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4.2 Abuse of Disabled Children

SCOPE OF THIS CHAPTER

For additional guidance, please see Safeguarding Disabled Children: Practice Guidance (issued by the DCSF in July 2009).

ACKNOWLEDGEMENTS

Wirral LSCB gratefully acknowledges information taken from Safeguarding Disabled Children: A Resource Guide for LSCBs from the Council for Disabled Children which was commissioned on behalf of the Department for Education and Skills.


Contents

  1. Introduction
  2. The Child
  3. The Safeguards
  4. Concerns and Referrals
  5. Recognition of Significant Harm
  6. Strategy Discussions
  7. Assessments and Section 47 Enquiries
  8. Challenging Carers
  9. Communications
  10. Other Factors to Consider
  11. Other Specific Circumstances
  12. Useful tools and contacts


1. Introduction

The available UK evidence on the extent of abuse among disabled children suggests that disabled children are at increased risk of abuse, and that the presence of multiple disabilities appears to increase the risk of both abuse and neglect (see Standards 5, 7 and 8 of the National Framework for Children, Young People and Maternity Services).

Research also indicates that as well as being the least protected, disabled children are also the least consulted in routine assessments.

All children have a number of human rights: the right to be protected from harm and have basic physical and social needs met; the right to respect private and family life; the right to know, the right to peaceful protest; the right to free expression and the right to receive equal treatment. The later right has been reinforced by the Disability Discrimination Acts 1995 and 2005 and the Equality Act 2010.

A failure to recognise disabled children's human rights can lead to abusive situations and practices. Needs relating to impairment, and discrimination against disabled children, can mean that particular effort is required to identify and meet disabled children's basic human rights. These areas include food and nutrition, appropriate levels of discipline or sanctions, finances, hygiene, physical comfort, social interaction, sexuality, liberty and sleep. These basic rights can be abused either through ignorance, lack of appropriate resources or support, or with intention to cause harm. Whether abuse of rights is unintentional or not, it is not acceptable for this to go unchallenged, as this does not promote children's welfare or safety. Moreover, when human rights are denied, children are vulnerable to further types of abuse.

Organisational culture and 'custom and practice' can contribute to institutional abuse or harm. Do not underestimate the power of tradition or how poor practice can become pervasive in influencing staff to behave inappropriately. Unreflective practice and risk aversive approaches from staff members can significantly reduce the quality of life for young people. Such cultures can also become ideal contexts for determined abusers to manipulate both children and adults. Good quality services readily seek the views of young people, parents and other professionals in reviewing their practice.

The significance of poor practice should be assessed in the context of the impact on the particular child. For example, if insufficient time is given for a child with restricted arm and hand movement to have adequate lunch, the child could experience hunger or dehydration. A one off experience like this may not be very damaging, but consider the impact of such an experience if it is repeated over a few days or weeks.

In considering these factors, be aware that poor care practices can have more significant consequences for some disabled children than for non-disabled children.  Poor care practices that, for a non-disabled child, may affect their emotional and physical development, may be life-threatening for a disabled child. The intimacy of the care needed by many disabled children also means that a lack of privacy and dignity can be abusive.


2. The Child

A child could be considered to be disabled if he or she has significant problems with communication, comprehension, vision, hearing or physical functioning.

There are a number of reasons for disabled children being more vulnerable to abuse including:

  • They are likely to be in contact with a larger number of service providers than non-disabled children and are likely to receive intimate care from a larger number of people;
  • They are more likely to spend time away from their families than non-disabled children, in short-break services, residential schools and so on;
  • Disabled children and their families may experience inadequate and poorly co-ordinated support services. This can lead to isolation which is widely recognised as a risk factor for abuse;
  • Practices which are abusive can sometimes go unrecognised. This happens in two ways: firstly, sometimes a practice is applied to a disabled child which if applied to a non-disabled child would be recognised as abusive (such as locking a child in a room in order to control his behaviour or using mechanical forms of restraints such as handling belts without sufficient guidance); secondly, for some disabled children a failure to provide a certain level of care can result in significant damage to their development, health and well-being, yet this is not always recognised;
  • There is a common failure to consult with and listen to disabled children about their experiences or recognise the additional support required to facilitate communication;
  • Parent's views and needs are sometimes considered before those of young people. Neglect and poor parenting are in some cases not  addressed with sufficient rigour where the young person presents challenging behaviour;
  • The speed of multi disciplinary decision making, quality of risk management decision making and rigour of audit processes, can also contribute to poorer outcomes for children with more complex support needs;
  • Underpinning all the many other factors which create a vulnerability to abuse are negative social attitudes towards disabled children - their lives and their experiences are commonly devalued;
  • Failure to acknowledge and promote disabled children's human rights means that abusive practices are seen as acceptable.


3. The Safeguards

Safeguards for disabled children are essentially the same as all other children. Particular attention should be paid to promoting a high level of awareness of the risks of harm and to high standards of practice, and strengthening the ability of children and families to help themselves.

Measures should:

  • Make it common practice to enable disabled children to make their wishes and feelings known in respect of their care and treatment;
  • Ensure that disabled children receive appropriate personal, health and social education (including sex education);
  • Make sure that all disabled children know how to raise concerns and give them access to a range of adults with whom they can communicate. This could mean using interpreters and facilitators who are skilled in using the child's preferred method of communication;
  • Recognise and utilise key sources of support including staff in schools such as support workers, friends and family members where appropriate;
  • Ensure that there is an explicit commitment to and understanding of disabled children's safety and welfare among all providers of services used by disabled children;
  • Develop the safe support services that families want, and a culture of openness and joint working with parents and carers on the part of services;
  • Provide guidelines and training for staff on good practice in intimate care; working with children of the opposite sex; managing behaviour that challenges families and services; issues around consent to treatment; anti-bullying and inclusion strategies; sexuality and safe sexual behaviour among young people; monitoring and challenging placement arrangements for young people living away from home.

There are specific issues in relation to the safeguarding of disabled children. Nationally these include:

  • There is a commonly held belief that disabled children are not abused. This can lead to a denial of, or a failure to report, abuse or Neglect;
  • There is a lack of awareness among carers, professionals and the general public of what the indicators of abuse or Neglect are for disabled children.  These can of course be the same as for non-disabled children but there is much anecdotal evidence of indicators of abuse or Neglect being misinterpreted as being related to impairment - the most common example being where a child's behaviour is put down to her impairment rather than as a possible indicator that she has been abused or neglected;
  • Those working in services for disabled children are commonly not trained in safeguarding children while those working to safeguard children are not familiar with disabled children and their needs;
  • A lack of familiarity with a child's impairment can get in the way of social worker using their safeguarding expertise - statements such as "He has a mental age of 5" can inhibit social workers and undermine their confidence in their own judgement concerning safeguarding and child development;
  • Disabled children are commonly held to be not 'credible witnesses' and therefore concerns about possible abuse may not result in a referral to Children's Specialist Services, or further enquiry. A belief that the police are unlikely to investigate abuse of a disabled child can act as a halt on social workers proceeding further with a complaint;
  • There is often a reluctance to challenge carers, particularly when the social worker knows that removing a child from home or a current placement would be difficult because it would be hard to find an alternative placement for the child;
  • A disabled child is more likely to be in contact with a number of different services and carers: there may be information recorded in a number of case files held by a number of different services and professionals.

This means that a retrospective analysis of records could be of value - often there is a pattern of incidents being recorded but not identified, at the time, as a cause for concern.  More time will often be required to gather information directly from a disabled child and specialist expertise or resources may be required.

Safeguarding strategies and activity should therefore acknowledge and address both disabled children's human right to be safe and protected from harm, and the additional action that has to be taken in order for disabled children to access this common human right. The specific needs and circumstances of disabled children should be addressed at all stages of the safeguarding process.


