MOD E TECH 26 Child protection/vulnerable adults/domestic violence Flashcards
Fact!
- 7% children experience serious physical abuse at the hands of their parents/carers
- 1% children experience sexual abuse by a parent
- 3% children experience sexual abuse by relative
- 6% children experience neglect
- 6% children experience frequent and severe emotional abuse
More facts
- Every week 2 children will die following cruelty.
- On average 80 child homicides every year.
- Every 10 days one child is killed at the hands of their parent. Average 35 per year.
- Babies under 1 yr are 4 times more likely to suffer a violent death than adults.
Every Child Matters 2004
- In response to the Victoria Climbie Inquiry by Lord Laming 2003
- “On 12 occasions, over 10 months, chances to save Victoria’s life were not taken. Social services, the Police and the NHS failed to do the basic things well to protect her.”
- This document aims to reduce the number of children who experience educational failure, engage in offending or anti-social behaviour, suffer from ill-health or become teenage parents.
Serious Case Reviews
•Serious Case Reviews shed light on whether lessons can be learned about the way local professionals and agencies work together in the light of a child death where abuse or neglect are suspected.
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•Serious Case Reviews are not inquiries into how a child dies or who is to blame. These are matters for coroners and for criminal courts.
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- Serious Case Reviews focus on improving practices that safeguard and promote the welfare of children.
- Establish whether there are lessons to be learnt from the case about the way in which local professionals and organisations work together to safeguard and promote the welfare of children
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•Identify clearly what those lessons are, how they will be acted on and what is expected to change as a result; and
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•As a consequence, improve inter-agency working and better safeguard and promote the welfare of children.
Focussing on optimal (best possible) outcomes
Being healthy
Staying safe
Enjoying and achieving
Making a positive contribution
Achieving economic well-being
What does all this mean to us?
A Duty to Protect…
All those who come into contact with children and families in their everyday work, including practitioners who do not have a specific role in relation to safeguarding children, have a duty to safeguard and promote the welfare of children.
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.’
Domestic Violence / Abuse
Any incident of threatening behaviour, violence or abuse between adults who are or have been intimate partners or family members, regardless of gender or sexuality.’
Can include any form of physical, sexual or emotional abuse between people in a close relationship.
Such as:
- physical assault
- sexual abuse
- rape
- threats & intimidation
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 (for example, rape or oral sex) or non-penetrative acts such as masturbation, kissing, rubbing and touching outside of clothing.
‘…They may include non-contact activities, such as involving children in looking at, or in the production of sexual images, watching sexual activities, 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.’
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 involve seeing or hearing the ill-treatment of another. It may involve serious bullying (including cyberbullying) 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.’
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)
- 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 needs.
Previously referred to as Munchausen’s Syndrome by proxy
Previously referred to as Munchausen’s Syndrome by proxy
Is a condition whereby:
- Illness is fabricated or induced by parent/carer
- Child presented for medical care/assessment persistently
- Perpetrator denies aetiology
- Signs & symptoms cease when child separated from perpetrator
Effects of child abuse
These can be wide ranging & profound. May include:
- behavioural problems
- educational problems
- mental health problems
- relationship difficulties
- drug & alcohol problems
- suicide or other self harm
- in extreme cases death
Presentation
Abuse may present in a variety of ways:
- Worrying injuries
- Numerous attendances at hospitals
- Allegations made by another person
- Disclosure by a young person / carer
- Parent/carers capacity to care impaired
Listening for child protection
uIf a child discloses abuse, remember that this may be the beginning of a legal process, as well as of a process of recovery for the child. Legal action against a perpetrator can be seriously damaged by any suggestion that the child has been led in any way
uRather than directly questioning the child, just listen and be supportive
uNever stop a child who is freely recalling significant events, but don’t push the child to tell you more than he/she wishes
uWrite an account of the conversation immediately. Put the date and timings on it, and mention anyone else who was present. Then sign it, and hand your record in to your Line Manager, who should contact the Children’s Social Care District Office where appropriate
Can we break a patients confidentiality to safeguard a child
Common Law Duty of Confidence
Personal information about children & families held by professionals & agencies is subject to a legal duty of confidence and should not normally be disclosed without the consent of the subject. However, the law permits the disclosure of confidential information necessary to safeguard children. Disclosure must be justifiable in each case.
(Working together to safeguard children 1999)
Safeguarding Policy and Procedure
- Please read
- Know what to do if you have concerns
- If not sure call the safeguarding helpline ………….. 0115 967 5098 for advice
- Childrens lead: Theresa Critchlow
- Head of safeguarding: Cathy Sheehan
What happens next?
- Ambulance crew will report using phone line
- Social care will investigate if appropriate
- Contact relevant agencies involved with child / family
- Medical procedures as required
- ? Case conference
- Identified as child / family in need
- Care package co-ordinated
- Rare to remove child from extended family
Seven golden rules for information sharing
- Remember that the Data Protection Act is not a barrier to sharing information but provides a framework to ensure that personal information about living persons is shared appropriately.
- Be open and honest with the person (and/or their family where appropriate) from the outset about why, what, how and with whom information will, or could be shared, and seek their agreement, unless it is unsafe or inappropriate to do so.
- Seek advice if you are in any doubt, without disclosing the identity of the person where possible.
Share with consent where appropriate and, where possible, respect the wishes of those who do not consent to share confidential information. You may still share information without consent if, in your judgement, that lack of consent can be overridden in the public interest. You will need to base your judgement on the facts of the case.
- Consider safety and well-being: Base your information sharing decisions on considerations of the safety and well-being of the person and others who may be affected by their actions.
Necessary, proportionate, relevant, accurate,
timely and secure: Ensure that the information you
share is necessary for the purpose for which you
are sharing it, is shared only with those people who
need to have it, is accurate and up-to-date, is shared
in a timely fashion, and is shared securely.
