Safeguarding in Specific Circumstances Part 2

23. Historical abuse

24. Honour based violence

25. Hospitals and receiving hospital services

26. Lack of parental control

27. Left Alone

28. Male circumcision

29. Missing from home and care and education

30. No access to a child

31. Not attending school

32. Parental mental illness

33. Parents with learning difficulties

34. Parents who misuse substances

35. Police power to remove

36. Prevent - preventing terrorism

37.  Pregnancy and motherhood of a child

38. Pre-trial therapy

39. Private fostering

40. Prostitution: parental involvement in

41. Psychiatric care of children

42. Psychiatric wards and facilities (children visiting)

43. Racial and religious harassment

44. Residential care

45. Residence Order made due to risk of significant harm

46. Restraint/ Physical intervention by professionals

47. Self harming and suicide behaviour

48. Sexual abuse by children and young people 

49. Sexually exploited children

50. Sexually active under age children and young people

51. Shaken baby syndrome

52. Spirit possession and religious beliefs

53. Surrogacy

54. Temporary accommodation

55. Trafficking, modern slavery and exploited children

56. Unborn babies

57. Whistle blowing

58. Working with interpreters

59. Working with unco-operative families

60. Young carers

23 Historical abuse

   Historical Abuse Allegations from an Adult

When an adult makes a disclosure to a professional that s/he suffered abuse as a child, the professional to whom the disclosure is made should:

  • Clarify whether there are any child/ren who may currently be at risk from the alleged perpetrator;
  • Ascertain whether the adult is aware of the alleged perpetrator’s recent or current whereabouts and any contact the alleged perpetrator may have with children;
  • Advise the adult to make a formal complaint to the police, explaining that there is a significant likelihood that a person who has previously abused a child will have continued and may still be doing so;
  • Offer the adult support in making a formal complaint to the police;
  • Provide information about relevant services.

Where it is believed that the alleged perpetrator has contact with a child a referral should be made to Children’s Social Care so that information can be gathered and a decision can be made whether to apply child protection procedures in respect of the child/ren with whom the alleged perpetrator has contact.

Where an adult making a disclosure chooses not to make a formal complaint to the police, the adult should be advised of the possible to risk to children. The adult should be advised that the information will be shared and a referral made to Children’s Social Care. If the adult wishes for his/her identity to remain anonymous this must be respected, however, they should also be asked if they would be willing to talk with a representative of Children’s Social Care to enable them to seek to safeguard any other child who may be at risk.

Where the professional remains concerned about issues in relation of consent and confidentiality s/he should liaise with his/her Manager or Named Person for Child Protection.

   Historical Abuse Allegations from a Child/Young Person

Any historical abuse allegation from a child/young person is to be treated as if it is recent in terms of appropriate response to the child and their needs.

In relation to the alleged perpetrator and other children who may be at risk, the same principles as above apply.

24 Honour based violence

   Honour based violence

Honour based violence is the term used to describe murders in the name of so-called honour, sometimes called ‘honour killings’. These are murders in which predominantly women are killed for perceived immoral behaviour, which is deemed to have breached the honour code of a family or community, causing shame.

Professionals should respond in a similar way to cases of honour violence as with domestic violence and forced marriage (i.e. in facilitating disclosure, developing individual safety plans, ensuring the child’s safety by according them confidentiality in relation to the rest of the family, completing individual risk assessments etc).

Honour based violence cuts across all cultures and communities, and cases encountered in the UK have involved families from Turkish, Kurdish, Afghani, South Asian, African, Middle Eastern, South and Eastern European communities. This is not an exhaustive list.

The perceived immoral behaviour which could precipitate a murder include:

  • Inappropriate make-up or dress;
  • The existence of a boyfriend;
  • Kissing or intimacy in a public place;
  • Rejecting a forced marriage;
  • Pregnancy outside of marriage;
  • Being a victim of rape;
  • Inter-faith relationships;
  • Leaving a spouse or seeking divorce.

Murders in the name of ‘so-called honour’ are often the culmination of a series of events over a period of time and are planned. There tends to be a degree of premeditation, family conspiracy and a belief that the victim deserved to die.

Incidents which may precede a murder include:

  • Physical abuse;
  • Emotional abuse, including:
  • house arrest and excessive restrictions;
  • denial of access to the telephone, internet, passport and friends;
  • to kill;

Pressure to go abroad. Victims are sometimes persuaded to return to their country of origin under false pretences, when in fact the intention could be to kill them.

Children sometimes truant from school to obtain relief from being policed at home by relatives. They can feel isolated from their family and social networks and become depressed, which can on some occasions lead to self-harm or suicide.

Families may feel shame long after the incident that brought about dishonour occurred, and therefore the risk of harm to a child can persist. This means that the young person’s new boy/girlfriend, baby (if pregnancy caused the family to feel ‘shame’), associates or siblings may be at risk of harm.

   Disclosure and response

When receiving a disclosure from a child, professionals should recognise the seriousness / immediacy of the risk of harm.

For a child to report to any agency that they have fears of honour based violence in respect of themselves or a family member requires a lot of courage, and trust that the professional / agency they disclose to will respond appropriately. Specifically, under no circumstances should the agency allow the child’s family or social network to find out about the disclosure, so as not to put the child at further risk of harm.

Authorities in some countries may support the practice of honour-based violence, and the child may be concerned that other agencies share this view, or that they will be returned to their family. The child may be carrying guilt about their rejection of cultural / family expectations. Furthermore, their immigration status may be dependent on their family, which could be used to dissuade them from seeking assistance.

Where a child discloses fear of honour based violence the professional response should include:

  • Seeing the child immediately in a secure and private place;
  • Seeing the child on their own;
  • Explaining to the child the limits of confidentiality;
  • Asking direct questions to gather enough information to make a referral to Children’s Social Care and the police, including recording the child’s wishes;
  • Encouraging and/or helping the child to complete a personal risk assessment
  • Developing an emergency safety plan with the child;
  • Agreeing a means of discreet future contact with the child;
  • Explaining that a referral to Children’s Social Care and the police will be made
  • Record all discussions and decisions (including rationale if no decision is made to refer to Children’s Social Care).

Children’s Social Care should incorporate into their initial and core assessments the safety planning, self-assessment and risk assessment processes in Safeguarding Children Abused Through Domestic Violence.

Professionals should not approach the family or community leaders, share any information with them or attempt any form of mediation. In particular, members of the local community should not be used as interpreters.

All multi-agency discussions should recognise the police responsibility to initiate and undertake a criminal investigation as appropriate.

Multi-agency planning should consider the need for providing suitable safe accommodation for the child, as appropriate.

If a child is taken abroad, the Foreign and Commonwealth Office may assist in repatriating them to the UK.

25 Children in hospital or receiving hospital services

Children who are in hospital or receiving other hospital services should have their overall welfare safeguarded and promoted in the same manner as all other children. Hospitals should take all reasonable steps to ensure that children are cared for in secure children’s wards and are provided with suitable adult supervision and care. 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.

   Child likely to be Hospital over three months

Where it is believed that a child will remain in hospital or be accommodated by a Health Trust for longer than three months, Children’s Social Care are to be informed so that they can assess the child’s needs and decide whether services are required under the Children Act 1989.

   Child where there are concerns for child’s care on discharge

No child known to Children’s Social Care who is an inpatient in hospital, and about whom there are concerns over his/her safety and welfare, is to be allowed to leave hospital until it has been established by Children’s Social Care that the home environment is safe, the concerns of the medical and nursing staff have been fully addressed, and there is a social work plan in place for the ongoing promotion and safeguarding of the child’s welfare.

   Communication by Doctors

All doctors involved in the care of a child, about whom there are concerns about possible deliberate harm, must provide Children’s Social Care with a written statement of the nature and extent of their concerns. If misunderstandings of a medical diagnosis occur, these must be corrected at the earliest opportunity in writing. It is the responsibility of the doctor to ensure that his or her concerns are properly understood.

Child with Child Protection Plan who has an Unplanned Admission to Hospital

If a child, who is subject to a Child Protection Plan, has an unplanned admission to hospital, Children’s Social Care should be notified without delay by the ward senior staff member.

The Social Worker should seek as much clarity as possible regarding the reasons for the unplanned hospital admission. Unless it can clearly be shown that the admission was not due to a lack of care or to inflicted harm, a Core Group meeting is to be held prior to the child’s discharge. This meeting should be chaired by the Deputy Service Manager/ Service Manager.

   Child who Ingests Illegal/Prescribed Substances

Where a child requires hospital treatment due to an ingested illegal/prescribed substance e.g. Methadone, an immediate referral is to be made to Children’s Social Care, who in turn are to contact the Police Protecting Vulnerable Person’s Unit without delay. The need for urgency of response in terms of the child’s welfare, the safety of other children in the house, initial assessment of the care by the parents and the home conditions and obtaining forensic evidence is of paramount importance.

   Refusal by Child of Medical Assessment/ Treatment

Any staff faced with a situation where a child/young person’s life may be in danger because of his/her refusal to accept medical assessment and/or treatment, should contact Children’s Social Care as a matter of urgency.

The Team Manager should, without delay, liaise with Legal Services and determine whether an application should be made to the Court for an order to obtain the medical assessment and/or treatment.

   Non-medical Supervision

Where a child is in hospital and the child requires supervision on non-medical grounds, it is the responsibility of Children’s Social Care to arrange that supervision.

26 Lack of parental control

When a child is brought to the attention of the police or the wider community because of their behaviour, this may be an indication of vulnerability, poor supervision or neglect in its wider sense. It is important to consider whether these are children in need and to offer them assistance and services that reflect their needs. This should be done on a multi-agency basis.

A range of powers should be used to engage families to improve the child’s behaviour where engagement cannot be secured on a voluntary basis.

The Child Safety Order (CSO) is a compulsory intervention available below the threshold of the child being at risk of significant harm. Children’s Social Care can apply for a CSO where a child has committed an act that would have been an offence if s/he were aged 10 or above, where it is necessary to prevent such an act, or where the child has caused harassment, distress or harm to others (i.e. behaved anti-socially). It is designed to help the child improve his or her behaviour, and is likely to be used alongside work with the family and others to address any underlying problems.

A Parenting Order can be made alongside a CSO or when a CSO is breached. This provides an effective means of engaging with and supporting parents, while helping them develop their ability to undertake their parental responsibilities.

 27 Left Alone

When a child is not ready to be left alone, it can be a sad, lonely, frightening and potentially dangerous experience. There are many possible risks, both physical and emotional, which could affect the child.

There is no rule in law that specifies the age at which it is legal to leave children alone. The NSPCC advise that most children under 13 are not mature enough to cope in an emergency, and should not be left alone for more than a very short while. While this recommendation does not have the force of law, it is suggested as a minimum age. Children need a certain level of maturity to be safely left on their own.

Babies and young children should never be left alone in the home, whether they are asleep or awake, not even for a very short time.

If a practitioner has reason to believe that a young child/ren is home alone, they are expected to use their judgement and respond, depending on the circumstances.

There should have been sufficient attempts to rouse the parent/carer and, for example, a check that the parent is not in the back garden.

If, for example, the practitioner believes the parent is actually at home but choosing not to answer, they should call through the door that they are contacting the Police as it appears the child has been left alone.

The practitioner should attempt to contact the parent immediately, by mobile phone, or other responsible family member. If for example the parent is at a neighbour’s and has left a child/ren alone, it should be made clear that the parent is to return immediately. The practitioner should discuss with the parent, after their return to the home and ascertaining that the child/ren is alright, the seriousness of leaving a child alone.

If it is not possible to quickly find out where the parent is and for them to return to the home and there is concern about a child’s immediate safety, the Police are to be contacted as they have a duty to take urgent protective action.

In all situations, the Practitioner is expected to remain at the home or outside the home if there is no access, until the parent returns or other action is taken, such as through the Police.

If necessary, the Practitioner should seek immediate advice from their Manager and/or the Named Person.

28 Male circumcision

Male circumcision is the surgical removal of the foreskin of the penis. The procedure is usually requested for social, cultural or religious reasons (e.g. by families who practice Judaism or Islam). There are parents who request circumcision for assumed medical benefits.

There is no requirement in law for professionals undertaking male circumcision to be medically trained or to have proven expertise. Traditionally, religious leaders or respected elders may conduct this practice.

   Circumcision for therapeutic / medical purposes

The British Association of Paediatric Surgeons advises that there is rarely a clinical indication for circumcision. Doctors should be aware of this and reassure parents accordingly.

Where parents request circumcision for their son for assumed medical reasons, it is recommended that circumcision should be performed by or under the supervision of doctors trained in children’s surgery in premises suitable for surgical procedures.

Doctors / health professionals should ensure that any parents seeking circumcision for their son in the belief that it confers health benefits are fully informed that there is a lack of professional consensus as to current evidence demonstrating any benefits. The risks / benefits to the child must be fully explained to the parents and to the young man himself, if Fraser competent.

The medical harms or benefits have not been unequivocally proven except to the extent that there are clear risks of harm if the procedure is done inexpertly.

   Non-therapeutic circumcision

Male circumcision that is performed for any reason other than physical clinical need is termed non-therapeutic circumcision.

The legal position on male circumcision is untested and therefore remains unclear. Nevertheless, professionals may assume that the procedure is lawful provided that:

  • It is performed competently, in a suitable environment, reducing risks of infection, cross infection and contamination;
  • It is believed to be in the child’s best interests;
  • There is valid consent from family / parents and the child, if old enough, is Fraser competent.

If doctors or other professionals are in any doubt about the legality of their actions, they should seek legal advice.

   Principles of good practice

The welfare of the child should be paramount, and all professionals must act in the child’s best interests. Children who are able to express views about circumcision should always be involved in the decision-making process:

  • Even where they do not decide for themselves, the views that children express are important in determining what is in their best interests;
  • Parental preference alone does not constitute sufficient grounds for performing a surgical procedure on a child unable to express his own view. Parental preference must be weighed in terms of the child’s interests;
  • When the courts have confirmed that the child’s lifestyle and likely upbringing are relevant factors to take into account. Each individual case needs to be considered on its own merits.

An assessment of best interests in relation to non-therapeutic circumcision should include consideration of:

  • The child’s own ascertainable wishes, feelings and values;
  • The child’s ability to understand what is proposed and weigh up the alternatives;
  • The child’s potential to participate in the decision, if provided with additional support or explanations;
  • The child’s physical and emotional needs;
  • The risk of harm or suffering for the child;
  • The views of parents and family;
  • The implications for the child and family of performing, and not performing, the procedure;
  • Relevant information about the child and family’s religious or cultural background.

Consent for circumcision is valid only where the people (or person) giving consent have the authority to do so and understand the implications (including that it is a non-reversible procedure) and risks. Where people with parental responsibility for a child disagree about whether he should be circumcised, the child should not be circumcised without the leave of a court.

   Recognition of harm

Circumcision may constitute significant harm to a child if the procedure was undertaken in such a way that he:

  • Acquires an infection as a result of neglect;
  • Sustains physical functional or cosmetic damage as a result of the way in which the procedure was carried out;
  • Suffers emotional, physical or sexual harm from the way in which the procedure was carried out;
  • Suffers emotional harm from not having been sufficiently informed and consulted, or not having his wishes taken into account.

Harm may stem from the fact that clinical practice was incompetent (including lack of anaesthesia) and / or that clinical equipment and facilities are inadequate, not hygienic etc.

The professionals most likely to become aware that a boy is at risk of, or has already suffered, harm from circumcision are health professionals (GPs, health visitors, A&E staff or school nurses) and childminding, day care and teaching staff.

If a professional in any agency becomes aware, through something a child discloses or another means, that the child has been or may be harmed through male circumcision, a referral must be made to children’s social care.

   Role of community / religious leaders

Community and religious leaders should take a lead in the absence of approved professionals and develop safeguards in practice. This could include setting standards around hygiene, advocating and promoting the practice in a medically controlled environment and outlining best practice if complications arise during the procedures.

29 Missing from home and care and education

This procedure relates to all children and young people in York and North Yorkshire who run away and go missing from care or home. This includes children and young people looked after in both the public and independent sectors and those attending residential school. It is based on “Statutory guidance on children who run away and go missing from home and care" (January 2014).

This procedure does not provide for situations where a child has been abducted or forcible removed from their place of residence. This is a “crime in action” and should be reported to the police immediately.

