5.1 Abduction

RELATED NATIONAL GUIDANCE

  Working Together to Safeguard Children

There are a number of useful websites on the internet which provide information and guidance in relation to Child Abduction:

Reunite International

International Child Abduction and Contact Unit (ICACU). Offices of Court Funds,

Official Solicitor and Public Trustee

RELATED CHAPTERS

Honour Based Abuse Procedure

Missinq Children and Families Procedure

Modern Slavery Procedure

Child Sexual Exploitation - Pan Lancashire Standard Operatinq Protocol Forced Marriaqes Procedure

Contents

Introduction

Action to Safeguard

How to Police use the Law to Safeguard Children at Risk of Sexual Exploitation

Introduction

1. Child abduction is the abduction or kidnapping of a child or baby by an older person. Several distinct forms of child abduction exist:
   • A stranger removing a child for criminal purposes: e.g. child sexual abuse, torture, murder, or for extortion - to elicit a ransom from the child's caretakers;
   • A stranger removes a child usually a baby, with the intent to rear the child as their own;
   • A parent removes or retains a child from another parent's care (often in the course of or after divorce proceedings).
2. Perhaps the most feared (but rare) kind of abduction is removal by a stranger. The most common form of abduction relates to parents removing or detaining a child from the other parent's care. Sometimes this may involve taking a child abroad without the other parent's consent, or wrongfully detaining them in a foreign country following an overseas trip. If a parent takes or sends a child out of the UK without the permission of those with Parental Responsibility or the permission of the court this would be classed as child abduction. If a person has a Child Arrangements Orders for a child they will not be acting unlawfully if the child is taken or sent out of the UK for less than 4 weeks without the appropriate consent.

Action to Safeguard

3. If a practitioner is concerned that a child who is being abused or neglected may be taken out of the country and as a result s/he may suffer Significant Harm, the practitioner should contact Children's Social Care and the local Police immediately. The local authority may need to consider whether it should use its powers under the Children Act 1989 to safeguard the child. A practitioner seeking to protect such a child should consider the need for independent legal advice about immigration from an accredited lawyer. Consideration should be given to liaison with UK Visas and Immigration, not only about the child but also about the abusers and anyone seeking to smuggle a child out of the country. It will be relevant to consider:
   • Why is the child being taken out of the UK?
   • Will the care arrangements for the child in the UK allow the local authority to discharge its safeguarding duties?
   • What is the child's immigration status? Has the child recently arrived in the UK, and how did they arrive?
   • What are the proposed arrangements for the child in their country of destination? Is it possible to check these arrangements?
   • Are you satisfied that these arrangements will safeguard and promote the welfare of the child?
4. Take advice if you suspect that a child is at risk of Significant Harm, but you are not sure what to do, consult a manager, Named Professional, designated member of staff, or Children's Social Care. Similarly, seek advice if you are dealing with a culture that you do not understand.

How the Police use the Law to Safeguard Children at Risk of Sexual Exploitation

5. Section 2 of the Child Abduction Act 1984 states that where a person removes, detains or keeps a child away from a person who has lawful control of the child then that person is guilty of an offence. This could simply be that the child is in the person's house or company when parents think the child is elsewhere.
6. If the Police, in conjunction with other agencies suspect that a child is involved in an inappropriate relationship with an adult but have no evidence to suspect any other criminal behaviour they may issue a warning under the Abduction Act. This warning in effect instructs the adult not to have any further contact with the child and informs them of the consequences should they choose to ignore it. This warning has been shown to be an effective tool in reducing the risks posed by some adults to children and removes any defence that person may have had to a prosecution under this legislation.
7. If there is reason to suspect that a child is being "groomed" for the purpose of sexual abuse the Police will arrest the adult detaining the child and commence an investigation.
8. In all cases where child abduction is suspected the Police should be contacted.

5.2 Alcohol Misusing Parents/Carers

RELATED NATIONAL GUIDANCE

Chapter 1 : Assessing need and providing help, Workinq Together to Safequard Children

Advisory Council on the Misuse of Druqs, The Home Office

Foetal Alcohol Syndrome, Drink Aware UK

RELATED LOCAL GUIDANCE

Safeguarding Children Living with Substance Using Parents/Carers - to follow

Blackburn with Darwen Triage Assessment Tool

Blackburn with Darwen Screeninq and Referral for Triaqe Form Substance Misuse

Blackburn with Darwen Comprehensive Assessment

RELATED CHAPTERS

Druq Misusing Parents/Carers Procedure

AMENDMENT

In November 2013, this chapter was updated in line with Working Together to Safeguard Children.

Contents

Alcohol

Alcohol Use in Pregnance

The Child

Concerns

Referrals

Assessment and Initial Child Protection Conference

Alcohol Use in Pregnancy

1. It has been suggested that that foetal alcohol syndrome is the biggest cause of non-genetic learning disability in the Western world and is the only one that is 100% preventable (McNamara, ibid).

"Not every child affected by prenatal alcohol exposure will experience severe learning disability, but learning disabilities are common... The primary... damage that alcohol exposure causes is to the central nervous system... it is important to emphasise that little is known about factors determining whether a child will develop alcohol-related problems, or how significant these will be. There is no cut off point that indicates that a specific amount of alcohol at a specific time will create certain types of problems, and less will not... mothers who maintain adequate nutrition even though drinking may give birth to children less severely affected

than mother's      who   have  poor  nutrition". - Foetal Alcohol Syndrome website.

The Child

2. The effects on children of the misuse of alcohol by one or both parents or carers are complex and may vary in time, which is why a thorough assessment of needs and risk of harm is important. In some cases the misuse of alcohol may be one factor which, when linked to domestic violence or mental illness, may increase the risks to the child.
3. The circumstances of children must be carefully assessed not only to consider immediate risks but also the long-term effects on the child of their parents' alcohol misuse.
4. The children of parents who misuse alcohol are at increased risk of developing alcohol problems themselves and of being separated from their parents. Research demonstrates that children who themselves start drinking at an early age are at greater risk of unwanted sexual encounters and injuries through accidents and fighting.

Concerns

5. The health and development of an unborn child may be affected by the parent's alcohol misuse and newborn babies may suffer foetal alcohol syndrome which as a result may interfere with the parent/child bonding process.
6. Babies may experience a lack of basic health care and poor stimulation and older children may experience poor school attendance, anxiety about their parents' health and taking on a caring role for the parent or siblings.
7. The parent's practical caring skills can be affected by the misuse in the following ways:

o Lack of attention to basic physical needs; o Lack of control of emotions; o Impaired judgement.

Referrals

8. Professionals, when confronted with a child in an alcohol-misusing environment must ask themselves "What is it like for a child in this environment?"
9. The Common Assessment Framework will assist in determining the level of vulnerability of the child and at what point a referral is made to Children's Social Care - see Making a Referral to Children's Social Care.
10. Information gathered during a Common Assessment should form the basis for the referral including relevant mufti agency Referral Forms.

Assessment and Initial Child Protection Conference

11. Children's Social Care will consider whether it is appropriate to undertake an Sinqle Assessment in relation to all Referrals.
12. In these circumstances Single Assessments will consider and take account of whether the person concerned is hiding or denying their alcohol misuse; whether they are engaged in any rehabilitation programme; whether they receive support from a partner, family or friends; the impact of the alcohol misuse on the quality of care given to the child and the day-to-day environment of the child as well as the long term impact on the child.
13. Throughout the assessment process and where it is decided to call a Strategy Discussion, undertake a Section 47 Enquiry and convene an Initial Child Protection Conference, those agencies who have worked with the parents in relation to their alcohol misuse must be asked to contribute and invited to participate in and attend relevant meetings.
14. If the concerns are in relation to an unborn child, the maternity services must be invited to attend the Strategy Discussion, and involved in any Section 47 Enquiry, Initial Child Protection Conference and, where appropriate, the Core Group.

5.3 Bullying                                                                                               

RELATED NATIONAL GUIDANCE

Preventinq and Tacklinq Bullying - Advice for Headteachers. Staff and

Governing Bodies, Department for Education March 2014

Workinq Together to Safequard Children

Mental Health and Behaviour in Schools (DfE)

RELATED CHAPTERS

Disabilities and Learninq Difficulties Procedure

Peer Abuse Procedure

Self-Harm or Suicidal Ideation Procedure Online Safeguarding Procedure

Contents

Definitions

Impact of Bullying on the Child Action to Safeguard

Definitions

1. The government has defined bullying as: "Behaviour by an individual or group, usually repeated over time, that intentionally hurts another individual or group either physically or emotionally" and cyberbullying as: "The use of Information Communications Technology ('CT), particularly mobile phones and the internet, deliberately to upset someone else". See also Online Safgquardinq Procedure;
2. Bullying can take many forms, but the three main types are:

o Physical; o Verbal; o Emotional.

3. Increasingly, information technology is being used as a means of communicating verbal and emotional bullying.
4. Bullying often starts with apparently trivial events such as teasing and name calling which nevertheless rely on an abuse of power. Agencies working with incidents of bullying should consider whether there are any child protection issues to be considered and whether a Referral to Children's Social Care is necessary in relation to the child bully, (see Action Taken When a Child is Referred to Local Authority Children's Social Care Services Procedure) the child victim or both, including under the Peer Abuse Procedure.

Impact of Bullying on the Child

5. Any child may be bullied but bullying often occurs if a child has been identified in some ways as vulnerable or different to the majority. They may also be inclined to spend more time on their own.
6. Children living away from home are particularly vulnerable to bullying and abuse by their peers.
7. The damage inflicted by bullying can frequently be underestimated. It can cause considerable distress to children, to the extent that it affects their health and development or, at the extreme, causes them Significant Harm (including selfharm). See Self-Harm or Suicidal Ideation Procedure
8. Children are often held back from telling anyone about their experience either by threats or a feeling that nothing can change their situation.
9. Parents, carers and agencies need to be alert to any changes in behaviour such as refusing to attend school or a particular place or activity or becoming withdrawn and isolated.

Action to Safeguard

10.AlI settings in which children are provided with services or are living away from home should have in place rigorously enforced anti-bullying strategies.

11. This includes schools as well as all youth clubs and all other children's organisations where the anti bullying strategies should be rigorously enforced.
12. The following principles will apply:
    • A sense of community will be achieved only if organisations take seriously behaviour which upsets children;
    • Recognition of each child's individual needs will reduce the likelihood of them becoming isolated and vulnerable and, where it is a residential setting, supports them to adapt to their living arrangements; o Friendships between children should be nurtured;
    • Support should be offered to children for whom English is not their first language to communicate needs and concerns;
    • Support should also be offered to children who have any difficulties in communicating as a result of a learning and/or physical disability - see also Disgbilities and Learninq Difficulties Procedure;
    • Children should be able to approach any member of staff within the organisation with personal concerns in the knowledge that the staff will respond appropriately.
13. Where a child is thought to be exposed to bullying, action should be taken to assess the child's needs and provide support services.

14.A range of active listening techniques which provide a more helpful response include:

THE LISTENER: Listening patiently with full attention, encouraging, clarifying, restating, reflecting, validating, summarising;

THE DETECTIVE: Investigating the situation sensitively and patiently;

THE SUPPORTER: Seeing their side, acknowledging and allowing expression of their feelings;

THE COACH: Checking out what help is being asked for and offering practical, realistic help.

15. Parents should be informed and updated on a regular basis. They should also, when applicable, be involved in supporting programmes devised to challenge bullying behaviour.

5.4 Child Sexual Exploitation - Pan Lancashire Standard Operating Protocol

RELATED NATIONAL GUIDANCE

Child sexual exploitation: Definition and a guide for practitioners (GOV-UK) definition and a guide for practitioners, local leaders and decision makers working to protect children from child sexual exploitation.

What to do if you're worried a child is beinq abused (GOV.UK) - guidance to help practitioners identify the signs of child abuse and neglect and understand what action to take.

Child Sexual Abuse — The Children's Commissioner

Responding to Child Sexual Exploitation- College of Policinq

Criminal Exploitation of children and vulnerable adults: County Lines quidance (Home Office)

Centre of Expertise on Child Sexual Abuse

Child sexual exploitation: Practice Tool (2017) (open access) - Research in Practice. Further background information about child sexual exploitation and additional commentary around some of the complexities of practically responding to the issue.

RELATED REGIONAL GUIDANCE

Child Sexual Exploitation and Missinq from Home/Care: North West CrossBorder Information Sharing Protocol

RELATED LOCAL GUIDANCE

Child Sexual Exploitation - Pan  Standard Operating Protocol Pan-Lancs CSE Checklist

Pan-Lancs CSE Teams — Contact Numbers — see Local Contacts

Blackburn with Darwen Enqaqe Team: Multi-Aqency Practice Guidance

Blackburn with Darwen Childrens Services • Child Sexual Exploitation (CSE) Toolkit

RELATED CHAPTERS

Missinq Children and Families Procedure

Abduction Procedure

Transfer Across_Local Authority Boundaries Procedure

Complex (Organised or Multiple) Abuse Procedure

Sexually Active Younq People Under the Aqe of 18 Procedure

Gang, Group Activity and Criminal Exploitation Affectinq Children Procedure

AMENDMENT

The Further Information section was revised and updated in May 2018 with a link to the Centre of Expertise on Child Sexual Abuse: Key Messages from research on child sexual exploitation and Child sexual exploitation: Practice Tool (2017) (open access) - Research in Practice - further background information about child sexual exploitation and additional commentary around some of the complexities of practically responding to the issue.

5.5 Children from Abroad, including Victims of Modern Slavery, Trafficking and Exploitation

SCOPE OF THIS CHAPTER

This procedure is concerned with children arriving into the UK:

Alone;

      In the care of adults who, whilst they may be their carers, have no Parental Responsibility for them;

In the care of adults who have no documents to demonstrate a relationship with the child;

      In the care of agents.

This is a broad cohort of children, and it may include (but is not limited to) children who have been subject to trafficking and/or modem slavery, and/or may have been exposed to the additional risks of commercial, sexual or domestic exploitation. It may also include children who have been trafficked internally within the UK.

Part 1 of this chapter covers issues which will apply across this cohort.

Part 2 of this chapter covers the additional issues which will apply where children are identified as being potential victims of trafficking and/or modern slavery.

AMENDMENT

This chapter was updated in May 2020 to take account of the new NRM digital referral form and the change to a Single Competent Authority (SCA).

Contents

Part 1 — All Children Presenting Alone or with Adults who are Not Their Parents

Part 2 — Child Victims of Trafficking and Modern Slavery

Further Information

Part 1 - All Children Presenting Alone or with Adults who are Not Their Parents

1.1 Introduction

Evidence shows that unaccompanied migrant children or those accompanied by someone who is not their parent are particularly vulnerable. Immigration legislation impacts significantly on work to safeguard and promote the welfare of children and young people from abroad.

It is important to note that regulations and legislation in this area of work are complex and subject to constant change through legal challenge. This guidance, therefore, intends to provide an overview of the additional issues faced by families and/or children set within the framework of immigration law. All practitioners need to be aware of this context in their contact with such families and/or children. Legal advice about individual cases may be required.

Additional issues are likely to arise in relation to this cohort of children, whether or not they are found to be, or suspected of being, victims of trafficking or modern slavery. Additional considerations in all cases are likely to include issues such as immigration status, the need for interpreters and specialist legal advice. Some of these children may have been persecuted and have witnessed or been subject to horrific acts of violence. Assessing the needs of these children is only possible if their legal status, background experiences and culture are understood, including the culture shock of arrival in this county.

Unaccompanied, intemally displaced children may have come to the UK seeking asylum or may be here to attend school or join their family. An unaccompanied child may be the subject of a Private Fostering arrangement, and subsequently exploited or abandoned when the arrangement fails (see Children Living Away from Home (including Children and Families living in Temporary Accommodation) Procedure).

Some children may say they are unaccompanied when claiming asylum - a trafficker may have told the child that in doing so they will be granted permission to stay in the UK and be entitled to claim welfare benefits.

A significant number of children who are referred to local authority care as trafficked children or unaccompanied asylum seeking children (UASC), often then go missing and many go missing within one week. It is thought that they are then trafficked internally, within the UK, or out of the UK to other European countries.

Whenever an unaccompanied child presents in a local authority area, all agencies dealing with the child should be alert to the possibility that the child may have been a victim of modern slavery, including the possibility that the child has been trafficked, and ensure that all relevant information about the child's circumstances is communicated to Children's Social Care. Information should be shared with consent where appropriate and where possible, but information can be shared without consent if the professional judgement is that there is good reason to do so, such as where their safety may be at risk.

If there are concerns that a child is a victim of trafficking, the practitioners will need to inform the National Referral Mechanism, which is a framework for identifying victims of human trafficking or modem slavery and ensuring that they receive the appropriate support. The child's details should be provided using the forms available on the National Referral Mechanism Digital Referral System: Report Modern Slavery.

In England and Wales, if someone is found not to be a victim of trafficking, the Competent Authority must go on to consider whether they are the victim of another form of modern slavery, which includes slavery, servitude and forced or compulsory labour.

This chapter should be read in conjunction with the following government guidance:

Care of Unaccompanied Migrant Children and Child Victims of Modern Slavery: Statutory Guidance for Local Authorities, November 2017 - This guidance sets out the steps local authorities should take to plan for the provision of support for looked after children who are unaccompanied asylum seeking children, unaccompanied migrant children or child victims of modem slavery including trafficking. Elements of this guidance will also be relevant for the care of looked after UK nationals who may also be child victims of modern slavery.

Safeguarding Children who May Have Been Trafficked (Home Office, 2011) nonstatutory government good practice guidance provides the detailed guidance on steps that local authorities should take, in partnership with other agencies, to identify and protect child victims of modern slavery, including trafficking, before they become looked after.

1.2 Issues and Challenges

The first contact with the child and carers is crucial to the engagement with the family and the promotion of trust which underpins the future support, advice and services.

Such children should be assessed as a matter of urgency as they may be very geographically mobile and their vulnerabilities may be greater. All agencies should enable the child to be quickly linked into universal services, which can begin to address educational and health needs.

The assessment has to address not only the barriers which arise from cultural, linguistic and religious differences, but also the particular sensitivities which come from the experiences of many such children and families.

Particular sensitivities which may be present include:

Concerns around immigration status;

Fear of repatriation;

Anxiety raised by yet another professional asking similar question to ones previously asked;

Lack of understanding of the separate role of Children's Social Care, and that it is not an extension of the police;

Lack of understanding of why an assessment needs to be carried out;

      Previous experience of being asked questions under threat or torture, or seeing that happen to someone else;

Past trauma - past regime/experiences can impact upon the child's mental and physical health. This experience can make concerns from the Authorities about minor injury or poor living conditions seem trivial and this mismatch may add to the fear and uncertainty;

The journey itself as well as the previous living situation may have been the source of trauma;

The shock of arrival - the alien culture, system and language can cause shock and uncertainty, and can affect mood, behaviour and presentation;

The child may have also been subject to frequent changes of address or location within the UK and may be living with the fear of sudden further unexplained moves.

Agencies should ensure that the interpreter shares a common language with the child, is professionally trained and has been screened through a DBS check. It is vital that the services of an interpreter are employed in the child's first language and that care is taken to ensure that the interpreter knows the correct dialect.

1.2.1 Age Assessments

The assessment of age is a complex task, which often relies on professional judgement and discretion. Many societies do not place a high level of importance upon age and it may also be calculated in different ways. Some young people may genuinely not know their age and this can be misread as lack of co-operation. Levels of competence in some areas or tasks may exceed or fall short of our expectations of a child of the same age in this country.

Age assessments should only be carried out where there is significant reason to doubt that the claimant is a child. Age assessments should not be a routine part of a local authority's assessment of unaccompanied or trafficked children. Care of Unaccompanied Migrant Children and Child Victims of Modern Slavery Statutory Guidance for Local Authorities (November 2017) provides that where the age of a person is uncertain and there are reasonable grounds to believe that they are under 18, they will be treated as a child in order to receive immediate access to assistance, support and protection in accordance with section 51 of the Modern Slavery Act 2015. An age assessment should only be carried out if it is appropriate to do so, and should not cause a delay in referring into the NRM. Where age assessments are conducted, they must be compliant with case law of Merton and subsequent judgments.

As the issue of age assessment in social work with asylum seeking young people remains controversial, the ADCS (Association of Directors of Children's Services) Asylum Task Force has worked with the Home Office to provide jointly agreed Age Assessment Guidance and Information Sharing Guidance for UASC.

The advice of a paediatrician with experience in considering age may be needed to assist in this, in the context of a holistic assessment. However, the High Court has ruled that, unless a paediatrician's report can add something specific to an assessment of age undertaken by an experienced social worker, it will not be necessary. Please also Assessing Age for Asylum Applicants (GOV.UK) Guidance.

1.2.2 Immigration Issues

The immigration status of a child and his/her family has implications for the statutory responsibilities towards the family. It governs what help, if any, can be provided to the family and how help can be offered to the child.

All children, irrespective of their immigration status, are entitled to protection under the law. Local authorities need to ensure that child victims receive legal advice and support.

Where families are subject to immigration legislation which precludes support to the family, many will disappear into the community and wait until benefits can be awarded to them. During this interim period the children may suffer particular hardship - e.g. live in overcrowded and unsuitable conditions with no access to health or educational services. They are particularly vulnerable to exploitation because of their circumstances.

Children who disappear, where there are concerns about the child's welfare, should be considered to be missing and Missing Children and Families Procedure should be followed.

It may be appropriate for unaccompanied children to be informed of the availability of the Assisted Voluntary Return Scheme.

Asylum Process — Possible Outcomes

There are four main possible outcomes of the asylum process for an unaccompanied child, which will determine what the long term solution might be. These are outlined below including the impact they may have on care and pathway planning:

Granted refugee status (i.e. granted asylum), with limited leave to remain for five years, after which time they can normally apply for settlement (i.e. indefinite leave to remain).

Refused asylum but granted humanitarian protection, with limited leave to remain for five years, after which time they can normally apply for settlement (i.e. indefinite leave to remain). This is most commonly granted where the person is at risk of a form of 'ill treatment' in their country of origin but which does not meet the criteria of the Refugee Convention.

As it is very likely that those granted refugee status or humanitarian protection will qualify for indefinite leave to remain, their care and pathway planning should primarily focus on their long-term future in the UK, in the same way as for any other care leaver.

Refused asylum but granted Unaccompanied Asylum Seeking Child (UASC) Leave. This is normally for 30 months or until the age of 17h, whichever is the shorter period. This form of leave is granted to unaccompanied children where they do not qualify for refugee status or humanitarian protection, but where the Home Office cannot retum them to their home country because it is not satisfied that safe and adequate reception arrangements are in place in that country. It is a form of temporary leave to remain and is not a route to settlement. This decision is a refusal of the child's asylum claim and will attract a right of appeal. The child should be assisted to obtain legal advice on appealing against such a refusal. Before the child's UASC Leave expires, they can submit an application for further leave to remain and/or a fresh claim for asylum, which will be considered. It is essential that they are assisted to access legal advice and make any such further application or claim before their UASC Leave   expires.

In such cases, care and pathway planning should therefore consider the possibility that the child may have to return to their home country once their IJASC Leave expires or that they may become legally resident in the UK longterm (if a subsequent application or appeal is successful). Planning should also cover the possibility that they reach the age of 18 with an outstanding application or appeal and are entitled to remain in the UK until its outcome is known.

Refused asylum and granted no leave to remain. In this case the unaccompanied child is expected to return to their home country and their care plan should address the relevant actions and the support required. The Home Office will not return an unaccompanied child to their home country unless it is satisfied that safe and adequate reception arrangements are in place in that country. Any appeal or further application should be submitted where appropriate by the child's legal adviser.

Although these are the four main types of outcomes for an unaccompanied child, there may be others. For example, a child may be granted discretionary leave depending on whether they meet other criteria such as needing to stay in the UK to help police with their enquires after being conclusively identified as a victim of trafficking. Other examples include: leave as a stateless person; limited or discretionary leave for compassionate reasons; and limited leave on the basis of family or private life.

Independent Family Returns Panel

The Secretary of State must consult the Independent Family Returns Panel in each family returns case, on how best to safeguard and promote the welfare of the children of the family, and in each case where the Secretary of State proposes to detain a family in pre-departure accommodation, on the suitability of so doing, having particular regard to the need to safeguard and promote the welfare of the children of the family.

A family returns case is a case where a child who is living in the United Kingdom is to be removed from or required to leave the United Kingdom, together with their parent/carer.

Pre-departure accommodation is a secure facility designed to be used as a last resort where families fail to co-operate with other options to leave the UK, such as the offer of assisted voluntary return.

The Panel may request information in order that any return plan for a particular family has taken into account any information held by other agencies that relates to safeguarding, welfare or child protection. In particular a social worker or manager from Children's Social Care may be invited to contribute to the Panel.

1.3 Referring a Potential Victim of Modern Slavery to the National Referral Mechanism (NRM)

A local authority (as a 'first responder') identifying a potential victim of modern slavery must refer them to the National Referral Mechanism (NRM) for consideration by the Single Competent Authority (SCA). Children's Social Care departments are able to make a referral into the NRM, as they may be entitled to further support. Victims can be of any nationality, and may include British national children, such as those trafficked for child sexual exploitation or those trafficked as drug carriers internally in the UK. The NRM does not supersede child protection procedures, so existing safeguarding processes should still be followed in tandem with the notifications to the NRM. See also National Referral Mechanism: Guidance for Child First Responders.

There js no minimum requirement for justifying a referral into the NRM and consent is not required for children. Communicate honestly with the child about your concerns and reasons for referring them into the NRM.

To complete and see where to send the forms, and the associated guidance, visit Digital Referral System: Report Modern Slavery.

The Duty to Notify - Local authorities have a duty to notify the Home Office about any potential victims of Modern Slavery. It is intended to gather better data about modern slavery. This requirement can be satisfied by completing the National Referral Mechanism Digital Form.

1.4 Protection and Action to be Taken

Whenever any professional comes across a child who they believe has recently moved into this country the following basic information should be sought:

Confirmation of the child's identity and immigration status;

Confirmation of the carer's relationship with the child and immigration status;

Confirmation of the child's health and education arrangements in this country;

Confirmation of the child's health and education arrangements in the country of origin and any other country that the child has travelled through.

This should be done in a way which is as unthreatening to the child and carer as possible.

When an unaccompanied child or child accompanied by someone who does not have Parental Responsibility comes to the attention of any practitioner, a referral should be made to Children's Social Care in accordance with the Making a Referral to Children's Social Care Procedure. An Assessment will be undertaken in order to determine whether they are a Child in Need of services, including the need for protection.

Whether they are unaccompanied or accompanied by someone who is not their parent they should be assumed to be a Child in Need unless assessment indicates that this is not the case. The assessment of need should include a separate discussion with the child in a setting where, as far as possible, they feel able to talk freely. This, in itself, may be a complex process where the assessor may not be able to speak the same language as the child.

Many unaccompanied and/or trafficked children are at risk of going missing from care, often within the first 72 hours, whilst others may be at risk of repeated missing episodes due to ongoing exploitation.

Assessment

The Assessment will be conducted in accordance with the Single Assessments Assessments under Children Act 1989 Procedure. The following additional issues will also need to be taken into consideration.

Assessing the needs of these children is only possible if their legal status, background experiences and culture are understood, including the culture shock of arrival in this country.

This is a highly complex area of work and professionals will need to have available to them a solid understanding of the asylum process or colleagues or other professionals with such expertise.

Seeking information from abroad should be a routine part of assessing the situation of an unaccompanied child. Practitioners from all key agencies - Health, Education, Children's Social Care and the Police - should all be prepared to request information from their equivalent agencies in the country or countries in which a child has lived, in order to gain as full as possible a picture of the child's preceding circumstances.

The child should be offered an Independent Visitor and, if they decline, their reasons should be recorded. Any Independent Visitor appointed should have appropriate training and demonstrate an understanding of the needs faced by unaccompanied or trafficked children.

The Assessment should take account of any particular psychological or emotional impact of experiences as an unaccompanied or trafficked child, and any consequent need for psychological or mental health support to help the child deal with them.

Unaccompanied migrant children and child victims of modern slavery will need access to specialist legal advice and support. This will be in relation to immigration and asylum applications and decisions and any associated legal proceedings. If they have been a victim of modem slavery, it may also be in relation to criminal proceedings or compensation claims. The assessment should note that specialist legal support is required and how it will be provided.

Planning for the child should include planning for a variety of possible outcomes regarding the child's immigration status - see Asylum Process — Possible Outcomes.

Part 2 - Child Victims of Trafficking and Modern Slavery

2.1 Definitions

'Modern slavery' is a form of organised crime in which individuals including children and young people are treated as commodities and exploited for criminal and financial gain. It encompasses human trafficking, slavery, servitude and forced labour.

The Modern Slavery Act 2015 provides better protection for victims and increases the sentences for committing these offences.

Grooming methods are often used to gain the trust of a child and their parents, e.g. the promise of a better life or education, which results in a life of abuse, servitude and inhumane treatment.

'Trafficking of persons' means the recruitment, transportation, transfer, harbouring or receipt of persons, by means of the threat or use of force or other forms of coercion, of abduction, of fraud, of deception, of the abuse of power or of a position of vulnerability or of the giving or receiving of payments or benefits to achieve the consent of a person having control over another person, for the purpose of exploitation.

'Exploitation' for modern slavery purposes is defined, as a minimum, to include: sexual exploitation, forced labour, domestic servitude and organ trafficking.

Trafficked victims are coerced or deceived by the person arranging their relocation, and are often subject to physical, sexual and mental abuse. The trafficked child or person is denied their human rights and is forced into exploitation by the trafficker or person into whose control they are delivered.

Children are not considered able to give 'informed consent' to their own exploitation (including criminal exploitation), so it is not necessary to consider the means used for the exploitation - whether they were forced, coerced or deceived, i.e. a child's consent to being trafficked is irrelevant and it is not necessary to prove coercion or any other inducement.

2.2 Types of Exploitation

Boys and girls of all ages are affected and can be trafficked into, within ('internal trafficking'), and out of the UK for many reasons and all forms of exploitation.

Victims may be sexually exploited and forced into sex work. Victims have been found in brothels, saunas and lap dancing clubs. Persons subject to forced labour have been found working with little or no pay in farms, factories, nail bars, car washes, hotels and restaurants. Domestic servitude involves victims who work in a household where they are subject to long working hours with little or no pay, often in very poor working conditions. Sometimes forced marriage can lead to domestic servitude. Criminal exploitation can involve young people being forced to work in cannabis cultivation, county lines exploitation, begging and pick-pocketing. Other types of exploitation include debt bondage (being forced to work to pay off debts that realistically they will never be able to), organ harvesting, financial fraud (including benefit fraud), and illegal adoption. For further information see Typology of 17 Types of Modern Slavery Offences in the UK.

Victims often face more than one type of abuse and slavery, for example they may be sold to another trafficker and then forced into another form of exploitation.

Children and young people may be exploited by parents, carers or family members. Often the child or young person will not realise that family members are involved in the exploitation.

The Modern Slavery Act 2015 (applicable mostly in England and Wales[l]) provides two civil prevention orders - the Slavery and Trafficking Prevention Orders (STPO) and Slavery and Trafficking Risk Order (STRO), and provision for child trafficking advocates.

[1] Some provisions also concern Northern Ireland and Scotland. Also see the Human

Trafficking and Exploitation (Criminal Justice and Support for Victims) Act (Northern Ireland) 2015 and the Human Trafficking and Exploitation (Scotland) Act 2015

2.3 Indicators

Identification of potential child victims of modern slavery/trafficking may be difficult as they might not show obvious signs of distress or abuse. Some children are unaware that they have been trafficked, while others may actively participate in hiding that they have been trafficked. Even when a child understands what has happened, they may still appear to submit willingly to what they believe to be the will of their parents or accompanying adults. It is important that these children are protected too. Children do not have the legal capacity to 'consent' to their trafficking or their exploitation.

Signs that a child has been trafficked may not be obvious, or children may show signs of multiple forms of abuse and neglect. Spotting the potential signs of child slavery/trafficking in referrals and children you work with can include:

A reluctance to seek help - victims may be wary of the authorities for many reasons such as not knowing who to trust or a fear of deportation or concern regarding their immigration status and may avoid giving details of accommodation or personal details;

The child may seem like a willing participant in their exploitation, e.g. involvement in lucrative criminal activity - however this does not mean they have benefitted from the proceeds;

Discrepancies in the information victims have provided due to traffickers forcing them to provide incorrect stories;

An unwillingness to disclose details of their experience due to being in a situation of dependency;

Brought or moved from another country;

An unrelated or new child discovered at an address;

Unsatisfactory living conditions - may be living in dirty, cramped or overcrowded accommodation;

Missing - from care, home or school - including a pattern of registration and de-registration from different schools;

Children may be found in brothels and saunas;

Spending a lot of time doing household chores;

May be working in catering, nail bars, caring for children and cleaning;

Rarely leaving their home, with no freedom of movement and no time for playing;

Orphaned or living apart from their family, often in unregulated private foster care;

Limited English or knowledge of their local area in which they live;

False documentation, no passport or identification documents;

Few or no personal effects - few personal possessions and tend to wear the same clothing;

No evidence of parental permission for the child to travel to the UK or stay with the adult;

Little or no evidence of any pre-existing relationship with the adult or even an absence of any knowledge of the accompanying adult;

Significantly older partner;

Underage marriage.

Physical Appearance - Victims may show signs of physical or psychological abuse, look malnourished or unkempt, or appear withdrawn.

Physical illnesses - Including work-related injuries through poor health and safety measures, or injuries apparently as a result of assault or controlling measures. There may be physical indications of working (e.g. overly tired in school or indications of manual labour).

Sexual health indicators - Sexually transmitted infections, or pregnancy; injuries of a sexual nature and [or gynaecological symptoms.

Psychological indicators - Suffering from post traumatic stress disorder which may include symptoms of hostility, aggression and difficulty with recalling episodes and concentrating. Depression/self-harm and/or suicidal feelings; an attitude of self blame, shame and extensive loss of control; drug and or/alcohol use.

2.4 Protection and Action to be Taken

Modern slavery and trafficking are child abuse, and any potential victim of child trafficking or slavery, servitude, or forced or compulsory labour should immediately be referred to Children's Services in the area, as they may be suffering significant harm see Making a Referral to Children's Social Care Procedure.

In addition to the usual actions to be taken, additional considerations will apply if the child is suspected of being a victim of trafficking and/or modern slavery. Once a potential victim has been identified, practitioners should inform them of their right to protection, support, and assistance in any criminal proceedings against offenders. Practitioners should arrange access to specialist legal advice and support. Trafficked children may apply to UK Visas and Immigration for asylum or humanitarian protection. This is because they often face a high level of risk of harm if they are forced to return to their country of origin.

If the child or anyone connected to them is in immediate danger the police should be contacted as normal.

Practitioners should meet any urgent health needs and arrange emergency medical treatment if appropriate.

Practitioners must arrange safe accommodation for the potential victim.

Assessment

Where a child is a victim or potential victim of Modern Slavery/Trafficking, the Assessment should be carried out immediately as the opportunity to intervene is very narrow. Many trafficked children go missing from care, often within the first 72 hours. There should be a clear understanding between the local authority and the police of roles in planning for the protection and responding if a child goes missing.

During the Assessment, the lead social worker should establish the child's background history including a new or recent photograph, passport and visa details, Home Office papers and proof and details of the guardian or carer.

Where the outcome of the assessment is that the child becomes looked after, the social worker and carers must consider the child's vulnerability to the continuing influence/control of the traffickers and how they may seek to contact them for instance by mobile phone or the internet. Planning and actions to support the child must minimise the risk of the traffickers being able to re-involve a child in exploitative activities:

The location of the child must not be divulged to any enquirers until they have been interviewed by a social worker and their identity and relationship/connection with the child established, with the help of police and immigration services, if required;

Foster carers/residential workers must be vigilant about anything unusual e.g. waiting cars outside the premises and telephone enquiries.

The social worker must immediately pass to the police any information on the child (concerning risks to her/his safety or any other aspect of the law pertaining either to child protection or immigration or other matters) which emerges during the placement. The social worker must try to make contact with the child's parents in the country of origin (immigration services may be able to help), to find out the plans they have made for their child and to seek their views. The social worker must take steps to verify the relationship between the child and those thought to be her/his parent/s.

Anyone approaching the local authority and claiming to be a potential carer, friend, member of the family etc, of the child, should be investigated by the social worker, the police and immigration service. If the supervising manager is satisfied that all agencies have completed satisfactory identification checks and risk assessments, the child may transfer to their care.

The child should be offered an Independent Visitor and, if they decline, their reasons should be recorded. Any Independent Visitor appointed should have appropriate training and demonstrate an understanding of the needs faced by unaccompanied or trafficked children.

The Assessment should take account of any particular psychological or emotional impact of experiences as an unaccompanied or trafficked child, and any consequent need for psychological or mental health support to help the child deal with them.

Practitioners must always ensure that a victim-centred approach to tackling all types of trafficking and modern slavery is taken. This can be achieved by the following:

Dealing with the child sensitively to avoid them being alarmed or shamed building trust, as victims commonly feel fear towards the authorities;

Keeping in mind the child's:

Added vulnerability; o Developmental stage; o Possible grooming by the perpetrator.

A child's credibility can be challenged if the child is subject to immigration control on the basis of their disclosure being made in instalments. It is important that practitioners make careful notes about what is disclosed, as a child may have difficulty recalling what they've experienced as a result of trauma. This will support the child and help others understand the process of disclosure.

When questioning a potential victim, initially observe non verbal communication and body language between the victim and their perpetrator.

It is important to consider the potential victim's safety and that of their loved ones. Confidentiality and careful handling of personal information is imperative to ensure the child's safety. Practitioners must not disclose to anyone not directly involved in the case, any details that may compromise their safety.

For further advice and support the Child Trafficking Advice Centre (CTAC) provides free guidance to professionals concerned that a child or young person is a victim of modern slavery.

Further Information

Care of Unaccompanied Migrant Children and Child Victims of Modern Slavery: Statutory Guidance for Local Authorities, November 2017

Safeguarding Children who May Have Been Trafficked (Home Office, 2011) - nonstatutory government good practice guidance.

Modern Slavery Helpline and Resource Centre - Unseen (Registered Charity) NSPCC Child Trafficking Advice Centre (CTAC) - specialist advice and information to professionals who have concerns that a child may have been trafficked.

Duty to Notify the Home Office of Potential Victims of Modern Slavery - Guidance and Forms

Home Office Circular - Modern Slavery Act 2015

Modern Slavery: Duty to Notify Factsheets (GOV-UK, October 2016)

Support for victims of modern slavery (GOV.UK)

Modern slavery: how to identify and support victims - guidance for how UK Visa and Immigration identifies and helps potential victims of modern slavery.

Guidance on Processing Children's Asylum Claims - sets out the process which immigration officials follow in determining an asylum claim from a child and the possible outcomes for the child.

National Referral Mechanism: Guidance for Child First Responders - provides details on how to refer a child into the NRM and complete the referral form, reviews of decisions and the benefits of referral.

National Transfer Protocol for Unaccompanied Asylum Seeking Children interim national transfer procedure and transfer flow chart for the safe transfer of UASC from one UK local authority to another.

Child Protection: Working with Foreign Authorities - guidance on child protection cases and care orders where the child has links to a foreign country.

Local Government Association - Council Support: Refugees, Asylum Seekers and Unaccompanied Children - resource for council staff, designed to answer questions about supporting refugees, asylum seekers and unaccompanied children.

Unaccompanied Asylum-seeking Children (UASC): Funding Instructions, 28 April 2014, Guidance, UKVI: Instructions to local authorities about the UASC funding (2013 to 2014) for the support and care of unaccompanied asylum-seeking children.

Modern Slavery Act 2015

Modern Slavery Act 2015: Recent developments - Briefing Paper, July 2016

College of Policing - Modern Slavery

NSPCC - Are You a Child Who Has Come to the UK from Another Country?

Modern Slavery - Royal College of Nursing Guide for Nurses and Midwives

Refugee and Unaccompanied Asylum Seeking Children and Young People: Age

Assessment and Children in Detention (Royal College of Paediatrics and Child Health)

Refugee Council - Children's Panel - national remit to offer advice and support to unaccompanied children, and advise other professionals who are involved in their care.

Modern Slavery and Human Trafficking Unit (National Crime Agency)

Gangmasters & Labour Abuse Authority

5.6 Children Living Away from Home (including Children and Families living— in Temporary Accommodation)

RELATED NATIONAL GUIDANCE

Workinq Together to Safeguard Children

The Children's Homes (England) Regulations 2015

Guide to the Children's Homes Regulations including the Quality Standards

RELATED LOCAL GUIDANCE

Joint Protocol Children and Young People Who Run Away or Go Missing from

Home or Care

RELATED CHAPTERS

Hospital Stays for Children Where there are Welfare Concerns Procedure Safeguardinq Children and Younq People in the Youth Justice System

Procedure

Bullyinq Procedure

Peer Abuse Procedure

Allegations Aqainst Persons who Work with Children (includinq Carers and Volunteers) Procedure

Missinq Children and Families Procedure Private Fosterinq Procedure

Contents

Introduction

Essential Safeguards

Children in Foster Care

Children Placed for Adoption

Children in Residential Settings

Children of Families Living in Temporary Accomodation

Introduction

1. Revelations of the widespread abuse and neglect of children living away from home have done much to raise awareness of the particular vulnerability of children living away from home. Many of these revelations have focused on sexual abuse, but physical and emotional abuse and neglect - including peer abuse, bullying and substance misuse - are equally a threat in institutional settings.
2. Concern for the safety of children living away from home has to be put in the context of attention to the overall developmental needs of such children, and a concern for the best possible outcomes for their health and development. Every setting in which children live away from home should provide the same basic safeguards against abuse, founded on an approach that promotes their general welfare, protects them from harm of all kinds, and treats them with dignity and respect. These values are reflected in regulations and in the National Minimum Standards for Children's Homes, which contain specific requirements on safeguarding and child protection for each particular regulated setting where children live away from home.
3. Procedures for safeguarding and promoting the welfare of children apply in every situation, and to all settings, including where children are living away from home. Individual agencies that provide care for children living away from home should have clear and unambiguous procedures to respond to potential matters of concern about children's welfare in line with the procedures in Part 3, Manaqinq Individual Cases where there are concerns about a child's safety or welfare.

Essential Safeguards

4. There are a number of essential safeguards that should be observed in all settings in which children live away from home, including foster care, residential care. Private Fosterinq, armed forces bases, healthcare, boarding schools (including residential special schools), prisons, Young Offenders' Institutions, Secure Training Centres and secure units. Where services are not directly provided, essential safeguards should be explicitly addressed in contracts with external providers.
5. These safeguards should ensure that:
   • Children feel valued and respected and their self-esteem is promoted;
   • There is openness on the pan of the institution to the external world and to external scrutiny, including contact with families and the wider community;
   • Staff and foster carers are trained in all aspects of safeguarding children, alert to children's vulnerabilities and risks of harm, and knowledgeable about how to implement safeguarding children procedures;
   • Children who live away from home are listened to, and their views and concerns responded to;
   • Children have ready access to a trusted adult outside the institution - e.g. a family member, the child's social worker, or children's advocate. Children should be made aware of the help they could receive from independent advocacy services, external mentors and ChildLine;
   • Staff recognise the importance of ascertaining the wishes and feelings of children and understand how individual children communicate by verbal or non-verbal means;
   • There are clear procedures for referring safeguarding concerns about a child to Children's Social Care;
   • Complaints procedures are clear, effective, user-friendly and are readily accessible to children and young people, including those with disabilities and those for whom English is not their preferred language. Procedures should address informal as well as formal complaints. Systems that do not promote open communication about 'minor' complaints will not be responsive to major ones, and a pattern of 'minor' complaints may indicate more deeply seated problems in management and culture that need to be addressed;
   • Records of complaints should be kept by providers of children's services e.g. there should be a complaints register in every children's home that records all representations or complaints, the action taken to address them and the outcomes. Children should genuinely be able to raise concerns and make suggestions for changes and improvements, which should be taken seriously; o Bullying is effectively countered;
   • Recruitment and selection procedures are rigorous and create a high threshold of entry to deter abusers;
   • There is effective supervision and support that extends to temporary staff and volunteers;
   • Contractor staff are effectively checked and supervised when on site or in contact with children;
   • Clear procedures and support systems are in place for dealing with expressions of concern by staff and carers about other staff or carers. Organisations should have a code of conduct, instructing staff on their duty to their employer and their professional obligation to raise legitimate concerns about the conduct of colleagues or managers. There should be a guarantee that procedures can be invoked in ways that do not prejudice the 'Whistle-blower's' own position and prospects;
   • There is respect for diversity, and sensitivity to race, culture, religion, gender, age, sexual orientation and disability;
   • Staff and carers are alert to the risks of harm to children in the external environment from people prepared to exploit the additional vulnerability of children living away from home.

Children in Foster Care

6. Where children are cared for in foster care placements it involves children being in the private domain of carers' own homes. It is important that children have a voice outside the family. Social workers are required to see children in foster care on their own (taking appropriate account of the child's views), and evidence of this should be recorded.
7. Carers should be provided with full information about the child and his/her family, including details of abuse or possible abuse, both in the interests of the child and of the foster family.
8. Carers should monitor the whereabouts of the children they care for, their patterns of absence and contacts. Foster carers should follow the recognised procedure of their agency whenever a child placed with them is missing from their home. This

will involve notifying the placing authority and where necessary the Police of any unauthorised absence by a child.

9. The procedures in Part 3 of the manual relating to Managinq Individual Cases where there are concerns about a Child's Safety or Welfare, apply on the same basis to children in foster care as they do to children who live within their own families. In addition any allegations should be dealt with in line with the Allegations Against Persons who Work with Children (includinq Carers and Volunteers) Procedure. In these circumstances, Section 47 Enquiries should consider the safety of any other children living in the household, including the foster carers' own children. The local authority in which the child is living has the responsibility to convene a Strategy Discussion, which should include representatives from the responsible local authority that placed the child. At the Strategy Discussion it should be decided which local authority should take responsibility for the next steps.

Children Placed for Adoption

10. There is a particular vulnerability about children who are placed for adoption but not yet adopted in that they are almost, but not quite in the category of no longer Looked After, and there is a risk that safeguarding concerns in respect of the prospective adoption may be missed. It is very common for these children to be placed at a significant distance from their home authority, making intense monitoring of the placement more challenging.

1 1 . Where an allegation of abuse or neglect is made in respect of a child placed for adoption or in respect of a prospective or approved adopter, the following actions must be taken:

• Where a child is placed with prospective adopters, a prompt referral must be made to the placing authority and/or local authority where the child is placed (if different) if any allegation of abuse or neglect is received, in order for it to be investigated under that authority's procedures;
• Where Section 47 Enquiries are made in respect of a child by the local authority where they are placed, full co-operation must be given by any other authority with information about that child;
• Where the child is not placed with prospective adopters, there must be a prompt referral to the local authority where the main office of the Adoption Agency concerned is based, in respect of any allegation of abuse or neglect relating to the prospective adopters;
• The Regulatory Authority must be notified of the instigation and outcome of any Section 47 Enquiry;
• Consideration must be given as to the implications of the outcome of any allegation, and any necessary measures taken in order to protect children placed with prospective adopters in line with the Alleqations Aqainst Persons who Work with Children Procedure (includinq Caters and Volunteers);
• Adoption agencies must ensure that appropriate individuals working for the purposes of the agency, prospective adopters and children placed by the agency have access to any necessary information to enable them to contact local authority where a child is placed, plus the Regulatory Authority in respect of any concern about child welfare or safety relating to an adoptive placement.

