5. Children in Specific Circumstances

Socially excluded / isolated children and families

When a family moves frequently multi-agency working must be very good in order for a child's welfare to be adequately monitored, the risk of disruption to service provision and information gathering which could happen with frequent case transfer needs to be minimised (see section 11. Mobile children and families).

• On a family's ability to safeguard their children and promote their welfare; and
• On a child's vulnerability to neglect or harm (within their family and in the wider community).

Significant harm is defined in section 4.1 Recognition and response as a situation where a child is suffering, or is likely to suffer, a degree of physical, sexual and / or emotional harm (through abuse or neglect), which is so harmful that there needs to be compulsory intervention by child protection agencies into the life of the child and their family.

• Be observant about the care and treatment of family pets whilst carrying out assessments;
• Ensure that assessments consider the needs and the risk of harm to children and animals within the family;
• Ensure that safety planning with victims of domestic violence considers the safety of children and animals within the family.

• Receive training about recognition and referral processes to enable them to raise appropriate concerns about children.

• Dealing with the offence of begging;
• Establishing the identity and address of any involved child;
• Referring the child to the LA children's social care for the area in which they live.

Significant harm is defined in section 4. Recognition and response as a situation where a child is suffering, or is likely to suffer, a degree of physical, sexual and / or emotional harm (through abuse or neglect), which is so harmful that there needs to be compulsory intervention by child protection agencies into the life of the child and their family.

• Presents immediate risk of Significant Harm to the child; or
• Is an ongoing activity and presents as a continuing risk of significant harm to the child.

Significant harm is defined in section 4. Recognition and response as a situation where a child is suffering, or is likely to suffer, a degree of physical, sexual and / or emotional harm (through abuse or neglect), which is so harmful that there needs to be compulsory intervention by child protection agencies into the life of the child and their family.

• When a mother who is known to be HIV positive refuses to accept treatment for herself in pregnancy and / or for the baby following delivery;
• When a mother who is known to be HIV positive insists on breast-feeding her baby against medical advice  (breast-feeding currently nearly doubles the risk of transmission from mother to child in the UK);
• Where a child is thought to have a blood-borne disease and their parents refuse to agree to medical testing and / or treatment;
• Where a child is on the appropriate treatment, but medication is given inconsistently or stopped altogether and there is a danger of resistance developing;
• Where a child has been sexually abused and the abuser is thought to be infected with a blood-borne disease (in these cases, HIV testing should be considered);
• Where a child has been exposed to contaminated needles and syringes.

Responding to the risks

Testing and treatment

For other blood-borne viruses, different testing may apply.

Confidentiality

• The disclosure of information would be in the best interests of the child or protect an individual at risk of infection;
• The professionals / agencies receiving the information are aware of its confidential nature and able to maintain the confidence.

• The child is at risk of Significant Harm if disclosure is not made;
• There is a legal requirement for information to be disclosed;
• There is an ongoing police investigation, which makes disclosure important in order to prevent others being put at risk. In these circumstances, legal advice should be sought.

• Consult with their manager;
• Have the decision authorised by the senior manager chairing a legal planning meeting;
• Provide the child and / or family with a full written explanation of the reason for overruling their wishes.

Advice, support and guidance

See also Children in Need and Bloodborne Viruses: HIV and Hepatitis (DH, 2004).

Significant harm is defined in section 4. Recognition and response as a situation where a child is suffering, or is likely to suffer, a degree of physical, sexual and / or emotional harm (through abuse or neglect), which is so harmful that there needs to be compulsory intervention by child protection agencies into the life of the child and their family.

