Safeguarding & Protecting Children and Young People Conference 30 th September 2004, London

The importance of recognising and responding effectively to maltreatment

Dr Catherine Powell

 University of Southampton

Victoria Climbié

• ‘Abandoned, unheard, unnoticed’ Laming, 2003  University of Southampton

My presentation will …

• Briefly outline some ‘facts and figures’ and current challenges • Open a debate on contemporary policy: what the NSF says about safeguarding children  University of Southampton

Child Protection: some key ‘facts and figures’

• ‘Maltreatment now

the

single biggest cause of morbidity in children’ • 1:10 of all children may be affected at some time during their childhood • 2-4 children die each week in the UK from abuse or neglect • Such children are often well-known to agencies – high risk groups  University of Southampton

In a double-decker bus going home at the end of a school day

• 7 children will be going home to a family that is not loving or close • 10 children will be shouldering a double-burden of housework/caring for parents who are incapacitated by their own health/social problems • two or three will be going home in fear of the frequent violence between their parents • two or three will be returning to a life of regular beatings or denigration • Some children will be experiencing several or all of these things. (Cawson

et al.

,2000)  University of Southampton

• There is often progression from ‘mild’ to ‘severe’ maltreatment over time • Milder abuse is more pervasive – in terms of numbers of children affected and negative impact on health and development • Fatal or severe abuse features prominently in the literature (research and as policy-driver)  University of Southampton

Impact on health ..

• Babies in violent families are ‘incubated in terror’ • Brains of abused children are significantly smaller (limbic system, hippocampus) • No other childhood factor, physiological, cognitive, environmental, or familial, predicts more of the variation in adult anti-social behaviour, than early aggression – linked to harsh parenting styles  University of Southampton

• Increasing evidence of the links between ‘ongoing’ abusive and neglectful situations and long term health problems and premature death in adulthood  University of Southampton

Complex relationship between attitudes to the treatment of children and experience of abuse … children experiencing serious assault often do not rate their treatment as abusive because they have learnt to regard it as normal.

 University of Southampton

Current challenges

• A number of studies point to a failure to report child maltreatment, especially neglect – why?

• What helps to ensure that child maltreatment is reported?

• How can we attract high-quality health professionals to this area of work?

 University of Southampton

Overview of research findings

• Professional hierarchies/dominance of medical viewpoint • Closed systems of working • Recruitment difficulties • Lack of training (especially GPs and mental health professionals) • Lack of supervision • Lack of continuing professional development • Real uncertainty about information sharing and confidentiality issues  University of Southampton

• A reluctance to refer due to time pressures • A belief that the referral will not benefit the child and family • An interruption of an established ‘therapeutic relationship’ • A role in ‘protecting’ families from social care agencies  University of Southampton

• Transference (guilt, fear, shame, sympathy) • Concern about own safety • Lack of feedback following a referral*  University of Southampton

RCPCH survey of paediatricians

• 14% had been subject to a complaint in relation to their CP work • Numbers of complaints had increased from <20 in 1995 to >100 in 2003 • Of the complaints that had gone to the GMC none have been upheld • One third of those who had received complaints said they were less willing to become involved in CP work in the future • One third of Designated Doctor posts are vacant March 2004  University of Southampton

What helps?

  • Being younger • Being female • Personal experience of maltreatment  Perceived severity  Certainty of ‘diagnosis’  Previous history of maltreatment Presence of more than just one injury Repeated attendances for health care  Type of abuse (physical)  University of Southampton

• Age of child – younger more likely to refer • Socio-economic status • Ethnicity • Referrals more likely where informed consent has been obtained • Easy access to professional support and advice  University of Southampton

• Policy and guidance is largely based on failures in child protection – rather than successes • Most of the one billion pounds spent on maltreatment each year in the UK is spent on response to the problem • Whilst MANY children in the UK are successfully protected from maltreatment by systems which are fundamentally sound and the envy of other countries … there is room for improvement  University of Southampton

Standard Five: Children’s NSF

All agencies work to prevent children suffering harm and to promote their welfare, provide them with the services they require to address their identified needs and safeguard children who are being or who are likely to be harmed.

(DfES and DH, 2004:145)  University of Southampton

• Rationale • Interventions • Strategy • Markers of Good Practice  University of Southampton

Rationale

• Children see being safe as a priority • Children want their views taken into account when key decisions are made about their lives • All adults have a responsibility to ensure that children and young people do not suffer harm.

• Provision of universal and targeted services • Agencies and staff need to work together to ensure that they identify serious child protection issues and have adequate recording and management systems  University of Southampton

Interventions

• Strategic inter-agency working (NB explicit role of housing, service users and members of the local community) • Commitment to safeguarding and promoting welfare of children reflected in local policies and procedures  University of Southampton

Strategy

• Safeguarding and promoting welfare included in Children and Young People’s Plan • Effective ACPC/LSCB representation and working • MAPPA partnerships • Leadership and responsibility – at executive level  University of Southampton

• Explicit systems for children and young people in special circumstances [looked after, care leavers, homeless, children exposed to DV, children of substance misusing parents] • Children with disabilities • Children and young people abused through prostitution • Mobile children, young people and families • Children living away from home • Young people in prison • Children who are deliberately harmed through FII  University of Southampton

PCT roles and responsibilities

• Clinical governance and audit • Named public health professional to input into issues as necessary • Named Nurse and Doctor professional lead across Trust • Designated Nurse and Doctor over-arching responsibility across PCT area • Funds, accountability • Ensure staff are alert to potential indicators of abuse • Ensure all families in resident community are registered with a GP • Access to experienced paediatricians • Co-ordinate health component of Serious Case Reviews  University of Southampton

NHS Trusts

• Named nurse and doctor – to lead on internal reports for serious case reviews (unless substantial involvement) • Ambulance Trusts, NHS Direct and NHS Walk-in Centres • Adult Health Services (Mental health, substance Misuse and others)  University of Southampton

Promoting welfare of children

• Promote awareness of UNCRC (Article 19) through public education campaigns • Single and multi-agency polices and procedures that are in tune with legislation, regulations and guidance • Safe recruitment • Robust complaints and whistle-blowing policies • Recording and supervision • Measuring outcomes • Single and multi-agency training  University of Southampton

Thank you for listening

Catherine Powell [email protected]

023 8059 7918  University of Southampton