Children in Residential Settings

12.All residential settings where children and young people are placed, including children's homes and residential schools, whether provided by a private, charitable or faith based organisation, or a local authority, must adhere to the Children's Homes Regulations 2001 and all other relevant regulations and to the relevant Quality Standards.

13. Clear records must be kept and reviews and inspections must take place in accordance with Quality Standards and regulations.
14. All such establishments must have in place complaints procedures for children and young people, visiting and contact arrangements with social workers and Independent Visitors (for looked after children), as well as parents, advocacy services.
15. Social workers have a legal duty to see children in residential care who are looked after, and evidence of this should be recorded on the child's records.
16. Where there is reasonable cause to believe that a child in a residential setting has suffered or is at risk of suffering Significant Harm, a referral must be made to Children's Social Care in accordance with the Referral Procedure. The concerns may range from bullying or abuse by other children to allegations against staff see Bullyinq  Peer Abuse Procedure and, where the concerns relate to a member or members of staff and/or the care the child is receiving in the residential setting, the Alleqations Against Persons who Work with Children (includinq Carers and Volunteers) Procedure will apply and a Strategy Meet(nq will be held.
17. When the concerns relate to a looked after child placed in residential care outside the area of the responsible local authority - see Transfer Across Local Authority Boundaries Procedure.
18. Where the concern arises in relation to a looked after child's placement, the local authority for the area where the child is placed also has responsibility to ensure that other local authorities who also have placed children in the same residential setting are aware of the concern or allegation and that consideration is given to protection of other children in the placement. They should also inform the Regulatory Authority.

Children of Families Living in Temporary Accommodation

19. Placement in temporary accommodation, often at a distance from previous support networks or involving frequent moves, can lead to individuals and families falling through the net and becoming disengaged from health, education, social care and welfare support systems. Some families who have experienced homelessness and are placed in temporary accommodation by local authorities under the main homeless duty can have very transient lifestyles. It is important that effective systems are in place to ensure that the children from homeless families receive services from health and education as well as any other specific types of services because these families move regularly and maybe at risk of becoming disengaged from services.
20. Where there are concerns about a child or children the procedures in Part 3 of the manual relating to Manaqinq Individual Cases where there are Concerns about a Child's Safety or Welfare should be followed.
21. If any professional is made aware that the temporary accommodation being provided for a child is unsuitable they should follow their agencies internal procedures in respect of notifying the local authority housing department of the need to take action.

5.7 Community, Voluntary and Faith Sector

RELATED NATIONAL GUIDANCE AND INFORMATION

o un a                                                    isauon		an	a

Multi-faith safeguarding hub: How to protect children and younq people within religious or faith settings (NSPCC) RELATED LOCAL GUIDANCE

Agreement Between Lancashire Council of Mosques and Pan Lancashire SCBs on Safequardinq Children

Guidance from the Diocese of Blackburn

Contents

Introduction Extract from Working Together to Safeguard Children

Introduction

1. Safeguarding children is everybody's responsibility and needs to be addressed by voluntary groups, from both religious and legal perspectives; to satisfy parents, organisers of the activities and the statutory organisations involved with child welfare;
2. Each organisation should ensure that they have in place policies and procedures in respect of the following:
   • What is child abuse and how you might recognise it; o Responding to a child reporting an incident;
   • Procedures to follow if the concern is about someone outside the organisation;
   • Procedures to follow if the concern is about someone inside the organisation, a Named Professional•
   • How to record concems and make a Referral to Children's Social Care if appropriate;
   • How the organisation recruits and checks the suitability of coaches/volunteers; o How to deal with bullying; o Guidelines for transport.
3. The organisation should develop their practice and procedures in line with law and the findings of research via links to the Blackburn with Darwen, Blackpool and Lancashire Children's Safeguarding Assurance Partnership (CSAP).

Extract from Working Together to Safeguard Children

The following is taken from Workinq Together to Safeguard Children - Chapter 2.

Voluntary, charity, social enterprise (VCSE) and private sector organisations and agencies play an important role in safeguarding children through the services they deliver. Some of these will work with particular communities, with different races and faith communities and delivering in health, adult social care, housing, prisons and probation services. They may as part of their work provide a wide range of activities for children and have an important role in safeguarding children and supporting families and communities.

Like other organisations and agencies who work with children, they should have appropriate arrangements in place to safeguard and protect children from harm. Many of these organisations and agencies as well as many schools, children's centres, early years and childcare organisations, will be subject to charity law and regulated either by the Charity Commission or other 'principal' regulators. Charity trustees are responsible for ensuring that those benefiting from, or working with, their charity, are not harmed in any way through contact with it. The Charity Commission for England and Wales provides guidance on charity compliance which should be followed. Further information on the Charity Commission's role in safeguarding can be found on: the Charity Commission's paqe on GOV.UK.

Some of these organisations and agencies are large national charities whilst others will have a much smaller local reach. Some will be delivering statutory services and may be run by volunteers, such as library services. This important group of organisations includes youth services not delivered by local authorities or district councils.

All practitioners working in these organisations and agencies who are working with children and their families are subject to the same safeguarding responsibilities, whether paid or a volunteer.

Every VCSE, faith-based organisation and private sector organisation or agency should have policies in place to safeguard and protect children from harm. These should be followed and systems should be in place to ensure compliance in this. Individual practitioners, whether paid or volunteer, should be aware of their responsibilities for safeguarding and protecting children from harm, how they should respond to child protection concerns and how to make a referral to local authority children's social care or the police if necessary.

Every VCSE, faith-based organisation and private sector organisation or agency should have in place the arrangements described in this chapter. They should be aware of how they need to work with the safeguarding partners in a local area. Charities (within the meaning of section 1 Charities Act 2011), religious organisations (regulation 34 and schedule 3 to School Admissions) and any person involved in the provision, supervision or oversight of sport or leisure are included within the relevant agency regulations. This means if the safeguarding partners name them as a relevant partner they must cooperate. Other VCSE, faith-based and private sector organisations not on the list of relevant agencies can also be asked to cooperate as part of the local arrangements and should do so

31

5.8 Complex (Organised or Multiple) Abuse

RELATED NATIONAL GUIDANCE

College of Policing: Managing Complex Child Abuse Investigations

Contents

Introduction

Action to Safeguard Children

Process of the Investigation

Introduction

1. Complex (organised or multiple) abuse may be defined as abuse involving one or more abusers and a number of children. The abusers concerned may be acting in concert to abuse children, sometimes acting in isolation, or may be using an institutional framework or position of authority to recruit children for abuse.
2. Organised and multiple abuse occur both as part of a network of abuse across a family or community and within institutions such as residential homes or schools. Its investigation is time consuming and demanding work requiring specialist skills from both Police and social work staff. Some investigations become extremely complex because of the number of places and people involved, and the timescale over which the abuse is alleged to have occurred.
3. The complexity is heightened where, as in historical cases, the alleged victims are no longer living in the situations where the incidents occurred or where the alleged perpetrators are also no longer linked to the setting or employment role. Cases of historical abuse often come to light when adults disclose abuse they suffered as children whilst living away from home. Such cases should be responded to in the same way as any other concerns. It is important to ascertain if the alleged perpetrator is still working with, or caring for children.
4. The Children's Social Care, in the area where the alleged incident took place, has case responsibility and should arrange a Strategic Planning Meeting to determine any further action required.

Action to Safeguard Children

5. Each investigation of organised or multiple abuse will be different, according to the characteristics of each situation and the scale and complexity of the investigation. Each requires thorough planning, good inter-agency working and attention to the needs of the children involved.
6. Once organised abuse is suspected, the Children's Social Care and/or Police must be informed as soon as possible. Within Children's Social Care, the relevant Manager must be informed. Other agencies should not make any further enquiries. The Police and Children's Social Care will liaise at senior management strategic level to consider the following issues:
   • The overall scope and management of the case, including the handling of political and media issues; o The deployment of appropriate resources and the support staff;
   • The need to establish a dedicated joint team who can conduct the criminal investigation and Section 47 Enquiries objectively;
   • A process of strategic review to oversee the whole investigation and to identify and act on lessons learned for future policy and procedure and practice;
   • A programme of Strategic Planning Meetings should be established to agree:
   • Terms of reference and lines of accountability and communication;

 Sharing of information, access to, and secure storage of records. See also Information Sharing & Confidentiality Procedure;

 Access to legal advice regarding the criminal, civil and employment processes;

• Whether there are any children involved who need active safeguarding and/or therapeutic help;
• How safeguarding and help can be achieved in a way consistent with the conduct of the criminal investigations;
• How victims' needs will be assessed and met;
• How care for the investigating team can be provided;
• How, at the end of the investigation, it can be assessed and lessons learned for the future.

Process of the Investigation

7. In all major investigations the CSAP organisations will aim to:
   • Bring together a trusted and vetted team from Police and social work (Children's Social Care or NSPCC or both) to manage and conduct major investigations where a criminal investigation runs alongside child protection enquiries;
   • Set out clearly the terms of engagement for the team, emphasising the need for confidentiality;
   • Ensure that the managers of the team have training and expertise in conducting investigations, legal processes, disciplinary proceedings, children's welfare and profiles and methods of abusers (in cases of sexual abuse);

 Ensure team members have expertise in conducting investigations, child protection processes and children's welfare and are committed to working closely together;

 Involve senior managers from involved agencies at a strategic level. The Police will appoint a Senior Investigating Officer of appropriate rank and experience;

 Ensure that appropriate resources are deployed and staff supported;

 Agree upon the handling of political and media issues arising from investigations;

 Ensure that records are safely and securely stored;

 Recognise and anticipate that an investigation may become more extensive than suggested by initial allegations;

• Ensure independence and objectivity on the part of the social work team, where Children's Social Care staff or foster carers are being investigated;

 Where it is practicable in the circumstances to conduct a rigorous and impartial investigation using the local authority's own staff, ensuring sufficient distance (in structural and geographical terms) between such staff and those being investigated This means that the inclusion of staff members or managers from the institution or workplace under investigation should be considered with particular care;

• Begin every investigation with a Strategic Planning Meeting to agree terms of reference and ways of working. Relevant areas for decision-making include the timing, parameters and conduct of the investigation; lines of accountability and communication; the safe and secure storage of records; the deployment of staff and resources; and a communications strategy encompassing members of staff, children and families, and the media;

Terms of reference should include assurances that the team will have full access to records and individuals that hold important information;

 Secure access to expert legal advice. The inter-relationship between criminal, civil and employment processes is complex;

 Use regular Strategic Planning Meetings and reviews to consider the conduct of the investigation, next steps and the effectiveness of joint working;

 Always minute meetings and records actions that have been agreed with timeframes;

 Agree clear written protocols between the Police, Children's Social Care and other agencies in relation to all key operational and policy matters including information sharing. See Information Sharing & Confidentiality Procedure;

 Consider first whether there are any children involved who need active safeguarding and/or therapeutic help and how this should be achieved in a way that is consistent with the conduct of criminal investigations;

 Make a thorough assessment of victims' needs and provide services to meet those needs;

 Provide a confidential and independent counseling service for victims and families;

 Agree guidelines with counseling and welfare services on disclosure of information to avoid the contamination of evidence;

 Provide welfare and support for the investigation team - much of the work may be difficult and distressing;

 Put in place a means of identifying and acting on lessons learned from the investigations (e.g. in respect of policies, procedures and working practices which may have contributed to the abuse occurring) as the investigation proceeds and at its close and at the conclusion of the investigation assess its handling and identify lessons for conducting similar investigations in future;

 At the conclusion of the investigation assess its handling and identify lessons for conducting similar investigations in future.

12.3.19 Concealed or Denied Pregnancy

AMENDMENT

This chapter was updated in August 2018.

Contents

1 . Introduction and Purpose of the Guidance

2. Definition
3. Evidence from Research and Serious Case Review
4. Implications of a Concealed or Denied Pregnancy
5. Where Suspicion Arises
6. When a Concealed or Denied Pregnancy is Revealed
7. Educational Settings Including Early Help Services
8. Health Professionals
9. Midwives and Midwifery Service
10. Children's Social Care

1 1 . Police

12. Other Agencies (including the Voluntary Sector)
13. Bibliography
14. Additional Reading

1. Introduction and Purpose of the Guidance

1. .1 The purpose of this policy and procedure is for anyone who may encounter a woman who conceals the fact that she is pregnant, where this is a known previous concealed pregnancy or where a professional has a suspicion that a pregnancy is being concealed or denied.

1.2 The concealment and denial of pregnancy will present a significant challenge to professionals in safeguarding the welfare and wellbeing of the foetus (unborn child) and the mother. There may be a number of reasons why a pregnancy is concealed or denied, for example:

A woman or girl may conceal their pregnancy if it occurred as the result of sexual abuse, either within or outside the family, due to her fear of the consequences of disclosing that abuse;

36

A pregnancy may be concealed in situations of domestic abuse, within a forced marriage or for a forced marriage to avoid shame on a family;

There is growing intelligence that suggests pregnant women are exploited for sham marriages and benefit fraud, likewise the unregulated nature of the surrogacy industry puts women and children at risk of exploitation and trafficking and may not therefore conceal their pregnancies due to control and coercion;

Due to stigma, shame or fear through cultural or family pressures, concealment may be a deliberate means of coping with the pregnancy or avoiding brining shame on the family;

Fear of a child being removed where a woman has had a previous child removed, or asylum seekers and illegal immigrants who may be reluctant to inform the authorities that she is pregnant;

In some cases the woman may be truly unaware that she is pregnant until very late in the pregnancy, either due to age or learning disability if they do not understand why their body is changing;

There are links between denial of pregnancy and dissociative states brought about by trauma or loss; or denial stems from an expectant mother misusing drugs or alcohol which can harm the foetus or because of mental illness, such as schizophrenia.

While concealment and denial, by their very nature, limit the scope of professional help better outcomes can be achieved by coordinating an effective inter-agency approach. This approach begins when a concealment or denial of pregnancy is suspected or in some cases when the fact of the pregnancy (or birth) has been established. This will also apply to future pregnancies where it is known or suspected that a previous pregnancy was concealed or denied.

2. Definition
   1. A concealed pregnancy is when a woman knows she is pregnant but does not tell anyone or any health professional; or when she tells another professional but conceals the fact that she is not accessing antenatal care; or when an expectant mother tells another person or persons and they conceal the fact from all health agencies.
   2. A denied pregnancy is when an expectant mother is unaware of or unable to accept the existence of her pregnancy. Physical changes to the body may not be present or misconstrued; they may be intellectually aware of the pregnancy but continue to think, feel and behave as though they were not pregnant. In some cases an expectant mother may be in denial of her pregnancy because of mental illness, substance misuse or as a result of a history of loss of a child or children (Spinelli, 2005).
   3. For the purpose of this protocol any reference to an expectant mother includes females of childbearing capacity (including under 18's). A pregnancy will not be considered to be concealed or denied for the purpose of this protocol until it is confirmed to be at least 24 weeks; (in some organisations late booking may be considered earlier than this and Pan Lancashire pre-birth protocol may be considered at 16 weeks where there are significant safeguarding concems). However by the very nature of concealment or denial it is not possible for anyone suspecting an expectant mother js concealing or denying a pregnancy to be certain of the stage the pregnancy is at.
3. Evidence from Research and Serious Case Review
   1. Research into concealment and denial of pregnancy is relatively recent, in the last 40 years, and this work has attempted to understand the characteristics of women who conceal or deny their pregnancy. Research has also been carried out to explore links between concealed pregnancy and infanticide (killing of a child in the first year of life). Reviews of cases where concealment or denial of pregnancy has been identified as a factor in the death or serious injury of a child. The issue of concealment and denial of pregnancy, and infanticide/filicide (the killing of a child by a parent) can be evidenced throughout human history.
   2. A summary of thirty-five major child death inquiries (Reder P, 1993) highlighted evidence of considerable ambivalence or rejection of some of those pregnancies and a significant number with little or no antenatal care. A follow-up study (Reder P. D., 1999) also identified a small sub-group of fatality cases where mothers did not acknowledge that they were pregnant and failed to present for any antenatal care and the babies were born in secret.
   3. Several studies (Earl, 2000); (Friedman S. M., 2005); (Vallone, 2003) highlight a well-established link between neonaticide - killing of a child by a parent in the first 24 hours following birth - and concealed pregnancy. A review of 40 Serious Case Reviews (DHSC, 2002) identified one death was significant to concealment of pregnancy.
   4. A number of studies have attempted to identify the frequency of concealment or denial of pregnancy (Nirmal, 2006); (Wessel, 2002). They suggest concealment might occur in about 1 :2500 cases (0.04%). A study by (Friedman S. H., 2007) showed a higher proportion with 0.26% of all pregnancies in their sample (approx. 31 ,OOO) to be concealed or denied. The characteristics of those in this study showed that 50% of those concealing the pregnancy and 59% of those denying the pregnancy were aged between 18 and 29 years. Only 40% of those concealing and 23% of those in denial of their pregnancy were under 18 years of age.
   5. A recent study in France into the rate of neonaticide by looking back at judicial data (court cases and inquests) concluded that the rate was 2.1 per 100,000 births, a much higher rate that the official mortality statistics suggested. All of the pregnancies identified in the study were concealed

but none were completely denied by the woman (no awareness of being pregnant). The characteristics of the women in the study were explored and over half of them lived with the child's father, and 13 of the 17 women identified were classed as professionally active with a status identical to that of the general population. The authors concluded that neonaticide appeared as a solution to an unwanted pregnancy that risked a family scandal or loss of a partner or lifestyle. (Tursz and Cook, 2010)

1. The majority of religious faiths traditionally expect pregnancy to follow after marriage. Dependent upon the culture and religious observance, a pregnancy outside of marriage may have serious consequences for the women involved. This can create a significant pressure on an expectant mother to seek to conceal a pregnancy or for the psychological conditions to be present where a pregnancy is denied. In some local and national cases collusion between family and partners has occurred to facilitate and encourage concealment of the pregnancy from those outside of the family or wider culture/community. Some pregnant women, or their partners, who abuse drugs and /or alcohol may actively avoid seeking medical help during pregnancy for fear that the consequences of increased attention from statutory agencies can result in the removal of their child.

4. Implications of a Concealed or Denied Pregnancy
   1. The implications of concealment and denial of pregnancy are wide-ranging. Concealment and denial can lead to a fatal outcome, regardless of the mother's intention.
   2. Lack of antenatal care can mean that potential risks to mother and child may not be detected. The health and development of the baby during pregnancy and labour may not have been monitored or foetal abnormalities detected. It may also lead to inappropriate medical advice being given; such as potentially harmful medications prescribed by a medical practitioner unaware of the pregnancy e.g. some epilepsy medication. NICE guidance published in October 2017 makes recommendations about practice in relation to children and young people under 18, including unborn babies.
   3. Underlying medical conditions and obstetric problems will not be revealed if antenatal care is not sought. An unassisted delivery can be very dangerous for both mother and baby, due to complications that can occur during labour and the delivery. A midwife should be present at birth, whether in hospital or if giving birth at home.

Good practice in antenatal care:

Midwives and GPs should care for women with an uncomplicated pregnancy, providing continuous care throughout. Obstetricians and specialist teams should be brought in where necessary;

In the first contact with a health professional, an expectant mother should be given information on folic acid supplements; food hygiene and avoiding food-acquired infections; lifestyle choices such as

smoking cessation or drug use; and the risks and benefits of antenatal screening;

The booking appointment with a midwife ideally should be around 10 weeks. This appointment should help the expectant mother plan the pregnancy, offer some initial tests and take measurements to help determine any specific risks for the pregnancy. The expectant mother should be given advice on nutritional supplements and benefits;

Give information that is easily understood by all women, including those with additional needs, learning difficulties or where English is not their first language. Ensure the information is clear, consistent and backed up by current evidence;

     Remember to give an expectant mother enough time to make decisions and respect her decisions even if they are contrary to your own views;

Women should feel able to disclose problems or discuss sensitive issues with you. Be alert to the symptoms and signs of domestic violence and abuse.

Adapted from Antenatal care: Routine care for the healthy pregnant woman, NICE, 2008 (NICE update due June 2020)

1. An implication of concealed or denied pregnancy could be a lack of willingness or ability to consider the baby's health needs, or lack of emotional bond with the child following birth. It may indicate that the mother has immature coping styles or is simply unprepared for the challenges of looking after a new baby. In a case of a denied pregnancy, the effects of going into labour and giving birth can be traumatic.
2. Where concealment is a result of alcohol or substance misuse there can be risks for the child's health and development in utero as well as subsequently. There may be implications for the mother revealing a pregnancy due to fear of the reaction of family members or members of the community; or because revealing the identity of the child's father may have consequences for the parents and the child.

5. Where Suspicion Arises
   1. This section outlines actions to be taken when a concealed or denied pregnancy is suspected (see Section 2, Definition). If a pregnancy is suspected of being concealed or denied, the expectant mother should be strongly encouraged to go to her GP or direct to midwife to access antenatal care. If the expectant mother accesses her GP, the GP practice will help her register with midwifery services for ultrasound scanning and advice about pregnancy and birth.
   2. Professionals must balance the need to conserve confidentiality and the potential concem for the unborn child and the mother's health and wellbeing. Where any professional has concerns about concealment or denial of pregnancy, they should contact any other agencies known to have involvement with the expectant mother so that a fuller assessment of the available information and observations can be made.
   3. Where there is strong suspicion of a concealed or denied pregnancy, it is necessary to share this irrespective of whether consent to disclose can be obtained or has been given. In these circumstances the welfare of the pregnant woman will override her right to confidentiality. A referral should be made to Children's Social Care about the unborn child - see Making Referrals to Children's Social Care Procedure and Pan Lancashire Pre Birth Protocol. A referral to Adult Social Care may be required if the mother has care and support needs. If the expectant mother is under 18 years, consideration will be given to whether she is a Child in Need. Where the mother is, or may have been at the time of conception, under the age of 18, professionals should follow the processes outlined in Sexually Active Young People Under the Age of 18 Procedure. In addition, if she is less than 16 years then a criminal offence may have been committed and this needs to be investigated.
   4. The reason for the concealment or denial of pregnancy will be a key factor in determining the risk to the unborn young person or newborn baby.

The reasons will not be known until there has been a multi-agency assessment. If there is a denial of pregnancy, consideration must be given at the earliest opportunity to a referral to enable the expectant mother to access appropriate mental health services for an assessment. Advice can be sought from the designated or named professional or from Children's Social Care.

Legal considerations about concealment and denial of pregnancy:

United Kingdom law does not legislate for the rights of unborn children and therefore a foetus is not a legal entity and has no separate rights from its mother. This should not prevent plans for the protection of the unborn child being made and put into place to safeguard the baby from harm both during pregnancy and after the birth;

In certain instances legal action may be available to protect the health of a pregnant woman, and therefore the unborn child, where there is a concern about the ability to make an informed decision about proposed medical treatment, including obstetric treatment. The Mental Capacity Act 2005 states that person must be assumed to have capacity unless it is proven that she does not. A person is not to be treated as unable to make a decision because they make an unwise decision. It may be that a pregnant woman denying her pregnancy is suffering from a mental illness and this is considered an impairment of mind or brain, as stated in the act, but in most cases of concealed and denied pregnancy this is unlikely to be the case;

There are no legal means for a local authority to assume Parental Responsibility over an unborn baby. Where the mother is a child and subject to a legal order, this does not confer any rights over her unborn young person or give the local authority any power to override the wishes of a pregnant young person in relation to medical help.

6. When a Concealed or Denied Pregnancy is Revealed
   1. This section outlines actions to be taken when a concealed or denied pregnancy is revealed. Midwifery services will be the primary agency involved with an expectant mother after the concealment is revealed, late in pregnancy or at the time of birth. However it could be one of many agencies or individuals that an expectant mother discloses to or in whose presence the labour commences. It is vital that all information about the concealment or denial is recorded and shared with relevant agencies to ensure the significance is not lost and risks can be fully assessed and managed.
   2. Where a pregnancy is revealed to be denied and concealed it is vital the circumstances in each case are explored fully with the expectant mother and appropriate support and guidance offered to her. It is important to understand the reasons why the pregnancy has been denied or concealed.
   3. When risks are identified as a results of a concealed on denied pregnancy then appropriate referrals should be made to relevant agencies for example Mental Health services or Children Social Care (please refer to MultiAgency Pre-Birth Protocol).
7. Educational Settings Including Early Help Services
   1. In many instances staff in these settings may be the professionals who know a young person best. There are several signs to look out for that may give rise to suspicion of concealed pregnancy: , Increased weight or attempts to lose weight;  Wearing uncharacteristically baggy clothing;  Concerns expressed by friends;

Repeated rumours around school or college;

Uncharacteristically withdrawn or moody behaviour;

Missing from education, child sex exploitation and missing from home.

1. Staff working in educational settings, including Early Help, should try to encourage the pupil to discuss her situation, through normal pastoral support systems, as they would any other sensitive issue. Every effort should be made by the professional suspecting a pregnancy to encourage the young person to obtain medical advice. However, where they still face total denial or non-engagement further action should be taken. It may be appropriate to involve the assistance of the Designated Lead Person for Safeguarding in addressing these concems.
2. Consideration should be given to the balance of need to preserve confidentiality and the potential concern for the unborn child and the mother's health and wellbeing. Where there is a suspicion that a pregnancy is being concealed it is necessary to share this information with other agencies, irrespective of whether consent to disclose can be obtained.
3. Staff may often feel the matter can be resolved through discussion with the parent of the young person. However, this will need to be a matter of professional judgment and will be clearly depend on individual circumstances including relationships with parents. It may be felt that the young person will not admit to her pregnancy because she has genuine fear about her parent's reaction, or there may be other aspects about the home circumstances that give rise to concern, such as domestic or sexual abuse, honour based abuse, forced marriage and FGM. If this is the case then a referral to Children's Social Care should be made without speaking to the parents first - see Making Referrals to Children's Social Care Procedure.
4. If education staff engage with parents they need to bear in mind the possibility of the parent's collusion with the concealment. Whatever action is taken, whether informing the parents or involving another agency, the young person should be appropriately informed, unless there is a genuine concern that in so doing she may attempt to harm herself or the unborn baby.

7 6 If there is a lack of progress in resolving the matter in the setting or escalating concerns that a young person may be concealing or denying she is pregnant, there must be a referral to Children's Social Care. Where there are significant concerns regarding the girl's family background or home circumstances, such as a history of missing from home, risk of CSE, abuse or neglect, a referral should be made immediately. As with any referral to Children's Social Care, the parents and young person should be informed, unless in doing so there could be significant concern for her welfare or that of her unborn child.

8. Health Professionals
   1. The local commissioners of health services are responsible for ensuring all its commissioned providers of health care fulfil their statutory responsibilities for safeguarding children.
   2. The health professionals whom may be involved include:

Paediatrician;

Health Visitors;

    School nurses;

    Sexual Health and GUM services;

    General Practitioners and Practice nurses;

Midwifes and Obstetricians/Gynaecologists;

Mental Health Nurses;

Drug and Alcohol workers;

Learning Disability workers;

    Psychologists and Psychiatrists;

    SUDC (Sudden or Unexpected Death in Childhood) Nurses;

Commissioned termination of pregnancy services.

(This is not an exhaustive list)

1. If a health professional suspects or identifies a concealed or denied pregnancy and there are significant concerns for the welfare of the unborn baby, (s)he must refer to Children's Social Care - see Making Referrals to Children's Social Care Procedure / pre-birth protocol - and inform all the health professionals, including the General Practitioner, involved in the care of the woman.
2. All health professionals should give consideration to the need to make or initiate a referral for a mental health assessment at any stage of concern regarding a suspected (or proven) concealed or denied pregnancy.
3. Accident and Emergency staff or those in Radiology departments need to routinely ask women of childbearing age whether they might be pregnant. If suspicions are raised that a pregnancy may be being concealed, these staff should follow safeguarding procedures (Section 5, Where Suspicion Arises) or revealed (Section 6, When a Concealed or Denied Pregnancy is Revealed).
4. Health professionals who provide help and support to promote children's or women's health and development should be aware of the risk indicators and how to act on their concerns if they believe a woman may be concealing or denying a pregnancy.
5. GP practices should record the concealed pregnancy on both the mothers and baby's notes as this information could be of relevance in future safeguarding decision making.

9. Midwives and Midwifery Service
   1. If an appointment for antenatal care is made late (beyond 24 weeks), the reason for this must be explored. If an exploration of the circumstances suggests a cause for concern for the welfare of the unborn baby, a referral to Children's Social Care must be made - see Making Referrals to Children's Social Care Procedure / pre-birth protocol. The expectant mother should be informed that the referral has been made, the only exception being if there are significant concerns for her safety or that of the unborn child.
   2. If an expectant mother arrives at the hospital in labour or following an unassisted delivery, where a booking has not been made, then an urgent referral must be made to Children Social Care. If this is in an evening, weekend or over a public holiday then the Children Social Care Emergency Duty Team must be informed.
   3. If the baby has been harmed in any way or there is a suspicion of harm, or the child is abandoned by the mother, then the Police must be informed immediately, and a referral made to Children's Social Care.
   4. Midwives should ensure information regarding the concealed pregnancy is placed on the child's, as well as the mother's, health records. Following an unassisted delivery or a concealed/denied pregnancy, midwives need to be alert to the level of engagement shown by the mother, and her partner/extended family if observed, and of receptiveness to future contact with health professionals. In addition, midwives must be observant of the level of attachment behaviour demonstrated in the postnatal period.
   5. Neither baby nor the mother should be discharged until they have had full assessment of their needs, including identification of risks and a multiagency discharge planning meeting held. A discharge summary from maternity services to the relevant GP must report if a pregnancy was concealed or denied or booked late (beyond 24 weeks).
10. Children's Social Care
    1. Children's Social Care / Emergency Duty Team may receive a referral from any source, which suggests a pregnancy is being concealed or denied. Safeguarding processes must be implemented and consideration of an assessment should be made.

This would ordinarily be done by voluntary agreement with the mother, although where the mother's consent is not freely given, consideration should be given to whether there are grounds for seeking an Emergency Protection Order to ensure the baby remains in hospital until a the discharge plan is agreed. Alternatively, the assistance of the Police - via Police Protection - may be sought to prevent the child from being removed from the hospital.

If the baby is bom at home the midwife or ambulance service (which ever professional is present), should ensure the baby is admitted to hospital even if the mother herself declines her own admission (see 4.3).

1. Where the expectant mother is under the age of 18, initial approaches should be made confidentially to the young person to discuss concerns regarding the potential concealed or denied pregnancy and unborn child. She should be provided with the opportunity to confirm the pregnancy by undertaking appropriate tests or to make plans for the baby. There may be significant reasons why a young person may be concealing a pregnancy from her family and a professional should consider speaking to her without her parent's knowledge in the first instance.
2. Where there are clear reasons for suspecting pregnancy in the face of continuing denial or concealment, the professionals will need to continue to assess the situation with a focus on the needs /welfare of woman. It must not be forgotten that where the mother is under 18, she may also be considered a Child in Need or Child in Need or Protection. Such a situation will require very sensitive handling.
3. Regardless of the age of the expectant mother where there are additional concerns (i.e. as well as the suspected concealed or denied pregnancy) where risk factors are present, including ongoing/previous child protection concerns Social Care must undertake an appropriate safeguarding assessment.
4. If an expected mother has arrived at hospital either in labour or following an unassisted birth when a pregnancy has been concealed or denied, an Assessment of risks is made and Children Social Care are to undertake an appropriate safeguarding assessment.
5. Where a baby has been harmed, has died or has been abandoned a section 47 enquiry must be completed in collaboration with the Police and the Pan Lancashire SUDC (Sudden or Unexpected Death in Childhood) Protocol initiated The Management of Sudden Unexpected Deaths in Childhood (SUDC)

10 7 In undertaking an assessment, the social worker will need to focus on the facts leading to the pregnancy, reasons why the pregnancy was concealed and gain some understanding of what outcome the mother intended for the child. These factors, along with the other elements of the Continuum of Need Risk Sensible Framework for Multi Agency Partners and Assessment Framework will be key in determining risk.

1 0.8 Accessing psychological services in concealment and denial of pregnancy may be appropriate and consideration should be given to referring an expectant mother for psychological assessment. There could be a number of issues for the woman, which would benefit from psychological intervention. A psychiatric assessment might be required in some circumstances, such as where it is thought she poses a risk to herself or others or in cases where a pregnancy is denied.

1 0.9 The pathway for psychological or psychiatric assessment, either before or after pregnancy, is the same. A referral should be made using the single point of entry to mental health services and the referral letter copied to the woman's GP. The referral should make clear any issues of concern for the woman's mental health and issues of capacity.

11. Police

1 1 .1 The Police will be notified of any child protection concerns received by Children's Social Care where concealment or denial of pregnancy is an issue. A police representative will be invited to attend the multi-agency Strategy Meeting and consider the circumstances and to decide whether a joint Child Protection investigation should be carried out.

1 1 .2 Factors to consider will be the age of the expectant mother who is suspected or known to be pregnant, and the circumstances in which she is living to consider whether she is a victim or potential victim of criminal offences. In all cases where a child has been harmed, been abandoned, died or expected to die it will be incumbent on the Police and Children's Social Care to work together to investigate the circumstances. This will involve the Pan Lancashire SUDC team in the event of a child death or where the prognosis is poor. Where it is suspected that neonaticide or infanticide has occurred then the Police will be the primary investigating agency.

12. Other Agencies (including the Voluntary Sector)
    1. All professionals or volunteers in statutory or voluntary agencies who provide services to women of childbearing age should be aware of the issue of concealed or denied pregnancy and follow this procedure when a suspicion arises.
    2. All referrals will be made to the Children's Social Care initially as a referral on an unborn child. Where the expectant mother is under 1 8 years of age she will be considered as a Child in Need and assessed accordingly.
13. Bibliography

This guidance is based on the Bury Concealed and Denied Pregnancy Protocol Brezinkha, C. H. (1994). Denial of Pregnancy: obstetrical aspects. Psychosomatic Obstetrics and Gynaecology, 1-8.

DHSC. (2002). Learning from Past Experience - A Review of Serious Case Reviews. London: Department of Health and Social Care.

Earl, G. B. (2000). Concealed pregnancy and child protection. Childright Volume 171 , 19-20.

Friedman, S. H. (2007). Characteristics of Women Who Deny or Conceal Pregnancy. Psychosomatics, 117-122.

Friedman, S. M. (2005). Child murder by mothers: A critical analysis of the current state of knowledge and a research agenda. The American Journal of Psychiatry, 15781587.

Moyer, P. (2006). Pregnant Women in Denial rarely receive Psychiatric Evaluation. Medscape Medical News (p. Abstract NR930). APA 159 Annual Meeting (May 25 2006).

Nirmal, D. T. (2006). The incidence and outcome of concealed pregnancies among hospital deliveries: an 1 1 year population based study in South Glamorgan. Journal of Obstetrics and Gynaecology, 118-121.

Reder, P. (1993). Beyond blame; Child Abuse tragedies revisited. London: Routledge. Reder, P. D. (1999). Lost Innocents: A follow-up study of fatal child abuse. London: Routledge.

Royal College of Obstetrics and Gynaecology. (2006). Law and Ethics in relation to court authorised obstetric intervention. London: RCOG.

Spielvogel, A. H. (1995). Denial of Pregnancy: a review and case reports. Birth, 220226.

Spinelli, M. (2005). In S. Friedman, Infanticide.

Tursz, A., & Cook, J. M. (2010, December 6). A population-based survey of neonaticides using judicial data. Retrieved October 3, 2011 , from Arch Dis Child Foetal Neonatal Ed

Vallone, D. H. (2003). Preventing the Tragedy of Neonaticide. Holistic Nursing Practice, 223-228.

Wessel, J. B. (2002). Denial of Pregnancy: Population based study. British Medical Journal (International Edition), 458.

14. Additional Reading

Antenatal Care: Routine care for the healthy pregnant woman, Quick Reference Guide. National Institute for Clinical Excellence, 2008

Law and Ethics in relation to court-authorised obstetric intervention; Ethics Committee

Guideline No. 1 Royal College of Obstetricians and Gynaecologists. Sept 2006

Lancashire Safeguarding Boards Serious Case Reviews

5.10 Dangerous or Out of Control Pets

SCOPE OF THIS CHAPTER

This guidance explains the importance of professionals making routine enquiries regarding dogs in the household whenever they are working with children and families. It then looks at the action which is required when a child is injured by a dog and / or when there are concems that a dog in the household may be dangerous or prohibited.

AMENDMENT

In May 2018, this chapter was reviewed and updated.

Contents

Introduction and Definition

Legislation Relating to Dangerous Dogs and Other Pets

Assessing Risks to Children and Young People

Protection and Action to be Taken

Practitioner Safety

Animal Welfare

Further Information

Introduction and Definition

The benefits of owning pets are well established. Living in a pet owing household can have physical and emotional benefits for children as well as teaching them about responsibility and caring for living creatures. However, in recent years a number of children of different ages have been seriously injured or have died from attacks by dogs, and it is important therefore that professionals working with children and families are aware of the issues around dangerous dogs and the risks they can pose to children and young people.

The aim of this chapter is to help practitioners to understand how to assess any risks which dogs in then household might pose to children and take action as necessary to protect children from serious injuries which can be inflicted by pets that are prohibited, dangerous or badly looked after or mistreated by their owners. It also provides advice for practitioners to enable them to undertake home visits more safely.

The guidance covers the following:

How to routinely ask questions about dogs in the household or in regular contact with children and young people and how to assess any associated risks;

The action that should be taken if a child is living in a household with a prohibited or dangerous dog; and

The information that should be gathered when any child is injured by a pet and the issues to be considered when making a referral in line with the Making a Referral to Children's Social Care Procedure.

The abuse of animals can be part of a constellation of intra-familial abuse, which can include maltreatment of children and domestic violence and abuse. However, this does not imply that children who are cruel to animals necessarily go on to be violent adults, or that adults who abuse animals are also violent to their partners and/or children. Effective investigation and assessment are crucial to determine whether there are any links between these factors and the possible risks to the safety and welfare of children and/or vulnerable adults.

Note that the chapter refers to pets throughout in order to promote the need for practitioners to consider the risks presented by any animal, however specific legislation only applies to dogs.

Legislation Relating to Dangerous Dogs and Other Pets

The Dangerous Dogs Act (1991) provides detailed information about the legislation covering certain types of dogs, sets out the responsibilities of the owners and described the actions that can be taken to remove and/or control dogs:

Certain dogs are 'prohibited' and if any agency has any knowledge or report of a dog of this type, the matter should be reported to the Police immediately;

Any dog can be 'dangerous' (as defined by the Act) if it has already been known to inflict or threaten injury;

Injuries inflicted by certain types of dog are likely to be especially serious and damaging. Strong, powerful dogs such as Pit Bull Types will often use their back jaws (as opposed to 'nipping') and powerful neck muscle to shake their victims violently as they grasp;

When reports of 'prohibited' dogs and known or potentially dangerous dogs are linked to the presence of children, all agencies should be alert to the possible risks to children and potential consequences.

Lancashire Constabulary have provided the additional guidance included within Section 6, Further Information which provides more detailed guidance for identifying dangerous dogs.

Part 7. of the Anti-social Behaviour, Crime and Policing Act 2014 strengthens powers to tackle irresponsible dog ownership by extending the offence of owning or being in charge of a dog that is dangerously out of control in a public place to also cover private places. It also provides that a dog attack on an assistance dog constitutes an aggravated offence.

Part 7. also ensures that the courts can take account of the character of the owner of the dog, as well as of the dog itself, when assessing whether a dog should be destroyed on the grounds that it is a risk to the public.

The Home Office Crime Classification 8/21 is amended to: "Owner or person in charge allowing a dog to be dangerously out of control in any place in England or Wales (whether or not in a public place) injuring any person or assistance dog." Section 3 (1 ) Dangerous Dogs Act 1991 as amended by Section 106 Anti-Social Behaviour Crime and Policing Act 2014.

The Dangerous Wild Animals Act 1976 requires keepers of dangerous or wild animals to hold a licence. These are issued by unitary and district authorities who may be able to advise practitioners who encounter unusual pets in the course of home visits.

Assessing Risks to Children and Young People

When a practitioner from any agency undertakes a home visit and there are both children and pets in the household, the practitioner should routinely consider whether the presence of the pets presents any kind of risk to the welfare of the child/ren. This should involve a discussion with the parents or the pet owner about the dog's behaviour. This is particularly important when there is a new baby in the household. The pet owner should be asked whether the dog's behaviour has changed since the baby was brought home. This assessment of risk should be repeated when the baby begins to become mobile.

There will be times when even the most well cared for pet, behaves in a way that had not been expected. The care, control and context of a pet's environment will impact on the pet's behaviour and the potential risks it may pose. Research indicates that neutered or spayed pets are less likely to be territorial and aggressive towards other dogs and people. Pets that are kept and/or bred for the purpose of fighting, defending or threatening others are likely to present more risks than genuine pets.

All children are potentially vulnerable from an attack by a pet but very young children are likely to be at greatest risk. A young child will be unaware of the potential dangers they could face and will be less able to protect themselves. Small children are of a size that leaves especially vulnerable parts of their body exposed. The question should be asked: 'is the pet left alone with the child?' This applies even if the child is in a cot, bed or seat of some kind.

See also Animal Welfare for guidance from the RSPCA on assessing the whether a dog's welfare needs are being met.

If it is the professional judgement of the practitioner that a pet is prohibited or presents a risk to a child, the Police or Children's Social Care should be contacted immediately.

National animal welfare charities provide a wide array of useful advice and information about looking after pets and ensuring the safety of children. The general advice that is provided from all animal welfare charities includes:

Do not leave babies and young children unattended around pets;

Do not leave doors open to children's rooms allowing pets access to sleep areas;

     Ensure children are not sleeping in areas of the house where the pets may usually also sleep;

Do not ignore pets when they show aggression — always separate pets away from children; and

Teach children not to disturb pets when they are sleeping, eating, caring for their offspring or when pets are ill or injured.

Protection and Action to be Taken

Any agency that becomes aware of a dog that could be prohibited or considered dangerous, should collect the following information:  The dog's name and breed and/or description;

Information about the owner;

The reason for keeping the dog and information about other family members, particularly young children.

Where there is a report of a child having been injured by any pet (or exposed to the risk of injury) a referral to Children's Social Care should be considered. In deciding whether or not to make a referral, consideration should be given to:

The nature of the injuries;

The circumstances of the attack / incident;

Whether the parents or dog owner sought medical advice;

Whether the dog has previously shown any aggression; and

What action the pet owner has taken to prevent a recurrence of any attack.

Remember, if a practitioner has reason to believe that a dog in the household is prohibited or presents a risk to a child, the Police or Children's Services should be contacted immediately. Other considerations before making a referral should be:

The injured child is under two years of age;

The child is under five years of age and the injuries have required medical treatment;

     The child is over five years and under 18 and has been injured more than once by the same pet;

The child/young person is under 18 years of age, the injuries have required medical treatment and initial information suggests the dog responsible could be prohibited and/or dangerous;

A prohibited and/or dangerous dog is reported and/or treated and is believed to be living with and/or frequently associated with children under five years.

A referral should also be made where a prohibited and/or dangerous dog is reported and/or treated and is believed to be living with and/or frequently associated with children.

Some referrals might be logged 'for information only' by the agencies, for example if it is clearly established that no significant or continued risk is likely to the child, or other children (for example, if the pet — which was the only dog in the household has already been 'put down' or removed to another house where no children are present).

Some referrals might prompt 'information leaflets' on Pets and Safe Care of Children to be issued for example, if the incident or injury was clearly minor, if the child was older or if the family have clearly shown themselves to be responsible pet owners. See

• Parent Tips - Keeping Babies and Children Safe Around Dogs in the Home (Institute of Health Visiting) and The Blue Cross Be Safe with Dogs Leaflet Guidance for Families.

In more serious cases a Strategy Discussion and joint Section 47 investigation should lead to further discussions with other agencies and home visits to complete assessments and to inform judgements on parenting and the care and control of the pet(s).

Advice might be sought from a veterinary professional to help determine the likely nature or level of risk presented by the pet(s). As with all other assessments 'the welfare of the child is paramount.'

Practitioner Safety

The following advice is adapted from East Riding LSCB and Lancashire Constabulary:

• Animals can sense fear so avoid eye contact and be confident;
• Where a sense of fear is not avoidable, ask the pet owner to move the pet(s) to another room or conduct the discussions of the home visit in another room;
• In subsequent visits to the service user, write in advance to the pet owner to ensure that the pet is in a different room or secure in its cage etc.
• Do not approach or stroke pets;
• Look out for signs of aggression in the pet and confidently request the owner to remove the pet from the room.

Animal Welfare

The RSPCA offer the following advice to all professionals who are in contact with a household where there is a dog/s present:

"When looking at, or asking about a dog think about the following points, which should not be considered an exhaustive list but are intended to prompt a professional's curiosity as to the state of the dog's welfare along with suggested courses of action."

"The points relate to Section 9 of the Animal Welfare Act, 2006 which imposes a duty of care on a person who is permanently or temporarily responsible for an animal. This duty of care requires that reasonable steps in all the circumstance are taken to ensure that the welfare needs of an animal are met to the extent required by good practice. The welfare needs are:

The need for a suitable environment;

The need for a suitable diet;

The need to be able to exhibit normal behaviour patterns;

    The need it has to be housed with, or apart from, other animals;

The need to be protected from pain, suffering, injury and disease.

During the visit ask if there is a dog in the property including the back garden. If there is, and the dog isn't in the same room as you, ask to see him."

Further Information

The Blue Cross Be Safe with Dogs Leaflet - Guidance for Families

The Dogs Trust: Staying Safe With Dogs

Battersea Dogs and Cats Home

Kennel Club's Safe & Sound Programme with Resources for Schools

National Animal Welfare Trust Advice Sheet/Free Webinar

Parent Tips - Keeping Babies and Children Safe Around Dogs in the Home (Institute of Health Visiting)

Advice on Dangerous Dogs — Powerpoint (Lancashire Constabulary)

RSPCA website

Pets, Toys and Play (Safekids website)

5.11 Disabilities and Learning Difficulties

RELATED NATIONAL GUIDANCE

Chapter 1 : Assessing need and providing helm Workinq Toqether to Safeguard Children

Safequardinq Disabled Children Practice Guidance published by the Department for Children, Schools and Families, in July 2009

RELATED CHAPTERS

Use of Interpreters, Signers or Others with Communication Skills Procedure

AMENDMENT

This chapter was extensively updated in November 2017 and should be read throughout.

