Responding to Abuse and Neglect

1. Introduction

Children/young people have a right to be safeguarded and protected. This is enshrined within the Children (Northern Ireland) Order 1995 (the Children Order) and the United Nations Convention on the Rights of the Child (UNCRC). The UNCRC's own preamble affords equal status to ALL convention rights and inter-dependence on each of the others. 

All staff and volunteers who work with children, young people or families - in whatever capacity - have a responsibility to safeguard and protect children/young people. According to Co-operating to Safeguard Children and Young People in Northern Ireland (revised August 2017), they must be alert to signs and indicators of harm, and know how to respond when concerns are identified. The term safeguarding is intended to be used in its widest sense, encompassing the full range of promotion, prevention and protection activity. Effective safeguarding arrangements should aim to meet the following key principles:

• Safeguarding is everyone's responsibility: for services to be effective, each individual and organisation should play their full part;
• A child-centred approach: for services to be effective, they should be based on a clear understanding of the needs and views of children in accordance with Article 12 UNCRC and Article 3 UNCRC in relation to the best interests of the child/young person;
• The child/young person's welfare must be the paramount consideration.

These Safeguarding Board for Northern Ireland (SBNI) Child Protection Policies and Procedures set out how agencies and individuals should work together to safeguard and promote the welfare of children/young people. This includes agencies responsible for commissioning or providing direct services to children/young people and their families including services for adults who are parents.

There is a continuum of services necessary to safeguard children/young people including early intervention which aims to prevent avoidable harm to children/young people. Many children/young people, especially some of the most vulnerable and those at greatest risk of social exclusion, will need early intervention and prevention services from health and social care agencies and professionals. These include Family and Child Care Social Work Services, GPs, Nursing, Allied Health Professionals, Midwifery and Specialist Community Public Health Nursing (health visiting/school nursing), from educational establishments such as Schools and Colleges, from Criminal Justice Agencies such as Police Service of Northern Ireland, Youth Justice Agency and Probation Board for Northern Ireland, and from the voluntary, community and independent sectors. Some services will be provided as universal services whilst others may be more targeted to meet specific needs. These agencies and indeed all those who are involved with children/young people and adults should:

• Be aware of potential indicators of child abuse and neglect;
• Be alert to the risks which abusers, or potential abusers, may pose to children/young people;
• Be alert to the existence of domestic and/or sexual violence, sexual exploitation and abuse;
• Listen to and ascertain the views of children/young people and give this due consideration;
• Share and help to analyse information so that an assessment can be made of the child/young person's needs and circumstances;
• Contribute to whatever actions are needed to protect and promote the child/young person's welfare;
• Take part in regularly reviewing the outcomes for the child/young person against specific plans;
• Work co-operatively and in partnership with parents, unless this is inconsistent with ensuring the child/young person's safety;
• Ensure professional and personal competence levels and Continuous Professional Development (CPD) in safeguarding are monitored and updated in line with required standards and the identified needs of staff.

2. The Concept of Significant Harm

Safeguarding

Co-operating to Safeguard Children and Young People in Northern Ireland (revised August 2017) states that safeguarding is more than child protection. Safeguarding begins with preventative activity which enables children and young people to grow up safely and securely in circumstances where their development and wellbeing is not adversely affected. It includes support to families and early intervention to meet the needs of children/young people and continues through to child protection, which refers specifically to the activity that is undertaken to protect individual children/young people who are suffering, or are likely to suffer harm.

Child in Need

Article 17 of the Children Order imposes a general duty on Health and Social Care (HSC) Trusts to provide a range of services for children in need within their area and states that a child shall be considered to be 'in need' if:

1. He is unlikely to achieve or maintain, or to have the opportunity of achieving or maintaining, a reasonable standard of health or development without the provision for him of services;
2. His health or development is likely to be significantly impaired, or further impaired, without the provision for him of such services; or
3. He is disabled.

'Family', in relation to such a child in need, includes any person who has parental responsibility for the child and any other person with whom he has been living.

In determining whether a child or young person is in need, consideration must be given to:

1. What will happen to a child or young person's development and health without services being provided; and
2. The likely effect the services will have on the child or young person's standard of health and development.

Article 18 of the Children Order requires HSC Trusts:

1. To safeguard and promote the welfare of children within its area who are in need; and
2. So far as is consistent with that duty, to promote the upbringing of such children by their families.

by providing a range and level of care appropriate to those children's needs. Fulfilling this duty is a key part of preventative safeguarding.

Child/Young Person in Need of Protection

A child/young person in need of protection is a child/young person who is at risk of, or likely to suffer, significant harm which can be attributed to a person or persons or organisation, either by an act of commission or omission; or a child who has suffered or is suffering significant harm as defined in Article 50 of the Children Order.

