13.13 Safeguarding Disabled Children
For detailed guidance, see Safeguarding Disabled Children: Practice Guidance (DCSF 2009)
Discrimination of all kinds is an everyday reality in many disabled children’s and young people’s lives and such prejudice damages them both physically and emotionally. It is therefore imperative that stereotyped assumptions should be avoided.
This guidance should be read together with the Surrey Safeguarding Children Board Procedures and other specific SSCB Practice Guidance’s.
The term “disabled children and young people” in this context is intended as a broad and inclusive term which may include any child or young person who has a physical, sensory or learning impairment or a significant health condition.
This practice guidance has been based on guidance published by Nottingham City and Nottinghamshire LSCB and Children’s Trust.
Nottingham’s guidance was based on work carried out by Margaret Kennedy. Nationally, Margaret Kennedy is recognised as a leading expert in terms of practice development for work with disabled children.
This guidance is for all staff in partner agencies that work with any such children, and is intended to be complementary to the procedures and other guidance referred to above, not to replace them.
Inevitably, not all areas of the guidance will apply to each child or young person and their particular circumstances.
Section 1 Purpose of Guidance
1.1 The purpose of this guidance is to ensure that all agencies are assisted in their responsibilities to:
- safeguard disabled children and young people
- apply the SSCB Safeguarding Children Procedures equally to disabled children as to non disabled children
- understand particular issues which influence the safety and well being of disabled children and young people
- communicate directly with disabled children and young people whose safety and well being is under investigation
Disabled children and young people have a right to services that support and safeguard them and maximise their independence.
Section 2 Vulnerability of Disabled Young People
2.1 Organisations must ensure that their staff are aware that disabled children and young people may be more vulnerable to being abused as a result of a number of factors attributed to their disabilities.
- Significant communication needs including children with social communication disorders many of whom are in main stream education.
- Physical vulnerabilities
- Intimate care needs
- Need for physical handling
- Having multiple carers
- Being socially isolated
They often do not have access to someone they can trust to disclose that they have been abused.
Care needs/challenging behaviours and the vulnerability of carers/parents given the demand /challengers of caring for a child with complex needs.
- Lack of support/training for parents and carers in dealing with difficult behaviour
- The child/young person being perceived as being of less importance
- Parents/carers may accept lesser standards of substitute care as a result of their need for support/respite
- Some children may behave in ways that are self-harming, this can lead to an abusive injury being missed.
- An assumption that behaviour is an integral part of the child’s condition, rather than a response to abusive treatment or a negative reaction to medication.
Mental health vulnerability.
Vulnerability from exploitation leading to criminalisation.
Vulnerability from Child Sexual Exploitation.
Vulnerability of forced marriage.
Vulnerability to radicalisation.
2.2 Organisations must ensure that arrangements are in place to minimise the likely impact of these vulnerabilities on disabled children and young people by:
- ensuring that the required policies and procedures are in place for dealing with challenging behaviours.
- ensuring that staff are trained appropriately, commensurate with their role and responsibility.
- where a child/young person is cared for away from home ensuring they have access to an independent advocate
- promoting children and young people’s rights and right to safeguarding
- ensuring children and young people have access to information about their rights
- ensuring that children and young people’s basic right to communication is always met.
- access to information about strategies for keeping safe that is usually available to other children and young people
- ensuring staff are aware of the warning signs of fabricated or induced illness, Female Genital Mutilation, Child Sexual Exportation and other Safeguarding Board Guidance.
Ensuring polices and procedures are in place for intimate care and administering medication.
2.3 Direct Payments/Self Directed Support
These methods of funding support for the child/Young person follows assessment by Children’s Social Care and provides parents with a budget to purchase services to meet the assessed needs of their child. Whilst the use of personal budgets and direct payments supports the empowerment and choices for the parents/carers and the disabled young person it can also contribute to the vulnerability of abuse if safer recruitment practices are not adopted, e.g. Checks are not made to ensure the person providing the service is suitable to do so. If Minimum requirements in respect of checks and references are not followed unsuitable people may be employed. The Local Authority can not insist that parents/carers undertake such checks but would strongly encourage them to do so. The Local Authority will exercise discretion in the making of payments and can decline to do so if they consider a child may be placed in a situation where they may have been at risk of harm. Surrey Children’s Service have Direct Payments Policy that staff should follow when making decisions in this regard.
Section 3 Listening to & Communicating with Disabled Children/Young People
3.1 All reports that are written about a disabled child or young person should include their views, wishes and feelings, and how they have been ascertained. The best practice for disabled children is for a worker with appropriate communication skills to be allocated.
3.2 Workers must identify barriers to access services and must aim to make information provided available to disabled children/young people and their parents. This information should take account of the child/young person’s impairment, the child/young person’s and parents’ preferred formats and be made available within agreed time frames.
3.3 Additional and alternative methods of communication include objects, pictures, symbols and signs or an electronic communication device. Professionals working with the child can provide advice and support for disabled children/young people and may be able to advise on a range of access issues. It is important to involve professionals who know the child well. Deaf children may need an independent sign language interpreter. Workers must not rely on someone who may be abusing the child to assist with communication. Due regard needs to be given to the fact that whilst some children are more likely to communicate with a familiar person any such familiar person is equally in a position to influence or abuse the child.