Good quality care

• Children feel valued and respected and their self-esteem is promoted;
• There is an openness on the part of the boarding school to the external world and external scrutiny, including contact with families and the wider community;
• Boarding school staff are trained in all aspects of safeguarding children, are alert to children's vulnerabilities and risks of harm, and knowledgeable about how to implement safeguarding children procedures;
• Children who live in boarding school are listened to and their views and concerns responded to;
• Children have ready access to a trusted adult outside the boarding school setting (e.g. a family member, the child's social worker, independent visitor, children's advocate). Children should be made aware of the help they could receive from independent advocacy services, external mentors, and ChildLine (see section 2.24.12 NSPCC);
• Boarding school staff recognise the importance of ascertaining the wishes and feelings of children and understand how individual children communicate by verbal or non-verbal means;
• There are clear procedures for referring safeguarding concerns about a child to the relevant LA children's social care service;
• In relation to complaints:
  • Complaints procedures should be clear, effective, user friendly and readily accessible to children and young people, including those with disabilities and those for whom English is not their preferred language;
  • Procedures should address all expressions of concern, including formal complaints. Systems that do not promote open communication about 'minor' complaints will not be responsive to major ones, and a pattern of 'minor' complaints may indicate more deeply seated problems in management and culture which need to be addressed;
  • Records of complaints should be kept by providers of children's services (e.g. there should be a complaints register in every boarding school which records all representations including complaints, the action taken to address them, and the outcomes);
  • Children should be genuinely able to raise concerns and make suggestions for changes and improvements, which are taken seriously.
    
    See section 18. LSCBs, quality assurance and conflict resolution
• Bullying is effectively countered (see section 5.6. Bullying);
• Recruitment and selection procedures are rigorous and create a high threshold of entry to deter abusers (see section 17. Safer recruitment);
• There is effective supervision and support, which extends to temporary staff and volunteers (see section 16. Supervision and training);
• The boarding school's contractor staff are effectively checked and supervised when on site or in contact with children;
• Clear procedures and support systems are in place for dealing with expressions of concern by boarding school staff about other staff or carers (see section 15. Allegations against staff);
• Organisations should have a code of conduct instructing boarding school staff on their duty to their employer and their professional obligation to raise legitimate concerns about the conduct of colleagues or managers. There should be a guarantee that procedures can be invoked in ways which do not prejudice the 'whistle-blower's' own position and prospects;
• There is respect for diversity and sensitivity to race, culture, religion, gender, sexuality and disability;
• Boarding school staff are alert to the risks of harm to children in the external environment from people prepared to exploit the additional vulnerability of children living in boarding school.

Significant harm is defined in Section 4. Recognition and response as a situation where a child is suffering, or is likely to suffer, a degree of physical, sexual and / or emotional harm (through abuse or neglect), which is so harmful that there needs to be compulsory intervention by child protection agencies into the life of the child and their family.

• Physical abuse (e.g. hitting, kicking, stabbing and setting alight), including for filming with mobile telephones and theft, commonly of mobile telephones;
• Verbal or mobile telephone / online (internet) message abuse (e.g. racist, sexist or homophobic name-calling or threats) - this type of non-physical bullying may include sexual harassment;
• Mobile telephone or online (internet) visual image abuse - these can include real or manipulated images;
• Emotional abuse (e.g. isolating an individual from the group or emotional blackmail).

See also section section 5.23. ICT based forms of abuse.

Significant harm is defined in section 4. Recognition and response as a situation where a child is suffering, or is likely to suffer, a degree of physical, sexual and / or emotional harm (through abuse or neglect) which is so harmful that there needs to be compulsory intervention by child protection agencies into the life of the child and their family.

