13.13 Safeguarding Disabled Children

4.13 Safeguarding Disabled Children

For detailed guidance, see Safeguarding Disabled Children: Practice Guidance (DCSF 2009) 

Also see Reducing the need for restraint and restrictive intervention

Introduction

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 Partnership Procedures, the Family Safeguarding model information and other specific SSCP Practice Guidance.

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 SSCP Safeguarding Children Procedures equally to disabled children as to non disabled children
• understand particular issues which influence the safety and wellbeing of disabled children and young people
• communicate directly with disabled children and young people whose safety and welfare 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.

These include:

• 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 demands and  challenges of caring for a child with complex needs can out extra strain on the relationship.

Some things to consider are:

• A lack of support/ training for parents/ 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 the displayed behaviour is an integral part of the child’s condition, rather than considering if it is a response to abusive treatment or a negative reaction to medication;
• Mental health vulnerability.
• Vulnerability to Child Criminal Exploitation (CCE).
• Vulnerability from Child Sexual Exploitation (CSE).
• Vulnerability of forced marriage.
• Vulnerability to radicalisation.
• Financial exploitation by carers/ others

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;
• Ensuring access to an independent advocate where a child/young person is cared for away from home;
• promoting children and young people’s rights and right to safeguarding;
• ensuring children and young people have access to information about their rights in a means that they can understand;
• ensuring that children and young people’s basic right to communication is always met;
• Ensuring access to information about strategies for keeping safe are available for disabled children/ young people; and,
• ensuring staff are aware of the warning signs of fabricated or induced illness, Female Genital Mutilation, Child Sexual Exportation and other Safeguarding Partnership Guidance.; and,
• Ensuring polices and procedures are in place for intimate care and administering medication.

All agencies and organisations have a duty to work together, as set out in the Statutory Working Together Guidance, as well as duties under the Children Act 2004.

2.3 Direct Payments/Self Directed Support

These methods of funding support for the child/ young person follows an assessment of need carried out by Children’s Social Care under section 17 of the Children Act 1989. It is a method of providing parents/ carers 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 child/ 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 there is a risk that  unsuitable people may be employed by the parent/ carer. The Local Authority cannot insist  that parents/ carers undertake such checks but would strongly encourage them to do so to ensure the safety and wellbeing of their child/ young person. The Local Authority will exercise discretion in the making of payments and can decline to do so if they believe that a child may be placed in a situation where there is potential risk of harm. Surrey Children’s Service have Direct Payments Policy that staff should follow when making decisions in this regard. Where necessary, the local authority will exercise its statutory duty and undertake a secton 47 child protection investigation if it is believed that the child is at risk, or likely risk of significant harm..

Section 3 Listening to & Communicating with Disabled Children/Young People

3.1 All reports that are written about a disabled child/ young person should include their views, wishes and feelings, and how they have been ascertained. The best practice for disabled children/ young people 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/ carers. 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 as soon as possible.

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, coerce or abuse the child.

3.4. Consideration should be given to whether the child or parent or both should be referr 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 from or at likely risk of significant harm. These are included in the SSCP Child Protection Procedures and apply to all children/ young people regardless of disabilities. There may be differences, and a child’s/ young person’s disability should always be considered when questioning whether significant harm is suspected/ evidenced.

4.2 Because of the particular needs of disabled children/ 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/ neglect;
• Physical practices, such as physical restraint, being carried out unnecessarily or not in accordance with available guidelines;
• Rough handling/ physical abuse;
• Extreme behaviour modification including the deprivation of clothing, medication, food, a special item/ toy, or 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’s/ 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;
• more susceptible to bullying; and/ or,

more vulnerable to abuse using Information Communication Technology/ online communication.