Contents

Introduction Practice Guidance for Professionals

Introduction

1 . It is a fundamental principle that children with disabilities and learning difficulties have the same right as children without disabilities and learning difficulties to be protected from harm and abuse and that standard procedures should be followed for Referrals, Sinqle Assessment and, when appropriate, Strateqy Discussions/Meetinqs (local processes for including disability and learning difficulty specialists in the safeguarding processes will vary). However in order to ensure that the welfare of children with disabilities is safeguarded and promoted, it needs to be recognised that additional action is required in particular assessing and addressing their equality needs in line with the Equality Act duties. This is because children with disabilities and learning difficulties have additional needs related to physical, sensory, cognitive and/or communication requirements and many of the problems they face are caused by negative attitudes, prejudice and unequal access to things necessary for a good quality of life.

2. Children with disabilities and learning difficulties are likely to have poorer outcomes across a range of indicators including low educational attainment, poorer access to health services, poorer health outcomes and more difficult transitions to adulthood. They are more likely to suffer family break up and are significantly overrepresented in the populations of looked after children and young offenders.
3. Where children with disabilities and learning difficulties are looked after they are more likely to be placed in residential care rather than family settings, which in turn increases their vulnerability to abuse.
4. Families with children with disabilities are more likely to experience poverty and children with special educational needs are more likely to be excluded from school, (70% of all permanent exclusions are for pupils with SEND).
5. Research evidence suggests that children with disabilities and learning difficulties are at increased risk of abuse and neglect, and that the presence of multiple disabilities and difficulties appears to increase the risk of both abuse and neglect, yet they are underrepresented in safeguarding systems. Children with disabilities and learning difficulties can be abused and neglected in ways that other children cannot and the early indicators suggestive of abuse and neglect can be more complicated than for children with disabilities. Research evidence also indicates that the indicators of abuse and neglect for children with disabilities and leaming difficulties can sometimes be confused with their conditions leading to delays in identifying abuse or neglect.
6. Whilst the practice guidance does not identify specific groups of children with disabilities or learning difficulties, particular reference is made to children with speech, language and communication needs. This includes those who use nonverbal means of communication as well a wider group of children who have difficulties communicating with others.
7. The guidance emphasises the critical importance of communication with children with disabilities and learning difficulties including recognising that all children communicate preferences if asked in the right way by those who understand their needs and have the skills to listen to them. Research evidence suggests that overreliance on the preferences communicated by parents/carers rather than through communicating with the child or observations can make it more difficult to identify and assess whether a child is suffering from abuse or neglect.
8. Various definitions of disability and leaming are used across agencies and professionals. Agreement between specialists on diagnosing a condition and it's of level of severity can make it more difficult to understand and provide for the additional needs the child may have. Whatever definition of 'disability' or 'learning difficulty' is used, the key issue is not what the definition is but the impact of abuse or neglect on a child's health and development, and consideration of how best to safeguard and promote the child's welfare. The definition of abuse and neglect is universal.

Practice Guidance for Professionals

9. The reasons why children with disabilities and difficulties are more vulnerable to abuse are summarised below:
   • Many children with disabilities and learning difficulties are at an increased likelihood of being socially isolated with fewer outside contacts than children without disabilities and learning difficulties;
   • Their dependency on parents and carers for practical assistance in daily living including intimate personal care and medical/medicine management increases their risk of exposure to abusive behaviour; o They have an impaired capacity to resist or avoid abuse;
   • They may have impairments in their cognitive ability to understand the abuse or neglect;
   • They may have speech, language and communication needs which may make it difficult to tell others what is happening;
   • They often do not have access to someone they can trust to disclose that they have been abused; o They are especially vulnerable to bullying and intimidation;
   • Looked after children with disabilities and learning difficulties are not only vulnerable to the same factors that exist for all children living away from home but are particularly susceptible to possible abuse because of their additional dependency on residential and hospital staff for day to day physical needs.
10. Where there are safeguarding concerns about a children with disabilities and learning difficulty, there is a need for greater awareness of the possible indicators of abuse and/or neglect as the situation is often more complex. It is crucial that the disability or learning difficulty is not allowed to mask or deter the need for an appropriate investigation of child protection concerns. Best practice recommends that specialists who work with children with disabilities and learning difficulties seek advice from practitioners that regularly assess abuse and neglect; safeguarding specialists and social workers in turn should seek advice from specialists in children's disabilities and learning difficulties (across the whole range of specialists that would be required to meet the child's needs) when assessing abuse and neglect.

1 1 The following are some indicators of possible abuse or neglect:

 Bruises, injuries or pressure sores in a site that might not be of concern on an ambulant child, but might be a concern on a non-mobile child or child with restricted ability to move;

 Not getting enough help with feeding leading to malnourishment;

 Poor toileting arrangements;

 Lack of stimulation;

 Unjustified and/or excessive use of restraint;

• Rough handling, extreme behaviour modification e.g. deprivation of liquid, medication, food or clothing, over feeding/over medication;

 Unwillingness to try to learn a child's means of communication;

                  Ill-fitting equipment e.g. calipers, sleep boards, inappropriate splinting;

 Misappropriation of a child's finances;

 Invasive procedures which are unnecessary or are carried out against the child's will;

 Patterns of missed appointments with medical and social care specialists (including consistently refusing assistance or parents/carers not being available to professionals) leaving the child with unaddressed needs;

• Parents showing hostility towards professionals or withdrawing their child from services when challenged with indicators of unmet need.

12. These indicators are not exhaustive and as each child's disability and learning difficulty will vary by severity requiring sometimes a whole range of specialists to diagnose and provide advice on management making it difficult to determine levels of unmet need. The definition for abuse or neglect does not vary from child to child and a multitude of persistent unmet needs is likely to indicate a child is suffering or likely to suffer significant harm.
13. Professionals may be reluctant to act on concerns because of a number of factors that include:

 Over identifying with the child's parents/carers and being reluctant to accept that abuse or neglect is taking or has taken place, or seeing it as being attributable to the stress and difficulties of caring for a child with disabilities and learning difficulties;

 A lack of knowledge about the impact of disability and learning difficulties on the child;

A lack of knowledge about the child, e.g. not knowing the child's usual behaviour;

Not being able to understand the child's method of communication;

 

Confusing behaviours that may indicate the child is being abused with those associated with the child's disability;

 Denial of the child's sexuality;

 Behaviour, including sexually harmful behaviour or self-injury, may be indicative of abuse;

 Being aware that certain health/medical complications may influence the way symptoms present or are interpreted. For example, some particular conditions cause spontaneous bruising or fragile bones, causing fractures to be more frequent.

14. Those in Children's Social Care who are likely to receive initial contacts and/or referrals concerning children with disabilities should have received appropriate training to equip them with the knowledge and awareness to assess the risk of harm to the child and know what action to take. Children's Services will have access to specialist teams in social care and education that routinely provide services to children with disabilities and learning difficulties and practitioners screening and assessing referrals should seek their advice in making decisions. Health specialists in the Multi-Agency Safeguarding Hubs(MASH) will have good knowledge and contacts with the range of specialists in community and in hospital settings that can also provide advice on disabilities and learning difficulties to understand the specific needs of a child.
15. Assessment should be undertaken by professionals who are both experienced and competent in child protection work, with additional input from those professionals who have knowledge and expertise of working with children with disabilities and learning difficulties (education and health). Where assessing a teenage child there may be an additional need to include adult services across health and social care into the assessment, planning and review processes.
16. A good question when assessing a child with disabilities is: Would I consider that option if the child did not have a disability or learning difficulty?
17. Extra resources may be necessary especially where the child has speech, language and communication needs. For example, it may be necessary to obtain an assessment from a teacher and speech and language specialist as to the best way of working with the child.
18. The child's preferred method of communication must be given the utmost priority.
19. The following questions should be asked when a referral is received concerning a child with disabilities:

 What is the disability, special need or impairment that affects the child? Ask for a description of the disability or impairment;

 Make sure that you spell the description of an impairment correctly;

 How does the disability or impairment affect the child on a day-to-day basis?

How does the child communicate? If someone says the child cannot communicate, simply ask the question: 'How does the child indicate he or she wants something?

o How does the child show s/he is unhappy?

 Has the disability or condition been medically diagnosed?

20. The number of carers involved with the child should be established as well as where the care is provided and when.
21. At the Strateqy Discussion, consideration should be given to appoint a support worker to consider any complex issues arising from the disability. If a facilitator or interpreter is required, he or she should be involved when planning the investigation. See also Use of Interpreters, _Siqners or Others with Communication Skills Procedure.
22. Where an interview with the child with disabilities or learning difficulty is required, consideration should be given to whether any additional equipment or facilities are required and whether someone with specialist skills in the child's preferred method of communication should be involved.
23. All those involved in an investigation must ensure that they communicate clearly with the child with disabilities and the family as well as with each other as there are likely to a greater number of professionals involved.
24. Professionals should be advised to refer to the appendices of the government's guidance for a list of helpful resources and more detailed assessment tools and research literature.
25. In assessing whether a child with disabilities and leaming difficulties is being abused or neglected, the Single Assessment must be fully informed by an Equalities Assessment. All public bodies (and services provided through public service commissions) have duties under the Equality Act 2010 and organisations will have appointed an Equalities Lead who can advise on completing equality impact assessments. For some children they may have a number of protected characteristics (see Diversity Procedure) and each must be equally assessed. Working Together guidance is clear that the rights of the child are paramount and so where a parent/carer equally has diversity needs, the child's rights must take priority to ensure they are safeguarded effectively.
26. Understanding and responding to abuse and neglect in children with disabilities and learning difficulties can be difficult for the different reasons outlined above. Practitioners should seek regular support and supervision to assist them in their roles, including specialist safeguarding supervision. Addressing the needs of a child with disabilities and leaming difficulties is not a single agency response and there must be frequent and purposeful multi-agency working across planning processes like CAF, EHCP, CiN, CP, LAC, Leaving Care etc. Multi-agency working will also involve very different disciplines (in health, social care, education, child or adult services, legal services in different providers, commissioners and providers) that talk different professional languages and supervision and support should also be used across the different disciplines to ensure misunderstandings do not arise and there are no gaps in the child's unmet needs.

5.12 Diversity

RELATED NATIONAL GUIDANCE AND LEGISLATION

Macpherson Inquiry Report (2000)

Working Together to Safeguard Children

Equality Act 2010

RELATED CHAPTERS

Bullyinq Procedure

AMENDMENT

In November 2015 this chapter was extensively updated and should be re-read.

Contents

Introduction

Principles

Eights Strands of Diversity

Institutional Racism

Introduction

1. The population of the regions covered by the Blackburn with Darwen, Blackpool and Lancashire Children's Safeguarding Assurance Partnership (CSAP) is multicultural. In order to make sensitive and informed professional judgements about a child's needs and parents' capacity to respond to their child's needs, it is important that professionals are sensitive to differing family patterns and lifestyles and to child rearing pattems that vary across different racial, ethnic and cultural groups.
2. Professionals should also be aware of the broader social factors that serve to discriminate against black and minority ethnic people. The assessment process should always include consideration of the way religious beliefs and cultural traditions in different racial, ethnic and cultural groups influence their values, attitudes and behaviour and the way in which family and community life is structured and organised.
3. Professionals should guard against myths and stereotypes, both positive and negative, but anxiety about being accused of racist practice should not prevent the necessary action being taken to safeguard a child.

Principles

The Blackburn with Darwen, Blackpool and Lancashire Children's Safeguarding Assurance Partnership (CSAP) and its agencies are committed to promoting equal opportunities and valuing diversity in all its functions, roles and services it provides. The regions covered by the CSAP are multi-racial, multi-religious, multi-language and multi-cultural. All our policies, procedures, practice and services should positively acknowledge, reflect and respect this fact.

This means the CSAP and its agencies will:

Work to achieve social justice and inclusion that enables all children and their families to have equality of opportunity;

Oppose and prevent discrimination, victimisation or harassment against any of the eleven characteristics of equality (nine characteristics required by the Equality Act 2010 and two adopted by local partnerships to reflect local needs);

Treat all citizens fairly and with respect;

Recognise the rights of individuals to participate fully in the social and economic life.

Eight Strands of Diversity

There are eight characteristics to this Diversity Policy which the CSAP and its agencies are committed to adhere to:

Age;

Disability;

     Gender / gender identity;

Marriage & Civil Partnerships;

     Pregnancy & Maternity;

•     

     Religion or Belief;

Sexual Orientation;

Section 149 of the Equality Act (2010) requires the following provisions to be made by agencies (public sector bodies) for their employees and service users:

Eliminate any discrimination, victimisation or harassment;

Advance equality of opportunity and foster good relations between persons who share a protected characteristic and persons who do not share it;

Remove or minimise disadvantages suffered by persons who share a protected characteristic that are connected to that characteristic;

Take steps to meet the needs of persons who share a relevant protected characteristic that are different from the needs of persons who do not share it;

Encourage persons who share a relevant protected characteristic to participate in public life or in any other activity in which participation by such persons is disproportionally low

Foster good relations between persons who share a relevant protected characteristic and persons who do not share to tackle prejudice and promote understanding.

Working Together to Safeguard Children outlines two key principles that underpin effective safeguarding arrangements and services: that safeguarding is everyone's responsibility; and the need for agencies to have a child-centred approach in their safeguarding work.

The following six competencies can be used as a framework for effective safeguarding practice:

Child Development — knowing how a healthy child presents or behaves so that signs of distress and impaired development can be identified as early as possible (Level 1 of the Continuum of Need and Response Framework);

Listening to the child and taking what they say seriously, including communication with the child (and family) in their preferred language;

Good holistic assessments that address all the principles and the three assessment domains in the Assessment Protocol, and take account of the Borough's Risk Sensible Model;

Awareness of the local and statutory protected characteristics so that in undertaking an assessment and providing services, due regard is given to what is prohibited, and what requires promotion, under the Equality Act (2010) and Human Rights Act (1998);

Knowing, learning about or seeking expert advice on a particular protected characteristic by which the child and family lives their daily lives; and

Knowing about local services (depending on the type of protected characteristic maybe even regional or national services) that are available to provide relevant input into prevention, support and rehabilitation services for the child (and their family).

Agencies must have essential safeguards in place to promote the welfare of children, particularly those vulnerable due to their protected characteristics not being effectively assessed and met:

Children should feel valued and respected with their self-esteem promoted;

Agencies should recognise that needs within each protected characteristic will not be uniform and attention needs to be given to the specific needs of the child and family;

Staff should recognise the importance of ascertaining the wishes and feelings of children and their families including their preferred means of communication and language interpretation needs;

That staff are trained and have access to resources to help them identify and assess vulnerabilities that can arise from not meeting the needs relating to protected characteristics of a child and/or their family;

Providing access to services for specific groups of children that can promote their different needs;

That agencies should fully understand the communities they serve and the needs and challenges in terms of safeguarding that these communities may have and how services will have to be delivered to promote welfare; and

Complaints and comments procedures are clear, effective, user-friendly and accessible.

Institutional Racism

4. Children from black and minority ethnic groups (and their parents) are likely to have experienced harassment, racial discrimination and institutional racism. Although racism can cause Significant Harm, it is not, in itself, a category of abuse. The experience of racism is likely to affect the responses of the child and family to assessment and Section 47 Enquiry processes. Failure to consider the effects of racism undermines efforts to protect children from other forms of Significant Harm.
5. The effects of racism differ for different communities and individuals, and should not be assumed to be uniform. Attention should be given to the specific needs of children of mixed parentage and refugee children. In particular, the need for neutral, high-quality, gender-appropriate translation or interpretation services should be taken into account when working with children and families whose preferred language is not English.
6. All organisations working with children, including those operating in areas where black and minority ethnic communities are numerically small, should address institutional racism, defined in the Macpherson Inquiry Report (2000) on Stephen Lawrence as 'the collective failure by an organisation to provide an appropriate and professional service to people on account of their race, culture and/or religion'

5.13 Domestic Violence and Abuse

RELATED NATIONAL GUIDANCE

Chapter 1: Assessinq need and providing help, Working Together to Safeguard Children

Violence against Women and Girls in the UK (GOV.UK) - guidance and regulation Safe Lives

Multi-Aqency Risk Assessment Conferences (MARAC)

Controllinq or Coercive Behaviour in an Intimate or Family Relationship:

Statutory Guidance Framework (December 2015)

Royal College of Nursing — Domestic Abuse: Professional Resources

Domestic Abuse: A Resource for Health Professionals (DHSC. 2017)

RELATED LOCAL GUIDANCE

Blackpool MARAC referral form

RELATED CHAPTER

Information Sharinq and Confidentiality Procedure

Processes for Manaqinq Risk Procedure, Multi-Aqency Risk Assessment

Conference (MARAC)

Honour Based Abuse Procedure

Female Genital Mutilation Procedure

Forced Marriaqes Procedure

RELATED LINKS

See also Domestic violence and abuse services such as Blackpool Children's Independent. Domestic Violence Advisers (CIDVA), Multi Agency Risk Assessment Conference (MARAC) and Victim Support.

AMENDMENT

In November 2019 a link to the refreshed HM Government Strategy for Ending Violence against Women and Girls Strategy 2016 — 2020, was added into Definition.

Contents

Introduction

Definition

Impact of Children and Young People

Action to Safeguard Children

Roles of Agencies

Checks with and Referrals to Children's Social Care

Strategic Work and Partnerships

Domestic Violence Protection Orders and the Domestic Violence Disclosure Scheme

Introduction

1. Domestic violence and abuse is a complex issue which affects every one of us and reaches every corner of our society. Domestic violence and abuse is a serious crime and should be treated as such. It does not recognise class, race, religion, gender, sexuality, culture or wealth and its effects on family life are devastating.
2. In the overwhelming majority of reported instances the abuser is male and the victim is female, although there are attacks by women on men and between two people of the same gender, whether current or ex partners or family members.

Definition

3. The Home Office Guidance Information for Local Areas on the Change to the Definition of Domestic Violence and Abuse (2013) states that the term 'domestic violence and abuse' should be used. The Government definition of domestic violence and abuse has been widened to include those aged 16-17 and the wording changed to reflect coercive control. (Note that this is not a legal definition.)

The new definition is:

%Any incident or pattem of incidents of controlling, coercive or threatening behaviour, violence or abuse between those aged 16 or over who are or have been intimate partners or family members regardless of gender or sexuality' This can encompass, but is not limited to, the following types of abuse:

 Psychological;

 Physical:

 Sexual;

 Financial;

 Emotional.

'Controlling behaviour is: a range of acts designed to make a person subordinate and/or dependent by isolating them from sources of support, exploiting their resources and capacities for personal gain, depriving them of the means needed for independence, resistance and escape and regulating their everyday behaviour.

Coercive behaviour is: an act or a pattem of acts of assault, threats, humiliation and intimidation or other abuse that is used to harm, punish, or frighten their victim.'

4. The definition Domestic violence and abuse includes Ferced Marriage, HonourBased Abuse and Female Genital Mutilation, and is clear that victims are not confined to one gender or ethnic group.

While the cross-government definition above applies to those aged 16 or above, 'Adolescent to parent violence and abuse' (APVA) can involve children under 16 as well as over 16. See: Information guide: adolescent to parent violence and abuse (APVA)Home Office.

For more details of the national plans to tackle domestic violence and abuse

see: Endinq Violence against Women and Girls Strategy 2016 — 2020

(refreshed 2019) which sets out a life course approach to ensure that all victims and their families - have access to the right support at the right time to help them live free from violence and abuse.

Impact on Children and Young People

5. Prolonged and / or regular exposure to domestic violence and abuse can have a serious impact on a child's development and emotional wellbeing, despite the best efforts of the victim parent to protect the child. Domestic violence and abuse has an impact in a number of ways. It can pose a threat to an unborn child, because assaults on pregnant women frequently involve punches or kicks directed at the abdomen, risking injury to both mother and foetus. It can also lead to other possible risks, such as i.e. foetal death, low birth weight, early birth, infection etc.
6. Older children may also suffer blows during episodes of abuse. Children are likely to be greatly distressed by witnessing the physical and emotional suffering of a parent or other family member. Both the physical assaults and psychological abuse suffered by adult victims who experience domestic violence and abuse can have a potential impact on their ability to look after their children. The negative impact of domestic violence and abuse is exacerbated when the abuse is combined with drink or drug misuse as this can increase the severity of the attacks. Children's exposure to parental conflict; even where abuse is not present, can lead to serious anxiety and distress among children, particularly when it is routed through them.
7. Children may suffer both directly and indirectly if they live in households where there is domestic violence and abuse. Domestic violence and abuse is likely to have a damaging effect on the health and development of children, and it will often be appropriate for such children to be regarded as a Child in Need. All those working with families and children should be alert to the frequent inter-relationship between domestic violence and abuse and the abuse and neglect of children.
8. When there is evidence of domestic violence and abuse, the implications for any children in the household should be considered, including the possibility that the children may themselves be subject to abuse or other harm. Conversely, where it is believed that a child is being abused, those involved with the child and family should be alert to the possibility of domestic violence and abuse within the family.
9. Domestic violence and abuse is a child protection issue. In relation to the impact of domestic violence and abuse on children, the amendment made in Section 120 of the Adoption and Children Act 2002 to the Children Act 1989 clarifies the meaning of "harm" in the Children Act, to make explicit that "harm" will include, for example, "impairment suffered from seeing or hearing the ill-treatment of another." This is now also specifically included in the definition of Emotional Abuse

Action to Safeguard Children

10. The Police are often the first point of contact with families in which domestic violence and abuse takes place. When responding to incidents of violence, the Police should find out whether there are any children living in the household. They should see any children present in the house to assess their immediate safety.

There should be arrangements in place between the Police and Children's Social Care to enable the Police to find out whether any such children are the subject of a Child Protection Plan.

11 The Police are already required to determine whether any court orders or injunctions are in force in respect of members of the household. The Police should make an assessment and, if they have specific concerns about the safety or welfare of a child, they should make a referral to Children's Social Care (see the Makinq a Referral to Children's Social Care). It is also important that there is clarity about whether the family is aware that a referral is to be made. Any response by Children's Social Care to such referrals should be discreet, in terms of making contact with victims in ways that will not further endanger them or their children. In some cases, a child may be in need of immediate protection. As indicated above, the amendment to the Children Act 1989 made in Section 120 of the Adoption and Children Act 2002 clarifies the meaning of 'harm' in the Children Act, to make explicit that 'harm' includes, for example, impairment suffered from seeing or hearing the ill-treatment of another.

12. Normally, one serious or several lesser incidents of domestic violence and abuse where there is a child in the household indicate that Children's Social Care should carry out a Single Assessment of the child and family, including consulting existing records. It is important to include in assessments agreed arrangements for contact between children and the non-resident parent. Children who are experiencing domestic violence and abuse may benefit from a range of support and services, and some may need safeguarding from Significant Harm. Often, supporting a non-violent parent is likely to be the most effective way of promoting the child's welfare. The Police and other agencies have defined powers in criminal and civil law that can be used to help those who are subject to domestic violence and abuse. Health visitors and midwives can play a key role in providing support, and need access to information shared by the Police and Children's Social Care. See the Information Sharing and Confidentiality Procedure.

CIDVA),

13. There is an extensive range of services for women and children, delivered through refuge projects operated by Women's Aid, and Probation Service provision of Women's Safety Workers, for partners of male perpetrators of domestic violence and abuse, where they are on a domestic violence and abuse treatment programme (in custody or in the community). These services have a vital role in contributing to an inter-agency approach in child protection cases where domestic violence and abuse is an issue. There are a number of services available to everyone suffering domestic violence and abuse, links to some of these can be found in the local contacts domestic violence and abuse services, such as Blackpool Children's Independent Domestic Violence Advisers Multi Agency Risk Assessment Conference (MARAC), Victim Support etc.
14. In responding to situations where domestic violence and abuse may be present, considerations include:
    • Ensure the perpetrator and victim are not sitting together when being asked these questions; o Ask direct questions about domestic violence and abuse;
    • Check whether domestic violence and abuse has occurred whenever child abuse is suspected, and consider the impact of this at all stages of assessment, Section 47 Enquiries and intervention;
    • Identify those who are responsible for domestic violence and abuse, in order that relevant family law or criminal justice responses may be made;
    • Take into account there may be continued or increased risk of domestic violence and abuse towards the abused parent and/or child after separation, especially in connection with post-separation child contact arrangements;
    • Provide non-abusing parents with full information about their legal rights, and about the extent and limits of statutory duties and powers;
    • Help victims and children to get protection from violence, by providing relevant practical and other assistance;
    • Support non-abusing parents in making safe choices for themselves and their children;
    • Work separately with each parent where domestic violence and abuse prevents non-abusing parents from speaking freely and participating without fear of retribution. This should always be done as victims will also be at risk if they speak freely about the abuse in front of the perpetrator.

Roles of Agencies

15. Professionals, carers or volunteers may be alerted to the possibility of domestic violence and abuse involving children in a number of different ways. The most important thing to do is not to ignore your concerns. Consult with your manager / Designated or Named Professional, Nurse / Designated Teacher. All professionals should undertake a Safe Lives Risk Identification Checklist with the non-abusing parent when domestic violence and abuse is an issue. This should also be completed for 16 - 17 year old and vulnerable adult victims and refer to MARAC if necessary. Vulnerable Adults should also be referred to Safeguarding Adults Team. See also Information Sharing and Confidentiality Procedure.

Children's Social Care

16. Children's Social Care has a responsibility to assist those who experience abuse through the provision of appropriate information, offering advice and support and signpost to other avenues of support. They have a statutory responsibility in respect of ensuring that children and young people are protected from harm. This responsibility is fulfilled by their undertaking an assessment of children's needs. Where there is domestic violence and abuse within a family where children are present, consideration should always be given to an assessment of the child's needs being undertaken.

Education Services

17. Schools and Education staff have an essential role in the recognition stage of work with Early Help and Children in Need, including those in need of protection. All schools and colleges should create and maintain a safe environment for children and young people and have sound policies and procedures for managing situations where there are child welfare concerns. Staff who have day-to-day contact with children have a crucial role to play in noticing indicators of possible abuse or neglect, including the possibility of domestic violence and abuse, which can affect a child. Education department staff and schools have a duty to assist Children's Social Care by providing information where there are concerns about a child's safety or well-being.

Police

18. The Police are often the first point of contact with families in which domestic violence and abuse takes place. Officers attending incidents where children are present in the household are aware of the need to ensure the safety and well-being of such children and, in extreme cases, to take immediate protection measures and refer to Children's Social Care immediately. The Police will notify Children's Social Care of all incidents where there are children present in the house or children affected by the domestic violence and abuse.
19. Specialist Domestic Violence and Abuse and Child Protection officers work together, within a Police Public Protection Unit. All incidents of domestic and child abuse, reported to the Police are referred to the Unit, where a database is maintained, enabling links to be identified and case referrals to other agencies and support groups, to be made. The Unit acts as a 'single point of contact' for any professional or member of the public who wishes to discuss any domestic or child abuse issue or concern and takes lead responsibility for referring cases to Children's Social Care.
20. Incidents involving serious domestic violence and abuse, repeat victims and persistent offenders, are dealt with by the Unit and, where appropriate, cases involving children are investigated by both domestic violence and abuse and child protection officers. Where children are, or are normally, present in households where such incidents have occurred, these cases will be referred to Children's Social Care by the Unit.

Health Service

21.All health care professionals must recognise that their response to individuals experiencing domestic violence and abuse is of great importance. It is essential that there is an understanding of the inter-relationship which frequently exists, between domestic violence and abuse and the abuse and neglect of children.

22. Where professionals believe that children are at risk, procedures for Manaqinq Individual Cases must be adhered to and a Referral made to Children's Social Care. The need to follow these procedures should be discussed with the patient / client, and their consent obtained if possible. However, the interests of the child are paramount, and initiating child protection procedures is not conditional on obtaining consent and where there is evidence of domestic violence and abuse, the implications for any children in the household should be considered, including the possibility that the children may themselves be subject to violence or harm. Conversely, where it is believed that a child is being abused, those involved with the child and family should be alert to the possibility of domestic violence and abuse within the family

Probation Service

23. The Probation Service is often asked to complete pre-sentence reports on offenders whose index offence is one of domestic violence and abuse or whose history contains a pattem of domestic violence and abuse. Such assessments often lead to supervision within the community on community based orders or, in some cases, on prison licence after release from custodial sentences. Nationally accredited programme's are currently being developed in addition to individual one to one packages. Such cases are routinely subject to multi-agency oversight and liaison with the Police, social services and other key voluntary and statutory agencies is critical to our role.

Blackpool Children's Independent Domestic Violence Advisor (Children's IDVA)

24. The Children's IDVA service offers specialised support to children and young people affected by domestic violence and abuse. This can be through witnessing domestic violence and abuse within the family unit, or direct experience (young people in their own relationships).
25. There are a number of aspects to our work and we endeavour to meet the needs of the individual. Examples of the Children's IDVA support include:

0 1:1 support - a chance for the individual to talk about their experiences in a safe environment using age appropriate resources, language and a flexible approach to meet each person's individual needs;

• Individual and group work sessions around topics such as safety planning, confidence and self esteem building, safe and unsafe relationships, and domestic violence and abuse. This can be delivered in a range of settings such as schools, children's centres, community centres, and is tailored towards the age of the individual or group;
• Peer support sessions - an opportunity to meet other young people who have had similar experiences, gain support from each other and reduce the feeling of isolation;
• For children under five, the service supports the non-abusing parent in relearning how to interact with their child/ren. This is aimed at rebuilding their relationships and establishing a positive parental role model;
• Drop in sessions at a number of local high schools, to make our service easily accessible, to as many young people as possible;
• Youth Forum - an opportunity for the children/young people to have their say on the issues and decisions which affect them. This is also an opportunity to meet new people and take part in activities and develop their social skills.

Checks with and Referrals to Children's Social Care

26.As stated there is frequently an inter-relationship between domestic violence and abuse and the abuse and Neglect of children and young people. Where there is domestic violence and abuse the implication of children remaining in the household should be considered. This includes the possibility that the children themselves may be subject to violence or other harm.

27. Local authority area must have a clear policy on when referrals should be made to the Children's Social Care. (See Blackburn with Darwen, Blackpool and Lancashire Continuum of Need and Thresholds Guidance.) Not all Referrals regarding domestic violence and abuse within a family will be considered as Child Protection Cases. However it is likely that where incidents are serious and frequent there will need to be an assessment of the child and families circumstances to address their support needs.
28. Where the Police are called to an incident of domestic violence and abuse or where information comes to the attention of other professionals involved regarding an incident of domestic violence and abuse and where there are children present or normally present within the household, a request should be made to Children's Social Care for a check to be made to determine whether the child is the subject of a Child Protection Plan. Where the child / young person is not the subject of a Child Protection Plan this should be logged as a contact unless there are serious concerns which would warrant a formal Referral under the Makinq a Referral to Children's Social Care Procedure (via Inter Agency Referral Form). This may lead to an investigation led by Children's Social Care. Where the child / young person is the subject of a Child Protection Plan or where a child who is resident at the address is an open case to the Children's Social Care details of the incident should be passed to the allocated social worker.

29.A serious incident of domestic violence and abuse which has been witnessed by a child or where children were present in the household at the time of the incident should result in a referral to Children's Social Care. Consideration should then be given to undertaking Section 47 Enquiries.

30. Concerns in respect of children should be referred to Children's Social Care, who will ensure all enquiries contain clear, precise and accurate information. Children's Social Care, in line with the Assessment Framework will make a decision as to the response within 24 hours. As such a Strategy Discussion is likely to be necessary.

31 Following completion of enquiries the allocated Social Worker should ensure that all professionals involved with the child / family and the parent / carers receive an outcome letter. If there are concerns regarding the outcome these should be addressed with the appropriate Social Work Team Manager.

32.ShouId there remain disagreement regarding the need for a Child Protection Conference the matter should be referred to the manager.

Strategic Work and Partnerships

33.A Domestic Violence and Abuse Strategic Partnership exists in all three areas, to raise awareness of domestic violence and abuse, to promote co-ordination between agencies in preventing and responding to violence, and to encourage the development of services for those who are subjected to violence or suffer its effects. There are Domestic Violence and Abuse Forums in most of the District Council Areas. They exist to raise awareness of issues and to promote the coordination and development of services. There should be a clear link between the Forum and the CSAP.

Domestic Violence Protection Orders and the Domestic Violence Disclosure Scheme

Domestic Violence Protection Orders

Domestic Violence Protection Orders (DVPOs) were implemented across England and Wales in March 2014.

They provide protection to victims by enabling the Police and magistrates to put in place protection in the immediate aftermath of a domestic violence incident.

With DVPOs, a perpetrator can be banned with immediate effect from returning to a residence and from having contact with the victim for up to 28 days, allowing the victim time to consider their options and get the support they need.

Before the scheme, there was a gap in protection, because Police could not charge the perpetrator for lack of evidence and so provide protection to a victim through bail conditions, and because the process of granting injunctions took time.

Domestic Violence Disclosure Scheme ('Clare's Law')

The Domestic Violence Disclosure Scheme (DVDS) (also known as 'Clare's Law') commenced in England and Wales in March 2014. The DVDS gives members of the public a formal mechanism to make enquires about an individual who they are in a relationship with, or who is in a relationship with someone they know, where there is a concern that the individual may be violent towards their partner. This scheme adds a further dimension to the information sharing about children where there are concerns that domestic violence and abuse is impacting on the care and welfare of the children in the family.

Members of the public can make an application for a disclosure, known as the 'right to ask'. Anybody can make an enquiry, but information will only be given to someone at risk or a person in a position to safeguard the victim. The scheme is for anyone in an intimate relationship regardless of gender.

Partner agencies can also request disclosure is made of an offender's past history where it is believed someone is at risk of harm. This is known as 'right to know'.

If a potentially violent individual is identified as having convictions for violent offences, or information is held about their behaviour which reasonably leads the Police and other agencies to believe they pose a risk of harm to their partner, the Police will consider disclosing the information. A disclosure can be made if it is legal, proportionate and necessary to do so.

For further information, see Domestic Yiolence Disclosure Scheme (GOV.UK website).

The Serious Crime Act 2015 created a new offence of controlling or coercive behaviour in intimate or familial relationships. Controlling or coercive behaviour does not relate to a single incident, it is a purposeful pattem of behaviour which takes place over time in order for one individual to exert power, control or coercion over another. Such behaviours might include:

Isolating a person from their friends and family;

Depriving them of their basic needs;

      Monitoring their time;

Monitoring a person via online communication tools or using spyware;

      Taking control over aspects of their everyday life, such as where they can go, who they can see, what to wear and when they can sleep;

Depriving them of access to support services, such as specialist support or medical services;

Repeatedly putting them down such as telling them they are worthless;

Enforcing rules and activity which humiliate, degrade or dehumanise the victim;

Forcing the victim to take part in criminal activity such as shoplifting, neglect or abuse of children to encourage self-blame and prevent disclosure to authorities;

Financial abuse including control of finances, such as only allowing a person a punitive allowance;

Threats to hurt or kill;

Threats to a child;

Threats to reveal or publish private information (e.g. threatening to 'out' someone).

•      

Criminal damage (such as destruction of household goods);

•      

Preventing a person from having access to transport or from working.

5.14 Drug Misusing Parents/Carers

RELATED NATIONAL GUIDANCE

Hidden Harm - Responding to the Needs of Children of Problem Drug Users, Advisory Council on the Misuse of Drugs (ACMD)

Chapter 1 : Assessinq need and providing help, Workinq Together to Safeguard Children

Foetal Alcohol Syndrome, Drink Aware UK

RELATED LOCAL GUIDANCE

Safeguarding Children Living with Substance Using Parents/Carers (Blackburn with Darwen) - to follow

arwen . na e sse s

Blackburn with Darwen Screening and Referral for Triage Form Substance

Misuse

RELATED CHAPTERS

Druq Misusinq Parents/Carers Procedure

Information Sharinq and Confidentiality Procedure

AMENDMENT

In November 2013, this chapter was updated in line with Working Together to Safeguard Children.

Contents

The Impact on Children and Families Eight Golden Rules

Confidentiality and Information Sharing

Assessments Initial Screening Assessment

Checklist

Children in the Family - Provision of Good Basic Care

Accommodation and Home Environment

Procurement of Drugs

Health Risks

If the Parent(s) Inject:

Family and Social Supports Parent's Perception of the Situation

Child Centred Assessment

Key Areas that could be Explored

Analysis: Making Sense of the Information

Pregnancy and Neo-Natal Care

The Impact on Children and Families

1 A child's growth and development depends on a variety of interacting social and biological factors, which can be broadly grouped into three categories: conception and pregnancy, parenting, and the wider family and environment.

2. Hidden Harm - Respondinq to the Needs of Children of Problem Druq Users (ACMD 2003) outlines the way in which problem drug use can impact on the development of children in affected families.
3. Throughout their lives children may need the services of various professionals. Positive interventions at different stages of their growth and development can contribute to children and young people reaching their full potential. Effective collaboration, good joint working and a sharp focus on the family as a whole are essential if children of substance misusing parents are to receive appropriate care and support.
4. It is recognised that there may be barriers to agencies working together; however, these must be addressed to ensure that all agencies act together appropriately and at the right time in accordance with the needs of children and young people. All agencies have a part to play in helping to identify problems at an early stage. Basic information should be gathered about the family and household circumstances of those who misuse substances.

Eight Golden Rules

Problem substance users normally want to be good parents;

Problem substance users should be treated in the same way as other parents whose personal difficulties interfere with their ability to provide good parenting;

Base your judgements on evidence, not optimism;

There will be many aspects of the child's life that are nothing to do with drugs or alcohol and may be equally or more important;

Recognise that the parents are likely to be anxious. They may be worried that they could lose their children. Children, especially older ones, may also share similar anxieties;

Do not assume that abstinence will always improve parenting skills;

The family situation will not remain static, assessment should be revisited at least every six months or when ever new concerns arise; whichever is sooner;  Understand what is the child's experience of living with substance misusing parents; speak to them alone or with an advocate.

Confidentiality and Information Sharing

5. See Information Sharing and Confidentiality Procedure. As in all situations of actual or possible harm to children the right to share information overrides the individual's right to confidentiality.

Assessments

6. When assessing the well-being of a family, agencies must look at the parents' drug and/or alcohol use from the perspective of the child to understand the impact this has on the child's life and development. Each child should be considered on an individual basis. It is important to consider that parents often do not stop using drugs or alcohol when they have children although it can often be a strong motivator for change.

Initial Screening Assessment

7. All agencies which engage with adults with substance use, in any capacity, must ask the following questions:
   • Are you a parent?
   • How many dependent children are you responsible for?
   • If the adult is under the influence of a substance or if the adult is in custody or receiving medical attention, ask where are the children currently?
8. Agencies supporting adults who are problem substance users should in addition obtain the following information in their initial screening assessment:

 The child(ren's) age and gender;

 Who is their primary carer?

• Which school or nursery do they attend, if aged two years or over?

 Who else is living in the household?

 Are there support agencies in touch with the family who are supporting the children (identify the child's Health Visitor, GP, School Nurse, Children's Centre, Drugs worker and, where involved, Social Worker). Is there is a Lead Professional?

 How do parent(s) views the impact of their substance use on their child?

 Can the extended family and / or friends can help?

• Are there any other agencies voluntary or statutory available to help?

 Is the parent/s willing to accept help?

• Is there a risk of losing their accommodation?
• Has a Common Assessment Framework (CAF) been completed? If answer is no, do you now need to commence a CAF?

9. This information may be obtained through the course of normal agency work over a period of time or in one session specifically designed to do so, depending on the agency's remit and normal working practices. It is recognised that consultation with other agencies may be necessary to complete this assessment (Social Work, Health, Education, Housing, Voluntary Sector agencies.) Where there are immediate child safety issues these should be referred on to Children's Social Care or the Police.
10. During work with substance users who are parents; agencies should be alert to stresses arising from the substance use, which are likely to impact on children. Professionals should advise and discuss with parents the harmful impact of their continued substance misuse on their children.

1 1 . When assessing parental substance misuse the following two models give an overview of the process. Examples of specific questions and areas for consideration and expansion are also detailed. To ensure good multi-agency working and information sharing, this assessment must be entered onto a CAF in line with local quidance.

Checklist

12.All Staff should be able to answer the following questions:

 Are children usually present at home visits, clinic or office appointments during normal school or nursery hours?

 What reason has been given for the child being absent from school?

 Is the child attending school/nursery regularly?

 Is the child punctuat for school/nursery?

• Do parents think that their child knows about their drug use?
• How do they know?
• What arrangements have been made for the children when the parent goes to get illegal drugs or attends for supervised dispensing of prescription drugs?

 How much money does the family spend on drug use? What % of the weekly income does this come to?

• Is the income from sources presently sufficient to feed, clothe and provide for children in addition to obtaining substances?

Who will look after the children if the parent is arrested or is unable to care for them?

• What arrangements are made for storing any drugs or prescription medication?

13. When deciding whether a child may need help, agencies should consider the following questions:

 Are there any factors which make the children particularly vulnerable, e.g. very young child, other special needs such as physical illness, behavioural and emotional problems, psychological illness or learning difficulty, threatened or actual loss of accommodation?

 Consider the needs of the unborn child.

 Are there any protective factors that may reduce risk to the child? (It may be necessary to consult with specialist children's service workers to determine this.)

 How does the child's health and development compare to that of other children of the same age and in similar situations?

 What kind of help do you think the child needs?

 Do the parents perceive any difficulties and how willing are they to accept help and work with professionals?

 What do you think might happen to the child? What would make it more or less likely?

 Is there suspicion of neglect, injury or abuse, now or in the past? What happened? What effect did/does that have on the child? Is it likely to recur?

 Is the concem the result of a single incident, a series of incidents or a culmination of concerns over a period of time?

 What does the child think? What do other family members think? How do you know?

Children in the Family - Provision of Good Basic Care

How many children are in this family?

What are their names and ages (wherever possible, include dates of birth)?

Are there any children living outside the family home and, if so, where? Why, and with whom?

Do the parents see any of the children as being particularly demanding?

     Are there any other special circumstances such as illness, disability which need to be considered?

For each child:

Is there adequate food, clothing and warmth for the child? Are height and weight normal for the child's age and stage of development?

Is the child receiving appropriate nutrition and exercise?

Is the child's health and development consistent with their age and stage of development? Has the child received necessary immunisations? Is the child registered with a GP and a dentist? Do the parents seek health care for the child appropriately?

Does the child attend nursery or school regularly? If not, why not? Is s/he achieving appropriate academic attainment?

Does the child present any behavioural or emotional problems? Does the parent manage the child's distress or challenging behaviour appropriately?

Who normally looks after the child?

Is the child engaged in age-appropriate activities?

Are there any indications that any of the children are taking on a parenting role within the family (e.g. caring for other children, excessive household responsibilities, etc)?

Is the care for the child consistent and reliable? Are the child's emotional needs being adequately met?

Is there a risk of repeated separation for example because of periods of imprisonment (e.g. short custodial sentences for fine default)?

How does the child relate to unfamiliar adults?

Are there non-substance using adults in the family readily accessible to the child who can provide appropriate care and support when necessary?

Does the child know about his/her parents substance use?

Is there evidence of drug/alcohol use by the child?

Describing Parental Substance Use

14. Identify sources of information, including conflicting reports, give consideration to negative impact on the child

 Specify drug of choice and how this is used, e.g. method, frequency quantity.

 Is the drug use by parent:

• Experimental - i.e. only used on a few occasions may be number of different drugs.
• Recreational - i.e. not using every day may be at weekends only on pay day or on nights out. (Some agencies are getting away from using this term, gives a feel of safety.)
• Chaotic - i.e. usually variety of substances and in varying amounts frequent periods of intoxication and withdrawal.
• Dependent- i.e. using substance or substances every day. Experiences withdrawal when not using however may be controlled and not chaotic use (see Definitions section 10).

 Identify whether the drug used is illicit or prescribed and whether use is regularly supplemented / 'topping up'

 Does the user move between these types of drug use at different times?

 Does the parent misuse alcohol?

 What patterns of drinking does the parent have?

 Is the parent a binge drinker with periods of sobriety? Are there patterns to their bingeing? i.e. weekends or at times of stress.

 Is the parent a daily heavy drinker?

 Does the parent use alcohol concurrently with other drugs?

 How reliable is current information about the parent's drug use?

 Is there a drug-free parent/non-problematic drinker, supportive partner or relative?

 Is the quality of parenting or childcare different when a parent is using drugs and when not using?

• Does the parent have any mental health problems alongside substance use? If so, how are mental health problems affected by the parent's substance use? Are mental health problems directly related to substance

 Is there any history of self harm?

 Is there any history of sexual abuse?

 Is there any history of domestic abuse?

• Are there known learning difficulties?

Accommodation and Home Environment

• Is the family's living accommodation suitable for children? Is it adequately equipped and furnished? Are there appropriate sleeping arrangements for each child, for example does each child have a bed or cot, with sufficient bedding?  Are rent and bills paid? Does the family have any arrears or significant debts?  Is there any evidence of fuel poverty?
• How long have the family lived in their current home/current area? Does the family move frequently? If so, why? Are there problems with neighbours, landlords or dealers?
• Is the household at risk of losing their accommodation? If yes, what action has been taken by the landlord?
• Do other drug users / problem drinkers share or use the accommodation? If so, are relationships with them harmonious, or is there conflict?
• Is the family living in a drug-using / heavy drinking community?
• If parents are using drugs, do children witness the taking of the drugs, or other substances?
• Have the parent/s ever overdosed intentionally or accidentally?
• Have any of the children witnessed their parents or other users having "overdosed"?
• Are children exposed to intoxicated behaviour/group drinking?
• Could other aspects of drug use constitute a risk to children (e.g. conflict with or between dealers, exposure to criminal activities related to drug use)?

Procurement of Drugs

• Where are the children when their parents are procuring drugs or getting supervised methadone? Are they left alone? Are they taken to unsuitable places where they might be at risk such as street meeting places, flats, needle exchanges, adult clinics?
• How much do the parents spend on drugs (per day? per week?) How is the money obtained?
• Is this causing financial problems?
• Do the parents sell drugs in the family home?
• Are the parents allowing their premises to be used by other drug users?
• Is/are the child/ren involved in the procurement of drugs?

Health Risks

• Where jn the household do parents store drugs / alcohol?
• What precautions do parents take to prevent their children getting hold of their drug / alcohol? Are these adequate?
• Do the children know where the drugs / alcohol are kept?
• Does the child/ren witness the parent/s taking their medication either at home or at the pharmacy? (Risk of young children copying their parents.)
• What do parent/s know about the risks of children ingesting methadone and other harmful substances?
• Do parents know what to do if a child has or they suspect has consumed methadone or other drugs?
• Do parents know what to do if a child has consumed a large amount of alcohol?
• Are they in touch with local agencies that can advise on issues such as needle exchanges, substitute prescribing programmes, detoxification and rehabilitation facilities? If they are in touch with agencies, how regular is the contact?
• Is there a risk of HIV, Hepatitis B or Hepatitis C infection?
• Blood-borne viruses (e.g. HIV, hepatitis B and C) are not in themselves issues for child protection and there is no evidence that child protection issues arise disproportionately in families affected by these viruses. Workers should seek specialist advice if issues about blood-bome viruses arise in the course of their work.
• Are parents aware of increased risk of cot death if baby is co-sleeping when parents are using substances including prescribed or illicit drugs and alcohol (NB This also applies if sleeping on sofa or chair etc)?