3.4. Consideration should be given to referring to an independent advocacy service.
Section 4 Indicators
4.1 Professionals in all agencies who come into contact with children and young people with disabilities are in a position to identify indicators that the child may be suffering or may be at risk of significant harm. These are included in the SSCB Child Protection Procedures and apply equally to disabled children and young people. There may be differences, and a child/young person’s disability should always be considered when questioning whether significant harm might be indicated.
4.2 Because of the particular needs of disabled children and young people they may also be at risk of being abused in other ways including:
- Force feeding or inappropriate feeding
- Their personal care needs may not be met adequately
- Physical practices such as physical restraint carried out unnecessarily or not in accordance with available guidelines.
- Rough handling
- Extreme behaviour modification including the deprivation of clothing, medication or food, limiting movement, restricting freedoms, locking doors etc.
- Misuse of medication, sedation, heavy tranquillisation
- Invasive procedures which are unnecessary or are carried out against\ the child/young person’s will
- Being denied access to required medical treatment
- Misapplication of programmes or regimes
- Ill fitting equipment e.g. callipers, sleep boards which may cause injury or pain,
- inappropriate splinting
- They may be more susceptible to bullying
- They may be more vulnerable to abuse using Information Communication Technology.
4.3 Professionals may find it more difficult to attribute indicators of abuse or be reluctant to act on concerns in relation to disabled children and young people because of a number of factors which may include:
- Professionals over identifying with the child/young person’s parents/carers and being reluctant to accept that abuse could have taken place, or seeing abuse as being attributable to the stress and difficulties of caring for a disabled child/young person
- A lack of knowledge about the impairment and its impact on the child/young person
- A lack of knowledge about the child/young person, e.g. not knowing the child/young person’s usual behaviour or demeanour
- Not being able to understand the child/young person’s communication
- Confusing behaviours that may indicate the child/young person is being abused with those associated with the child/young person’s impairment
- Denial of the child/young person’s sexuality
- Denial of young person’s mental health needs
- The child/young person having a number of carers.
- Behaviour, including sexually harmful behaviour or self -injury, may be indicative of abuse.
- Carers may have unrealistic expectations of the child
- Failure to follow treatment plans
4.4 Any bruising on a disabled child is a concern particularly if the child is not independently mobile. An explanation should always be sought and the child’s history taken into consideration. Any response needs to be appropriate to the level of concern and none accidental injury should always be considered. A referral should be made to Children’s Services if there are concerns for the child’s safety or welfare.
4.5. Certain health/medical complications may influence the way symptoms present or are interpreted. Certain indicators may be present that are attributable to the child/young person’s condition or medical treatment e.g. some particular conditions can cause fragile bones increasing the likelihood of fractures during normal day to-day activities. It is therefore important to seek medical advice to explore any underlying medical condition.
4.6 Because of this it is essential that relevant and pertinent information is recorded clearly on a child/young person’s file with the use of such tools as body maps. This may include communication methods used by the child/young person to understand and express themselves, severity of disability, numbers of care givers, and level of care required etc.
4.7 The requirement to consult with the parents of any child or young person if there are concerns about their well-being, applies to disabled just as to non disabled children and young people.
4.8 Where there are concerns about a child/young person it is essential that workers with the required knowledge and skills, and who know that child, are involved promptly.
4.9 Where a worker is not clear if a child/young person’s particular injury or behaviour is indicative of abuse, or is associated with their disability, they should seek advice from a professional who knows the child and the implications of their disability well, for example, a community paediatrician, GP, a school nurse, a teacher, etc and raise the matter with their Safeguarding lead for advice and support.
Section 5 Making a referral to children’s social care
Concerns about the welfare and safety of a disabled child should be acted upon in the same way as any other child in accordance with SSCB multi-agency safeguarding procedures . and the referring practitioners organisations safeguarding children policies and procedures. Practitioners should discuss their concerns with their organisations safeguarding lead/named professional for further advice and decision upon the necessity for a referral. However, a formal referral or any urgent medical treatment must not be delayed by the need for such consultation.
Prior to any referral practitioners should consult with SSCB Levels of Need Document to support their decision making that the level of need and or risk faced by a child is escalating to a point where intervention would be needed via a statutory assessment under the Children Act 1989.
Consultation may also be made directly with Children's Social Care. Where consultation with Children's Social Care is sought, and Children's Social Care then concludes that a referral is required, the information provided will be regarded and responded to.
Practitioners should phone the referral to Children’s Services via referral assessment and Intervention Service (RAIS) or Emergency Duty Team (EDT) (see Appendix 2: Contact details). All phone referrals must be followed up in writing within 48 hours using the multi-agency referral form (MARF).
A referral should be child focused and comprehensive; it must include as much information as possible such as any significant events, chronologies and completed body maps detailing any physical injuries. A comprehensive referral will contribute to a thorough assessment that supports professionals to understand whether a child has needs relating to their care or a disability and/or is suffering, or likely to suffer, significant harm. Additionally the referral should include information on whether the child and family have received support through the early help provision and provide an evaluation of the impact of services and help being delivered.
