Safeguarding Children Overview for PHC

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Safeguarding Children

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Safeguarding Children:

Safeguarding Children An overview for Primary Care John R. Kimberley

Learning Outcomes:

Learning Outcomes The aim of this training session is to raise awareness of child protection and safeguarding in a Primary Care setting. Have an awareness of current Child Protection legislation. Be able to identify the signs and symptoms of abuse. Know what to do if you have safeguarding or child protection concerns. Have an understanding of the roles and responsibilities of key people in your organisation in relation to child protection and safeguarding.

Legislation/Guidance:

Legislation/Guidance Children Acts 1989 and 2004 Working Together to Safeguard Children 2010 Framework for Assessment of Children in Need What to do if you’re worried a child is being abused – Local Board Protocol Information Sharing: practitioners guide 2008

Facts & Figures:

Facts & Figures 31% bullied during childhood 7 % seriously physically abused by parents or carers during childhood 1% sexually abused by a parent or carer during childhood 3% sexually abused by another relative during childhood On average 1 child is killed by their parent or carer every week in England and Wales Ref: NSPCC

Our Feelings:

Our Feelings When faced with child abuse situations we may feel: Denial - difficult to accept abuse takes place Guilt - because we all make mistakes Fear - that we won’t know what to do Anger - that people can do such things to children Pain - at the recognition of abuse in our own lives Jealousy - if we have to let another professional take over

Professional awareness and responsibility:

OBLIVION What? “There’s no such thing as child abuse” “ Abuse doesn’t happen amongst people I know” “Too much is made of abuse – it isn’t that common” OBSESSION “ Everyone abuses children “ Abuse is very common in some types of family” “ Any single person who works with children is an abuser” REALITY Enough awareness to: Recognise abusive situations Help children who are abused Protect children Prevent abusive situations Both extremes can be abusive Professional awareness and responsibility

Principals of The Children’s Act:

Principals of The Children’s Act The welfare of the child is paramount Partnership between the state and parents Parental responsibility for the child Prevention of abuse Protection of the child

Framework For Assessment Of Children In Need:

Framework For Assessment Of Children In Need CHILD Safeguarding and promoting welfare CHILD'S DEVELOPMENTAL NEEDS FAMILY & ENVIRONMENTAL FACTORS PARENTING CAPACITY Basic Care Ensuring Safety Emotional Warmth Stimulation Guidance & Boundaries Stability Health Education Emotional & Behavioural Development Identity Family & Social Relationships Self Care Family History & Functioning Wider Family Housing Employment Income Family’s Social Integration Community Resources

Categories of Abuse:

Categories of Abuse Physical – Shaking, biting, hitting, burning, fabricated or induced illness. Neglect – Lack of food, clothing, warmth, healthcare. Emotional – Made to feel worthless, inadequate, unloved. Sexual – Physical contact, penetrative sex, prostitution, internet/video porn

Non-Accidental Injuries:

Non-Accidental Injuries Inconsistent story Story does not fit injury Story does not correspond to development of the child Injuries not witnessed Frequent A&E attendances Failure to attend for treatment early enough or not at all Injuries in areas of body protected by clothes Families where Domestic Violence exists Parents who demonstrate aggression

Common Sites of NAI:

Common Sites of NAI Knee Elbow Forehead Crown bony spine protuberance Shin

Common Sites of NAI:

Common Sites of NAI ears eyes mouth cheeks Back thighs Front thigh Genitals Stomach Chest Inner arm Shoulder upper arm Shoulder

Parents Behaviour as Indicators for Emotional Abuse:

Parents Behaviour as Indicators for Emotional Abuse Fail to provide consistent love and nurture Habitual verbal harassment Exert overt hostility Reject children Highly critical of their children Frequently ridicule children Have excessively high expectations Language used is always negative “High criticism, low warmth”

Child in Need (section 17 CA 1989):

Child in Need (section 17 CA 1989) He / she is unlikely to achieve or maintain or have the opportunity of achieving or maintaining a reasonable standard of health or development without the provision for him / her / of services by a local authority. His / her health or development is likely to be significantly impaired or further impaired without the provision for him / her of such services. He / She is disabled

Information Sharing:

Information Sharing Legal Restrictions Common law duty of confidence e.g. doctor/patient Human Rights Act 1998 Data Protection Act 1998

Consent & Confidentiality:

Consent & Confidentiality In general it is and has always been good practice to obtain parent’s’/carers consent to make a referral to the SSD or to obtain further information from another agency. Seeking consent should be the ‘norm’. Exceptions are: Where you (the referrer) make a professional judgement that seeking consent would place the child(ren) and/or other people at increased risk.

Information Sharing:

Information Sharing In Child Protection it is vital to consider the following: It may not be safe for the child or children to seek consent (that is – seeking consent may place a child at greater risk of harm). A crime may have been committed – seeking consent could well undermine its detection There is a legal basis for sharing information without seeking consent.

Consent & Confidentiality:

Consent & Confidentiality Exceptions are: Where the child has made an allegation or disclosure of sexual abuse/assault. Where a crime has clearly been committed. Most situations will not involve exceptions! If you are in any doubt seek advice from the Duty Team – SSD, Named Nurse or from the Police (CAIU).

Listening to Children:

Listening to Children The role of the Practice is to establish whether there is a child protection concern. Practice staff must not investigate. Practices should Create the opportunity and environment for children to be able to talk about their concerns. Establish systems to enable cover for the member of staff listening to a child’s concerns if the Safeguarding Officer is unavailable, or if there is a particular reason that the member of staff is the most appropriate person.

Appropriate Procedure:

Appropriate Procedure Receive Listen, remain neutral, and accept what the child says. Reassure Stay calm, reassure the child that they have done the right thing, don’t make promises including promises on confidentiality, try to alleviate feelings of guilt and shame, empathise with the child. React Only use open questions, don’t criticise the perpetrator, explain what happens next, inform the Safeguarding Officer. Record Make notes and use child’s actual words where possible, keep notes safe, be objective. Note dates, times, who was present, positions in the room, anything factual about the child’s appearance. If possible use a silent witness.

Non leading questions:

Non leading questions Has something happened to you? Can you tell me what happened? Where did it happen? When did it happen? Was anyone else there? Can you tell me about it in your own words?

Never ask leading questions:

Was it your dad that hit you? (or some other named person) Does your brother bully you? (or some other named person) Did it happen at home? (or some other named place) So that must have upset/hurt you? Never ask leading questions

Practice’s Reporting Protocol Development Considerations:

Practice’s Reporting Protocol Development Considerations Appoint a Practice Safeguarding Officer The key co-ordinator and single point of contact within the Practice for all agencies. Awareness of local Child Protection guidelines. Adopt PHCT’s implementation strategy. How to maintain working relationships with families during and after the child abuse investigative process. Attendance at Child Protection case conference and preparation of relevant reports.

GP’s Role in Child Protection: Tensions:

GP’s Role in Child Protection: Tensions Family Medicine Family Support Confidentiality Professional autonomy Child Protection Paramount principle Information sharing Interagency collaboration

Any Questions?:

Any Questions? Thank you

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