4. Concerns and Referrals

Concerns about the welfare of a disabled child should be acted upon in the same way as any other child in accordance with the Contacts and Referrals Procedure. The same thresholds for action apply.  Expertise and resources in both safeguarding and promoting the welfare of children and in working with disability have to be brought together to ensure that disabled children receive the same levels of protection from harm as other children

The following points are important for those receiving initial queries and referrals concerning a disabled child:

  • When, in Children's Specialist Service, a query which relates to a disabled, child, do not assume that it should automatically be passed to the Children with Disabilities Team, as the mainstream children's teams also deal with children with less severe disabilities;
  • As with non-disabled children it is not always obvious from the initial contact with Children's Specialist Services that there is a safeguarding matter. Professionals, the family, the child or others may emphasise another type of need and the need for protection from harm may not always be obvious. The person receiving the query should seek information about what needs and circumstances have prompted the contact;
  • Where a child is already known to the Children with Disabilities Team, any contact about that child and his/her sibling should be passed to that team. The Children with Disabilities Team should undertake any investigation where a child has severe disabilities. The same applies if a mainstream children's team is working with a disabled child and need specialist advice and support from the Children with Disabilities Team.

When an initial contact is passed on or a referral is made to Children's Specialist Services, it will be important that those receiving it have clear information in order to understand the context of any concern. In addition to establishing all the usual information, the following questions should be asked when the contact or referral concerns a disabled child:

  • What is the disability, special need or impairment that affects this child? Ask for a description of the disability or impairment: for example, 'learning disability' could mean many things and does not tell you much about the child or their needs;
  • If you do not know how to spell a word that describes an impairment or condition ask how it is spelt. This will be important if further enquiries are required about how the condition might be expected to affect the child;
  • How does the disability or impairment affect the child on a day-to-day basis?
  • How does the child communicate? If someone says the child can't communicate, try asking "How does the child indicate s/he wants something?"
  • How does s/he show s/he is happy or unhappy?
  • Has the disability or condition been medically assessed/diagnosed?


5. Recognition of Significant Harm

In addition to the universal indicators of abuse/neglect listed in the Recognition of Significant Harm Procedure, the following abusive behaviours must be considered:

  • Force feeding;
  • Physical interventions (including restraint), which are not carried out in accordance with the local authority's Physical Intervention Policy, Procedure and Guidance;
  • Inappropriate behaviour modification including the deprivation liquid, medication, food or clothing;
  • Misuse of medication, sedation, heavy tranquillisation;
  • Invasive procedures which are unnecessary or carried out against the child's will, or by people without the right skills or support;
  • Being denied access to medical treatment and deliberate failure to follow medically recommended regimes;
  • Non compliance with programmes or regimes;
  • Failure to address ill-fitting equipment e.g. callipers, sleep boards which may cause injury or pain, inappropriate splinting;
  • Misappropriation/misuse of a child's finances;
  • Failure to meet the communication needs of a hearing impaired child to the point where his or her development is impaired;
  • A parent seeking residential schooling to the exclusion of access to ordinary family life and social and emotional development;
  • Being denied mobility, communication or other equipment;
  • Being denied access to education, play and leisure opportunities.
Where a child is unable to tell someone of the abuse, they may convey anxiety or distress in some other way, e.g. behaviour or symptoms and carers and staff must be alert to this - see Section 9, Communications.


6. Strategy Discussions

A Strategy Discussion/Meeting, convened by Children's Specialist Services, must always take place where there are concerns that a child may be at risk of Significant Harm - see the Strategy Discussions/Meetings and Section 47 Enquiries as Part of Social Work Assessment of Needs and Strengths Procedure.

The Strategy Discussion/Meeting is key to sharing information and making clear decisions about how to proceed, and it is essential that all agencies involved with that child and family participate.