If the Parent(s) Inject:

• Where is the injecting equipment kept? In the family home? Are works kept securely?
• Is injecting equipment shared?
• Is a needle exchange scheme used?
• How are syringes disposed of?
• What do parent/s know about the health risks of injecting or using drugs?
• If pregnant, are they aware of screening tests for blood borne viruses and appropriate immunisations?

Family and Social Supports

• Do the parents primarily associate with other substance users, non-substance users or both?
• Are relatives aware of parent(s) problem alcohol/drug use? Are they supportive of the parent(s) and/or/child(ren)?
• Will parents accept help from relatives, friends or professional agencies?
• Is social isolation a problem for the family?
• How does the community perceive the family? Do neighbours know about the parents drug use? Are neighbours supportive or hostile?
• Have you considered the support of the Senior Parenting Practitioner (NB post primarily linked to Anti Social Behaviour (ASB) and referrals accepted where there are ASB concerns as well as other issues i.e. drugs/alcohol/mental health/domestic abuse) or family support services?

Parent's Perception of the Situation

• What do parents think of the impact of the substance misuse on their children?
• Is there evidence that the parents place their own needs and procurement of alcohol or drugs before the care and welfare of their children?

 Do the parents know what responsibilities and power agencies have to support and protect children at risk?

Child Centred Assessment

15. In working with and assessing the needs of children with drug or alcohol using parents, the work that is undertaken with them should aim to establish what it feels like for the child(ren) to live in that household and to establish whether the child(ren) need information and/or support in dealing with the issues that impact upon and affect them.
16. In doing so, the worker should approach the child(ren) in a way which is appropriate to their age and development which enables the child to tell a story without putting them on the spot and forcing them to "tell tales." The worker should attempt to establish the child's level of awareness and understanding about substance misuse and the willingness of the child to provide information or answer questions. It is also important for the worker to try and establish what support the child(ren) needs and who might be an acceptable source for that help e.g. a friend or friend's parent, family member, concerned other and so on.

Key Areas that could be Explored:

What they do on a daily basis;

Whether or not they feel safe;

Where do they turn for help, protection and comfort;

What it is like when their parents are under the influence of drugs and/or alcohol;

What it is like when they are not;

What fears, hopes and anxieties they have about their parents' behaviour;

What they would most like to change;

What they would most like to stay the same;  Is there violence in the home;

Does anything else happen that frightens them;

Extent of caring responsibilities they might assume because of parental drug/alcohol use;

The extent to which developmental milestones are being met;

Are they being bullied at school?

Analysis: Making Sense of the Information

17. This is the most important part of the assessment process as a poor analysis of the information that has been collated will invariably lead to poor decision making and care planning. In making sense of the information that has been gathered, where that information should take the worker is framed in terms of the following questions:

 Is the parents' drug or alcohol use significantly affecting parenting capacity?

Is the parents' drug or alcohol use and associated behaviour significantly impacting upon the child's health and safety, social, emotional and educational development?

 What are the resources and strengths in this family and how might they impact on the care of the child?

 What is the parents' understanding and attitude on the need for change?

 What change might be acceptable and attainable?

What types of professional intervention will help reduce the harm to the children?

 Consider the use of universal provision as the preferred option as this is often less stigmatising for the children.

Where, on the continuum of early help, children in need, children in need of protection, does this particular family sit?

18. Outlined below are some suggestions which may assist the analysis component of the assessment:
    • A chronology of significant events;
    • Who else is involved and why - a synthesis of current information, observations and any other assessments;

O The views and perspectives of all interested parties, including children, parents, family, neighbours and members of the community and other professionals/agencies; o Checks to test the reliability of information/evidence and its sources;

• Identify any other factors that may influence the assessment e.g. values of individual worker; parental attitudes and level of co-operation and honesty;
• Evidence based judgements underpinned by research and theory relating to drug and/or alcohol use, child welfare and parenting;
• Identify and utilise pooled knowledge, skills, resources and support networks.
• Completion of the Grade Care Profile if neglect is the issue.

86

Pregnancy and Neo-Natal Care

Introduction

19. Pregnancy may act as a catalyst for change presenting a 'window of opportunity'. Drug users may not use general health services until late into pregnancy and this increases the health risks for both the mother and child. Individualised care will be provided for substance using women, in line with Polices and guidelines of the unit at which the women selects to access maternity care.
20. Attracting and maintaining women in drug treatment services is vital (Hepburn 1993) as follow-up studies demonstrate that the long-term outcome in women who enter a methadone treatment programme during pregnancy is better in terms of their pregnancy, childbirth and infant development, irrespective of continuing illicit drug use (Finnegan, 1991). Women attending treatment services usually have better antenatal care and better general health than drug using women not in treatment, even if they are still using illicit drugs (Batey & Weissel 1993). Therefore Drug and Alcohol Services will prioritise all pregnant women with drug and or alcohol problems to allow for the earliest engagement possible.
21. Engagement of a drug and or alcohol using partner in treatment is an important aspect of enabling the pregnant women to achieve progress at the earliest possible stage.

Management of Antenatal Care

22. The key aims of management are to attract the women into health care treatment services, provide antenatal care and stabilize or reduce drug use to the lowest possible dose. Professionals should advise and discuss with parents the harmful impact of their continued substance misuse on their children and this should be recorded.
23. It is important that no agency worker advises a pregnant woman to stop using drugs or alcohol without first referring the matter to the midwifery service or discussion with the key worker in addiction services. The immediate withdrawal of such drugs or alcohol could result in premature birth or miscarriage.
24. Good co-ordination and information sharing between relevant parties is imperative. In Lancashire, please see the Multi-Aqency Pre-Birth Protocol for more information.
25. In Blackburn with Darwen: Given the possibility of early delivery, it is recommended that a meeting is held between 24 weeks - 32 weeks gestation to ensure that care and support is appropriate to the needs of the woman the baby and her immediate family and that plans are in place for the family post-delivery. This should reduce the need for emergency child protection proceedings at birth. The parents should be informed about all meetings and supported and encouraged to attend.
26. Where agencies or individuals anticipate that the unborn baby may be at risk of Significant Harm, a referral to Children's Social Care must be made as soon as the concerns are identified. See Makinq a Referral to Children's Social Care Procedure for more information.

Effects of Substances on the Foetus and Baby

27. It is important for clinicians to note that some of the effects of different drugs used during pregnancy are broadly similar and are largely non-drug specific. Intrauterine groMh retardation and pre-term deliveries contribute to increased rates of low birth-weight and increased prenatal mortality rate. These outcomes are multifactorial and are also affected by factors associated with socio-economic deprivation, including smoking (Kaltenbach &Finnegan 1997).
28. Higher rates of early pregnancy loss and third-trimester placental abruption appear to be major complications of maternal cocaine use. Increased rates of stillbirth, neonatal death and sudden infant death syndrome are found. Heroin has been shown to have a direct effect on foetal growth and an association with pre-term delivery. It has also been shown to result in a higher rate of small-for-date babies, even when allowing for other compounding factors and the expression of neonatal abstinence syndrome (NAS). There is shown to be a significant correlation between methadone dose and NAS.

Maternal Health Problems

29. There are a number of health problems in pregnancy, which need to be discussed with the woman and reviewed throughout the pregnancy. These include general nutrition, risks of anaemia, dental hygiene and complications from chronic infection related to injection practice. These all contribute to the increased rate of obstetric complications and premature delivery found in drug using women. Drug using women are at high risk of antenatal and postnatal mental health problems.

Management of Labour

30. Each Hospital Trust has its own procedures for the management of labour.

Neonatal Withdrawal

31 . Many babies will not need paediatric interventions, but it is important to have access to skilled neonatal paediatric care. However, all babies of substance using mothers will be subject to a withdrawal scoring sheet, which some women might interpret as intervention.

32. Signs of withdrawal from opiates are vague and multiple and tend to occur 24-72 hours after delivery. They include a spectrum of symptoms such as a high-pitched cry, rapid breathing, hungry but ineffective sucking, and excessive wakefulness. At the other end of the spectrum symptoms include hypertonicity and convulsions but these are not common. Neonatal withdrawal can be delayed for up to 7-10 days if the woman is taking methadone in conjunction with benzodiazepines. Benzodiazepine use causes more prolonged symptoms, including respiratory problems and respiratory depression.

Postnatal Management

33. Breastfeeding should be encouraged, even if the mother continues to use drugs, except where she uses a very high dose of benzodiazepines, crack/cocaine.

Specialist advice should be sought if she is HIV positive. Methadone treatment is not a contraindication to breastfeeding.

34. Health professionals should note that the care of the pregnant drug user and the safe delivery of the baby is just the start of care. Continuing support, which may need to include parenting advice and skills training, may be desirable both pre-and post-discharge if the ideal outcome of maintaining mother and child together is to be achieved.

Discharge Planning

35. To ensure that care and support continues on discharge a planning meeting should be considered and arranged on an individual basis if required. Prior to discharge all information should be reviewed and plans documented in the case notes, with liaison on discharge to relevant agencies. Relevant agencies will be notified of the discharge plan and the midwifery services will contact Substance Misuse Services to ensure continuation of prescribed medication. Details of the discharge plan should be entered onto the CAF.

Prescribing Drugs for Pregnant Drug Users

36. Substitute prescribing can occur at any time in pregnancy and is lower risk than continuing illicit use. it has the advantage of allowing engagement and therefore identification of both health and social needs as well as offering the opportunity for brief interventions and advice to improve outcomes. (Note specialist advice must always be sought.)

37 Expectant mothers who are drinking dependently should be referred as a matter of priority to a Drug and Alcohol Service and not be advised to stop without supervision due to the risk of withdrawal.

 

Pan-Lancs Safeguarding Children Boards

FABRICATED OR INDUCED ILLNESS

Fll

April 2016

Acknowledqement

I would like to thank many colleagues who have significantly contributed to the development of the Fll guidelines. A number of meetings were held in the process of developing these guidelines involving colleagues working in the field of children safeguarding from health, children social care (CSC) and police. I would like to thank them all for their time and effort in this respect. The discussions that took place in these meetings helped to enrich the understanding on Fll and in developing the guidelines. An excellent Fll conference organised by CSC in early 2015 significantly helped in clarifying many aspects within Fll. Many colleagues suggested some changes to earlier drafts of the guideline and I am indebted to them. A special mention goes to Dr Danya Glaser whose contribution to the conference mentioned earlier, and her work and many publications on Flt have greatly assisted me in developing these guidelines.

Dr Dhia Mahmood, Consultant Paediatrician,

Designated doctor for safeguarding,

Contents

         Headinq                                                      Page

1.      Definition  4

2.      The spectrum of Fll           5

3.      Impact of Fll on Child   6

4.      When to suspect Fll        7

5.      Characteristics of Perpetrator of Fll     8

6.      What to do when you suspect Fll         9-1 1

7.      The strategy meeting      12-13

8.      Information sharing and consent         14

9.      The Chronology 14

10. Outcome of section 47 investigation   15

        1 1 . Court Video Surveillance                                    16

          Appendix 1: Flt warning signs Template(WST)     17

          Appendix 2: Fll WST explained                                18-20

          Appendix 3: The Chronology proforma                   21

           Appendix 4: Flowchart when Fll is suspected         22

            References                                                                   23

Fabricated or Induced Illness (FII)

1 . Definition

Fabricated or Induced Illness (Fll) (Known previously as Munchhausen Syndrome by Proxy; other synonyms: Factitious disorder imposed on another) is a spectrum of conditions where a child experiences or likely to experience significant harm and impairment due to the health care seeking behaviour and actions of the caregiver(s), usually the mother. Such behaviour and actions may take one or more of the following forms:

1. Erroneous (incorrect or misleading) reporting of medical history, symptoms or signs, with or without an intention to deceive which may include

False reporting of non-existing symptoms and signs,

Exaggeration of existing symptoms and signs,

Misinterpretation of real events on the basis of mistaken belief about their meaning.

2. Deception by use of hand including:

Falsification of medical records

Interference with investigations, specimens, intravenous lines, ... .etc

Inducing illness in the child by overdosing, poisoning (e.g. Adding salt to baby's feed), suffocation, none administration of medications (e.g. inhalers for asthma, medication for epilepsy, thyroxin for under active thyroid gland), Etc.

For the abuse in Fll to occur, there needs to be a three way interaction between the caregiver (usually the mother), the child, and health professionals as illustrated below.

Mother

tnterf0iۥs with

Might have a genuine

Illness or disorder

2. The FII Spectrum

The Fll spectrum includes cases with varying degree of severity. The emphasis when investigating such cases should be on the impact of parents' health care seeking behaviour on the child. Cases therefore may be classified as high risk (to the child), and lower risk, cases.

1. High risk Cases are those where there is suspicion of induction and/ or fabrication /exaggeration (as described earlier) of symptoms and signs, with the intention to deceive. It is very likely that children are at significant risk of harm as a result of parents' actions.
2. Lower risk cases are those in which parent(s) exaggerate/ misinterpret symptoms and signs due to their strong, but false, belief that the child is ill/ more ill; or when parents suffer from a psychiatric illness (e.g. delusional disorder) which leads them to believe that the child is genuinely I'll. In these cases, although the carer may genuinely believe that the child is ill/ more ill, there may be harm and impairment to the child in terms of frequent, invasive and unnecessary medical investigations or treatment, limitation in daily activities and missed educational opportunities.
3. There is a category of cases where carers exaggerate or falsify their child's illness to fraudulently obtain benefits. These carers may not actively seek medical tests or treatment for the child and may actually avoid contact with medical services. The degree of impact on the child in these cases may vary. In a proportion of these cases harm or potential harm to the child in terms assuming the sick role, loss of education, and possible investigations, may be significant, and Fll therefore, should be considered.

It must be made clear from the outset that the way in which various cases within the spectrum are dealt with may vary significantly: In "high risk" cases when there is suspicion of induction or deception by carer(s) with significant risk of harm to the child as a result, an immediate referral to social services is indicated.

Lower risk "of harm" cases listed above are usually dealt with by health care professionals to change carer's perception of their children's health issues. In these cases referral to social services would be considered when such attempts by health care professionals fail, and the child continued to be at risk of harm from parents' actions.

The guidelines will in the main be dealing with the "higher risk" aspect of the spectrum of cases. In situations when we will be dealing with other low risk cases, these will be specifically mentioned as such.

3. Impact of FII on child

The impact of FII on the child can be significant. Research suggests that Flt can result in death (6%), requirement for intensive care treatment (12%), and significant emotional problems in the child. There are also significant risks of re-abuse. Following identification of Flt in a child, the way in which the case is managed has a major impact on the developmental outcomes and morbidity for the child.

The harm to the child can be grouped within three domains:

A. Physical health

1. The child has repeated procedures, investigations and treatment that are unnecessary.
2. Illness induction usually associated with serious harm/ death.

B. Daily life and functioninq

3. Low or interrupted school attendance and education.
4. Few normal activities such as sport.
5. Assuming of a 'sick role'
6. Social isolation.

C. Psychological health

g.        Develop a distorted view of health

h.        Develop anxiety

Develop fabricated or somatoform (characterised by symptoms suggesting a physical disorder but for which there is no known organic cause or physical findings) disorders in the future

              j.       Collude with illness presentation

4. When to suspect FII

The following are indicators that should alert professionals that a child is likely to be suffering harm as a result of FII. These indicators form the basis for the template used to assist in the diagnosis Fll (appendix 1 &2):

1. Reported symptoms and signs are not explained by any 'known' medical condition;
2. Physical examination and results of investigations do not explain reported symptoms and signs;
3. New symptoms are reported on resolution of previous ones;
4. Reported symptoms and identified signs are not observed in the absence of parent(s);
5. Treatment for an agreed condition does not produce the expected effects;
6. Repeated presentations to a variety of health care professionals and with a variety of problems;
7. The child denies parental reports of symptoms.
8. The child's normal daily life activities are being curtailed beyond that which may be expected from any known medical disorder from which the child is known to suffer;

Child usually presents with specific unexplained episodic problems such as apnoea, fits, choking or collapse.

10. History of unexplained illnesses or deaths or multiple surgery in parents or siblings.
11. Past history in the parent of child abuse, self-harm, somatisation, or false allegations of physical or sexual assault
12. Objective evidence of fabrication or induction. Examples include biologically implausible events, test results such as toxicology studies or blood typing; and direct evidence of fabrication or induction.

5. Characteristics of the perpetrator of FII

1. Fll is not a recognised psychiatric condition.
2. Studies vary in describing the characteristics of perpetrators depending on population and case definition. However, in many studies, perpetrators of Fll tend to share a number of characteristics.
3. Perpetrators of Flt are usually mothers (over 70%), and are also mostly females (93%). Remember however that fathers and other cares (e.g. grandparents) may be implicated.
4. A number of studies have shown that many perpetrators have a somatoform (physical presentation without any organic cause that can be identified) or factitious disorder(s).
5. Other studies have identified personality disorders in high percentage of parents.
6. In general, the non-perpetrating fathers tend to be distant, uninvolved, and emotionally and physically detached from the family system. Some fathers are truly unaware, some might believe the mother's contentions, and some might be suspicious and attempt to challenge the mother unsuccessfully.
7. Alleged perpetrators are likely to be seen as highly devoted to the child but paradoxically appear unconcerned about the child's illness (particularly if the illness is genuine).
8. They appear disappointed at negative test findings.

l. The alleged perpetrator is typically knowledgeable about the child's illness and treatment, is happy to be in hospital and forms close, and often controlling, relationships with the healthcare staff.

10. There may be a background of seeking financial or other gains through illness behaviour.
11. An avoidance of professionals who challenge or question (i.e. shopping around).

6. What to do when you suspect FII: All Professionals (Flow chart appendix 2)

1. Concerns regarding Fll may be raised by professionals from a number of agencies, including health, education, children's social care, voluntary sector, and possibly police. The majority of concerns however, arise within health.
2. The emphasis of these concerns should be on the impact that any suspected fabrication and/or induction of illness has on the child and the possible risk of harm; especially where there is suspicion of induction of illness (or risk of immediate harm) In such cases immediate referral to Child Social Care (CSC) is indicated.
3. Any Professional who has concerns that a parent or carer may be fabricating or inducing illness in a child must discuss their concerns with their line manager and their agency's nominated safeguarding children adviser / lead. It is vital that other professionals are aware of the concerns. Information sharing (without parental consent) is encouraged at an early stage in the best interests of the child, both within the agency (e.g. with other members of a GP practice) and within the wider team (eg the health visitor/school nurse).
4. If it is deemed that such concerns have substance they should be discussed with the child's lead health professional who would then follow their internal safeguarding processes. The child's GP and Paediatrician (if the child is under the care of a Paediatrician), must also be consulted. N.B Parents must not be informed of Fll suspicion at this stage.
5. All health care staff in primary, secondary or tertiary care settings such as Paediatrics, CAMHS, Learning Disability, Physiotherapy, Universal services etc. should consult with their safeguarding leads or other experienced colleagues within their own organisation.
6. The Paediatrician looking after the child will assume the role of the "responsible Paediatrician". If a number of Paediatricians are involved in the care of the child, they must collaborate and nominate a lead paediatrician who will be the "responsible Paediatrician" for the coordination of health care across all providers.
7. There may be occasions where concerns arise regarding Fil when children are under the care of consultants who are not paediatricians, or not under the care of any consultant. In cases where there are physical symptoms and signs, a referral to a paediatrician should be made. Such referral would preferably be made to a senior consultant or a consultant with a subspecialty and expertise in the signs and symptoms the child is presenting with.
8. In cases where a referral to a Paediatrician is not deemed necessary, the case should be discussed with the designated or named doctor for safeguarding who will assume the role of the "responsible Paediatrician".

l. Medical / health practitioners are ideally placed to recognise anxiety related, misconstrued, and exaggerated illness, within the context of any perplexing or medically unexplained conditions.

10. Where safe to do so, and in the absence of evidence of significant harm or suspicions of deception or induction, formulating a supportive safe plan aimed at containing the escalation of health seeking behaviours may suffice (seek the advice and support of agency nominated safeguarding leads). Early intervention in such low risk cases may negate the need for a referral to Children Social Care.
11. If there is full agreement that such course of action should be followed, then the lead paediatrician and relevant colleagues can meet with the parents and explain that they are unable to give a diagnosis or an explanation because they
    1. 'do not know'
    2. There is no explanation for reported signs and symptoms Reported symptoms are not 'life threatening'

d. There is no medical treatment

Further investigations and repeat presentations to medics are more harmful than doing nothing

6. The child and the family need to be helped to function alongside the symptoms
7. The child will not come to any harm as a result of no further action

12. The doctor can then initiate a rehabilitation programme and work towards full return to normal function / better state of health.
13. If following containment and an attempt at 'rehabilitation' parents are still exhibiting 'exaggeration' of health care seeking behaviours, a period of hospital observation and only if necessary, any possible further investigations, may be considered.
14. However in this milder end of the Fll spectrum, if Parents / carers:

i. disagree with or dispute independent / clinical observations and / or request more investigations ii. seek more medical opinions when more than one already obtained iii. decline rehabilitation plan & child's functioning is being impaired

Then a referral to CSC should be considered in conjunction with the named/ designated safeguarding individual. The referrer should make it clear that s/he is making the referral under Fll procedures.

15. In the high risk severe end of spectrum where:
    1. Deception by carer is strongly suspected in child's presentations,

Or

2. Suspicion of induction arise at any time,

Then a referral to Children Social services should be made. Parents in these categories should not be informed of Fll suspicions at this stage.

16. Parents should not be informed of the referral at this stage. Under no circumstances should the parent/carer be challenged or confronted by anyone outside a multiagency planned approach
17. Once a referral is received Children's Social Care should decide, and record within one working day, what response is necessary.
18. The majority of the children where the risk to the child is more serious will be dealt with through investigations by the Police and Children's Social Care under Section 44 of the Children Act 1989. However for those children to whom the risk is very great they may be in need of immediate protection. Children subject to such immediate risk can be removed from parents care via the Police through a Police Protection Order or through an application by the Local Authority for an Emergency Protection Order. Such significantly interventionist action however requires clear medical evidence of the child being at imminent risk of significant harm through action attributable to their parents/carers.

s. It is expected that the paediatric consultant responsible for the child's healthcare is the lead health professional and therefore has lead responsibility for all decisions appertaining to the child's healthcare. All previous records, plus out of area, should be scrutinised by the consultant paediatrician

20. Any suspected case of fabricated or induced illness may involve the commission of a crime and therefore the police should always be involved during the investigation stage.
21. All professionals involved with suspected Fll cases must ensure that their record keeping is detailed and accurate including clear documentation of all decision making. It is particularly important to document who attends with the child and who reports which symptoms. Any examination should be thoroughly described including negative findings. Professionals should also clearly document what they have recommended. This will clarify any misinformation that may arise from parents reporting different versions to different professionals.
22. Any involved professional can request that a strategy meeting be held although this is usually the role of social care.
23. The strategy meeting will be chaired by an experienced Independent Reviewing Officer (IRO), or other personnel as per local guidance of each LSCB, who have sufficient understanding of managing the complexities involved in possible Fll
24. It is strongly advisable that early on in the process when suspicions arise, a chronology of child's health history should be compiled to focus attention and aid in the identification of possible Fll. Chronologies will be discussed further later on in the guidelines..

7. The Strateqy Meeting:

A. If there is a reasonable cause to suspect that the child is suffering, or likely to suffer, significant harm, or that parent(s) actions have significant negative impact on the child, children's social care (CSC) should convene and chair a strategy meeting, in line with section 47 child protection enquiries, involving all the key professionals. Participants must include as a minimum:

    Chaired by IRO (or an alternative chair as per each specific LSCB guidelines)

    Children social care.

•    

    The "responsible Paediatrician"  GP or their report.

    School/ nursery if applicable

As medical information are crucial in these meetings, it is extremely important that as much as possible, the date, time and place of the meeting should be suitable for the GP and Paediatrician to attend.

Other professionals are invited as appropriate and may_jnclude:

    A senior ward nurse if the child is an in-patient;

    A medical professional with expertise in the relevant branch of medicine;

    Allied health professionals

    Health visitor or school nurse;

    CAMHS services

    Named/ designated safeguarding professionals.

    Local authority Legal Advisor (In some LSCBs this is a must attend)

2. The participants in the strategy meeting would examine evidence of Fll and explore the impact of carer's actions on the child and other children in the family.
3. Such evidence is usually presented in the form of chronologies of significant events prepared by different agencies with opportunity to debate and challenge provided. If chronologies are not available for the first strategy meeting, they should be available for a subsequent strategy meeting to have an informed discussion.
4. As the child's circumstances are likely to be complex, it may be necessary to have more than one strategy meeting.
5. Chronologies from different agencies should eventually be merged together into a multiagency chronology. This is usually done by the Children Social Care.
6. Staff attending should be sufficiently senior to be able to contribute to the discussions of very complex information, and to be able to make decisions on behalf of their agency
7. If the outcome of the strategy meeting(s) is that section 47 enquiry is needed, the following issues should be determined:
   1. The level of risk of harm to child and siblings, and any immediate steps necessary to reduce such risks
   2. Communication with carers and confidentiality (including how, when, and by whom they should be informed of any child protection concerns). It is advisable that informing parents should be done jointly by CSC and health, with police involved if criminal aspect is suspected.
   3. The planning of further medical and nursing assessment, including any outstanding investigations. This may include cancelling unnecessary medical procedures or instituting closer observation of the child.
   4. The development of an integrated health (and other) chronology (and agreement on who should do this)
   5. Whether the carers should be allowed on the ward if the child is an inpatient
   6. The level of professional observation required
   7. The need for forensic sampling, special observation or Covert Video surveillance (CVS)
   8. The needs of carers, particularly after disclosure of concerns
   9. Clarification of who will be the responsible paediatric consultant for the child

(if not already explicit)

10. In many cases of suspected HI, information about siblings and carers, including their past medical history, current health and any treatment, equipment, and benefit they receive, are very relevant to the case discussed. Such information are very likely to aid in the diagnosis of Fll and need to be shared.

8. Information sharinq and consent

1. Information sharing (2015), states that, where possible, information are shared with consent. However, the guidelines also states that "if it is unsafe or inappropriate to do so, i.e. where there are concerns that a child is suffering, or is likely to suffer significant harm" , one "would not need to seek consent". So sharing information without consent should be done when it is judged that seeking consent would places the child at risk.
2. In the majority of cases of suspected Fll, consent to obtain information regarding siblings and parents is not possible as parents are usually not informed of suspicions in this early stage of investigation. Seeking consent is likely to jeopardise the investigation and very likely to put the child at risk of harm. Consent to obtain information in most HI cases is, therefore, unnecessary, and is not required.
3. It is important that any information shared should be necessary (for the purpose for which it is shared for), proportionate, relevant, adequate, accurate (up to date, and based on facts not opinion), timely and shared securely

9. Chronoloqv (Pro forma Appendix 3)

At A child's chronology forms an important tool in the identification and management of cases of Fll and therefore should be compiled in all cases of suspected Fll.

2. An experienced person from each agency should compile the chronology for that agency and should be given adequate time and resources to do so.
3. Chronologies should then be merged in a "multi-agency" Chronology. This is usually done by children's social care.
4. The chronology should points to the actual or potential harm to the child caused by various events in terms of unnecessary investigations and treatment, loss of education, and curtailment of activities, possible psychological effects.... etc..
5. It is very useful that each chronology would attempt to reference some significant events in child's life to different Fll warning signs if applicable.
6. Each chronology should have a summary of events and their impact on the child.
7. A chronology regarding siblings and possibly carers may be required to have a full picture of the extent of the problem, and would likely to aid in diagnosis. As discussed earlier, consent is not required in obtaining such information in most cases.
8. Once available, the chronology should be shared with clinical colleagues and within the multiagency setting of the strategy meeting and case conference, if applicable.

10. Outcome of section 47 investigation

1. Investigation may show that concerns are not substantiated (e.g. tests may identify a medical condition that explains the signs and symptoms).
2. It may be that no protective action is required, but the family should be provided with the opportunity to discuss whether they require support.
3. As in all areas of chid protection certainty is not required but evidence — written, verbal and observed, should be considered and professional judgement on the likelihood of risk of actual harm should be made on the balance of probability. To protect children we must concentrate on assessing harm to the child.
4. Concerns may be substantiated, but an assessment may be formed that the child is not at continuing risk of harm. In this case, the decision not to proceed to a child protection conference must be endorsed by the LA children's social care manager or child protection advisor
5. Where concerns are substantiated and the child is judged to be suffering, or at risk of suffering, significant harm, a child protection conference must be convened. All evidence should be thoroughly documented by this stage and the protection plan for the child already in place.
6. Child protection investigations in Flt may take more time than usual. However, professionals should ensure that any child protection conference is held within 15 working days of the last strategy meeting, and that regular strategy discussions take place throughout the investigation.
7. The maximum timeframe for the assessment to conclude, such that it is possible to reach a decision on next steps, should be no longer than 45 working days from the point of referral.
8. If, in discussion with family and other professionals, an assessment exceeds 45 working days the social worker should record the reasons for exceeding the time limit. Whatever the timescale for assessment, where particular needs are identified at any stage of the assessment, social workers should not wait until the assessment reaches a conclusion before commissioning services to support the child and their family. In some cases the needs of the child will mean that a quick assessment will be required.

11. Covert Video Surveillance (CVS)

1. The use of covert video surveillance should be the last resort in Fll investigation. It may be considered when there is no alternative way of obtaining information to explain child's signs and symptoms.
2. The decision to use CVS may be made only by the multiagency strategy discussions to investigate suspected Fll.
3. The use of CVS is governed by the Regulation of Investigatory Power Act (the 2000 Act). The operation is controlled by the police and accountability for it is held by police manager. They will need to demonstrate that the use of CVS may lead to detection or prevention of crime.
4. Police officers should carry out any necessary monitoring. All personnel, including nursing staff, who will be involved in its use, should have received specialist training in this area.

Warninq Signs Template

    Appendix 1               FII

Category	arning signs of Fabricated or Induced Illness
1	Reported symptoms and signs are not explained by any medical condition from which the child may be suffering.
2.	Physical examination and results of medical investigations do not support/ explain reported symptoms and signs.
3.	There is an inexplicably poor response to prescribed medication and other treatment.
4.               New symptoms are reported on resolution of previous ones.
5.	Reported symptoms and signs are not seen when the carer is not present.
6.	Once the perpetrator's access to the child is restricted, signs and symptoms fade and eventually disappear.
7.	Repeated presentation to a variety of doctors with the same or different health problems.
8.              History of unexplained illnesses or deaths or multiple surgery in parents or siblings.
9.	The child's normal, daily life activities are being curtailed beyond that which might be expected for any medical disorder from which the child is known to suffer.
10.	Incongruity between seriousness of story and action of parents
1 1 .	Erroneous or misleading information provided by the parent.
12.	other extended family members are

*Please Note: The categories within the template are not absolutes — there may be numerous possible explanations one of which is possible FII.

      Appendix 2:               Warninq Siqns Template items explained

1	Reported symptoms and signs found on examination are not explained by any medical condition from which the child may be suffering. Information obtained through history and physical examination do not correlate with any recognised disease or where there is a disease known to be present. A very simple example would be a skin rash, which did not correlate with any known skin disease and had, in fact, been produced by the perpetrator. An experienced doctor should be on their guard if something described is outside their previous experience.
2.	Physical examination and results of medicai Investigations do not explain reported symptoms and signs. Physical examination and appropriate investigaiions do not confirm the reported clinical story. For example, it is reported a child turns yellow (has jaundice) but no jaundice is confirmed when the child is examined and a test for jaundice, if appropriate, is negative. A child with frequent convulsions every day.. has no abnorma;ittes on a 24-hour v:aeo telemetry (continuous video and EEG recording) even during a so-called 'convulsion'
3.	There is an inexplicably poor response to prescribed medication and other treatment. The practitioner should be alerted when treatment for the agreed condition does not produce the expected effect, for example asthma medications not making any difference to described wheezing and cough. This can result in escalating drugs with no apparent response, using multiple medications to control a routine problem and multiple changes in medication due to either poor response or frequent reports of side effects. On investigation, toxic drug levels commonly occur but may be interspersed with low drug levels suggesting extremely variable administration of medication fluctuating from over- medication to withdrawal of medication. Another feature may be the welcoming of intrusive investigations and treatments by the parent.
	New symptoms are reported on resolution of pcevlous ones. New symptoms often bear no likely relationship to the preuious set of symptoms. For example, in a child where the focus has been on diarrhoea and vomiting, when appropriate assessments tail to confirm this, the story changes to one of convulsions Sometimes this is manifest by the parents transferring consultation behaviour to another child in the family,
5.	Reported symptoms and found signs are not seen to begin in the absence of the carer, In this respect, the perpetrator is the only witness of the signs and symptoms. For example, reported symptoms and signs are not observed at school or during admission to hospital. This should particularly raise anxiety of Fll where the severity and/or frequency of symptoms reported is such that the lack of independent observation is remarkable. Caution should be exercised when accepting statements from non-medically qualified people that symptoms have been observed. Example would be school describing episodes as fits' because they were told that was the appropriate description of the behaviour they were seeing.

 

 

6.	Once the perpetrator's access to the child is restricted. signs and symptoms fade and evefituauy disappeaiA (similar to category S aboveh T nis is a planned separation of perpetrator and child which it nas Deen agreed Will nave a high likelihood ot proving (or disproving) Fil abuse It can be difficult in practice, and appear heartless, to separate perpetrator and child. The perpetrator frequently insists on remaining at the child's bedside, is unusually close tc the medical team and thrives in a hospttai environment-   Repeated presentation to a variety of doctors with a same or different health problems. At its most extreme this has been referred to as 'doctor shopping'. The extent and extraordinary nature of the additional consultations is orders of magnitude greater than any concerned parent would explore. Often consultations about the same or different problems are concealed in different medical facilities. Thus the patient might be being investigated in one hospital with one set of problems and the parent will initiate assessments elsewhere for a completely different set of problems (or even the same) without informing these various medical professionals about the other consultations.   History of unexplained ihnesses or deaths or multiple surgery in parents or siblings of the family. The emphasis here is on the unexpgained, Illness and deaths in parents or slDllngs can frequently be a clue to further investigation and hence a diagnosis in naturally occurring illness. In Fll abuse, perpetrators frequently have had multiple unexplained medical problems themselves, ranging from frequent consultations with the general practitioner through to the extreme of Munchausen syndrome where there are multiple presentations with fabricated or induced illness resulting in multiple (unnecessary) operations. Self-harm, often multiple; and eating disorders are further common features in perpetrators. Additionally, other children either concurrently or sequentially might have been subject to Fll abuse and their medical history should also be examined
7
9.	The child's normal, daily life activities are being curtailed beyond that which might be expected for any medical disorder from which the child is known to suffer. The carer limits the child's activities to an unreasonable degree and often either without knowledge of medical professionals or against their advice. For example, confining a child to a wheelchair when there is no reason for this, insisting on restrictions of physical activity when not necessary, adherence to extremely strict diets when there is no medical reason for this, restricting child's school attendance
10.	Incongruity between the seriousness of the story and the actions of the parents Given a concerning story, parents by and large will cooperate with medical efforts to resolve the problem. They will attend outpatients, attend for investigations and bring the child for review urgently when requested. Perpetrators ot Fli abuse, apparently paradoxically, can be extremely creative at avoiding contacts which would resolve the problem. There is incongruity between their expressed concerns and the actions they take. They repeatedly fail to attend for crucial investigations They go to hospitals that do not have The background information. They repeatedly produce the flimsiest of excuses for failing to attend for crucial assessments (somebody else's birthday, thought the hospital was closed, went to outpatients at one o'clock in the morning).
Il	Erroneous or misleading information provided by parent. These perpetrators are adept at spinning a web of misinformation which perpetuates and amplifies the illness story, increases access to interventions in the widest sense (more treatment, more investigations, more restrictions on the child or help, etc.). An extreme example of this is spreading the idea that the child is going to die when in fact no-one in the medical profession has ever

 

	suggested this. Changing or inconsistent stories should be recognised and challenged. Accurate and detailed documentation is key here.
1 2.	Exaggerated catastrophes or tahricated bereavements and other extended family problems are reported. Trus IS an extension of category 8. On exploring reported illnesses or deaths in other farnily members (ovcen very dramatic stories) no evidence is found to confirm these stones. They were largely or wno;ty fictitious

 

 

     Appendix 3                            The Chronology

Date	Source	Event	Action taken	Actual/ potential impact/harm on child	Template category corresponding to FII warning signs.

Appendix 4: Flowchart when FII is suspected

Practitioner has concerns about possible Fll in a child

Practitioner shares concerns and seeks support and advice from Line Manager and Safeguarding

Children's Team.                                                                                 If at any time there is concern regarding child safety or welfare, refer to

Medical evaluation led by Paediatrician in consultation with all other involved health care professionals including GP. HV, School nurse, CAMS.. etc. (if no

Paediatrician involved, refer to Paeds)

Explanation for

Completion of medical tests, with care Signs and taken to avoid iatrogenic harm (harm symptoms found. from medical investigation/treatment) Treatment given

No explanation for signs or

symptoms	Fabrication or induction of illness strongly suspected. Professional meeting may be held (to include Paeds, GP. named professionals. HVI school nurse, other health
Further specialist advice and treatment provided ensuring care taken to avoid	rofessionalsi thera -ists /
iatrogenic harm	Suspected deception/	No suspected deception:
	Suspected induction of illness/	Paediatrician explains to
	Unwillingness to accept medical	parents results of tests.
	opinion regarding results	Reassure regarding health.
Discuss with named designated doctor		Problems resolve: No further
Compile a chronology		action needed

Initiate referral to social services/ police

References

1. Bass C & Glaser D: 2014: Early recognition and Management of Fabricated or Induced illness in children; The Lancet, Vol 283, issue 9926, pages 14121421.
2. HMG department for children, schools & families. 2008: safeguarding children in whom illness is fabricated or induced; supplementary guidance to working together to safeguard children.
3. Royal Colleqe of Paediatrics & Child Health. 2009: Fabricated or Induced Illness by Carers (FII), a guide for Paediatrician.
4. Manchester LSCB: FII guidelines.
5. London LSCB: Fll guidelines
6. Joint Cardiff & Vale of Glamorqan LSCB , 2012: Protocol for Fabricated or induced Illness and related Conditions.
7. Information sharinq : Advice for practitioners providing safeguarding services to children, young people, parents and carers. March 2015.
8. Workinq toqether to safeguard children: A guide to inter-agency working to safeguard and promote the welfare of children. March 2015.
9. Diagnostic and Statistical Manual of Mental Disorders 2013: (DSM), 5^th edition USA;

 

5.16 Female Genital Mutilation

AMENDMENT

In July 2019 this chapter was updated to incorporate the FGM tool.

Contents Definition Indicators

NHS Actions

Mandatory Reporting of FGM

Protection and Action to be Taken

Issues

Further Information

Law

Definition

Female genital mutilation (FGM) is a collective term for procedures, which include the removal of part or all of the external female genitalia for cultural or other nontherapeutic reasons. The practice is medically unnecessary, extremely painful and has serious health consequences, both at the time when the mutilation is carried out and in later life. The procedure is typically performed on girls aged between 4 and 13, but in some cases it is performed on new-born infants or on young women before marriage or pregnancy.

FGM has been a criminal offence in the U.K. since the Prohibition of Female Circumcision Act 1985 was passed. The Female Genital Mutilation Act 2003 replaced the 1985 Act and made it an offence for the first time for UK nationals, permanent or habitual UK residents to carry out FGM abroad, or to aid, abet, counsel or procure the carrying out of FGM abroad, even in countries where the practice is legal.

The rights of women and girls are enshrined by various universal and regional instruments including the Universal Declaration of Human Rights, the United Nations Convention on the Elimination of all Forms of Discrimination Against Women, the Convention on the Rights of the Child, the African Charter on Human and Peoples' Rights and Protocol to the African Charter on Human and Peoples' Rights on the rights of women in Africa. All these documents highlight the right for girls and women to live free from gender discrimination, free from torture, to live in dignity and with bodily integrity.

FGM has been classified by the World Health Organisation (WHO) into four types:

Type 1 — Clitoridectomy: partial or total removal of the clitoris (a small, sensitive and erectile part of the female genitals) and, in very rare cases, only the prepuce (the fold of skin surrounding the clitoris);

90

 

Type 2 — Excision: partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora (the labia are the 'lips' that surround the vagina);

Type 3 — Infibulation: narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the inner, or outer, labia, with or without removal of the clitoris; and

Type 4 — Other: all other harmful procedures to the female genitalia for nonmedical purposes, e.g. pricking, piercing, incising, scraping and cauterising the genital area.

For more detail, please refer to the Multi-aqency statutory guidance on female qenital mutilation April 2016 (GOV.UK).

Click here to access the GOV.UK website for Female Genital Mutilation.

Indicators

These indicators are not exhaustive and whilst the factors detailed below may be an indication that a child is facing/at risk of FGM, it should not be assumed that is the case simply on the basis of someone presenting with one or more of these warning signs. These warning signs may indicate other types of abuse such as forced marriage or sexual abuse that will also require a multi-agency response. See also statutory guidance Annex B: Risk, for details.

The following are some signs that the child may be at risk of FGM:

A female child is bom to a woman who has undergone FGM or whose older sibling or cousin has undergone FGM;

The family belongs to a community in which FGM is practised or have limited level of integration within UK community;

The family indicate that there are strong levels of influence held by elders and/or elders are involved in bringing up female children;

If a female family elder is present, particularly when she is visiting from a country of origin, and taking a more active / influential role in the family;

The family makes preparations for the child to take a holiday, e.g. arranging vaccinations, planning an absence from school;

The child talks about a 'special procedure/ceremony' that is going to take place;

An awareness by a midwife or obstetrician that the procedure has already been carried out on a mother, prompting concern for any daughters, girls or young women in the family;

Repeated failure to attend or engage with health and welfare services or the mother of a girl is very reluctant to undergo genital examination including cervical smears;

Where a girl from a practising community is withdrawn from Sex and

Relationship Education (also known to withdrawn from mainstream education completely to either home education/religious education institutions) - they may be at risk from their parents wishing to keep them uninformed about their body and rights.

Consider whether any other indicators exist that FGM may have or has already taken place, for example:

1. The child has changed in behaviour after a prolonged absence from school;
2. The child has health problems, particularly bladder or menstrual problems;
3. The child has difficulty walking, sitting or standing and may appear to be uncomfortable.

A Strategy Discussion will determine the need for a medical assessment and where it is believed that FGM has already taken place

It should be remembered that this will have lifelong consequences, and can be highly dangerous at the time of the procedure and directly afterwards.

If you are worried about a girl under 18 who is either at risk of FGM or who you suspect may have had FGM, you should share this information with Children's social care or the Police immediately, whichever is most appropriate see Protection and Action to be Taken. See also Female Genital Mutilation Pan - Lancashire Multi-Aqency Pathway for Children.

From the 31st October 2015, regulated professionals in health and social care and teachers/teaching assistants in England and Wales have a duty to report 'known' cases of FGM in under 18s to the Police see Mandatory Reportinq of FGM.

Professionals must take into consideration that by alerting the girl's or woman's family to the fact that she is disclosing information about FGM may place her at increased risk of harm and professionals should therefore take sufficient steps to minimise this risk.

It should not be assumed that families from practising communities will want their girls and women to undergo FGM, however a multi-agency response must take place to establish the risk if any.

NHS Actions

Since April 2014 NHS Acute hospital Trusts have been required to record

      If a patient has had Female Genital Mutilation;

If there is a family history of Female Genital Mutilation;

If a Female Genital Mutilation-related procedure has been carried out on a patient.

Since September 2014 all acute hospitals have been required to report this data centrally to the Department of Health and Social Care on a monthly basis. This was the first stage of a wider ranging programme of work in development to improve the way in which the NHS will respond to the health needs of girls and women who have suffered Female Genital Mutilation and actively support prevention.

A midwife/obstetrician/gynaecologist/General Practitioner may become aware that Female Genital Mutilation has occurred when treating a female patient. This should trigger concern for other females in the household.

For further information, see Female Genital Mutilation Datasets (NHS).

Mandatory Reporting of FGM

From the 31st October 2015, regulated professionals in health and social care and teachers/teaching assistants in England and Wales have a duty to report 'known' cases of FGM in under 18s which they identify in the course of their professional work to the Police. Following consultation with social care professionals as well as other relevant professionals, only then will the Police take action to ensure the girl/young woman is safe and her needs are prioritised.

'Known' cases are those where either a girl informs the person that an act of FGM — however described — has been carried out on her, or where the person observes physical signs on a girl appearing to show that an act of FGM has been carried out and the person has no reason to believe that the act was, or was part of, a surgical operation within Section I(2)(a) or (b) of the FGM Act 2003.

A failure to report the discovery in the course of their work could result in a referral to their professional body. The Home Office has produced guidance Mandatory Reportinq of Female Genital Mutilation — procedural information to support this duty and a fact sheet on the New Duty for Health and Social Care Professionals and Teachers/teachinq assistants to Report Female Genital Mutilation (FGM) to Police.

If there are suspicions that a girl under the age of 18 years may have undergone FGM or is at risk of FGM professionals must still report the issue by following their internal safeguarding procedures. Professionals must share the information about their concerns, potential risk and/or the actions which are to be taken. Next steps should be discussed with the safeguarding lead and if necessary a social care referral made.

Protection and Action to be Taken

Where concerns about the welfare and safety of a child or young person have come to light in relation to FGM a referral to Children's social care should be made in accordance with Makinq @ R_eferral to Children's Social Care Procedure.

Please also see FGM Assessment Tool that can be used where there are concerns about FGM.

Children's social care will undertake an assessment and, jointly with the Police, will undertake a Section 47 Enquiry if they have reason to believe that a child is likely to suffer or has suffered FGM. A strategy discussion/meeting should include the relevant Health professionals and, if the child is of school age, the relevant school representative.

Where a child has been identified as having suffered, or being likely to suffer, Significant Harm, it may not always be appropriate to remove the child from an otherwise loving family environment. Parents and carers may genuinely believe that it is in the girl's best interest to conform to their prevailing custom. Professionals should work in a sensitive manner with families to explain the legal position around FGM in the UK. The families will need to understand that FGM and re-infibulation (the process of resealing the vagina after childbirth) is illegal in the UK and that if they are insistent upon carrying out the practice, it can lead to child protection and criminal justice actions taken against them. Interpretation services should be used if English is not spoken or well understood and the interpreter should not be an individual who is known to the family.

