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Child Protection Basic Awareness

Child Protection Basic Awareness. Tania Atcheson Designated Nurse Child Protection Safeguarding Lead Buckinghamshire CCGs 01296 585916 / 07768 023100. GMC Principles. All children have a right to be protected from abuse and neglect

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Child Protection Basic Awareness

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  1. Child Protection Basic Awareness Tania Atcheson Designated Nurse Child Protection Safeguarding Lead Buckinghamshire CCGs 01296 585916 / 07768 023100

  2. GMC Principles • All children have a right to be protected from abuse and neglect • All doctors must consider the needs and well-being of children • Children are individuals with rights • Children have a right to be involved in their own care • Decisions made about children must be made in their best interests • Children and their families have a right to receive confidential medical care and advice • Decisions about child protection are best made with others • Doctors must be competent and work within their competence to deal with child protection issues

  3. What do you need to know? • What is child abuse and neglect? • Signs and indicators of abuse and neglect • What to do in response to concerns • Maintain a child focus – work in partnership • Normal Child Development • Impact of abuse and neglect • Factors associated with child maltreatment • Documentation and sharing information

  4. Why is safeguarding necessary in General Practice? • It is unusual for children and young people not to be registered with a GP Practice • The surgery are often the first point of contact for health problems • Practice staff are often the first to recognise parental / carer health problems • Long term effects of abuse include psychological, emotional and social problems will present in General Practice

  5. Working Together ‘Ultimately, effective safeguarding of children can only be achieved by putting children at the centre of the system, and by every individual and agency playing their full part, working together to meet the needs of our most vulnerable children. ’ WTSC 2013

  6. Statutory guidance • Responsibilities are clearly set out • Children Act 1989 • Children Act 2004 • Working Together 2013 • Department of Education website www.education.gov.uk

  7. Other resources • Protecting children and Young people: • The Responsibilities of all doctors GMC July 2012 http://www.gmc-uk.org/guidance/ethical_guidance/13257.asp • Safeguarding Children &Young People: • A Toolkit for General Practice RCGP 2011 • http://www.rcgp.org.uk/clinical-and-research/clinical-resources/child-and-adolescent-health/safeguarding-children-toolkit.aspx • NICE clinical guideline 89 – When to suspect child maltreatment http://www.nice.org.uk/nicemedia/pdf/CG89NICEGuideline.pdf

  8. The role of the LSCB - Local Safeguarding Children Board • The LSCB is the key statutory mechanism for agreeing how the relevant organisations in each local area will co-operate to safeguard and promote the welfare of children in that locality, and for ensuring the effectiveness of what they do • Buckinghamshire LSCB www.bucks-lscb.org.uk

  9. Looked After Children Children in Care S47 S17 Early Help ALL LEVELS OF NEED

  10. Early Help as part of the Whole System of Children’s Services Threshold for S17/47 met Includes; Children in Care, Children with Disabilities, Children in need of Protection, Fostering & Adoption, CATCH, Court Assessment Unit, YOS Integrated Children’s System (ICS) CIN Units & Specialist Units/Teams Family Outcomes Star Early Help Family Resilience Service & other Early Help providers e.g. Children’s Centres All Children in the Community Universal Services

  11. Safeguarding and Promoting the Welfare of Children • Protecting children from maltreatment • Preventing impairment of children’s health and development • Ensuring that children are growing up in circumstances consistent with the provision of safe and effective care

  12. Children can be harmed by • a single traumatic event such as a non-accidental injury. • More commonly, ‘significant harm’to a child results from • a compilation of adverse events that change or damage their health and development. This includes situations where children’s health and developmental needs are neglected.

  13. ASSESSMENT FRAMEWORK Basic Care Health Education Ensuring Safety Emotional & Behavioural Development Emotional Warmth CHILD Safeguarding& Promoting Welfare Identity CHILDREN’S DEVELOPMENTAL NEEDS Stimulation Family & Social Relationships PARENTING CAPACITY Guidance & Boundaries Social Presentation Stability Selfcare Skills FAMILY& ENVIRONMENTAL FACTORS Income Community Resources Family History & Functioning Housing Family’s Social Integration Wider Family Employment

  14. Identifying possible signs of abuse • CONSIDER • Physical and behavioural signs • Alternative explanations • Age and stage of development • Attitude of parents/carers • Whole context of child’s life • Children with disabilities • Is judgement being clouded?

  15. Exercise Identifying indicators of possible abuse

  16. Physical Abuse • Physical abuse may involve hitting, shaking, throwing, poisoning, burning or scalding, drowning, suffocating, or otherwise causing physical harm to a child. Physical harm may also be caused when a parent or carer fabricates the symptoms of, or deliberately induces illness in a child.

