Working together to safeguard and protect children

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Working together to safeguard and protect children

    Wandsworth Teaching Primary Care Trust

    Working Together to Safeguard and

    Protect Children

    Internal Guidelines, Policies and


    September 2005

    Produced by Wandsworth tPCT

    Safeguarding Children Team and the Nurse Advisory Committee Sub-Group for

    Safeguarding Children.




    3/4Key definitions and concepts (2005)

    4/5-7What is abuse and neglect?(2005)

    5/8-9The impact of maltreatment on children(2005)6/10-12Sources of stress for children and families (2005)7/13-14When clinicians suspect abuse(2005)

    8/15Assessing Need and Vulnerability; Working with the Common

    Assessment Framework (under development)

    9/16Working with vulnerable families in the

    antenatal period(2005)

    10/17-18Safeguarding Children attending NHS walk-in centres &

    minor injuries departments (2001)

    11/19-20Safeguarding Children in General Practice(2005)Working with the Child Protection Process

    12/22-23Child Protection Conferences(2005)

    13/24-27Report writing for Child Protection Conferences


    14/28Working with children on the Child Protection Register(2005)15/29-30When a baby or child dies(2005)

    16/31-34Aspects of record management(2005)

    17/35-37Guidelines for Clinical supervision of Community Nurses

    working with children in need.(2005)

    18/38Guidelines for clinicians dealing with solicitors and

    police requesting information for legal purposes(2005)19/39The Unseen Child(2005)

    Links to other Policies



    41-45ACPC Practice Guidelines in relation to Pre-Birth Assessments

    and Pre-Birth Child Protection Conferences(2004)46-48WtPCT child protection training strategy(2003)49Supervision Activity Return

    50Supervision Record of Communication

    51-52Supervision Contract format

    53Glossary of Terms


    55Phone Numbers

    Final Draft for Consultation: Safeguarding Children: Draft Policy :2

Wandsworth Teaching Primary Care Trust

    Working Together to Safeguard Children

    Internal Guidelines, Policies and Procedures


    1.1.This document is written for all staff both directly and indirectly employed or contracted working within Wandsworth Teaching Primary Care Trust. (WtPCT). This includes managers, nurses, health visitors, midwives, doctors, dentists, practice staff, therapists and support staff. Some guidelines apply to specific staff groups, while others apply to all staff whose work brings them into contact with children and their families.

    1.2.It is not the intention to duplicate existing statutory and non-statutory practice guidance as issued by HM Government, but to provide local direction and clarification regarding process within WtPCT. The guidance, with which all staff must be familiar, is available on WtPCT website under working for us? policies and procedures?child protection.

    1.3.All staff should be familiar with the practice guidance What to do if you are

    worried a child is being abused produced by the Department of Health in 2003/5. It

    is available on WtPCT website or from . Hard copies are also available from WtPCT safeguarding children team.

    1.4.Front line staff who have a specific role in safeguarding and promoting the welfare of children through there work with children and/or their parents and carers should be familiar with the forthcoming HM Government guide Working together to

    safeguard children; A guide to inter-agency working to safeguard and promote the welfare of children, 2005/6. This guidance, addressed to practitioners, front line and senior managers, will supersede the 1999 Working together. It is written in two parts, the first of which provides statutory guidance under the Children Act 2004, the second non-statutory practice guidance.

    1.5.The London Child Protection Committee (LCPC) has produced extensive practice guidance to which statutory and non statutory agencies working with children and their families in London are signed up. This guidance, London Child

    Protection Procedures 2003, has largely replaced the guidance previously provided by Area Child Protection Committee (ACPC) to member agencies and is available on WtPCT website or from ACPCs will be stsuperseded from 1 April 2006 by statutory Local Safeguarding Children Boards (LSCB).

    1.6.Working together to safeguard children; A guide to inter-agency working to safeguard and promote the welfare of children, 2005/6 signposts the reader to a

    range of other documents which underpin the whole Every Child Matters: Change for Children agenda of which safeguarding children is an integral part. All are available on

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2. Introduction

    The abuse of a child has a serious impact on all aspects of the child’s health, development and well being which can last throughout adulthood.

    2.1.The Children Act 1989 &2004 places a specific legal duty on health agencies and their employees to safeguard and promote the welfare of children; in the discharge of their duties; by working with parents and carers in the interests of vulnerable children; by providing services for children in need and by working in partnership with other agencies where there is reasonable cause to suspect that a child is suffering, or is likely to suffer, significant harm. Safeguarding and promoting the welfare of children is an integral part of clinical governance.