Good quality care

• Children feel valued and respected and their self-esteem is promoted;
• There is an openness on the part of the custodial setting to the external world and external scrutiny, including contact with families and the wider community;
• Custodial settings and support staff are trained in all aspects of safeguarding children, are alert to children's vulnerabilities and risks of harm and are knowledgeable about how to implement safeguarding children procedures;
• Children who live in custodial settings are listened to and their views and concerns responded to;
• Children have regular access to a trusted adult from outside the custodial setting (e.g. a family member, the child's social worker, independent visitor, children's advocate). Children should be made aware of the help they could receive from independent advocacy services, external mentors, and ChildLine (see section 2.24.12 NSPCC);
• Custodial service staff recognise the importance of ascertaining the wishes and feelings of children and understand how individual children communicate by verbal or non-verbal means;
• There are clear procedures for referring safeguarding concerns about a child to the relevant LA children's social care service;
• In relation to complaints:
  • Complaints procedures should be clear, effective, user friendly and readily accessible to children and young people, including those with disabilities and those for whom English is not their preferred language;
  • Procedures should address all expressions of concern, including formal complaints. Systems that do not promote open communication about 'minor' complaints will not be responsive to major ones, and a pattern of 'minor' complaints may indicate more deeply seated problems in management and culture which need to be addressed;
  • Records of complaints should be kept by providers of children's services (e.g. there should be a complaints register in every boarding school which records all representations including complaints, the action taken to address them, and the outcomes);
  • Children should be genuinely able to raise concerns and make suggestions for changes and improvements, which are taken seriously.
    
    See section 18. LSCBs, quality assurance and conflict resolution.
• Bullying is effectively countered - this is especially important in any institution providing accommodation and care for groups of young people (see section 5.6. Bullying);
• Recruitment and selection procedures are rigorous and create a high threshold of entry to deter abusers (see section 17. Safer recruitment);
• There is effective supervision and support, which extends to temporary staff and volunteers (see section 16. Supervision and training);
• The custodial service contractor staff are effectively checked and supervised when on site or in contact with children;
• Clear procedures and support systems are in place for dealing with expressions of concern by custodial service staff about other staff or carers (see section 15. Allegations against staff);
• Organisations should have a code of conduct instructing staff on their duty to their employer and their professional obligation to raise legitimate concerns about the conduct of colleagues or managers. There should be a guarantee that procedures can be invoked in ways which do not prejudice the 'whistle-blower's' own position and prospects;
• There is respect for diversity and sensitivity to race, culture, religion, gender, sexuality and disability;
• Custodial service staff are alert to the risks of harm to children in the external environment from people prepared to exploit the additional vulnerability of children living away from home.

LA children's social care

• Have agreed local protocols for referral, assessment and the provision of services to children in custody, including child protection procedures;
• Ensure that the governor of the custodial establishment is invited to be a member of the Local Safeguarding Children Board (LSCB);
• Ensure, through the LSCB, that arrangements are in place to safeguard the welfare of children in custody (e.g. liaison arrangements for undertaking s47 enquiries, holding strategy meetings / discussions and undertaking serious case reviews) and that LA children's social care is represented on the young offender institution's safeguarding committee;
• Have local protocols in place in the event of the death of a child in custody, taking into account national guidelines from the Youth Justice Board, Department for Children, Schools and Families (formerly the DfES) and Prisons and Probation Ombudsman.

Young offender institutions (YOIs), Secure Training Centres (STCs) and secure children's homes

Definition of contact

Significant harm is defined in section 4. Recognition and response as a situation where a child is suffering, or is likely to suffer, a degree of physical, sexual and / or emotional harm (through abuse or neglect) which is so harmful that there needs to be compulsory intervention by child protection agencies into the life of the child and their family.

Contact requests and registers

Parental support for contact

Looked after children

Multi-agency assessment

• The police in the child's home authority (see section 11.9.2. Definition of home and host authorities):
  • The prison establishment police liaison / intelligence officer must be provided with the details of the prisoner and the child/ren (including photographs of the child/ren);
  • The police liaison / intelligence officer will then make contact with the police in the child's home authority requesting any information about the risk of harm to the child or further information about the prisoner;
• LA children's social care in the child's home authority (see section 11.9.2. Definition of home and host authorities):
  • The first approach by the prison establishment should be by letter (with a photograph of the child) to the Director of Children's Services, followed by a telephone call to the LA child protection adviser (LA children's social care should reply within two working days);
  • LA children's social care should undertake an assessment and provide a written report with recommendations within three weeks; 
  • The views of the child should be an important element of the assessment;
• The prison establishment's probation officer should be provided with the details of the prisoner's application for contact;
  • Where a prisoner will be subject to licence supervision on release or has been recalled for breach of licence for the current offence. In these cases, the probation officer should contact the relevant home probation area with a request for information and comments concerning the prisoner's application for contact;
  • Where the prisoner applying for contact is a young offender and is supervised. In these cases, LA children's social care in the child's home authority must be contacted;
• Where appropriate, the NSPCC may be contacted for additional information. Some prison establishments who have developed a relationship or a partnership with the NSPCC have negotiated an arrangement where the NSPCC will search their database for information relating to the risk of harm to a child. There is no obligation for the NSPCC to do this check, but it would enhance the assessment if such an arrangement were in place.

