14.9 Safeguarding Children with Disability

Research consistently highlights that children with disability are at increased risk of abuse and neglect.  Professionals working with children with disability, carers and families must recognise and be alert to these vulnerabilities (Sidebotham et al 2016; Schooling 2017).   Nationally, children with disability are over represented in serious case reviews yet underrepresented in child protection plans; this indicates that children with disability’s safeguarding needs are overlooked.

Organisations must ensure that their staff are aware that children with disability may be more vulnerable to being abused as a result of a number of factors. These include significant communication needs which impact upon their ability to be understood in relation to their health and social care needs and their wishes and feelings;

• Physical vulnerabilities
• Intimate care needs
• Need for physical handling
• Having multiple carers
• Being socially isolated
• The child/young person being perceived as being of lower status
• Some children may behave in ways that are self-harming
• An assumption that behaviour is an integral part of the child’s condition, rather than a response to abusive treatment or a negative reaction to medication
• Children with disabilities sometimes miss universal health and care services (including dental) because presentations and behaviours are often interpreted through the prism of their disability.
• Children with disabilities can be more vulnerable to criminal and sexual exploitation
• Children with disabilities can be more vulnerable to hate crime
• Vulnerability of Families where there is a child or children with disability
• Care needs and behaviours of a disabled child can challenge family members’ ability to cope
• The rate of family break up is higher than in families where there is no disability
• There is a risk of social isolation
• There are increased risks to parents and carers physical, mental and emotional health.

Organisations must ensure that arrangements are in place to minimise the likely impact of these vulnerabilities on children with disability by:

• ensuring that the required policies and procedures are in place for dealing with difficult behaviour
• ensuring that staff are trained appropriately
• promoting children and young people’s rights and right to safeguarding
• ensuring that children and young people’s basic right to communication is always met.
• access to information about strategies for keeping safe that is usually available to other children and young people

ensuring staff are aware of the warning signs of perplexing presentation/fabricated or induced illness (see Pan Merseyside Protocol).

In order to include the disabled child or young person appropriately in any investigation of their needs, their views must be listened to. Therefore any particular communication needs they have must be met.

The local authority has a duty to investigate in accordance with the Children Act 1989, Section 47. The Children Act 2004, however, strengthens the Local Authority’s responsibility to “ascertain the child’s wishes and feelings regarding the action to be taken with respect to him” [Children Act 2004 section 53].

All reports that are written about a disabled child or young person should include their views, wishes and feelings, and how they have been ascertained.

Workers must identify barriers to access services and must aim to make information provided available to children with disability and their parents. This information should take account of the child/young person’s impairment, the child/young person’s and parents’ preferred formats and be made available within agreed time frames.

Many children with disability need alternative or additional means of communication to understand and to express them. The best practice for children with disability is for a worker with appropriate communication skills to be allocated.

Additional and alternative means include objects, pictures, symbols and signs or an electronic communication device. Professionals such as speech and language therapists, occupational therapists and physiotherapists, doctors and school nurses can provide advice and support for children with disability and may be able to advise on a range of access issues. As some children with disability use means of communication that are very personal to them, it is important to involve professionals who know the child well. Deaf children may need an independent sign language interpreter. Workers must not rely on someone who may be abusing the child to assist with communication.

A child who is disabled and has specific additional needs, has special educational needs (whether or not they have a statutory Education and Health Care Plan) should be a child to whom practitioners are especially alert to the potential for Early Help services (Working Together to Safeguard Children 2018 (6)).  Where a child’s needs are relatively low level, individual services and universal services may be able to take swift action.

All children with disability are Children in Need under section 17 Children Act 1989 and are therefore entitled to an assessment as a disabled child. 

Duties to a disabled child extend beyond the general provisions of the Children Act 1989: the Chronically Sick and Disabled Persons Act 1970, Section 2 confers a duty on a local authority to provide a service which in its own assessment a child needs.