    2.2.All children deserve the opportunity to achieve their full potential. Every Child

    Matters: Choice for Children 2004, sets out the five outcomes for children and young

    people, given legal force in the Children Act 2004. These are described on page ***.

    Children’s rights in Britain are also described within the Human Rights Act 2000 and the United Nations Convention on the Rights of the Child.

    2.3.All staff must be alert to the possibility of child abuse or neglect. They should be able to recognise possible indicators of abuse and be aware of particular sources of stress for children and families. Staff working with children with disabilities should be aware that their vulnerabilities might lead to an increased risk of abuse.2.4.Staff working primarily with adults must consider if the care of any child is or

    might be compromised; adult mental health problems, adults with learning

    difficulties, substance and alcohol misuse, domestic violence and social

    exclusion are all associated with increased risk of harm and neglect of children

    and should always alert professionals to the needs of the children. Working

    Together to Safeguard Children 2005/6Paragraphs 8.3-8.10 discusses

    sources of stress on families.

    2.5.Where intervention or extra support is required to prevent significant impairment to a child’s health or development, staff must know the process to be followed. 2.6.Professional judgements on how best to intervene when there are concerns of harm to a child inevitably involve uncertainties and risk. All staff must ensure they have access to training in child protection and receive advice, support and clinical supervision from an experienced manager or supervisor. WtPCT safeguarding children team are pleased to assist in the development of suitable training and supervision for staff. See WtPCT child protection training strategy page*.

    2.7.Line managers of all new staff working directly with children and families should ensure the staff member knows:

    What to do in an emergency situation to protect a child;

    how to access the policies and guidance discussed within this document;the importance of documentation, including the rational of any decisions made;the supervision arrangements appropriate to their role (see page*)

    how to contact WtPCT safeguarding children team;

    what training in safeguarding children is required. (see page*).

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3. Key definitions and concepts:


    In this document, as in the Children Acts 1989 and 2004, a child is anyone who has not yet threached their 18 birthday. “Children” therefore means “children and young people” throughout.

    3.2. Safeguarding, promoting welfare and child protection

    are defined as:

    protecting children from maltreatment;

    preventing impairment of children’s health and/or development;

    ensuring that children grow up in circumstances consistent with the provision of safe and effective care;

    and sometimes taking the role to enable children to have optimum

     life chances and to enter adulthood successfully.

    Protecting children from maltreatment is important in preventing the impairment of health or development. However all children deserve the opportunity to achieve their full potential.

    3.3. Every Child Matters: Change for Children 2004 DfES

    This guidance to the Children Act 2004, sets out the five outcomes identified as being key to children and young people’s wellbeing.

    Stay Safe

    Be healthy

    Enjoy and achieve

    Make a positive contribution

    Achieve economic well-being

    Stay Safe includes:

    Safe from maltreatment, neglect, violence and sexual exploitation.

    Safe from accidental injury and death

    Safe from bullying and discrimination

    Safe from crime and anti-social behaviour in and out of school

    Have security, stability and are cared for.

    3.4.Child protection is a subset of safeguarding and promoting welfare.

    This refers to activities undertaken to protect specific children who are suffering or are at risk of suffering significant harm. Effective child protection is essential as part of wider work to safeguard and promote the welfare of children. However, all agencies and individuals should aim to proactively safeguard and promote the welfare of children so that the need for action to protect children from harm is reduced.

    3.5.Children in need

    Children who are defined as being “in need”, under section 17 of the Children Act 1989, are those whose vulnerability is such that they are unlikely to reach or maintain a satisfactory level of health or development, or their health and development will be significantly impaired, without the provision of services (section 17(10) of the Children Act 1989), plus those who are disabled. The critical factors to be taken into account in deciding whether a child is in need under the Children Act 1989 are what will happen to a

    child’s health or development without services being provided, and the likely effect the

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    services will have on the child’s standard of health and development. Local Authorities have a duty to safeguard and promote the welfare of children in need.3.6.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 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.

    Under s31(9) of the Children Act 1989 as amended by the Adoption and Children Act


    harm” means ill-treatment or the impairment of health or development, including, for example, impairment suffered from seeing or hearing the ill-treatment of another;development” means physical, intellectual, emotional, social or behavioural development;

    health” means physical or mental health; and

    ill-treatment” includes sexual abuse and forms of ill-treatment which are not physical.Under s31(10) of the Act:

    Where the question of whether harm suffered by a child is significant turns on the child’s health and development, his health or development shall be compared with that which could be reasonably be expected of a similar child.”