Prison establishment operational manager's decision

• The child's needs, wishes and feelings;
• The capacity of the parent to protect the child from likely harm;
• The prisoner's risk to the public;
• The OASys assessment;
• Static risk assessment (Thornton's Risk Matrix 2000);
• Pre -sentence report;
• Previous convictions;
• Custodial behaviour and any other documentation highlighting risk.

Level of contact decided

• Level one: full restrictions apply. No contact with any child is permitted and all correspondence and telephone calls will be monitored;
• Level two: contact is only permitted via written correspondence. All correspondence and telephone calls will be monitored;
• Level three: contact is permitted via written correspondence and telephone. All correspondence and telephones calls will be monitored;
• Level four: no restrictions necessary. May have contact via correspondence, telephone, visits and family visit (if available). Routine sampling applies - reading of correspondence, listening to telephone calls, general observation in visiting area.

Monitoring

Ensuring correct identification of children

Reviewing contact decisions

Appeals process

Significant harm is defined in section 4. Recognition and response as a situation where a child is suffering, or is likely to suffer, a degree of physical, sexual and / or emotional harm (through abuse or neglect) which is so harmful that there needs to be compulsory intervention by child protection agencies into the life of the child and their family.

Diplomatic immunity

Action by LA children's social care and the police

Significant harm is defined in section 4 . Recognition and response as a situation where a child is suffering, or is likely to suffer, a degree of physical, sexual and / or emotional harm (through abuse or neglect) which is so harmful that there needs to be compulsory intervention by child protection agencies into the life of the child and their family.

• A need for practical assistance in daily living, including intimate care from what may be a number of carers;
• Carers and staff lacking the ability to communicate adequately with the child;
• A lack of continuity in care leading to an increased risk that behavioural changes may go unnoticed;
• Physical dependency with consequent reduction in ability to be able to resist abuse;
• An increased likelihood that the child is socially isolated;
• Lack of access to 'keep safe' strategies available to others;
• Communication or learning difficulties preventing disclosure;
• Parents' or carers' own needs and ways of coping conflicting with the needs of the child.

• Force feeding;
• Unjustified or excessive physical restraint;
• Rough handling;
• Extreme behaviour modification, including the deprivation of liquid, medication, food or clothing;
• Misuse of medication, sedation, heavy tranquillisation;
• Invasive procedures against the child's will;
• Deliberate failure to follow medically recommended regimes;
• Misapplication of programmes or regimes;
• Ill fitting equipment (e.g. callipers, sleep board that may cause injury or pain, inappropriate splinting);
• Undignified age or culturally inappropriate intimate care practices.

See section 5.47 Working with interpreters / communications facilitators.

'Any incident of threatening behaviour, violence or abuse (psychological, physical, sexual, financial or emotional) between adults who are or have been, intimate partners or family members, regardless of gender or sexuality'.

The main characteristic of domestic violence is that the behaviour is intentional and is calculated to exercise power and control within a relationship.

• To protect the child/ren, including unborn child/ren;
• To empower the mother to protect herself and her child/ren;
• To hold the abusive partner accountable for his violence and provide him with opportunities to change.

Impact

The legal definition of 'significant harm' was amended from 31 January 2005 to include "the harm that children suffer by seeing or hearing the ill-treatment of another, particularly in the home".  This is not a new ground under s31 Children Act 1989 but it does recognise Domestic Violence formally as a cause of harm to children and therefore can be used in supporting applications to the Court.