  17. Emotional Abuse (1) • Emotional abuse is the persistent emotional maltreatment of a child such as to cause severe and persistent adverse effects on the child’s emotional development. • It may involve conveying to children that they are worthless or unloved, inadequate, or valued only in so far as they meet the needs of another person. • It may include not giving the child opportunities to express their views, deliberately silencing them or ‘making fun’ of what they say or how they communicate. • It may feature age or developmentally inappropriate expectations being imposed on children. These may include interactions that are beyond the child’s developmental capability, as well as overprotection and limitation of exploration and learning, or preventing the child participating in normal social interaction.

  18. Emotional Abuse (2) • It may involve seeing or hearing the ill-treatment of another. • It may involve serious bullying (including cyber bullying), causing children to feel frightened or in danger, or the exploitation or corruption of children. • Some level of emotional abuse is involved in all types of ill treatment of a child, though it may occur alone

  19. Sexual Abuse • Sexual abuse involves forcing or enticing a child or young person to take part in sexual activities, whether or not the child is aware of what is happening. • The activities may involve physical contact, including assault by penetration (e.g. rape or oral sex) or non-penetrative acts such as masturbation, kissing, rubbing and touching outside 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

  20. Neglect • Neglect is the persistent failure to meet a child’s basic physical and/or psychological needs, likely to result in the serious impairment of the child’s health or 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 • - 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 • It may also include neglect of, or unresponsiveness to, a child’s basic emotional needs

  21. Involvement of families • If you are worried about a child, it is crucially important to be open and honest with parents, and where age-appropriate the child or young person, as to the nature of your concerns and the need to involve other agencies, unless to do so would place the child or others at greater risk. The vast majority of children who are subject to a Child Protection Plan will remain in the family home, and parents have the key role and responsibility for ensuring their future protection from harm.

  22. Recent research has highlighted the impact of parental difficulties such as domestic abuse, adult mental health problems and substance misuse on children’s health and development. Social isolation of families can also be a factor. • Those of you who work primarily with adults have a responsibility to consider how the nature of their health or social problems impact on the ability to parent and to consider what this means for their children.

  23. Put yourself in the place of the child & consider first and foremost how the situation must feel for them • Be aware of how easy it is to find yourself justifying and reassuring yourself that all is well, rather than taking a more objective consideration of what has occurred; • Recognise that sympathy for the parents can lead to your expectations of their parenting being set too low; • Remember that whatever role you have (i.e. working with the child or their parents/carers or as a member of the public) be clear that it is not acceptable to do nothing when a child may be in need of help. Laming 2009

  24. What does good practice look like? • Child-centred assessment • Clear and contemporaneous notes • Not expected to be expert • Seek advice and support • Understanding of normal childcare and development • Regular update to knowledge

  25. Case Scenario Tatiana

  26. What to do if you are worried a child is being Abused • If child needs emergency treatment refer to A&E but contact Paeds and Social Care • Contact First Response Team 0845 4600 001 or • Emergency Duty Team (0800 999 7677) out of hours. • Complete referral form • Inform child and carer that you need to discuss or report your concerns unless you feel this will increase the risk to child • Record details of conversations and examination findings carefully You have a duty of care to child and it is your responsibility to follow up with Social care if you do not hear anything

  27. What Happens Next? • Referral received via telephone, fax, email etc • Decision whether Section 47 or Section 17 Investigation • A Strategy Discussion • Home visit to the family & Interview with child • Decision about taking the family to Child Protection conference and/or • Immediate removal of child under Police Protection/ Emergency Protection Order/ Interim Care Order

  28. REFERRAL • Initial assessment • Strategy Discussion • Investigation •  • INITIAL CHILD PROTECTION CONFERENCE •  • CORE GROUP • Completion of Core Assessment • Detailed Plan • Implementing the plan •  • REGULAR REVIEW CONFERENCES •  • EXIT FROM THE SYSTEM • Ongoing support/services or no further action

  29. Case Scenario Mr G

  30. Parental Responsibility – a reminder • The Adoption and Children Act 2003 changed Parental Responsibility (PR) – practitioners need to be aware of the implications for consent. • A married couple who have children together individually have PR which continues after divorce. • Mothers automatically have PR. Where the parents are not married, the unmarried father has PR if: • - his name is registered on the birth certificate for births after 30 November 2003 • - he later marries the mother • - both parents have signed an authorised PR agreement • - he obtains PR order from Court • - he obtains a residence order from the Court • - he becomes the child’s guardian

  31. Information Sharing • Remember that the Data Protection Act is not a barrier to sharing information • Be open and honest • Seek advice • Share with consent where appropriate • Consider safety and well-being • Necessary, proportionate, relevant, accurate, timely and secure • Keep a record

  32. Ellie • Ellie is a 16 year old patient who comes to see you for family planning advice. You are concerned as she is not seem very mature and is clearly uncomfortable. Eventually she begins to cry and then says, ‘It’s my brother you see. He wont leave me alone’ • What are your concerns? • What would you do next?