   Risks faced by young people who go missing

Research shows that the main causes of young people running away are family conflict, including domestic violence or forced marriage, or personal problems such as substance misuse, bullying or relationship problems. Young people who run away from care are often unhappy or are influenced by others and do so to fit in with the group.

The risks faced by young people are the same regardless of how often they have run away from home. However younger children and those who runaway more often are more likely to face serious, long term problems.

The immediate risks associated with running away include:

  • No means of support or legitimate income – leading to high risk activities;
  • Possible involvement in criminal activities, e.g. prostitution;
  • Becoming a victim of crime, for example through sexual assault and exploitation;
  • Alcohol and substance misuse;
  • Deterioration of physical and mental health;
  • Loss of education and training.

Longer term risks include:

  • Long-term drug dependency;
  • Involvement in crime;
  • Homelessness.

Joint Protocol Children who go missing from home and care North Yorkshire and York April 2015

The above protocol was agreed to support the local authority to meet the requirements of National Indicator 71. The protocol aims to ensure that:

  • All appropriate agencies and individuals are notified if children and young people are missing and/or return;
  • A clear plan of effective inter-agency action is taken to trace or return children and young people who run away or go missing;
  • Appropriate and effective actions are taken when children and young people return or are located. This includes provision of a return interview;
  • Processes are established to track children and young people who are missing from other authorities;
  • The Police are appropriately notified of children and young people who go missing;
  • Information is gathered to support the new national indicator and inform local practice;
  • Children and young people are positively encouraged to influence the outcome of any professional intervention.

   Legal Issues

The law does not generally regard young people under the age of 16 as being able to live independently away from home. Relevant legal processes are outlined in LSCB Procedures, Harbourers of Missing Children, Section 9.23).

   Definitions

The new statutory guidance makes provision for children and young people who are looked after to take “unauthorised absence”. Within clear guidelines agreed between the Police and Children’s Social Care, young people who are looked after no longer need to be reported as missing to the Police whenever they failed to return to their placement at agreed times. This allows foster carers and residential staff to involve the Police without the young person being reported as a missing person.

   Unauthorised absence

Absent for a short period of time i.e. less than overnight, and after a careful and thorough risk assessment the absence does not raise concern for their immediate safety or that of the public

Children who fall within the category of “unauthorised absence” must be the subject of continuous review whilst they remain absent. During the absence the circumstances may change and staff need to be in a position to respond accordingly. In this phase the local authority should take all reasonable and practical steps which a good parent would take to establish the whereabouts or destination of a child or young person, or the location of any persons with whom he or she is likely to be associating and arrange for those places to be checked.

If the location of a child is known or suspected then it is the responsibility of the relevant carers to attempt to ensure the safe return of the child or young person. However, if there are thought to be specific issues of safety of the public or public order difficulties involved in returning the child, an action should be agreed between Police and Children’s Social Care staff. These circumstances would mean the child should be categorised as “missing”.

In the instance of any child or young person having an unauthorised absence of more than six hours, consideration must be given to classifying them as missing. The risk assessment should be used to assist in situations such as this. Where the child or young person has not returned and not been seen over the 24 hour period by relevant social care staff, he or she must be reported as missing.

   Missing children and young people

Children and young people who have gone missing independently from their families. Where concern is raised about the child or young person’s absence because their location is unknown; the reason for their absence is unknown; they are vulnerable and and/or there is a potential danger to the public.

Designated responsibilities within the missing from home and care processes

The Local Authority and police have a named senior manager in charge of missing children issues. The named manager in the Police has responsibility for:

  • Improving links with local services for runaways;
  • Developing specialist skills and knowledge about running away;
  • Providing a more consistent and efficient response to runaways

These senior managers within the police and local authority are accountable for ensuring the processes agreed as part of the protocol are followed.

The Local Authority and police will also ensure that there is a process in place to manage the exchange of notifications of missing children and young people between the two agencies in a timely way and that information is collated.

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   Multi agency working

Running away is a clear risk factor making young people vulnerable to negative outcomes. Key triggers for running away are:

  • Young people feeling they have no one to talk to;
  • Young people not knowing what else they can do;
  • Young people not knowing where they can go for help;
  • The help they require not being available or accessible.

The Common Assessment Framework will allow agencies to share information and more easily identify early warning signs when young people are at risk of running away. Agencies in contact with young people should consider the use of a risk assessment to determine:

  • What is the risk that the young person might run away?
  • What risks might they face if they ran away?
  • With whom is it permissible for them to stay overnight and in what circumstances?

A risk assessment is used by the police when children run away (see Appendix A). This risk assessment tool incorporated into a common assessment can help to establish a wider package of support.

Where a child needs support from several agencies, a Lead Professional should help ensure coordination of services.

However where the child or young person is potentially a Child in Need or a Child in Need of Protection a referral should then be made directly to Children’s Social Care through the Customer Contact Centre. In such circumstances a common assessment should not be started/ completed if already underway.

Such criteria for a referral to Children’s Social Care would include:

  • Where a child has developed a repeated pattern of running;
  • Where the child is, or is likely to have experience of significant harm, including sexual exploitation;
  • Where the parent appears unable, or unwilling, to work to support and meet the needs of the child;

Action to take when a child runs away or is missing

  • Attempt to locate – contact friends/school etc., check bedroom and known locations where person attends;
  • Establish if the child is subject to a care order, court order or contact order is privately fostered and who has parental responsibility
  • Contact the Police noting whether the child is missing or whether this is an unauthorised absence (for children in care).
  • A child is classed as unauthorised absence where it is believed that the child has absented themselves for a short time and is not necessarily at risk (some children test boundaries).
  • A child is classed as missing if their location or reason for absence is unknown and there is a cause for concern because of their vulnerability or their potential danger to the public.

If the location of the child is known they should not be reported to the Police as a missing person or an unauthorised absence. However if there is concern for their safety they may be reported as a child or young person at risk of harm. For example where parents report their teenage child staying over and refusing to leave a house where there is known drug misuse.

When young people missing from home are located but have not been reported missing to the Police by their families, further investigation might be warranted. It may be necessary to inquire into whether there are any continuing safeguarding concerns or whether the young person should be offered family support services.

   Role of the Police

The priorities of the police in responding to reports of missing persons are:

  • To ensure that every report of a missing person is risk assessed so that missing persons who may be vulnerable or represent high risk are immediately identified;
  • To investigate reports of missing persons;
  • To adopt a proactive multi agency approach in dealing with missing persons;
  • To support the needs of the family, those close to the missing person and the community.

   Action to be taken by the Police

A risk assessment will be carried out in every case. The outcomes of the risk assessment will be the guide for the police response and the level of enquiries undertaken. The missing young person will be classified as low, medium or high risk based on the professional judgement of the reporting officer.

Enquiries will continue as required until the child or young person is located. A Police Supervisor will review action taken daily. Contacts with relevant agencies will be made and all information recorded by the Police.

The Police will advise the media and request their assistance after appropriate consultation with parents/guardians and/or the local authority in certain circumstances after a thorough risk assessment has been conducted.

   The Police Safe and Well Check

When a missing child or young person is found, the police officer should physically see and interview them as soon as possible. The objects of the interview are to:

  • Determine the reasons why the child went missing and in particular, if they have been subject to violence, abuse or bullying;
  • To establish if they have committed crime whilst missing;
  • To discover where and by whom they have been harboured;
  • To obtain information which may lead to their early discovery should they disappear again;
  • To put in place any support and preventative measures to avoid such a recurrence;
  • inform the child and their family that either:
    • A referral has been made to Children’s Social Care for an assessment of need, or
    • To offer a return interview with an independent agency and explain notification, if there is agreement.

The Police should also see and interview the child or young person’s parent/s or carers to satisfy themselves that the child or young person is safe for the time being.

The police will ensure that notifications are passed to the Police Missing Persons Coordinator the day of the child’s return. They will include/ attach brief details of the interview with the child/young person for every young person that has been missing. This will allow a timely exchange of information with the local authority.

Where a young person goes missing frequently, it may not be practicable to see them every time they return. In these cases, the reasonable decision should be taken about the frequency of such checks. This will mainly apply to young people missing from care who will have other people responsible for their welfare to check this. This decision should be agreed and recorded as part of the plan for the young person.

   The Return Interview

Police Safe and Well Checks are not designed to explore the causes of why children go missing or run away. All children and young people must now be offered a more in-depth interview on their return.

It is recommended that this interview takes place within 72 hours of the young person being located or returning from absence. It is especially important that a Return Interview takes place when a child or young person:

  • Has been missing for over 24 hours;
  • Has been missing on two or more occasions;
  • Has engaged or is believed to have engaged in criminal activities during their absence;
  • Has been hurt or harmed whilst they have been missing ( or this is believed to be the case);
  • Has known mental health issues;
  • Is at known risk of sexual exploitation;
  • Has contact with persons posing a risk to children.

Not all young people would welcome a return interview but the police in their interview will establish whether this is the case and advise the young person and their family accordingly.

The return interview should be undertaken by the professional agency or person that the child or young person has identified with.

The purpose of the return interview is to:

  • Give the child or young person the chance to talk about why they ran away;
  • Assess need including risk of future running away. This assessment should take the form of the Common Assessment Framework where Children’s Social Care are not involved;
  • Help the young person to find ways of dealing with their problems.

The assessment should consider:

  • Whether the provision of advice, information and support from the interviewing agency is sufficient to meet the young person’s needs;
  • Whether it is appropriate to link the child and/or family to an alternative service such as family support or drug and alcohol services;
  • Whether a referral to Children’s Social Care is required for those living at home.

Agreement should be reached with the child or young person about when and where to undertake the interview. Parents, carers and those with parental responsibility should be told if appropriate.

   Out of hours responses

If there is concern a young person may be at risk if returned home, they should be referred to Children’s Social Care to assess their needs and make appropriate arrangements for their accommodation.

National guidance requires that the local authority makes available an effective form of emergency accommodation for young people who need somewhere safe to go so they are not put at even greater risk and that this accommodation can be accessed at any time of the day or night.

Police stations are not an appropriate place to accommodate children even for a short time and bed and breakfast accommodation should never be used for unaccompanied children aged under 15 years. No 16 or 17 year old should be placed in B&B accommodation by housing services or CYPS except in an emergency where this is the only available alternative to rooflessness. In these exceptional cases, B&B accommodation should be used for the shortest time possible and support offered to the young person during their stay.

Additions when vulnerable children and young people are missing

For all children (other than looked after children), the following process must take place where assessment deems that the young person is vulnerable and/or considered at increased risk of harm.

If the child or young person has not been traced within 48 hours, a strategy meeting must be held. This meeting must take place within 5 working days of the date of the child/young person going missing at the latest. Members of the meeting will need to consider:

  • If the young person is thought to have travelled to another area whether to circulate their details to other local authority and other agencies in that area;
  • Notifying national authorities and agencies including social security, the benefits agency and child benefit agency;
  • If there is cause to believe that the child/young person may be removed from UK jurisdiction any legal measures to be taken.

Further to the strategy meeting, a review child protection conference must be brought forward for any child with a child protection plan, remaining missing for 7 days or more.

When the child is located a strategy meeting/ discussion between the agencies involved should take place within the same working day to consider:

  • Any immediate safety issues and whether to start a S.47 enquiry;
  • Who will interview the child if not part of a S.47 enquiry;
  • Who needs to be informed of the child’s return (both locally and nationally).

If a child or young person has a Child Protection Plan, Children’s Social Care must consult with Core Group members to consider the effectiveness of the current Child Protection Plan and decide and record whether to hold a review child protection conference.

   Children missing from care

Every “missing” child who returns to the care of the local authority will be interviewed. This will normally be conducted by an independent person not involved with the line management of the home or foster home. This may be the child’s Social Worker, IRO or another social worker. Children’s Social Care will ensure that there are a range of options to consider when the child returns.

The full CYSCB Missing from Home and Care Procedure is available here

 

   Planning for return

Each children’s home must have written procedures that must be followed when a child is missing. These must be compatible with the protocols for responding to missing persons agreed between the police and the local authority in the area where the home is located and with the “National Minimum Standards and Regulations for Children’s Homes and Fostering Services Regulations (2002)“.

Planning and assessment of young people in care by staff and carers should include a risk assessment of whether the child or young person may run away from their placement. This should be revised and updated regularly.

Whenever possible prior to the return of a looked after child or young person whose absence falls within the definition of ‘missing’, their Social Worker should commence planning for when the child is located. These plans should include:

  • Will the child or young person return to their previous placement?
  • How will she/he be taken to the placement?
  • Do the Police wish to make further enquiries before the child or young person returns to the placement?
  • Who will be the appropriate "independent person" to talk to the child or young person after her/his return?
  • Is it appropriate to apply for a recovery order?

   Care Planning

Looked after reviews provide an opportunity to check that a child’s care plan has been amended to address the reasons why they were absent and may include a strategy to prevent recurrence should the child go missing in the future.

Alongside the care plan, the Placement Information Record (PIR) should be completed. The PIR should describe how the foster carer or residential staff will meet the child’s needs. It will include detail of any specific behaviour-management strategies that the provider is expected to follow to prevent where possible the young person going missing. This is essential where there is already an established pattern of running away.

Children Missing from Education

Guidance in regard to Children Missing from Education is available here.

Children missing from a residential school

The processes for looked after children are applicable to all children and young people who are missing or having unauthorised absence from residential school. This is regardless of whether it is believed the young person is making their way to their family home as the distances involved place that child or young person in danger.

National Indicator 71 (Missing from home and care) requires that:

  • Local information about running is gathered;
  • Local needs analysis-based information gathered about the levels or causes of running are in place;
  • Local procedures to meet the needs of runaways agreed;
  • Protocols for responding to urgent/ out of hours referral from the Police or other agencies are in place:
  • Local procedures to support effective prevention and early intervention work.
 

30 No access to a child

   Meaning of ‘No Access’

‘No Access’ is a term which describes the following situations, in a context where there are concerns for the physical safety of a child:

  • Admittance to the house is not obtained for a visit that has been made by appointment and there is not a plausible reason for this;
  • There is no response to a visit to the home, whether or not by appointment, and there is reason to believe that the lack of response is due to non-cooperation;
  • Once in the home, access to the child/ren in the house is unreasonably denied;
  • An appointment made to see the children, whether in the home or elsewhere, is not kept.

Practitioners must also be aware of possible attempts to delay or avoid contact, such as requests to re-arrange a planned visit, particularly also when the re-arranged appointment is not kept.

‘No access’ may occur at any point.

   ‘Closure’

In considering the meaning of any difficulties in making contact or seeing children whose physical safety may be at risk, which includes situations of domestic violence, account should be taken of the work of Reder Duncan & Gray (1993) who identified a process they termed ‘closure’.

‘Closure’ is defined by tightening of boundaries within the family in order to exclude outside intervention and influence. Closure could present, for example, as parental refusal to the child/ren being seen, non-attendance or decreasing attendance at nursery/school, failure to attend or to be available for pre-arranged appointments etc. and can show in physical signs such as curtains being consistently closed.

Closure may be partial, intermittent, persistent or terminal in nature and is due to an attempt to regain a perceived loss of control. It may signal an increase of stress within a family and an escalation of abuse towards the child/ren. Within families where there is domestic violence, no access may be linked to coercion, threats or intimidation by the perpetrator.

Any pattern to indicate that a form of closure is taking place, in a situation where there are concerns for a child’s safety, must be taken seriously, particularly where there is a history of child abuse, as closure can be considered to have potential fatal consequences for the child.

   ‘No Access’ Visits

There can be a simple explanation for a ‘No Access’ visit which does not indicate any increased concern for the child. On the other hand, such a visit may indicate increased concerns. In each case a careful judgement should be made.

Where there is a ‘No Access’ visit to a child and the appointment had been arranged and there are known indicators of risk, including domestic violence, which give cause for concern for the safety of the child, the Social Worker should:

  • Leave a note/letter giving a further early appointment i.e. the same or next working day and contact details;
  • Attempt to contact the parent by phone;
  • Attempt to find out the whereabouts of the child and parents;
  • Liaise with other practitioners involved to ascertain if they have seen the child or parents;
  • Make the Team Manager aware so that the facts of the case can be judged and a decision made as to whether further action is necessary that day.

