Recognising Abuse and Neglect

These Liverpool LSCP Child Protection Procedures set out how agencies and individuals should work together to safeguard and promote the welfare of children and young people. The target audience is professionals (including unqualified staff and volunteers) and front-line managers who have particular responsibilities for safeguarding and promoting the welfare of children, and operational and senior managers, in:

• Agencies responsible for commissioning or providing services to children and their families and to adults who are parents;
• Agencies 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 agencies such as GPs and health visiting, 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:

Working Together to Safeguard Children (trix please link) provides that all agencies and practitioners should:

• Have an applied understanding of what constitutes a child suffering actual or likely significant harm;
• Be alert to potential indicators of abuse, neglect and exploitation, and listen carefully to what a child says, how they behave, and observes how they communicate if non-verbal (due to age, special needs and/or disabilities, or if unwilling to communicate);
• Consider the severity, duration and frequency of any abuse, degree of threat, coercion, or cruelty, the significance of others in the child’s world, including all adults and children in contact with the child (this can include those within the immediate and wider family and those in contexts beyond the family, including online), and the cumulative impact of adverse events;
• Try to understand the child’s personal experiences and observe and record any concerns;
• Communicate in a way that is appropriate to the child’s age and level of understanding and use evidence-based practice tools for engaging with children, including those with special educational needs and disabilities;
• When practitioners have concerns or information about a child that may indicate a child is suffering or likely to suffer significant harm, share them with relevant practitioners and escalate them if necessary, and update colleagues when they receive relevant new information;
• Never assume that information has already been shared by another professional or family member and always remain open to changing their views about the likelihood of significant harm.

Working Together to Safeguard Children defines Safeguarding as:

• Protecting children from maltreatment, whether the risk of harm comes from within the child’s family and/or outside (from the wider community), including online;
• Preventing impairment of children's mental and physical 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.

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. Harm can be determined 'significant' by "comparing a child's health and development with what might be reasonably expected of a similar child" (Children Act 1989).

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 'child-on-child abuse'.

Some children have pre-existing vulnerabilities which may make them more susceptible to further and ongoing abuse. Children with learning difficulties, mental health challenges and who are socially isolated are more likely to be victims of online abuse and may find it difficult to disclose what is happening to them.

Working Together to Safeguard Children Chapter 3, Section 1 sets out national guidance on early help. Early help means providing support as soon as a problem emerges at any point in a child's life that improves a family’s resilience and outcomes or reduces the chance of a problem getting worse.  It is not an individual service, but a system of support delivered by local authorities and their partners working together and taking collective responsibility to provide the right provision in their area. Some early help is provided through ‘universal services’, such as education and health services. They are universal services because they are available to all families, regardless of their needs. Other early help services are coordinated by a local authority and/or their partners to address specific concerns within a family and can be described as targeted early help. Examples of these include parenting support, mental health support, youth services, youth offending teams and housing and employment services. Early help may be appropriate for children and families who have several needs, or whose circumstances might make them more vulnerable. It is a voluntary approach, requiring the family’s consent to receive support and services offered. These may be provided before and/or after statutory intervention.

The Early Help System Guide provides a toolkit to assist local strategic partnerships responsible for their early help system in their area. Effective provision relies upon local organisations and agencies working together to:

• Identify children and families who would benefit from early help;
• Undertake an assessment of the need for early help which considers the needs of all members of the family;
• Ensure good ongoing communication, for example, through regular meetings between practitioners who are working with the family;
• Co-ordinate and/or provide support as part of a plan to improve outcomes. This plan will be designed together with the child and family, and updated as and when the child and family needs change;
• Engage effectively with families and their family network, making use of family group decision-making, such as family group conferences, to help meet the needs of the child.

Any child may benefit from early help, but practitioners should, in particular, be alert to the potential need for early help for a child who:

• Is disabled and has specific additional needs;
• Has special educational needs (whether or not they have a statutory Education, Health and Care Plan);
• Is a young carer;
• Is bereaved;
• Is showing signs of being drawn in to anti-social or criminal behaviour, including being affected by gangs and county lines and organised crime groups and/or serious violence, including knife crime;
• Is frequently missing/goes missing from care or from home;
• Is persistently absent from education, including persistent absences for part of the school day;
• Is at risk of modern slavery, trafficking, sexual and/or criminal exploitation;
• Is at risk of being radicalised;
• Is viewing problematic and/or inappropriate online content (for example, linked to violence), or developing inappropriate relationships online;
• Is at risk of so called 'honour'-based abuse or Forced Marriage;
• At risk of Female Genital Mutilation (FGM);
• Is in a family circumstance presenting challenges for the child, such as drug and alcohol misuse, adult mental health issues and domestic abuse;
• Is misusing drugs or alcohol themselves;
• Is suffering from mental ill health;
• Has returned home to their family from care;
• Is a privately fostered child;
• Has a parent/carer in custody;
• Is missing education, or persistently absent from school, or not in receipt of fulltime education;
• Has experienced multiple suspensions and is at risk of, or has been permanently excluded.