Expertise and resources in both safeguarding and promoting the welfare of children and in working with disability have to be brought together to ensure that disabled children receive the same levels of protection from harm as other children. Therefore, in accordance with procedures other specialist workers or teams such as the Children’s Disabilities Teams who are involved with the child and family must be notified of the referral and included in any investigative process.
Ensuring the Child’s immediate Safety
The safety of children is paramount in all decisions relating to their welfare. Any action taken by the referring practitioner should ensure that no child is left in immediate danger.
Where abuse is alleged, suspected or confirmed in a child presented at A&E or admitted to hospital, (s)he must not be sent home / discharged until:
· Children's Social Care has been notified by phone that there are child protection concerns;
· A Strategy Discussion/Meeting has been held including relevant hospital staff.
Urgent Medical Attention
If the child is suffering from a serious injury, medical attention must be sought immediately from an Emergency Department (ED) In these circumstances, Children's Social Care and the duty consultant paediatrician must be informed.
Except in cases where emergency treatment is needed, Children's Social Care and the Police are responsible for arranging any safeguarding medical/paediatric assessment required as part of a Section 47 Enquiry are initiated.
Section 6 Assessing and Investigating allegations of child abuse involving disabled children/young people or siblings of disabled children/young people
6.1 Where there is reasonable cause to believe that a child or young person is at risk of significant harm they should be referred to Children’s Social Care in order that relevant enquiries can be carried out and the child effectively safeguarded in accordance with the SSCB Child Protection Procedures. The first responsibility is to ensure that the child is safe while further enquiries are carried out.
6.2 It is crucial that in relation to a disabled child or young person the enquiries are planned and carried out in a way which is informed by an understanding of their impairment.
6.3 Where an investigation is being planned as a result of concerns about significant harm to a disabled child or young person, an early strategy discussion should be held involving key professionals who know them. Specific considerations for the strategy discussion or meeting include:
- The child/young person’s preferred communication method for understanding and expressing themselves
- Who should interview the child/young person?
- Whether someone with a specialist on the child/young person’s preferred communication method should be involved
Consideration to support from someone with an understanding of the child’s level of need being involved in the process.
- Whether the interview will have to be significantly adapted to support the child/young person understands and their involvement
- The venue of the interview
- whether additional facilities or equipment is necessary
- The care needs of the child or young person
- The caring network surrounding the child or young person
- Available medical information about health needs which may have a bearing on an Investigation
- If there is a need for a medical examination, follow Surrey Safeguarding Children Board procedures, Child Protection Medical Guidance and relevant procedures.
6.4 It is important that efforts to meet these requirements do not unduly slow down the enquiry.
6.5 In situations where there are allegations against an employee or volunteer in that relation to the child, referral should be made to the Local Area Designated Officer (LADO) and see the SSCB child protection procedures sections in chapter 7
6.6 Agencies must not make decisions about the enquiries based on assumptions about the ability of a disabled child or young person to give credible evidence, or to withstand the rigours of the Achieving Best Evidence Practice Guidance.
6.7 Where an Initial Child Protection Conference is held it is crucial that professionals who know the child or young person and who have information about the nature of their disability are involved.
6.8 In addition efforts must be made to ensure that the child/young person’s views are shared with the meeting.
Section 7 Responding to Concerns about Sexual Abuse by a Young Person
7.1, There may be occasions where professionals become concerned that sexual behaviour is abusive. The professional needs to take into consideration the age/stage of development/disability before arriving at any conclusion. All possible explanations need to be considered.
7.2 Where significant harm is indicated as a result of concerns about abuse, Children’s Social Care should be notified in order that an assessment can be carried out to ensure that the young people are safeguarded.
7.3 All referrals to Social Care regarding Child Sexual Abuse should be referred to the Solace Centre (SARC) and whenever possible a Consultant Paediatrician to be invited to be part of any strategy discussion.
Section 8 Restrictive Practices
Restrictive practices refers to any practice where one person or more restricts the movement of another. This can be physical barriers, which involves a child being prevented from freedom of movement, being confined inappropriately (including long periods of time. Examples are;
- Spending long periods of time in a wheelchair within the home environment against professional advice.
- Leaving immobile children in bed for prolonged periods of time against professional advice
- Locking children in a room, sometimes referred to as seclusion.
- Using ‘reins’ for older children whilst out in the community
When workers become aware that parents/carers are using restrictive practice then they should recognise that this requires further assessment and that parents/carers are supported to find an alternative approach to manage the child/young persons behaviour.
In most cases where restrictive practice is identified and in all cases that involve a child being locked in, a referral must be made to children’s social care.
The law underlying the subject of restricting the liberty of a person is complex and cannot be dealt with fully in practice guidance such as this. Each case depends on its own facts and the distinction between a situation in which significant harm is to be inferred and one which is not present may be a fine one. If a child protection concern arises due to concerns around restrictive practice, then legal advice should be sought by Children’s Services.