Throughout any Social Work Assessment of Needs and Strengths process, including a Section 47 Enquiry, all service providers must ensure that they communicate clearly with the disabled child and the family and with one another as there is likely to be a greater number of services and staff involved than for a non-disabled child. All steps must be taken to avoid confusion so that the welfare and protection of the child remains the focus. The increased amount of exposure a disabled child has to a number of adults raises their vulnerability to being abused by someone. There is also more room for miscommunication or assumptions that 'someone else' is addressing concerns. This means Section 47 Enquiries may be more complex and may take longer to complete. There may be more adults to be interviewed and more potential perpetrators. These difficulties need thorough consideration in the Strategy Discussion to ensure all risk factors are identified and contamination of evidence is avoided.

More than one Strategy Discussion may be needed, as the planning of the investigation will be complex and take time. However, this must not prevent any concern of Significant Harm being properly investigated.

Issues for additional consideration at a Strategy Discussion concerning a disabled child are:

  • Does the child need a supporter or advocate?
  • What are the child's communication needs and who is to ensure they are met?
  • Arranging for interpreters and signers to facilitate communication;
  • When is the best time, venue, location to interview the child - how should it be structured (a child may be more alert in the morning, need disabled access, be able to access IT, need significant preparation before an interview). Has the child personal care needs that need support during any interview?
  • Will the child need medication or health support (e.g. if diabetic or has epilepsy)?
  • How is the child getting to the venue and who is transporting?
  • If a parent or carer is suspected of abuse and needs to leave the family home, what support services will be needed for the child to remain at home?
  • What other sources of evidence are available to be considered if there is a possible criminal charge? - is it appropriate for the child to have a medical, is there forensic evidence that can be gathered, has someone else observed an abusive situation, what is recorded?


7. Assessments and Section 47 Enquiries

As part of any assessment and investigation concerning disabled children, the areas below must be considered:

Carers

  • What are the arrangements for caring for the child? There may well be carers additional to those usually involved with non-disabled children. For example, respite foster carers, social workers, family support workers, residential short-break carers, community/home-based support workers, sitters, home help, volunteers, advocates, play and development workers;
  • Where does the child get looked after and when? For example, hospital, residential short breaks, residential school, holidays, foster carers?

Health

A disabled child may be in contact with a large number of health professionals. These professionals may be vital sources of information about both the child's needs and their experience or risk of harm:

  • GP;
  • School nurse;
  • Health visitor;
  • Community/District nurse;
  • Hospital Consultant;
  • Paediatrician;
  • Physiotherapist;
  • Occupational therapist;
  • Dietician;
  • Speech and language therapist;
  • Clinical psychologist;
  • Psychiatrist;
  • Complementary health workers;
  • CAMHS.

Education and schools

Disabled children, whether in a mainstream or special school, are likely to be in regular contact with a number of people in a number of different roles:

  • Teachers;
  • Special educational needs co-ordinator (SENCO) or Inclusion Co-ordinator, Special Education Service staff;
  • Teaching assistants;
  • Lunchtime assistants;
  • Transport drivers;
  • Transport escorts;
  • Volunteers;
  • Peripatetic teachers;
  • Providers of out-of-school activities - horse-riding, swimming, leisure centre.

It is important for professionals to recognise that they may need to seek specialist advice and information in order to make judgements about whether a child is suffering or likely to suffer Significant Harm, and what action should follow.

Such issues may fall outside their previous experience and specialist advice may be necessary in the context of a number of judgements to be made, including:

  • The impact of potentially abusive behaviour upon the physical and psychological development of the child;
  • The long and short term consequences of any impairment caused by abusive behaviour or Neglect;
  • The emotional consequences of abuse and Neglect;
  • The ability of the child to engage in, or the availability of, therapeutic services.


8. Challenging Carers

Carers are relied upon (whether family or paid carers) as a source of information about disabled children and to interpret and explain behaviour or symptoms.

Professional staff can potentially feel out of their depth in terms of knowledge of a disabled child's impairment, where the familiar developmental milestones may not apply.