Where a child appears to be in immediate danger of mutilation, legal advice should be sought and consideration should be given, for example, to seeking a Female Genital Mutilation Protection Order, an Emergency Protection Order or a Prohibited Steps Order, making it clear to the family that they will be breaking the law if they arrange for the child to have the procedure.

The 2003 Female Genital Mutilation Act makes it illegal for any residents of the UK to perform FGM within or outside the UK. The punishment for violating the 2003 Act carries 14 years imprisonment, a fine or both.

If the outcome of social care enquiries is that female child may be at risk of future harm, community agencies (school nurses, GPs, schools etc.) with regular contact with the child should be informed of any risks and requested to make an immediate referral should any of the indicators above are identified.

Issues

Where is FGM Practised?

As a result of immigration and refugee movements, FGM is now being practiced by ethnic minority populations in other parts of the world, such as USA, Canada, Europe, Australia and New Zealand. FORWARD estimates that as many as 6,500 girls are at risk of FGM within the UK every year.

 

The most recent estimates of prevalence within England & Wales down to local authority level can be found at the City University London website.

The report draws on prevalence data from across 27 countries where FGM is known to be part of cultural practices. From census and education data it is known that across Pan-Lancashire residents originate from at least two-thirds of FGM practising countries (including eight out of the eleven countries where FGM prevalence rates are above 70% in women.

The City University London and Equality Now report along with the indicators outlined above will allow professionals to analyse the likelihood of risk and the types of risk girls may face.

There is no Biblical or Koranic justification for FGM and religious leaders from all faiths have spoken out against the practice - There are however some extreme views within some religious teachings that FGM is required to maintain female chastity and purity which may therefore perpetuate the practice and cause conflict within families and communities around FGM practice.

Consequences of FGM

Depending on the degree of mutilation, FGM can have a number of short-term health implications:

1. Severe pain and shock;
2. Infection;
3. Urine retention;
4. Injury to adjacent tissues;
5. Immediate fatal haemorrhaging.

Long-term implications can entail:

1 . Extensive damage of the external reproductive system;

2. Uterus, vaginal and pelvic infections;
3. Cysts and neuromas;
4. Increased risk of Vesico Vaginal Fistula;
5. Complications in pregnancy and child birth;
6. Psychological damage;
7. Sexual dysfunction;
8. Difficulties in menstruation.

In addition to these health consequences there are considerable psycho-sexual, psychological and social consequences of FGM.

Justifications of FGM

The justifications given for the practise are multiple and reflect the ideological and historical situation of the societies in which it has developed. Reasons include:

1 . Custom and tradition;

2. Religion, in the mistaken belief that it is a religious requirement;
3. Preservation of virginity/chastity;
4. Social acceptance, especially for marriage;
5. Hygiene and cleanliness;
6. Increasing sexual pleasure for the male;
7. Family honour;
8. A sense of belonging to the group and conversely the fear of social exclusion;
9. Enhancing fertility.

FGM is a complex and sensitive issue that requires professionals to approach the subject carefully. An accredited female interpreter may be required. Any interpreter should ideally be appropriately trained in relation to FGM, and in all cases should not be a family member, not be known to the individual, and not be someone with influence in the individual's community.

In light of this, professionals must give careful thought and consideration to developing a safety and support plan for the girl/woman prior to meeting with her. If a girl/woman is seen by someone within the community who she perceives as 'hostile' this may pose a risk to her safety. By mutually agreeing in advance another reason why they are there and/or why they are meeting could potentially minimise this risk.

Further Information

Female Genital Mutilation Pan - Lancashire Multi-Aqency Pathway for Children

AFRUCA (Child Protection of African Children)

Forward (Foundation for Women's Health Research and Development)

Multi-Aqency Statutory Guidance on Female Genital Mutilation

FGM Protection Orders: Factsheet

Female Genital Mutilation and its Management: Royal College of Obstetricians and Gynaecoloqists 2015

Female Genital Mutilation: Resource Pack (GOV.UK)

Mandatory Reporting of Female Genital Mutilation — procedural information

Working Together to Safequard Children

Female Genital Mutilation Risk and Safequardinq - Guidance for Professionals (Department of Health and Social Care)

FGM Mandatory Reportinq Duty (Department of Health and Social Care)

FGM Mandatory Reporting Duty - What you need to do (Department of Health and Social Care)

FGM — Supportinq Girls. Information for Patients (NHS)

Statement opposinq Female Genital Mutilation (Health passport) Female Genital Mutilation (FGM)

Law

The Female Genital Mutilation (FGM) Act was introduced in 2003 and came into effect in March 2004. The act:

1. Makes it illegal to practice FGM in the UK;
2. Makes it illegal to take girls who are British nationals or permanent residents of the UK abroad for FGM whether or not it is lawful in that country;
3. Makes it illegal to aid, abet, counsel or procure the carrying out of FGM abroad;
4. Has a penalty of up to 14 years in prison and/or, a fine.

The Serious Crime Act 2015 has amended the Female Genital Mutilation Act

2003

1. Created a new offence of failing to protect a girl from FGM with a penalty of up to 7 years in prison or a fine or both. -A person is liable if they are "responsible" for a girl at the time when an offence is committed. This will cover someone who has "parental responsibility" for the girl and has "frequent contact" with her and any adult who has assumed responsibility for caring for the girl in the manner of a parent. This could be for example family members, with whom she was staying during the school holidays;
2. Introduced Female Genital Mutilation Protection Orders ("FGMPO") - breaching an order carries a penalty of up to five years in prison. The terms of the order can be flexible and the court can include whatever terms it considers necessary and appropriate to protect the girl or woman;
3. Allowing for the anonymity of victims of FGM — prohibiting the publication of any information that could lead to the identification of the victim. Publication covers all aspects of media including social media;
4. Extended the extra-territorial reach of Female Genital Mutilation (FGM) offences to include "habitual residents" of the UK;
5. Created a new duty of Mandatory Reporting of Female Genital Mutilation for regulated professionals in health and social care professionals and teachers/teaching assistants in England and Wales which came into force on the 31 st October 2015.

5.17 Forced Marriages

RELATED NATIONAL GUIDANCE

Working Together to Safequard Children

Please also see further information from the Forced Marriage Unit in relation to Forced Marriage and Adults with Learninq Disabilities (circulated by ADASS)

Co-ordinated Action Aqainst Domestic Abuse (CAADA) Risk Identification

Checklist (RIC) & Quick Start Guidance for Domestic Abuse, Stalkinq and Honour-Based Violence (DASH)

Multi-Aqency practice quidelines: Handling cases of forced marriage (2014) Forced Marriage Unit (GOV.UK) Contact the Forced Marriage Unit (FMU) if you're trying to stop a forced marriage or you need help leaving a marriage you've been forced into.

Apply for a forced marriage protection order (GOV.UK)

Protocol on the handling of 'so-called' Honour Based Violence/Abuse and

Forced Marriage Offences between the National Police Chiefs' Council and the

Crown Prosecution Service

RELATED LOCAL GUIDANCE

Flowchart for Cases Where Forced Marriage is Suspected

RELATED CHAPTERS

Honour Based Abuse Procedure

Missinq Children and Families Procedure

Abduction Procedure

Modern Slavery Procedure

Child Sexual Exploitation - Pan Lancashire Standard Operatinq Protocol

AMENDMENT

In November 2017, links were updated in the Related National Guidance section.

Contents

Introduction

Motives Prompting Forced Marriage

The Legal Position

Symptoms of Risk Factors

Dealing with Concerns and the "One Chance Rule"

Notes of Caution

Flowchart for Cases Where Forced Marriage is Suspected

Introduction

1 . A 'forced' marriage (as distinct from a consensual "arranged" marriage) is defined as one which is conducted without the valid consent of both of the parties and where duress is a factor. Duress includes both physical and emotional pressure and cannot be justified on religious or cultural grounds. Forced marriage is child abuse and can put children and young people at risk of physical, emotional and sexual abuse. Children's Social Care has a duty to make enquiries into allegations of abuse or neglect against a child under s.47 Children Act 1989 (and where appropriate s. 17 of the Act);

2. The majority of cases of forced marriage encountered in the UK involve South Asian families. This is partly a reflection of the fact that there is a large population in the UK. Indeed, it is clear that forced marriage is not solely a South Asian problem and there have been cases involving families from East Asia, the Middle East, Europe, and Africa. Some forced marriages take place in the UK with no overseas element, while others involve a partner coming from overseas or a British citizen being sent abroad. Most cases involve young women and girls aged between 13 and 30, although there is evidence to suggest that as many as 15 per cent of victims are male;

The term "Forced Marriage" can cover a variety of crimes including assault, imprisonment and murder where the person is being punished by their family or community for actually or allegedly undermining what the family or community believes to be the correct code of behaviour and therefore bringing 'shame' or 'dishonour' onto the family or community. (Home Office)

3. Young people, especially those aged 16 and 17, can present specific difficulties to agencies as there may be occasions where it is appropriate to use both child and adult protection frameworks. For example, some 16 and 17 year olds may not wish to enter the care system but prefer to access refuge accommodation. Victims aged 16 and over should be assessed using the CAADA/The National Police Chiefs Council DASH and, if assessed as high risk, referred to the MARAC;

4 All professionals working with victims of forced marriage and honour based violence need to be aware of the 'one chance rule'. That is, they may only have one chance to speak to a potential victim and thus they may only have one chance to save a life. This means that all professionals working within statutory agencies need to be aware of their responsibilities and obligations when they come across forced marriage cases. If the victim is allowed to walk out of the door without support being offered, that one chance might be wasted;

5. Children's Social Care has a duty to make enquiries into allegations of abuse or neglect against a child under Section 47 Children Act 1989. Forced marriage is child abuse and can put children and young people at risk of physical, emotional and sexual abuse;
6. Mediation and involving the family can place a child or young person in danger and should not be undertaken as a response to forced marriage. This includes visiting the family to ask them whether they are intending to force their child to marry or writing a letter to the family requesting a meeting about their child's allegation that they are being forced to marry.

Motives Prompting Forced Marriage

7. Parents who force their children to marry often justify their behaviour as protecting their children, building stronger families, and preserving cultural or religious traditions. They do not see anything wrong in their actions. Forced Marriage cannot be justified on religious grounds; every major faith condemns it and freely given consent is a prerequisite of Christian, Jewish, Hindu, Muslim and Sikh marriages. Whilst it is important to have an understanding of the motives that drive parents to force their children to marry, these motives should not be accepted as justification for denying the child the right to choose a marriage partner. Forced marriage should be recognised as a human rights abuse;
8. Some key motives that have been identified are:

 Controlling unwanted behaviour and sexuality (including perceived promiscuity, or being gay, lesbian, bisexual or transgender) - particularly the behaviour and sexuality of women;

 Protecting 'family honour';

 Responding to peer group or family pressure;

 Attempting to strengthen family links;

 Ensuring land, property and wealth remain within the family;

 Protecting perceived cultural or religious ideals (which can often be misguided or out of date);

Preventing unsuitable relationships, e.g. outside the ethnic, cultural, religious or caste group;

 Assisting claims for residence and citizenship;

 Fulfilling long standing family commitments.

The Legal Position

9. In 2004, the Government's definition of domestic violence was extended to include acts perpetrated by extended family members as well as intimate partners. Acts such as forced marriage and other so-called 'honour crimes' which can include abduction and homicide, can now come under the definition of domestic violence. Many of these acts are committed against children. Perpetrators can be prosecuted for offences including threatening behaviour, assault, kidnap, abduction, imprisonment and murder. Sexual intercourse without consent is rape;
10. Sexual intercourse without consent is rape, regardless of whether this occurs within the confines of a marriage;

ll .ln addition, the Forced Marriage (Civil Protection) Act 2007, which was implemented in November 2008, makes provision for protecting children, young people and adults from being forced into marriage without their full and free consent (through Forced Marriage Protection Orders);

12. Anyone threatened with forced marriage or forced to marry against their will can apply for a Forced Marriage Protection Order. Such an order can be granted to prevent a marriage occurring or, where a forced marriage has already taken place, to offer protective measures. Orders may contain prohibitions (e.g. to stop someone from being taken abroad), restrictions (e.g. to hand over all passports and birth certificates and not to apply for a new passport), requirements (e.g. to reveal the whereabouts of a person or to enable a person to return to the UK within a given timescale) or such other terms as the court thinks appropriate to stop or change the conduct of those who would force the victim into marriage. A power of arrest may be added where violence is threatened;
13. Third parties such as relatives, friends, voluntary workers and Police officers can apply for a protection order with the leave of the Court. Since 1 November 2009, local authorities can apply for a protection order for a vulnerable adult or child without the leave of the court;
14. For further advice and information about how to make such an application, see the Guidance for Local Authorities on Applyinq for Forced Marriage Protection Orders, published by the Ministry of Justice in November 2009.

The Anti-social Behaviour, Crime and Policing Act 2014 made it a criminal offence, with effect from 16 June 2014, to force someone to marry. This includes:

Taking someone overseas to force them to marry (whether or not the forced marriage takes place);

Marrying someone who lacks the mental Capacity to consent to the marriage (whether they're pressured to or not).

Breaching a Forced Marriage Protection Order is also now a criminal offence. The civil remedy of obtaining a Forced Marriage Protection Order through the family courts, as set out above, continues to exist alongside the criminal offence, so victims can choose how they wish to be assisted.

Forcing someone to marry can result in a sentence of up to 7 years in prison.

Disobeying a Forced Marriage Protection Order can result in a sentence of up to 5 years in prison.

Symptoms of Risk Factors

16. The factors below, collectively or individually may be an indication that a young person fears they may be forced to marry, or that a forced marriage has already taken place:
    • Education - truancy from lessons, low motivation in school, poor exam results, extended periods of 'authorised absence' for sickness or oversees family commitments, unofficial withdrawal from school, history of older siblings missing education and marrying early;
    • Health - self-harm, attempted suicide, eating disorders, depression, isolation;
    • Employment - poor performance, poor attendance, limited career choices, not allowed to work, unreasonable financial control e.g. confiscation of wages/income;
    • Family history - siblings forced to marry, family disputes, domestic violence and abuse, running away from home, unreasonable restrictions house   arrest.

See also the Multi-agency Practice Guidelines on Forced Marriage Chart of Potential Warning Signs or Indicators.

Dealing with Concerns and the "One Chance Rule"

17. Forced marriage is abusive and when it concerns children and young people under the age of 18 years should be dealt with. Any agency becoming aware that a child is to be forced into marriage should make a referral to Children's Social Care, under the Referrals Procedure. A flowchart for the management of these cases can be found below;
18. All professionals working with victims of forced marriage need to be aware of the 'one chance rule'. That is, they may only have one chance to speak to a potential victim and thus they may only have one chance to save a life. This means that all professionals working within statutory agencies need to be aware of their responsibilities and obligations when they come across forced marriage cases. If the victim is allowed to walk out of the door without support being offered, that one chance might be wasted;
19. Young people, especially those aged 16 and 17, can present specific difficulties to agencies as there may be occasions where it is appropriate to use both child and adult protection frameworks. For example, some 16 and 17 year olds may not wish to enter the care system but prefer to access refuge accommodation. Victims aged 16 and over should be assessed using the CAADA Risk Identification Checklist & Quick Start Guidance for Domestic Abuse, Stalkinq and Honour-Based Violence (DASH) and, if assessed as high risk, referred to the MARAC.

Notes of Caution

20. Mediation and involving the family can place a child or young person in danger and should not be undertaken as a response to forced marriage: this includes visiting the family to ask them whether they are intending to force their child to marry or writing a letter to the family requesting a meeting about their child's allegation that they are being forced to marry;
21. Extreme caution must be exercised. Do not discuss concerns about forced marriage with the young person's family or friends, or share information outside child protection Information Sharing and Confidentiality Procedures without the express consent of the young person. Such action could place a child or young person at increased risk. If approached parents may deny that the young person is being forced to marry, move the young person, expedite any travel arrangements and bring forward the forced marriage;
22. If there are concerns that a child (male or female) is in danger of a forced marriage, local agencies and professionals should contact the Forced Marriage Unit where experienced caseworkers will be able to offer support and guidance (020 7008 0230). The Police and Children's Social Care should also be contacted. All those involved will want to bear in mind that mediation as a response to forced marriage can be extremely dangerous. Refusal to go through with a forced marriage has, in the past, been linked to so-called 'honour crimes'.

Flowchart for Cases Where Forced Marriage is Suspected

5.18 Gambling

1. Holders of gambling premises licences or Gambling Permits, and personal licences have a statutory responsibility to promote the protection of children (and other vulnerable persons) from being harmed or exploited by gambling in of their premises.
2. The protection of children from harm requires the proactive involvement (and sometimes training) of licensees, management and staff to ensure that the needs of under 18¹s are considered and addressed in the day-to-day operation of the premises. Family-friendly premises benefit from a loyal customer base with time and money to spend, but like anybody customers have their own set of needs. Premises that want to profit by catering for families must ensure the way they operate meets the needs of under 18s.
3. There are premises which will want to provide activities that are not suitable for children and those children and young people will therefore be excluded:

o From the area of the premises where the activities take place o From the premises as a whole; at the time the activities take place; or o At all times.

4. All licensing applications are screened by officers from Children's Social Care on behalf of the Children's Safeguarding Assurance Partnership.
5. The Portman Group offers substantial advice and suggestions related to steps licensees can undertake which directly relate to promoting the licensing objectives including but not limited to age identification schemes.

5.19 Gang, Group Activity and Criminal Exploitation Affecting Children

RELATED INFORMATION

Knife, Gun and Ganq Crime (GOV.UK)

 

The Centre for Social Justice: Girls and Gangs

Statutory Guidance Injunctions to Prevent Gang-Related Violence and GanqRelated Druq Dealing, May 2016 (Home Office)

YOT Practitioner's Guide: Injunctions to prevent gang related violence (Youth Justice Board July 2015)

Preventinq Gang and Youth Violence: Spottinq Signals of Risk and Supportinq Children and Younq People

Criminal Exploitation of children and vulnerable adults: County Lines quidance (Home Office) - This guidance outlines what county lines (and associated criminal exploitation) is, signs to look for in potential victims, and what to do about it.

County Lines - Gang Violence Exploitation and Drug Supply (NCA 2019)

Children's Voices - A review of evidence on the subjective wellbeinq of children involved in gangs in England (Children's Commissioner, November 2017) RELATED CHAPTERS

Child Sexual Exploitation - Pan Lancashire Standard Operating Protocol

Radicalisation Procedure

AMENDMENT

This chapter was updated in May 2018 to include a link to the Home Office publication Criminal Exploitation of Children and Vulnerable Adults: County Lines. Information was also added throughout to describe how organised criminal groups exploit young people and use them to distribute money and illegal drugs along 'county lines'.

Contents Definition

Risks

Indicators

Protection and Action to be Taken

Issues

Definition

Defining a gang is difficult. They tend to fall into three categories: peer groups, street gangs and organised crime groups. It can be common for groups of children and young people to gather together in public places to socialise, and although some peer group gatherings can lead to increased antisocial behaviour and low level youth offending, these activities should not be confused with the serious violence of a street gang.

A street gang can be described as a relatively durable, predominantly street-based group of children who see themselves (and are seen by others) as a discernible group for whom crime and violence is integral to the group's identity.

A street gang will engage in criminal activity and violence and may lay claim over territory (not necessarily geographical for example it could include an illegal economy territory). They have some form of identifying structure featuring a hierarchy usually based on age, physical strength, propensity to violence or older sibling rank. There may be certain rites involving antisocial or criminal behaviour or sex acts in order to become part of the gang. They are in conflict with other similar gangs.

An organised criminal group is a group of individuals normally led by adults for whom involvement in crime is for personal gain (financial or otherwise). This involves serious and organised criminality by a core of violent gang members who exploit vulnerable young people and adults. This may also involve the movement and selling of drugs and money across the country, known as 'county lines' because it extends across county boundaries and is coordinated by the use of dedicated mobile phone lines. It is a tactic used by groups or gangs to facilitate the use of vulnerable people or children to sell drugs in an area outside of the area in which they live, which reduces their risk of detection.

Selling drugs across county lines often involves the criminal exploitation of children and young people. Child criminal exploitation, like other forms of abuse and exploitation, is a safeguarding concern and constitutes abuse even if the young person appears to have readily become involved. Child criminal exploitation is typified by some form of power imbalance in favour of those perpetrating the exploitation and usually involves some form of exchange (e.g. carrying drugs in return for something). The exchange can include both tangible (such as money, drugs or clothes) and intangible rewards (such as status, protection or perceived friendship or affection). Young people who are criminally exploited are at a high risk of experiencing violence and intimidation and threats to family members may also be made. Gangs may also target vulnerable adults and take over their premises to distribute Class A drugs in a practice referred to as 'cuckooing'.

Young people can become indebted to the gang/groups and then exploited in order to pay off debts. Young people who are criminally exploited often go missing and travel to other towns (some of which can be great distances from their home addresses). They may have unexplained increases in money or possessions, be in receipt of an additional mobile phone and receive excessive texts or phone calls.

White British children are often targeted because gangs perceive they are more likely to evade police detection and some children may be as young as 12, although 15 to 16 years old is the most common age range. The young people involved may not recognise themselves as victims of any abuse and can be used to recruit other young people.

It is important to remember the unequal power dynamic within which this exchange occurs and to remember that the receipt of something by a young person or vulnerable adult does not make them any less of a victim.

If a young person is arrested for drugs offences a long way from home in an area where they have no local connections and no obvious means of getting home, this should trigger questions about their welfare and they should potentially be considered as victims of child criminal exploitation and trafficking rather than as an offender.

Agencies also need to be proactive and make contact with statutory services in the young person's home area to share information.

Where there are concerns that children are victims of child criminal exploitation they should be referred to the National Referral Mechanism - see Modern Slavery Procedure. Referring a Potential Victim of Modern Slavery to the National Referral Mechanism (NRM).

There is a distinction between organised crime groups and street gangs based on the level of criminality, organisation, planning and control. However, there are significant links between different levels of gangs for example street gangs can be involved in drug dealing on behalf of organised criminal groups Young men and women may be at risk of sexual exploitation in these groups.

Children may be involved in more than one 'gang', with some cross-border movement, and may not stay in a 'gang' for significant periods of time. Children rarely use the term 'gang', instead they used terms such as 'family', 'breddrin', 'crews', 'cuz' (cousins), 'my boys' or simply 'the people I grew up with'.

Safeguarding should focus on both young people who are / vulnerable of making the transition to gang involvement as well as those already involved in gangs. Practitioners should be aware of particular risks to young people involved in gangs from violence and weapons; drugs and sexual exploitation.

Risks

The risk or potential risk of harm to the child may be as a victim, a gang member or both - in relation to their peers or to a gang-involved adult in their household. Teenagers can be particularly vulnerable to recruitment into gangs and involvement in gang violence. This vulnerability may be exacerbated by risk factors in an individual's background, including violence in the family, involvement of siblings in gangs, poor educational attainment, or poverty or mental health problems.

A child who is affected by gang activity, criminal exploitation or serious youth violence can be at risk of significant harm through physical, sexual and emotional abuse. Girls may be particularly at risk of sexual exploitation.

Violence is a way for gang members to gain recognition and respect by asserting their power and authority in the street, with a large proportion of street crime perpetrated against members of other gangs or the relatives of gang members.

The specific risks for males and females may be quite different. There is a higher risk of sexual abuse for females and they are more likely to have been coerced into involvement with a gang through peer pressure than their male counterparts.

There is evidence of a high incidence of rape of girls who are involved with gangs. Some senior gang members pass their girlfriends around to lower ranking members and sometimes to the whole group at the same time. Very few rapes by gang members are reported.

Gang members often groom girls at school using drugs and alcohol, which act as disinhibitors and also create dependency, and encourage / coerce them to recruit other girls through school / social networks.

Indicators

Child withdrawn from family;

Sudden loss of interest in school or change in behaviour. Decline in attendance or academic achievement (although it should be noted that some gang members will maintain a good attendance record to avoid coming to notice);

Being emotionally 'switched off, but also containing frustration / rage;

Starting to use new or unknown slang words;

Holding unexplained money or possessions;

Staying out unusually late without reason, or breaking parental rules consistently;

Sudden change in appearance — dressing in a particular style or 'uniform' similar to that of other young people they hang around with, including a particular colour;

Dropping out of positive activities;

New nickname;

Unexplained physical injuries, and/or refusal to seek / receive medical treatment for injuries;

Graffiti style 'tags' on possessions, school books, walls;

Constantly talking about another young person who seems to have a lot of influence over them;

Breaking off with old friends and hanging around with one group of people;

    Associating with known or suspected gang members, closeness to siblings or adults in the family who are gang members;

Starting to adopt certain codes of group behaviour e.g. ways of talking and hand signs;

    Going missing;

Being found by Police in towns or cities many miles from their home;

Expressing aggressive or intimidating views towards other groups of young people, some of whom may have been friends in the past;

    Being scared when entering certain areas; and

Concerned by the presence of unknown youths in their neighbourhoods.

An important feature of gang involvement is that, the more heavily a child is involved with a gang, the less likely they are to talk about it.

There are links between gang-involvement, criminal exploitation and young people going missing from home or care. Some of the factors which can draw gang-involved young people away from home or care into going missing are linked to their involvement in canying out drugs along county lines. There may be gang-associated child sexual exploitation and relationships which can be strong pull factors for girls who go missing.

In suspected cases of radicalisation, social workers and local authorities have a duty to refer the case to the local Channel panel, which will then decide the correct, if any, intervention and support to be offered to that individual.

Protection and Action to be Taken

Any agency or practitioner who has concerns that a child may be at risk of harm as a consequence of gang activity including criminal exploitation should contact Children's Social Care or the police for the area in which the child is currently located. The Makinq a Referral to Children's Social Care Procedure should be followed. An Early Help Assessment may be crucial in the early identification of children and young people who need additional support due to risk of involvement in gang activity.

Support and interventions should be proportionate and based on the child's needs identified during the assessment.

A Child in Need Assessment should be led by a qualified social worker and evidence and information sharing across all relevant agencies will be key. It may be appropriate for the social worker to be embedded in or work closely with, a team (for example in the Police or Youth Offending Service), which has access to 'real time' gang intelligence in order to undertake a reliable assessment.

Practitioners should be aware that children who are Looked After by the Local Authority can be particularly vulnerable to becoming involved in gangs and being criminally exploited. There may be a need to review their Care Plan in light of the assessment and to provide additional support.

Where there are concerns about a child or young person being criminally exploited (for example If a young person is arrested for drugs offences away from home in an area where they have no local connections and with no obvious means of getting home) the Police and Children's Social Care, from the first point of contact with the young person, should consider whether they are victims of child criminal exploitation or trafficking and pursue a safeguarding, rather than criminal justice, response.

Children are often in fear of ending their contact with the gang because it might leave them vulnerable to reprisals from those former gang members and rival gang members who may see the young person as without protection.

If there is a possible "threat to life",the Police may consider it appropriate to issue an Osman Warning. In these circumstances this should trigger an automatic referral by the Police to Children's Social Care, (see the Makinq a Referral to Children's Social Care Procedure) the initiation of a Strategy Discussion and consideration of the need for immediate safeguarding action, unless to do so would place the child at greater risk.

Any decision not to refer a child should be actively reviewed to allow a referral to Children's Social Care to be made at an appropriate stage in order to protect the young person's safety.

Information and local knowledge about the specific gang should be shared, including the use, or suspected use, of weapons or drug dealing. There should also be consideration of possible risk to members of the child's family and other children in the community.

Unless there are indications that parental involvement would risk further harm to the child, parents should be involved as early as possible where there are concerns about gang activity.

Gang Injunctions

"Gang injunctions offer local partners a way to intervene and to engage a young person aged 14-17 with positive activities, with the aim of preventing further involvement in gangs, violence and/or gang-related drug dealing activity. " (Home Office, June 2015)

The Serious Crime Act 2015) amended the Crime and Security Act 2010 to extend this provision from 18 years and to include children and young people (14-17 year olds). Gang injunctions also now covers drug dealing activity" as well as "violence" including the threat of violence. Applications should focus on gang related behaviour that may lead to violence, and not other problematic antisocial behaviour.

In order to make a gang injunction, the court must be satisfied that the respondent has engaged in, encouraged or assisted gang-related violence or drug dealing activity. In addition, the court must then be satisfied that:

The gang injunction is necessary to prevent the respondent from engaging in, encouraging or assisting gang-related violence or drug dealing activity; and/or

The gang injunction is necessary to protect the respondent from gang related violence or drug taking activity

Issues

Children involved in gangs may be known to other services for offending behaviour or school exclusion.

Girls and young women involved with gangs can be affected by sexual violence, domestic violence, drug and alcohol misuse, school exclusion and going missing from home. Girls will often be controlled and manipulated by male gang members and sexual violence is a common feature of the experience of girls involved with gangs. Sisters or female family members who are not actively involved with gangs can be targeted and sexually assaulted by rival gangs.

Children may often be at the periphery of involvement for some time before they become active gang members. Children may also follow older siblings into gang involvement. This may provide opportunities for preventative work to be undertaken with children.

5.20 Historical Abuse Allegations

RELATED NATIONAL GUIDANCE

Workinq Together to Safeguard Children

RELATED CHAPTERS

Safe Recruitment. Selection and Supervision of Staff Procedure

Complex (Organised or Multiple) Abuse Procedure

Contents

Introduction

Significance

Action to Safeguard

Introduction

1. Allegations of child abuse are sometimes made by adults and children many years after the abuse has occurred. There are many reasons for an allegation not being made at the time including fear of reprisals, the degree of control exercised by the abuser, shame or fear that the allegation may not be believed. The person becoming aware that the abuser is being investigated for a similar matter or their suspicions that the abuse is continuing against other children may trigger the allegation.
2. These cases may be complex as the alleged victims may no longer be living in the situations where the incidents occurred or where the alleged perpetrators are also no longer linked to the setting or employment role. Such cases should be responded to in the same way as any other concerns. It is important to ascertain as a matter of urgency if the alleged perpetrator is still working with or caring for children.
3. The Children's Social Care in the area where the alleged incident took place, has case responsibility and should arrange a Strategy Discussion to determine any further action required.

Significance

4. Organisational responses to allegations by an adult of abuse experienced as a child must be of as high a standard as a response to current abuse because:
   • There is a significant likelihood that a person who abused a child/ren in the past will have continued and may still be doing so;
   • Criminal prosecutions will still take place despite the fact that the allegations are historical in nature and may have taken place many years ago.
5. An allegation may be made against (for example) a foster carer, adoptive parent, residential care staff, teacher, doctor, Police officer, volunteer or any other person who currently has, or previously had contact with children and young people. The alleged abuse may not have been an isolated incident. If it comes to light that the historical abuse is part of a wider setting of institutional or organised abuse, the case should be dealt with according to the procedures in Complex (Orqanised or Multiple) Abuse Procedure.

Action to Safeguard

6. As soon as it is apparent that an adult is revealing childhood abuse, the professional involved must explain that relevant information will need to be shared with the Police in order to safeguard children. They must record what has been said by the service user, and the responses given by the worker. A Chronology should be undertaken and all records must be dated and the authorship made clear by a legible signature or name.
7. If possible, the professional should establish if the adult is aware of the alleged perpetrators recent or current whereabouts and contact with children.
8. Whilst an adult service user should be asked whether s/he wants a Police investigation it should be made clear that dependent upon the nature of the information provided the worker may need to share this information with the Police if it will help to protect children. Adult service users must be reassured that the Police Protection Unit is able and willing to undertake such work even for those adults who are vulnerable as a result of mental health or learning difficulties.
9. Consideration must be given to the therapeutic needs of the adult and reassurance given that, even without her/his direct involvement all reasonable efforts will be made to look into what s/he has reported.
10. The worker should:
    • Inform the Police and establish if there is any knowledge regarding the alleged perpetrators current contact with children;
    • Institute a Section 47. Enquiry if the alleged perpetrator is believed to be currently caring for, or having access to children. This will include making the necessary referral to the area where the alleged perpetrator is known to live.

5.21 Honour Based Abuse

RELATED NATIONAL GUIDANCE

Workinq Together to Safeguard Children

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O		Honour- a

College of Policing website, Forced Marriage and Honour Based Violence

Forced Marriage Guidance—Home Office — information and practice quidelines for professional protecting. advising and supporting victims. This includes MultiAgency Statutory Guidance for dealing with forced marriage and Multi-Agency practice guidelines: Handling cases of forced marriage.

Endinq Violence against Women and Girls (VAWG) Strategy: 2016 to 2020 (refresh)

Protocol on the handlinq of 'so-called' Honour Based Violence/Abuse and

Forced Marriage Offences between the National Police Chiefs' Council and the

Crown Prosecution Service

RELATED CHAPTERS

Missinq Children and Families Procedure

Abduction Procedure

Modern Slavery Procedure

Child Sexual Exploitation - Pan Lancashire Standard Operating Protocol Forced Marriages Procedure

Contents

Introduction

Assessment Tool

Introduction

The definition of honour based abuse is:

A variety of crimes including assault, imprisonment and murder where the person is being punished by their family or community for actually or allegedly undermining what the family or community believes to be the correct code of behaviour and therefore bringing 'shame' or 'dishonour' onto the family or community." (Home Office);

All professionals working with victims of honour based abuse need to be aware of the 'one chance rule'. That is, they may only have one chance to speak to a potential victim and thus they may only have one chance to save a life. This means that all professionals working within statutory agencies need to be aware of their responsibilities and obligations when they come across these cases. When a case of HBA is first reported it is important to obtain as much information as possible as there may not be another opportunity for the individual reporting to make contact. Ifthe victim is allowed to walk out of the door without support being offered, that one chance might be wasted.

Assessment Tool

The SafeLives Risk Identification Checklist (RIC) & Quick Start Guidance for Domestic Abuse, Stalkinq and Honour-Based Violence (DASH).

Young people, especially those aged 16 and 17, can present specific difficulties to agencies as there may be occasions where it is appropriate to use both child and adult protection frameworks. For example, some 16 and 17 year olds may not wish to enter the care system but prefer to access refuge accommodation. Victims aged 16 and over should be assessed using the SafeLives/DASH Risk Assessment and, if assessed as high risk, referred to the MARAC.

This Assessment Tool can be used to identify the risk of violence or abuse. Domestic abuse can take many forms but it is usually perpetrated by men towards women in an intimate relationship such as boyfriend/girlfriend, husband/wife. This checklist can also used for lesbian, gay, bisexual relationships and for situations of "honour?-based violence or family violence. Domestic abuse can include physical, emotional, mental, sexual or financial abuse as well as stalking and harassment. They might be experiencing one or all types of abuse; each situation is unique. It is the combination of behaviours that can be so intimidating. It can occur both during a relationship or after it has ended.

The purpose of the tool is to give a consistent and simple tool for practitioners who work with adult victims in order to help them identify those who are at high risk of harm and whose cases should be referred to a MARAC meeting in order to manage their risk. If you are concerned about risk to a child or children, you should make a referral to ensure that a full assessment of their safety and welfare is made.

5.22 Hospital Stays for Children Where there are Welfare Concerns

RELATED NATIONAL GUIDANCE

National Service Framework for Children, Younq People and Maternity Services. Executive Summary - Standards 6 and 7. DHSC. October 2004

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ur e a th	ri to o					Command Paper: CM 5207

Workinq Together to Safeguard Children

RELATED CHAPTER

Private Fostering Procedure

Pan-Lancashire Procedure for the Supervision of Parents/Carers in Hospital

Settings when there are Child Protection Concerns

AMENDMENT

In November 2013, this chapter was updated in line with Working Together to Safeguard Children and the Single Assessment Framework.

Contents

Introduction

Considerations When Child is in Hospital

Actions to Safeguard

Category A Cases (Child Protection Cases)

Category B Cases (High Level Concerns)

Category C Cases (Children in Need)

Introduction

1. The National Service Framework for Children, Young People and Maternity Services (NSF) (2004) sets out standards for hospital services. Standard 6 of the NSF is to be taken alongside the hospital standard, which was published in 2003 to meet the commitment made in the Government's response to the report of the Public Inquiry into Children's Heart Surgery at the Bristol Royal Infirmary 1984-1995: Leaming from Bristol. The Healthcare Commission has undertaken an improvement review of the NHS implementation of the hospital standard.

Considerations When Child is in Hospital

2. When children are in hospital, this should not in itself jeopardise the health of the child or young person further. The NSF requires hospitals to ensure that their facilities are secure and regularly reviewed. There should be policies relating to breaches of security and involving the Police. The Local Authority where the hospital is located is responsible for the welfare of children in its hospitals.
3. Children should not be cared for on an adult ward. The NSF Standard for Hospital Services requires care to be provided in an appropriate location, and in an environment that is safe and well suited to the age and stage of development of the child or young person. Hospitals should be child-friendly, safe and healthy places for children. Wherever possible, children should be consulted about where they would prefer to stay in hospital, and their views should be taken into account and respected. Hospital admission data should include the age of children, so that hospitals can monitor whether children are being given appropriate care in appropriate wards.

Actions to Safeguard

4. Section 85 of the Children Act 1989 requires Hospital and Health Trust with inpatient care to notify the 'Responsible Authority' - i.e. the local authority for the area where the child is ordinarily resident, or where the child is accommodated if this is unclear - when a child has been, or will be, accommodated by the CCG for three months or more (e.g. in hospital). This is so that the local authority can assess the child's needs and decide whether services are required under the Children Act 1989.
5. A referral to Children's Social Care should be explicitly considered for any child admitted to hospital following an episode of deliberate self harm - see the Makinq a Referral to Children's Social Care Procedure.
6. When children are in hospital and there are concerns about their welfare if they are discharged then the protocol described in the flow charts - to follow should be followed.

Hospital Discharge Arrangements

7. Where abuse is alleged, suspected or confirmed and children have been admitted to hospital they should not be discharged until:
   • Children's Social Care has been notified initially by telephone of the Child Protection Concems;
   • Written confirmation of the nature of concerns is provided within 24 hours;
   • A Strategy Discussion (usually in the form of a meeting) is held which includes relevant hospital staff in order to ensure that the professionals involved are clear in respect of the Discharge Plan.
8. It is the responsibility of Children's Social Care to undertake a Assessment to ascertain whether it is safe for the child to return home and to assess the support required to ensure that the child/young person's welfare is safeguarded following discharge. Such an assessment and decision making should involve discussion with the child/young person. If a decision is taken that this is not appropriate or possible the reason for this decision should be recorded on the child/young person's file and explained to other professionals.
9. If it is not safe for the child/young person to be discharged from hospital, consideration should be given to reasonable steps being taken to ensure that the child's removal from hospital is prevented until support can be in place and a full Assessment/Enquiry completed.

Category A Cases (Child Protection Cases)

10. This category will include:

 Actual non- accidental injuries;

 Serious health concerns of presentation; or o Repeated presentations that are considered to be fabricated illness;

 Significant injuries where there are serious doubts about the explanation or inconsistent explanations;

 Actual sexual abuse;

 Mental health/disability; or

 Drug/alcohol abuse having an immediate and significant impact on the child or the parent's ability to parent adequately;

 Evidence of domestic violence;

 The death of sibling under suspicious circumstances.

Category B Cases (High Level Concerns)

11. This category will include:

 Unusual inappropriate behaviour of parent/carer; o Unexplained delay in seeking medical attention for significant injuries;

 Serious or repeated weight loss;

 Failure to thrive without medical reason;

 Previous child protection registration/strategy meeting in respect of a child in the family;

 Serious concerns about drug or alcohol misuse;

 Suspicion of sexual abuse;

 Serious concerns about home conditions;

 Suspicion of domestic violence;

 Serious concerns about a parent's reluctance or inability to cope with a child with disabilities;

o Significant mental health of child/parent.

Category C Cases (Children in Need)

12. This category will include:

 Frequent visits to the GP;

 Number of child or sibling A & E attendance's in last 12 months;

 Non-suspicious death of a sibling;

 Not registered with a GP;

 A display of fear or apprehension when partner/carer visits;

 Parental ability to cope;

 Concerns Child/YP's drug or alcohol misuse;

o Concerns parent's drug or alcohol misuse where it may affect their children;

 History of repeated separation of parents/partners/carers;

 Frequent change of address;

 Concerns about a parent's reluctance or inability to cope with a child with disabilities;

 Parent's reluctance to visit child in hospital;

 Concerns about the mental health/disability of the parent;

 Aggression or violence on the ward (Immediate internal response).

5.23 International Cross-Border Child Protection Cases Under the 1996—— Hague Convention

RELATED GUIDANCE AND INFORMATION

Non-statutory advice from the Department for Education: The 1996 Haque Convention - Departmental Advice.

The International Child Abduction and Contact Unit

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e artmental advice for local authori			ervice mana	n
es law ersaul 2

AMENDMENT

In May 2015, a link to information about the International Child Abduction and Contact Unit and Working with Foreign Authorities: Child Protection Cases and Care Orders Departmental advice for local authorities, social workers, service managers and children's services lawyers July 2014 was added to Related Guidance and Information.

Contents

Introduction

Key Points

The Central Authority

Making Requests for Information or Action

Requesting Information on the Need for Protective Measures

Taking Action when a Child Usually Lives in Another State

Transferring Jurisdiction

Placing a Child Living in England in Foster/ResidentiaI Care

Asking Another State to Trace a Child

Asking Another State to Protect a Child Living in that State

Providing a Report to Support Parents Contacting a Child

Handling Requests from Other Contacting States

Introduction

The 1996 Hague Convention on Jurisdiction, Applicable Law, Recognition, Enforcement and Co-operation in Respect of Parental Responsibility and Measures for the Protection of Children ('the Hague Convention') (implemented in the UK on 1 November 2012) provides an agreed set of legal provisions and cooperation arrangements to cover the handling of cross-border cases where children's safety or welfare may be an issue.

Non-statutory advice from the Department for Education: The 1996 Haque Convention - Departmental Advice is designed to help local authorities when dealing with cross-border child protection cases.

The advice sets out the key steps that local authorities can take to:

Ask for help or essential information from authorities abroad when dealing, for example, with a child from this country who is in need of support or protection; and

Respond to similar requests put to them by authorities abroad.

Key Points

The Convention applies to situations where contracting states need to cooperate over child protection and welfare cases when there is an international dimension. This can include Care Proceedings, contact cases and foster placements abroad.

The aim of the Convention is to bring about better co-operation between countries so that the handling of cases and protections put in place is more efficient, avoids delays and delivers better outcomes for the children involved;

This advice is distinct from Department guidance that already exists on the other main types of cross-border cases — inter-country adoption and child abduction;

The Convention's provisions do not mean major change for local authorities — in a number of respects they mirror arrangements already in place governing co-operation arrangements between EU member states on these types of children's cases;

The Convention does, however, extend these arrangements in some situations, and will mean that similar co-operation processes will now also apply between this country and countries outside the EU which have implemented the Convention. It will not apply between England and the other jurisdictions of the

Under the Convention, contracting states can ask each other for information or other types of help when a child's welfare or protection is at issue. The different types of requests include, for example:

Asking for another state's help in tracing a child;

Asking for a report on a child habitually resident in another contracting state;

Asking another state to take measures to protect a child's welfare;

Seeking the agreement of another state for a child to be placed there in foster or residential care; and

Asking for the transfer of jurisdiction for a child from his/her home state, enabling an authority to make decisions about a child's welfare if it feels it is best placed to do so.

Local authorities may also be asked by a parent to consider preparing a report on their suitability to have contact with a child living in another state.

Under the Convention contracting states can ask each other for information or other types of help when a child's welfare or protection is at issue.

A list of the countries that have implemented the Convention (referred to as 'contracting states') can be found on the Haque Conference for Private International Law website. In this list only those States which have 'Entered into Force' (EIF) are operating the Convention.

The Central Authority

Each country is required to establish a Central Authority to help ensure effective communication between child welfare authorities in contracting states. For England the day-to-day administration of the Central Authority's role will be carried out by the International Child Abduction and Contact Unit (ICACU) which is co-located in the office of Official Solicitor and Public Trustee.

Certain types of request have to be made via Central Authorities, while in some cases local authorities can deal directly with their counterparts abroad. It is recommended, however, that local authorities consult ICACU in the first instance for advice about the most appropriate way to make their request. The Central Authority holds useful information about authorities in other countries, and has a wealth of practical experience of cross-border cooperation on child protection cases.

The English Central Authority also monitors the volume and effectiveness of cases handled under the Convention. If local authorities decide to deal directly with their counterparts in other contracting states it is recommended that they notify the Central Authority so they can build as complete a picture as possible of the work arising from the Convention.

There are other agencies too that can offer practical advice, direct services and support on handling cross-border cases. These include:

    Children and Families Across Borders (CFAB). CFAB runs a national advice line on inter-country casework (funded by the DfE);

    Africans Uni@Aqainst Child Abuse (AFRUCA).

Although the Regulations that support the Convention place a duty on local authorities to respond in a timely way to certain types of request, there is no prescription as to the form that responses should take. As far as possible, authorities should follow their existing local procedures, based on a proportionate response to the level of risk of harm to the child.

Local authorities are encouraged to agree a first point of contact to manage any communications between the Central Authority and relevant frontline staff and to let the Central Authority know the contact details. The nominated person should be of sufficient seniority to make decisions on action for international cases, and there should be cover to ensure that urgent requests can be dealt with promptly.

Making Requests for Information or Action

The Convention enables a local authority to:

Ask another state to provide a report/information to inform decisions on whether child protection measures should be taken;

Take action to protect a child at immediate risk of harm, even if the child is usually resident in another contracting state;

Ask another contracting state to transfer jurisdiction for a child if a local authority feels it is better placed to make decisions about his/her welfare, or ask another state to take on jurisdiction in the reverse situation;

Consult with the relevant authority in another state about placing a child in foster or residential care in that state;

Ask for help in tracing a child in a contracting state when a local authority is concerned about his/her welfare;

Ask another state to consider taking measures to protect a child who lives in that state;

Provide a report to support a parent's case for contact with a child living in another contracting state.

Requesting Information on the Need for Protective Measures

If a local authority is considering action to protect or safeguard a child, it can ask a competent authority in another contracting state to communicate information it holds that is relevant to the case, regardless of where the child is habitually resident.

If a local authority has welfare concerns about a child who is temporarily living in or visiting their area, it can ask the child's main country of residence for a report on his/her situation — see Chart 1 -requesting a report to support decisions on the need for child protection measures for the recommended process for this.

The authority in the contracting state is not formally obliged to provide this report. If a local authority has difficulty in getting the information it needs, the English Central Authority may be able to help through liaison with the other state's Central Authority. A contracting state can specify that these requests for information must be routed through their Central Authority. You can check whether the country you need to approach has specified this by checking the 'Reservations/Declarations' column for that country in the Hague Convention Status Table, available at the Haque Conference for Private International Law website.

Taking Action when a Child Usually Lives in Another State

If a local authority identifies a child in need of immediate protection, it must exercise its duties to safeguard and promote the welfare of that child under the Children Act 1989. In urgent cases the Convention provides the local authority with the jurisdiction to take any necessary steps to protect the child until the authorities in the state where the child is habitually resident have taken any necessary action. The presence of an international element to the case should not delay the necessary protective measures.