    There are no absolute criteria on which to rely when judging what constitutes significant harm. For further guidance and debate refer to Section one ofWorking together to safeguard children, 2005/6

    3.7.Framework for the Assessment of Children in Need

    The Framework for the Assessment of Children in Need and their Families was

    published in 2000 by the Department of Health. This is still current guidance and provides a systematic basis for collecting and analysing information to support professional judgements about how to help children and families. The three main aspects of the framework – the child’s developmental needs, parenting capacity, and wider family and environmental factors – are diagrammatically portrayed on three sides of a triangle with the child in the middle. See appendix***** and guidance on assessing need and vulnerability.

    3.8.The Common Assessment Framework

    The Common Assessment Framework (CAF) is a standardised approach to

    assessing children’s needs for services. It has been designed for practitioners in all agencies to help them communicate and work together more effectively. It is particularly suitable for use in universal services such as health and education to identify problems before they become too serious. It is a key component in the Every Child Matters: Change for Children programme, playing an important role in the provision of early intervention. The CAF is being widely consulted on and piloted

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    during 2005 with full guidance and implementation expected in April 2006. See ECM fact sheet.

    3.9.Information Sharing

    Sharing information for the purpose of safeguarding and promoting the welfare of children by professionals is essential. In many case it is only when information from a range of sources is put together that a child can be seen to be in need or at risk of harm.

    Professionals may be anxious about the legal or ethical restrictions on sharing information with other agencies and should be aware of the law and guidance applicable to their professions. There is rarely an absolute barrier to disclosure and professionals should be prepared to exercise professional judgement. All decisions and the rational behind them, must be fully documented. The potentially serious consequences of not passing on information must be considered.

    Consent to share information with other professionals should always be sought from the parent or child unless to do so would place the child at further risk of harm. The principal remains from the Children Act 1989 that “the interest of the child is


    Further discussion and guidance on information sharing may be found in What to do

    if you are worried a child is being abused 2003; Working together to safeguard

    children2005/6 and in the consultation document, Sharing Information on Children

    and Young People. Aug 05, DfES; or contact WtPCT safeguarding children team.

    3.10. The Children’s, Young People’ and Maternity National Service

    Framework 2004

    Published as part of HM Governments Every Child Matters: Change for Children agenda. It is a ten year strategy for improving the health and well being of the nation’s children. It sets standards to, amongst other things, promote and safeguard the welfare of children and ensure all staff are suitably trained and aware of action to take if they have concerns about a child’ welfare. (Core standard five).

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4. What is Abuse and Neglect? From Working together to safeguard children;

    A guide to inter-agency working to safeguard and promote the welfare of children, 2005/6

    Abuse and neglect are forms 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 a stranger. They may be abused by an adult or adults or another child or children. A child may suffer from one or more of the following four categories of abuse.

    4.1. Physical abuse

    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 or carer fabricates the symptoms of, or deliberately induces illness in a child.

    4.2. Emotional Abuse

    Emotional abuse is the persistent emotional maltreatment of a child such as to cause severe and persistent adverse effects on the child’s emotional development. It may involve conveying to children that they are worthless or unloved, inadequate, or valued only insofar as they meet the needs of another person. It may feature age or developmentally inappropriate expectations being imposed 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. It may involve seeing or hearing the ill-treatment of another. It may involve causing children frequently to feel frightened or in danger, or the exploitation or corruption of children. Some level of emotional abuse is involved in all types of maltreatment of a child, though it may occur alone.4.3. Sexual Abuse

    Sexual abuse involves forcing or enticing a child or young person to take part in sexual activities, including prostitution, whether or not the child is aware of what is happening. The activities may involve physical contact, including penetrative (eg rape, buggery or oral sex) or non-penetrative acts (oral sex). They may include non-contact activities, such as involving children in looking at, or in the production of, pornographic material or watching sexual activities, or encouraging children to behave in sexually inappropriate ways.

    4.4. 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 abuse. Once a child is born, neglect may involve a parent or carer failing to provide adequate food and clothing, shelter including exclusion from home or abandonment, failing to protect a child from physical and emotional harm or danger, failure to ensure adequate supervision including the use of inadequate care-takers, or the failure to ensure access to appropriate medical care or treatment. It may also include neglect of, or unresponsiveness to, a child’s basic emotional needs.

