation meant that there was often a lack of a child focus to interventions by professionals.

9. Protecting children from abuse and neglect is: • Everyone’s responsibility • A shared responsibility • An individual staff member responsibility

10. What is Child Abuse? • Abuse and Neglect are forms of maltreatment of a child. • Somebody may abuse or neglect a child by inflicting harm or failing to act to • prevent harm. • Children may be abused in the family, institutions or in community settings, by • those known or more rarely by those unknown to them eg. Via the internet. • Abuse can include radicalisation, child trafficking or sexual exploitation , Female • Genital Mutilation (FGM) and you need to consider the PREVENT agenda. • See SCB website for further details: www.safechildren-cios.co.uk

11. Exercise 1 • In your groups consider: • 1.What are the signs and symptoms of abuse? • 2.How these will impact on the child? • 3. What would stop professionals identifying risk and reporting abuse?

12. Four Categories of Child Abuse • There are four broad categories of child abuse used: • Physical Abuse - e.g. hitting, shaking, poisoning, burning, suffocating, fabricated/induced illness etc • Sexual Abuse - e.g. forcing/enticing a child to take part in sexual activities (including non contact activities). Sexual Exploitation issues. • Neglect - e.g. failure to provide adequate food, shelter, clothing, protection from harm, access to medical care etc • Emotional Abuse - e.g. conveying to children they are worthless, unloved or inadequate, exploiting/corrupting children, causing children to feel frightened or in danger e.g. witnessing domestic violence

13. When considering abuse: • Think what would be developmentally normal for that child. • Is the behaviour of someone else impacting on the child? • How is this being reflected in the child’s presentation?

14. Factors which can increase the likelihoodof child abuse: • The Toxic Trio: • Domestic abuse • Parental mental health • Parental substance misuse • Some other factors include teenage parents, children with complex needs, prematurity, poor housing, poverty.

15. Common sites for accidental injury

16. Common sites for non-accidental injury

17. Parenting and later outcomes Parenting Smoking/drugs Self-esteem Behaviour Promiscuity Infants’ brain Emotional Regulation School Failure Relationships Delinquency Emotional regulation via attachment Empathy Eating Disorders and Obesity Jane Barlow University of Warwick Learning

18. Assessment Framework Health Basic Care u Education Ensuring Safety Emotional & Behavioural Development Emotional Warmth Parenting Capacity Child’s Development Needs Identity CHILD Safeguarding & Promoting welfare Stimulation Family & relationships Guidance and Bounds Social Presentation Selfcare Skills Stability Family & Environmental Factors Family History & Functioning Family ‘s Social integration Employment Community Resources Wider Family Housing Income

19. Cornwall Multi Agency Thresholds of Need LEVEL 2 LEVEL 3 VEL1 LEVEL 4

20. CHILDREN ACT 1989: Section 47 • Places a general duty on the Local Authority to investigate a child’s welfare where there is a reasonable cause to suspect that a child is suffering or likely to suffer significant harm. • It also places a duty on the Local Authority, Education, Health or the NSPCC (unless it would be unreasonable to do so) to assist these enquiries e.g. by providing relevant information and advice.

21. CHILDREN ACT 1989: Section 17 • It is the duty of every local authority to: • “”safeguard and promote the welfare of children within their area who are in need; and so far as is consistent with that duty, to promote the upbringing of such children by their families, by providing a range and level of services appropriate to those children's needs.”

22. Confidentiality Where possible and safe, share concerns with family. Always need consent to share information in Common Assessment Framework (CAF) process (Section 17). We have a duty to and do not need consent to share information in child protection (Section 47).

23. Group work • Look at the case studies in your group. • Discuss what the impact is for the child. • What would be your action? • Looking at the threshold: • What threshold level would this case meet? • What process would you follow? • What would the likely outcome be?

24. Recording keeping • Record your concerns as soon as possible (in accordance with professional guidelines on record keeping). • Be as factual and accurate as possible. Begin by putting all the facts down; what you saw , what was said, physical evidence – for example,’the mother said this’, ‘the bruise was here’ and so on. • Add your opinions and interpretations separately. For example; ‘I thought this might be because…’, or ‘it seemed to me that the child was frightened’ or ‘in my opinion the child…’ • Use Body maps where appropriate. • Note any other witnesses/colleagues with whom you shared information or who can corroborate any part of your record. • Date, time and sign the record.

25. Documentation • Record Keeping is: • An important part of professional accountability. • Identified in National and local enquiries as essential to good practice. • A legal and professional requirement. • Essential to working effectively across agency and professional boundaries. • A process that provides a chronology of involvement in a case. • An essential source of evidence for investigations and inquiries. • Records may be requested as part of court proceedings.

26. When a referral is made to Children’s Social Care: • Telephone 0300 123 1116 • Follow up in writing within 48 hours using the multi-agency referral form. http://intra.cornwall.nhs.uk/Intranet/AZServices/C/ChildProtection/ChildProtection.aspx • Be prepared to give information about: • Child’s name, age, address • Your concerns identifying the risk to the child • Your name and details • Other children in the family

27. Children’s Social Care Response • Children's Social Care has a duty to investigate allegations of abuse. • The referrer should be informed of this course of action within 48 hours. • Health has a duty to cooperate with any investigations made by Children's Social Care.

28. Professional Differences • If you do not agree with the advice you are given and feel that a child remains at risk it is your responsibility to take further action. • You can contact: • The Safeguarding Children’s team. • Use the Safeguarding Children Board escalation policy for guidancewww.safechildren-cios.co.uk • If you have concerns about a professional a Local Authority Designated Officer is in place to deal with issues, a policy is in place and you should contact HR or you manager.

29. Child Protection Conference • Multi-agency meeting with all those involved with the child to consider the welfare of the child. • Signs of safety format is used. • Always inform manager or supervisor, if you are asked to attend. • Inform and seek help from Named Professionals. • If your agency is invited a written report will be required and must be shared with the family. • The report should be completed on the approved case conference template.

30. Learning lessons • Datix/Safeguard • Serious Incident • Child Death Review • Internal Management Reviews • Serious Case Reviews

31. Looked After Children • Looked After Children are particularly vulnerable. • All Looked After Children will have a social worker • If a Looked After Child is accessing treatment, it needs to be clear who has parental consent. • Contact details for the Children in Care team and information regarding consent issues can be found on the intranet: http://intra.cornwall.nhs.uk/Intranet/AZServices/C/ChildreninCare.aspx

32. Web Links http://www.swcpp.org.uk/

33. Key points: • Listen to children • Share information • Challenge yourself, your colleagues and other professionals • Don’t delay passing on information • Communicate with each other • Impact of parental mental and physical health • Be confident where to go for additional advice

34. Contact Numbers for NHS Organisations • RCHT • Named Nurse: Alison O’Neill 01872 252596 or via switchboard • Named Midwife: Teresa Phillips via switchboard • Named Doctor: Dr Chris Williams via switchboard • Cornwall Foundation Trust • Named Nurse: Elizabeth Cox 01208 834777 mobile 07500975537 • Named Doctor: Dr Ellen Wilkinson via switchboard • Peninsula Community Health • Named Nurse: Dee Hore 07771981189 • Named Doctor: Dr Janine Glazier via switchboard • Countywide • Designated Nurse: Judith Parsons 01872 254552 • Designated Doctor: Dr Roger Jenkins 01872 254552

35. Conclusion • Our aim…