Harm and Significant Harm

The likelihood or actuality of significant harm is the threshold that justifies compulsory intervention in family life in the best interests of children.

Where a HSC Trust has reasonable cause to suspect that a child who lives, or is found, in the Trust's area is suffering, or is likely to suffer, significant harm it has a duty (under Article 66 of the Children Order) to make, or cause to be made, such enquiries as it considers necessary to enable it to decide whether it should take any action to safeguard or promote the welfare of a child/young person.

Additionally, a court may only make a Care Order or Supervision Order (Article 50 of the Children Order) in respect of a child/young person if it is satisfied that:

• The child is suffering, or is likely to suffer, significant harm; and
• The harm, or likelihood of harm, is attributable to a lack of adequate parental care or control.

Harm

Harm is defined in the Children Order as ill-treatment or the impairment of health or development. The Order states that 'ill-treatment' includes sexual abuse, forms of ill-treatment which are physical and forms of ill-treatment which are not physical; 'health' means physical or mental health; and 'development' means physical, intellectual, emotional, social or behavioural development.

Significant Harm

The significance of harm will be a matter for assessment and judgment in relation to each individual child. The question of whether harm is significant should be determined in accordance with Article 50(3) of the Children Order, which states that 'where the question of whether harm suffered by a child is significant turns on the child's health or development, his health or development shall be compared with that which could reasonably be expected of a similar child.'

Consideration of the significance of harm may include the degree and the extent of physical harm, the duration and frequency of abuse and neglect, the extent of premeditation, the presence or degree of threat and the assessed impact of the harm upon the child/young person.

Each of these elements has been associated with more severe effects on the child/young person, and/or relatively greater difficulty in helping the child/young person overcome the adverse impact of the maltreatment.

Sometimes, a single traumatic event may constitute significant harm (for example. a violent assault, suffocation or poisoning). More often, significant harm is a compilation of significant events, both acute and long-standing, which interrupt, change or damage the child/young person's physical, sexual and/or psychological development.

Some children/young people live in family and social circumstances where their health and development are neglected. For them, it is the corrosiveness of neglect, emotional, physical or sexual abuse that causes impairment to the extent of constituting significant harm.

Likelihood

3. Prevention and Early Intervention

Most agencies in Northern Ireland have agreements in place consistent with the UNOCINI Framework which provides effective ways to identify emerging problems and potential unmet needs for individual children, young people and families as well as clear guidance and procedures for all staff, including those in universal services and those providing services to adults with children/young people.

Staff are supported through training and supervision to understand their role in identifying emerging vulnerabilities and sharing information with others to assist with early identification and assessment.

The Understanding the Needs of Children in Northern Ireland – Thresholds of Need Model includes information as follows:

• The process for the assessment and the type of services to be provided;
• The criteria, including the level of need, for when a child should be referred to children's services for assessment and for statutory services under:
  • Article 17 of the Children NI Order 1995 (Children in need and their families);
  • Article 18 as defined by Article 17 of the Children NI Order 1995 (General duty of authority to provide personal social services for children in need, their families and others);
  • Article 21 of the Children NI Order 1995 (Provision of accommodation for children: general);
  • Article 50 of the Children NI Order 1995 (Care orders and supervision orders);
  • Article 66 of the Children NI Order 1995 (Authority's duty to investigate).

4. Types of Abuse

Child abuse occurs when a child/young person is neglected, harmed or not provided with proper care. Children/young people may be abused in many settings, in a family, in an institution or community setting, by those known to them, or, by a stranger. There are different types of abuse and a child/young person may suffer more than one of them. The procedures outlined in this document are intended to protect children/young people who are at risk of, or have suffered, significant harm because of abuse or neglect.

The following definitions are those identified in Co-operating to Safeguard Children and Young People in Northern Ireland (revised August 2017):

Physical Abuse

Physical Abuse is deliberately physically hurting a child. It might take a variety of different forms, including hitting, biting, pinching, shaking, throwing, poisoning, burning or scalding, drowning or suffocating a child.

Sexual Abuse

Sexual Abuse occurs when others use and exploit children sexually for their own gratification or gain or the gratification of others. Sexual abuse may involve physical contact, including assault by penetration (for example, rape, or oral sex) or non-penetrative acts such as masturbation, kissing, rubbing and touching outside clothing. It may include non-contact activities, such as involving children in the production of sexual images, forcing children to look at sexual images or watch sexual activities, encouraging children to behave in sexually inappropriate ways or grooming a child in preparation for abuse (including via e-technology). Sexual abuse is not solely perpetrated by adult males. Women can commit acts of sexual abuse, as can other children.