A carer of that child may also require the local authority to undertake an assessment of their ability to provide support under section 1 of the Carers (Recognition and Services) Act 1995.  The local authority must take account of such an assessment when deciding whether or not to provide services to the disabled child.

If a local authority considers that a parent carer of a disabled child may have support needs , it must carry out an assessment under section 17ZD of the Children Act 1989.  The local authority must also carry out such an assessment if the parent carer requests one.

Short breaks for carers of children with disability are outlined in the short breaks services statement as required by the Breaks for Disabled Children Regulations 2011.

The Children and Families Act 2014 outlines the systems required to support children and young people with Special Educational Needs (SEN) including the introduction of Education Health and Care Plans (EHCP) based on assessments of need.  ECHPs are led by education but must include contributions from health and social care. EHCPs must be informed by an assessment of care needs, the views of the child and the views of the carers. This is in recognition that support for children and young people with SEN is most helpful and effective when it takes into account their needs beyond their education. 

Children who have complex health care needs which are not met by universal services may qualify for an assessment under Children’s Continuing Care.

If a child with disabilities is assessed by children’s social care with needs under section 17 Children Act 1989; those needs, associated interventions and support, and anticipated outcomes are identified in a Child in Need (CIN) Plan.  The CIN plan is produced which is reviewed by all partners at an interval agreed by those partners; at a minimum a Child in Need Plan would be reviewed 6 monthly with an annual reassessment of need.  The social worker visits the child at appropriate intervals between the CIN Reviews on their own to obtain their views. The frequency of visits will be determined by what the need is within the family. There may be some children who cannot safely be seen alone but their views will be gathered and understood.  The CIN Plan is amended or closed following the Child in Need Review.

Professionals in all agencies who come into contact with children and young people with disabilities are in a position to identify indicators that the child may be suffering or may be at risk of significant harm. These are included in the SSCP Child Protection Procedures and apply equally to children with disability. There may be differences, and a child/young person’s disability should always be considered when considering whether significant harm might be indicated. For example a bruise in a site that might not be of concern on an ambulant child/young person, such as the shin, might be of concern on a non-mobile child/young person.

Because of the particular needs of children with disability they may also be at risk of being abused in other ways including:

• force feeding or inappropriate feeding
• Their personal care needs may not be met adequately
• Physical restraint being carried out unnecessarily or not in accordance with available guidelines
• Rough handling
• Extreme behaviour modification including the deprivation of clothing, medication or food, limiting movement, restricting freedoms, locking doors etc.
• Misuse of medication, sedation, heavy tranquillisation
• Invasive procedures which are unnecessary or are carried out against\ the child/young person’s will
• Being denied access to required medical treatment
• Misapplication of programmes or regimes
• Ill-fitting equipment e.g. callipers, sleep boards which may cause injury, inappropriate splinting
• They may be more susceptible to bullying
• They may be more vulnerable to abuse using Information Communication Technology

Professionals may find it more difficult to attribute indicators of abuse or be reluctant to action concerns in relation to children with disability because of a number of factors which may include:

• Professionals over identifying with the child/young person’s parents/carers and being reluctant to accept that abuse could have taken place, or seeing abuse as being attributable to the stress and difficulties of caring for a disabled child/young person
• A lack of knowledge about the impairment and its impact on the child/young person
• A lack of knowledge about the child/young person, e.g. not knowing the child/young person’s usual behaviour or demeanour
• Not being able to understand the child/young person’s communication
• Confusing behaviours that may indicate the child/young person is being abused with those associated with the child/young person’s impairment
• Denial of the child/young person’s sexuality
• The child/young person having a number of carers.

Behaviour, including sexually harmful behaviour or self -injury, may be indicative of abuse.

• Carers may have unrealistic expectations of the child
• Failure to follow treatment plans

Certain health/medical complications may influence the way symptoms present or are interpreted. Certain indicators may be present that are attributable to the child/young person’s condition or medical treatment. For example, some anti-convulsants may lead to spontaneous bruising and some particular conditions can cause fragile bones increasing the likelihood of fractures during normal day to-day activities.