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/ 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 stresses and difficulties of caring for a disabled child/ young person therefore minimising, dismissing or justifying what would otherwise be deemed abuse;
• 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;
• Attributing 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;
• Not connecting or associating the displayed behaviours with possible behaviours indicating abuse, such as sexually harmful behaviour or self –harm;
• Carers may have unrealistic expectations of the child- either over or under-estimating what they can do; and,
• Failure to follow treatment plans despite the advice given.

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 non- 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. If uncertain or unaware of any such medical conditions, or suspicious with the explanation, refer to Children’s Services so that the correct procedures can be followed.

4.6 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/ carers of any child or young person if there are concerns about their well-being, applies to all children/ young people, including those who are disabled.  The only time where a parent/ carer should not be consulted is if there is reason to believe that the child has or is likely to experience significant harm, and it is believed that harm was caused by the parent/ carer, or they are implicated within it. In such cases, refer to Children’s Services as soon as possible.

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 follow the procedure outlined in Section 5 below.  

Section 5 Making a referral to children’s social care 

Concerns about the welfare and safety of a disabled child/ young person should be acted upon in the same way as any other child in accordance with SSCP multi-agency safeguarding procedures and in line with the referring practitioner’s organisation’s safeguarding children policies and procedures. Practitioners should discuss their concerns with their organisation’s safeguarding lead/ named professional as soon as possible for further advice and for them to make a 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 being made to Children’s Service, practitioners should consult with Continuum of Support for Children and Families living in Surrey 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 make the referral to Children’s Services via the Children's Single Point of Access (C-SPA)  (see Contact Children's Services for more details) using the Request for Support Form.

A referral should be child focused and comprehensive; it must include as much information as possible about the context [who, what, when, where, how and why- if known], as well as  any significant events, chronologies and completed body maps detailing any physical injuries. A comprehensive referral will contribute to a thorough assessment that supports Social Care 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. Where significant harm is suspected and the parents are implicated, the parent/ carer should not be contacted prior to contacting C-SPA as this has potential to place the child at further risk, or to manipulated and coerce the child into not disclosing.

Expertise and resources in both safeguarding and working with disability have to be brought together to ensure that disabled children/ young people.

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 Emergency Department (ED)  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 Meeting has been held including relevant hospital staff to determine if a child protection investigation is required; and,

Agreement is reached as to the interim safety plan for that child. .

Urgent Medical Attention

If the child is suffering from a serious injury, medical attention must be sought immediately from an 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 SSCP 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. This strategy discussion will be organised by social care staff, if there is reason to believe the child is at, or is likely to be at, risk of significant harm. 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 a specialist on the child/young person’s preferred communication method should be involved
• whether there is a need for 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 child protection medical examination,. This will  follow Surrey Safeguarding Children Partnership 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, a referral should be made to the Local Area Designated Officer (LADO) [ see the SSCP Procedures in chapter 3.2].

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 Efforts must be made to ensure that the child/young person’s views, wishes and feelings are shared within 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, or is likely, as a result of concerns about abuse, Children’s Social Care must be notified in order that an investigation 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 should 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 for long periods of time]. Examples are; 

1. Spending long periods of time in a wheelchair within the home environment against professional advice.
2. Leaving immobile children in bed for prolonged periods of time against professional advice
3. Locking children in a room, sometimes referred to as seclusion.
4. Using ‘reins’ for older children whilst out in the community 
5. Keeping children in a cot, or other contraption which prevents freedom of movement.

When workers become aware that parents/ carers are using restrictive practice then they should recognise that this requires further assessment. Parents/ carers should be supported to find an alternative approach to manage the child/ young person’s behaviour.

In most cases where restrictive practice is identified and in all cases that involve a child being locked in, or their liberty being restricted, 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. The distinction between a situation in which significant harm is to be inferred and one where it is not present may be a fine one. If the worker is concerned and uncertain, this too warrants contact with the CSPA for a discussion and advice can then be gained as to the most appropriate action. If a child protection concern arises due to concerns around restrictive practice, then legal advice should be sought by Children’s Services.