  33. Dealing with Disclosure • Stay calm and listen • Go slowly • Reassure them they have not done anything wrong • Be supportive • Gather essential facts • Explain what will happen next • Report • Make notes

  34. A 14 year old girl presents with a 24 hour history of sudden onset lower abdominal pain. She is unaccompanied She thinks she might be pregnant What will you do? What would you do if she is 12/13

  35. Young People and Sexual Activity Sexual Offences Act 2003 -1 • Legal age for consensual sex is 16yrs for all including gay / bisexual • Majority of young people have first sex around 16 years old • Although legal age is 16 no intention to prosecute young people of a similar age involved in mutually agreed consensual sex unless concerns about abuse / exploitation • Sexual activity with a child under 13yrs is never acceptable, children of this age cannot legally give consent (Seek advice from named Child Protection /Safeguarding Lead)

  36. Young People and Sexual ActivitySexual Offences Act 2003 - 2 Under the Act young people, including those under 16yrs have the right to confidential advice on contraception, condoms , pregnancy and abortion. The Act states that a person is not guilty of aiding, abetting or counselling a sexual offence against a child where they are acting for the purpose of: • Protecting a child from pregnancy or sexually transmitted infection (STI) • Protecting the safety of a child • Promoting the child’s welfare by the giving of advice

  37. When consulted by someone under 16 for contraceptive advice and treatment a health professional will consider the following • Whether the young person understands the potential risks andbenefits of the treatment and the advice given • That the value of parental support is discussed - the health professional should encourage the young person to inform parents / carers of the consultation and explore the reasons if the patient is unwilling to do so. They must also assure the young person that their confidentiality will be respected whether they inform their parents / carers or not • Whether the young person is likely to have sexual intercourse without contraception. • Whether the young person’s physical or mental health is likely to suffer if they do not receive contraceptive advice or treatment. • Whether it is in the young person’s best interests to provide contraceptive advice and treatment without parental consent

  38. Sexual exploitation • The sexual exploitation of children and young people under 18 involves exploitative situations, contexts and relationships where young people (or a third person or persons) receive 'something' (e.g. food, accommodation, drugs, alcohol, cigarettes, affection, gifts, money) as a result of performing, and/or others performing on them, sexual activities.Child sexual exploitation can occur through use of technology without the child's immediate recognition, for example the persuasion to post sexual images on the internet/mobile phones with no immediate payment or gain. In all cases those exploiting the child/young person have power over them by virtue of their age, gender, intellect, physical strength and/or economic or other resources.

  39. Risk of sexual exploitation • missing or runaway or homeless children • looked after children • children with prior experience of sexual, physical or emotional abuse or neglect • adolescents or pre-adolescents • girls (boys are also at risk but current research suggests most victims are girls. Boys are considered less likely to disclose which may explain the gender imbalance and may also make boys more vulnerable) • children not in education through exclusion or truancy or children regularly absent from school • social exclusion from services such as health services • children from black and minority ethnic communities • children from migrant communities • refugee children and unaccompanied asylum seeking children • trafficked children • children with mental health conditions • children who use drugs and alcohol • children with learning difficulties and disabilities • children involved with gangs or living in communities where gangs are prevalent • children from families or communities with offending behaviours • children living in poverty or deprivation.

  40. Possible signs of sexual exploitation • unexplained gifts or expensive habits (alcohol, drugs) • drug use, alcohol abuse • going missing, running away, homelessness • disengagement with school, not in school, truancy, exclusion • repeat sexually transmitted infections; in girls repeat pregnancy, abortions, miscarriage • inappropriate sexual behaviour or sexually risky behaviour, 'swapping' sex • association with older men • unexplained changes in behaviour or personality (chaotic, aggressive, sexual) • involved in abusive relationships, intimidated and fearful of certain people or situations • self-harming, suicide attempts, overdosing, eating disorders • injuries from physical assault, physical restraint, sexual assault • moving around the country, appearing in new towns or cities, not knowing where they are • gang fights, gang membership

  41. Case Scenario • A patient asks the duty doctor to ‘check my baby is ok’ as she has just been attacked. She is 27 weeks pregnant. • On examination you notice bruising to the patient’s neck.

  42. Responding to domestic abuse • Recognise patients whose symptoms mean they might be more likely to be experiencing domestic abuse • Enquire sensitively and provide a safe and emphatic first response • Understand the process for responding to disclosure, and know what to do when there is immediate risk of harm to patients and their children • Document domestic abuse within patients records safely and keep records for evidence purposes • Share information appropriately. Information will be shared only with the consent of the patient unless child protection/adult safeguarding concerns are identified • Advise patients about the services available – • Refer to appropriate local specialist domestic abuse service, if the patient consents • Signpost to domestic abuse resources and discuss basic safety plan if patient unwilling to engage with services at this time • Ensure that child protection and adult safeguarding procedures are initiated where required, especially where there is immediate risk of harm to patients and their children

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