Because of this it is essential that relevant and pertinent information is recorded clearly on a child/young person’s file. This may include communication methods used by the child/young person to understand and express themselves, severity of disability, numbers of care givers, and level of care required etc.

The requirement to consult with the parents of any child or young person if there are concerns about their well-being applies to children with disability just as to children without disability.

Where there are concerns about a child/young person it is essential that workers with the required knowledge and skills, and who know that child, are involved promptly.

Where a worker is not clear if a child/young person’s particular injury or behaviour is indicative of abuse, or is associated with their disability, they should seek advice from a professional who knows the child and the implications of their disability well, for example, a community paediatrician, a school nurse, a teacher, etc.

There will be situations where there are significant concerns about a child or young person, and it will be necessary to clarify their risk of significant harm under Part 111 of the Children’s Act, 1989

In these circumstances the objective of the Local Authorities involvement is to determine whether action is required to safeguard and promote the welfare of the child or children who are subjects of the enquiries.

A Children and Families assessment is the means by which a Section 47 enquiry is carried out. Sefton children’s social care has the lead responsibility for the Children and Families under section 47 of the children’s Act, 1989.

The assessment is undertaken in accordance with the ‘Framework for Assessment of Children in Need and Their Families’ (DoH).  It should be led by a qualified and experienced social worker.

Where there is reasonable cause to believe that a child or young person is at risk of significant harm they should be referred to Children’s Social Care in order that relevant enquiries can be carried out and the child effectively safeguarded in accordance with the SSCP Safeguarding ProceduresThe first responsibility is to ensure that the child is safe while further enquiries are carried out.

It is crucial that in relation to a disabled child or young person the enquiries are planned and carried out in a way which is informed by an understanding of their impairment.

Where an investigation is being planned as a result of concerns about significant harm to a disabled child or young person, a strategy discussion should be held involving key professionals who know them within 1 working day. Specific considerations for the strategy discussion or meeting include:

• The child/young person’s preferred communication method for understanding and expressing themselves
• Who should interview the child/young person?
• Whether someone with a specialist on the child/young person’s preferred communication method should be involved
• Whether the interview will have to be significantly adapted to support the child/young person understands and their involvement
• The venue of the interview
• Whether additional facilities or equipment is necessary
• The care needs of the child or young person
• The caring network surrounding the child or young person
• Available medical information about health needs which may have a bearing on an investigation
• If there is a need for a medical examination, consider the most appropriate medical professional, venue, timing and the child/young person’s ability to understand the purpose of the medical

It is important that efforts to meet these requirements do not unduly slow down the enquiry.

In situations where there are allegations against an employee or volunteer in that relation to the child, see SSCP Managing Allegations Procedure.

Agencies must not make decisions about the enquiries based on assumptions about the ability of a disabled child or young person to give credible evidence, or to withstand the rigours of the Achieving Best Evidence Practice Guidance.

Where an Initial Child Protection Conference is held it is crucial that professionals who know the child or young person and who have information about the nature of their disability are involved.  The principles and guidance for the Child Protection Conference, section 47 enquiries and core group meetings remain the same for all children.

Children with disability should be supported to remain safe as their sexuality develops; to understand which behaviour is appropriate in which settings and to understand about consent. However, there may be occasions where professionals may become concerned that sexual behaviour between two young people is abusive, exploitative or coercive. In this event it will be useful to seek information from Children’s Social Care.

The Government is committed to improving the protection for vulnerable and intimidated witnesses during the criminal justice process, especially children, including children with disabilities. Interviews under Achieving Best Evidence Guidance can only be undertaken by suitably qualified social workers and police officers that have completed the required training and are familiar with “Achieving Best Evidence in Criminal Proceedings: Guidance on Interviewing Victims and Witnesses, and using Special Measures”. Chapter 2 gives guidance on interviewing children and paragraphs 202 to 222 gives additional guidance on interviewing children with disability.