Disabled children should not be left in situations where there is a high level of neglect or other forms of abuse, because a professional feels the parent, carer or service "is doing their best".

Carers of disabled children will need to be challenged in the same way as carers of non-disabled children.

Remember that evidence of good quality care does not always mean there are no safeguarding issues.

Those who perpetrate abuse (both within and outside the child's home) may also be perceived as quality caregivers with good relationships with children, families and professionals. Their ability to engage successfully with children may be a necessity in securing the trust, privacy and opportunity which enables abuse to take place. This applies as much to disabled children as to non-disabled children.

The dependence on a carer by a disabled child may be such that opportunities for abuse to take place are increased because of the child's needs.


9. Communications

Be aware that disabled children often experience greater barriers to disclosing abuse than non-disabled children.

Disabled children may have different communication needs. They may use other communication systems such as British sign language, symbols or hand gestures (e.g. Makaton, Rebus).  Children's Specialist Services and the Police should be aware of non-verbal communication systems and should be familiar with the Use of Interpreters, Signers or Others with Communication Skills (See Use of Interpreters, Signers or Others with Communication Skills Procedure).

The child might have very limited communication with only a sign or word or movement that indicates yes and another that indicates no. This does not mean the child cannot understand or is not able to communicate what has happened to them.

If a parent or professional tells you that a child cannot communicate, explore a bit further with them what (s)he actually means. Ask how do they know when the child is in pain? Hungry? Hot/cold? Or doesn't like something? This will then inform you of how the child communicates.

For some children, their only way of communicating with you will be through changes in their behaviour. It is very important therefore to maximize the use of observation and reports from those in contact with the child. For example, where a child's response to personal care changes suddenly; or where they express fear or aversion to a particular carer.

Abuse and neglect are as harmful for disabled children as they are for non-disabled children. Sometimes it is thought that because a child has impaired cognitive functioning (learning disabilities) they will not understand that what has happened to them is abuse or will not suffer from being neglected. For example, it may be assumed that, if a child has very limited understanding of sexual activity and relationships and Sexual Abuse is perpetrated in a 'loving' way, the child will never realise that they have been abused. The psychological impact of Physical Abuse or Emotional Abuse or Neglect may also be underestimated. It is sometimes concluded that, as long as the abuse stops, there will be no other impact on the child, and no reason to consider further protection or therapeutic services.

However, disabled children can also suffer from stress, anxiety and depression, and be severely emotionally affected by what has happened to them. Agencies working with disabled children need to be aware that if a child or young person has no or limited communication, this emotional impact may show itself in other ways such as self-harming, aggressive or destructive behaviour, or withdrawal. It is essential that the child or young person does not become 'the problem' as a result and that children and young people are supported through a difficult time for them.

Communication can be affected by both the child's impairment and by the actions of an abuser. An abuser may restrict a child's access to aids for communication, including access to vocabulary. An abuser can also threaten a child or threaten to withdraw care.  Threats can be more effective where a child has high personal care needs.  Dependency can both increase a disabled child's vulnerability to abuse and decrease their ability to communicate what is happening. Where there are communication impairments or learning difficulties, particular attention should be paid to the communications needs of the child to ascertain the child's perception of events and his or her wishes and feelings.

Additional care may need to be taken when receiving a telephone call or visit from a disabled child or adult. Duty social workers can unwittingly create barriers to communication when presented with someone whose method of communication, appearance or behaviour they are not familiar or comfortable with. If you do not understand what the person is trying to say, do not guess. Do not make assumptions based on communication method or difficulties, or on appearance or behaviour. Do not put the phone down too quickly, because someone may need extra time to speak. Find out if there are steps you can take to assist the person to communicate their concerns.  Take into account that some environmental and other factors have particular significance for disabled children's risk of harm.

Agencies must not make assumptions about the inability of a disabled child to give credible evidence, or to withstand the rigours of the Court process.