Emotional Abuse

Emotional Abuse is the persistent emotional maltreatment of a child/young person. It is also sometimes called psychological abuse and it can have severe and persistent adverse effects on a child's emotional development

Emotional abuse may involve deliberately telling a child that they are worthless, or unloved and inadequate. It may include not giving a child opportunities to express their views, deliberately silencing them, or 'making fun' of what they say or how they communicate. Emotional abuse may involve bullying – including online bullying through social networks, online games or mobile phones – by a child's peers.

Neglect

Neglect is the failure to provide for a child/young person's basic needs, whether it be adequate food, clothing, hygiene, supervision or shelter that is likely to result in the serious impairment of a child/young person's health or development. Children/young people who are neglected often also suffer from other types of abuse. It may also include neglect of, or unresponsiveness to a child's basic emotional, social and educational needs.

Exploitation

Exploitation [1] is the intentional ill-treatment, manipulation or abuse of power and control over a child or young person; to take selfish or unfair advantage of a child or young person or situation, for personal gain. It may manifest itself in many forms such as child labour, slavery, servitude, engagement in criminal activity, begging, benefit or other financial fraud or child trafficking. It extends to the recruitment, transportation, transfer, harbouring or receipt of children for the purpose of exploitation. Exploitation can be sexual in nature.

[1] Although 'exploitation' is not included in the categories of registration for the Child Protection Register, professionals should recognise that the abuse resulting from or caused by the exploitation of children and young people can be categorised within the existing CPR categories as children who have been exploited will have suffered from physical abuse, neglect, emotional abuse, sexual abuse or a combination of these forms of abuse (Co-operating to Safeguard Children and Young People revised 2017).

5. Professional and Agency Response

5.1 Internal Policies and Procedures

These SBNI Child Protection Policy and Procedures are in place to support and provide information about how and what action to take when there are concerns that a child/young person is suffering or likely to suffer significant harm. In addition each agency should have their own specific child protection policy and procedures to help operationalise the requirements of the SBNI Child Protection Policies and Procedures.

Internal Child Protection Policies and Procedures should provide clear guidance and information to ensure that staff working within the agency understands their responsibilities in relation to protecting and safeguarding children and young people, and have access to safeguarding advice, support, supervision and training.

Such Child Protection Policy and Procedures will include information about how to:

• Identify potential or actual harm to children/young people in accordance with the child/young person's needs;
• Discuss and record concerns and agreed actions with their line manager/Designated Safeguarding Lead;
• Liaise with and share information with partner agencies as appropriate;
• Analyse concerns based on information available;
• Seek advice, if required, to decide upon the necessity for a referral to Gateway services or police;
• Escalate concerns when necessary.

5.2 Raising a Concern

Anyone with a concern about the safety or welfare of a child/young person should contact children's social services in the relevant HSC Trust. Even when individuals are unsure about whether a concern needs to be referred, they can contact the HSC Trust to obtain advice. Advice can also be obtained from the NSPCC Helpline. Outside normal working hours advice can be sought from the Regional Emergency Social Work Service. Please refer to Referrals Policy and Procedure.

5.3 Where there are Concerns that a Child/Young Person has Suffered or is Likely to Suffer Significant Harm

Children/young people who are suffering or at risk of suffering significant harm often feel unable to disclose this to others. They may have communication/language difficulties for example, through having a disability, or due to their age, that may make it difficult to tell others what is happening. Some children/young people may not recognise they are being abused. However, whenever a child/young person does report that they are suffering or have suffered significant harm through abuse or neglect, or have caused or are causing physical, emotional or sexual harm to others, the initial response from all staff should be to listen carefully to what the child/young person says and to observe the child/young person's behaviour and circumstances. It is essential that the child/young person's cognitive skills in terms of their ability to understand and their communication needs are established to allow staff to:

• Listen carefully and record as precisely as possible what the child/young person says;
• Observe the child/young person's behaviour;
• Clarify the information provided regarding the concerns;
• Offer re-assurance about how the child/young person will be kept safe;
• Explain what action will be taken and within what timeframe;
• Find out the views of the child/young person;
• Explain, if the child/young person can understand the significance and consequences of making a referral, that whilst their views will be taken into account, staff have a responsibility to take whatever action is required to ensure the child/young person's safety and the safety of other children/young people;
• Communicate effectively. Any cognitive, communication or language barriers present should be addressed, the child/young person should receive the necessary support to ensure full participation in the process. This may include the use of Interpreters/translator/registered intermediaries, the involvement of appropriate staff such as speech and language therapists and or communication tools. Explanatory leaflets and communication methods can be used if appropriate.

Staff must not:

• Give false assurances of absolute confidentiality;
• Press the child/young person for information, lead, or cross-examine, as this could prejudice police investigations.