Recognition and response

Where an Interim Care Order is made the Court may make an 'exclusion requirement' under s38A(2) of the Children Act 1989. The Court must be satisfied that if the abusive partner is excluded from the home the children will cease to suffer, or be likely to suffer Significant Harm.

Referral and assessment

The mother should be encouraged and / or helped to complete a personal risk assessment.

Core support group

Section 47 referral

Young women abused through domestic violence

• Fabrication of signs and symptoms, including fabrication of past medical history;
• Fabrication of signs and symptoms and falsification of hospital charts, records, letters and documents and specimens of bodily fluid;
• Induction of illness by a variety of means.

Impact on the child

Abusers

• Not as concerned about the child as medical personnel;
• Remaining with child on ward constantly;
• Investing significant emotional / intellectual effort in the illness;
• Having a history of conduct or eating disorders / contact with mental health agencies;
• Other carer uninvolved in child care;
• Reports of distant passive father.

Recognition

• The state of health of the child, which may vary from being entirely healthy to being sick;
• The parental view which at one end is neglectful, and at the other end causes excessive intervention either directly or indirectly;
• The medical view, which is equally on a spectrum from being dismissive at one end to performing excessive intervention or treatment at the other.

• Reported symptoms and signs found on examination are not explained by any 'normal' medical condition;
• Physical examination and results of investigations do not explain reported symptoms and signs;
• New symptoms are reported on resolution of previous ones;
• Reported symptoms and identified signs are not observed in the absence of the parent;
• The child's normal daily life activities are being curtailed beyond that which may be expected from any known medical disorder from which the child is known to suffer;
• Treatment for an agreed condition does not produce the expected effects;
• Repeated presentations to a variety of doctors and with a variety of problems;
• The child denies parental reports of symptoms;
• Specific problems (e.g. apnoea, fits, choking or collapse);
• Child becoming drawn into the parent's illness;
• History of unexplained illnesses or deaths or multiple surgery in parents or siblings of the family;
• A past history in the parent of child abuse, self harm or somatising, or false allegations of physical or sexual assault.

There may be a number of explanations for these circumstances, and each requires careful consideration and review.

Response

Medical assessment and referral

See also section 6.4. Referral criteria and the indicator table at 6.4.4, which provides guidance on the difference in LA children's social care between s47 / Core Assessment and an initial assessment.

Initial consideration of referral

Initial assessment, outcomes and immediate protection

Strategy meeting

• A senior ward nurse if the child is an in-patient;
• A medical professional with expertise in the relevant branch of medicine;
• GP;
• Health visitor or school nurse;
• Staff from education settings;
• Local authority legal adviser.

In cases of possible FII, it may be necessary not to tell the parents about the meeting prior to it taking place in order to protect the child.

• Whether the child requires constant professional observation and, if so, whether the carer should be present;
• The designation of a medical clinician to oversee and co-ordinate the medical treatment of the child to control the number of specialists and hospital staff the child may be seeing;
• Arrangements for the medical records of all family members, including children who may have died or no longer live with the family, to be collated by the consultant paediatrician or other suitable medical clinician;
• The nature and timing of any police investigations, including analysis of samples and covert surveillance (this will be police led and co-ordinated, with advice available from the National Crime Faculty);
• The need for extreme care over confidentiality, including careful security regarding supplementary records;
• The need for expert consultation;
• Any particular factors, such as the child's and family's race, ethnicity, language and special needs, which should be taken into account;
• The needs of the siblings and other children with whom the alleged abuser has contact;
• The needs of parents;
• Obtaining legal advice over evaluation of the available information (if a legal adviser is not present at the meeting).

Police investigation

Outcome of enquiries

Initial child protection conference

• Professional with expertise in working with children in whom illness is fabricated or induced and their families;
• Paediatrician with expertise in the branch of paediatric medicine able to present the medical findings.

In some cases legal action may be necessary before this point is reached, in which case the appropriateness of holding an initial conference at this stage will need to be considered.