Each child should be assessed carefully and supported where relevant to participate in the criminal justice system when this is in their interests as set out in Achieving Best Evidence which includes comprehensive guidance on planning and conducting interviews with children and a specific section about interviewing disabled children.

Participation in all forms of meetings such as Child Protection Conferences and Core Groups must be encouraged and facilitated and take into account any issues about access.


10. Other Factors to Consider

Circumstances such as poverty, social and physical isolation, lack of support and other environmental factors can have a particular impact on disabled children and their families. These issues will obviously be considered in some detail in an assessment but those receiving initial Referrals should also be aware of their significance.

Poverty:

Families with disabled children are at increased risk of poverty and, at the same time, impairment can create additional costs. The financial pressures on a family and carers may increase stress, and stress can be a factor or indicator of risk of abuse. The child may become the focal point of the tensions or be seen to be the cause of the stress.

Social isolation:

For many disabled children their opportunities to take part in social activities, hobbies or clubs are limited and significantly less than non-disabled children. This means disabled children have less access to trusted adults or peers outside their circle of immediate carers. It also means less opportunity for them to have a variety of experiences and relationships. If the only relationships or contact they have are abusive they may have nothing to compare this with and, therefore, not know that it is wrong.

Physical factors:

A child may be at increased risk of harm if the environment restricts their ability to avoid, or remove themselves from, abusive or potentially abusive situations. An understanding of a disabled child's environment will help to develop an appropriate response to a referral to Children's Specialist Services. For example:

  • The child's access internally to the different parts of the home/school;
  • Access to and facilitation of external communication systems - private use of telephones, e-mail, internet; and
  • Facilitation and access to external contacts and activities.

Sometimes concerns have been raised about a particular child, or about a service they are receiving, which have not resulted in any action. There is some evidence that this is more likely to happen with disabled children. It will be helpful therefore to establish whether concerns have been previously raised. If such concerns have not been effectively addressed in the past the child may be at increased risk of harm.

Health

Medical and health issues have particular implications for identifying significant harm. The potential to abuse or neglect children through medical and health issues is greater than with children who are not as reliant on specific health needs being met. The main areas of concern are the misuse of medication:

  • To restrict liberty;
  • To control emotion and behaviour; and
  • To impair physical and emotional capacity to resist abuse.

The neglect of health needs:

  • Poor, uncoordinated or non-existent assessment of need;
  • Poor equipment, adaptation and aids, which may result in harm. For example, a child who is constantly being made sore by an ill fitting back brace with no-one addressing this;
  • Tampering with equipment to restrict liberty. For example, removing batteries out of an electric wheelchair might equate to a non-disabled child being locked in a room or having their legs tied;
  • Neglect of basic health care needs. For example, teeth cleaning, hair washing;
  • Failure to consider the emotional well being of the child and access to play and leisure opportunities;
  • Insufficient consideration of the developing sexual and relationship needs of the young person as they develop towards adulthood;
  • Denying or restricting access to food and nourishment. For example, if a child cannot help themselves to a drink it is abusive to withhold drink as a punishment or for malicious reason.

Experiences such as these can inhibit children's ability to reach their full potential and also can affect their ability to resist abusive behaviours towards them, making them more vulnerable to further abuse.

Physical Injury

If someone tells you that a child's injury or behaviour is a normal part of their disability make sure you verify this opinion. You could do this either by asking other individuals who know the child or seeking written evidence by looking at care plans or school records. For example, if the concern regards suspicious bruising and someone says the child often gets bruising like this, look at medical and school records. The times when the child has been bruised in this way should have been noted by doctors, teachers and physiotherapists. A previous occurrence, however, should not act as verification of 'normality' and it may be necessary to seek medical or other specialist advice.


11. Other Specific Circumstances

11.1 Disabled Children in Residential Care and Residential Schools

See also Children Living Away From Home (Including Children and Families Living in Temporary Accommodation) Procedure.