Where there is a second ‘No Access’ visit, no plausible reason as to why that should be and there are concerns for the child’s safety, the Social Worker should:

  • Leave a strongly worded note to stress the importance of being able to see the child;
  • Attempt to contact the parents and other family members;
  • Liaise with others involved;
  • Discuss the case further with the Deputy Service Manager/ Service Manager who should make a decision as to whether further action is necessary.

Depending on the seriousness of the situation, irrespective of whether it is a first or subsequent ‘No Access’ visit, there may be a need to seek Police assistance. Alternatively, where s47 enquiries are being frustrated by the lack of access, it may be appropriate to apply for an Emergency Protection Order.

Where this relates to a child who is subject to a Child Protection Plan, there should also be liaison with the Chair of the Child Protection Conference.

31 Not attending school

A range of school attendance resources are available on the YorOk website.

(Guidance on children missing from education is also available.) 

A minimum standard of safety should be afforded to children not attending school. This includes four groups of children:

  • Children who are registered with schools and who are or go missing from school, and give rise to concern about their welfare (these children may be classified as missing, whereabouts unknown);
  • Children who are poor attendees at school or who have interrupted school attendance;
  • Children of school age who are not registered with a school;
  • Children of school age who are educated at home but where there are concerns about their welfare.

   Child registered at school who goes missing: Initial response

On the first day a child is not in school without a valid reason (e.g. a telephone call or letter from the parent giving a valid explanation), a staff member trained to do so should telephone the child’s parent / home to seek reasons for the absence and reassurance from a parent that the child is safe at home.

If contact is made with the parent and the child is missing, the staff member should advise the parent to contact all family and social contacts, the police and services such as the local accident and emergency departments and the child’s GP.

If contact cannot be made with the parent or the staff member is concerned about the response they receive (e.g. the parent not informing the people listed above), the staff member should consider, with the school’s Designated Person for Child Protection, the degree of vulnerability of the child to decide on whether any further action is required at this stage. Any decision not to act should be reviewed on each subsequent day the child is absent.

   Children with poor, irregular or interrupted school attendance: Initial response

On the first day a child is not in school, the procedures outlined above should be followed.

If contact is made with the parent and the child is not missing from home, the member of staff will follow their school procedures for children who are absent. However, if they are concerned about the welfare of the child (and this is likely to be the case if there is any reason to doubt the reason given by the parent for the child’s absence from school), the staff member should discuss the case with the school’s Designated Person for Child Protection.

Schools must have systems for monitoring attendance, and where children are attending irregularly the education welfare service should be notified to ensure the child is safe. The Government threshold for concern about school attendance is that 20 per cent plus non-school attendance raises concern about a child’s education. Most education services therefore use this threshold for referral to education welfare and school attendance services. The local authority has a range of legal powers to enforce school attendance, including the prosecution of parents who fail to ensure that their children attend school regularly.

If a parent fails to comply with local authority efforts to ensure regular school attendance for a child, this must be viewed as a child welfare matter and a referral made children’s social care.

   Children who are vulnerable or at risk of harm

When a child is absent or missing from school, they could be at risk of significant harm through physical or sexual abuse. The child may be absent or missing because they are suffering physical, sexual or emotional abuse and / or neglect.

Children who are absent or missing from school may also be missing from care or home.

Teachers, in consultation with the Designated Person for Child Protection at the school, should make an immediate referral to children’s social care if:

  • There is good reason to believe the child may be the victim of or involved in a crime;
  • The child is subject of a child protection plan;
  • The child is a looked after child;
  • The child is privately fostered child;
  • There is planned or current children’s social care or adult social care involvement (e.g. a child protection [s47 enquiry] investigation);
  • The child is subject to serious concerns about their health, safety or welfare;
  • There is a person present in or visiting the family who poses a risk of harm to children.

The family may be avoiding contact and therefore the quicker the response the more likely they will be traced. Delay may increase the risk of harm to the child.

Additional concerns may be caused if:

  • There has been children’s or adult’s social care or criminal justice system involvement in the past;
  • There is a history of mobility;
  • There are immigration issues;
  • The parents been subject to proceedings in relation to attendance;
  • There is a history of poor attendance;
  • There is information which suggests the child may be subject to a forced marriage, honour based violence, female genital mutilation or sexual exploitation.

   Reasonable enquiry

   Day one

The process of ‘reasonable enquiry’ starts with the questions above as soon as the child is discovered to be missing (i.e. on the first day). After school staff have exhausted the avenues of enquiry open to them, the education welfare service should continue checking databases within the local authority and other databases (e.g. housing, health and the police) with agencies known to be involved with the family, with the local authority the child moved from originally, and with any local authority to which the child may have moved.

   Days two to twenty-eight

If the judgement on the first day of absence is that there is no reason to believe the child is at risk of harm and the school delays further action, the process of reasonable enquiry should be repeated and enhanced, including reviewing the responses to the causes for concern for up to four weeks. This should be undertaken jointly between the school and the education welfare officer.

   More than twenty school days

If a child continues to be absent from school for more than twenty school days and both the school and Education Services have made reasonable enquiries to locate them, it is permissible under current regulations for the child’s name to be removed from the school roll. and for their details to be uploaded to the DCSF Lost Pupil Database at: www.teachernet.gov.uk/management/ims/datatransfers/. However, this would be very unusual in these circumstances.

If concerns remain in relation to the welfare of the child, the education welfare service and/or children’s social care should continue to pursue reasonable enquiries in accordance with Missing from Home and Care and Education.

   Children of school age who are not registered with a school

Children of school age who are not registered with a school share the same vulnerabilities as those outlined in section above.

Educational achievement contributes significantly to children’s well-being and development; all children have a right to education and young children who reach school age or children already in education who move home should be supported to enrol in a new school as seamlessly as possible. This is particularly because children who move frequently are often already vulnerable through being looked after or in temporary accommodation.

Where parents appear not to have taken steps to ensure their child is registered with a school or receiving an appropriate education, the education welfare or service should make urgent enquiries about the child’s welfare, and interview the child. If the parent fails to comply with local authority efforts to place the child in school or to receive education in some other way and there are concerns that the child is suffering or is likely to suffer significant harm, this must be referred to children’s social care as a child protection matter.

This process should be initiated for all children, including those who are likely to remain in the county only temporarily or whose stay in the UK is intended to be temporary (other than if a child is visiting for a short holiday). In particular, this process should be implemented for children whose stay may originally be temporary but where they are privately fostered.

Any professional encountering a child of school age who does not appear to be in a school should ask the parent about this and, if the child is not on a school roll or they are concerned that the parent may be evasive about this issue, they must contact their agency’s nominated child protection advisor to discuss whether to make a referral to the education welfare or service.

   Children of school age who are educated at home but where there are concerns about  their welfare

The law allows parents of children in England and Wales to educate their child however they wish. The local authority has limited powers to intervene or even to be informed about this.

If a parent never registers their child at a school, they are not obliged to inform the local authority.

If a parent registers their child at an independent sector school and then withdraws their child from school to educate them at home, they are not obliged to inform the local authority. Nor is the independent school obliged to inform the local authority. Independent schools however in York and North Yorkshire are recommended to inform the Senior Education Social Worker who will support them in attempting to locate the child.

If the parent registers their child at a state school and then withdraws their child to educate them at home, they are not obliged to inform the local authority. However, they are obliged to inform the state school, which in turn is obliged to inform the local authority within two weeks of removing the child from the school roll. Parents should be encouraged to ask the new school to confirm the child’s attendance when they start and if this is not forthcoming within two weeks, the local authority will follow internal missing from school procedures.

Where the local authority is informed of a parent’s desire to educate their child at home, they have limited powers but the parent is required to assure them about the nature and quality of the education they are giving to the child.

However, there may be circumstances where the parent is seeking to avoid agency intervention in the child’s life to conceal abuse or neglect or where, however well meaning, their desire to educate their child at home may give rise to general concerns about the child’s welfare. In these circumstances, it may be necessary for children’s social care to conduct an assessment into whether the child’s needs are being met or whether they are at risk of significant harm.

32 Parental mental illness

Parental mental illness does not necessarily have an adverse impact on a child’s care and developmental needs, however, a study of 100 child deaths through abuse or neglect showed clear evidence of parental mental illness in one-third of cases (Falkov, 1996).

Post-natal depression can also impact adversely on a mother’s ability to care for a child. The impact of parental mental ill health on the child’s development is linked to the overall parenting capacity and family and environmental factors.

Where any of the following parental risk factors are evident, consideration should be given to whether there is a current concern for the child which needs assessing:

  • Previous or current history of mental health problems;
  • Pre-disposition to or severe post-natal illness;
  • Non-compliance with treatment, reluctance or difficulty in engaging with necessary services and lack of insight into the effects of the illness and impact on the child;
  • Delusional thinking which involves the child;
  • Obsessional compulsive behaviours which involve the child;
  • Self-harming behaviour and suicide attempts;
  • Altered states of consciousness.

The presence of other risk factors such as domestic abuse and parental substance misuse may compound the concerns for the child. Where there is a concern for a child whose parent has a mental health illness it is important to liaise with Adult Mental Health Services in order to:

  • Share information and knowledge on both the child and the parent(s);
  • Establish whether the parent is currently subject to the Care Programme Approach (CPA) and the nature of the mental health concern;
  • Establish the nature of previous mental health problems;
  • Use validated assessment tools;
  • Gain advice and consultation in respect of the needs of the parent with mental health problems.

Health professionals, including doctors, are required to share relevant information in order to safeguard children. Any difficulties in obtaining relevant information should be immediately brought to the attention of a Manager and/or Named Person so that the matter can be progressed.

Following Initial Assessment of a child whose parent has a mental illness, careful consideration should be given to completing a Core Assessment and requesting a specialist assessment as appropriate.

Where a child’s plan is agreed and the parent is subject to the Care Programme Approach (CPA) the child’s plan and the care plan for the parent must remain independent whilst at the same time, complementary of each other.

33 Parents with learning difficulties

A parent with a learning disability does not necessarily have difficulty in meeting her/his child’s needs. Learning disabled parents may need additional support to develop their understanding, resources, skills and experience to help them meet the needs of their children. This will particularly be the case where other stress factors are present such as:

  • Domestic abuse;
  • Poor physical health;
  • Poor mental health;
  • Substance misuse;
  • Poor housing;
  • Social isolation;
  • Social intimidation or harassment from others;
  • Poverty;
  • A history of growing up in care

Children of learning disabled parents are at increased risk from inherited learning disability, psychiatric disorders and behavioural problems. The presence of such factors will add additional pressures for parents. Children may end up taking increasing responsibility for caring for themselves and, at times, for their siblings, parents and other family members.

A mother with a learning disability may be at increased risk of being targeted by men who wish to gain access to her children for the purpose of sexually abusing them.

Where there is concern for a child whose parent(s) has a learning disability it is important to liaise with the Adult Learning Disability Service to:

  • Share information and knowledge;
  • Use validated assessment tools;
  • Gain advice and consultation in respect of the needs of the learning disabled parent.

Following Initial Assessment of a child whose parent has a learning disability, careful consideration should be given to both completing a Core Assessment and requesting a specialist assessment. See 2007 DfES/DOH Guidance on working with parents with a learning disability.

34 Parents who misuse substance

   Possible Effects on Parenting

It is important not to make assumptions about the impact on a child of parental drug and/or alcohol misuse. It is however important that the implications for the child are properly assessed.

A parent's practical caring skills may be diminished by misuse of drugs and/or alcohol. Some substance misuse may give rise to mental states or behaviour that put children at risk of injury, psychological distress or neglect. Some substance misusing parents may find it difficult to give priority to the needs of their children. Finding money for drugs and/or alcohol may reduce the money available to the household to meet basic needs or may draw families into criminal activities.

Children may be at risk of physical harm if drugs and paraphernalia, e.g. needles, are not kept safely out of reach. Some children have been killed through inadvertent access to drugs, e.g. methadone stored in a fridge. In addition, children may be in danger if they are a passenger in a car whilst a drug/alcohol misusing carer is driving.

The risk will be greater when the adult's substance misuse is chaotic or otherwise out of control. Children are particularly vulnerable when parents are withdrawing from drugs.

The children of substance misusing parents are at increased risk themselves of developing drug and alcohol problems.

   Substance Misuse and Unborn Babies

Maternal substance misuse in pregnancy can have serious effects on the health and development of the unborn baby.

If there are concerns that an unborn baby is at risk of significant harm, a referral should be made to Children’s Social Care without delay.

35 Powers of entry: Police powers

Whenever concern is expressed to the Police about a child, Officers should take positive steps to see the child to establish the child’s welfare.

This concern may come from an incident that Police are dealing with or it may be a request from a partner agencies. It is important to note that there are a number of agencies and professionals who work in partnership with the Police to safeguard children e.g. Social Workers and Health Visitors. They will only ask for Police assistance when absolutely necessary. Police should deal with such requests positively, remembering that these professionals do not enjoy the same powers of entry that Police Officers do.

Checking on a child’s welfare should be with the consent of the parent or carer where possible. If an offence is reasonably suspected or there is a reasonable suspicion of harm an officer will be acting legally in obtaining entry, with or without consent. It may be that refusal to allow entry by a parent or carer arouses suspicion that a child has been harmed and indicates an intention to conceal that harm.

The exercise of powers of entry in order to protect children and respond to suspicions of child abuse should generally be considered reasonable within the Human Rights Act 1998. Police Officers should record in their notebook their reasons for taking action.

 36 'Prevent' - preventing terrorism

What is Channel?

Channel is a key element of the Prevent Strategy. It is a Home Office publication designed to stop people becoming terrorists or supporting terrorism. Channel is a multi-agency approach to protect people at risk from radicalisation using existing collaboration between local authorities, statutory partners, the police and local community to

  • Identify individuals at risk of being drawn into terrorism
  • Assess the nature and extent of that risk and
  • Develop the most appropriate support plan for the individual concerned

It is about early intervention diverting people away from the risk they face. In order to do this, information sharing is crucial. Section 115 of the Crime and Disorder Act 1998 allows partners to share personalised and depersonalised information for the purposes of reducing crime and disorder and therefore covers us in relation to the needs of Prevent.

When should I refer?

If you have information that suggests an individual is exhibiting behaviour or making comments that suggest he/she may be involved in activity which could be linked to terrorism. For example:

  • Accessing information on the internet with links to terrorist activity
  • Use of extreme right wing symbols
  • Significant changes in behaviour
  • Spending significant periods of time alone, withdrawal from social interaction
  • Sudden and obsessive interest in topical terrorist related news stories
  • Use of terminology or words associated with terrorism

NOTICE, CHECK, SHARE

Once a concern is raised (NOTICE) it is important to check whether any further action should be taken. The Prevent Lead within City of York Council is:

Jane Mowat, Head of Community Safety 01904 555742, 07984496352 or email jane.mowat@york.gov.uk

If you feel that there is threat to life for the individual or others, you must report the matter to the police on 999.

Police Channel Officers are DC Carolyn Hardman & DC Julie Whitehouse. They can be contacted by dialling 101 and following the instructions or by email on:

 Carolyn.hardman@northyorkshire.pnn.police.uk

Julie.whitehouse@northyorkshire.pnn.police.uk

Local 'prevent' guidance and a flowchart is available here.

37 Pregnancy and motherhood of a child

Professionals have a responsibility to consider the welfare of both the prospective mother and her baby. However, the paramount concern must be for the welfare of the baby, and there should be no circumstances in which concerns about the baby are not shared and investigated for fear of damaging a relationship with a young parent.

Where a parent is herself a child, in the absence of support for her needs and responsibilities, her baby could be at risk of significant harm, primarily through neglect or emotional abuse.

   Mother under 16 years

Professionals in all agencies should be alert to situations where a teenage mother is not in contact with Children’s Social Care. If she is under 16, then a referral should be made to Children’s Social Care at the earliest opportunity, Children’s Social Care should undertake an assessment of the unborn child’s needs and any potential risk of harm posed to them from the mother’s needs and circumstances, including the mother’s relationship with the father / current partner.

   Mother over 16 years

If a young mother is over 16, professionals should:

  • Make an assessment of the risk of harm to the baby, consulting their agency’s child protection adviser as appropriate;
  • Assess the risk of harm to the mother through her relationship with the father / current partner.

If, on the basis of these assessments, a professional has concerns about the ability of a young mother over the age of 16 to care for her baby without additional support, then a referral should be made to Children’s Social Care.