- Keep a record of your decision and the reasons for it – whether it is to share information or not. If you decide to share, then record what you have shared with whom and for what purpose.
Barriers to Reporting
The biggest barrier to diagnosis on NAI is the existence of emotional blocks in the minds of the professionals. These can be so powerful that they prevent the diagnosis being considered in even the most obvious cases.
All those working with children should be warned that their overwhelming impulse will be to want to cover it up.
The most important step in diagnosing NAI is to force yourself to think of it in the first place.”
BMJ 1989 vol 298 P 879-881
Avoid allegations against staff
- Keep parents/carers in room
- If child alone make efforts to contact parent
- Parental consent/responsibility
- Female to examine female & vice versa
- When examining a child ensure crew mate in room if at all possible
How should you respond?
•Remain calm
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•Listen carefully – make factual notes
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•Communicate appropriately
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•Be aware of your non-verbal messages
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•Acknowledge their courage
How you should not respond
Do not:
• Show shock / distaste
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- Probe for more information
- Make promises
Actions:
- A B C
- History taking
- ? inform parents of your suspicions
- Convey to hospital if possible – ? Need police or another vehicle
- Inform triage nurse/discuss with triage nurse
- Phone referral number
- Complete PRF / ePRF
- Inform nurse at receiving hospital
- Care of yourself/crew mate
Who is a vulnerable adult ?
Any person aged 18 years or over who:
is or appears to be eligible for local authority services assistance by reason of mental ill health, physical or learning disability, age or illness
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And:
may be unable to take care of themselves or protect themselves against significant harm or exploitation
Facts
- 10.8 million people in the UK over 60
- Estimated 500,000 elderly population regularly suffer abuse
- Level of abuse in care homes in 51% but only represents 5% of elderly population
- 82% of medication given to elderly in care homes is wrong
- 2005 poll found 47% of disabled population regularly suffered abuse
Vulnerable Adults
•Older people > 65 yrs
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• People with learning disabilities
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• People with mental health issues
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• People with physical disabilities
Abuse is:
a violation of an individuals human and civil rights by any other person or persons.’
- It may consist of a single or repeated acts.
- It may be an act of neglect or omission.
- When a vulnerable person is persuaded to enter into a financial or sexual act to which they have not / cannot give consent.
Any real or potential infliction of physical or psychological harm, injury or pain which is the result of –
- a non-accidental act or conduct
- a non-accidental failure to act where there is duty to act
- deprivation of services
- mistreatment of a dependant person by formal/informal carer
- may be intentional or unintentional or the result of neglect
Who abuses
A wide range of people including relatives, family members, professional staff, paid care workers, volunteers, other service users, neighbours, friends, associates, people who deliberately exploit the vulnerable and strangers.
Categories of Adult Abuse
- Physical
- Sexual
- Psychological
- Neglect / negligence
- Discrimination
- Financial
- Institutional
Deprivation of Liberty (DOLS)
(DOLS)
Means depriving a person of their basic freedoms and rights – denying them the right to think, act and decide things for themselves
Actions which amount to a deprivation are unlawful unless formal authorisation is obtained
DOLS
A person may only be deprived of their liberty:
•In their own best interests
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•If the deprivation is a proportionate response to the likelihood and seriousness of the harm and
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•If there is no less restrictive alternative
Reporting Mechanisms
24 hour safeguarding referral line
For Adults and Children
0115 967 5098
Number is on key fobs for all vehicles
Referral Process
Information to be passed on needs to be:
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- Clear
- Concise information
- Factual
- Relevant
Document everything on EPRF/PRF
Remember:
‘If its not written down its not been done’
Key National Facts:
•Domestic Violence accounts for 1 in 7 (14%) of all reported violence incidents
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- One incident of domestic violence is reported to the police every minute
- 1 in 3 (31%) of all violent crimes against women were incidents of domestic violence, compared to 5% of incidents against men
- 77% of all victims of domestic violence are women
Key National Facts:
On average, two women a week are killed by a current or former male partner
1 in every 4 women will experience domestic violence at sometime in their lives
Key National Facts
•In 90% of domestic violence incidents, children were in the same or adjacent room
Recognise…what are the signs?
- Injuries inconsistent with the explanation
- Trying to hide injuries or minimise their extent
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•Frequent calls to an address for vague symptoms
Partner answers for the patient, minimises injuries, provide excuses, is aggressive or dominant
•History of repeated miscarriage stillbirths or pre-term labour
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- Depression, anxiety, self-harm or psychosomatic symptoms
- Woman reluctant to speak in front of partner
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- Suicide attempts – particularly with Asian women
- Non-compliance with treatment
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•Multiple injuries at various stages
of healing
- Injuries to the breast or abdomen – including bites, burns and bruising
- Recurring sexually transmitted infections or urinary tract infections
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•Injuries below the clothing line
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•Strangulation/Air restriction injuries
MARAC
Multi-Agency Risk Assessment Conference
A MARAC is a meeting where information is shared on the highest risk domestic abuse cases between representatives of local police, probation, health, social care and specialists from the statutory and voluntary sectors.
Signposting
Support & Advice
- Women’s Aid 08457 023 468 www.womenaid.org.uk
- LGBT (Broken Rainbow) 0300 999 5428
- The Men’s Advice Line 0808 801 0327
- Karma Nirvana (Asian Honour Based Violence) 08005999247
- NSPCC 0808 800 5000
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Policy & Further Reading
- Department of Health Guidance (2005) Responding to
- domestic abuse: A handbook for health professionals
- Local Safeguarding Children & Adult Boards
- MARAC & the Ambulance Service www.caada.org.uk/marac/toolkit-ambulance-service-feb-2012.pdf