• The Government guidance Safeguarding Children in Whom Illness is Fabricated or Induced (DoH 2002).
• The guidance Fabricated or Induced Illness by Carers (Royal College of Paediatricians and Child Health, 2002).

Legal status

Significant harm is defined in section 4. Response and recognition as a situation where a child is suffering, or is likely to suffer, a degree of physical, sexual and / or emotional harm (through abuse or neglect) which is so harmful that there needs to be compulsory intervention by child protection agencies into the life of the child and their family.

Cultural underpinnings

• Brings status and respect to the girl;
• Preserves a girl's virginity / chastity;
• Is a rite of passage;
• Gives a girl social acceptance, especially for marriage;
• Upholds the family honour;
• Helps girls and women to be clean and hygienic.

See Safeguarding Children at Risk of Abuse through Female Genital Mutilation (London Board, 2007) for a fuller list of reasons

Types of FGM

• Type 1: Circumcision -  Excision of the prepuce with or without excision of part or all of the clitoris;
• Type 2: Excision (Clitoridectomy) - Excision of the clitoris with partial or total excision of the labia minora. After the healing process has taken place, scar tissue forms to cover the upper part of the vulva region;
• Type 3: Infibulation (also called Pharaonic Circumcision) -This is the most severe form of female genital mutilation. Infibulation often (but not always) involves the complete removal of the clitoris, together with the labia minora and at least the anterior two-thirds and often the whole of the medial part of the labia majora;
• Type 4: Unclassified - This includes all other procedures on the female genitalia, and any other procedure that falls under the definition of female genital mutilation given above.

Implications of FGM for a child's health and welfare

Women with FGM Type 3 require special care during pregnancy and childbirth.

Identifying a child who has been subjected to FGM or who is at risk of being abused through FGM

• The family comes from a community that is known to practise FGM;
• A child may talk about a long holiday to her country of origin or another country where the practice is prevalent, including African countries and the Middle East;
• A child may confide to a professional that she is to have a 'special procedure' or to attend a special occasion;
• A child may request help from a teacher or another adult;
• Any female child born to a woman who has been subjected to FGM must be considered to be at risk, as must other female children in the extended family;
• Any female child who has a sister who has already have undergone FGM must be considered to be at risk, as must other female children in the extended family.

• A child may spend long periods of time away from the classroom during the day with bladder or menstrual problems if she has undergone Type 3 FGM;
• A prolonged absence from school with noticeable behaviour changes on the girl's return could be an indication that a girl has recently undergone FGM;
• Professionals also need to be vigilant to the emotional and psychological needs of children who may/are suffering the adverse consequence of the practice (e.g. withdrawal, depression etc.);
• A child requiring to be excused from physical exercise lessons without the support of her GP;
• A child may ask for help.

Responding to FGM - referral to LA children's social care

Responding to FGM - the role of health

• Younger siblings;
• Daughters or daughters she may have in the future;
• Extended family members.

Reducing the prevalence of FGM

• There is a very real risk of possible death and injury; and
• When a child sets fires, it may indicate that they are at risk of, or experiencing, serious mental or emotional harm (see section 4.3. Recognition of abuse and neglect).  

Significant harm is defined in section 4. Recognition and response as a situation where a child is suffering, or is likely to suffer, a degree of physical, sexual and / or emotional harm (through abuse or neglect) which is so harmful there needs to be compulsory intervention by child protection agencies in the life of the child and their family.

• Curiosity;
• A cry for help;
• Lack of parental control;
• Serious emotional disturbance, which may be related to abuse and neglect.

Recognition

Significant harm is defined in section 4. Recognition and response as a situation where a child is suffering, or is likely to suffer, a degree of physical, sexual and / or emotional harm (through abuse or neglect), which is so harmful that there needs to be compulsory intervention by child protection agencies into the life of the child and their family.