If the child is only temporarily present in England, the child's home country will have jurisdiction, and the appropriate authority there is responsible for decisions about the child's welfare and protection beyond the immediate measures taken (unless a transfer of jurisdiction is sought — see Section 7, Transferrinq Jurisdiction).

Once steps have been taken to protect the child, the local authority should contact the relevant authority in the child's home country to inform them of the action taken, ask for information about the child's circumstances, and agree what further action is needed. Chart 2 - Takinq action for a child at immediate risk sets out the recommended process for such cases.

An initial approach to the English Central Authority is recommended, although in these cases contact can be via Central Authorities, or directly to the local authority's equivalent in the other state. The Central Authority of the other state should be able to provide information on the child protection procedures in that state and may be able to supply the contact details for the appropriate equivalent authority.

If the child needs continuing protection while the local authority is liaising with authority in the other state, the Parental Responsibility and Measures for the Protection of Children (International Obligations) (England and Wales and Northern Ireland) Regulations 2010 allow for an application for an Interim Care Order or Interim Supervision Order, even though it is anticipated that another state will take over jurisdiction before a final order is required.

Transferring Jurisdiction

A local authority can seek a transfer of jurisdiction for a child who is habitually resident in another state if it feels it is better placed to make decisions about that child's welfare. This is done via an application to the High Court, who will then make the request to the child's home country if appropriate.

The authority in the child's home country may itself ask for jurisdiction to be transferred to the English local authority. The Central Authority in England aims to keep a record of transfers of jurisdiction, and local authorities are therefore asked to notify ICACU when such arrangements are made.

Placing a Child Living in England in Foster/Residential Care

The types of situation that this part of the Convention apply to include those where:

A local authority feels that the most appropriate placement for a child is with family or other Connected Persons in another state;

A child's foster carer may want to move abroad and the local authority considers it in the child's best interests to stay with that carer; and

Where a child may need placement in a specialist residential unit in another country.

If a local authority wants to make arrangements for a child in their care (i.e. one subject to a Care Order or Interim Care Order) to live outside England and Wales, it must make an application to court for leave to place the child outside their jurisdiction in accordance with the Children Act 1989 Schedule 2 paragraph 19. If the child is Accommodated under section 20 the Court's leave is not required, but the authority must obtain the consent of every person with Parental Responsibility for the child before placing the child outside of this jurisdiction.

Under the Convention, a local authority considering this type of placement must consult the relevant authority in the other state, and a placement cannot be made unless consent is given by this authority. This is one of the areas however where there is a practical difference between the application of the Hague 1996 Convention and the EU Council Regulation known as Brussels Ila. If local authorities are considering a placement in a country that is a Member State of the EU, they must do so under Brussels Ila. Placement to another Member State requires their consent only if the law of that state requires public authority intervention for the type of placement concerned. Where consultation is required, the local authority must provide a report on the child and the reasons for the proposed placement. The Child's Permanence Report, Foster Carer's assessment report or any matching report would contain adequate information for this purpose - there should be no need to create a new report form. The Convention allows for requests to be made either via the Central Authority of the proposed state of placement or to a competent authority. It is recommended however that local authorities route these requests through the English Central Authority who will then liaise with the Central Authority in the other state. Chart 3 - Placinq a child currently livinq in England in foster of residential care in another contractinq state sets out the recommended process for making this type of request.

If the child is the subject of court proceedings the court may approach the authority in the other state for permission to place the child. If the court sends the request directly to the Central Authority or competent authority in the other state, it must also send a copy of the request to the Central Authority for England.

The local authority must also satisfy the requirements of Regulation 12 of the Care Planning, Placement and Case Review (England) Regulations 2010 in placing a child in care outside England and Wales, ensuring that adequate arrangements are in place for supervising and reviewing the placement. See the Placements Outside England and Wales Procedure in your Children's Social Care procedures manual:

    Blackburn with Darwen Children's Services Procedures;

    Blackpool Social Work and Safeguardinq Service Procedures;

    Lancashire Children's Social Care Procedures.

This part of the Convention does not apply to:

Adoptive placements (these are governed by the 1993 Hague Convention on Inter country Adoption);

Placements which are private family arrangements; or

Placements of children under Special Guardianship Orders— these are private law orders and do not constitute a placement by a local authority.

It will however apply to placements of a child in care for assessment in a possible adoptive placement. If a placement of this sort is contemplated the local authority should seek legal advice.

Asking Another State to Trace a Child

If a local authority has taken steps to safeguard a child's welfare (or plans to do so) and believes that he/she has been taken out of the local authority area to another contracting state, the Convention enables the local authority to ask another contracting state for help in determining the child's location. Chart 4 - askinq a central authority in another state to locate a child describes the process for this type of request.

These requests should be made to the Central Authority of the state to which it is believed the child has moved, but it is recommended that this is done via the English Central Authority. The requests should be accompanied by an explanation of the child's circumstances and any information which might assist the other state in tracing the child's address.

If the child is habitually resident in England and court proceedings are started or ongoing, the court can request the authorities in the other state to assume jurisdiction over the child if they appear better placed to do so.

If there are serious concerns about a child suffering Siqnificant Harm and this child is moved into another state, the local authority must inform the relevant authorities of that other state of the danger to that child and also of any measures they were taking or considering to protect the child.

Asking Another State to Protect a Child Living in that State

The Convention enables a local authority to ask another contracting state to consider the need to protect a child from harm who is habitually resident in that state. Local authorities should provide sufficient information for the authority in the other state to make a decision. This request can be made via the English Central Authority or directly to the Central Authority in the other state. The Central Authority in that state can ask its competent authority to consider the need to take protective measures, but the authority is not obliged to do so.

Providing a Report to Support Parents Contacting a Child

If a parent in England is seeking by court proceedings to obtain or maintain contact with a child living in another contracting state, he/she can ask their local authority to prepare a report on their suitability to have this contact for submission as evidence to the authorities in the other state.

There is no duty on an English local authority to agree to prepare such a report or provide any information. However local authorities must exercise their discretion reasonably and cannot have a blanket policy of refusing to prepare such reports.

If a local authority agrees to this request, it can gather information about the parent's suitability to have contact with the child and about any conditions that it thinks it would be appropriate for the overseas court to impose. The court or authority dealing with the application for contact in the child's home state must consider the local authority's report before making their decision.

A local authority may charge a 'reasonable' fee for providing this service. This means a charge that is as close as possible to the actual costs of providing that service, including indirect costs (for example a proportion of the on costs). Local Authorities will need to include their charging scheme, if any, as part of their policy on providing this service.

A local authority may provide a service under this Article by subcontracting the work to another agency.

Handling Requests from Other Contacting States

Just as local authorities in this country can ask for certain types of help or information from other contracting states, other contracting states can ask for a similar range of help from our authorities.

Handling a request for information on a child's situation

A local authority may be asked for information about a child by a competent authority in another contracting state that is considering protection measures for that child, regardless of where the child usually lives. These types of request to an English local authority should be routed through the English Central Authority.

If a child is habitually resident and present in England, an authority of another contracting state with which the child has a substantial connection may ask the English Central Authority to provide a report on the child's situation. If the Central Authority thinks that it is appropriate to do so, it will pass the request on to the local authority which must provide a report as soon as reasonably practicable.

The implementing Regulations for the Convention allow local authorities to supply relevant information lawfully, providing that doing so would not put the child or their property at risk, or threaten the life or liberty of a member of the child's family. Further advice on information sharing can be found in the Question and Answer Section of the 1996 Haque Convention Advice DfE website.

There is no prescribed format for responding to these requests. A letter may be enough, or if a more detailed report is required, a format similar to those used to respond to Court requests for reports under section 7 (a welfare report) or section 37 (Court direction to investigate child's circumstances and consider whether to apply for a Care or Supervision Order) of the Children Act 1989 would be appropriate.

On occasions the local authority approach for this type of information may be made to CAFCASS — for example, in situations where Cafcass has been involved with the child or the family in other court proceedings.

Chart 5 - Handlinq a request for a report/information on a child's situation sets out the recommended process for handling this type of request. Handling requests to transfer jurisdiction for a child

An authority in another contracting state can seek a transfer of jurisdiction for a child if it feels that it is better placed to assess the child's best interests.

The other contracting state will need to make an application to the High Court for transfer of jurisdiction, unless the child is already the subject of court proceedings. In this case the court dealing with the matter will need to transfer the request to the High Court for consideration.

12.3 Request from another state for foster care or home transfer

An authority in another contracting state can only place a child in foster care or a residential unit in England if the competent authority has consented to the placement. This restriction applies to a placement of a child for whom the authority of another state is responsible. It does not apply to placements for adoption as these are governed by the 1993 Hague Convention on Inter-country Adoption.

In England, the competent authority for these purposes is the local authority with responsibility for children's services in the area where the contracting state proposes to place the child.

In many cases, the child will not be the subject of any proceedings here. The authority in the contracting state must provide the English local authority with a report about the child and the reasons why the placement is being considered. The relevant local authority should deal with the placement request as quickly as possible.

Before consenting to the placement, the local authority, acting as the competent authority, will need to make its own independent assessment of whether the proposed placement is appropriate in the best interests of the child and provides him or her with the same safeguards as a comparable arrangement for the placement of an English child.

For example the authority may wish to consider such issues as:

Whether based on the information provided about the child's needs the placement for the child appears to be appropriate;

The frequency and suitability of arrangements for keeping the plan under review;

Arrangements for family contact (if appropriate);

Whether the plan has taken the wishes and feelings of the child into account and allows for the child to have access for support should they wish; and

The planned duration of placement and aftercare arrangements.

Should a local authority, (acting as a competent authority), not have sufficient information to be able to give informed consent that confirms that the proposed placement is appropriate for the child concerned, it may seek further information from the authority in the contracting state wishing to make the placement.

The competent authority will be entitled to refuse consent. For example, following scrutiny of information, the authority could come to the view that the proposed placement is unsuitable for the individual child — perhaps because arrangements for review of the plan or for aftercare are not suitable; or because the authority is concerned about the quality of the proposed placement indicating its unsuitability, because of other information in its possession about the care and safety of other children placed there.

If the local authority controls, manages or has some other interest in the institution at which the child is proposed to be placed, the local authority must ensure that the decision as regards consent is made autonomously from its involvement in running the institution.

If the local authority agrees to the placement, the legal framework under which the child will be placed should be established. The two authorities should agree the responsibility for monitoring and review of the placement. Such monitoring and review arrangements must be compatible with the equivalent arrangements for placing English children in comparable placements. See the Looked After Reviews Procedure in your Children's Social Care procedures manual:

    Blackburn with Darwen Children's Services Procedures;

    Blackpool Social Work and Safequardinq Service Procedures;

    Lancashire Children's Social Care Procedures.

Where the child is to be placed with a foster carer, the local authority should establish whether the legal structure of the placement gives the carer Parental Responsibility. If it does not, regardless of any agreement between the authorities, the local authority will have responsibility to monitor the placement as a Private Fostering arrangement. If the child is the subject of any court proceedings in England and Wales the competent authority to make the decision is the court, which will fix a directions hearing to consider the request.

Requests to locate a child believed to be in the LA area

If an authority in a contracting state is concerned that a child needs protection and believes the child has been removed from their area and taken to England, they may request assistance from the English Central Authority in tracing that child. Chart 6 Request to locate a child believed to be in the local authority area sets out the recommended process for handling these requests.

Local authorities have a duty to assist with these requests. It is suggested that the starting point should be the usual local authority procedure for tracing a child missing from care or education. If initial checks of any relevant databases do not trace the child, local authorities can decide what level of further checking is proportionate to the risk factors described by the requesting authority.

If the risk of harm to a child is significant and there is a credible reason to believe that the child is in the local authority's area, it may be proportionate to share information with other professionals, including community and voluntary agencies.

If an address is found for the child, the local authority should consider whether disclosing this information will pose a risk of harm to the child or his family, or be a criminal offence or contempt of court. Local authorities can withhold information in these circumstances. If in contempt of court cases the local authority feels it is in the child's interests to disclose information, they must seek the court's leave to do so.

Handling requests to protect a child living in the LA area

If a Central or other authority in a contracting state has concerns about the welfare of a child habitually resident and present in England, it can ask the relevant local authority to take measures to protect that child. The request needs to be made with supporting reasons to the Central Authority in England, who may pass the request on to the local authority.

5.24 Learning Difficulties and Disabilities of a Parent/Carer

RELATED NATIONAL GUIDANCE

Chapter 1 : Assessing need and providing help, Working Together to Safeguard

Children

RELATED CHAPTER

Disabilities and Learning Difficulties Procedure

Contents

Introduction

Risk to Children

Action to Safeguard

Introduction

1. Where a parent has a learning disability it is important not to generalise or make assumptions about their parental capacity. Learning disabled parents may need support to develop the understanding, resources, skills and experience to meet the needs of their children. Such support is particularly needed where they experience additional stressors such as having a disabled child, domestic violence, poor physical and mental health, substance misuse, social isolation, poor housing, poverty and a history of growing up in care. It is these additional stressors, when combined with a learning disability, that are most likely to lead to concerns about the care a child or children may receive.

Risk to Children

2. Children of parents with Learning Difficulties and Disabilities are at increased risk from inherited learning disability and are more vulnerable to psychiatric disorders and behavioural problems. From an early age, children may assume the responsibility of looking after their parent, and in many cases other siblings, one or more of whom may be learning disabled. Unless parents with Learning Difficulties and Disabilities are comprehensively supported - e.g. by a capable non-abusive relative, such as their own parent or partner - their children's health and development may be impaired. A further risk of harm to children arises because mothers with Leaming Difficulties and Disabilities may be attractive targets for men who wish to gain access to children for the purpose of sexually abusing them.

Action to Safeguard

3. If any worker has concerns about a child whose parents have Learning Difficulties and Disabilities, A CAF should always be undertaken and consideration given to making a referral to Children's Social Care where appropriate. Where a child is considered to be at risk of Significant Harm, a

referral must be made using the Making a Referral to Children's Social Care Procedure.

4. A comparative study of children and families with learning disabled parents referred to Children's Social Care showed twice as many children had severe developmental needs, and five times as many had parents who were experiencing severe difficulties in meeting their children's needs. The research found that parents with Learning Difficulties and Disabilities are more likely to need long-term support.
5. A comparative study of methods of supporting parents with Learning Difficulties and Disabilities found that group education, combined with home-based support, increases parenting capacity. In some areas, services provide accessible information, advocacy, peer support, multi-agency and multidisciplinary assessments, and on-going home-based and other support. This 'parenting with support' appears to yield good results for both parents and children.
6. A specialist assessment is often needed and is recommended. Where specialist assessments have not been carried out and/or learning disability support services have not been involved, evidence from inspections has shown that crucial decisions could be made on inadequate information.
7. Adult learning disability services, particularly community nurses, can provide valuable input to core assessments, and there are also validated assessment tools available.

5.25 Licensed Premises

RELATED INFORMATION

Portman Group - Information for Licensees about Best Practice in relation to Alcohol

1. Holders of premises licences, club certificates and personal licences have a statutory responsibility to promote the protection of children from harm in and in the vicinity of their premises and should consider the need to protect children from sexual exploitation when undertaking licensing functions.
2. The protection of children from harm requires the proactive involvement (and sometimes training) of licensees, management and staff to ensure that the needs of under 18's are considered and addressed in the day-to-day operation of the premises. Family-friendly premises benefit from a loyal customer base with time and money to spend, but like anybody customers have their own set of needs. Premises that want to profit by catering for families must ensure the way they operate meets the needs of under 18s.
3. There are premises which Wilf want to provide activities that are not suitable for children and those children and young people will therefore be excluded:

o From the area of the premises where the activities take place o From the premises as a whole o At the time the activities take place; or o At all times.

4. Licensees have a responsibility to ensure that where children are excluded, they do not become victims of crime, disorder, nuisance or poor safety standards originating in the premises and spilling out into the local vicinity.
5. Alf licensing applications should be screened by officers from Children's Social Care on behalf of the Children's Safeguarding Assurance Partnership.
6. The Portman Group offers substantial advice and suggestions related to steps licensees can undertake which directly relate to promoting the licensing objectives including but not limited to age identification schemes.

5.26 Mental Illness of a Parent or Carer

RELATED NATIONAL GUIDANCE

Chapter 1 : Assessinq need and providinq help, Working Together to Safeguard Children

Think Parent - Think Child - Think Family

AMENDMENT

In November 2013, this chapter was updated in line with Working Together to Safeguard Children and the Single Assessment Framework.

Contents

Introduction

Risk Indicators

High Risk Indicators

Action to Safeguard

Introduction

1. Mental ill health in a parent or carer does not necessarily have an adverse impact on a child, but it is essential always to assess its implications for any children involved in the family. The parent or carer may neglect their own, or their children's physical, emotional and social needs. The child may take on inappropriate caring responsibilities, which may have an adverse effect on his or her development.
2. Some forms of mental ill health may blunt parent or carers' emotions and feelings or cause them to behave in bizarre or violent ways towards their children or environment. At the extreme a child may be at risk of severe injury, profound neglect, or even death. A study of 100 reviews of child deaths where abuse or neglect had been a factor in the death, showed clear evidence of parental mental ill health in one third of cases. Post-natal depression can also be linked to both behavioural and physiological problems in the infants of such mothers.
3. All professionals have a responsibility to safeguard the welfare of children and young people. Remember Think Parent - Think Child - Think Family.
4. Children may not be exposed to or involved with specific symptoms, yet parenting can still be altered. The presence of mental illness can reduce and/or change a parent's responsiveness toward their child. For example, a parent may become less emotionally involved, less interested, less decisive or more irritable with the child. This will affect the quality of the parent-child relationship, parenting capacity and the child's well-being.

Risk Indicators

5. Significant history of violence and parental non-compliance with services and treatment are risk factors for children. The adverse effects on children of parental mental illness are less likely when parental problems are mild, last only a short time, are not associated with family disharmony, and do not result in the family breaking up. Children may also be protected from harm when the other parent or a family member can help respond to the child's needs. Children most at risk of Significant Harm are those who feature within parental delusions, and children who become targets for parental aggression or rejection, or who are neglected as a result of parental mental illness.

High Risk Indicators

6. A Referral to Children's Social Care (see Making a Referral to Children's Social Care Procedure) must be made where there evidence of:
   • Delusional beliefs involving any child;
   • Homicidal thinking involving children prior to completing/ attempting suicide or might harm their child as part of a suicide plan.
7. Children's Social Care should be consulted and a referral must be considered where there is evidence of:

 Psychotic beliefs particularly if involving the child;

 Persistent negative views expressed about a child, including rejection ongoing emotional unavailability, unresponsiveness and neglect;

 Inability to recognise a child's needs and to maintain appropriate parentchild boundaries;

 Ongoing use of a child to meet a parent's own needs;

 Distorted, confusing or misleading communications with a child including involvement of the child in the parent's symptoms or abnormal thinking. For example, delusions targeting the child, incorporation into a parent's obsessional cleaning/contamination rituals, or a child kept at home due to excessive parental anxiety or agoraphobia;

 Ongoing hostility, aggression, irritability and criticism of the child;

 Serious neglect of the child;

 Any history of domestic violence.

Action to Safeguard

8. When there is a childcare issue of concem, Health, Children's Social Care and non-statutory sectors should ensure that lines of communication are opened and remain open during the process of referral, assessment, planning and reviews.
9. Joint assessments should be undertaken between agencies to facilitate assessments and safeguard children, when it is recognised and agreed that it is necessary to do so. The mental health professional involved in the assessment would normally be the care co-ordinator for the Care Programme Approach. If not then outcomes must be fed back to the care co-ordinator.
10. If a parent or carer is admitted to hospital, a notification must be sent to the paediatric liaison nurse or nearest equivalent. If a referral is made between Children's Social Care and Mental Health Services, a check should be made through the information system as to whether the family member is known to the service. If other workers are involved, they should be informed of the Referral.
11. Where there is difficulty in accessing agency or professional support the Children's Social Care Mental Health Managers, the Safeguarding Lead should consult with each other on how to proceed with a case if they have concerns.
12. Requests for and provision of information should be followed up in writing within 5 working days, if not made in writing in the first instance.
13. Where the Children's Social Care and Adult Mental Health Services are involved with an individual or family, a representative from each service should be invited and should attend standard assessment or Strateqy Discussions. The standard meetings and conferences are:
    • Mental Health - Patient or service user assessment or screening, Hospital Ward meeting, patient discharge meeting, CPA meeting and follow-up CPA Review meetings;
    • Children's Social Care - Single Assessment Meeting, Strategy Discussion, Initial Child Protection Conferences and Child Protection Review Conferences, Children in Need (Family Support)

Meetings and Reviews; o Early Help — CAF Assessment Meeting, CAF Reviews.

14. The whereabouts and any risks must be considered during any leave including Section 17 leave arrangements.
15. Those working in all agencies should be aware of the designated and named professionals for child protection who can provide advice.
16. Close collaboration and liaison between adult mental health services and Children's Social Care are essential in the interests of children. This will require sharing information to safeguard children and promote the welfare of children or to protect a child from Significant Harm. See also Information Sharinq and Confidentiality Procedure.
17. Where Child and Adolescent Mental Health Services (CAMHS)are involved in a family and adults are also known to the Adult Mental Health Services, close collaboration should take place between both services.
18. Information about the child/children in families must be recorded at assessment or as soon as possible and recorded on CPA documentation/client records.
19. Assessments, CPA monitoring, reviews, and discharge planning arrangements and procedures should prompt staff to consider if the service user is likely to have or resume contact with their own child or other children in their network of family and friends, even when the children are not living with the service user, and consider any risks posed to those children.
20. Risks should also be considered for service users who are not parents but are in contact with children e.g. service users with child siblings or grandchildren.
21. Children may take on caring roles within the family when a parent is mentally ill. This may include additional chores, caring for siblings and emotional concerns like worrying about the ill parent. Hospitalisation of a parent may lead to changes in roles and/or living circumstances for the family. The impact on children following admission to hospital of a single, socially isolated parent will have quite different implications compared to hospitalisation of a mentally ill adult in a family where good quality alternative carers are available. The specific needs and safety of the children must be assessed directly and not assumed.
22. Mental Health personnel may also be requested to contribute to Single Assessments led by Children's Social Care.
23. In addition to the interagency working described above, it is especially important to ensure that Health Visiting and Primary Health Care staff and Children's Social Care are involved in any cases involving mothers being treated for postnatal depression or puerperal psychosis.

24.Approprjate completion of the Health and Children's Social Care assessment documentation under the CPA should ensure that any childcare issues are highlighted so that a referral to Children's Social Care can be made where appropriate under the Makinq Referral to Children's Social Care Procedure. This should be documented and any subsequent childcare responsibilities also documented in the adult's care plan.

5.27 Missing Children and Families

RELATED NATIONAL GUIDANCE AND INFORMATION

Chapter 1: Assessinq need and providinq help, Working Together to Safeguard Children

Statutory guidance on children who run away or go missinq from home or care (DE. January 2014)

n

ance o

1

The International Child Abduction and Contact Unit

Keeping Children Safe in Education (DfE, GOV.UK)

Children Missinq Education (DfE, GOV.UK)

RELATED LOCAL GUIDANCE

Joint Protocol Children and Younq People who Run Away or Go Missing From

Home or Care

Blackburn with Darwen

Procedures and Protocol for Children Missinq From or Not Receiving a Suitable

Education

Blackpool

Children Missinq Or Not Receivinq a Suitable Education Procedure Handbook

2017

RELATED CHAPTERS

Forced Marriages Procedure

AMENDMENT

In November 2017, a link was added to Children Missing from Education.

Contents

Children Who Go Missing Families Who Go Missing

Introduction

Initial Action

Strategy Discussion/Meeting

Follow-up Action by Children's Social Care

When the Child, Family or Adult is Found

Children Missing from other Local Authorities

Children Who Go Missing from Education

Introduction

Children Likely to Go Missing from Education

What the Local Authority Does Regarding Children who are Missing from Education

Attendance Strategy

Common Transfer Form (CTF)

Admissions and Leavers Database

Choice Adviser

School Admissions Elective Home Education

Independent Schools

Truancy and Beat-Sweep Patrols

Education Welfare Officers (EWOs)

Government Lost Pupil Database (s2s)

Pupil Referral Unit (PRU) Other Agencies

Children Who Go Missing

See also Joint Protocol Children and Younq People who Run Away or go Missinq from Home or Care.

Families Who Go Missing

Introduction

1. Local agencies and professionals, working with children and families where there are outstanding concerns of actual or potential Significant Harm, must bear in mind that non-school attendance, a series of missed appointments, cancelled or abortive home visits, may indicate that the family has moved out of the area to another area within the UK or that the family has moved abroad;
2. This possibility must also be borne in mind when there are concerns about an unborn child who may be at future risk of Significant Harm;
3. These procedures apply if a child in the following circumstances goes missing (including where it is suspected that they may have moved abroad) or cannot be traced:
   • A child who is the subject of a child protection referral or Section 47

Enquiry,

• A child who is the subject of a Child Protection Plan who goes missing or is removed from her/his address outside the terms of the Child Protection Plan;
• Any child known to a statutory agency who goes missing in circumstances which raise concerns, e.g. where a child is removed from hospital against medical advice and cannot be traced.

4. These procedures also apply to adults whose whereabouts become unknown in the following circumstances:
   • A pregnant woman when there are concerns about the welfare of the child following birth;
   • A family where there are concems about the welfare of the child because of the presence of an individual who poses a risk of harm; o A parent known to be experiencing domestic abuse.
5. For children who go missing where there are concerns about forced marriage, see Forced Marriages Procedure.

Initial Action

6. In any of the above circumstances Children's Social Care holding case responsibility must be notified immediately;
7. The Designated Manager (Children with a Child Protection Plan) must be informed if a child who has a Child Protection Plan goes missing;
8. Children's Social Care must contact all local agencies who know the child to inform them of the situation and, where the child is the subject of a Child Protection Plan, all members of the Core Group must be informed in writing;
9. Existing records in these agencies must be checked to obtain any information, which may help to trace the missing child, e.g. details of friends and relatives, and this information should be passed to any Police officer undertaking the missing person enquiry;
10. The Designated Nurse must be notified about a missing child, family or a pregnant woman. S/he then has responsibility for initiating appropriate local or national notifications of Clinical Commissioninq Groups and Hospital Trusts;

1 1 The Children Missing from Education Office should notify colleagues in other areas about a pupil whose name may show up on the roll of a new school. See Children Missinq from Education (Blackburn with Darwen local policy);

12. The social worker must ensure, wherever practicable, that all those with Parental Responsibility are informed that the child is missing;
13. The social worker must discuss with her/his manager whether to notify members of the extended family and if so, how

Strategy Discussion/Meeting

14. If the child has not been traced, a Strategy Discussion/Meetinq should be convened within a maximum of 5 working days or sooner depending on the level of risk and complexity - see Strategy Discussions Procedure;
15. Members of the Strategy Discussion/Meeting will need to consider whether to circulate other local authorities and other agencies in the area in which the child and family are thought to have gone;
16. Consideration should be given to national notification of authorities and agencies including the appropriate Benefits Agencies;

17.A senior member of Children's Social Care should seek assistance from the Department for Work and Pensions if the Police have not already contacted them;

18. If there is any suspicion that the child may be removed from UK jurisdiction, appropriate legal interventions should be considered and Legal Services consulted about options. It may also be appropriate to contact the Child Abduction Unit or the Consular Directorate at the Foreign and Commonwealth Office, which may be able to follow up a case through their consular post in the country or countries concerned.

Follow-up Action by Children's Social Care

19. If the Strategy Discussion/Meeting agrees that the details of the child or family are to be circulated to other local authorities, the social worker should draft a short letter giving details of:
    • The children in the family; o Other family members or significant adults;

O The circumstances causing concern;

 Action required if a child is found, including any immediate protective action to be taken;

• Details of contact arrangements for the social worker - including out of office hours contact;
• Where possible physical descriptions of the key people and photographs, if available.

20. The letter should be sent to the Designated Manaqer (CbiJ4ren with a Child Protection Plan) for distribution to her/his peers nationally, who in turn should circulate within their own Children's Social Care and local agencies;
21. If the child is subject to a Child Protection Plan and not found within 20 working days, the Child Protection Review Conference must be brought forward to consider whether any other action should be taken.

When the Child, Family or Adult is Found

22. When a child is found or returns to their home authority, there should, if practicable, be a further Strategy Discussion/Meeting within one working day, attended by previously involved agencies to consider:

 Immediate safety issues;

 Whether to instigate a Section 47 Enquiry and agree if a single or joint agency enquiry is necessary;

 Who will interview the child if a Section 47 Enquiry is to be initiated;

 Who will interview the child if a Section 47 Enquiry is not required;

 Who needs to be informed of the child's return (locally and nationally).

23. Any child who is found following a period missing should, regardless of whether s/he is believed to have experienced, or be at risk of, Siqnificant Harm, be offered an interview by a social worker and/or Police officer; where the child requests it, arrangements should be made for the interview to be conducted by an independent person;
24. If the child indicates a wish to be interviewed by an alternative professional, all reasonable efforts must be made to accommodate the child's wishes;
25. This interview should provide a safe opportunity for the child to discuss any concerns regarding her/his care, including if they chose to run away from an abusive situation;
26. When the child is found outside the area of the child's home local authority and is not likely to return, see Transfer Across Local Authority Boundaries Procedure;
27. If the child is subject to a Child Protection Plan, consideration must be given by the social worker and manager in consultation with the Conference Chair, as to the need to bring forward the next Child Protection Review Conference.

Children Missing from Other Local Authorities

28. The Designated Manager (Children with a Child Protection Plan) must ensure that a system for keeping and referring to a list of the 'Notifications of children and/or families who are missing' is in place;
29. If, after 2 years there is no communication from the authority where the child and/or family went missing, the child and/or family's details will be removed from the list.

Children Who Go Missing from Education

See also Blackburn with Darwen Procedures and Protocol for Children Missinq from or not Receivinq a Suitable Education and Blackpool Children Missing From Education.

Introduction

30. Children who go missing from education may also be suffering from Siqnificant Harm as they are no longer in an environment which enables agencies to safeguard and promote their welfare. If it is suspected or becomes apparent that a child is not receiving education the Child Missing Education contact person should be informed;
31. If a child or young person is receiving an education, not only do they have the opportunity to fulfil their potential, but they are also in an environment that enables local agencies to safeguard and promote their welfare. If a child goes missing from education they could be at risk of Significant Harm;

Children Likely to Go Missing from Education

32. There are a number of reasons why children go missing from education. These can include:
    • Failing to start appropriate provision, and hence never entering the system;
    • Ceasing to attend due to exclusion (including illegal and/or unofficial exclusions) or withdrawal;
    • Failing to complete a transition between providers (e.g. being unable to find a suitable school place after moving to a new local authority area).

Below is a list of children who are likely to go missing from education:

 Young people who have committed criminal offences;

 Children living in women's refuges;

 Children in homeless families, perhaps living in temporary accommodation, houses of multiple occupancy or Bed and Breakfast accommodation;

 Young runaways;

 Children with long-term medical or emotional health problems;

 Unaccompanied Asylum Seekers and refugees, or the children of asylum seeking families;

 Looked After children; o Children from Gypsy/Roma/TraveIler background;

 Young carers;

 Children from transient families, i.e. students who have experienced high levels of mobility between different education providers;

 Teenage mothers;

 Children excluded from school;

 Children in Private Fosterinq arrangements;

 Children informally excluded from school and/or those placed on longterm part-time timetables;

 Children taken off roll following a lengthy absence due to an extended family holiday taken in term-time;

 Children entering or leaving the independent schools sector;

 EC nationals who have the right of abode in the UK - this now includes a significant number of asylum seekers granted status by other EC countries and who have subsequently moved to the UK;

 Others who have come from abroad to live and/or work in the UK.

What the Local Authority Does Regarding Children who are Missing from

Education

33. The local authority and its partners are committed to ensuring that:
    • There are secure procedures and monitoring systems in place for ensuring that all children aged 0 - 16 are known to health and children's services;
    • Partner services will bring any children and young people who they support to the attention of the nominated person for Children Missing Education when such children are not attending/accessing education or training;
    • There are secure arrangements for sharing information when children and young people aged 0 - 16 move across locality areas, including unknown destinations;
    • This policy recognises the importance of reducing the risk of children missing from education, and it is envisaged that this will be best achieved by establishing, implementing and maintaining:
    • Awareness raising with the general public regarding our need to know about any children missing from education - this to include publicising details of the local authority's nominated person for Children Missing from Education;
    • Procedures for making prompt referrals to the Education Welfare Officer - Pupil Tracking;
    • Procedures to identify and locate children who go missing from education - through liaison with the other services and agencies who are most likely to come into contact with such children;
    • Procedures to identify children missing education through liaison with other local authorities and access to national databases, e.g UK Visas and Immigration;

 Maintaining a regularly updated central register of all local children know to be missing from education;

• Procedures to re-engage missing children & young people, with appropriate educational provision through a Lead Professional and action planning process;
• Maintaining and developing systems for identifying those at risk of becoming Children Missing Education.

Attendance Strategy

34. The attendance strategy defines the different roles and responsibilities of all those concerned in ensuring that children attend school regularly and the actions that may be taken to achieve this. The local authority has also produced an extended-leave policy (covering family holidays taken in term-time) which

advises schools on procedures that must be followed if a child fails to return to school by the date agreed with parents/carers.

Common Transfer Form (CTF)

35. The law requires that CTF data is sent to a pupil's "new" maintained school by the former school within 15 days after the pupil ceases to be registered at the "old" school;
36. The unique pupil number (UPN) needs to be included in the CTF as a unique identifier for the pupil. If a child's destination is not known, schools are advised not to post the CTF to the 'Lost Pupil Database' (LPD) without first contacting the education welfare team.

Admissions and Leavers Database

37. All schools are requested to inform the local authority of children who are admitted to their school. They are also required to inform the local authority with details of children who are no longer on roll at their school. The information is shared with local health centres.

Choice Adviser

38. The 'Choice Adviser' supports the local authority's admissions team by offering impartial advice to parents applying for their child's school admission. The parents/carers of children who fail to apply for school place are contacted by the Choice Advisor.

School Admissions

39. The local authority's admissions team is provided with details by both the Council's legal team and the local voluntary aided faith schools of those children whose admission appeals have not been successful. This information and details of those children who fail to attend school either in their reception year group or Year 7 are provided to the local authority's education welfare team;
40. The local authority also has protocols in place for identifying and reintegrating children permanently excluded, with fair access protocols (formerly known as hard to place pupils) for managed moves and transfers between schools. The local authority is in the process of developing new mechanisms for identifying Gypsy, Roma and Traveller children who move into the area, so that their suitable education can be secured;

41 . UK Visas and Immigration provides details to the local authority of any asylum seeking families moving into the borough.

Elective Home Education

42. The law allows parents to arrange for their children to be educated at home, rather than at school. The local authority has a robust system in place for monitoring the education of children that are educated at home.

Independent Schools

43. Independent schools are legally required to advise the local authority about the details of all children admitted and removed from the roll of their school. The independent schools are also required to complete a Common Transfer Form.

Truancy and Beat-Sweep Patrols

44. Truancy Sweeps are a joint initiative between the local authority's education welfare service and the Police, and these take the form of a series of locality patrols that are run across the area, with joint teams of Police and education welfare officers approaching children who are on the streets during school hours. They serve to help prevent 'truanting' children from being involved in crime or becoming victims of crime;
45. During a truancy sweep, children and young people out of school are approached and their basic personal details are taken. Checks are then made regarding educational placements and the young people are then (following an interim assessment of their circumstances and the level of risk) returned to their educational placement or escorted home. In both cases, follow-up contact is made with parents/carers. In addition to identifying children missing from their educational placement, these patrols have also located children not registered at any school.

Education Welfare Officers (EWOs)

46. EWOs will work closely with the local authority's admissions team when dealing with parents of children who have failed to register their children at school. EWOs monitor their particular areas for new families, while home visiting. They follow up enquiries or concerns from members of the public who believe children are being kept away from school;
47. EWOs will carry out checks on school registers to ensure correct attendance codes are used and pupils who are absent are known to them and those on approved educational activity are monitored by schools;
48. If the EWO and the school are unable to contact parents/carers of a child who has been absent for maximum of ten days, they should inform the Principal Education Welfare Officer for consideration of what further enquiries are necessary.

Government Lost Pupil Database (s2s)

49. The local authority will regularly check the lost pupil database for children who are missing. It will also respond and send referrals to other local authorities about children missing education.

Pupil Referral Unit (PRU)

50. The local authority will refer all excluded children requiring admission at the PRU. PRU will retain responsibility for ensuring children's regular attendance and take necessary steps for informing others if children leave the establishment.

Other Agencies

51. Staff from any agencies who come across any children who they believe may not be accessing educational provision are requested to contact the nominated Children Missing Education officer. These may involve Housing Officers, Neighbourhood Wardens, Community Safety Officers, Police etc.

5.28 Modern Slavery                                                                                   

SCOPE OF THIS CHAPTER

Victims of modem slavery should be given protection, get the help they need to recover from their experiences and access to the justice they deserve. This chapter sets out guidance on how to identify and respond to a child or young person where there are concerns that they are a victim or a potential victim of modern slavery. It should be read in conjunction with the Makinq a Referral to Children's Social Care Procedure.

RELATED CHAPTERS

Child Sexual Exploitation - Pan Lancashire Standard Operating Protocol

Missinq Children and Families Procedure

International Cross-Border Child Protection Cases Under the 1996 Haque Convention Procedure

This chapter was added to the manual in November 2017.

Contents

Definition

Risk Factors and Vulnerable Circumstances

Indicators

Protection and Action to be Taken

Issues and Challenges

Further Information

Definition

Modern slavery is a form of organised crime in which individuals including children and young people are treated as commodities and exploited for criminal gain. Traffickers and slave drivers trick, force and/or persuade children and parents to let them leave their homes. Grooming methods are used to gain the trust of a child and their parents,

e.g. the promise of a better life or education, which results in a life of abuse, servitude and inhumane treatment.

Child trafficking or child modem slavery is identified as child abuse which requires a child protection response (see Protection and Action to be Taken). It is an abuse of human rights, and all children, irrespective of their immigration status, are entitled to protection under the law.

Children are recruited, moved or transported and then exploited, forced to work or sold. The Modern Slavery Act 2015 (applicable mostly in England and Wales[l] includes two substantive offences i) human trafficking, and ii) slavery, servitude and forced or compulsory labour.

Children are not considered able to give 'informed consent' to their own exploitation (including criminal exploitation), so it is not necessary to consider the means used for the exploitation - whether they were forced, coerced or deceived, i.e. a child's consent to being trafficked is irrelevant and it is not necessary to prove coercion or any other inducement.

Boys and girls of all ages are affected and can be trafficked into, within ('internal trafficking'), and out of the UK for many reasons and all forms of exploitation - e.g. sex trafficking - children can be groomed and sexually abused before being taken to other towns and cities where the sexual exploitation continues. Victims are forced into sexual acts for money, food or a place to stay. Other forms of slavery involve children who are forced to work, criminally exploited and forced into domestic servitude. Victims have been found in brothels or saunas, farms, in factories, nail bars, car washes, hotels and restaurants and commonly are exploited in cannabis cultivation. Criminal exploitation can involve young people as drug carriers, begging and pick-pocketing. Debt bondage (forced to work to pay off debts that realistically they will never be able to), organ harvesting and benefit fraud are other types of modern slavery.

Victims often face more than one type of abuse and slavery, for example they may be sold to another trafficker and then forced into another form of exploitation.

Children and young people may be exploited by parents, carers or family members. Often the child or young person will not realise that family members are involved in the exploitation.

The Modern Slavery Act 2015 (applicable mostly in England and Wales[l]) provides two civil prevention orders - the Slavery and Trafficking Prevention Orders (STPO) and Slavery and Trafficking Risk Order (STRO) and provision for child trafficking advocates.

Some young people may not be victims of human trafficking but are still victims of modern slavery. Slavery, servitude and forced or compulsory labour may also be present in trafficking cases; however, not every young person who is exploited through forced labour has been trafficked. In all cases, protection and support is available through the National Referral Mechanism (NRM) process (in England and Wales[2]). The NRM is a 'victim identification and support process' for all the different agencies that may be involved (e.g. the Police, Home Office, including Border Force, UK Visas and Immigration, local authorities and voluntary organisations). See Referrinq a Potential Victim of Modern Slavery to the National Referral Mechanism (NRM)

[1] Some provisions also concem Northern Ireland and Scotland. Also see the Human Trafficking and Exploitation (Criminal Justice and Support for Victims) Act (Northern Ireland) 2015 and the Human Trafficking and Exploitation (Scotland) Act 2015 [2] (In Scotland and Northern Ireland, however, only trafficking cases (rather than all modern slavery cases) are processed through the NRM

Risk Factors and Vulnerable Circumstances

Victims may not always be recognised by those who come into contact with them. They may be unwilling to come forward to agencies not seeing themselves as victims, or fearing further reprisals from their abusers.

Vulnerable circumstances include:

Poverty, limited opportunities at home, low levels of education, and the effects of war are some of the key drivers that contribute to trafficking of victims;

Poor and displaced families may hand over care of their children to traffickers who promise to provide them with a source of income, education or skills training, but ultimately exploit them;

Wanting to help their families back at home or seeking better futures;

Escaping familial situations of harm and abuse, homelessness or being orphaned;

A lack of equal opportunities, discrimination or marginalisation and social customs such as children being expected to respect and follow the adult in charge. Faith abuse and other specific practices may be used to control the child. A demand for cheap or free labour or a workforce who can be easily controlled and forced into criminal activity;

Unaccompanied, internally displaced children;

Some children may say they are unaccompanied when claiming asylum - the trafficker may have told the child that in doing so they will be granted permission to stay in the UK and be entitled to claim welfare benefits;

Former victims of modern slavery or trafficking;

Trafficked children have an increased risk of going missing from care in the UK, with some rejoining those who exploited them in the first place.

Indicators

Signs that a child has been trafficked may not be obvious, or children may show signs of multiple forms of abuse and neglect. Spotting the potential signs of child slavery/trafficking in referrals and children you work with can include:

A reluctance to seek help - victims may be wary of the authorities for many reasons such as not knowing who to trust or a fear of deportation or concern regarding their immigration status and may avoid giving details of accommodation or personal details;

The child seeming like a willing participant in their exploitation, e.g. involvement in lucrative criminal activity - however this does not mean they have benefitted from the proceeds;

Discrepancies in the information victims have provided due to traffickers forcing them to provide incorrect stories;

An unwillingness to disclose details of their experience due to being in a situation of dependency;

Brought or moved from another country;

An unrelated or new child discovered at an address;

Unsatisfactory living conditions - may be living in dirty, cramped or overcrowded accommodation;

Missing - from care, home or school - including a pattern of registration and de-registration from different schools;

Children may be found in brothels and saunas;

Spending a lot of time doing household chores;

May be working in catering, nail bars, caring for children and cleaning;

Rarely leaving their home, with no freedom of movement and no time for playing;

Orphaned or living apart from their family, often in unregulated private foster care;

Limited English or knowledge of their local area in which they live;

False documentation, no passport or identification documents;

Few or no personal effects - few personal possessions and tend to wear the same clothing;

No evidence of parental permission for the child to travel to the UK or stay with the adult;

Little or no evidence of any pre-existing relationship with the adult or even an absence of any knowledge of the accompanying adult;

Significantly older partner;

Underage marriage.

Physical Appearance - Victims may show signs of physical or psychological abuse, look malnourished or unkempt, or appear withdrawn. Physical illnesses - including work-related injuries through poor health and safety measures, or injuries apparently as a result of assault or controlling measures. There may be physical indications of working (e.g. overly tired in school or indications of manual labour).

Sexual health indicators - sexually transmitted infections, or pregnancy; injuries of a sexual nature and [or gynaecological symptoms.

Psychological indicators - suffering from post traumatic stress disorder which may include symptoms of hostility, aggression and difficulty with recalling episodes and concentrating. Depression/self-harm and/or suicidal feelings; an attitude of self blame, shame and extensive loss of control; drug and or/alcohol use.

Protection and Action to be Taken

Modern slavery is child abuse, and any potential victim of child trafficking or slavery, servitude, or forced or compulsory labour should immediately be referred to Children's Services in the area, as they may be suffering significant harm - see Makinq  a Referral to Children's Social Care Procedure.

Once a potential victim has been identified, practitioners should inform them of their right to protection, support, and assistance in any criminal proceedings against offenders.

Practitioners should meet any urgent health needs and arrange emergency medical treatment if appropriate. Local Community Safety Partnerships commission services for victims of modern slavery and should be contacted to identify the relevant services required for victims.

Any agency or individual practitioner or volunteer who has a concern regarding the possible trafficking of a child should immediately make a referral to Children's Social Care. Practitioners should not do anything which would heighten the risk of harm or abduction to the child.

Prompt decisions are needed when the concerns relate to a child who may be trafficked in order to act before the child goes missing (practitioners must be alert that there will be a high risk of the victim going missing from any accommodation due to their pull factors with abusers).

Decision-making following the receipt of a referral will normally follow discussions with the Police, the person making the referral and may involve other professionals and services.

Specific action during the Single Assessment of a child who is possibly trafficked should include:

     Seeing and speaking with the child and family members as appropriate - the adult purporting to be the child's parent, sponsor or carer should not be present at interviews with the child, or at meetings to discuss future actions;

Drawing together and analysing information from a range of sources, including relevant information from the country or countries in which the child has lived. All agencies involved should request this information from their counterparts overseas. Information about who to contact can be obtained via the Foreign and Commonwealth Office or the appropriate embassy or consulate in London (see National Contacts);

Checking all documentation held by child, the family, the referrer and other agencies. Copies of all relevant documentation should be taken and together with a photograph of the child be included in the social worker's file.

Even if there are no apparent concerns, child welfare agencies should continue to monitor the situation until the child is appropriately settled.

The Strategy Discussion / Section 47 enquiry should decide whether to conduct a joint interview with the child and, if necessary, with the family or carers. Under no circumstances should the child and their family members or carers be interviewed together.

Professional interpreters, who have been approved and checked, should be used where English is not the child's preferred language. Under no circumstances should the interpreter be the sponsor or another adult purporting to be the parent, guardian or relative.

On completion of a Section 47 Enquiry a multi-agency meeting should be held convened by the social worker, and involving the social worker's manager, the referring agency if appropriate, the Police and other relevant professionals to decide on future action. Further action should not be taken until this meeting has been held and multi-agency agreement obtained to the proposed plan, including the need for a Child Protection Conference and possible Child Protection Plan.

Where it is found that the child is not a member of the family with whom he or she is living and is not related to any other person in this country, consideration should be given to whether the child needs to be moved from the household and/or legal advice sought on making a separate application for immigration status.

Any law enforcement action regarding fraud, trafficking, deception and illegal entry to this country is the remit of the Police and the local authority should assist in any way possible.

