This chapter was updated in January 2018 with a link to the health guidance on the assessment of sub-conjunctival haemorrhage in infants.
- The Concept of Significant Harm
- Early Help
- Definitions of Child Abuse and Neglect
- Potential Risk of Harm to an Unborn Child
- Bruising / Unexplained Injuries in Non-Mobile Baby / Child
- Professional and Agency Response
- Hearing and Observing the Child/Young Person
- Parental Consultation
- Urgent Medical Attention
- Making a Referral
- Concerns Raised by a Member of the Public
- Adult Services Responsibilities in Relation to Children
- Schools and Educational Establishments
These LSCB Child Protection Procedures set out how organisations and individuals should work together to safeguard and promote the welfare of children and young people. The target audience is practitioners (including unqualified staff and volunteers) whose work brings them into contact with children, young people, their families and adults who are parents or carers; front-line managers who have particular responsibilities for safeguarding and promoting the welfare of children; operational and senior managers, in:
- Organisations responsible for commissioning or providing services to children and their families and to adults who are parents or carers;
- Organisations with a particular responsibility for safeguarding and promoting the welfare of children.
Many children, especially some of the most vulnerable children and those at greatest risk of social exclusion, will need early co-ordinated help services from health organisations such primary and secondary health services, educational establishments such as schools and colleges, Children's Centres, local authority children's social care, the private, voluntary, community and independent sectors, including youth justice services. Some services will be provided as universal services whilst others may be more targeted to meet specific needs, whatever the circumstances of the child:
All organisations and practitioners should:
- Be alert to potential indicators of abuse or neglect;
- Be alert to the risks which individual abusers, or potential abusers, may pose to children;
- Implement systems and processes which facilitate the sharing and analysis of information so that assessments can be made of the child's needs and circumstances;
- Contribute to whatever actions are needed to safeguard and promote the child's welfare;
- Take part in regularly reviewing the outcomes for the child against specific plans;
- Work cooperatively with parents and carers, unless this is inconsistent with ensuring the child's safety.
These procedures are based on the Working Together to Safeguard Children Guidance which sets out what should happen in any local area when a child or young person is believed to be in need of support. Effective safeguarding arrangements should aim to meet the following two key principles:
- Safeguarding is everyone's responsibility: for services to be effective, each individual and organisation should play their full part; and
- A child-centred approach: for services to be effective, they should be based on a clear understanding of the needs and views of children.
Working Together to Safeguard Children defines Safeguarding as:
- Protecting children from maltreatment;
- Preventing impairment of children's health or development;
- Ensuring that children grow up in circumstances consistent with the provision of safe and effective care; and
- Taking action to enable all children to have the best outcomes.
2. The Concept of Significant Harm
Some children are in need because they are suffering, or likely to suffer, significant harm. The Children Act 1989 introduced the concept of significant harm as the threshold that justifies compulsory intervention in family life in the best interests of children, and gives local authorities a duty to make enquiries (Section 47) to decide whether they should take action to safeguard or promote the welfare of a child who is suffering, or likely to suffer, significant harm.
Additionally, a Court may only make a Care Order or Supervision Order in respect of a child 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 (Section 31).
In addition, 'harm' is defined as the ill treatment or impairment of health and development. This definition was clarified in section 120 of the Adoption and Children Act 2002 (implemented on 31 January 2005) so that it may include 'impairment suffered from seeing or hearing the ill treatment of another' for example, where there are concerns of Domestic Violence and Abuse.
There are no absolute criteria on which to rely when judging what constitutes significant harm. Consideration of the severity of ill-treatment may include the degree and the extent of physical harm, the duration and frequency of abuse and neglect, the extent of premeditation, and the presence or degree of threat, coercion, sadism and bizarre or unusual elements.
Each of these elements has been associated with more severe effects on the child, and/or relatively greater difficulty in helping the child overcome the adverse impact of the maltreatment.
Sometimes, a single traumatic event may constitute significant harm (e.g. a violent assault, suffocation or poisoning). More often, significant harm is a compilation of significant events, both acute and longstanding, which interrupt, change or damage the child's physical and psychological development.
Some children live in family and social circumstances where their health and development are neglected. For them, it is the corrosiveness of long-term neglect, emotional, physical or sexual abuse that causes impairment to the extent of constituting significant harm.
