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1.3 Recognition of Significant Harm


Contents

  1. Introduction
  2. Safeguarding and Promoting Welfare and Child Protection
  3. Concept of Significant Harm
  4. What is Abuse and Neglect?
  5. Physical Abuse
  6. Emotional Abuse
  7. Sexual Abuse
  8. Neglect


1. Introduction

1.1 This chapter outlines the key definitions and concepts in understanding and recognising child abuse and the impact it may have on children. 


2. Safeguarding and Promoting Welfare and Child Protection

2.1

Safeguarding and promoting the welfare of children is defined for the purposes of this guidance as:

  • Protecting children from maltreatment; preventing impairment of children's health or development;
  • Ensuring that children are growing up in circumstances consistent with the provision of safe and effective care;
  • And undertaking that role so as to enable those children to have optimum life chances and to enter adulthood successfully.


3. Concept of Significant Harm

3.1 The Children and Young Persons Act 2001 introduced Significant Harm as the threshold that justifies compulsory intervention in family life in the best interests of children.
3.2 Physical Abuse, Sexual Abuse, Emotional Abuse and Neglect are all categories of Significant Harm.
3.3 Harm is defined as the ill treatment or impairment of health and development. Suspicions or allegations that a child is suffering or likely to suffer Significant Harm may result in a Core Assessment incorporating a Section 46 Enquiry.
3.4 There are no absolute criteria on which to rely when judging what constitutes Significant Harm. Sometimes a single violent episode may constitute Significant Harm but more often it is an accumulation of significant events, both acute and longstanding, which interrupt, damage or change the child's development.


4. What is Abuse and Neglect?

4.1 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 for example, via the internet. They may be abused by an adult or adults, or another child or children.


5. Physical Abuse

5.1 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.
5.2

For more information about physical abuse, see the NSPCC leaflets:

NSPCC Leaflet "Bruises on Children"

NSPCC Leaflet "Fractures in Children"

NSPCC Leaflet "Oral Injuries and Bites on Children"

NSPCC Leaflet "Thermal Injuries on Children"

NICE Guidelines 'When to suspect child maltreatment'


6. Emotional Abuse

6.1 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 include not giving the child opportunities to express their views, deliberately silencing them or 'making fun' of what they say or how they communicate. It may feature age or developmentally inappropriate expectations being imposed on children.
6.2 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 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.


7. Sexual Abuse

7.1

Overview

  7.1.1 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 also 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.
  7.1.2 Enquiries into situations of alleged sexual abuse should be carried out by professionals who have training in this specific area of work.  It is likely that enquiries will be conducted jointly by Police and Social Services in line with procedures set out in Section 46 Enquiries and Core Assessment Procedure.
  7.1.3

Enquiries and assessments should include consideration of:

  • The nature of sexual offending, i.e. how sexual offenders operate; the possibility of professionals being “groomed”, as well as children and families, and ways in which children may be silenced by their abusers.  See for example Calder, M. (2000) Complete Guide to Sexual Abuse Assessments;
  • Factors associated with the non-abusing carer’s capacity to protect the child. See Smith, G. (1995) ‘Assessing Protectiveness in Cases of Child Sexual Abuse’ in Reder, P., & Lucey, C., (eds) Assessment of Parenting;
  • Alleged sexual abuse within the whole family context and the possible association with other forms of abuse;
  • The impact of sexual abuse on children and the support they are likely to need throughout the assessment process.
  7.1.4

The severity of impact on the child will increase:

  • The longer the abuse continues;
  • The more extensive the abuse;
  • The older the child.
  7.1.5

Other features associated with severity of impact are:

  • A close relationship between the abuser and the child;
  • Premeditated abuse;
  • The degree of threat and coercion, sadism, bizarre and unusual elements.

7.2

Interventions and Child Sexual Abuse

  7.2.1 Plans for children who have been sexually abused need to take account of the overall needs of the child rather than focusing on the sexual abuse alone.
  7.2.2 While self-protection work may be part of the plan, care must be taken not to rely solely on this, as to do so is rendering the child responsible for their own protection.
  7.2.3

A review of the literature identified the following practice implications in relation to intervention (Jones, D., and Ramchandani, P (1999) Child Sexual Abuse – Informing Practice from Research):

  • Psychological treatments are more effective than the passage of time alone;
  • Treatments cannot work in isolation, but require direct social casework support to enable them to be effective, and need to be fully integrated with wider case management;
  • Children must remain safe from further maltreatment in order to benefit from treatment
  • All child victims could benefit from education concerning sexual abuse and its causes and effects, but this would need to be sensitive to the developmental stage of the child;
  • Children expressing the symptoms of sexual abuse can, in addition, benefit from focused treatments;
  • Of these focused treatments, cognitive behavioural therapy has the greatest proven benefit for sexually abused children;
  • Treatments must involve the non-abusive parent or carer;
  • A variety of treatment approaches needs to be available to cover the disparate needs of this population group.