  38 Pre-trial therapy

One or more assessment interviews should be conducted in order to determine whether and in what way the child is emotionally disturbed, and also whether therapeutic treatment is needed. This could be as part of an assessment undertaken using the Assessment Framework.

The decision about the need for therapeutic support (separate from formal court preparation of a child witness) should be considered:

  • Keeping the child’s interests paramount;
  • Taking the child’s wishes and feelings into account;
  • On a multi-agency basis;
  • In consultation with the child’s parent/s;
  • Taking the potential impact on criminal proceedings into account.

The decision should normally be made following a professional assessment of the child’s need for therapy, and may be taken as part of a strategy meeting or in a child protection conference, or, if the child is not subject to child protection processes, in a multi-agency meeting arranged for this purpose.

If there is a demonstrable need for the provision of therapy and it is possible that the therapy will prejudice the criminal proceedings, consideration may need to be given to abandoning those proceedings in the interests of the child. Alternatively, there may be some children for whom it will be preferable to delay therapy until after the criminal case has been heard, to avoid the benefits of the therapy being undone.

While some forms of therapy may undermine the evidence given by the witness, this will not automatically be the case. Multi-agency advice must be sought on the likely impact on the evidence of the child receiving therapy.

An assessment may be needed to inform a decision on whether a child with special needs (e.g. disabled children and those with learning disabilities, hearing and speech impairments etc) can, with the appropriate assistance, be a competent witness.

Therapeutic support may be sought / offered through a number of routes. Professionals who provide therapeutic support to children must be aware of the guidance Provision of Therapy for Child Witnesses (Home Office / CPS / DoH 2001, available at www.cps.gov.uk and the implications for the criminal process in terms of both disclosure and contamination of evidence.

The initial joint investigative interview with the child, including any visually recorded interview, should be undertaken prior to any new therapeutic work in order that the original disclosure is not undermined.

Where it becomes apparent that a child is already receiving therapeutic support at the point of the criminal investigations and child protection enquiries, there must be discussion as to how the work should proceed. The fact that therapeutic work is already underway will not necessarily prevent a case proceeding before a criminal court. Prosecutors may need to be made aware of the contents of the therapy sessions, as well as other details specified in the above paragraph, when considering whether or not to prosecute and their duties of disclosure.

   Crown Prosecution Service

The police should inform the Crown Prosecution Service as soon as therapeutic support is recommended, using a named contact point for the case relating to the child. Direct consultation between the professionals may be advisable in some cases and should be arranged through the police officer in the case.

The Crown Prosecution Service should advise the police of the potential impact of any proposed therapeutic support on criminal proceedings in each individual case. It is the responsibility of the reviewing crown prosecution lawyer to seek confirmation from the police as to:

  • Whether therapeutic work has been undertaken;
  • If so, whether the witness said anything inconsistent with the disclosure to the police;
  • What sort of therapeutic work was undertaken.

   Therapeutic services

Professionals who provide therapeutic support to children must have appropriate training according to the level of work to be undertaken, as well as a thorough understanding of the effects of abuse. They must be a member of an appropriate professional body or have other recognised competence. They must also have a good understanding of how the rules of evidence for witnesses in criminal proceedings may require modification of techniques.

   Pre-trial planning meeting

Where it is considered that therapeutic intervention is appropriate and has been commissioned, a pre-trial planning meeting should be convened.

Where Children’s Social Care is involved with the child, the Deputy Service Manager/ Service Manager should convene and chair the meeting, and arrange for a formal record of it to be made. Where Children’s Social Care is not involved, the therapeutic service commissioned to undertake work, or already involved with the child, should convene the meeting. A formal record of the meeting should be made, and it should be noted that this may be disclosed in criminal proceedings.

Pre-trial planning meetings will involve relevant professionals from Children’s Social Care, police and the service offering therapeutic work. They may also include:

  • Parents (unless implicated in the alleged abuse);
  • The child, if of sufficient age and understanding;
  • Other relevant professionals.

   Considerations at the pre-trial therapy meeting

The purpose of the pre-trial meeting is to:

  • Confirm that therapeutic intervention is in the best interests of the child (including taking into account the child’s right to justice);
  • Agree the parameters and nature of any proposed therapeutic support, ensuring that the process is subject to regular review;
  • Agree lines of communication between the professional who will undertake the work and other professionals.

In deciding on what therapeutic support is appropriate to pursue pre-trial, the following considerations apply:

  • Therapeutic support is on an individual basis (i.e. no joint or group sessions are normally acceptable because of the increased risk of contamination of evidence);
  • Where joint or group sessions are already in progress, the implications for continuing must be considered, and in addition the particular implications for recording what take place.
  • Therapeutic support may be subject to challenge at court.

Therefore, it is better that only one worker provides the support.

   Therapy

The professional providing therapeutic support must be able to demonstrate professional competence or a sufficient level of supervision if called in a subsequent trial.

If, during a therapeutic session, a child refers to the abuse they have suffered, the worker should:

  • Listen and acknowledge what has been said;
  • Not seek clarification or ask probing or investigative questions;
  • Consider whether there is new or additional allegations or information which require urgent discussion with the police / social worker.

The professional who will provide therapeutic support should be given sufficient information about the nature of the abuse alleged by the child to be able to judge if the child begins to make new or additional allegations within a session.

Care should be taken in the recording of therapeutic sessions (videos, tapes and written records). Immediate, factual, concise and accurate notes must be made for each session, which must be retained in their original format so that they can be produced at a later date if required. Any notes, visual or audio recordings, pictures etc. used during the therapeutic sessions must be similarly maintained.

A pro-forma document will be completed following each session and will include:

  • Date and location of session;
  • Duration of session;
  • Details of the professional undertaking the work with the child;
  • Details of child;
  • Details of other professionals present;
  • Confirmation that records of the therapy sessions have been made.

The pro-forma documents will be copied prior to any criminal trial and the original document forwarded to the Crown Prosecution Service via the police.

   Confidentiality not guaranteed

The professional undertaking therapeutic work needs to ensure that parents and any child of sufficient age and understanding are told that records are kept and that confidentiality cannot be guaranteed.

Any disclosure of new allegations by the child, or any material departure from or inconsistency with the original allegations should be reported to the Police Protecting Vulnerable Persons Unit and to the child’s social worker.

In newly arising allegations, therapy should not usually take place before a witness has provided a statement or, if appropriate, before a video-recorded interview has taken place. A further pre-trial planning meeting will be convened at the earliest opportunity to determine and agree the best course of action in the light of the new information or allegations.

   Problem resolution

Any dissatisfaction should be resolved as simply as possible. This would normally be via discussion between the social worker, the professional providing the therapeutic support and the police officer in the criminal case. Where disputes remain, a further pre-trial planning meeting should be convened with the Crown Prosecution Service, and involving appropriately senior agency representatives.

39 Private Fostering

Private fostering is when children and young people are cared for on a full time basis by a person who is not their parent, a person with parental responsibility or a “relative”. Private fostering arrangements are those where it is intended for the placement to be of 28 days or more. They are generally made with the agreement of the child’s parent, but this may not necessarily be the case.

Private fostering only applies to children under 16 years, or under 18 if they are disabled.

Private foster carers can be part of the child’s wider family, a friend of the family, the parents of the child’s boyfriend or girlfriend or someone unknown but willing to foster a child. Relatives, as defined by the Children Act 1989 to include a grandparent, brother, sister, uncle or aunt (whether of full or half blood or by marriage), or a step-parent, are not private foster carers. Note that the unmarried partner of a parent is not a “step-parent” for this purpose and will be considered to be a private foster carer.

A large range of children can be covered by these arrangements, including:

  • children (sometimes very young) where a parent is unable to care for them because of chronic ill health or where there are alcohol, drug or mental health issues. Sometimes the parent may be in prison;
  • adolescents temporarily estranged from their parents;
  • children in services families where parents are posted overseas;
  • children from overseas where parents are not resident in this country;
  • children from abroad who attend a language school or mainstream school in England, staying with host families.

The Chair of the City of York Safeguarding Children Board will receive a report from the local authority every year about how the welfare of privately fostered children is safeguarded and promoted, including how they cooperate with other agencies in this area.

   Making arrangements

Any parent proposing to have their child looked after by someone other than a close relative for more than 28 days, or a carer who is proposing to look after someone else’s child, must notify Children’s Social Care at least 6 weeks before the arrangement is due to begin.

This is known as a proposed arrangement. In these circumstances the Contact Centre should be contacted in writing and the referral will be passed on to the relevant geographical social work team.

The social work team will make arrangements to see the child, the child’s parents (if possible), the carers and other members of the carer’s household. An assessment will be made about the suitability of the proposed arrangements, including Enhanced Criminal Record Bureau checks on all members of the household aged over 16 years.

Where a private fostering arrangement is existing or is an emergency arrangement the carer or parent must tell Children’s Social Care within 48 hours of receiving the child. A social worker will visit within 7 days to see the child, the child’s parents (if possible), the carers and other members of the carer’s household. An assessment will be made about the suitability of the arrangements, as in the paragraph above.

   Where arrangements are suitable

Where the decision is taken that the arrangements are suitable a social worker will visit the child every 6 weeks during the first year and then every 12 weeks thereafter. Their role is to promote the welfare of the child and check that arrangements are still suitable. The social worker will also provide advice and support to the carers and the parents.

The social worker should make sure the child’s racial, cultural, linguistic and religious needs are being met. The social worker should see the child alone on each visit and will write a record of each visit.

If there are any changes in circumstances the private foster carer should inform the social worker. Likewise the carer or parent (person with parental responsibility) must notify Children’s Social Care immediately about any change in circumstances, including if the child changes address, someone living in the household is convicted of an offence, or someone joins or leaves the household.

   Where arrangements are not suitable

Where the assessment decides that the arrangements are not suitable Children’s Social Care has a number of powers, in addition to their existing powers, to take action to safeguard and promote the child’s welfare. Steps may need to be taken to secure the care and accommodation of the child. Actions can include stopping someone from privately fostering children or setting limits to how they care for children. Some people are not allowed to become private foster carers and others can be prohibited if they are not seen as suitable carers.

   The roles of other professionals

Wherever professionals become aware of an existing or proposed private fostering arrangement they should encourage the child’s parent or carer to notify Children’s Social Care.

Professionals who come into contact with privately fostered children – such as teachers, religious leaders, doctors and health visitors – are required to tell Children’s Social Care about the private fostering arrangement so that Children’s Social Care can carry out their duty to safeguard the child. Professionals should refer the privately fostered child through the Contact Centre.

40 Prostitution: Parental involvement in prostitution

Involvement of family members in prostitution does not necessarily mean children will suffer significant harm.

Where there is a concern for a child whose parent or carer is involved in prostitution the following factors should be considered when undertaking an Initial Assessment:

  • Any exposure of the child to unsuitable adults and sexual activity or materials especially where the parent works from home;
  • Any emotional, physical or sexual abuse of the parent or any behaviour in another adult which leaves the parent involved in prostitution in fear;
  • Child left unattended or being left with the responsibility of younger siblings;
  • Factors associated with substance misuse and/or mental health difficulties;
  • Inconsistent care.

Where there is a concern for a child whose parent is involved in prostitution, the Core Assessment should always consider the child’s development in the context of parenting capacity and family and environmental factors.

41 Psychiatric care of children

   Psychiatric care for children

Children who require treatment as an in-patient in a psychiatric setting will usually be admitted on a voluntary basis, otherwise the Mental Health Act 1983 or the Children Act 1989 will apply. The admission criteria will differ, such as acute (crisis or short term), for eating disorders or challenging behaviour. Age ranges can vary considerably and some children may be admitted to an adult psychiatric setting. Catchment areas for some hospitals may cover a regional or national area depending on the specialism.

Where consent for treatment is required, it should be clarified by the lead professional (e.g. Children’s Social Care, child and adolescent mental health services (CAMHS)) whether this is being carried out under the Mental Health Act 1983 or the Children Act 1989.

If any child who is considered to be Gillick competent is unwilling to remain as an informal patient consideration should be given to use the Mental Health Act 1983. For children under 16 where a Gillick competent child wishes to discharge him or herself as an informal patient from hospital, the contrary wishes of those with parental responsibility will ordinarily prevail. Where there is dispute consideration should be given to use the Act. Similarly if a 16 or 17 year old in unwilling to remain in hospital as an inpatient, consideration may need to be given whether he or she should be detained under the Act.

Children in psychiatric settings may need to be isolated from other patients or require control and restraint on occasions, and staff should be appropriately trained to meet their needs and safeguard their welfare. When a child is admitted to psychiatric settings where adults are inpatients, a risk assessment must be undertaken to avoid the child being placed in vulnerable situations.

Children admitted to psychiatric settings may disclose information about abuse or neglect concerning themselves or others. Disclosures may be made when the child feels it is safe to talk or when the child is angry, distressed or anxious. All allegations should be treated seriously and usual procedures followed.

   Children visiting psychiatric wards and facilities

Visits by children to psychiatric wards or hospitals should be undertaken to maintain a positive relationship for the child with the patient, who will usually be their parent or more rarely a family member such as a sibling. A visit by a child should only take place if it is in their best interest.

This section applies to children visiting all patients receiving in-patient treatment and care from specialist psychiatric services, whether or not they are detained under the Mental Health Act 1983. This includes children visiting detained adolescent patients and adolescents who are being cared for in adult facilities.

   Visiting patients in psychiatric wards

When children visit adult patients, all psychiatric in-patient settings should:

  • Place child welfare at the heart of professional practice for all staff involved in the assessment, treatment and care of patients;
  • Take account of the needs and wishes of children as well as patients;
  • Address the whole process, including preadmission assessment, admission, care planning, discharge and aftercare;
  • Assess the desirability of contact between the child and patient, identify concerns and assess the potential risks of harm to the child in a timely way;
  • Establish an efficient procedure for dealing with requests for child visits in those cases where concerns exist;
  • Establish a process for child visits which is:
    • Not bureaucratic;
    • Supportive of both the child and the adult;
    • Does not cause delay in arranging contact;
    • Maximises the therapeutic value of the visit;
    • Ensures the child’s welfare is safeguarded.
    • Set and maintain standards for the provision of facilities for child visiting;
    • Ensure that staff are competent to manage the process of child visits.

   Compulsory admission

When a compulsory admission is planned for an adult who is a parent, the approved social worker must assess the child/ren’s needs and the suitability of arrangements for their care. If there are concerns about the safety or care arrangements of the child/ren, the approved social worker must request that Children’s Social Care undertakes an assessment. Children’s Social Care should make a recommendation to the hospital about the suitability of the children visiting their parent.

The approved social worker should, wherever possible, provide the hospital with the child/ren’s assessment information. This may, as appropriate, include the recommendation made by Children’s Social Care when the patient was admitted, together with the views of those with parental responsibility about the child/ren visiting the patient in hospital.

   Expected visit by a child

The ward manager is responsible for the decision to allow a visit by a child. When a visit by a child is expected, the ward manager should consider the available information about the child, alongside the assessment of the patient’s needs for treatment and care and an assessment of the current state of the patient's mental health. The ward manager should then make the decision in consultation with other members of the multi-disciplinary hospital team.

The ward manager must make their decision on the basis of the interests of the child being paramount, superseding those of the adult patient.

   Unexpected visit by a child

If a child visits unexpectedly, the ward manager is responsible for deciding whether it is feasible, whilst they wait, to consider the available information 18 The Guidance on the Visiting of Psychiatric Patients by Children HSC 1999/222; and LAC (99) 32: Mental Health Act 1983 code of practice : guidance on the visiting of psychiatric patients by children about the child, alongside the assessment of the patient’s needs for treatment and care and an assessment of the current state of the patient's mental health. The ward manager should then make the decision in consultation with other members of the multi-disciplinary hospital team. If this is not feasible, the visit must be refused.

   Patients admitted informally

Most patients are admitted informally. When a patient has been admitted on an informal basis, nursing staff should seek out information about children who may be visiting. When nursing staff are aware that a patient has a child, and there is a LA children’s social worker or adult mental health care coordinator working with the patient, nursing staff should check with the social worker / care co-ordinator about the desirability of children visiting and the arrangements which have been made. Such discussions should be clearly documented.