Trafficked children may be accommodated by the local authority under Section 20 of the Children Act 1989. The assessment of their needs to inform their Care Plan and should include a risk assessment of how the local authority intends to protect them from any trafficker being able to re-involve the child in exploitative activities. This plan should include plans to prevent the child from going missing and contingency plans to be followed if the child goes missing. Whilst the child is Looked After, residential and foster carers should be vigilant about, for example, waiting cars outside the premises, telephone enquiries etc.

The local authority should continue to share with the Police any information which emerges during the placement of a child who may have been trafficked, concerning potential crimes against the child, risk to other children or relevant immigration matters.

Trafficked children need:

Professionals to be informed and competent in matters relating to trafficking and exploitation;

Someone to spend sufficient time with them to build up a level of trust;

Separate interviews - at no stage should adults purporting to be the child's parent, sponsor or carer be present at interviews or at meetings with the child to discuss future action;

Safe placements if children are victims of organised trafficking operations and for their whereabouts to be kept confidential;

Legal advice about their rights and immigration status;

Discretion and caution to be used in tracing their families;

     Risk assessments to be made of the danger if he or she is repatriated; and

Where appropriate, accommodation under Section 20 of the Children Act 1989 or an application of an Interim Care Order.

Referring a Potential Victim of Modern Slavery to the National Referral Mechanism (NRM)

Referrals to the NRM for consideration by the competent authority should be made by the local authority for all potential child victims of trafficking and modern slavery, as they may be entitled to further support - victims can be of any nationality, and may include British national children, such as those trafficked for child sexual exploitation or those trafficked as drug carriers internally in the UK. The NRM does not supersede child protection procedures, so existing safeguarding processes should still be followed in tandem with the notifications to the NRM. See also: How to Report a Victim of Modern Slavery factsheet.

There is no minimum requirement for justifying a referral into the NRM and consent is not required for children. Communicate honestly with the child about your concerns and reasons for referring them into the NRM.

To complete and see where to send the forms, and the associated guidance, visit Modern Slavery Victims: Referral and Assessment Forms.

The Duty to Notify - Local authorities have a duty to notify the Home Office about any potential victims of Modern Slavery. For children, completing the NRM form is sufficient to satisfy this requirement.

If the child or anyone connected to them is in immediate danger the Police should be contacted as normal.

Practitioners must arrange safe accommodation for the potential victim.

Where there is reason to believe a victim could be a child, the individual must be given the benefit of the doubt and treated as a child until an assessment is carried out. An age assessment should only be carried out if appropriate to do so, and should not cause a delay in referring into the NRM.

Practitioners must always ensure that a victim-centred approach to tackling all types of trafficking and modern slavery is taken. This can be achieved by the following:

Dealing with the child sensitively to avoid them being alarmed or shamed building trust, as victims commonly feel fear towards the authorities;

Keeping in mind the child's:

Added vulnerability; o Developmental stage; o Possible grooming by the perpetrator.

It is important that practitioners make careful notes about what is disclosed, as a child's credibility can be challenged if the child is subject to immigration control on the basis of their disclosure being made in instalments. This will support the child and help others understand the process of disclosure.

When questioning a potential victim, initially observe non verbal communication and body language between the victim and their perpetrator.

It is important to consider the potential victim's safety and that of their loved ones. Confidentiality and careful handling of personal information is imperative to ensure the child's safety. Practitioners must not disclose to anyone not directly involved in the case, any details that may compromise their safety.

For further advice and support the Child Traffickinq Advice Centre (CTAC) provides free guidance to professionals concerned that a child or young person is a victim of modern slavery.

Issues and Challenges

Children who are trafficked outside of the UK may intrinsically be linked to the immigration system. Practitioners should be aware of the risk of harm to the child if the adult is not able to confirm their immigration status, to avoid a potential child trafficking situation being misconstrued as an 'immigration matter' and thus preventing victims from being recognised. It is important that plans for the child's long term safety are linked to their immigration status, in order to fully understand the child's real identity and the reasons for not having identification documents or false documentation.

Modern slavery is often hidden in nature, and goes unnoticed in our communities, with under-reporting a major concern. Practitioners have the challenge of reaching out to a vulnerable and an 'invisible' set of children. As well as assessing the significant harm to the child, there will need to be consideration for other key areas such as organised crime, working with UK Visas and Immigration, foreign authorities and the National Crime Agency.

Further Information

Child Traffickinq Advice Centre (CTAC) - helpline for professionals dealing with potential victims of modern slavery Modern Slavery Helpline

Support for victims of modern slavery (GOV.UK)

National Referral Mechanism: Guidance for Child First Responders

Modern slavery: how to identify and support victims

Home Office Circular - Modern Slavery Act 2015

Modern Slavery Act 2015

Modern Slavery Act 2015: Recent developments - Briefing Paper, July 2016 College of Policing - Modern Slavery

Modern Slavery and Human Traffickinq Unit (National Crime Aqency)

Modern Slavery: Duty to Notify Factsheets (GOV.UK, October 2016)

Workinq Witb_Eoreiqn Authorities Guidance

Care of Unaccompanied Miqrant Children and Child Victims of Modern Slavery

• Statutory Guidance for Local Authorities

NSPCC - Are You a Child Who Has Come to the UK from Another Country? Unseen

Modern Slavery - Royal Colleqe of Nursing Guide for Nurses and Midwiv_es

5.29 Neglect

Neglect is the ongoing failure to meet a child or young person's basic needs.

This includes:

• Food, clothing and shelter;  A safe place to live;
• Love, care or attention;
• Education, health and dental care.

Neglect is the most common form of child abuse. It is dangerous and can cause serious, long-term damage to children and young people. It can result in death.

Neglect Strategies

Blackburn with Darwen Neglect Strategy

Blackpool Neglect Strateqy

Lancashire Multi Agency Neglect Strategy

Neglect Indicators and Toolkits

Blackpool

Lancashire

5.30 Online Safeguarding

RELATED NATIONAL GUIDANCE

Child Exploitation and Online Protection Centre

Chapter 1 : Assessinq need and providing help, Working Together to Safeguard

Children

Pan-Lancashire

Pan-Lancashire LSCB Online Safeguardinq Strategy 2017 - 2019

RELATED CHAPTERS

Bullyinq Procedure

AMENDMENT

In November 2017, this chapter was extensively updated and should be read throughout.

Contents mpac o

Working Practices

Policy Decisions

Communications Policy

Impact of the Online Environment for Information Communication Technology (ICT) on Children and Young People

1. Communication technologies have become a significant tool in the distribution of indecent photographs/pseudo photographs of children. Internet chat rooms, social networking sites, gaming sites, virtual worlds, instant messaging, discussion forums and bulletin boards are used as a means of contacting children with a view to grooming them for inappropriate or abusive relationships, which may include requests to make and transmit indecent images of themselves, orto perform sexual acts live in front of a camera via live streaming services or other such platforms. Contacts made initially in a group environments such as a chat rooms or online forums are likely to be carried on and further developed through (typically encrypted) social media platforms as part of the grooming process.
2. There is also cause for concern about the exposure of children to inappropriate material such as adult pornography and/or extreme forms of obscene material, including access to extremist content and it is important to recognise that extremist radicalisation of young people is itself a form of grooming. Allowing or encouraging a child to view such material over an appreciable period of time may warrant further enquiry. Children themselves may engage in online bullying (Cyberbullying), deliberately send explicit images/video of themselves (Sexting)

or use mobile phone cameras to capture violent assaults of other children for circulation;

3. Where there is evidence of a child using ICT technology (including gaming devices) excessively, this may be a cause for concern more generally, in the sense that it may inhibit the development of real-world social relationships, become a factor contributing to physical health and wellbeing, mental health concerns or negatively impact on their educational attainment. It may also indicate either a contemporary problem, or a deeper underlying issue that ought to be addressed, such as addictive behaviour and behaviour relating to the obsessive use of technologies, particularly around online gaming environments;
4. There is evidence that people found in possession of indecent photographs/pseudo photographs of children are likely to be involved directly in child abuse. Thus when somebody is discovered to have placed or accessed such material online, the Police should normally consider the likelihood that the individual is involved in the active abuse of children. In particular, the individual's access to children should be established, within the family, employment contexts, and in other settings (e.g. work with children as a volunteer or in other positions of trust);
5. If there are particular concems about one or more specific children, procedures should be followed for Referrals, Single Assessments and, when appropriate, Strateqy Discussions/Meetinqs. As part of their role in preventing abuse and neglect, the Blackburn with Darwen, Blackpool and Lancashire Children's Safeguarding Assurance Partnership (CSAP) is a key partner in the development and delivery of training and education programmes, with the Child Exploitation and Online Protection Centre (CEOP). This includes building on the work of HM Government departments and organisations such as the UK Council for Child Internet Safety (UKCCIS), the UK Safer Internet Centre (UKSIC) and IT-industry partners in raising awareness about the safe use of technology by our children and young people.

Working Practices

6. CSAP partner organisations will:
   • Ensure that they have an appropriately trained person nominated as the lead Online Safeguarding Champion who receives regular updates on emerging trends / technologies and potential risks;
   • Promote that the use of Internet derived materials by service providers and children and young people complies with copyright law;
   • Provide guidance on using Social Networking platforms and other associated technologies safely and responsibly;
   • Provide guidance on managing inappropriate use of technology by children, young people and staff;
   • Encourage children and young people to be critically aware of online content including becoming critical consumers of information and promoting the development of broader digital resilience;
   • Encourage and support parents and carers to become more aware of online issue affecting children and young people and how to address them;
   • Ensure that they use digital images and video of children and young people responsibly and safely and encourage children, young people, their parents and carers to do the same;
   • Provide guidance on using online platforms positively, safely and responsibly;
   • Encourage the safe and responsible use of mobile technologies such as smartphones and tablets by children and young people;

Where agencies use social media, software and broader communication technologies to monitor if a child is suffering or likely to suffer significant harm, the agency must have in place robust and effective policies and procedures compliant with local information sharing protocols and safeguarding policies.

Policy Decisions

7. Authorising Access to ICT
   • All organisations must have robust and effective Acceptable Use/Behaviour Policies in place which users must read (and sign where applicable) before using any ICT resources;
   • The organisation should keep a record of all users (including staff and pupils) who are granted Internet access. The record will be kept up-todate, for instance a member of staff may leave or a pupil's access be withdrawn;
   • Those with parental responsibility will be asked to sign and return a consent form.

8. Assessing Risks

• The organisation will take all reasonable precautions to ensure that users access only appropriate material. Any inappropriate access, whether intentional or unintentional, will escalated in line with the organisation's Online Safety Policy and procedures;
• The organisation will regularly audit Online Safety provision to establish if their policies and procedures are adequate, up to date and implemented effectively

9. Handling Online Safety-related Complaints
   • Complaints of Internet misuse will be dealt with by the person supervising internet use in the first instance in line with established safeguarding procedures;
   • Any complaint about staff misuse must be referred to the management within the organisation in line with established safeguarding procedures;
   • Complaints of a child protection nature must be dealt with in a timely and effective manner in accordance with the organisation's child protection procedures;
   • Children and young people and those with parental responsibility will be informed of the complaints procedure on request.

Communications Policy

10. Introducing the Online Safety Policy to Children and Young People
    • Online Safety rules should be posted in all rooms with computer access and discussed with the Children and Young People at least annually;
    • Children, Young People and their Parents/Carers should be informed that network and Internet use can be monitored;
    • The importance of Online Safety will be explained by school staff to Children and Young People including the standards expected both inside and outside of the school environment, particularly in relation to the use of Social Media platforms.

1 1 . Staff and the Online Safety Policy

• All staff will be given the organisation's Online Safety Policy (or its equivalent) and its importance explained, including the requirement to maintain appropriate professional standards both inside and outside of the work environment (e.g. Social Networking Sites);
• All staff must read and understand Part 1 of the DfE statutory guidance Keeping Children Safe in Education'
• Staff should be made aware that internet traffic may be monitored and traced to the individual device or login. Discretion and professional conduct is essential;
• The organisation may use monitoring systems and/or software where this is available to ensure that inappropriate materials are not being stored or used on the organisation's equipment.

12. Enlisting Parents' Support

o The attention of those with parental responsibility will be drawn to the organisation's           Online Safety Policy.

For further information, guidance and resources can be found on the below link: http://www.Iancashiresafequardinq.orq.uWonIinesafeguardinq.aspx

5.31 Peer Abuse

LOCAL GUIDANCE

Pan-Lancashire Procedure for Children and Young People Who Display Sexually

Harmful Behaviour (added November 2013)

AMENDMENT

In November 2013, this chapter was updated in line with the Single Assessment Framework.

1. Children, particularly those living away from home, are also vulnerable to physical, sexual and emotional bullying and abuse by their peers. Such abuse should always be taken as seriously as abuse perpetrated by an adult. It should be subject to the same safeguarding children procedures as apply in respect of any child who is suffering, or at risk of suffering, Significant Harm from an adverse source. A significant proportion of sex offences are committed by teenagers and, on occasion, such offences are committed by younger children. Staff and carers of children living away from home need clear guidance and training to identify the difference between consenting and abusive, and between appropriate and exploitative peer relationships. Staff should not dismiss some abusive sexual behaviour as 'normal' between young people, and should not develop high thresholds before taking action;
2. Work with children and young people who abuse others - including those who sexually abuse/offend - should recognise that such children are likely to have considerable needs themselves, and also that they may pose a significant risk of harm to other children. Evidence suggests that children who abuse others may have suffered considerable disruption in their lives, been exposed to violence within the family, may have witnessed or been subject to physical or sexual abuse, have problems in their educational development, and may have committed other offences. Such children and young people are likely to be Children in Need, and some will, in addition, be suffering, or at risk of suffering, Significant Harm, and may themselves be in need of protection. Children and young people who abuse others should be held responsible for their abusive behaviour, while being identified and responded to in a way that meets their needs as well as protecting others. Allegations of peer abuse will be taken as seriously as allegations of abuse perpetrated by an adult;
3. Three key principles should guide work with children and young people who abuse others:
   • There should be a coordinated approach on the part of Youth Justice, Children's Social Care, education (including educational psychology) and health (including Child and Adolescent Mental Health (CAMHS) agencies;

 The needs of children and young people who abuse others should be considered separately from the needs of their victims. This should include both the risk posed to the child and the risk posed by the child;

• An assessment should be carried out in each case of abuse, appreciating that these children may have considerable unmet developmental needs, as well as specific needs arising from their behaviour.

4. Where a professional has concerns that a child may cause harm to another child, it is important that information is shared between Agencies, to ensure that a risk management plan is in place. Information should be shared in accordance with Information Sharing and Confidentiality Procedures;
5. A social worker from the relevant locality team will carry out an Single Assessment. Different social workers will be allocated to the victim and to the child with the alleged abusive behaviour, even if they live in the same household, to ensure that both are supported through the process of the enquiry and that both their needs are fully assessed;
6. It should be recognised that disclosure of sexually inappropriate behaviour or abusive behaviour by a child can be extremely distressing for a parent/carer. The child and family should always be advised of their right to seek legal representation to support them through the process;
7. The Police should always consult with Targeted Services regarding cases that come to their attention in order to ensure that there is an assessment of the victim's needs and that in all cases there is an assessment of the alleged abusing child's needs. Each child should be referred to the locality team responsible for the area where the child resides;
8. Children with sexually abusive behaviour who are returning to the community following a custodial sentence or time in secure accommodation also require consideration through this procedure;
9. In all cases where the suspected or alleged abuser is a child, Targeted Services and the Police must convene a Strategy Meeting within the timescales set out. This will be chaired by a Quality Assurance Officer;
10. If the children involved are the responsibility of different local authorities, each must be represented at the Strategy Discussion which will usually be convened by the authority in which the victim resides;

1 1 . Consideration should be given to separate Strategy Discussions being held for the child who is alleged to have abused another and for the alleged victim(s);

12. Care must be taken to ensure that the appropriate professionals attend the right meeting to ensure appropriate confidentiality. For example, school representatives should only attend for the pupil at their school. The Police officer and social worker who are investigating should attend both sets of Strategy Discussions. Where the abusing child is over 10 years a Youth Offending Team representative should be in attendance;
13. The Strategy Discussion must plan in detail the respective roles of those involved in the enquiries and ensure the following objectives are met:
    • Information relevant to the protection and needs of the alleged victim is gathered; o Any criminal aspects of the alleged abuse are investigated;
    • Any information relevant to any abusive experiences and protection needs of the child who is the alleged abuser is gathered;
    • Any information about the risks to self and others, including other children in the household, extended family, school, peer group or wider social network is gathered.
14. Section 47 Enquiry will be pursued in respect of the alleged abusing child when he/she is personally suffering or at risk of Significant Harm;
15. Where there is suspicion that the child who is the alleged abuser is also a victim of abuse the Strategy Meeting must decide the order in which the interviews should take place;
16. When a child is aged 10 or over and is alleged to have committed an offence the Police must undertake the first interview under the Police and Criminal Evidence Act 1984;
17. If a child is to be interviewed as a victim of or witness to an alleged offence under the provisions of the Achieving Best Evidence guidance and the child admits these offences, these incidents should normally be the subject of a separate interview;
18. In complex situations where there are a number of victims and possible abusers the Strategy Discussion should involve Group Managers to coordinate the process;
19. If it appears that the alleged abusing child is suffering or is at risk of Significant Harm the Section 47 enquiry and Single Assessment process will be followed;

20.1n assessing a child or young person who abuses another, relevant considerations include:

• The nature and extent of the abusive behaviours. In respect of sexual abuse, there are sometimes perceived to be difficulties in distinguishing between normal childhood sexual development and experimentation, and sexually inappropriate or aggressive behaviour. Expert professional judgment may be required, within the context of knowledge about normal child sexuality. It may be appropriate to undertake a joint assessment;
• The context of the abusive behaviours;
• The child's development and family and social circumstances (if a child is Looked After and is at risk of sexual offending due consideration must be given as to whether a Child Protection Conference [multiagency plan is required);
• Needs for services, specifically focusing on the child's harmful behaviour as well as the child's other significant needs;
• The risks to self and others, including other children in the household, extended family, school, peer group or wider social network. This risk is likely to be present unless the opportunity for further abuse is ended, the young person has acknowledged the abusive behaviour and accepted responsibility, and there is agreement by the young abuser and his/her family to work with relevant agencies to address the problem.

21 Decisions for local agencies (including the Crown Prosecution Service where relevant) according to the responsibilities of each include:

 The most appropriate course of action within the criminal justice system, if the child is above the age of criminal responsibility;

o Whether the young abuser should be the subject of a Child Protection Conference;

 What plan of action should be put in place to address the needs of the young abuser, detailing the involvement of all relevant agencies.

22. If there is a balance of probability that nothing abusive or inappropriate took place, then no further action may be required. However in cases of alleged sexual abuse, it is important to keep this separate from the issue of denial. Strength of denial by the child and/or the family should have no bearing on any decision about no further action;
23. If there is a continuing risk of Significant Harm, an Initial Child Protection Conference should be held. If the child becomes the subject of a Child Protection Plan, the coordination of services will continue through the Core Group, which should address the child's inappropriate behaviour as well as the concerns, which resulted in their need for a Child Protection Plan;
24. If the child is not considered as requiring a Child Protection Plan but is assessed to be a Child in Need, a meeting should be held, as set out in the paragraph below;
25. Where there are insufficient grounds for holding a Child Protection Conference, or where a Child Protection Plan was not needed, a multi-agency approach will still be needed if the young abuser's needs are complex;
26. In such cases a multi-agency planning meeting should be convened by Children's Social Care to pool information, allocate roles and set a time-table for an assessment of the needs of the child and the risk posed by them, as well as co-ordinate any other interim intervention;
27. Those invited should include participants of the Strategy Meeting and representatives from health (including Child and Adolescent Mental Health Services), school, YOT and any other appropriate service provider, the child and her/his parents / carers;
28. In cases where the young abuser is also looked after by the local authority consideration should be given to the need for a plan to minimise risk of future offending, agreed with carers and their agency;

29.0n completion of the assessment, the same forum will be reconvened to consider the outcome, to review and co-ordinate roles of relevant agencies in providing any identified intervention, including specialist input with regard to service users with special needs. Care must be taken to provide services culturally appropriate to the needs of the child and the family;

30. Intervention should be reviewed at regular multi-agency meetings. At the point of closure, the review will consider the possible need for long-term monitoring and the availability of advice and other services;
31. Children's Targeted Services will undertake a multi-agency assessment when a young person has committed an offence against a child and is due to be released following a custodial sentence or time in secure accommodation.

Criminal Proceedings

32. When the child is over 10 years, the Police will consult other agencies including the Crown Prosecution Service to decide the most appropriate course of action within the criminal justice system before any decision is made to issue a reprimand, final warning or informal disposal, or to pursue prosecution;
33. In cases where criminal proceedings are taken against an alleged abusing child, the YOT should be added to the list of possible attendees at any meetings. Both the compilation of the YOT Asset Assessment and the preparation of a Single Assessment will be facilitated through this;
34. When a case is going through the Youth Court or the Crown Court, the YOT will provide information for the Single Assessment process. This may include plea, bail conditions and variations between adjournments;
35. LSCP's and Youth Offending Teams should ensure that there is a clear operational framework in place, within which assessment, decision-making and case-management take place. Neither child welfare nor criminal justice agencies should embark on a course of action that has implications for the other without appropriate consultation.

The Child Victim

36. Where the assessment of the child or children who have been abused concludes that they may still be at risk of Significant Harm, an Initial Child Protection Conference must be convened to assess the risks and safeguard them through a Child Protection Plan if needed;
37. They may require services to support them through interviews in line with Achieving Best Evidence Guidance. The assessments undertaken may determine that there is a need for support services, such as counselling services, whether the child is in need of safeguarding or a Child in Need.
38. Bullying
39. Bullying may be defined as deliberately hurtful behaviour, usually repeated over a period of time, where it is difficult for those bullied to defend themselves. It can take many forms, but the three main types are:
    • Physical (e.g. hitting, kicking, theft); o Verbal (e.g. racist or homophobic remarks, threats, name-calling);
    • Emotional (e.g. isolating an individual from the activities and social acceptance of their peer group).
40. The damage inflicted by bullying can frequently be underestimated. ft can cause considerable distress to children, to the extent that it affects their health and development or, at the extreme, causes them Significant Harm (including selfharm). All settings in which children are provided with services or are living away from home should have in place rigorously enforced anti-bullying strategies.

5.32 Private Fostering

RELATED NATIONAL GUIDANCE

Working Together to Safeguard Children

RELATED LOCAL GUIDANCE

Lancashire Private Fostering Procedure

Blackpool Private Fostering Procedure

RELATED CHAPTER

Safeguarding Children and Young People in the Youth Justice System

Procedure

AMENDMENT

In May 2016, Actions for Safeguarding was updated to include all referrals to notify and request assessment for private fostering must be made through local MultiAgency Safeguarding Hub (MASH) arrangements, including by social workers already working with a family. The MASH process will involve checks through Police (PNC, PND & Borders Agency) and determine allocation for assessment.

Contents

Introduction

Legal Basis

Principles

Actions for Safeguarding

Raising Awareness

Introduction

1. A private fostering arrangement is essentially one that is made privately (that is to say without the involvement of the local authority) for the care of a child under the age of 16 (under 18, if disabled) by someone other than: o A parent of the child; o A person who has parental responsibility for the child; o A close relative to the child.

with the intention that it should last for 28 days or more.

2. Private foster carers may be from the extended family, such as cousin or great aunt. However, a person who is a relative under the Children Act 1989 i.e. Grandparent, brother, sister, uncle or aunt (whether of the full or half blood or by marriage) or step-parent, will not be a private foster carer.
3. A private foster carer may be a friend of the family, the parent of a friend of the child, or someone previously unknown to the child's family who is willing to privately foster a child.
4. The period for which a child is cared for and accommodated by the foster carer is continuous, but that continuity is not broken by the occasional shod break. If a period of care lasts less than 27 days but further periods are planned which total 28 days or more, then the private fostering procedures apply. A break in the period for the child to visit his/her parents at home for a brief period, e.g. weekend, would not effect the total calculation of the number of days of the placement. Such a break does not therefore constitute the end of the private fostering arrangement.
5. A child is not privately fostered while he/she is:
   • Being looked after by the local authority;
   • Placed in the care of a person who proposes to adopt him/her under arrangements made by an adoption agency in line with Adoption legislation; o A protected child;
   • In the care of any person in compliance with a supervision order made in criminal proceedings under the CYPA1969 or a supervision requirement under the Social Work (Scotland) Act 1995;
   • Liable to be detained, or subject to guardianship, under the Mental Health Act 1983(7).
6. A child is deemed to be privately fostered where a person assumes care in a personal capacity and not as part of their duties in relation to any one of the following establishments:

 Any children's home;

 Accommodation provided by or on behalf of any voluntary organization;

 Any school in which he/she is receiving full-time education;

 Any health service hospital;

 Any residential care home, nursing home or mental nursing home;

 Any other home or institution provided, equipped and maintained by the Secretary of State.

7. A private fostering arrangement is made by parents or a person with parental responsibility, directly with the private carers not through a voluntary agency or social care department. The arrangement is not paid for nor arranged by the local authority. If the local authority is sufficiently involved in financing and planning such a placement then the arrangement falls within the responsibilities discharged to local authorities for "Looked After Children"
8. Private fostering is the arrangement made by the parent and the private foster carer. Local authorities do not approve or register private foster carers. A proper balance needs to be maintained between the rights of parents to make private arrangements for the care of their children, and other statutory duties towards privately fostered children.
9. Privately fostered children are a diverse and sometimes vulnerable group. They may include:
   • Children sent from abroad to stay with another family, usually to improve their educational opportunities; o Asylum-seeking and refugee children;
   • Children and young people who are staying with friends or other nonrelatives; o Language students living with host families.

Legal Basis

10. Privately fostered children are not Looked After Children, and local authorities are not involved in the making of such arrangements. A Privately Fostered Child is not necessarily a 'child in need'.
11. Local authorities do not formally approve or register private foster carers. However, it is their duty to be satisfied that the welfare of children who are privately fostered within their area is satisfactorily safeguarded and promoted.
12. Under the Children Act 1989 private foster carers and those with Parental Responsibility are required to notify the local authority of their intention to privately foster or to have a child privately fostered, or where a child is privately fostered in an emergency. Teachers, health and other professionals should notify the local authority of a private fostering arrangement that comes to their attention, where they are not satisfied that the local authority has been or will be notified of the arrangement.
13. It is the duty of every local authority to be satisfied that the welfare of children who are privately fostered within their area is being satisfactorily safeguarded and promoted, and to ensure that such advice as appears to be required is given to private foster carers. In order to do so, they must visit privately fostered children at regular intervals. The minimum visiting requirements are set out in the regulations. They have the power to impose requirements on the private foster carer or, if there are serious concerns about an arrangement, to prohibit it.
14. The Children Act 1989 creates a number of offences in connection with private fostering, including for failure to notify an arrangement or to comply with any requirement or prohibition imposed by the authority. Certain people are disqualified from being private foster carers.
15. Local authorities are required to promote awareness in their area of requirements as to notification and to ensure that such advice as appears to be required is given to those concerned with children who are, or are proposed to be, privately fostered. This will include private foster carers (proposed and actual) and parents.

Principles

16. Privately fostered children will be protected from sexual, physical and emotional abuse and neglect and any concerns will be dealt with in line with procedures in this manual. Persons identified as unsuitable will be prevented from fostering a child privately.
17. Children's views wishes and feelings will be considered at all times. All assessments of prospective carers will focus on the carers ^t ability to meet the needs of children. Children's Social Care will work in partnership with parents and children, carers and their families, and other professionals and agencies to ensure that services are provided to meet assessed needs.
18. Private fostering service provision will be based on fair and equal access and anti-discriminatory practice. The arrangements for the care of privately fostered children will take a holistic and life long view of the child's needs to maximise their life chances. The child's parent and the private foster carers should work in partnership to promote the child's health and education.

19.All agencies should encourage parents and carers to notify Children's Social Care of any private fostering arrangements and take steps to check that notification takes place. Assessment of Private Fostering Arrangements will be undertaken using the Single Assessment and will be subject to Children's Social Care case management and supervision arrangements.

Actions for Safeguarding

20.All referrals to notify and request assessment for private fostering must be made through local Multi-Agency Safeguarding Hub (MASH) arrangements, including by social workers already working with a family. The MASH process will involve checks through Police (PNC, PND & Borders Agency) and determine allocation for assessment.

21 Children's Social Care will arrange for a social worker to visit the parents and talk about their child's needs and the proposed private fostering arrangements. The social worker will also visit the person who is fostering, or intends to foster the child within 7 days of receiving notification and will inspect the accommodation. Everyone over 16 years of age will be required to undergo checks including a Disclosure and Barring Service enhanced check.

22. If the Single Assessment identifies that the proposed arrangements would not be appropriate for the child, the child's parents will be offered appropriate advice and support to enable them to make alternative arrangements for the care of their child. Parents would also be advised on attachment issues and the desirability of keeping siblings together wherever possible, unless a child had particular needs that needed to be met separately
23. The social worker will write a report about the arrangements, and a senior Children's Social Care manager will decide whether the placement should go ahead, and whether any restrictions should be made such as limiting the number of children that the carer can privately foster, or requiring that particular safety measures are taken in the home.

Raising Awareness

24. Section (7A) of Schedule 8 to the Children Act 1989, inserted by section 44 of the Children Act 2004, places a duty on local authorities to promote public awareness, in their area, of the notification requirements. Local authorities need to develop a programme of communication activities, including local authority staff, and arrange and distribute up to date publicity materials. They also need to make available information on the notification requirements which reflect the requirements of Schedule 1 to the Children (Private Arrangements for Fostering) Regulations 2005.
25. Local Authorities, when undertaking awareness-raising activities, should involve other agencies, such as schools and GPS surgeries, so as to enable professionals in turn to encourage private foster carers and parents to notify the local authority. Other agencies need also to be aware that failure by a private foster carer or parent to notify a local authority of a private fostering arrangement is an offence, and if local authorities are not aware of such arrangements they cannot carry out their duty to satisfy themselves that the welfare of the children concerned is being satisfactorily safeguarded and promoted.
26. Education, health and other professionals should notify the local authority of a private fostering arrangement that comes to their attention, where they are not satisfied that the local authority have been, or will be, notified of the arrangement, so that the local authority can then discharge its duty to satisfy itself that the welfare of the privately fostered child concerned is satisfactorily safeguarded and promoted. This is, of course, a matter of good practice.

  5.33 Radicalisation                                                                                  

SCOPE OF THIS CHAPTER

The guidance provides advice on how to manage and respond to concerns of children and young people identified as being vulnerable to and affected by the radicalisation of others.

RELATED NATIONAL GUIDANCE

Channel: Protectinq vulnerable people from beinq drawn into terrorism 2015

Prevent Duty Guidance

DfE Prevent Duty Guidance

Association of Directors of Children's Services — Resources Educate Aqainst Hate website (HM Government)

Advice For Local Authorities — Safequardinq Children Returning To The UK

From Syria (Home Office)

AMENDMENT

In November 2017, a link was added to Advice For Local Authorities — Safeguarding Children Returning To The UK From Syria (Home Office) in the Related National Guidance section.

Contents

Introduction

National Guidance and Strategies

         Understanding and Recognising Risks          and    Vulnerabilities    of

Radicalisation

Channel: Referral and Intervention Processes

Local and National Support

Introduction

1. Terrorism under the Terrorism Act 2000 is defined as action that endangers or causes serious violence to a person, causes serious damage to property, or seriously interferes or disrupts an electronic system. The use or threat of terrorism must be designed to influence the government or to intimidate the public and is made for the purpose of advancing a political, religious or ideological cause;
2. Extremism is defined in the 2011 Prevent Strategy as vocal or active opposition to fundamental British values, including democracy, the rule of law, individual liberty and mutual respect and tolerance of different faiths and beliefs. The definition also includes calls for the death of members of British armed forces, whether in this country or overseas. Extremism can be by violent or non-violent means;
3. Radicalisation is defined as the process by which people come to support terrorism and extremism and, in some cases, to then participate in terrorist groups;
4. There is no obvious profile of a person likely to become involved in extremism or a single indicator of when a person might move to adopt violence in support of extremist ideas. The process of radicalisation is different for every individual and can take place over an extended period or within a very short time frame;
5. Safeguarding in this context is the process of protecting vulnerable children and young people, whether from crime, other forms of abuse or being drawn into terrorism or extremism;

National Guidance and Strategies

6. In March 2015, the Government published the Prevent Duty Guidance on the duties within the Counter Terrorism & Security Act 2015. The Act places a duty on various specified authorities that all have an important role in Prevent delivery. The specified authorities include local authorities, education providers (across all ages), health sector, Police, and prison and probation services amongst others;

7 The new legislation builds upon the Prevent Strategy 2011, which aims to reduce the threat to the UK from terrorism by stopping people becoming terrorists or supporting terrorists, and has three specific strategic objectives:

• Respond to the IDELOGICAL challenge and the threat faced by the UK from those who promote extremism and seek to radicalise people;
• Prevent INDIVIDUALS from being radicalised and drawn into terrorism to ensure they are given the appropriate advice and support; and
• Work with sectors and INSTITUTIONS where there are risks of radicalisation that need to be addressed.

8. These strategic objectives have become known as the three I's. The Counter Terrorism & Security Act 2015 requires that all specified agencies (including through their commissioned services and services they have licensing or health and safety responsibilities for) will work in partnership to deter, disrupt and prosecute. In the context of safeguarding, to use the powers under the Children Act 1989 and Children Act 2004 to safeguard and protect children who may be being radicalised, involved in extremism or terrorism.
9. Channel: Protecting vulnerable people from_beinq drawn into terrorism: A quide for local partnerships was published by HM Government in October 2012 and updated in 2015. The Channel programme is an initiative led by the Police and partners, which operates to provide support to people at risk of being drawn into extremism;
10. The Channel Guidance identifies a multi-agency approach to protect vulnerable people by:
    • Identifying individuals at risk;
    • Assessing the nature and extent of that risk; and
    • Developing the most appropriate support plan for the individuals concemed.

Understanding and Recognising Risks and Vulnerabilities of Terrorism or Extremism

11. Children and young people can be drawn into terrorism or they can be exposed to the messages of extremist groups by many means. Children and young people are vulnerable to exposure to, or involvement with, groups or individuals who advocate terrorism as a means to a political or ideological end. Examples of extremist causes where individuals or groups have used violence or nonviolent means to achieve their ends include animal rights, the far right, environmentalists, domestic, single issue activists and international terrorist organisations;
12. These can include through the influence of family members or friends and/or direct contact with extremist groups and organisations or, increasingly, through the internet (see Online Safeguardinq Procedure and How Social Media is Used to Encourage Travel to Syria and Iraq (DfE / Home Office)) This can put a child or young person at risk of being drawn into criminal activity and has the potential to cause Significant Harm;
13. Most individuals, even those who hold radical views, do not become involved in extremism. Numerous factors can contribute to and influence the range of behaviours that are defined as extremism. It is important to consider these factors in order to develop an understanding of the issue. It is also necessary to understand those factors that build resilience and protect individuals from engaging in extremist activity;
14. It is important to be cautious in assessing these factors to avoid inappropriately labeling or stigmatising individuals because they possess a characteristic or fit a specific profile;
15. It is vital that all professionals who have contact with vulnerable individuals are able to recognise those vulnerabilities and help to increase safe choices;
16. It is necessary to remember that extremist behaviour operates on many levels in the absence of protective factors and that individuals largely act within the context of their environment and experiences;
17. Research shows that indicators of vulnerability can include:
    • Identity Crisis - Distance from cultural / religious heritage and uncomfortable with their place in the society around them;
    • Personal Crisis - Family tensions; sense of isolation; adolescence; low self-esteem; disassociating from existing friendship group and becoming involved with a new and different group of friends; searching for answers to questions about identity, faith and belonging;
    • Personal Circumstances - Migration; local community tensions; events affecting country or region of origin; alienation from British values; having a sense of grievance that is triggered by personal experience of racism or discrimination or aspects of Government policy;
    • Unmet Aspirations - Perceptions of injustice; feeling of failure; rejection of civic life;
    • Criminality Experiences of imprisonment; poor resettlement / reintegration; previous involvement with criminal groups.
18. However, this list is not exhaustive, nor does it mean that all young people experiencing the above are at risk of exploitation for the purposes of extremism — individuals may show some, all or none of the vulnerabilities;
19. The process of radicalisation is different for every individual and can take place over an extended period or within a very short time frame. Given this, it is important that awareness, sensitivity and expertise are developed within all contexts to recognise signs and indications of radicalisation;
20. The risk of radicalisation is the product of a number of factors and identifying this risk requires that staff exercise their professional judgement, seeking further advice as necessary. It may be combined with other vulnerabilities or may be the only risk identified. This can put a young person at risk of being drawn into criminal activity and has the potential to cause Significant Harm;

21 Potential indicators identified by the Channel Guidance include:

 Use of inappropriate language;

 Possession or accessing violent extremist literature;

 Behavioural changes;

 The expression of extremist views;

 Advocating violent actions and means;

 Association with known extremists;

 Articulating support for violent extremist causes or leaders;

 Using extremist views to explain personal disadvantage;

 Joining or seeking to join extremist organisations;

 Seeking to recruit others to an extremist ideology.

22.Annex C of the Channel Duty Guidance 2015 provides the Vulnerability Assessment Framework that Channel Panels will use to guide decision making. It is also a useful tool for agencies to use to guide their assessment and referral decision making processes;

23. No research has identified a definitive list of indicators which would show that someone is vulnerable to radicalisation to violent extremism. Rather, the risk of radicalisation is the product of a number of factors and identifying this risk requires that staff exercise their professional judgement, seeking further advice as necessary;
24. Some children may be at risk due to living with or being in direct contact with known extremists or individuals suspected to be involved in the radicalisation process. Such children may be identified by the Police or through MAPPA processes (See Processes for Manaqinq Risk Procedure) or by all agencies through the allegations against people who work with children processes (LADO);
25. Should it come to a worker's attention that an individual has been arrested for terrorism, extremism or radicalisation offences, the worker should consider with their agency's safeguarding lead whether safeguarding measures need to be taken in respect of the family members and connected / influenced individuals of the arrested individual. The Chair of the Channel Panel and Police Channel Co-ordinators will be able to advise on these matters and on wider safeguarding measures (emergency protection or Police protection orders) to reduce vulnerability.

Channel: Referral and Intervention Processes

26. Like child protection,Channel is a multi-agency safeguarding programme run in every local authority in England and Wales. It works to support vulnerable people from being drawn into terrorism and provides a range of support such as mentoring, counselling, assistance with employment etc. Channel is about early intervention to protect vulnerable people from being drawn into committing terrorist-related activity and addresses all types of extremism.
27. Participation in Channel is voluntary. It is up to an individual, or their parents for children aged 17 and under, to decide whether to take up the support it offers. Channel does not lead to a criminal record.
28. Staff working with children should use the model below to assist them in identifying and responding to concerns about children who may be vulnerable to radicalisation or being drawn into extremist activity;
29. Early identification of concerns should resuft in responses being made through Universal provision (Tier 1) or through targeted interventions (Tier 2). Diagram 1 below, Appropriate, proportionate responses and interventions gives examples of appropriate and proportionate responses at each tier. The headings for the examples follow the four aspects of the Learning together to be safe Toolkit and further guidance and activities can be found in the Learning Together to be Safe Workbook;
30. In a few cases, an individual may move beyond being vulnerable to extremism to involvement or potential involvement in supporting or following extremist behaviour. Where this is identified as a potential risk, further investigation by the Police will be required, prior to other assessments and interventions;
31. Any member of staff who identifies such concerns, for example as a result of observed behaviour or reports of conversations to suggest the child supports terrorism and/or extremism, must report these concerns to the named or designated safeguarding professional in their organisation or agency, who will consider what further action is required;
32. The Channel Referral process outlined below (diagram 2) should be used to guide the named or designated safeguarding professional in making the
33. Some children who are at risk of being drawn into extremist activity may pose a risk to others. There must not be a conflict between the welfare needs of the child/young person perpetrator and the victim; agencies have a duty to safeguard both. Many perpetrators/abusers are in need of care and protection themselves; however, they must also be held accountable for their own actions;
34. The named or designated safeguarding professional should consider whether a situation may be so serious that an emergency response is required. Staff should exercise professional judgement and common sense to identify whether an emergency situation applies; examples in relation to violent extremism are expected to be very rare but would apply when there is information that a violent act / life threatening act is imminent or where weapons or other materials may be in the possession of a young person, another member of their family or within the community or imminent to travel to a conflict zone. In this situation, a 999 call should be made.
35. The Pan-Lancashire Channel Panel Chair is Paul Lee, Head of Operations and Safeguarding (Blackburn with Darwen Borough Council). Meetings are held on a monthly basis. If you have any concerns about someone and would like more advice ring 101/999 urgent, not then email concern@Iancashire.pnn.PoIice.uk. Any information, advice or concern will be handled with sensitivity and where possible anonymity will be maintained. Referrals can be made directly to the email inbox by any individual or organisation and will be dealt with discretion.
36. Reporting online material, which promotes extremism such as illegal or harmful pictures or videos, can be done through the government website (Report online materjd.promotinq terrorism or extremism (GOV.UK)). Although professionals should follow the Makinq a Referral to Children's Social Care Procedure, non professionals may make a report anonymously.

Diagram 1 : Appropriate, Proportionate Responses and Interventions

Click here to view Diagram 1: Appropriate, Proportionate Responses and Interventions.

Diagram 2: Channel Referral Process

Click here to view Diagram 2: Channel Referral Process.

36. Some concerns which are identified may have a security dimension to them. For this reason, it is important that liaison with the Police forms an early part of all investigations;

37 The named or designated safeguarding professional, in discussion with other professionals (including the local Police Prevent team) as appropriate, will need

to determine the most appropriate level and type of support to offer the child and their family:

• Tier 1 - Universal Responses and Support- Wherever possible the response should be appropriately and proportionately provided from within the normal range of universal provision of the organisation working with other local agencies and partners. Responses could include curriculum provision, additional tutoring or mentoring, additional activities within and out of school, family support;
• Tier 2 - Targeted Responses and Support- Where a higher level of targeted and multi-agency response is indicated a formal multi-agency assessment should be conducted. The Common Assessment Framework (CAF) may be used with parents/carers' agreement. Support may come from several agencies and be co-ordinated via Team Around the Child (TAC) meetings. A formal plan, based on the level of need either a CAF or Child in Need Plan should be completed and a lead person nominated (for CIN Plans the lead will be a social worker);
• Tier 3 - Specialist Support- Where a child is thought to be at risk of significant harm, and/or where investigations need to be carried out (even though parental consent is withheld) a referral to Social Care should be made. However, it should be recognised that concerns of this nature in relation to extremism are most likely to require a Police investigation (as part of Pursue) in the first instance. The multi-agency assessment will involve the Police in the making of decisions about the appropriate response. All cases at this level will be reported to Social Care who would monitor all referrals and make regular reports to the Children's Safeguarding Assurance Partnership.

38. For all types of response, where services and agencies are referring directly to specialist services commissioned through 'Prevent' initiatives, rather than through the Channel Panel, it is important to notify the local Prevent Coordinator of this referral;
39. For all types of response, a clear plan must be developed and documented to set out how the needs of the child will be met, and who will have responsibility for doing this. Early discussion with either the Prevent Coordinator or officers in the local Prevent team will allow the designated safeguarding professional to decide if a referral to the Channel Panel is required, or if services at tier 1 or 2 are sufficient to manage any risks. The plan will include agreed arrangements for review of progress;

40.A discussion with the local Prevent team will advise how the referral can be made;

41 . The Channel Panel will discuss each new referral to determine where multiagency response, co-ordination and review are beneficial. Also at each meeting, all Channel Panel cases will be reviewed to determine if services are effective in safeguarding the child or young person and reducing the risks of radicalisation and extremism. All services, provided at any tier, will have a responsibility to the Channel Panel to regularly report on progress being made.

The local Prevent team on behalf of the Channel Panel chair will co-ordinate responses and attendance to the Channel Panel;

42. Reviews must be carried out at the agreed intervals, or sooner if a change in circumstances indicates this is appropriate. All reviews should be documented appropriately and records retained by services and agencies working with the child or young person. Where a child is being provided services through CAF, CIN, CPP or LAC processes, the review by the Channel Panel will report into the relevant multi-agency processes;
43. Unless it is deemed appropriate to end the agreed response, each review meeting should agree dates of further reviews, along with the person responsible for convening the review meeting and the people who should be involved in this;
44. All those involved with the child or young person should continue to monitor the situation, and consider modifying the response if circumstances change. If the risk is perceived to diminish, it may be appropriate to end the response. However, if the risk is perceived to increase, an escalation of the response may be required and may take the case outside of the 'Prevent' strand of the CONTEST strategy;
45. Where the Channel Panel response ends it may be that the child or young person still has outstanding needs being met through CAF, CIN, CPP or YOT processes. These processes should continue to be reviewed until all needs are met. Every case from the Channel Panel that has ended will be reviewed 6-12 months after exiting the process to ensure there are no new risks or intelligence that require a response. Where new risks or intelligence suggest a repeat of concerns the assessment process can be restarted at any point. Agencies where they become aware of new or repeat risks should not wait for the 6-12 month review, and must discuss the concerns immediately with their local Prevent team. The outcome of Channel Panel reviews will be shared with lead professionals in CAF, CIN, CPP & LAC processes.

Local and National Support

If you are concerned about the safety or welfare of a child please contact:

Blackburn with Darwen Children's Social Care

Lancashire Children's Social Care

Blackpool Children's Social Care Social Work Team

For Strategic or Policy Support or advice contact Blackburn with Darwen or Burnley Prevent Co-ordinators:

Medina Patel

Prevent Co-ordinator

Community Safety Team

Blackburn with Darwen Borough Council

Environment, Housing & Neighbourhoods

3rd Floor, Old Town Hall

Blackburn

BBI 7DY

Tel: 01254 585 263

Email: Medina.Patel(Oblackburn.qov.uk

Rob Grigorjevs

Programme & Projects Co-ordinator

Burnley Borough Council

Burnley Town Hall

Manchester Road

Burnley

Lancashire

BB11 9SA

Tel: 01282 477112

Mobile: 07854 784 611

For non urgent safeguarding concerns around terrorism, extremism and radicalisation, email the Police Channel Team on concern@Iancashire.pnn.Police.uk.

Duty Desk: 01772 412 742 (8am to 6pm weekdays).

Out of Hours: Contact Police on 101 or 999 — ask that the Duty Inspector and Force Incident Manager are made aware and make necessary contact with CounterTerrorism Branch.

For advice and arrangements for training: Prevent Teams can be contacted on:

     East Lancashire (BwD, Burnley, Pendle etc) — 01254 353 541 ;

, West/South/North Lancashire (Blackpool, Lancaster, Chorley etc) — 01772 209

733;

     National Prevent Training can be accessed at the E-LearninA_Traininq on Prevent website (Uome Office);

     National E-learning on the Channel Panel can be accessed at the Channel General Awareness website.

