Child Protection and Welfare

1. Child Protection and Welfare SinéadMcGarry Senior Medical Social Worker smcgarry@stjames.ie

2. Victoria’s Story

3. “The food would be cold and would be given to her on a piece of plastic while she was tied up in the bath. She would eat it like a dog, pushing her face to the plate. Except, of course that a dog is not usually tied up in a plastic bag full of its excrement. To say that Kouao and Manning treated Victoria like a dog would be wholly unfair; she was treated worse than a dog’ Neil Garnham QC, Counsel to the Inquiry.

4. Key Health failings in Climbié Case • Failure in obtaining, managing, recording and sharing information about Victoria. • No designated responsibilities • Assumption that someone else had/ would do it. • Status and priority given to child protection in the context of paediatric medicine. • Relationship between social work staff and healthcare staff – multi disciplinary meeting fell apart, 18 months prior to Victoria’s death.

5. The Aftermath: Lord Laming Report 2003. • Every Child Matters 2003 • Children Act 2004 • Creation of Children’s Commissioner. • Establishment of the Local Safeguarding Children Boards in every local authority. • Working together to Safeguard Children 2010 • ‘Baby P case’ led to the ‘Protection of Children in England, a Progress Report’ 2009, the ‘Munro Review of Child Protection’ 2010.

6. Safeguarding young children and young People, Intercollegiate document 2014: • Explicitly sets out role for health care staff. • Health care staff: Safeguarding young children and young people, roles and competences for health care staff, Intercollegiate document, March 2014. • Based on knowledge, skills, attitudes and values. • ED staff = Level 3.

7. Children in Ireland: • Ireland has highest proportion of children in EU. • In 2011, there were 1,148,687 children living in Ireland. This accounted for 25% of the total population. • 6,160 children living in care • 18.8% live at risk of poverty. • 9.3% live in consistent poverty • 18.3% children live in a lone parent household. (State of the Nation’s Children, 2012)

8. Legislation and Policy: • The Irish Constitution 1937 • Report of the Task Force on Child Care Services 1975 • Child Care Act 1991 • United Nations Convention on the Rights of the Child 1992 • The Kilkenny Case 1993; The Kelly Fitzgerald Report 1996 & The West of Ireland Farmer Report 1998 • Protection of Persons Reporting Child Abuse 1998 • Children First 1999 • Children Act 2001 • National Children’s Office established in 2001 • Ombudsman for Children – first took office in 2004 • HSE established in 2005 – child protection managed on national, rather than local basis. • Office of the Minister for Children 2005 • Ryan Report 2009, Monageer Report 2009, Roscommon Report 2010. • Task Force set up in 2009 to assess current system. • Children First: revised in 2011 • Child and Family Handbook 2011 • The Report of the Independent Child Death Review Group 2012. • Children’s Referendum 2012 • Child and Family Agency Act 2013 • Children First Bill 2014

9. Referrals to Child and Family Agency: In 2013 : 41,599 child welfare and protection reports to the HSE. Welfare: 22,192 Physical Abuse: 4330 Sexual Abuse: 3,385 Emotional Abuse: 5217 Neglect: 6,421 (Child and Family Agency, 2013).

10. Children we must safeguard: • All patients under 18 • Presenting as a patient • Presenting as a visitor • Discussed in Dept, living in community, not sighted in ED.

11. Categories of Abuse: • Neglect • Emotional Abuse • Sexual Abuse • Physical Abuse

12. Significant Harm: • Harm can be defined as the ill treatment or the impairment of the health and development of the child. Whether it is significant is determined by his/her health and development as compared to that which could reasonably be expected of a child of similar age

13. Neglect: • An omission, where the child suffers significant harm or impairment of development by being deprived of food, clothing, warmth, hygiene, medical care, intellectual stimulation, supervision and safety, attachment to affection from adults

14. Emotional Abuse: • When a child’s need for affection, approval, consistency and security are not met. Emotional abuse is normally found in the relationship between a care giver and a child.

15. Sexual Abuse: • When a child is used by another person for his/her gratification or sexual arousal or for that of others.

16. Physical Abuse: • Any form of non accidental injury or injury which results from wilful or neglectful failure to protect a child

17. Risk Factors in Child Protection: • Parent or caregiver factors • Family factors • Child factors • Environmental factors

18. Messages from Research: • Age of the child • Domestic and sexual violence • Parental mental health illness • Parental substance abuse • Parental Intellectual disability • Childhood disability • Unknown male partners • Families who are ‘unco-operative’ or ‘hard to engage’ • Poverty and social exclusion.

19. Be alert to Caregivers: • Where are the children? Names, addresses and Date of Birth of each child? • Who is caring for them, and where? • Note inconsistencies in an account. • Do you have concerns about this person being a primary caregiver for a child? Why? • Note severity of substance abuse/behaviour. • What are the protective factors? What is the potential for harm? What might be the outcomes for the child?

20. How can child abuse come to your attention? • Direct disclosure. • Direct observation. • Information from a third party. • Observation of an injury. • Aspects of the child’s behaviour. • Consistent signs of neglect over a period of time

21. Confidentiality: • Giving information to others for the protection of a child is not a breach of confidentiality. • Information regarding concerns are shared on a need to know basis in the interests of the child. • No undertakings of secrecy can be given.

22. In the event of disclosure from a child: • Take the child seriously • Listen openly and calmly – do not interview. • Reassure the child that you will do something to help. • Do not guarantee confidentiality or make promises about what will happen. • Record conversation in detail.

23. In event of disclosure from an adult: • Express belief • Establish if there are any children currently at risk from the alleged abuser. • Take as much information as the person can recall if there any children currently at risk, in relation to the abuser, known addresses, means of contact etc. • Provide referral details to HSE National Counselling Service.

24. Recognising and Reporting: • All front line staff must be alert to indicators of actual or potential child abuse. Know the action plan in your department. If there isn’t one, ask for it! • Concerns immediately reported to most senior staff member. • Refer to MSW and Out of Hrs Social Wkr if in area. • If concerned about immediate risk, call gardai • Comprehensive medical/social h/x should be taken and recorded

25. Reporting and Recording: • Records should be factual not judgmental. • Give detail of full names, addresses and contact details of adults and children involved • Ensure contact details are accurate. • Record all observations and your concerns, direct quotes are very useful. • Clearly name staff members with individual responsibilities. • Designated person will ensure the referral is made. • Parents are informed about referral unless doing so will endanger their child