If there are concerns about the safety or care arrangements of the child/ren and there is no LA children’s social worker involved, the ward manager must request that Children’s Social Care undertake an assessment. Children’s Social Care should make a recommendation to the hospital about the suitability of the child/ren visiting the patient.

Where Children’s Social Care has been asked to undertake such an assessment, their report should be sent back within one week of receipt of the written request / referral from the ward manager in order to avoid delay in arrangements for the child.

The ward manager is responsible for the decision to allow a visit by a child, and must follow the same decision making process for informal admissions and for compulsory admission.

In the vast majority of cases where no concerns have been identified, arrangements should be made to support the patient and child and to facilitate contact.

   Identifying concerns

Concerns about the desirability of a child visiting may arise in a number of areas. These could relate to:

  • Consideration of the child’s best interests;
  • The patient’s history and family situation;
  • The patient’s current mental state (which may differ from an assessment made immediately prior to or on admission);
  • The response by the child to the patient’s illness;
  • The wishes and feelings of the child;
  • The developmental age and emotional needs of the child;
  • The views of those with parental responsibility;
  • The nature of the service and the patient population as a whole;
  • Availability of a suitable environment for contact.

The hospital multi-disciplinary team may use the Framework for Assessing Children in Need and their Families to consider the best interests of the child in these situations.

A range of options may present themselves when concerns are identified in any of the areas above, and the concerns need not automatically result in a refusal of visiting. The hospital multi-disciplinary team must obtain a balance between the management of risk of harm and the interests of the child/ren and patients.

It may be helpful for the Hospital Trust to consider whether or not to provide a service to facilitate contact. Research has highlighted the dangers of loss of contact with children for people who are psychiatric in-patients in hospital. Decisions to refuse a child’s visits

The ward manager may refuse to allow a child to visit if they have reason to believe it is not in the best interest of the child or patient.

The decision to prohibit a visit should be regarded as a serious interference with the rights of the patient and should only be taken in exceptional circumstances.

Decisions to refuse visits should be given verbally and confirmed in writing. They must be supported by clear evidence of concerns and the difficulties of managing them.

Policies should clearly set out the steps to be taken in making the decision to refuse visiting, including the process for:

  • Consulting with the patient, the child (depending on age and understanding), those with parental responsibility and, if different, person/s with day to day care for the child, advocates and, where relevant, the Children’s Social Care;
  • Communicating the decision to the patient, other family members, the child and those with parental responsibility;
  • Reviewing any decision and the means of communicating this to the patient, advocate or other person or agency involved in the decision;
  • Enabling a patient and others with parental responsibility to make representation against any decision not to visit, including access to assistance and independent advocacy. Such a system should be consistent with the Trust’s overall complaints procedure and should contain an independent element.

   Making arrangements for visits

The hospital or mental health trust providing the service must ensure that the hospital contains facilities for all patients to have contact with their children in a venue which is conducive to the child’s safety and good quality contact for both child and patient.

Children should have appropriate supervision according to their age and need when they are visiting mental health service users. They should normally be accompanied by someone who has parental responsibility for their care and well being.

In some cases, it may be better for arrangements to be made for visiting away from the hospital. In the case of detained patients, this will require due consideration of the need for leave. Staff must be aware of the child protection and child welfare issues in granting leave of absence under s.17 of the Mental Health Act 1983.

   Visiting patients in the special hospitals:

Ashworth, Broadmoor and Rampton Specialist hospitals must have procedures for child visiting that have been developed specifically for that service. Decisions about whether to permit a child to visit a unit must always be based on:

  • The interests of the child;
  • The service user’s offending history;
  • The clinical history of the service user;
  • The conditions under which the visit will take place.

A hospital may not allow a child to visit any patient unless the hospital’s authority has approved the visit in accordance with the directions pertaining to the patient’s admission (see The Directions and associated guidance to Ashworth, Broadmoor and Rampton Hospital Authorities (HSC 1999/160)) and in particular is satisfied that the visit is in the child’s best interests. The only exception to this is where there is a contact order made under the Children Act 1989 which specifies that the child may visit the patient in the special hospital. In such cases, visits should be allowed except where there are concerns about the patient’s mental state at the time of the proposed visit, such that the nominated officer decides the visit would not be in the child’s best interests.

   Request for a child to visit

There may be cases where the patient has been:

  • Convicted of murder or manslaughter, or an offence which leads to them being identified (by probation / youth offending services, police or health services, individually or via the Multi-Agency Public Protection Arrangements) as posing an ongoing risk to a child; or
  • Found unfit to be tried or not guilty by reason of insanity, in respect of a charge of murder or manslaughter or an offence which leads to them being identified (by probation / youth offending services, police or health services, individually or via the Multi-Agency Public Protection Arrangements) as posing an ongoing risk to a child, In these circumstance, the child must be within the permitted categories of relationship set out in The Directions and associated guidance to Ashworth, Broadmoor and Rampton Hospital Authorities (HSC 1999/160).

If the patient’s circumstances are not those in section or the child is within the permitted categories of relationship, the nominated officer should:

  • Obtain written permission from the patient to contact those with parental responsibility for the child;
  • Write to the person/s with parental responsibility for the child:
    • Explaining that a request for a visit has been made;
    • Asking for confirmation of the relationship between the patient and the child;
    • Requesting consent for the child to visit the patient;
    • Explaining that before a visit can proceed, Children’s Social Care will be asked to assess whether the visit is in the child’s best interests.
  • Write to any person/s without parental responsibility but with day-to-day care for the child (e.g. a grandparent), explaining that a request for a visit has been made and that the person with parental responsibility will be contacted.

In the case of a child who is looked after by the local authority and subject to a care order (with parental responsibility shared by the local authority and the parent/s), Children’s Social Care has responsibility for providing consent (following consultation with those with parental responsibility). Where a child is looked after by the local authority but not subject to a care order, the person with parental responsibility is required to give their consent.

If those with parental responsibility state that they are prepared to allow their child to visit the patient, the nominated officer should arrange for the patient's clinical team to undertake an assessment. This assessment is to judge the level of risk, if any, presented by the patient to children and to the particular child for whom the visit request has been made. Procedures for undertaking this type of assessment should be agreed with both the relevant Children’s Social Care service and Local Safeguarding Children Board for the hospital.

If the hospital's assessment of the risk of harm posed by the patient to the child does not rule out a visit, the nominated officer must:

  • Contact the Director of Children’s Services for the Children’s Social Care service where the child resides to request advice on whether the visit is in the best interests of the child;
  • Include in the request a copy of the hospital's assessment and any other any relevant information about the patient, to assist Children’s Social Care to assess whether the proposed visit is in the child’s best interests;
  • Include in the request any information about other Children’s Social Care services which have relevant information about the child or the child's family;
  • Inform the parents of the child that Children’s Social Care have been asked to make contact with the family.

   Children’s Social Care response

On receipt of the request from the hospital, Children’s Social Care should contact those with parental responsibility (and those caring for the child if they are different) to arrange to undertake an assessment to establish:

  • The child's legal relationship with the named patient;
  • The quality of the child's relationship with the named patient, prior to hospitalisation and currently;
  • Whether there has been past abuse of the child, alleged or confirmed, by the patient;
  • The likelihood of future risks of significant harm to the child if the visits took place;
  • The child's wishes and feelings about the visit, taking account of their age and understanding;
  • The views of those with parental responsibility and, if different, person/s with day-to-day care for the child;

If it is known the child has lived in other Children’s Social Care areas, what other relevant information is known about the child and family; the frequency of contact that would be appropriate.

Children’s Social Care should send the completed assessment report to the nominated officer, advising whether the visit would be in the best interests of the child.

If Children’s Social Care advises that a visit would be in the child's best interests, the nominated officer should discuss this with Children’s Social Care and make a decision about the visit, taking account of any potential risk posed by the patient and the potential risk of significant harm being suffered by the child.

If the person/s with parental responsibility refuses to co-operate with the LA Children’s Social Care assessment, Children’s Social Care should consider its legal position:

  • If the child is known to Children’s Social Care, it could make its report on the basis of the information it has already but make clear that the information is not up to date and does not take account of the wishes and feelings of the child;
  • If Children’s Social Care holds no information about the child, it should inform the hospital that it is unable to make any report.

   The visit

Any visits by children must:

  • Take place in an appropriate atmosphere and setting (i.e. child-centred and child-friendly), taking account of the age of the children (as advised by the Children’s Social Care service local to the hospital) whilst maintaining the required level of security;
  • Be properly supervised throughout the visit, with sufficient staff present (of an appropriate grade and with requisite knowledge and understanding and enhanced Criminal Record Bureau checks – for children, not just vulnerable adults) to supervise the children's visits at all times and to prevent unauthorised contacts;
  • Allow the child contact with only the named patient for whom a visit has been approved. No children are to visit on the ward areas.

The nominated officer must ensure that a child's contact with a patient within the hospital takes place at a frequency which is in the child's best interests, taking account of advice from Children’s Social Care. All visits by children shall be specifically authorised by the nominated officer.

   Refusing a visit

There are five circumstances in which the nominated officer must refuse to allow a child to visit. These are if:

  • The relationship between the patient and the child is not within the permitted categories of relationship as set out in paragraph 2(2)(b) of the Directions. The nominated officer must notify the patient of the decision and reasons for it in writing. However, the patient has no right to make representations against this decision;
  • The person/s with parental responsibility responds to the nominated officer stating that they do not agree to the child visiting the patient. The decision and the reasons for the decision must be put in writing to the patient;
  • The hospital's assessment indicates that the patient's mental health state and/or risk to children is such (in the immediate or longer term) that it would not be appropriate for the child to visit the patient. The decision to refuse the visit must be put in writing to the patient and the person with parental responsibility and include details of the complaints procedure;
  • The relevant Children’s Social Care service concludes that a visit is not or may not be in the child's best interests. The decision to refuse the visit must be put in writing to the patient, the child (if appropriate), those with parental responsibility, person/s with day to day care for the child, if different, and Children’s Social Care.
  • Details of the review procedure should be given.
  • There are concerns about the patient’s mental state at the time of the visit. The reasons for the refusal should be explained to the patient, those with parental responsibility, person/s with day to day care for the child, if different, and, if appropriate, the child.
  • The Directions and associated guidance to Ashworth, Broadmoor and Rampton Hospital Authorities (HSC 1999/160) sets out the assessment process to be followed when deciding whether a child can visit a named patient in these hospitals; and LAC(99)23 sets out local authority duties and responsibilities assist the hospital by assessing whether it is in the interests of the child to visit the patient.

42 Psychiatric wards and facilities (children visiting)

Visits by children to psychiatric wards or hospitals should be undertaken to maintain a positive relationship for the child with the patient, who will usually be their parent or more rarely a family member such as a sibling. A visit by a child should only take place if it is in their best interest.

When a child visits a psychiatric ward or hospital, they could be at risk of significant harm through physical, sexual and/or emotional harm.

This section applies to children visiting all patients receiving in-patient treatment and care from specialist psychiatric services, whether or not they are detained under the Mental Health Act 1983. This includes children visiting detained adolescent patients and adolescents who are being cared for in adult facilities.

   Visiting patients in psychiatric wards

When children visit adult patients, all psychiatric in-patient settings should:

  • Place child welfare at the heart of professional practice for all staff involved in the assessment, treatment and care of patients;
  • Take account of the needs and wishes of children as well as patients;
  • Address the whole process, including preadmission assessment, admission, care planning, discharge and aftercare;
  • Assess the desirability of contact between the child and patient, identify concerns and assess the potential risks of harm to the child in a timely way;
  • Establish an efficient procedure for dealing with requests for child visits in those cases where concerns exist.
  • Establish a process for child visits which is:
  • Not bureaucratic;
  • Supportive of both the child and the adult;
  • Does not cause delay in arranging contact;
  • Maximises the therapeutic value of the visit;
  • Ensures the child’s welfare is safeguarded.
  • Set and maintain standards for the provision of facilities for child visiting;
  • Ensure that staff are competent to manage the process of child visits.

   Pre-visit arrangements

   Compulsory admission

When a compulsory admission is planned for an adult who is a parent, the approved social worker must assess the child/ren’s needs and the suitability of arrangements for their care. If there are concerns about the safety or care arrangements of the child/ren, the approved social worker must request that Children’s Social Care undertakes an assessment.

Children’s Social Care should make a recommendation to the hospital about the suitability of the children visiting their parent. The approved social worker should, wherever possible, provide the hospital with the child/ren’s assessment information. This may, as appropriate, include the recommendation made by Children’s Social Care when the patient was admitted, together with the views of those with parental responsibility about the child/ren visiting the patient in hospital.

   Expected visit by a child

The ward manager is responsible for the decision to allow a visit by a child. When a visit by a child is expected, the ward manager should consider the available information about the child alongside the assessment of the patient’s needs for treatment and care and an assessment of the current state of the patient's mental health. The ward manager should then make the decision in consultation with other members of the multi-disciplinary hospital team. The ward manager must make their decision on the basis of the interests of the child being paramount, superseding those of the adult patient.

   Unexpected visit by a child

If a child visits unexpectedly, the ward manager is responsible for deciding whether it is feasible, whilst they wait, to consider the available information about the child alongside the assessment of the patient’s needs for treatment and care and an assessment of the current state of the patient's mental health. The ward manager should then make the decision in consultation with other members of the multi-disciplinary hospital team. If this is not feasible, the visit must be refused.

   Patients admitted informally

Most patients are admitted informally. When a patient has been admitted on an informal basis, nursing staff should seek out information about children who may be visiting. When nursing staff are aware that a patient has a child, and there is a children’s social worker or adult mental health care coordinator working with the patient, nursing staff should check with the social worker / care co-ordinator about the desirability of children visiting and the arrangements which have been made. Such discussions should be clearly documented.

If there are concerns about the safety or care arrangements of the child/ren and there is no children’s social worker involved, the ward manager must request that Children’s Social Care undertake an assessment. Children’s Social Care should make a recommendation to the hospital about the suitability of the child/ren visiting the patient.

Where Children’s Social Care has been asked to undertake such an assessment, their report should be sent back within one week of receipt of the referral from the ward manager in order to avoid delay in arrangements for the child.

The ward manager is responsible for the decision to allow a visit by a child, and must follow the same decision making process for informal admissions and for compulsory admission. In the vast majority of cases where no concerns have been identified, arrangements should be made to support the patient and child and to facilitate contact.

   Identifying concerns

Concerns about the desirability of a child visiting may arise in a number of areas. These could relate to:

Consideration of the child’s best interests;

The patient’s history and family situation;

The patient’s current mental state (which may differ from an assessment made immediately prior to or on admission);

  • The response by the child to the patient’s illness;
  • The wishes and feelings of the child;
  • The developmental age and emotional needs of the child;
  • The views of those with parental responsibility;
  • The nature of the service and the patient population.

A range of options may present themselves when concerns are identified in any of the areas above, and the concerns need not automatically result in a refusal of visiting. The hospital multi-disciplinary team must obtain a balance between the management of risk of harm and the interests of the child/ren and patients.

   Decisions to refuse a child’s visits

The ward manager may refuse to allow a child to visit if they have reason to believe it is not in the best interest of the child or patient.

The decision to prohibit a visit should be regarded as a serious interference with the rights of the patient and should only be taken in exceptional circumstances. Decisions to refuse visits should be given verbally and confirmed in writing. They must be supported by clear evidence of concerns and the difficulties of managing them.

Policies should clearly set out the steps to be taken in making the decision to refuse visiting, including the process for:

  • Consulting with the patient, the child (depending on age and understanding), those with parental responsibility and, if different, person/s with day to day care for the child, advocates and, where relevant, the Children’s Social Care;
  • Communicating the decision to the patient, other family members, the child and those with parental responsibility;
  • Reviewing any decision and the means of communicating this to the patient, advocate or other person or agency involved in the decision;
  • Enabling a patient and others with parental responsibility to make representation against any decision not to visit, including access to assistance and independent advocacy. Such a system should be consistent with the Trust’s overall complaints procedure and should contain an independent element.

   Making arrangements for visits

The hospital or mental health trust providing the service must ensure that the hospital contains facilities for all patients to have contact with their children in a venue which is conducive to the child’s safety and good quality contact for both child and patient.

Children should have appropriate supervision according to their age and need when they are visiting mental health service users. They should normally be accompanied by someone who has parental responsibility for their care and well being.