Sometimes 'significant harm' refers to harm caused by one child to another (which may be a single event or a range of ill treatment), which is generally referred to as 'peer on peer abuse'.
3. Early Help
Some other children are in need because they have additional or extensive needs that universal services cannot provide for alone but do not result in significant harm.
Both Nottingham City (see Early Intervention, Nottingham City Council website) and Nottinghamshire (see Early Years and Early Intervention Service, Nottinghamshire County Council website) have multi-agency agreements in place, which provide guidance for professionals to assist in:
- Assessing the level of need of a child;
- Identifying thresholds for different levels of intervention;
- Identifying the range of services available;
- Understanding the criteria, including the level of need, for when a child should be referred to children's social care for assessment and for statutory services under:
- Section 17 of the Children Act 1989 (children in need);
- Section 47 of the Children Act 1989 (safeguarding);
- Section 31of the Children Act 1989 (care proceedings);
- Section 20 of the Children Act 1989 (duty to accommodate a child).
In Nottingham City, this is the Family Support Strategy and Pathway, which can be accessed here: Family Support Strategy and Pathway.
In Nottinghamshire, this is the Pathway to Provision, which can be accessed here: Pathway to Provision.
4. Definitions of Child Abuse and Neglect
The following definitions are those identified in Working Together to Safeguard Children and Keeping Children Safe in Education:
A form of maltreatment of a child. Somebody may abuse or neglect a child by inflicting harm or by failing to act to prevent harm. Children may be abused in a family or in an institutional or community setting by those known to them or, more rarely, by others (e.g. via the internet). They may be abused by an adult or adults or another child or children.
Physical abuse may involve hitting, shaking, throwing, poisoning, burning or scalding, drowning, suffocating, or otherwise causing physical harm to a child.
Physical harm may also be caused when a parent fabricates the symptoms of, or deliberately induces illness in a child.
Emotional abuse is the persistent emotional maltreatment of a child such as to cause severe and persistent effects on the child's emotional development, and may involve:
- Conveying to children that they are worthless or unloved, inadequate, or valued only insofar as they meet the needs of another person;
- Imposing age or developmentally inappropriate expectations on children. These may include interactions that are beyond the child's developmental capability, as well as overprotection and limitation of exploration and learning, or preventing the child participating in normal social interaction;
- Seeing or hearing the ill-treatment of another e.g. where there is domestic violence and abuse;
- Serious bullying, causing children frequently to feel frightened or in danger;
- Exploiting and corrupting children.
Some level of emotional abuse is involved in all types of maltreatment of a child, though it may occur alone.
Sexual abuse involves forcing or enticing a child or young person to take part in sexual activities, not necessarily involving a high level of violence, whether or not the child is aware of what is happening. The activities may involve physical contact, including assault by penetration (e.g. rape or oral sex) or non-penetrative acts such as masturbation, kissing, rubbing and touching outside of clothing.
Sexual abuse includes non-contact activities, such as involving children in looking at, including online and with mobile phones, or in the production of, pornographic materials, watching sexual activities or encouraging children to behave in sexually inappropriate ways or grooming a child in preparation for abuse (including via the internet). Sexual abuse is not solely perpetrated by adult males. Women can also commit acts of sexual abuse, as can other children.
In addition; Sexual abuse includes abuse of children through sexual exploitation. Penetrative sex where one of the partners is under the age of 16 is illegal, although prosecution of similar age, consenting partners is not usual. However, where a child is under the age of 13 it is classified as rape under s5 Sexual Offences Act 2003.
See guidance on Child Neglect
Neglect is the persistent failure to meet a child's basic physical and/or psychological needs, likely to result in the serious impairment of the child's health or development.
Neglect may occur during pregnancy as a result of maternal substance misuse, maternal mental ill health or learning difficulties or a cluster of such issues. Where there is domestic abuse and violence towards a carer, the needs of the child may be neglected.
Once a child is born, neglect may involve a parent failing to:
- Provide adequate food, clothing and shelter (including exclusion from home or abandonment);
- Protect a child from physical and emotional harm or danger;
- Ensure adequate supervision (including the use of inadequate care-givers);
- Ensure access to appropriate medical care or treatment.
It may also include neglect of, or unresponsiveness to, a child's basic emotional, social and educational needs.
These definitions are used when determining significant harm and children can be affected by combinations of maltreatment and abuse, which can be impacted on by for example domestic violence and abuse in the household or a cluster of problems faced by the adults.