Children living away from home are particularly vulnerable, as family contact may be reduced because of distance, or family support is weak because of a breakdown in the family circumstances. Children are also exposed to a high number of carers in these settings, which again increase the risk of abuse.

For residential care and schools in Wirral LSCB's area, all establishments must have the following in place:

  • A clear safeguarding and child protection policy which highlights the vulnerability of disabled children;
  • Clear guidance on the use of medication, eating and drinking, intimate care;
  • Clear guidance on restrictive physical intervention (restraint), which defines what is and is not acceptable;
  • Risk assessments which clearly outline how the child's needs for care, supervision and safety are to be met, and what are permissible forms of restraint and control;
  • All staff have attended the LSCB training on Safeguarding Disabled Children;
  • A clear procedure regarding allegations against staff is in place.

Where a child is placed outside of Wirral, the placing social worker must confirm together with the Contracts Section that the above is in place as part of the contract agreement.

It is essential that children are regularly visited and where necessary, an advocate or Independent Visitor is appointed to ensure that contact is made with the child, and their views sought about their care.

If a child is not looked after but is placed for educational reasons in a residential school, the Participation and Inclusion Branch of the Children and Young Persons Directorate must notify Children's Specialist Services under Section 85 of the Children Act 1989 if this is going to be for longer than 3 months. Children's Specialist Services must then consider what steps are "reasonable and practical" to safeguard and promote the child's welfare. The LSCB recommends that an assessment is undertaken in these circumstances, and clarification sought as to who is going to visit the child when in placement, and how the child can have access to an advocate or visitor to ascertain their welfare.

There is a new requirement upon the Authority from 1 April 2011 to ensure that arrangements are made for the child to be visited by a social worker.On each visit, the social worker must speak to the child in private unless:

  • The child, being of sufficient age and understanding to do so, refuses,
  • The social worker considers it inappropriate to do so, having regard to the child's age and understanding; or
  • The social worker is unable to do so.

Where the child's  needs for the purposes of the 1989 Act have not been assessed by any local authority in the past twelve months, the social worker must visit:

  • Within seven working days of the notification; and
  • Thereafter, at intervals of not more than six months.

Where the child's needs have been assessed in the past twelve months, the social worker must  visit:

  • Within three months of the notification; and
  • Thereafter, at intervals of not more than six months.

In addition, the social worker must visit:

  • Whenever reasonably requested to do so by the child; and
  • Whenever satisfied that circumstances require the child  to be visited in order to safeguard and promote his/her welfare.

The social worker must provide a written report of each visit, including the social worker's assessment of:

  • The child's wishes and feelings about the accommodation, so far as the social worker  has been able to ascertain them;
  • Whether the child's welfare is adequately safeguarded and promoted;
  • Whether further additional visits are required in order to safeguard and promote the child's welfare;
  • Any services which the social worker considers appropriate to be made available with a view to promoting contact between the child and his/her family; and
  • Any other steps that should be taken by the local authority exercising its functions under the 1989 Act to safeguard and promote the child's welfare.

The report must be copied to:

  • The child, unless it would not be appropriate to do so, having regard to age and understanding;
  • Any parent/person who has Parental Responsibility, unless to do so would mean the child would suffering or was likely to suffer Significant Harm;
  • Where different from the responsible local authority, the local authority in whose area the child  is accommodated; and
  • Any other person with responsibility for safeguarding and promoting the child's welfare under the 1989 Act.

11.2 Disabled Children in Health Care Settings

See also Children Living Away From Home (Including Children and Families Living in Temporary Accommodation) Procedure and Management of Children and Young People in Need Who Are Medically Fit for Discharge Procedure.

All health care settings (hospital adult and children's wards, hospices, nursing homes) must have appropriate safeguarding and care policies in place for disabled children as outlined in the previous section. Again, if a child has been in hospital for 3 months or the intention on admission is that he/she will be there for 3 months or longer, Children's Specialist Services must be notified by the Hospital Trust under section 85 of the Children Act 1989 and an assessment undertaken to ascertain how their needs are being met and how their welfare is being safeguarded - see 11.1 above for requirements as to social work visits.