8. Neglect

8.1

Overview

  8.1.1

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, 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.
  8.1.2 It may also include neglect of, or unresponsiveness to, a child's basic emotional needs.
  8.1.3 Severe neglect of young children has adverse effects on a child’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 varies depending on how long children have been neglected, the children’s age, and the multiplicity of neglectful behaviours children have been experiencing.
  8.1.4 Concerns about neglect may come to light suddenly, but, more often, enquiries will be commenced following involvement with the family by a number of agencies over time. There is evidence that such situations may result in information becoming fragmented (see Reder, P., Duncan, S., & Gray, M. (1993) Beyond Blame: Child Abuse Tragedies Revisited) and professionals becoming ‘stuck’, not seeing evidence which challenges their ideas about a family (see Munro, E (2001) Effective Child Protection) and at times finding ways to minimise their involvement (see Bridge Child Care Consultancy (1995) Paul: Death through Neglect).
  8.1.5

It is therefore important that during the process of enquiries:

  • Information is gathered from all those who may have had contact with the child and family, including voluntary agencies and adult services;
  • There is the opportunity for those involved to reflect with their supervisor on the impact that working with the family has had on them and whether this has led them to have become ‘stuck’ and miss important information.
  8.1.6 When making enquiries in cases of neglect, consideration should always be given as to whether a medical assessment is required in order to determine the impact of the care giving environment on a child’s development.
  8.1.7 Research has shown that in order to adequately assess situations of possible neglect it is important to use an ecological framework (Turney, D., & Tanner, K. (2005) Understanding and Working with Neglect)
  8.1.8

Enquiries must therefore gather information about:

  • The child and their current development (including their views);
  • The family history and network including both parents’ history of being parented and how this might affect their parenting capacity and relationship with the child(ren);
  • The environment/community within which the family are living, including stressors and supports;
  • The impact of the wider societal values and beliefs, including the impact of such factors as racism or disability.
  8.1.9 Once the above information has been gathered, the assessment should focus on the way in which the factors interact and the impact that this has on the likely developmental outcomes for the child both in the short term and the long term.

8.2

Deciding When to Refer - Neglect

  8.2.1 Deciding how to act in situations of neglect presents some of the greatest challenges to professionals, and may require careful, close observation of parenting, and child behaviour. Severe neglect of young children 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.  Neglect can result, in extreme cases, in death. See also Referral to Social Services Procedure.
  8.2.2 Where any of the following are present the practitioner should discuss the child’s needs with a senior member of staff in order to decide the most appropriate course of action.
  8.2.3

The basic essential needs of the child not being met. Parental factors contributing to failure to meet needs may be substance misuse, mental ill health, Domestic Abuse or learning disability. Other signs and indicators are:

  • Physical signs e.g. growth not within the expected range; recurrent infections; skin conditions; unkempt dirty appearance; inadequate clothing; unmanaged/untreated health conditions; frequent accidents or injuries;
  • Developmental signs e.g. developmental delays; poor attention/concentration; lack of self-confidence/poor self-esteem; educational underachievement (including erratic or non-school attendance);
  • Behavioural signs e.g. over-active; aggressive; impulsive behaviours; indiscriminate friendliness; withdrawn with poor social relationships; wetting, soiling or destructive behaviours; substance misuse or running away; school non-attendance; sexual promiscuity; self-harm; offending behaviours;
  • Signs in the home environment e.g. dirty, hazardous environment; personal or environmental odour; poor state of children’s bedding; inadequate ventilation or heating; lack of play opportunities; isolation of parents and children from the local community.
  8.2.4 If any practitioner has been working with a family for more than three months and they are concerned that there may be features of neglect that are not being responded to appropriately by either their own agency or others, they must take the case to supervision for discussion and record a plan of action in the child’s file. 
  8.2.5

The Significant Harm Threshold will have been met where there is evidence of:

  • Persistent neglect of a child’s physical and/or emotional needs i.e. occurring over a period of time and/or not likely to change within the child’s time frame.
  • Repetition of neglectful parenting which is continuing despite interventions.
  • Severity i.e. severe detrimental outcomes for the health or development of child(ren).
  • Parents’ own emotional impoverishment affecting their ability to sufficiently meet the child(ren’s) physical and/or emotional needs regardless of material/financial circumstances or assistance.

8.3

Interventions with Neglect

“The distinction must be made between neglect caused by financial poverty, which can be alleviated by financial help, and that caused by emotional poverty.  These may co-exist, but relief of the former condition does not relieve the latter”

(Rosenberg, D & Cantwell, H 91993) ‘The consequences of neglect’ in Hobbs, CJ & Wynne, Child Abuse and Neglect: A Clinician’s Handbook.

  8.3.1

Interventions in situations of neglect must be:

  • Congruent with the findings of the Core Assessment;
  • Take a flexible approach which includes a wide range of formal and informal responses. These are likely to include provision of concrete resources, the development of social supports and work focusing on family relationships.
  8.3.2 Evidence points to the importance of casework and empowerment skills (Turney, D., & Tanner, K. (2005) Understanding and Working with Neglect) in addressing difficulties that underpin neglect. It is important that the relationship between practitioners and parents should involve interventions that empower the family members to develop a sense of personal efficacy and agency.
  8.3.3

In cases of chronic neglect, there may be a need to plan for long term intervention. These plans must:

  • Be underpinned by in-depth assessment;
  • Include measurable objectives for change;
  • Describe strategies for achieving these changes;
  • Include ways of evaluating whether the required changes have taken place.
  8.3.4 Once it is clear that interventions are in place and meeting the developmental needs of the child, it is likely that these will be delivered outside the formal Child Protection Plan.
  8.3.5 If it is clear that family-focused interventions are not meeting the needs of the child, it is likely that the plan will need to include removal of the child.
  8.3.6

Parenting skills programmes may be helpful. Contra-indications for such programmes without a lot of individual support to enable parents to make use of them are:

  • Depression;
  • Stress;
  • Low socioeconomic status;
  • Lack of sense of self-efficacy;
  • Social isolation;
  • Poor relationship;
  • Chronic nature of problems.
  8.3.7 Home visiting programmes at the ante-natal and early post-natal stage can be effective in facilitating the development of a sensitive and empathic relationship between the parent and young child which may forestall attachment and other relationship difficulties.
  8.3.8

Protective factors for children experiencing neglect are:

  • Achievement at school;
  • The opportunity to develop talents and interests;
  • The experience of an enduring, supportive relationship in which they feel valued.

End