5. Potential Risk of Harm to an Unborn Child
In some circumstances, organisations or individuals are able to anticipate the likelihood of significant harm with regard to an unborn baby (e.g. where there is information known about domestic abuse, substance misuse or a diagnosis of a mental health problem which may impact on parental capacity).
These concerns should be addressed as early as possible before the expected birth of the baby, so that a full assessment can be undertaken and support offered to enable the parent/s or carers (wherever possible) to provide safe care to the baby. See Safeguarding babies at birth and young infants where the risks are too great to leave them in the care of their parents: Practice Guidance and Toolkit (Nottingham City SCB, Oct 2013).
6. Bruising / Unexplained Injuries in Non-Mobile Baby / Child
Several studies have increased our knowledge about the age, frequency, site and association with developmental stage in relation to bruising in children. (Welsh Child Protection Systematic Review Group. 2012). See Core-Info: Bruises on Children, NSPCC and Bruising in Babies Flowchart.
Sub-conjunctival hemorrhages (bleeding of the conjunctiva of the eye) can occur as a result of a traumatic birth. However where sub-conjunctival hemorrhage is noted on a non-mobile baby and there is no documented record or an explanation as a result of a birth injury, practitioners should consider the possibility of non-accidental injury.
See Practice Guidance on the Assessment of Subconjunctival Hemorrhage in infants in the Community Setting in the additional Local Resources section.
Continence is a common problem for children and young people. The National Institute for Health and Care Excellence (NICE) has produced guidance for staff who are working with children and young people who experience continence issues. The emphasis is on normalisation, no blame, no shame and strictly no punishments. The guidance makes clear that children should not be held responsible for their bedwetting. Rewards for dry nights are therefore unhelpful.
The guidance makes it clear that maltreatment should be considered if a child or young person is consistently reported to be deliberately bed-wetting, the parents or carers are seen to repeatedly punish the child and the problem is not addressed by advice.
There is a specialist continence service for children in Nottingham. This is delivered by CityCare and referrals can be made by telephoning the Continence Advisory Service on 0115 883890 or by clicking here.
Where specialist continence services are involved it is important to ensure that their work is incorporated into wider multi-agency planning and reviewing.
8. Professional and Agency Response
All practitioners, whether paid or voluntary, in all organisations, where they come in to contact with children and young people, or similarly, all those who work in some way with adults, who may be parents or carers, should:
- Be alert to potential indicators of abuse or neglect;
- Be alert to the risks which individual abusers or potential abusers, may pose to children;
- Be alert to the impact on the child of any concerns of abuse or maltreatment;
- Be able to gather and analyse information as part of an assessment of the child's needs.
Each agency and the Local Safeguarding Children Board have child protection procedures in place to support and provide information about how and what action to take when there are concerns about a child. Those child protection procedures will include information about how to:
- Identify potential or actual harm to children;
- Discuss and record concerns with a first line manager / in supervision;
- Analyse concerns by completing an assessment;
- Discuss concerns with the agency's named or designated safeguarding children advisor (able to offer advice and decide upon the necessity for a referral to LA children's social care).
When concerns arise, practitioners in all organisations should use their knowledge and agency resources to contact local children's social care or the police about their concerns directly and to complete the appropriate referral form, if there are urgent concerns.
In such circumstances a formal referral to LA children's social care, the police or emergency medical services (if the child requires urgent medical attention) must not be delayed by the need for consultation with management or the nominated safeguarding children adviser, or the completion of an assessment.
All practitioners in organisations with contact with children and members of their families must make a referral to LA children's social care if there evidence that a child or an unborn baby:
- Is suffering significant harm through abuse or neglect;
- Is likely to suffer significant harm in the future.
The timing of such referrals should reflect the level of perceived risk of harm as soon as possible and not longer than within one working day of identification or disclosure of harm or risk of harm.
In urgent situations, out of office hours, please see the Referrals Procedure, 'Making a Referral'.
9. Hearing and Observing the Child/Young Person
Whenever a child reports that they are suffering or have suffered significant harm through abuse or neglect, or have caused or are causing physical or sexual harm to others, the initial response from all practitioners should be to listen carefully to what the child says and to observe the child's behaviour and circumstances to:
- Clarify and document the concerns;
- Offer re-assurance about how the child will be kept safe;
- Explain what action will be taken and within what timeframe;
- Listen carefully to what the child says and observe the child's behaviour and circumstances.