A lead practitioner should co-ordinate the activity around the family, ensure the assessment and the family plan responds to all needs identified, and lead on ensuring the family co-produce the plan. The plan might include the family network. The time commitment to deliver this role will vary family by family depending on the complexity of their needs. Where appropriate, local authorities should engage families, including children, to have a say in who their lead practitioner is, and have a process in place to collate feedback on their relationship with them. The lead practitioner role could be held by a range of people. More details about which practitioners may act as a lead practitioner, their roles and responsibilities along with additional guidance, are provided in the Early Help System Guide.

The practitioners in Liverpool are supported through training and supervision to understand their role in identifying emerging problems, so that they:

• Know when to share information with other practitioners and what action to take to support early identification and assessment;
• Are able to identify and recognise all forms of abuse, neglect, and exploitation;
• Have an understanding of domestic and sexual abuse, including controlling and coercive behaviour as well as parental conflict that is frequent, intense, and unresolved;
• Are aware of new and emerging threats, including online harm, grooming, sexual exploitation, criminal exploitation, radicalisation, and the role of technology and social media in presenting harm;
• Are aware that a child and their family may be experiencing multiple needs at the same time.

The agencies in Liverpool have agreements in place such as the Threshold document which provide effective ways to identify emerging problems and potential unmet needs for individual children and families as well as clear guidance and procedures for all practitioners, including those in universal services and those providing services to adults with children. The provision of early help services should form part of a continuum of support to respond to the different levels of need of individual children and families.

The local Threshold document includes information as follows:

• The process for early help assessments and the type and level of early help and targeted early help services to be provided;
• The criteria, including the level of need, for when a child should be referred to Liverpool children's social care for assessment and for statutory services under:
• Section 17 of the Children Act 1989 (children in need, including how this applies for disabled children);
• Section 47 of the Children Act 1989 (reasonable cause to suspect a child is suffering or likely to suffer significant harm);
• Section 31 of the Children Act 1989 (care and supervision orders);
• Section 20 of the Children Act 1989 (duty to accommodate a child); and
• Clear procedures and processes for cases relating to:
• The abuse, neglect and exploitation of children;
• Children managed within the youth secure estate;
• Disabled children.

The following definitions are based on those identified in Working Together to Safeguard Children and Keeping Children Safe in Education:

In some circumstances, agencies or individuals are able to anticipate the likelihood of significant harm with regard to an expected baby (e.g. where there is information known about domestic violence, parental substance misuse or mental ill health).

These concerns should be addressed as early as possible before the birth, so that a full assessment can be undertaken and support offered to enable the parent/s (wherever possible) to provide safe care to the baby.

All professionals, whether paid or voluntary, in all agencies and 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 Liverpool Safeguarding Children Partnership 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 designated safeguarding children advisor (able to offer advice and decide upon the necessity for a referral to Liverpool Children's Social Care).

Professionals in all agencies 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 Liverpool Children's Social Care, the police or accident and emergency services (for any urgent medical treatment) must not be delayed by the need for consultation with management or the nominated safeguarding children adviser, or the completion of an assessment.

All professionals in agencies with contact with children and members of their families must make a referral to Liverpool Children's Social Care if there are signs 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, not longer than within one working day of identification or disclosure of harm or risk of harm.

In urgent situations, out of office hours, the referral should be made to the LA Children's Social Care emergency duty team / out of hour's team.

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 professionals should be to listen carefully to what the child says and to observe the child's behaviour and circumstances to:

• Clarify the concerns;
• Offer re-assurance about how the child will be kept safe;
• Explain what action will be taken and within what timeframe.

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.

If the child can understand the significance and consequences of making a referral to Liverpool Children's Social Care, they should be asked for their views.

It should be explained to the child that whilst their view will be taken into account, the professional has a responsibility to take whatever action is required to ensure the child's safety and the safety of other children.

See Good Practice Supporting the Voice of the Child Procedure.

Concerns which have been raised, should, where practicable, be discussed with the parent and agreement sought for a referral to Liverpool Children's Social Care unless seeking agreement is likely to place the child 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 induced illness has taken place.

Where a professional decides not to inform parents before making a referral to Liverpool 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 Liverpool Children's Social Care. Professionals should consult with their line manager/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 agreement must be recorded;
• The parent's withholding of permission must form part of the verbal and written referral to Liverpool 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.

If the child is suffering from a serious injury, the professional must seek medical attention immediately from accident and emergency services and must inform LA Children's Social Care, and the duty consultant paediatrician at the hospital.

Where abuse is alleged, suspected or confirmed in a child admitted to hospital, the child must not be discharged until:

• Liverpool Children's Social Care are notified by telephone that there are child protection concerns. (Note: notification may also include another local authority if the child is normally resident elsewhere);
• A Strategy Meeting/discussion has been held, which should then include relevant hospital and other agency professionals.

Referrals should be made to LA Children's Social Care for the area where the child is living or is found.

If the child is known to have an allocated social worker, the referral should be made to them or in their absence to the social worker's manager or a duty children's social worker. In all other circumstances referrals should be made to the duty officer.