• Controlling unwanted behaviour and sexuality (including perceived promiscuity, or being gay, lesbian, bisexual or transgender) - particularly the behaviour and sexuality of women;
• Protecting 'family honour';
• Responding to peer group or family pressure;
• Attempting to strengthen family links;
• Ensuring land, property and wealth remain within the family;
• Protecting perceived cultural and/or religious ideals (which are often misguided or out of date);
• Preventing 'unsuitable' relationships (e.g. outside the family's cultural, ethnic, religious or caste group);
• Assisting claims for residence and citizenship;
• Fulfilling long standing family commitments;
• Debt repayment;
• Alleviation of poverty;
• Appeasement of an aggrieved family member.

Response

• See the child immediately in a secure and private place;
• See the child on their own;
• Explain to the child the limits of confidentiality;
• Tailor their approach according to whether the child is already married or is at risk of being married (e.g. are there indications of a specific plan to force the child to marry?). There may also be information suggesting a child will be taken out of the country, often for a 'holiday' during a vacation period, and professionals should be aware that this could be linked to suspicions or concerns that the child is at risk of forced marriage;
• Encourage and/or help the child to complete a personal risk assessment (see the proformas in the supplementary London procedure Safeguarding Children Abused through Domestic Violence);
• Develop an emergency safety plan with the child;
• Explain all the options to the child (starting with the fact that forced marriage is illegal in the UK) and recognise and respect the child's wishes. If the child does not want LA children's social care to intervene, the professional will need to consider whether the child's wishes should be respected or whether the child's safety requires that further action be taken. This requires the professional to make an assessment of the risk of harm facing the child;
• Agree a means of discreet future contact with the child;
• Contact, as soon as possible, the agency's nominated safeguarding children adviser, who should be involved in the assessment of risk;
• Record all discussions and decisions (including rationale if no decision is made to refer to LA children's social care).

• Treat such allegations merely as a domestic issue and send the child back to the family home as part of routine child protection procedures. It is not unusual for families to deny that forced marriage was the intention, and once aware of professional concern they may move the child and bring forward both travel arrangements and the marriage;
• Ignore what the child said or dismiss out of hand the need for immediate protection;
• Approach the child's family, friends or those people with influence within the community without the express consent of the child, as this will alert them to agency involvement / enquiries;
• Contact the family. If the family are approached, they may deny that the child is being forced or was forced to marry, move the child, expedite any travel arrangements, bring forward the forced marriage or harm the child;
• Share information outside child protection information-sharing protocols without the express consent of the child;
• Breach confidentiality, except where necessary in order to ensure the child's safety;
• Attempt to be a mediator. This can put the child at considerable risk of harm, possibly of being murdered.

Considerations for all agencies

• Keep information from case files and databases strictly confidential, and preferably restricted to named members of staff only;
• Consider, with their managers, staff safety when visiting the family home and any other settings (see section 10. 7 Keeping professionals safe);
• Get as much information as possible when a case is first reported, as there may not be another opportunity for the individual reporting to make contact - particularly if the child is going overseas;
• When referring a case of forced marriage to other agencies, ensure they are capable of handling the case appropriately. If in doubt, consider approaching established women's groups who have a history of working with survivors of domestic violence and forced marriage and ask these groups to refer them to reputable agencies;
• Recognise the police responsibility to initiate and undertake a criminal investigation as appropriate;  
• Encourage the child to get in touch with the Community Liaison Unit at the Foreign and Commonwealth Office. The Unit gives advice to children who fear they may be forced to marry.

Action by LA children's social care

• A child who fears they may be forced to marry in the UK or overseas;
• A report by a third party of a child having been taken abroad for the purpose of a forced marriage;
• A child who has already been forced to marry;
• A child repatriated to the UK from overseas;
• A spouse who has come to the UK from overseas.

The Association of Directors of Social Services website (social workers) and

The Foreign and Commonwealth Office website (health professionals)

Local agencies and professionals can contact the Forced Marriage Unit where experienced caseworkers will be able to offer support and guidance, on 020 7008 0151.

Significant harm is defined in section 4. Recognition and response as a situation where a child is suffering, or is likely to suffer, a degree of physical, sexual and / or emotional harm (through abuse or neglect) which is so harmful that there needs to be compulsory intervention by child protection agencies into the life of the child and their family.