The child must not be pressed for information, led or cross-examined or given false assurances of absolute confidentiality, as this could prejudice police investigations, especially in cases of sexual abuse.
The child or young person should be given information and asked their views about the referral to children's social care in a way appropriate to their age and developmental level unless to do so is felt likely to cause increase risk of harm to them or others. If the child can understand the significance and consequences of making a referral to LA children's social care the possible outcomes and the different stages of the process should be explained to them. Their views and comments should be recorded.
It should be explained to the child that whilst their views will be taken into account, the practitioner has a responsibility to take whatever action is required to ensure the child's safety and the safety of other children.
10. Parental Consultation
Concerns which have been raised, should, where practicable, be discussed with the parent and agreement sought for a referral to LA children's social care unless seeking agreement is likely to place the child or the worker at risk of significant harm through delay or from the parent's actions or reactions; For example in circumstances where there are concerns or suspicions that a serious crime such as sexual abuse, domestic violence or fabricated or induced illness has taken place.
Where a professional decides not to seek parental permission before making a referral to LA children's social care, the decision must be clearly noted in the child's records with reasons, dated and signed and confirmed in the referral to LA children's social care. Practitioners should consult with their line manager/named or designated safeguarding advisor, if at all practicable, for advice.
When a referral is deemed to be necessary in the interests of the child, and the parents have been consulted and are not in agreement, the following action should be taken:
- The reason for proceeding without parental or competent young person's agreement must be recorded;
- The parent's or competent young person withholding of permission must form part of the verbal and written referral to LA children's social care;
- The parent should be contacted to inform them that, after considering their wishes, a referral has been made.
A child protection referral from a professional cannot be treated as anonymous and where any court proceedings may follow, whether criminal or family court, the information may be made available.
11. Urgent Medical Attention
If the child is suffering from a serious injury, unwell or in pain the practitioner must arrange appropriate medical attention and must inform LA children's social care, and ensure the safeguarding concerns are communicated with any medical services involved with immediate care e.g. the ambulance service, Accident and Emergency Department. They should also contact the on call consultant paediatrician for child protection at the hospital the child is attending.
Where abuse is alleged, suspected or confirmed in a child admitted to hospital, the child must not be discharged until:
- LA children's social care local to the hospital and the child's home address (may be two different LA children's social care) are notified by telephone that there are child protection concerns;
- A strategy meeting/discussion has been held, if appropriate, which should then include relevant hospital and other agency practitioners;
- There is an agreed plan between the responsible Consultant and Children's Social Care as to how those concerns will be addressed and the child adequately safeguarded on discharge.
12. Making a Referral
Referrals should be made to the Local Authority for the area where the child is living or is found. More detailed guidance on the referral processes for Nottingham City and Nottinghamshire can be accessed by following the these links:
Where an assessment has been completed prior to referral, these details should also be conveyed at the point of referral.
Children's social care should within one working day of receiving the referral make a decision about the type of response that will be required to meet the needs of the child. The referrer should be notified of the outcome of this decision within 3 days and if this does not occur, the referrer should contact these services again and, if necessary, ask to speak to a line manager to establish progress.
If the child is known to have an allocated social worker, the information should be passed to that worker, the duty children's social worker in the allocated team or the social worker's manager without delay. In all other circumstances referrals should be made to the duty officer.
In the event of nobody being available from the allocated team the information should be given to the initial points of contact in the responsible authority.
For further details see Referrals Procedure.
Nottingham City and Nottinghamshire County Council have standards for the delivery of social care services. Feedback about Nottinghamshire (see Compliments, Comments and Complaints, Nottingham County Council website) and Nottingham City (see Complaints Process, Nottingham City Council website) services is welcomed and encouraged from referrers and service users.
13. Concerns Raised by a Member of the Public
When a member of the public telephones or approaches any agency with concerns about the welfare of a child or an unborn baby, the professional who receives the contact should always:
- Gather as much information as possible, to be able to make a judgement about the seriousness of the concerns;
- Take basic details:
- Name, address, gender and date of birth of child;
- Name and contact details for parent/s, educational setting (e.g. nursery, school), primary medical practitioner (e.g. GP practice), practitioners providing other services, a lead professional for the child.