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5. The impact of Maltreatment on Children. From Working together to

    safeguard children; A guide to inter-agency working to safeguard and

    promote the welfare of children, 2005/6 . Chapter 8.1 –8.21


    5.1Our knowledge and understanding of children’s welfare – and how to respond

    in the best interests of the child to concerns about maltreatment (abuse and

    Neglect)- develops over time, informed by research, experience and critical

    scrutiny of practice. Sound professional practice involves making judgments

    supported by evidence: evidence derived from research and experience

    about the nature and impact of child maltreatment, and when and how to

    intervene to improve outcomes for children: and evidence derived through

    assessment about a specific child’s health, development and welfare, and his

    or her family circumstances.

    5.2.This chapter summarizes what is known about the impact of maltreatment on

    children’s health and development and source of stress in families which may

    also have an impact on children’s developmental progress. It goes on to set

    out some of the key messages from research and inspection, which have

    informed this guidance, and draws out some messages that have important

    and enduring implications for policy and practice.

    The impact of Maltreatment on Children

    5.3.The sustained maltreatment of children physically, emotionally, sexually or

    through neglect can have major long-term effects on all aspects of a child’s

    health, development and well-being. Sustained maltreatment is likely to have

    a deep impact on the child’s self-image and self-esteem, and on his or her

    future life. Difficulties may extend into adulthood: the experience of long-term

    abuse may lead to difficulties in forming or sustaining close relationships,

    establishing oneself in work, and to extra difficulties in developing the

    attitudes and skills which are necessary to be an effective parent.5.4.It is not only the stressful events of maltreatment that have an impact, but

    also the context in which they take place. Any potentially abusive incident

    has to be seen in context to assess the extent of harm to a child and decide

    on the most appropriate intervention. Often, it is the interaction between a

    number of factors which serve to increase the likelihood or level of significant


    5.5.For every child and family, there may be factors that aggravate the harm

    caused to the child, and those that protect against harm. Relevant factors

    include the individual child’s means of coping and adapting, support from a

    family and social network, and the impact of any interventions. The effects on

    a child are also influenced by the quality of the family environment at the time

    of maltreatment, and subsequent life events. The way in which professionals

    respond also has a significant bearing on subsequent outcomes.Physical Abuse

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    5.6.Physical abuse can lead directly to neurological damage, physical injuries,

    disability or – at the extreme – death. Harm may be caused to children both

    by the abuse itself, and by the abuse taking place in a wider family or

    institutional context of conflict and aggression. Physical abuse has been

    linked to aggressive behaviour in children, emotional and behavioural

    problems, and educational difficulties. Violence is pervasive and the physical

    abuse of children frequently co-exists with domestic violence.Emotional Abuse

    5.7.There is increasing evidence of the adverse long-term consequences for

    children’s development where they have been subject to sustained emotional

    abuse. Emotional abuse has an important impact on a developing child’s

    mental health, behaviour and self-esteem. It can be especially damaging in

    infancy. Underlying emotional abuse may be as important, if not more so,

    than other more visible forms of abuse in terms of its impact on the child.

    Domestic violence, adult mental health problems and parental substance

    misuse may be features in families where children are exposed to such


    Sexual Abuse

    5.8.Disturbed behaviour including self-harm, inappropriate sexualised behaviour,

    depression and a loss of self-esteem, have all been linked to sexual abuse.

    Its adverse effects may endure into adulthood. The severity of impact on a

    child is believed to increase the longer abuse continues, the more extensive

    the abuse, and the older the child. A number of features of sexual abuse

    have also been linked with severity of impact, including the relationship of the

    abuser to the chid, the extent of premeditation, the degree of threat and

    coercion, sadism, and bizarre or unusual elements. A child’s ability to cope

    with the experience of sexual abuse, once recognised or disclosed, is

    strengthened by the support of a non-abusive adult carer who believes the

    child, helps the child understand the abuse, and is able to offer help and

    protection. The reactions of practitioners also have an impact on the child’s

    ability to cope with what has happened, and his or her feelings of self worth.5.9.A proportion of adults who sexually abuse children have themselves been

    sexually abused as children. They may also have been exposed as children

    to domestic violence and discontinuity of care. However, it would be quite

    wrong to suggest that most children who are sexually abused will inevitably

    go on to become abusers themselves.


    5.10.Severe neglect of young children has adverse effects on children’s ability to

    form attachments and is associated with major impairment of growth and

    intellectual development. Persistent neglect can lead to serious impairment

    of health and development, and long-term difficulties with social functioning,

    relationships and educational progress. Neglected children may also

    experience low self esteem, feelings of being unloved and isolated. Neglect

    can also result, in extreme cases, in death. The impact of neglect various

    depending on how long children have been neglected, the children’s age, and

    the multiplicity of neglectful behaviours children have been experiencing.Final Draft for Consultation: Safeguarding Children: Draft Policy :10

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