5.34 Religious Beliefs and Linked Abuse                                                 

RELATED NATIONAL GUIDANCE AND INFORMATION

Working Together to Safeguard Children

Research Report RR750 by Eleanor Stobart: Child Abuse Linked to Accusations of Possession and Witchcraft, (2006)

Safeguarding Children from Abuse Linked to a Belief in Spirit Possession, DCSF (2007).

 

Further contacts for advice can be found from the local representatives for some faiths from organisations such as the Churches Child Protection Advisory Service (CCPAS) who provide information about exorcism; Churches Together in England and the the Muslim Parliament of Great Britain, all of whom are consulting about and developing guidance.

RELATED CHAPTERS

Complex (Organised or Multiple) Abuse Procedure

Community, Voluntary and Faith Sector Procedure

AMENDMENT

In November 2013, links were added to: Part 3 of this manual for Managing Individual

Cases where there are Concerns about a Child's Safety and Welfare, Community, Voluntary and Faith Sector Procedure and Working Together to Safeguard Children.

Contents

Key Considerations

Definitions and Incidence

Forms of Abuse

Why are Children Abused or Neglected in this Way?

Assessment

Action to Safeguard

Services to Support Children

Concerns about a Place of Worship

Key Considerations

1. The following points can assist in understanding the issues and actions to safeguard children from, abuse or neglect linked to a belief in spirit possession are:

• Child abuse is never acceptable in any community, in any culture, in any religion, under any circumstances. This includes abuse that might arise through a belief in spirit possession or other spiritual or religious beliefs;
• Everyone working with or in contact with children has a responsibility to recognise and know how to act on evidence, concerns, and signs that a child's health, development and safety is or may be being impaired, especially when they suffer or are at risk of Significant Harm;
• Standard child safeguarding procedures apply and must always be followed in all cases where abuse or neglect is suspected including those that may be related to a belief in spirit possession. Children suffering or at risk of suffering from such abuse or neglect will be identified and appropriately safeguarded if statutory procedures are implemented correctly. Anyone with concerns that a child may have suffered, or is likely to suffer Significant Harm should follow the procedures in Part 3 of this manual for Managing Individual Cases where there are concerns about a child's safety and welfare;
• Child abuse linked to a belief in spirit possession sometimes stems from a child being used as a scapegoat. Whilst specific beliefs, practices, terms or forms of abuse may exist, the underlying reasons for the abuse are often similar to other contexts in which children become at risk of poor outcomes due to factors such as family stress, deprivation, domestic violence, substance abuse and or mental health problems. In addition, children who are different in some way, perhaps because they have a disability, an illness, learning needs, or are exceptionally bright, might be targeted in this kind of abuse. In some cases, there will be no obvious difference and the child will have been targeted because they will have been perceived to be 'spiritually' different;
• The number of identified cases of such abuse is small but where it does occur the impact on the child is great, causing much distress and the child will be suffering Significant Harm. It is possible that a significantly larger number of cases remain undetected;
• Professionals with safeguarding responsibilities need to be able to identify links, where they exist, between individual cases of such child abuse and individual faith leaders as well as wider belief, faith or community practices. Where connections are identified and appropriate action is taken, the risk that other children will be similarly abused can be greatly reduced. In some cases, links to a belief in possession may not come to light until some way into the investigation of abuse. Where the concerns relate to a number of children, consideration should be given to whether the Complex (Organised and Multiple) Abuse Procedure should be implemented;
• Local agencies and institutions should also work to minimise risk of harm, by building trust and understanding of child abuse issues with local communities. Robust local partnerships advance early identification and safeguarding of children. Local agencies and institutions share responsibility for safeguarding and promoting the welfare of children and young people. They should act if they have concerns about a child's welfare, and ensure that practices that lead to abuse that may be linked to a belief in spirit possession or any other belief, are challenged and stopped;
• People working with children should always take advice whenever they feel it is required, in accordance with information sharing protocols and guidance. The fact that a suspected case of abuse or neglect may be linked to spirit possession can initially seem daunting. It is important to use the experience of colleagues, including those in other services, to overcome misgivings and understand complexities. A child's safety and welfare must always come first.

Definitions and Incidence

2. The term 'belief in spirit possession' is defined for the purposes of this guidance as the belief that an evil force has entered a child and is controlling him or her. Sometimes the term ^twitch' is used and is defined here as the belief that a child is able to use an evil force to harm others. There is also a range of other language that is connected to such abuse. This includes black magic, kindoki, ndoki, the evil eye, djinns, voodoo, obeah, demons, and child sorcerers. In all these cases, genuine beliefs can be held by families, carers, religious leaders, congregations, and the children themselves that evil forces are at work.
3. Families and children can be deeply worried by the evil that they believe is threatening them, and abuse often occurs when an attempt is made to 'exorcise', or 'deliver' the child. Exorcism is defined here as attempting to expel evil spirits from a child.
4. The number of identified child abuse cases linked to a belief in spirit possession is small especially when compared to the total number of children known to be abused. Research by Stobart (2006) reviewed child abuse cases that had occurred since January 2000. Thirty-eight cases involving 47 children were found to be relevant and sufficiently documented. This is in comparison to 26,400 children on Child Protection Registers in England at 31st March 2006. Indicators reported in the cases usually involve children aged between 2 and 14, both boys and girls, and have generally been reported through schools or non-governmental organisations. Whilst the number of identified cases is small, the nature of the child abuse can be particularly disturbing and the impact on the child is substantial and serious. The abuse may be carried out by the child's parents or carers or others in the family network, as well as by faith leaders.

Forms of Abuse

5. The abuse usually occurs in the household where the child lives. It may also occur in a place of worship where alleged 'diagnosis' and 'exorcism' may take place.
6. The most common forms of abuse include:

• Physical Abuse: in the form of beating, shaking, burning, cutting, stabbing, semi-strangulating, tying up the child, or rubbing chilli peppers or other substances on the child's genitals or eyes, or placing chilli peppers or other substances in the child's mouth;
• Emotional/psychological abuse: in the form of isolation, for example, not allowing a child to eat or share a room with family members or threatening to abandon them, or telling a child they are evil or possessed. The child may also accept the abuse if they are coerced into believing they are possessed;
• Neglect: in the form of failure to ensure appropriate medical care, supervision, regular school attendance, good hygiene, nourishment, clothing or keep the child warm;
• Sexual abuse: children abused in this way may be particularly vulnerable to sexual exploitation, perhaps because they feel powerless and worthless and feel they will not be believed if they tell someone about the abuse.

7. There have been reported cases of individuals who present themselves as faith leaders/healers being paid by parents and carers to 'exorcise' children. The belief that a child is possessed can be supported by faith leaders and the child, and in some cases the family may be ostracised by community members. The child can come to hold the belief that they are possessed and this may be harmful in itself and can significantly complicate their rehabilitation.
8. Where such abuse or neglect is identified, some children are placed in an alternative family, through long-term foster care or adoption, and some are returned to the family home within the framework of a child protection plan.
9. Where abuse exists but is not identified, or there is no intervention to safeguard the child's welfare, children may continue to be severely abused. There are also circumstances where carers or parents believe that a child has passed evil spirits to an unborn child, and professionals will need to be mindful that a prebirth assessment may be required, and that children subsequently born into the household may be vulnerable to harm.

Why are Children Abused or Neglected in this Way?

10. It is not helpful to stereotype those who might abuse or neglect a child because of a belief in spirit possession. A belief in 'spirits' and 'possession' is relatively widespread, whilst abuse linked to such beliefs is rare. This kind of abuse is not confined to particular countries, cultures, religions or communities. Abusers may appear to be quite ordinary and may be family members, family friends, carers, faith leaders or other figures jn the community. There are, however, a number of common factors that put a child at risk of harm:

o Rationalising misfortune by attributing it to spiritual forces: As in many child abuse cases, abuse linked to a belief in spirit possession generally occurs when problems within a family or in their broader circumstances exist. In these particular cases a spiritual explanation is sought in order

to rationalise misfortune. Child abuse can occur when rationalisation takes the form of believing oneself to be cursed and that a child is the source of the problem because they have become possessed by evil spirits;

 A child is scapegoated because of an obvious or perceived difference: The reason why a particular child is singled out and accused of being possessed is complex. It often results from a combination of a weak bond of affection between a child and parent or carer, a belief that the child is violating family norms and above all a perception that the child is 'different ^I . It may be that the child is being cared for by adults who are not the parents, and who do not have the same affection for the child as their own children. A child can also be viewed as being different for disobedience, rebelliousness, over independence, bedwetting, nightmares, illness, perceived or actual physical abnormality or a disability. Disabilities involved in documented cases included learning disabilities, mental health, epilepsy, autism, a stammer and deafness. Many of the children were also described by their families or carers as being naughty. In other cases there were no obvious reasons, but a perceived issue;

 Belief in evil spirits: In the cases identified by Stobart's (2006) research (see Child Abuse Linked to Accusations of Possession and Witchcraft), every child had an accusation of 'evil' made against him or her. This was commonly accompanied by a belief that they could 'infect' others with such 'evil'. The explanation for how a child becomes possessed varies widely but includes through food that they have been given or through spirits that have been in contact with them;

 Social factors: A range of social factors that may make a child more vulnerable to accusations of being possessed were also identified by Stobart (2006). These included:

Changes in family structure or dynamics - The research found that children had become more vulnerable following a change in family structure. Carers often had new, transient or several partners. The family structure also tended to be complex so that exact relationships to the child were not immediately apparent. This may mean the child is living with extended family or in a private fostering arrangement. In some cases this may even take on a form of servitude;

A family's disillusionment with life or negative experience of migration - In the majority of identified cases the families were first or second generation migrants to the UK. The research suggested that the families often suffered from the difficulties and stress of migration including isolation from extended family, a sense of not belonging, alienation or feeling threatened or misunderstood, as well as significantly unfulfilled expectations of quality of life;

A parent's or carer's mental health - In over a quarter of identified cases there were concerns for the mental health of a parent or carer. The illnesses involved included post-traumatic stress disorder, depression and schizophrenia.

1 1 . In working to identify such child abuse or neglect it is important to remember every child is different. Some children may display a combination of indicators of abuse whilst others will attempt to conceal them. In addition to the social factors above, there is a range of common features across identified cases. These indicators of abuse, which may also be common features in (other kinds of abuse), include:

• A child's body showing signs or marks, such as bruises or bums, from physical abuse;
• A child becoming noticeably confused, withdrawn, disorientated or isolated and appearing alone amongst other children;
• Deterioration of a child's personal care - for example through a loss of weight, being hungry, turning up to school without food or lunch money, or being unkempt with dirty clothes and even faeces smeared on to them;
• Lack of concem or close bond between the child and his or her parent or carer;
• A child's attendance at school becoming irregular or the child being taken out of school altogether without another school place having been organised, or a deterioration in a child's performance at school;
• A child reporting that they are or have been accused of being 'evil', and/or that they are having the 'devil beaten out of them'.

Assessment

12. Anyone with concerns that a child may have suffered, or is likely to suffer Significant Harm linked to spiritual or religious beliefs should follow the procedures in Part 3 of this manual for Managing Individual Cases where there are Concerns about a Child's Safety and Welfare. The same thresholds for action apply. Professionals who have concerns about a child's welfare should discuss these concerns with their manager or a designated member of staff, or a Named Professional.
13. Whilst there is a need to be culturally sensitive in working with families where there are these concems, it is important to remain mindful that the safety and protection of the child are paramount. In view of the nature of the risks a full medical assessment of the child should be considered to establish the overall health of the child, the medical history and the current circumstances.
14. Abuse linked to a belief in spirit possession can be hard for professionals to accept and it may be difficult to understand what they are dealing with - it can often take a number of visits to recognise such abuse.
15. In cases of suspected abuse linked to a belief in spirit possession it may be particularly useful to consider the following:

 How do I understand the particular risk of harm to the child?

The completion of a Common Assessment Framework assessment may provide a helpful way of gathering and summarising information about a child so as to clarify whether there is a safeguarding concern or whether other action to assist the child should be undertaken.

 How do I build a relationship of trust with the child?

Children and young people will usually stick to their account and not speak until they feel comfortable. It will be important to spend time with the child alone and build a relationship of trust. It is important to ascertain the child's wishes and feelings and understand the environment in which the child lives;

The child must be seen and spoken to on his/her own. Their bedroom or sleeping arrangements must be inspected.

 What are the beliefs of the family?

 Beliefs in spirits and possession are widespread. The key feature in cases of abuse is not the beliefs of a family, but that the perpetrator of abuse uses these beliefs as a justification for abuse of a child;

You should seek advice if you are dealing with a culture or set of beliefs that you do not understand, or which are unfamiliar to you. Professionals need to have an understanding of religious beliefs and cultural practices in order to help gain the trust of the family or community. The use of correct terminology will help to build up trust with the child and family. Asking questions or seeking advice about a culture, religion, or set of beliefs you are not familiar with.

 What is the family structure?

In cases of abuse linked to a belief in possession, the relationship between the child and their carer may be unclear. These cases of abuse will sometimes relate to the arrival of a new adult into the household, or the arrival of the child, perhaps from abroad. What are the roles of the adults in the household? Who looks after the child? Is the child being privately fostered? If the child has recently arrived, what was their care structure in their country of origin? What is the immigration status of the child? The identities and relationships of all members of the household should be identified, including with documentation. It may be appropriate to consider DNA testing.

    Are there reasons why the child might be picked on?

Are they different from other children in the family or community? Are they disabled? Have their parents been labelled as possessed?

    Do I need a professional interpreter? What is the preferred language of the child and family?

There may be a need for neutral, high quality, gender-appropriate translation or interpretation services. Children should never be expected to interpret on behalf of adults or other family members. If working with a very small community, what is the relationship between interpreter and the family? Are they part of the same social network?

Action to Safeguard

16. In order to safeguard and promote the welfare of the child in these cases it may be particularly useful to consider:
    • What pressures are the family under?

 Is there anything you can do to address relevant pressures on the family? These cases of abuse will sometimes relate to blaming the child for something that has gone wrong in the family;

• Involve the family: A belief that the child is possessed may mean they are stigmatised in their family. Do members of the family have the same views about the situation? If the child has been labelled as possessed, how does this affect their relationship with others in the extended family and community?
• Is the perpetrator of abuse isolated?
• The perpetrator may believe that they are doing what they should to rid the child of evil spirits and might even believe that they are not harming the child.
• Are these beliefs supported by others in the family or in the community?
• Would it help to involve a senior faith leader?

17. Any evidence that the parent or carers will take the child out of the country/abandon the child must be taken seriously.

o Anyone with concerns that a child may have suffered, or is likely to suffer Significant Harm linked to spiritual or religious beliefs should follow the procedures in Part 3 of this manual for Managing Individual Cases where there are Concerns about a Child's Safety and Welfare.

Services to Support Children

18. Abuse of a child linked to a belief in possession can take the form of physical, emotional or sexual abuse and neglect. In some cases the abuse can be very severe and there may be a substantial psychological impact on the child, particularly if they are ostracised by the family or community or if they themselves believe that they are possessed.
19. The services that a child needs will depend on their individual circumstances but services that may be particularly relevant to such abuse include:
    • Children's Social Care, including a placement away from home in foster care, residential care, or adoption;
    • Child and Adolescent Mental Health Services (CAMHS): it may also be appropriate to engage adult mental health services to assess and where appropriate work with the perpetrator of abuse and/or child's parents or carers; o Health services, especially for victims of severe abuse or neglect;
    • Faith groups, the family's faith community may need advice from Children's Social Care. They may be able to help a family understand how to treat their child and offer support to the child or family to help promote the welfare of the child. However, care should be taken to establish whether the faith group that the victim's parents or carers are affiliated to support the practice of abusive exorcism. Social workers may also want to seek advice from faith groups to aid their understanding of reasons behind any abuse; o Wider family support services from the statutory and voluntary sector;
    • A multi-agency response: There will be a variety of different agencies in the community involved with children and their development. Professionals should be aware of the services that are available locally to support the child and how to gain access to them;
    • The Police: Where a social worker believes that a criminal offence may have been committed, they or their manager should discuss the child with the Police at the earliest opportunity;
    • Schools: Schools may identify concerns about children. Where a child of school age is the subject of a child protection plan the school should be involved in the preparation of the plan, and where appropriate in its delivery.

Concerns about a Place of Worship

20. Concerns about a place of worship may emerge where:
    • A lack of priority is given to the protection of children and there is a reluctance by some leaders to get to grips with the challenges of implementing sound safeguarding policies or practices;
    • Assumptions exist that 'people in our community' would not abuse children or that a display of repentance for an act of abuse is seen to mean that an adult no longer poses a risk of harm;
    • There is a denial or minimisation of the rights of the child or the demonization of individuals; o There is a promotion of mistrust of secular authorities; o There are specific unacceptable practices that amount to abuse.

21 . Services should consider how best to tackle the concerns, whether intervention is needed to safeguard children and whether concerns can be addressed through influence and engagement.

5.35 Safeguarding Children and Young People in the Youth Justice System

RELATED GUIDANCE

For additional information please see:

Pan-Lancashire Procedure for Children and Young People Who Display Sexually Harmful Behaviour

Mental Health and Behaviour in Schools (DfE)

Contents

Legal Requirements

Actions to Safeguard Children of Prisoners

Legal Requirements

1. The Children Act 1989 applies to children and young people in the secure estate and the local authority continues to have responsibilities towards them in the same way as they do for other Children in Need. The Safeguarding Children Partnership will have oversight of the safeguarding arrangements within secure settings in their area;
2. The Youth Justice Board (YJB) has a statutory responsibility for the commissioning and purchasing of all secure accommodation for children and young people who are sentenced or remanded by the courts. It does not deliver services directly to young people but is responsible for setting standards for the delivery of those services;
3. There are three types of secure accommodation in which a young person can be placed, which together make up the secure estate for children and young people:
   • Young Offender Institutions (YOI's) - YOI's are facilities run by both the Prison Service and the private sector and accommodate 15- to 1 7-yearolds. Young people serving Detention and Training Orders can be accommodated beyond the age of 17 subject to child protection considerations. The majority of YO's accommodate male young people, although there are four dedicated female units;
   • Secure Training Centres (STC's) - STC's are purpose-built centres for young offenders up to the age of 17. STC's can accommodate both male and female young people who are held separately. They are run by private operators under contracts, which set out detailed operational requirements. There are four STC's in England;
   • Secure Children's Homes (SCH's) - Most SCH's are run by local authority children'social care. They can also be run by private or voluntary organisations. They accommodate children and young people who are placed there on a secure welfare order for the protection of themselves or others, and for those placed under criminal justice legislation. SCI-I's are generally used to accommodate young offenders aged 12 to 14, girls up to the age of 16, and 15 to 16-year-old boys who are assessed as vulnerable.

4. All these establishments have a duty to effectively safeguard and promote the welfare of children and young people, which should include:

o Protection of harm from self; o Protection of harm from adults; and o Protection of harm from peers.

5. Local authorities, Safeguarding Children Partnerships, YOT's and secure establishments should have agreed protocols setting out how they will work together and share information to safeguard and promote the welfare of children and young people in secure establishments.
6. All members of staff working in secure establishments have a duty to promote the welfare of children and young people and ensure that they are safeguarded effectively. In addition, Governors, Directors and senior managers have a duty to ensure that appropriate procedures are in place to enable them to fulfil their safeguarding responsibilities. These procedures should include, but not be limited to, arrangements to respond to:

o Child protection allegations; o Incidents of self-harm and suicide; and o Incidents of violence and bullying.

7. All staff working within secure establishments should understand their individual safeguarding responsibilities and should receive appropriate training to enable them to fulfil these duties. Appropriate recruitment and selection processes should be in place to ensure staffs suitability to work with children and young people. These procedures should cover any adult working within the establishment, whether or not they are directly employed by the Governor/Director.

Actions to Safeguard

8. If a child in custody in an establishment in the region makes allegations about abuse that happened before they entered the custodial establishment, or it becomes clear that they may be at risk of Siqnificant Harm on leaving the establishment, a referral should be made to Makinq @Referral to Children's Social Care Procedure.
9. Children's Social Care will:
   • Co-ordinate an Assessment;
   • Convene, if required a Strategy Discussion to consider whether to initiate a Section 47 Enquiry; and
   • Liaise with any other Local Authority in whose area the child was living or will be living, or where the abuse is alleged to have taken place, where appropriate.

10. The Manager of the Record of Children subject to a Child Protection Plan should be notified of any serious incidents or if a child dies in custody in an establishment in the region. If the child was ordinarily resident in the region, the Serious Case Review Panel will then consider whether to commission a Serious Case Review - see the Serious Case Reviews Procedure.

Children of Prisoners

Where there is concern for the welfare of a prisoner's child within a custodial establishment, the procedures in Part 3, Managing Individual Cases where there are concerns for the welfare and safety of a child, will apply (see Making a Referral to Children's Social Care Procedure).

5.36 Safeguarding Guidance for Early Years Settings

RELATED GUIDANCE

Statutory framework for the early years foundation stage, Setting the standards for learning, development and care for children from birth to five

Contents

Introduction

Principles

Designated Lead Practitioner for Safeguarding

Procedures — Significant Harm — Immediate Harm

Injuries

Where a Staff Member Believes a Parents/Carer May be Under the Influence of Alcohol or Drugs

Prevent Duty

Confidentiality

Managing Allegations Against Members of Staff or Volunteers

Recommended Documentation

Introduction

This chapter provides guidance for Early Years settings to support them in their statutory duty to 'take all necessary steps to keep children safe'. This guidance should be used alongside the setting's own safeguarding and child protection policies and procedures and national guidance 'Working Together to Safeguard Children', What to do if you're worried a child is being abused - GOV.UK, and the Prevent Duty 2015.

The purpose of this guidance is to make sure that the actions of any adult in the context of the work carried out by Early Years settings are transparent and safeguard and promote the welfare of all young people.

Early Years registered providers are responsible for ensuring that their staff are competent and confident in carrying out their responsibilities for safeguarding and promoting children's welfare.

Principles

This guidance is underpinned by two key principles:

Safeguarding is everyone's responsibility: for services to be effective each professional and organisation should play their full part; and

A child-centred approach: for services to be effective they should be based on a clear understanding of the needs and views of children.

Designated Lead Practitioner for Safeguarding

The EYFS requires that:

"A practitioner must be designated to take lead responsibility for safeguarding children in every setting. Childminders must take the lead responsibility themselves. The lead practitioner is responsible for liaison with local statutory children's services agencies, and with the LSCP. They must provide support, advice and guidance to any other staff on an ongoing basis, and on any specific safeguarding issue as required."

It is important that all members of staff and any volunteers know who this designated practitioner is, and also what to do if that person is not available when an urgent safeguarding concern arises.

The Role and Responsibilities of the designated lead practitioner are:

To ensure all staff and volunteers are aware of what they should do and who they should go to if they are concerned that a child/young person may be subject to any form of abuse;

To ensure any concerns about a child/young person are acted on promptly, clearly recorded, referred on where necessary and, followed up to ensure the issues are addressed;

To record any reported incidents in relation to a child/young person or breach of Child Protection policies and procedures. This must be kept in a secure place and its contents must be confidential;

To ensure any concerns about the actions of any member of staff, volunteer, or person living or working on the premises are acted on promptly, clearly recorded, referred on where necessary and followed up to ensure the issues are addressed;

     To liaise with the Registered Provider and ensure they are fully aware of any serious concerns within the setting;

To ensure information is shared when necessary, in line with Working Together to Safeguard Children guidance, and that information and records are passed on to the appropriate person if the child transfers to another setting or school.

Procedures — Significant Harm — Immediate Harm

Any member of staff who believes that a child may be suffering, or is likely to be at risk of suffering, significant harm, including sexual, physical or emotional abuse or neglect, must make a referral to the Children's Social Care Duty and Assessment Team as follows:

1. Discuss your concerns immediately with the designated lead practitioner;
2. Designated lead practitioner should advise whether parents/carers should be informed/consulted in the first instance or whether this would place the child at further risk;
3. Referrals must be made in accordance with Making Referral to Children's Social Care Procedure;
4. A safeguarding record should be opened by the designated lead practitioner and an initial cause for concern form completed. A copy of the referral should also be kept, and details of any discussion with parents should be logged and included. A date to review the cause for concern should be made and recorded on the initial cause for concern form. Any subsequent incidents or concerns should be recorded on an incident report and social care should be updated as necessary. Brief details should be added to a chronology sheet which should be kept at the front of the file.

NO ATTEMPT SHOULD BE MADE BY STAFF TO CONDUCT AN INVESTIGATION INTO CASES OF SUSPECTED ABUSE. NO CHILD SHOULD BE TOUCHED OR EXAMINED. Social Care and the Police are responsible for undertaking investigations. Inappropriate actions by others may negate or contaminate evidence.

Key points when making a referral:

     Parents should be alerted of your intention to inform the Children's Social Care Duty and Assessment Team, unless you feel this would put the child at further risk;

When speaking to the Children's Social Care, give your name and your role within the setting; (HAVE THE CHILD'S PERSONAL RECORD WITH YOU AND THE RECORD OF THE CONCERN);

Explain your concerns, giving as much information as possible. It may be difficult at the time but try to give clear, concise and accurate information based on your professional judgement. The Social Care Worker will discuss with you any concerns you have about your immediate course of action. For example, if you are caring for a child and the parent is due to collect them;

Obtain and record the name and role of person who you have spoke along with the date and time the telephone call was made;

Ensure all information is recorded accurately and in a timely manner.

Advice

If you are unsure about your referral and wish to have a discussion, you can contact Children's Social Care for advice, you may be put through to one of the Advanced Practitioners or a Social Work Assistant.

Making a referral when the child already has a Social Worker:

If the child you have concerns about already has a Social Worker, telephone them directly. If the Social Worker is unavailable escalate your concerns to a Manager;

Please note: it is not appropriate just to email the social worker in these cases; contact must be made with the social worker/duty worker/team manager by telephone on the same day;

The Social Care Worker will assess the situation and, if required, initiate the appropriate procedures to protect the child. The designated lead practitioner will need to co-ordinate any further action the setting is required to take by the social worker, this may involve gathering information and discussions with other team members;

A record of any discussions and/or actions should be added to the child's safeguarding file;

As with all significant events staff should ensure the chronology at the front of the file is completed.

Professional Disagreements

If the designated lead practitioner has a concern regarding the advice given or action taken once they have referred to Social Care they should follow the Resolving Professional Disagreements (Escalation and Conflict Resolution) Procedure.

Injuries

If a staff member notices a mark or injury on a child they must report the injury to the designated lead practitioner immediately and record that they have done so. Staff should use a body / face map to record the details of an injury/mark, and be as specific as possible about size, shape, location and colouration of any mark or injury.

If a staff member notices a mark or injury on a child on arrival at the setting, the staff member should complete an 'Injuries on Arrival Form' (detailing the time the injury was noticed). This should be done with the person who has brought the child to the setting present, the explanation of the injury should be recorded as described, and the form should be signed by the person bringing the child. The staff member should immediately report this to the designated lead practitioner. If a staff member does not notice the mark or injury on arrival but later into the session then they must complete an 'Injuries on Arrival Form' retrospectively (detailing the time the injury was noticed). The staff member should immediately report this to the designated lead practitioner. The injury should be discussed with the parent when they return, explanation recorded and the form signed retrospectively.

If the child with an injury has a Social Worker then the designated lead practitioner must immediately report it to them (by telephone and then followed up in writing). If the Social Worker is unavailable by telephone concerns should be discussed with a duty social worker or a team manager. Please note: it is not appropriate just to email the social worker in these cases; contact must be made with the social worker/duty worker/team manager by telephone, on the same day.

If the child with an injury does not have a Social Worker then the designated lead practitioner would use their professional judgement to assess the situation. This may involve seeking advice from Social Care depending on the nature of the injury and any history of injuries, in most cases however the designated lead practitioner would usually ask the child's Key Worker/Person to speak to the child's parent and ask how the injury occurred. This information given by the parent must be immediately shared with the designated lead practitioner and accurately recorded. The lead practitioner will then assess using their professional judgement if the explanation is plausible and consistent with the children's development level or whether it is a safeguarding issue (if it is safeguarding a cause for concern will be actioned).

When noting explanations from parents/carers regarding injuries staff should record whether a parent/carer volunteered the information on arrival or whether the staff member had to ask for the explanation.

Where a Staff Member Believes a Parents/Carer May be Under the Influence of Alcohol or Drugs

If parent/carer presents at a setting and a member of staff feels the parent/carer maybe under the influence of Alcohol or Drugs staff member should immediately alert the designated lead practitioner. If it is felt that the parent/carer is impaired to such an extent that they are not able to care for the child, and letting the child leave the setting with them would put them at risk, the practitioner should ask if there is another family member who could collect and care for the child. If there is no other suitable and responsible adult available, the setting should contact Children's Social Care, and if necessary to prevent the parent from taking the child, the Police. If the parent/carer is not presenting as impaired, the incident should be recorded and any repeat occurrences should be discussed with the parent, including undertaking an Early Help assessment and signposting to alcohol and substance misuse services where appropriate.

Prevent Duty

See: Radicalisation Procedure.

Section 36 to 41 of the Counter-Terrorism and Security Act 2015 sets out the duty on Local Authorities and partners of local Panels to provide support for people vulnerable to being drawn into terrorism. In England and Wales this duty is the Channel programme. The term "Channel" refers to the duty as set out in the Counter Terrorism and Security Act. Channel is a key aspect of the Prevent strategy which in turn is a fundamental part of the UK Governments Counter Terrorism Strategy (CONTEST).

Channel is a multi-agency approach to protecting people at risk from radicalisation. Channel uses existing collaboration between local authorities and statutory partners to:

Identify individuals at risk of being drawn into terrorism;

Assess the nature and extent of that risk;

Develop the most appropriate support plan for the individuals concerned.

Channel is focused around safeguarding children and adults who may be at risk of being drawn into committing terrorist-related activity. Channel uses early intervention to protect and divert people away from the risks they face before the threat from extremism and violent extremism is posed.

Confidentiality

See: Information Sharing and Confidentiality Procedure.

Personal information about children and families held by professionals and agencies is subject to a legal duty of confidentiality and should not normally be disclosed without the consent of the family. The law does however permit the disclosure of confidential information without permission if it is necessary to safeguard a child or children; this includes cases of Safeguarding. In addition all staff must follow their own setting's confidentiality policy.

Keeping children safe from harm requires people who work with children to share information - see Information sharing: advice for safeguarding practitioners.

Managing Allegations Against Members of Staff or Volunteers

See: Allegations Against Persons who Work with Children (Including Carers and Volunteers) Procedure.

All staff are required to disclose any convictions, cautions, court orders, reprimands and warnings which may affect their suitability to work with children (whether received before or during their employment at the centre). Providers must not allow people, whose suitability has not been checked, including through a Disclosure and Barring Service (DBS) check, to have unsupervised contact with children being cared for. If you have information which suggests an adult who works with children (in a paid or unpaid capacity) has:

      Behaved in a way that has harmed or may have harmed a child;

Possibly committed a criminal offence against, or related to, a child;

Behaved towards a child/ren in a way that indicated s/he is unsuitable to work with children.

You should speak immediately to the designated lead practitioner. They should consult with/make a referral to the LADO (Local Authority Designated Officer) Safeguarding Children Unit.

Please note: If the designated lead practitioner is implicated in the concerns, the matter should be discussed with someone of responsibility within the setting if possible, for example the manager or registered provider. If this is not possible, the person with the concem should discuss the concem directly with the LADO.

Ofsted must also be informed on: 0300 1231231 as soon as is reasonably practicable, but at the latest within 14 days of the allegation being made.

Recommended Documentation

      Safeguarding Notification - Initial Cause for Concern Form;

      Body Map;

      Safeguarding Notification - Subsequent Report Form;

      Safeguarding Children Meeting - Attendees Own Record of Meeting;

      Early Years Setting internal Action Plan for work with families on a statutory plan (level 4);

      Safeguarding Notification - Final Report Form;

      Safeguarding File Chronology Form;

      Injuries on Arrival.

5.37 Self-Harm or Suicidal Ideation

RELATED NATIONAL GUIDANCE

Chapter 1 : Assessing need and providing help, Working Together to Safeguard Children

Mental Health and Behaviour in Schools (DfE)

RELATED GUIDANCE

Prompt sheet for people working with children who self-harm or have the potential for suicide

Contents

Introduction

Who is this Document for?

Definitions to Support the Care Pathway Why do some Young People Self-Harm?

Risk Factors

Responding to Self-Harm

Levels of Risk and Suggested Action

Do's and Dont's

Appendix 1 - Care Pathway

Appendix 2 - Checklist for Agencies/EstabIishments - Supporting the Development of Effective Practice

Introduction

1. This is Pan Lancashire mufti-agency guidance for those working with children who Self-harm or have the potential for Suicide and their families.
2. This guidance seeks to support staff in working with children to reduce the potential damage self-harm can cause to both the child's physical body and to their mental well-being, e.g. self-esteem and provide them with the information required to make confident, informed and consistent decisions and responses when dealing with a child who has self-harmed.
3. This care pathway document recognises that young people who self-harm are doing so as a coping mechanism, and that just telling them to stop does not work.
4. This guidance advocates a 'harm reduction/minimisation' approach. Both the child and member of staff will be working towards replacing the self-harming behaviours with less risk taking and potentially life threatening coping strategies.
5. Children who self-harm mainly do so because they have no other way of coping with problems and emotional distress in their lives. This can be to do with factors ranging from bullying to family breakdown. But self-harm is not a good way of dealing with such problems. It provides only temporary relief and does not deal with the underlying issues.

Who is this Document for?

6. It is for all those working in the Children and Young People workforce, primarily for use with:
   • Children identified as using self-harm as a coping strategy;
   • Children when they require access to specialist mental health services as a result of self-harm, suicide ideation and/or attempted suicide.

Definitions to Support the Care Pathway

, Child

This is any child under the age of 18.

• Suicide

Suicide is an intentional, self-inflicted, life-threatening act resulting in death from a number of means.

• Suicidal     intent

This is indicated by evidence of premeditation (such as saving up tablets), taking care to avoid discovery, failing to alert potential helpers, carrying out final acts (such as writing a note) and choosing a violent or aggressive means of deliberate self-harm allowing little chance of survival.

Self-harm

7. Lancashire's Youth and Community Service conducted some research with young people in 2002 and produced a paper which offers a helpful baseline (Coupe et al, 2002):

"Self-harm might be described as the term used to describe the coping strategy that some people use to deal with stresses in their life:

• It involves a person hurting themselves physically;
• Self-harm often takes the form of a person cutting, burning or banging themselves;
• According to the young people who participated, self-harm is often about "surviving", "coping", "taking control", "release of pressure", "distraction from other stuff- places/people", "complex emotions".

8. Self-harm describes a wide range of things that people do to themselves in a deliberate and usually hidden way. In the vast majority of cases self-harm remains a secretive behaviour that can go on for a long time without being discovered.
9. Self-harm can involve:

 Cutting, often to the arms using razor blades, or broken glass;

 Burning using cigarettes or caustic agents;

 Punching and Bruising;

 Inserting or swallowing objects;

 Head banging;

 Hair pulling;

 Restrictive or binge eating;

 Overdosing;

 Problematic substance misuse;

 Frequent and repetitive risk taking behaviour e.g. taking away and driving cars, 'playing chicken'.

                           (Mental                       Health                        Foundation                         2006)

The term self-harm is often used as an all encompassing term referring to suicidal ideation and attempted suicide.

10. Some young people who self-harm may say that they want to die and a proportion of them may genuinely want to. Nevertheless, self-harm and suicide differ in terms of the intent behind the behaviour - self-harm is motivated by the desire to endure and survive. Understandably, many people assume that when a person injures themselves they are making a suicide attempt. But "self injury is not the same thing as a suicide attempt, in fact it is usually something very different: a desperate attempt to cope and to stay alive in the face of great emotional pain" (Arnold and Magi", 1996).
11. Despite these differences, self-harm is associated with an increased risk of suicide, since both actions are based in distress. For example, someone may resort to suicide when self-harm no longer works for them as a coping strategy. Some motivations for self-harming 'overlap' with suicidal motivations: when, for example, a person feels ambiguous about whether the action kills them or not, and given the risks inherent in self-harm, a small proportion of people who selfharm may kill themselves accidentally. As a result, statistics indicate that people who self-harm are more likely to commit suicide (e.g. Hawton 1992) - although the often hidden nature of self-harm means that statistics can be unrepresentative.

Why do some Young People Self-Harm?

12. Research indicates that a number of factors may motivate young people to selfharm and the list below is not exhaustive:

 To express emotional distress: "you're showing other people how much you're hurting inside"; (Bywaters and Rolfe 2002)

 Release and relief from pressure: "it's like a release. It feels better after I've taken tablets"; (Spandler 1996)

 Letting bad feelings 'out': "getting all the anger and the hurt out, and the pain"; (Bywaters and Rolfe 2002)

 Distraction from emotional pain: "Taking the pain away from what's in your head and transferring it onto your body"; (Bywaters and Rolfe 2002)

 To gain control over seemingly out-of-control situations and feelings: "You've got to have control over something"; (Spand/er 1996)

 To induce a pleasurable state: "my whole body goes kind of calm", (Bywaters and Rolfe 2002)

 To feel special, to express individuality: "l took a certain pride in being able to take pain. It was like I was good at something"; (Spandler 1996)

 To physically express emotional pain: "it's my way of turning emotion and pain, and things like that into something physical, which is a lot easier to handle in the long-run (Bywaters and Rolfe 2002)

13. According to 'Youth and self-harm" (Samaritans 2002), the most common reasons given for self-harm by school-age young people were 'to find relief from a terrible state of mind'. Contrary to popular belief, few were 'trying to frighten someone' or 'get attention'.

Risk Factors

Issues that may trigger self-harm

14.A number of factors may trigger the self-harm incident:

 Family relationship difficulties (the most common trigger for younger adolescents);

 Difficulties with peer relationships e.g. break up of relationship (the most common trigger for older adolescents);

 Bullying;

 Significant trauma, e.g. bereavement, abuse;

 Self-harm behaviour in other students (contagion effect);

 Self-harm portrayed or reported in the media;

 Difficult times of the year (e.g. anniversaries);

 Trouble in school or with the Police;

 Feeling under pressure from families, school and peers to conform/achieve;

 Exam pressure;

 Times of change (e.g. parental separation/divorce).

Individual factors:

Previous deliberate self-harm or suicide attempt;

Intent - does the young person wish to die? What do they understand by death? Do they think that what they have done, or are planning to do, will kill them? N.B. it is the young person's perception of or belief in potential lethality that is important here, not what a professional thinks;

Evidence of mental illness, especially depression, anxiety, psychosis or eating disorder;

Poor problem-solving skills - are problems seen as over-whelming? Does the young person see themselves as capable of solving, or coping with, problems? Have they been able to solve problems in the past? May be linked to poor communication skills;

Impulsivity/planning - Were steps taken to avoid discovery? Were any preparations for death made? A tendency to impulsive behaviour may increase risk of repetition and thus the likelihood of significant harm, but evidence of planning may indicate higher levels of seriousness for any given attempt. But remember that an impulsive act can be just as damaging as a planned one;

     Substance use including alcohol and volatile substances (especially important in impulsive males);

Hopelessness - is there a future, or any reason to continue living? What plans for the future does the young person have? This has been described as "the missing link" between depression and suicide. It can be especially significant if there has been previous deliberate self-harm or attempts at suicide;

Anger/hostility/anti-social behaviour - some research suggests conduct disorder may be a higher risk factor than depression. This may be difficult to assess, as information will be needed from sources other than the young person;

     Low self esteem;

Drug or alcohol abuse.

Family factors:

Instability (this can mean more than divorce or separation and can include repeated house moves). History of depression, deliberate self-harm, suicide or mental illness in the family, especially in first-degree relatives. History of substance use. Arguments or disputes can be important;

     History of neglect or abuse, whether physical, emotional or sexual, but especially the latter;

Has the young person experienced prolonged parenting style characterised by "High Criticism and Low Warmth"?

     Experiencing or witnessing domestic abuse;

Loss or bereavement - this may include such things as loss of status as well as deaths. Anniversaries of losses can be significant;

     Unreasonable expectations;

Poor parental relationships and arguments.

Social factors:

Persistent bullying, peer rejection or other victimisation, such as experiencing racial or sexual discrimination, and including homophobic bullying (see next point);

Issues of gender or sexual orientation - a very high proportion of young people who either are homosexual or think they might be, self-harm or attempt suicide;

Current stressors or life events;

Absence of a supportive helping network (could be family, extended family, peers, or professional);

Absence of a trusted approachable adult;

Difficulty in making relationships/loneliness;

Easy availability of drugs, medication or other methods of self-harm.

Other considerations:

Function of deliberate self-harm (other than a clear suicide attempt) - what did the young person hope the act would achieve: a sense of relief or release; punishment; purification; a desire to feel physical rather than emotional pain; a form of communication of distress or other significant matter; something else?

Method of self-harm - be aware of unintended consequences, such as liver damage from repeated 'Paracetamol' overdoses, stomach ulceration from aspirin overdose, brain damage from oxygen starvation in attempted hanging, drowning or exhaust poisoning, or bone damage resulting from jumping;

Time of year may be significant, especially when school-related factors are involved, such as bullying or exams. Hence the start of terms or exam periods may see an increase in self-harming behaviour;

Young people may be highly ambivalent in their views of themselves and any act of self-harm.

Responding to Self-Harm

Immediate response to injuries

It is ok and appropriate to show concern. Make sure the child / young person is safe; give them something to treat any injuries (e.g. plaster or bandage) and/or seek medical advice and attention as required. Encourage the young person to seek medical attention if they are reluctant and provide the necessary support to facilitate this.

The young person who has just harmed themselves usually feels upset and vulnerable (although they may hide this). Just because they caused the harm to themselves this does not mean that they will not feel hurt, frightened or shocked by their injuries. Be reassuring rather than questioning them at this stage. They may want to talk, so allow for this.

People often fear that being sympathetic will somehow 'reinforce' the behaviour as an 'attention-seeking' strategy, thereby perpetuating it and possibly making it worse. In fact, being punitive, hostile or withholding care and support is likely to make the young person feel even worse about themselves, thereby increasing risk. (However, avoid 'amateur' psychology and/or therapy at all costs, unless you are trained and/or qualified to provide either or both!)

Messages to give young people

15. It is usual for people to feel shocked, frightened, anxious and/or upset when they first encounter a child or young person who is self-harming. However, the messages that adults give at this initial point of contact are crucial:

 Calmness - Remain calm and do not openly display the very powerful feelings of shock, anger, distress or panic that you may have;

 Acceptance - Tell the young person that it is okay to talk about selfharm, it is something that you know about and can handle;

 Acknowledgement - Tell the young person how hard it can be to talk about this and acknowledge the courage that it takes to do so;

Concern - Demonstrate that you are concerned about the distress which lies behind the self-harm;

 Understanding - Make it clear that self-harm is something that can be understood, that there are reasons for it and that other young people do it too - they are not alone;

o Respect and Reassurance - Acknowledge their use of this particular coping strategy and with how frightening it might feel if they think someone is going to take it away;

 Hope - Some people who self-harm think it absolutely impossible to stop; let them know that lots of people who do it are able to stop hurting themselves;

 Information - Provide information about appropriate resources and sources of further help, advice and support but do not rush the young person on to someone else; remember that being available to listen and talk is important in itself and avoids giving messages of being fobbed off or that the problem is simply too big for anyone to deal with);

 Confidentiality - Respect confidentiality whilst ensuring that appropriate procedures are followed. The 'usual' balance needs to be struck here e.g. make it clear why and to whom you may have to pass information on and encourage and support a young person to talk to an appropriate person. (See Information Sharing and Confidentiality Procedure)

Levels of Risk and Suggested Action

	Suicidal thoughts are fleeting and soon dismissed						Ease distress as far as possible. Consider what may be done to resolve difficulties
	No plan						Link to other sources of support
	Few or no signs of depression						Make use of line management or supervision to discuss particular cases and concems
	No signs of psychosis						Review and reassess at agreed intervals
	No self-harming behaviour						Consider completing a CAF
	Current situation felt to be painful but bearable
Suicidal thoughts are frequent but still fleeting						Ease distress as far as possible. Consider what may be done to resolve difficulties
No specific plan or immediate intent						Consider safety of young person, including possible discussion with parents/carers or other significant figures
Evidence of current mental disorder, especially depression or psychosis						Seek specialist advice
Significant drug or alcohol use						Possible mental health assessment discussion with, for example, service's safeguarding champion, primary mental health workers in CAMHS/AMHS
			Situation felt to be immediate crisis	painful,	but no				Consider consent issues for the above
			Previous, especially attempt	recent,	suicide				Consider       increasing      levels  of support/professional input
			Current self-harm						Review and reassess at agreed intervals - likely to be quicker than if risk is low
		Frequent suicidal thoughts, which are not easily dismissed						Ease distress as far as possible. Consider what may be done to resolve difficulties
		Specific plans with access to potentially lethal means						Safety - discussion with parents/carers or other significant figures more likely
		Evidence of current mental illness						Request      for Specialist CAMHS involvement
		Significant drug or alcohol use						Consider consent issues
		Situation felt to be causing unbearable pain or distress						Consider       increasing      levels  of suppoffprofessional input in the mean time
		Increasing self-harm, either frequency, potential lethality or both						Monitor in light of level of Specialist CAMHS involvement

N.B. at any time during assessment and review, emergency medical treatment may be found to be necessary or child protection concerns may be raised. See Making a Referral to Children's Social Care Procedure.

Direct referral route to Specialist or Emergency Care

16. Based on the notion that the level of perceived risk could change at any time, ongoing support systems need to be put in place irrespective of the level of risk.
17. Ongoing support may take many forms and may be offered via numerous sources and will be dependent on the child or young person's needs and wishes.

Do's and Dont's

Do's

Make an assessment of risk e.g. emergency medical attention;

Take suicide gestures seriously;

Be yourself, listen, be non-judgemental, patient, think about what you say;

Check associated problems such as bullying, bereavement, relationship difficulties, abuse, and sexuality questions;

Check how and when parents will be contacted;

Encourage social connection to friends, family, trusted adults;

Implement initial care pathway;

Implement support/contact with young person;

     Seek risk assessment from those in your service who have been trained to provide this level of assessment;

Make appropriate referrals;

Using CAF processes set up a meeting to plan the care pathway interventions based upon an understanding of the risks and difficulties;

Provide opportunities for support, and to strengthen existing support systems.

Don'ts

     Jump to quick solutions;

Dismiss what the children or young people are saying;

Believe that a young person who has threatened to harm themselves in the past will not carry it out in the future;

Disempower the child or young person;

Ignore or dismiss people who self-harm;

     See it as attention seeking;

Assume it is used to manipulate the system or individuals;

     Trust appearances.

Appendix 1 - Care Pathway

Click here for Appendix 1 - Care Pathway

Appendix 2 - Checklist for Agencies/Establishments - Supporting the Development of Effective Practice

Click here for Appendix 2 - Checklist for Agencies/Establishments - Supporting the Development of Effective Prac