5.4 Parental Consultation

Concerns about the safety or welfare of a child/young person, should, where practicable, be discussed with the parent and consent sought for a referral to children's social services in the local HSC Trust, unless seeking agreement is likely to place the child/young person at further risk through delay or undermine any criminal investigative process (for example in circumstances where there are concerns or suspicions that a crime has taken place); or there is concern raised about the parent's actions or reactions. The communication/language needs of the parents/carers should be established for example in relation to disability/ethnicity and the parent's/carer's capacity to understand should be ascertained. These should be addressed through the provision of appropriate communication methods, including, where necessary, translators, signers, intermediaries or advocacy services.

Effective protection for children/young people may, on occasions, require the sharing of information without prior parental/carer consent in advance of that information being shared.

Where staff decide not to seek parental consent before making a referral to children's social services in the local Health and Social Care Trust or the police, the reason for this decision must be clearly noted in the child/young person's records and included within the verbal and written/UNOCINI referral. Staff should consult with their line manager/Nominated Safeguarding Lead in accordance with each individual agency's policies and procedures.

When a referral is deemed to be necessary in the interests of the child/young person, and the parents/carers have been consulted and do not consent, the following action should be taken:

• The reason for proceeding without parental consent must be recorded;
• The withholding of permission by the parent/carer must be included in the verbal and written referral to children's social services;
• The parent/carer should be contacted to inform them that, after considering their wishes, a referral has been made.

6. Cases Requiring Urgent Medical Attention

If the child/young person appears to be suffering from an injury requiring urgent medical attention as a consequence of possible abuse, staff must:

• Contact Emergency Services and ensure timely attendance at an Emergency Department;
• Inform children's social services in the local HSC Trust or the Regional Emergency Social Work Service;
• Ensure parent/carer is advised of the admission to the Emergency Department unless to do so would place the child at continuing or further risk and/or undermine any criminal investigation;

Contact the Emergency Department to advise medical staff of circumstances surrounding the child/young person's injury.

7. Cases Requiring Medical Assessment

Where abuse of a child/young person is alleged, suspected or confirmed medical assessment may be required, for example during the investigation of alleged or suspected abuse under the Joint Protocol arrangements. In these circumstances it is essential that there is effective liaison between relevant medical professionals, children's social services (and hospital social workers where appropriate), and professionals from other agencies.

In relation to children/young people who have been sexually abused, assaulted or raped, whether this happened in the past or more recently, referral to The Sexual Assault Referral Centre (SARC), known as the Rowan Centre should be made where a range of support and services is available 24 hours a day, 365 days a year.

8. Child Protection in a Hospital Setting

Where, during the course of a child/young person's attendance at hospital, the doctor treating them suspects or is made aware of an allegation of abuse, that doctor should inform the Consultant responsible for the case (or his line manager) and consult the Hospital Social Worker. A senior Paediatrician should immediately be consulted for advice and referral made to children's social services in that HSC Trust. This also applies to adolescents in the 14-17 year age group who may be admitted to adult wards. The Child Protection Register should be consulted to establish if the child/young person is currently the subject of an inter-agency Child Protection Plan. Please refer to the The Child Protection Register Policy and Procedure.

Any general examination which is undertaken should only be for the purpose of establishing the need for immediate investigation/treatment. The Paediatrician will liaise with the responsible Consultant (or his line manager) about who is the most appropriate person to carry out the medical assessment. In the case of children presenting with signs and symptoms suggestive of sexual abuse or an allegation or disclosure, it may not be appropriate to examine the child/young person at all as this may interfere with possible forensic evidence. It is likely that the child/young person will require expert examination and the doctor should discuss the case immediately with a senior Paediatrician. In all such circumstances, examinations should be arranged in accordance with the Protocol for Joint Investigation by Social Workers and Police Officers of Alleged and Suspected Cases of Child Abuse.

Prior to discharge of the child/young person, a multi-disciplinary meeting/discussion should take place to share information which includes both hospital and community professional staff. A clear discharge plan with arrangements in place to protect the child/young person's welfare on return to the community should be agreed by the multi-disciplinary team. If there is dissent by a professional regarding a discharge plan, this should be escalated to line management for resolution.

Should the person with parental responsibility for the child/young person refuse to allow them to be admitted to hospital, or wish to discharge the child/young person against medical advice and there is reason to believe that the child/young person needs to be safeguarded, the appropriate social worker or duty social worker must be immediately contacted. In the event of the doctor considering that the level of danger to the child/young person would be life-threatening then the PSNI must be contacted to provide police protection.

For further information see Referrals Policy and Procedure.

9. Adult Services Responsibilities in Relation to Children/Young People

Staff working within Adult Services have a responsibility to be alert to any potential indicators of risk or harm to a child/young person. They should consider the impact of the adult's condition or behaviour on the welfare of the service user's own child/young person or any other child/young person and refer their concerns to children's social services for assessment.