In some cases, it may be better for arrangements to be made for visiting away from the hospital. In the case of detained patients, this will require due consideration of the need for leave. Staff must be aware of the child protection and child welfare issues in granting leave of absence under s.17 of the Mental Health Act 1983.

   Visiting patients in the special hospitals: Ashworth, Broadmoor and Rampton

Specialist hospitals must have procedures for child visiting that have been developed specifically for that service. Decisions about whether to permit a child to visit a unit must always be based on:

  • The interests of the child;
  • The service user’s offending history;
  • The clinical history of the service user;
  • The conditions under which the visit will take place.

A hospital may not allow a child to visit any patient unless the hospital’s authority has approved the visit in accordance with the directions pertaining to the patient’s admission (see The Directions and associated guidance to Ashworth, Broadmoor and Rampton Hospital Authorities (HSC 1999/160)) and in particular is satisfied that the visit is in the child’s best interests.

The only exception to this is where there is a contact order made under the Children Act 1989 which specifies that the child may visit the patient in the special hospital. In such cases, visits should be allowed except where there are concerns about the patient’s mental state at the time of the proposed visit, such that the nominated officer decides the visit would not be in the child’s best interests.

   Request for a child to visit

There may be cases where the patient has been:

  • Convicted of murder or manslaughter, or an offence which leads to them being identified (by probation / youth justice, police or health services, individually or via the Multi-Agency Public Protection Arrangements) as posing an ongoing risk to a child; or
  • Found unfit to be tried or not guilty by reason of insanity, in respect of a charge of murder or manslaughter or an offence which leads to them being identified (by probation / youth justice services, police or health services, individually or via the Multi-Agency Public Protection Arrangements) as posing an ongoing risk to a child,

In these circumstances, the child must be within the permitted categories of relationship set out in The Directions and associated guidance to Ashworth. If the patient’s circumstances are not those sections above or the child is within the permitted categories of relationship, the nominated officer should:

Obtain written permission from the patient to contact those with parental responsibility for the child;

Write to the person/s with parental responsibility for the child:

  • Explaining that a request for a visit has been made;
  • Asking for confirmation of the relationship between the patient and the child;
  • Requesting consent for the child to visit the patient;
  • Explaining that before a visit can proceed, children’s social care will be asked to assess whether the visit is in the child’s best interests.

Write to any person/s without parental responsibility but with day to day care for the child (e.g. a grandparent), explaining that a request for a visit has been made and that the person with parental responsibility will be contacted.

In the case of a child who is looked after by the local authority and subject to a care order (with parental responsibility shared by the local authority and the parent/s), children’s social care has responsibility for providing consent (following consultation with those with parental responsibility).

Where a child is looked after by the local authority but not subject to a care order, the person with parental responsibility is required to give their consent.

If those with parental responsibility state that they are prepared to allow their child to visit the patient, the nominated officer should arrange for the patient's clinical team to undertake an assessment. This assessment is to judge the level of risk, if any, presented by the patient to children and to the particular child for whom the visit request has been made.

43 Racial and religious harassment

The experience of racism/and or religious harassment is likely to affect the responses of the child and family to the assessment and enquiry processes. All professionals involved with families who may be experiencing or who have in the past experienced racial or religious harassment should take account of race, culture and religion and the individual needs of the child and family.

Failure to protect a child from racism (whether it originates from within or outside of the family) or take action when racism is being alleged is likely to undermine all other efforts being made to promote the welfare of the child.

Children and families may suffer racial and/or religious harassment sufficient in frequency and seriousness to undermine parenting capacity. In responding to concerns about children in the family, full account needs to be taken of this context and every reasonable effort made to end the harassment.

44 Residential care

A child in residential care is vulnerable to physical, sexual or emotional abuse and / or neglect. If there are lapses in the care provided, the child can suffer to such a degree that it constitutes significant harm.

   Good quality care

The welfare and safety of children living in residential care should be promoted and provided for at a minimum, in line with the relevant National Minimum Standards (see www.ofsted.gov.uk), in all residential care settings.

All commissioners and providers of residential care services for children are responsible for ensuring that children are safeguarded. Commissioner contracts and provider procedures should be comprehensive and unambiguous in setting out the responsibilities and processes for safeguarding and promoting children’s welfare. Local Safeguarding Children

Boards should monitor the welfare of children living in residential care.

The standards for children living in residential care include that:

  • Children feel valued and respected and their self-esteem is promoted;
  • There is an openness on the part of the residential care service to the external world and external scrutiny, including contact with families and the wider community;
  • Residential care and support staff are trained in all aspects of safeguarding children, are alert to children’s vulnerabilities and risks of harm, and are knowledgeable about how to implement safeguarding children procedures;
  • Children who live in residential care are listened to and their views and concerns responded to;
  • Children have ready access to a trusted adult outside the residential care setting (e.g. a family member, the child’s social worker, independent visitor, children’s advocate). Children should be made aware of the help they could receive from independent advocacy services, external mentors, and ChildLine
  • Residential care and support 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 the relevant children’s social care service;
  • In relation to complaints:
    • Complaints procedures should be clear, effective, user friendly and readily accessible to children and young people, including those with disabilities and those for whom English is not their preferred language;
    • Procedures should address all expressions of concern, including 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 which 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 boarding school which records all representations including complaints, the action taken to address them, and the outcomes);
    • Children should be genuinely able to raise concerns and make suggestions for changes and improvements, which are taken seriously.
  • 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, which extends to temporary staff and volunteers;
  • The residential care service contract 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 residential care and support staff about other staff or carers;
  • Organisations have a code of conduct instructing residential care and support 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 which do not prejudice the ‘whistle-blower’s’ own position and prospects;
  • There is respect for diversity and sensitivity to race, culture, religion, gender, sexuality and disability;
  • Residential care and support staff 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.

   Promoting and protecting a child’s welfare

It is important that children have a voice outside the residential unit. Social workers are required to see children in residential units on their own (taking appropriate account of the child’s wishes and feelings) at regular intervals and evidence of this should be recorded.

Residential carers should be provided with full information about the child and their family, including details of abuse or possible abuse and whether the child has harmed others, both in the interests of the child and of the staff and other children in the residential unit.

Residential carers should monitor the whereabouts of the children, including their patterns of absence and contacts. Residential carers should follow the recognised procedure of their agency on sharing general concerns about a child, and whenever a child is missing from the unit. This will involve notifying the placing authority and, where necessary, the police of any unauthorised absence by a child.

Residential carers should have guidance on sharing more general concerns (e.g. alerting other professionals, considering child behaviour around contact, absences, school, moods etc).

The local authority’s duty to undertake s47 enquiries, when there is reasonable cause to suspect that a child is suffering, or is likely to suffer, significant harm, applies on the same basis to children in residential care as it does to children who live with their own families.

Such enquiries will consider the safety of any other children living in the residential unit. If child protection concerns are raised about the care in a residential unit, the local authority in which the child is living has the responsibility to convene a strategy meeting / discussion, which should include representatives from the responsible local authority which placed the child; a representative from Ofsted should also be invited. At the strategy meeting / discussion, it should be decided which local authority should take responsibility for the next steps, which may include a s47 investigation.

45 Residence order or Special Guardianship Order made due to risk of significant harm

At times a Residence Order or Special Guardianship Order (SGO) will be granted to a family member/other person following court proceedings where Children’s Social Care have supported the making of the order because of the risk of significant harm if the child is in the care of the parent. .

Any parent seeking to resume the care of children should be advised to make application to the Court and/or to hold discussions with Children’s Social Care.

Any practitioner who is aware of the likelihood or actuality of a child returning to live with a parent in these circumstances is to refer to Children’s Social Care without delay.

Where the following applies, irrespective of whether Children’s Social Care have received a referral or they are anyway involved with the family, child protection procedures must be applied:

  • A child is, or was previously, at any stage, the subject of a Child Protection Plan and;
  • The Child Protection Plan was discontinued because the Conference believed the child would be cared for permanently by another person, through a Residence Order or SGO and;
  • The parent(s) wishes for, or is found to have resumed, the care of the child.

A multi-agency Strategy Meeting (not a Strategy Discussion) must be held, with a specific request for the involvement of the Police Protecting Vulnerable Person’s Unit and Health Named Nurse Child Protection and Education Child Protection Officer (where applicable).

Unless there are exceptional circumstances whereby all involved agreed there is no need to proceed further, which should be clearly recorded and explained, it is expected that the outcome of the Strategy Meeting would be a Section 47 enquiry and core assessment.

An arrangement should be made, at this point, for a timely further Strategy Meeting at which a decision is to be made as to whether a return to a Child Protection Conference is necessary.

46 Restraint/ Physical intervention by professionals

To be developed

47 Self harming and suicide behaviour

Any child or young person who self-harms or expresses thoughts about this or about suicide has to be taken seriously and appropriate help and intervention offered at that point.

   Definitions and Meanings (National Inquiry ‘Young People an Self-harm’)

The difference between suicide and deliberate self-harm is not always so clear. For example, deliberate self-harm is a common precursor to suicide, also children and young people who deliberately self-harm may kill themselves by accident.

 

   Responding to the Child or Young Person

In every case, the practitioner who is made aware that a child or young person has self-harmed, or is contemplating this or suicide, should talk with them without delay and:

  • Ascertain if they have taken any substances, including tablets, or injured themselves (if so, the child or young person should receive urgent medical attention, even if they appear well, as harmful effects can sometimes be delayed);
  • Try to find out what may be troubling them;
  • Explore to what extent self-harm is likely or imminent or planned;
  • Ascertain what help or support the child or young person would wish.

A supportive attitude, respect and understanding of the child or young person, along with a non-judgmental stance, is of prime importance. Note also that a child or young person who has a learning disability will find it more difficult to express their thoughts.

   Child or Young Person Requiring Hospital Treatment for Physical Harm

Where a child or young person requires hospital treatment in relation to physical self-harm, practice should be as follows, in line with the NICE 2004 guidance:

  • Triage, assessment and treatment for under 16’s should take place in a separate area of the Emergency Department;
  • There should be overnight admission to a Paediatric or Adolescent ward with detailed assessment the following day, with input from the CAMHS service;
  • Assessment should be undertaken by healthcare practitioners experienced in this field;
  • Assessment should follow the same principles as for adults who self-harm, but should also include a full assessment of the family, their social situation, family history and child protection issues
  • Initial management should include advising carers of the need to remove all medications or other means of self-harm available to the child or young person who has self-harmed;

Any child or young person who refuses admission should be reviewed by a senior Paediatrician in Accident and Emergency and, if necessary, their management discussed with the on-call Child and Adolescent Psychiatrist.

   Multi-agency Response

Duty/Access points in Children’s Social Care can advise whether the particular child’s circumstances warrant referral to Children’s Social Care as a child in need or whether other forms of multi-agency working would be more appropriate.

Wherever there is a serious concern for a child or young person, a multi-agency planning meeting should take place, without delay. Depending on the circumstances of the individual child, this may be arranged through, for example, hospital staff or by Children’s Social Care if the child is considered to be in need.

The purpose of the meeting is to:

  • Consider the concerns;
  • Devise a care plan to support the young person in the community;
  • Consider support services for the family;
  • Agree plans for an inter-agency assessment and management of risk.

Where the Young Person is a Carer for a Child or Pregnant

Where a young person, who is a carer for a child or is pregnant, self-harms, or threatens this, a referral must be made to Children’s Social Care in respect of the child/unborn baby.

Where Child/Young Person involved in Family Court Proceedings

Where the child or young person is currently the subject of Family Court Proceedings, whether public or private law, the Court must be informed of any self-harm or attempted suicide incident.

 48 Sexual Abuse by children and young people

Please click here to be directed to the procedure

49 Sexually exploited children

Full guidance is available here. This includes a CSE screening tool and the information sharing form. The CYSCB CSE screening tool is also available separately.

   Referral to Children’s Social Care

Children and young people, who are being sexually exploited through prostitution, or may be at risk of this, can come to the attention of any practitioner in any agency, including Health, Education, Voluntary Agencies, Housing, Street Angels etc.

Any child or young person in this situation is to be referred to Children’s Social Care. In all instances there is to be a response under Child Protection Procedures and a Strategy Meeting convened.

   Child/Young Person Comes to Notice of Police

Police Officers coming into contact with children and young people who are being exploited through prostitution will take the child or young person to the local police station or victim suite (or equivalent).

Children’s Social Care/Emergency Duty Team (or equivalent) will be contacted and asked to attend, within an hour, to undertake a joint risk assessment with the Police Officer and to identify a safe place where the child or young person can be taken. (If resources do not allow Children’s Social Care to send a member of staff within an hour it will at the discretion of the Police to decide if they can wait longer. If not, the Police will attempt to find a safe place for the child or young person to be taken and inform Children’s Social Care that this has occurred).

The risk assessment should seek to identify any perpetrator(s) or further risks to the child or young person, in accordance with ‘Achieving Best Evidence’. This will help establish how best any offence may be investigated. Any evidence that may assist in proving offences committed against the child or young person (e.g. CCTV, clothing, witnesses, medical, photographs, etc) should be secured. Any further risks to the child or young person also need to be identified.

Any medical examination for the child or young person should be undertaken in line with local inter-agency child protection procedures.

In identifying a safe place for the child or young person, consideration should be given to possible provision of accommodation by friends, family, fostering or residential services, giving consideration to the possible impact of the child or young person’s placement on carers, staff and other children and young people.

The Police Officer will share information with the local project (where these exist) that provides services for children and young people being sexually exploited. The Police Officer will also fax a written report giving details of the child or young person and the incident to the Police Protecting Vulnerable Person’s Unit.

   Child/Young Person Already Known to Children’s Social Care

The child or young person concerned may currently have Children’s Social Care involvement and be subject to some form of plan aimed at enabling the child or young person to exit the exploitation. Where information comes to light that the child or young person is continuing to be exploited through prostitution a new referral is required to Children’s Social Care. The Deputy Service Manager or Service Manager will decide whether to recall the core group for the child/young person or to convene a Strategy Meeting.

   Strategy Meeting

Children’s Social Care should convene a Strategy Meeting (as opposed to a telephone Strategy Discussion). This applies whether or not the referral was received from the Police.

Representatives from Police, Health, Education, and others involved with the child or young person, should attend. It is essential that a representative from any local specialist project, providing services to children and young people exploited through prostitution, be involved in the meeting.

In addition to the usual requirements of a Strategy Meeting, there should also be consideration of whether:

  • A parent or carer is involved in, or is condoning, the exploitation, or knowingly failing to prevent it;
  • The child or young person is living in an abusive environment e.g. a coercer’s residence, brothel or place where the child or young person has regular contact with child abusers or coercers;
  • The child or young person, or known acquaintance(s), have been moved into the region for the purpose of sexual exploitation, including the trafficking of children and young people;
  • Any of the information is relevant to agencies outside the local authority area and if so, make arrangements for this to be passed on.

The Strategy Meeting should initiate an Action Plan, irrespective of any other outcomes of the Strategy Meeting.

   Action Plan (see following page for template)

Children’s Social Care are responsible for ensuring that an Action Plan is in place. It should be initiated at the Strategy Meeting and developed on the basis of ongoing enquiry/assessment. At a maximum, an agreed robust inter-agency Action Plan should be in place within fifteen working days of referral.

Where the child or young person is not subject to an Initial Child Protection Conference, the Action Plan should be confirmed or finalised via a multi-agency Planning Meeting, to be held within fifteen working days of referral. Subsequent confirmation or revision of the Action Plan should take place at further Inter-agency Planning Meetings to review the situation of the child or young person. These should be held on a three month basis or more often if necessary.

Where the child or young person is subject to an Initial Child Protection Conference, the Action Plan should be confirmed or finalised via the Conference and reviewed through Review Conference/Core Group arrangements. If a Protection Plan is not made, the Action Plan should be confirmed or revised at three monthly Inter-agency Planning Meetings, or more often if necessary.

The child or young person should be involved as far as possible in planning in all of the above.

   Children moving into or re-entering a local authority area

Children and young people with inappropriate sexual behaviour who are re-entering the community following a custodial sentence or time in secure accommodation, or who move into the area from another local authority, require the multi-agency response described above. The response should be initiated at the earliest opportunity.

Where a child has been convicted of sexual offences involving the abuse of other children is released into the community, the MAPPA must be invoked to ensure the safety of the community in line with Section 12 of these procedures.