11.3 Disabled Children who are Accused of Abuse

See also Children and Young People who Display Sexually Inappropriate and Harmful Behaviour Procedure

Studies of adolescent sexual offenders have found that between a third and a half are children and young people with learning disabilities. This group are also over-represented amongst those being treated for harmful sexual behaviour. It is not clear why this is but one relevant factor is that many of the young perpetrators have also been abused themselves - and children and young people with learning disabilities are particularly vulnerable to abuse.

Successful interventions with young abusers require specialist treatment and it is important that disabled young people are not denied access to such treatment. Multi-agency assessment and joint working will be particularly important for this group of young people. Specialist input from learning disability services is available, even if the young person's level of impairment would not normally meet the service's eligibility criteria.


12. Useful tools and contacts

All Join In

This is a video/DVD about communication, inclusion and emotional literacy. It was made with a diverse group of 3-7 year olds. Produced by Triangle and the NSPCC in 2004. It is available from triangle website.

Two Way Street: Communicating with Disabled Children and Young People.

A training DVD/video and handbook about communicating with disabled children and young people. It is aimed at all professionals whose role includes communicating with children and was developed in consultation with disabled children and young people.  The handbook (also available separately) gives further information and guidance plus details of the main communication systems in current use in the UK and annotated references to good practice publications. It is available from triangle website.

How it is

This is an image vocabulary for children about feelings, rights and safety, personal care and sexuality. It was developed - with the involvement of over 100 children - to support children to communicate about a range of important issues and was designed to fill the gaps in existing symbol vocabularies. There are 380 images available for free download at triangle website or as a booklet with CD-Rom from triangle website.

Communicating with Vulnerable Children: a Guide for Practitioners, Dr David Jones (Gaskell, 2003) ISBN 9781901242911. Includes some information about communicating with disabled children.

How to use Easy Words and Pictures
This guide is produced by the Disability Rights Commission.

I'll Go First: The planning and review toolkit for use with children with disabilities
This pack by Lucy Kirkbride was designed for use with children in short term foster care, family-based short term care, in a residential children's centre or with a Education, Health and Care Plan. It is published by the Children's Society.

Talking Mats

Talking Mats(tm) is an interactive resource that uses 3 sets of picture symbols: topics; options relating specifically to each topic; and a visual scale in order to allow participants to indicate their general feelings about each topic and option. For example, whether they are happy, unsure, unhappy. talkingmate website, nspcc website.

Talking Point
I CAN runs a website called Talking Point. This provides information about speech, language and communication difficulties in children. The site is for parents and professionals who help children with speech, language and communication difficulties and includes speech and language information, a glossary, a directory of resources, news, case studies, discussion groups, ask-the-panels write ups and frequently asked questions.

The Child's World (assessing children in need): Training and Development Pack
Produced by the NSPCC in 2000, this includes a video with disabled and non-disabled children giving their experiences of assessment. 

In My Shoes
In My Shoes is a computer package that helps children and learning disabled adults communicate about potentially distressing experiences. Extensive testing shows it can be used in a wide range of circumstances, including with children who may have been abused. It has been used successfully in interviewing Adults at Risk.

The ABCD Pack - a Training and Resource Pack for Trainers in Child Protection and Disability

The ABCD Pack is a training and resource pack to assist trainers to design courses that help to:

  • Raise awareness of child abuse and disability;
  • Prevent the abuse of disabled children;
  • Investigate and assess possible abuse;
  • Empower and support abused and disabled children;
  • Identify the implications of this work for managers.

The pack has 5 modules:

  • Foundation and Awareness;
  • Prevention;
  • Investigation and Assessment;
  • Survival;
  • Management and Policy.

The material was developed with two target groups in mind:

  • Everyone who works directly with, or whose agency provides a service for, disabled children;
  • Everyone involved in safeguarding work.

It is available from nspcc website.

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