The referrer should confirm verbal and telephone referrals in writing, within 48 hours.

Where an assessment has been completed prior to referral, these details should also be conveyed at the point of referral.

LA 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. If this does not occur within three working days, the referrer should contact these services again and, if necessary, ask to speak to a line manager to establish progress.

For further details see Referrals Procedure.

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:
  1. Name, address, gender and date of birth of child;
  2. Name and contact details for parent/s, educational setting (e.g. nursery, school), primary medical practitioner (e.g. GP practice), professionals 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:
  1. Make a referral to Liverpool Children's Social Care;
  2. Make a referral to the lead professional, if the case is open and there is one;
  3. Make a referral to a specialist agency or professional e.g. educational psychology or a speech and language therapist;
  4. 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.

The member of the public should also be given the number for their Liverpool Children's Social Care and encouraged to contact them directly. The agency receiving the initial concern should always make a referral to Liverpool 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 Liverpool 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, professionals should respect the referrer's request for anonymity. However professionals 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.

Referrals should not be deemed malicious without a full and thorough multi-agency assessment, including talking with the referrer and agreement with the appropriate manager. Referrals should also not be described as malicious in professional conclusions, due to the risks associated with this language.

Non-recent abuse, also known as historical abuse, is an allegation of neglect, physical, sexual or emotional abuse made by or on behalf of someone who is now 18 years or over, relating to an incident which took place when the alleged victim was under 18 years old.

Allegations of child abuse are sometimes made by adults and children many years after the abuse has occurred. There are many reasons for an allegation not being made at the time including fear of reprisals, the degree of control exercised by the abuser, shame or fear that the allegation may not be believed. The person becoming aware that the abuser is being investigated for a similar matter or their suspicions that the abuse is continuing against other children may trigger the allegation.

Reports of historical allegations may be complex as the alleged victims may no longer be living in the situations where the incidents occurred or where the alleged perpetrators are also no longer linked to the setting or employment role. Such cases should be responded to in the same way as any other concerns and the Referrals Procedure should be followed. It is important to ascertain as a matter of urgency if the alleged perpetrator is still working with, or caring for, children.

Organisational responses to allegations by an adult of abuse experienced as a child must be of as high a standard as a response to current abuse because:

• There is a significant likelihood that a person who abused a child/ren in the past will have continued and may still be doing so. In such cases, it is important to find out whether the person against whom the allegation is made is still working with children and if so, to refer to the Local Authority Designated Officer. Decisions regarding informing the person’s current employer or voluntary organisation should be made in consultation with the LADO;
• Criminal prosecutions can still take place despite the fact that the allegations are historical in nature and may have taken place many years ago.

If it comes to light that the historical abuse is part of a wider setting of institutional or organised abuse, the case will be dealt with according to the Complex (Organised or Multiple) Abuse Procedure.

Adult services and professionals 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 professional 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 Liverpool 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 professionals 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.

Adult Services, whether commissioning and provider organisations, employ safeguarding children professionals to take the lead on safeguarding children matters. The roles and responsibilities of designated and named safeguarding children professionals should be clear and accessible to all staff and made known to partner agencies to assist in the process of sharing information.

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 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', which applies to all the schools referred to above, and departmental advice 'What to do if you are worried about a child'.

Schools also have additional responsibilities in cases of suspected Female Genital Mutilation (FGM), Child on Child abuse and children at risk of exploitation. In addition patterns identified in schools may also be reflective of the wider issues within a local area and it would be good practice to share emerging trends with safeguarding partners.

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 Safeguarding Children Partnership.

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.

All staff should be aware that children can abuse other children (often referred to as child-on-child abuse), and that it can happen both inside and outside of school or college and online. All staff should be clear as to the school's or college's policy and procedures with regard to child-on-child abuse and the important role they have to play in preventing it and responding where they believe a child may be at risk from it.

Schools and colleges should be aware of the importance of:

• Making clear that there is a zero-tolerance approach to sexual violence and sexual harassment, that it is never acceptable, and it will not be tolerated. It should never be passed off as 'banter', 'just having a laugh', 'a part of growing up' or 'boys being boys'. Failure to do so can lead to a culture of unacceptable behaviour, an unsafe environment and in worst-case scenarios a culture that normalises abuse, leading to children accepting it as normal and not coming forward to report it;
• Recognising, acknowledging, and understanding the scale of harassment and abuse and that even if there are no reports it does not mean it is not happening, it may be the case that it is just not being reported;
• Challenging physical behaviour (potentially criminal in nature) such as grabbing bottoms, breasts and genitalia, pulling down trousers, flicking bras and lifting up skirts. Dismissing or tolerating such behaviours risks normalising them.

See also: Keeping Children Safe in Education Part five: Child on Child Sexual Violence and Sexual Harassment and Addressing Child-on-child Abuse: a Resource for Schools and Colleges (Farrer and Co.).

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 safer recruitment policies and procedures in place.

Clear policies and procedures in accordance with the local LSCP procedures for managing allegations against people who work with children must be in operation (see Allegations Against Persons who Work with Children Procedure).