   Parents/Carers

It is essential that the role played by parents/carers be ascertained at an early point. They may be able to provide valuable information about the behaviour of the child or young person and any associated adults. They may be able to provide a key role in assisting the child or young person to exit the sexually exploitative situation and recover from its effects. On the other hand, a parent/carer may be actively involved in the child or young person’s exploitation or knowingly failing to prevent it.

In situations where a child or young person has been trafficked into the country, there is a possibility that the presenting parents/family are not, in reality, the family of the young person. Their identities and the nature of their relationship with the child or young person should be examined.

   Child Protection Conference

Following child protection enquiries, a Child Protection Conference should be held if the child or young person is at continuing risk of significant harm. Factors for consideration include:

  • A parent or carer is involved in, or is condoning, the exploitation, or is knowingly failing to prevent it;
  • The child or young person is living in an abusive environment e.g. a coercer's residence, brothel or place where the child or young person has regular contact with child abusers or coercers;
  • The child or young person’s level of co-operation and engagement with services is nil or low;
  • The child or young person has been moved into the region for the purpose of sexual exploitation, including the trafficking of children and young people into the country;
  • It is thought by agencies involved that holding a Child Protection Conference is necessary in order to protect the young person.

If a Child Protection Conference is held and the child or young person is made subject to a Protection Plan, this should include the Action Plan. If there is a decision that a Protection Plan is not necessary, the Action Plan should be confirmed/completed nonetheless.

   Prosecution of the Child or Young Person

Police powers to prosecute the child or young person should not be invoked unless there is a persistent, voluntary return to prostitution. The Police should consult with the other agencies involved before a decision is made to prosecute, or caution, the child or young person.

   Case Closures and Transfers

Children’s Social Care should continue with their involvement until the risk of actual or likely harm to the child or young person has been reduced, support needs have been addressed and recommendations from an inter-agency review (e.g. Child Protection Conference or inter-agency planning meeting) have been considered.

At the point of case closure by Children’s Social Care or transfer to another area, Children’s Social Care should ensure that other involved professionals are informed, including those who were involved in the Strategy Meeting/Discussion.

 If the child or young person moves permanently to another local authority area in the UK, Children’s Social Care should make a referral to the Children’s Social Care in the new area and make formal arrangements to hand over case responsibility.

If the child or young person leaves the UK, Children’s Social Care should provide the Children’s Social Care or equivalent in the receiving country with information in relation to the child protection/child in need concerns for that child or young person.

50 Sexually active under-age children and young people

   Introduction

This policy has been devised with the understanding that most young people under the age of 18 will have a healthy interest in sex and sexual relationships. It is designed to assist those working with young people to identify relationships which may be abusive and where young people may need protection or additional services

In developing this policy, the Safeguarding Children Board recognises that safeguarding children includes the provision of sexual health education and support, whilst protecting the child or young person from inappropriate or abusive sexual contact. It is therefore essential that children and young people are not deterred from accessing sexual health services and that a balance is struck that promotes a child or young person’s welfare.

   Identifying cause for concern

All young people regardless of gender, who are believed to be engaged in, or planning to be engaged in, sexual activity should have their needs for health education, support and/or protection assessed by the agency that has contact with them.

If you identify any concerns you must follow agency policies and local safeguarding procedures.

The considerations in the checklist (see below) should be taken into account when assessing the extent to which a child/young person (or other children/young people) may be suffering or at risk of harm.

If you have concerns that a young person may be at risk of sexual exploitation through prostitution, please refer to the relevant procedure.

For staff involved in giving contraceptive treatment to a young person, it is considered good practice for workers to follow the Fraser Guidelines.

Ongoing consideration should be given as to whether a young person’s circumstances have changed and/or if further information is given which may lead to the need for referral or re-referral.

In working with young people, it must always be made clear to them that absolute confidentiality cannot be guaranteed, and that there will be some circumstances where the needs of the young person can only be safeguarded by sharing information with others. This discussion with the child/young person may prove useful as a means of emphasising the gravity of some situations.

   Young people under the age of 13

In all cases where the sexually active young person is under the age of 13, there must be a discussion with the organisation’s child protection lead. There should be a presumption that a referral will be made to City of York Children’s Services and a strategy meeting held.

Where there are extenuating circumstances and a referral is not made, the professional and agency concerned is accountable for the decision and a good standard of record keeping must be made, including the reasons for not making a referral to Children’s Services (please see guidance).

Where a discussion is held with the child protection lead an enquiry should be made to the Child Protection Register. Telephone number 01904 555618.

When a girl under 13 is found to be pregnant, a referral to Children’s Services must be made, they will hold a strategy discussion with the police and/or other agencies and a multi agency support package should be formulated.

In cases of concern where sufficient information is known about the sexual partner/s the agency concerned should give this information to Children’s Services when referring who will check with the police and other agencies as appropriate.

Under the Sexual Offences Act 2003, children under the age of 13 are considered of insufficient age to give consent to sexual activity.

   Young people between 13 and 15

Sexually active young people in this age group should have their needs assessed by the agency which has contact with them to establish whether they are at risk of harm. Discussion with the child protection lead is not mandatory and will depend on the level of risk/need assessed by those working with the young person.

Where a discussion is held with the organisations child protection lead an enquiry should be made to the Child Protection Register.

Within this age range, the younger the child, the stronger the presumption must be that sexual activity will be a matter of concern.

In cases of concern, e.g. where a person is suspected of targeting a young person/s, and information is known about the person the agency concerned should share this information with their child protection lead who will check with the police Child Abuse Investigation Team to find out what is known about the person.

   Young people between 16 and 18

Young people under the age of 18 are still classed as children under the Children Act 1989. Although sexual activity in itself is not an offence over the age of 16, young people under the age of 18 are still offered the protection of the Child Protection Procedures.

Where young people are believed to have or have been sexually harmed a referral must be made to Children’s Services.

Where a person aged 18 or over is in a position of trust with a young person under 18, it is an offence for that person to engage in sexual activity with or in the presence of that child, or to cause or incite that child to engage in or watch sexual activity.

Consideration should be given to cases where it comes to light that a person under the age of 18 is sexually involved with someone who works with children and young people the City of York Safeguarding Children Board Allegations Against Staff Procedures must be followed.

   Sharing information with parents

Decisions to share information with parents will be taken using professional judgement and in consultation with the Child Protection Procedures. Decisions will be based on the level of risk involved.

Checklist

Organisations need to ensure that they incorporate the following information into their own paperwork.

 

Name

Age

DOB

Carer

School/College

 

 

Attending Yes/No

Clinic/Site

 

 

Contact details

Age of partner:

 

Name of partner:

 

Length of current relationship:

 

 

Does the Young person know that it is illegal to have sex under 16? (Statutory rape for under 13’s)

 

Yes/No

 

 

 

Further information/comments:

 

Signed ______________________________ Date____________ Time______

 

There is a need to balance the information and use your professional judgement as to whether the child is suffering or likely to suffer significant harm and the need for a referral to Children’s Services.

The following screening tool is intended to help with this decision

A discussion must take place with your agency child protection lead regarding the referral to Children’s Services in the following situations:

  • Familial child sex offences
  • Coercion or bribery
  • Overt aggression or power imbalance
  • The use of substances (alcohol or drugs) so that he/she is unable to make an informed choice about any activity
  • Any attempts to secure secrecy by the sexual partner (beyond what would be considered usual in a teenage relationship)
  • Use of methods consistent with grooming

The following factors may indicate a level of concern dependant on the details; a discussion with your agency child protection lead is regarded as good practice in the following situations:

  • An age imbalance
  • Unusual behaviour e.g. withdrawn or anxious
  • Lack of maturity and understanding
  • Whether the child denies, minimises or accepts concerns
  • Is the sexual partner/s known by one of the agencies
  • Are there any concerns about their living circumstances?

If you are unsure as to whether a referral should be made to Children’s Services you must consult with your agency lead for child protection and/or Children’s Services.

   Guidance

Most young people under the age of 18 will have a healthy interest in sex and sexual relationships. This guidance is designed to assist those working with young people to identify relationships, which may be abusive, and where young people may need protection or additional services.

In developing the guidance the CYSCB recognises that safeguarding children includes the provision of sexual health education and support, whilst protecting the child from inappropriate or abusive sexual contact. It is therefore essential that children and young people are not deterred from accessing sexual health services and that a balance is struck that promotes a child or young person’s welfare.

The former Department for Education and Skills recognised the dilemma faced by sexual health workers when it stated:

There is evidence that young people having under-age sex are the group least likely to use contraception and therefore the group at most risk of unwanted pregnancy and sexually transmitted infections. A key reason for this is that they have concerns that disclosure of mutually agreed sexual activity will lead to a referral to social services or the police. A strategy of formal referral to the police of every case of sexual activity of under 16 year olds is therefore likely to have a negative effect on young people seeking support. (LASSL (2004) 21)

Importantly, those professionals providing sexual health advice and care to children and young people should be reassured that, providing advice to young people, over the age of 13 years. Achieving the right balance requires skill, professional judgement and knowledge of the issues involved, however, the child or young person’s welfare should always been viewed as paramount a point reflected in guidance issued by the Teenage Pregnancy Unit (2004) and supported by the CYSCB:

Although the age of consent remains at 16, it is not intended that the law should be used to prosecute mutually agreed teenage sexual activity between two young people of a similar age, unless it involves abuse or exploitation, however, the younger the person, the greater the concern about abuse or exploitation. It is therefore expected that local policies will reflect the need for social care practitioners to use their discretion in weighing up the circumstances of each individual case to determine whether a formal notification to the police is necessary.

   Young people under the age of 13

Sexual activity involving a child under the age of 13 years should always be considered to be of serious concern with a presumption that a referral should be made to Children and Family Services and/or the police. However, consideration should still given to what is in the best interest of the child.

When dealing with any child, especially children under the age of 13, it is recommended that those providing sexual health advice explore the nature of the child’s relationship in order to ascertain the child’s own wishes and feelings. On occasions children may experience ambivalence, feeling obliged (short of coercion), to engage in sexual activity for example as a result of peer pressure, a desire to conform or a belief that such behaviour equates to affection. In such cases a referral to Children and Family Services should be made.

Where a professional assesses that making a referral is not in the best interest of the child, there must be a discussion with a recognised ‘named person (child protection)’ and the decision endorsed, in writing, by a person with sufficient authority within the organisation. This discussion should be informed by the assessment undertaken using this guidance.

All such decisions must be recorded, in writing, and placed on the child’s file. The recording should include the rationale for the decision, the advice sought, and the name of the person authorising the decision.

   Fraser guidlines (also known as the ‘Gillick competence)

It is considered good practice for workers to follow the Fraser guidelines when discussing personal or sexual matters with a young person under 16. The Fraser guidelines give guidance to doctors, social care and health professionals in England and Wales on providing advice and treatment to young people under 16 years of age. These hold that sexual health services can be offered without parental consent providing that:

  • The young person understands the advice that is being given.
  • The young person cannot be persuaded to inform or seek support from their parents, and will not allow the worker to inform the parents that contraceptive advice is being given.
  • The young person is likely to begin or continue to have sexual intercourse without contraception.
  • The young person's physical or mental health is likely to suffer unless they receive contraceptive advice or treatment.
  • It is in the young person's best interest to receive contraceptive advice and treatment without parental consent.

   Assessment

All young people, regardless of gender, who are believed to be engaged in, or planning to be engaged in, sexual activity should have their needs for health education, support and/or protection assessed by the agency involved.

In assessing the nature of any particular behaviour, it is essential to look at the facts of the actual relationship between those involved. Power imbalances are very important and can occur through differences in size, age and development and where gender, sexuality, race and levels of sexual knowledge are used to exert such power (of these age may be a key indicator, e.g. a 15-year-old girl and a 25-year-old man).

If the young person has a learning disability or other communication difficulty and cannot easily communicate to someone that they have been abused, then the behaviour may well have been abusive. There may also be an imbalance of power if the young person’s sexual partner is in a position of trust.

In order to determine whether the relationship presents a risk to the young person, the following factors should be considered:

  • Whether the young person is competent to understand, and consent to, the sexual activity they are involved in
  • The nature of the relationship between those involved, particularly if there are age or power imbalances as outlined above whether overt aggression, coercion or bribery was involved including misuse of substances as a dis-inhibitor
  • Whether the young person’s own behaviour, for example through misuse of substances, places them in a position where they are unable to make an informed choice about the activity
  • Any attempts to secure secrecy by the sexual partner beyond what would be considered usual in a teenage relationship
  • Whether the sexual partner is known by the agency as having other concerning relationships with similar young people
  • Whether the young person denies, minimises or accepts concerns
  • Whether methods used to secure compliance and/or secrecy by the sexual partner are consistent with behaviours considered to be ‘grooming’ as per sexual exploitation

If, at this stage, you have concerns that the young person may be at risk of sexual exploitation through prostitution, please refer to the CYSCB’s Child Protection Procedures.

   Process

When working with young people, it must always be made clear to them at the earliest appropriate point, that absolute confidentiality cannot be guaranteed, and that there will be some circumstances where the needs of the young person can only be safeguarded by sharing information with others. This discussion with the young person may prove useful as a means of emphasising the seriousness of some situations.

On each occasion that a young person is seen, consideration should be given as to whether their circumstances have changed or further information is given which may lead to the need for referral or re-referral.

In some cases urgent action may need to be taken to safeguard the welfare of a young person although in most circumstances there will need to be a process of information sharing and discussion in order to formulate an appropriate plan. There should be time for reasoned consideration to define the best way forward.

Anyone concerned about the sexual activity of a young person should initially discuss this with the person, or unit, in his or her agency responsible for child protection. There may then be a need for further consultation with Children's Social Care.

All discussions should be recorded, giving reasons for action taken and who was spoken to, as support for the professional decisions made. It is important that all decision-making is undertaken with full professional consultation.

Following any referral to social services there may be one of these responses:

  • No further action deemed necessary
  • An initial assessment undertaken which may identify the young person as a child in need and additional services provided
  • An initial assessment undertaken which may identify the young person as a child at risk of significant harm and in need of child protection intervention

Wherever possible, appropriate support should be offered and agencies should continue to offer the services provided.

   Sharing information with parents

Decisions to share information with parents will be taken using professional judgement and in consultation with the Child Protection Procedures. Decisions will be based on the child’s age, maturity, and their ability to appreciate what is involved in terms of the implications and risks to themselves. This should be coupled with the parents’ ability and commitment to protect the young person. Given the responsibility that parents have for the conduct and welfare of their children, professionals should encourage the young person, at all points, to share information with their parents where ever safe to do so.

   Confidentiality

Good practice is for any information, which has been shared ‘in confidence’, should only be passed to, or discussed with, another with the consent of young person. However, where it is felt that the information amounts to a concern about the young person’s own or another’s welfare, a judgement has to be made as to whether to dispense with the person’s consent

51 "Shaken baby syndrome”

   Terminology

Various terms are in use to describe babies or young children with a possible inflicted head or brain injury. These include:

  • Shaken Baby Syndrome
  • Inflicted Traumatic Brain Injury
  • Battered Child Syndrome
  • Inflicted Head Trauma
  • Shaken Impact Syndrome
  • Shaking Injury
  • Whiplash Infant Syndrome
  • Whiplash-shaking injury

The above terms refer to the internal head injuries a baby or young child sustains from being violently shaken or thrown. This can cause a range of serious injuries to a baby or small child, which are often fatal. These injuries are mainly to the head but there may also be injuries to the body.

From a medical, social care and judicial perspective, the main interest is the consequence of any non-accidental injuries in terms of treatment, investigation, identifying who may be responsible and safeguarding the child and any siblings from further harm.

   Initial Possible Signs

The child is in a collapsed state and presenting some or a combination of the following:

  • Lethargy
  • Irritability
  • Abnormal movements or seizures
  • Drowsiness
  • Increased or decreased muscle tone
  • Vomiting
  • Poor feeding
  • Irregular breathing
  • Apnoea (stopping breathing)

Child Protection Considerations for Hospital Staff

  • A history/explanation should be sought from the parents/carers;
  • The history/explanation given by the parents/carers should be assessed for consistency with the injuries;
  • If there is any doubt a Paediatric opinion should be sought;
  • When injuries follow genuine accidents, the child is normally presented promptly and there is a clear history of an accident;
  • When injuries are non-accidental, there may be delay in seeking medical advice (although on occasion a delay may follow an accident where the parents had initially thought the infant was alright);
  • When injuries are non-accidental, the history may be vague.