- Discuss the case with their manager and the agency's designated safeguarding children advisor to decide whether to:
- Make a referral to LA children's social care;
- Make a referral to the lead professional, if the case is open and there is one;
- Make a referral to a specialist agency or professional e.g. educational psychology or a speech and language therapist;
- Undertake an assessment.
Record the referral contemporaneously, with the detail of information received and given, separating out fact from opinion as far as possible.
The opportunity for a face to face meeting or interview should be offered to the member of the public to clarify information and offer advice, if needed.
Referrers in Nottingham City should contact Children & Families Direct (Nottingham City Council website) in the first instance.
The member of the public should also be given the number for their LA children's social care and encouraged to contact them directly. The agency receiving the initial concern should always make a referral to LA children's social care and to the lead professional if there is one, in case the member of the public does not follow through (which can happen).
Some people may prefer not to give their name to LA children's social care, or they may disclose their identity but not wish for it to be revealed to the parent/s of the child concerned. Wherever possible, practitioners should respect the referrer's request for anonymity. However practitioners should not give referrers any guarantees of confidentiality, as there are certain limited circumstances in which the identity of a referrer may have to be given (e.g. the court arena). Consideration for the referrer's safety may be an issue in some cases.
14. Adult Services Responsibilities in Relation to Children
Adult services and practitioners working with adults need to be competent in identifying the service users' or patient's role as a parent. They need to be able to consider the impact of the adult's condition and/ or behaviour on:
- A child's welfare and development;
- Family functioning;
- The adult's parenting capacity.
Where a practitioner working with adults has concerns about the parent's capacity to care for the child and considers that the child is likely to be harmed or is being harmed, they should immediately refer the child to the police or LA children's social care, in accordance with their agency's child protection procedures.
Requests for information about a child, which are often made to health practitioners such as GPs or specialist services for mental health or substance misuse, by LA children's social care should be directed to the correct professional and not dealt with by administrative staff or intermediaries although it is reasonable for these staff to initially obtain demographic information and information about consent arrangements for the information request.
Adult Services, whether commissioning or provider organisations, employ safeguarding children practitioners to provide leadership on safeguarding children matters. The roles and responsibilities of designated and named safeguarding children should be clear and accessible to all staff and made known to partner organisations to assist in the process of sharing information.
15. Schools and Educational Establishments
One of the main sources of referrals about children is schools, which means all schools whether maintained, non- maintained or independent schools, including academies and free schools, alternative provision academies and pupil referral units. 'School' includes maintained nursery schools.
All schools, educational establishments and colleges must have regard to the statutory guidance Keeping Children Safe in Education (September 2016) when carrying out their duties to safeguard and promote the welfare of children.
'Keeping children safe in education' contains information on what schools and colleges should do and sets out the legal duties with which schools and colleges must comply. It should be read alongside the statutory guidance 'Working Together to Safeguard Children' 2015, which applies to all the schools referred to above, and departmental advice 'What to do if you are worried a child is being abused: Advice for Practitioners'.
The different schools and education settings for all age groups should have systems in place to promote the welfare of children and a culture of listening to children taking in to account their views and wishes.
Each establishment should have a designated professional lead for safeguarding. This role should be clearly set out and supported with a regular training and development program in order to fulfil the child welfare and safeguarding responsibilities. Arrangements within each school should set out the processes for sharing information with other professionals and the local LSCB.
All school and college staff have a responsibility to provide a safe environment in which children can learn.
All school and college staff have a responsibility to identify children who may be in need of extra help or who are suffering, or are likely to suffer, significant harm. All staff then have a responsibility to take appropriate action, working with other services as needed. All school and college staff members should be aware of the signs of abuse and neglect so that they are able to identify cases of children who may be in need of help or protection. Staff members working with children are advised to maintain an attitude of 'it could happen here' where safeguarding is concerned. When concerned about the welfare of a child, staff members should always act in the interests of the child.
In addition to working with the designated safeguarding lead staff members should be aware that they may be asked to support social workers to take decisions about individual children.
All educational establishments including Free Schools, Academies, Children's Centres/ nurseries, public schools and colleges must have safe recruitment policies and procedures in place.
Clear policies and procedures in accordance with the local LSCB procedures for managing allegations against people who work with children must be in operation (see Allegations Against Staff or Volunteers Procedure).