Account should also be taken of associated risk factors, which include:

  • Child or siblings subject to a Child Protection Plan;
  • Previous history of sudden infant death or apparent life threatening events in the family;
  • Very young parents;
  • Parents suffering from addictive behaviours;
  • Parents showing odd behaviour, for example, very aggressive;
  • A history of domestic violence;
  • If the child appears to be failing to thrive.

If at any point during the course of admission, examination, treatment or tests etc., there is reason to suspect that the injuries to the child are non-accidental, an immediate referral is to be made to Children’s Social Care, irrespective of the time or day. The referral should be followed in writing to Children’s Social Care within 48 hours.

52 Spirit possession and religious beliefs

The belief in ‘possession’ and ‘witchcraft’ is widespread. It is not confined to new immigrants, particular countries, culture or religions.

Whilst the number of known cases of child abuse linked to ‘possession’ or ‘witchcraft’ or other spiritual beliefs is small, children involved can suffer considerable harm.

A parent or carer who views a child as being ‘possessed’ or a parent who is involved in ‘witchcraft’ can abuse a child in many different ways, including attempts exorcise the child which can involve severe abuse.

Staff in all agencies should be alert to indicators of child abuse linked to spiritual or religious beliefs and refer to Children’s Social Care.

See also ‘Safeguarding Children from Abuse Linked to a Belief in Spirit Possession’ DCSF 2007.

53 Surrogacy

Surrogacy is legal in the UK, with reasonable expenses only being paid to the surrogate mother. Surrogacy arrangements are not legally enforceable.

It is illegal to advertise for a surrogate in the UK. Most people have a family member or friend willing to carry the child, others join a surrogacy organisation.

Partial surrogacy uses the egg of the surrogate mother and the sperm of the intended father, thus the baby is biologically related to the intended father and the surrogate mother. This can make it difficult for the surrogate mother to give up her own biological child, but also for the intended mother to accept a child which her husband has fathered with another woman.

Total surrogacy uses the egg of the intended mother combined with the sperm of her husband or donor sperm. A baby conceived by this method has no biological connection to the surrogate mother.

A professional in any agency may become aware of the surrogacy arrangement and have concerns about:

  • The suitability of the intended parents to care for the child;
  • Conflict between the adults in a surrogacy arrangement e.g. that the surrogate mother is under pressure to relinquish the child against her will (see, as appropriate, section 5.11. Domestic violence); and / or
  • The amount being paid for the child.

In these circumstances, all staff have a responsibility to safeguard and promote the welfare of the unborn or newborn child, and professionals should follow the procedures for referral to Children’s Social Care.

Children’s Social Care responses should be proportionate to what are likely to be very individual circumstances, and legal advice should be sought.

54 Temporary accommodation

Any placement in temporary accommodation can be stressful to children and families. Any professional who becomes aware of a child living in temporary accommodation must make every effort to ensure that the child is registered with a GP, is in receipt of all other appropriate health services and in the case of a school aged child is attending a school.

Where there is concern that a child is not in receipt of social, health and education services as necessary to promote their health and development, the child should be considered, in the first instance, to be a child with additional needs.

Where there is concern that a child who is in temporary accommodation is in need, or in need of protection the appropriate referral should be made.

55 Trafficking, modern slavery and exploited children

   A Growing Problem

Trafficking is defined as ‘the recruitment, transportation, transfer, harbouring or receipt of children by means of threat, force or coercion for the purpose of sexual or commercial sexual exploitation or domestic servitude’ (AFRUN/NSPCC).

It is a rapidly growing global problem and is a violation of human rights affecting all communities. There is evidence that large numbers of children and young people, from different parts of the world, are subject to such exploitation within the UK or that the UK is used as a step in the process, with children and young people arriving here and at a later point being trafficked to another part of the world.

North Yorkshire Police Modern Slavery Toolkit can be downloaded here.

Further information on modern slavery and human trafficking can be found on the National Crime Agency website including information about the National Referral Mechanism

   Indicators

A number of factors identified by the initial assessment may indicate that a child or young person has been trafficked. In all such cases the first priority is to ensure the safety of the child or young person.

  • The child or young person may present as unaccompanied;
  • Child or young person may go missing;
  • Multiple use of the same address may indicate that this is a sorting house;
  • Contracts, consent and financial inducement with parents may become apparent;
  • The child or young person may hint at threats to family in their country of origin;
  • Talk of financial bonds and the withholding of documents;
  • Befriending of a vulnerable child or young person;
  • False hopes of improvement in their lives;
  • The child or young person may present as unaccompanied;
  • Child or young person may go missing;

Some children and young people are also trafficked for the purpose of domestic labour.

These may be less obvious but may be picked up during a private fostering assessment or because someone notices that a child or young person is not in school. Children and young people who enter the country apparently as part of re-unification arrangements can be particularly vulnerable to domestic exploitation.

   Action

If any suspicions are raised that a child or young person is being trafficked, or at risk of this, immediate action to safeguard the child or young person is required. This includes urgent liaison with the Police. Planning of the investigations should be within a Strategy Meeting, for the immediate protection of the child or young person and to address possible crimes having been committed.

Any child or young person from abroad who goes missing should be reported to the Police and Immigration Department immediately. Inter-agency procedures in respect of missing children/young people are to be applied.

   Risk of Being Trafficked for Child or Young Person Looked After

Where a child or young person from abroad becomes the responsibility of Children’s Social Care, the degree of risk to the child or young person of possible abduction should be assessed and should inform placement choice. Foster carers/residential staff should have an understanding of the child/young person’s situation and of the risk of exploitation and trafficking and be clear about what is expected of them to ensure the safety of the child or young person.

Anyone approaching Children’s Social Care and claiming to be a potential carer, friend or member of the family of the child or young person should be thoroughly investigated. The immigration services should be contacted for any relevant information they may have. The possibility that the child or young person is, or may be, vulnerable to exploitation or trafficking must be considered and checked out. Agreement from appropriate Managers and Panels should be sought before allowing the child or young person to transfer to the person’s care.

Guidance in regard to Slavery and Trafficking Prevention Orders and Risk Orders  in line with the Modern Slavery Act 2015  can be accessed at: https://www.gov.uk/government/publications/slavery-and-trafficking-prevention-and-risk-orders  

Further resources and guidance are available here:

http://cdn.hopeforjustice.org/wp-content/uploads/2015/06/Online-Resource-RJC.pdf

56 Unborn babies

   Referring an Unborn Baby to Children’s Social Care

Where an unborn baby is likely to be in need of services from Children’s Social Care when born, a referral is to be made to Children’s Social Care.

Wherever possible, the referrer should share their concerns with the prospective parent(s) and seek to obtain agreement to refer to Children’s Social Care, unless this action may place the unborn child at risk, for example, through termination of the pregnancy or the parent(s) possibly making their whereabouts unknown.

These circumstances include:

  • Where concerns exist regarding the mother’s ability to protect
  • Where alcohol or substance abuse is thought to be affecting the health of the expected baby, and is one concern amongst others;
  • Where the expectant parent(s) are very young and a dual assessment of their own needs as well as their ability to meet the baby’s needs is required;
  • Where a previous child in the family have been removed because they have suffered harm or been at risk of significant harm;
  • Where a person who has been convicted of an offence against a child, or is believed by child protection professionals to have abused a child, has joined the family;
  • Where there are acute professional concerns regarding parenting capacity, particularly where the parents have either severe mental health problems or learning disabilities;
  • Where the child is believed to be at risk of significant harm due to domestic violence.

In any of the above circumstances, or where there are other factors which meet the criteria for services, the referral is to be accepted and a pre-birth assessment is to be undertaken, led by Children’s Social Care. In these circumstances, the referral must never be redirected into, for example, a Common Assessment Framework system or similar.

   Timing of Referral

Referrals about unborn babies should be made by the 18th week of the pregnancy, unless it has not been possible to meet this timescale, for example, because the pregnancy has been concealed.

Referring at this time:

  • Provides sufficient time for a full and informed assessment;
  • Avoids initial approaches to parents in the latter stages of pregnancy, as this is already an emotionally charged time;
  • Enables parents to have more time to contribute their own ideas and solutions to concerns and increases the likelihood of a positive outcome;
  • Enables the provision of support services so as to facilitate optimum home circumstances prior to the birth;
  • Provides sufficient time to make adequate plans for the baby’s protection, where this is necessary.

   Initial Multi-disciplinary Planning Meeting

An initial multi-disciplinary planning meeting is to be held to plan the pre-birth assessment. A pre-birth assessment must be based on a robust assessment model, such as that given in Section Two.

The meeting, to be convened by Children’s Social Care, is to be held during the 19th or 20th week of pregnancy.

Agencies/professionals who should be invited include:

  • Children’s Social Care Team Manager and Social Worker
  • Identified Midwife
  • The likely Health Visitor
  • The family GP
  • A representative of any local family centre or equivalent, where appropriate.
  • Any other professional involved with the family.

Relevant information held by the Police and by the Named Nurse/Senior Nurse for Child Protection should be obtained.

Parents should throughout be involved in planning as far as possible.

A date should be set for a further multi-disciplinary planning meeting (which is to take the form of a child protection strategy meeting if the assessment outcome indicates the baby is likely to be at risk of significant harm).

   Pre-birth Assessment led by Children’s Social Care

A pre-birth assessment is always to be undertaken in the following circumstances:

  • Where concerns exist regarding the mother’s ability to protect;
  • Where alcohol or substance abuse is thought to be affecting the health of the expected baby, and is one concern amongst others;
  • Where the expectant parent(s) are very young and a dual assessment of their own needs as well as their ability to meet the baby’s needs is required;
  • Where previous children in the family have been removed because they have suffered harm or been at risk of significant harm;
  • Where a person who has been convicted of an offence against a child, or is believed by child protection professionals to have abused a child, has joined the family;
  • Where there are acute professional concerns regarding parenting capacity, particularly where the parents have either severe mental health problems or learning disabilities;
  • Where the child is believed to be at risk of significant harm due to domestic violence.

The assessment is to be completed within core assessment timescales of 35 working days from being commissioned.

A pre-birth assessment must be thorough and robust, covering all relevant areas.

   Assessment re Parental Substance Misuse, including Alcohol Misuse

‘Substance’ refers to both legal and illicit substances, for example heroin, cocaine, crack, amphetamines, benzodiazepines, LSD, methadone, ecstasy, prescription drugs, solvents and problematic alcohol use.

Parental substance misuse can particularly impact on the health and development of the child before birth and very seriously affect the life chances and future health and development of the child.

Practitioners must ensure a thorough assessment of risk to the baby, both before and after the birth.

Professionals must remember that substance misuse may be one significant feature amongst others, such as domestic abuse, previous harm to a child etc. and should therefore not be the only focus for assessment.

Professionals undertaking this assessment are expected to use the SCODA questionnaire/ assessment tool given in Appendix 8.

   Further Multi-disciplinary Planning Meeting or Strategy Meeting

The completed pre-birth assessment report should be considered at a further multi-disciplinary planning meeting.

If it is clear from the Pre-birth Assessment Report that there is reasonable cause to believe the baby will be at risk of significant harm when born, this meeting should be replaced by a strategy meeting held under child protection procedures.

Either meeting is to be held by the end of the 28th week of the pregnancy.

The purpose of either meeting is to consider the findings and recommendations from the report and make plans about next steps in relation to support and any necessary intervention to protect the baby.

Where a Strategy Meeting is being held, it should include those already involved and Named Nurse for the appropriate area of the county. The Police Protecting Vulnerable Person’s Unit should also be invited and relevant information sought.

If the Strategy Meeting/Discussion concludes that it is likely the baby will be at risk of significant harm when born, arrangements are to be made for a Pre-birth Child Protection Conference. This applies whether or not there is an intention to take legal proceedings in respect of the child when born.

57 Whistleblowing

Every employee working with children has a duty and responsibility to disclose any concerns about the conduct of another professional. Whistle blowing will be seen as a protective disclosure and, if made in good faith, should not result in any form of detriment to the worker.

If the concerns relate to a person/persons in the same agency, that agency's reporting procedures must be followed.

If the concerns relate to a person/persons from another agency, the person raising the concerns must contact a senior manager within his/her own agency, and a decision be made as to how the concern will be addressed, and by whom. It is the responsibility of the senior manager within the agency of the person raising the concern to ensure that a response is received from the agency to which the concern relates.

The person raising the concern and his/her senior manager must maintain a written record of events which give rise to the concern and of subsequent actions and responses.

 58 Working with interpreters, signers or others with special communication skills

All agencies need to ensure they are able to communicate fully with parents and children.

When either making or receiving a referral staff must establish the communication needs of the child, parents and other significant family members. Relevant specialists may need to be consulted, e.g. a speech and language therapist, teacher of hearing impaired children, paediatrician etc.

The use of accredited interpreters, signers or others with special communication skills must be considered whenever undertaking an assessment or enquiries involving children and/or family members:

  • For whom English is not the first language (even if reasonably fluent in English, the option of an interpreter should be available when dealing with sensitive issues);
  • With a hearing or visual impairment;
  • Whose disability impairs speech;
  • With learning difficulties;
  • With a specific language or communication disorder;
  • With severe emotional and behavioural difficulties;
  • Whose primary form of communication is not speech.

Family members and children should not be used as interpreters within interviews although can be used to arrange appointments and establish communication needs.

Interpreters used for assessment and child protection work should have been subject to references and CRB checks. Wherever possible, they should be used to interpret their own first language. There should be a written agreement regarding confidentiality.

Interpreters are expected to have undertaken relevant child protection training and this should be ascertained.

Staff need to first meet with the interpreter to explain the nature of the assessment/enquiries and clarify:

  • The interpreter’s role in translating direct communications between professionals and family members;
  • The need to avoid acting as a representative of the family;
  • When the interpreter is required to translate everything that is said and when to summarise;
  • That the interpreter is prepared to translate the exact words that are likely to be used – especially critical for sexual abuse;
  • When the interpreter will explain any cultural issues that might be overlooked (usually at the end of the interview, unless any issue is impeding the interview);
  • The interpreter’s availability to interpret at other interviews and meetings.

59 Working with uncooperative families

There can be a wide range of unco-operative behaviour by families towards professionals. From time to time all agencies will come into contact with families whose compliance is apparent rather than genuine, or who are more obviously reluctant, resistant or sometimes angry or hostile to their approaches.

In extreme cases, professionals can experience intimidation, abuse, threats of violence and actual violence. The child’s welfare should remain paramount at all times and where professionals are too scared to confront the family, they must consider what life is like for a child in the family.

60 Young carers

A young carer is a young person under the age of 18 who has a responsibility for caring on a regular basis for a relative or friend who has an illness or disability. This is usually a parent, grandparent, sometimes a sibling or occasionally a friend. This can be primary or secondary caring and can lead to a variety of losses for the young carer. Young carers can experience:

  • Low level of school attendance;
  • Some educational difficulties;
  • Social isolation;
  • Conflict between loyalty to their family and their wish to have their own needs met;
  • High levels of anxiety;
  • High level of demands leading to tiredness and loss of concentration.

Professionals in all agencies should be alert to a child being a young carer. Where a young carer is identified, professionals should in the first instance refer the child to Children’s Social Care as a “child in need”. Wherever possible, the young carer’s consent and the consent of their parent should be sought, through a discussion of why the referral must be made and the possible outcomes.

There are circumstances in which a young carer can be suffering, or at risk of suffering, significant harm through emotional abuse and / or neglect. This should be made clear in the referral. Where a young carer or parent does not give consent, but it is still considered necessary to refer to Children’s Social Care, both the child and parent should be kept informed of all decisions made and offered support throughout.

Professionals in all agencies should enquire through Adult and Community Services whether the family is receiving all their entitlements under the provisions of the Carers (Recognition and Services) Act 1995.

Where a young carer is caring for another child, each individual child should be subject to an initial assessment as a child in need.

Agencies that work with young carers such as schools, should implement policies outlining the support services available to these children. See the National Strategy for Carers (Chapter 8, Young Carers) (DOH, 1999), available at www.doh.gov.uk.