Significant harm is defined in section 4. Recognition and response as a situation where a child is suffering, or is likely to suffer, a degree of physical, sexual and / or emotional harm (through abuse or neglect) which is so harmful that there needs to be compulsory intervention by child protection agencies into the life of the child and their family.

Good quality care

• Children feel valued and respected and their self-esteem is promoted;
• There is an openness on the part of the fostering service and the foster carers to the external world and external scrutiny, including contact with families and the wider community;
• Foster carers are trained in all aspects of safeguarding children, are alert to children's vulnerabilities and risks of harm, and are knowledgeable about how to implement safeguarding children procedures;
• Children who live in foster care are listened to and their views and concerns responded to;
• Children have ready access to a trusted adult outside the foster care setting (e.g. a family member, the child's social worker, independent visitor, children's advocate). Children should be made aware of the help they could receive from independent advocacy services, external mentors, and ChildLine (see section 2.24.12 NSPCC);
• Foster carers recognise the importance of ascertaining the wishes and feelings of children and understand how individual children communicate by verbal or non-verbal means;
• The foster carer is aware of the procedures for referring safeguarding concerns about a child to the relevant LA children's social care service;
• In relation to complaints:
  • Complaints procedures should be clear, effective, user friendly and readily accessible to children and young people, including those with disabilities and those for whom English is not their preferred language;
  • Procedures should address all expressions of concern, including formal complaints. Systems that do not promote open communication about 'minor' complaints will not be responsive to major ones, and a pattern of 'minor' complaints may indicate more deeply seated problems in management and culture which need to be addressed;
  • Records of complaints should be kept by providers of children's services (e.g. there should be a complaints register in every boarding school which records all representations including complaints, the action taken to address them, and the outcomes);
  • Children should be genuinely able to raise concerns and make suggestions for changes and improvements, which are taken seriously.
    
    See section 18 - LSCBs, quality assurance and conflict resolution
• Bullying is effectively countered (see section 5.6. Bullying);
• Recruitment and selection procedures for local authority foster carers are rigorous and create a high threshold of entry to deter abusers (see section 17. Safer recruitment);
• There is effective supervision and support, which extends to temporary or back-up carers, fostering service staff and volunteers (see section 16. Supervision and training);
• Clear procedures and support systems are in place for dealing with expressions of concern by foster carers and fostering service staff about other staff or carers (see section 15. Allegations against staff);
• Organisations should have a code of conduct instructing foster carers and fostering service staff on their duty to their employer and their professional obligation to raise legitimate concerns about the conduct of colleagues or managers.  There should be a guarantee that procedures can be invoked in ways which do not prejudice the 'whistleblower's' own position and prospects;
• There is respect for diversity and sensitivity to race, culture, religion, gender, sexuality and disability;
• Foster carers and fostering service staff are alert to the risks of harm to children in the external environment from people prepared to exploit the additional vulnerability of children living away from home.

Promoting and protecting a child's welfare

For further details on this see section 15. Allegations against staff, section 6 Referral and assessment, , including section 6.4. Referral criteria and the indicator table at 6.4.4 which provides guidance on the difference in LA children's social care between s47 / Core Assessment and an initial assessment; and section 7. Child protection enquiries.

Significant harm is defined in section 4. Recognition and response as a situation where a child is suffering, or is likely to suffer, a degree of physical, sexual and / or emotional harm (through abuse or neglect), which is so harmful that there needs to be compulsory intervention by child protection agencies into the life of the child and their family.

See also section 5.6 Bullying, and section 2.10.36. Screening and searching pupils for weapons.

Recognition and referral of abuse

• The relative chronological and developmental age of the two children (the greater the difference, the more likely the behaviour should be defined as abusive);
• Whether the alleged abuser is supported or joined by other children;
• A differential in power or authority (e.g. related to race, gender, physical, emotional or intellectual vulnerability of the victim);
• The actual behaviour (both physical and verbal factors must be considered);
• Whether the behaviour could be described as age appropriate or involves inappropriate sexual knowledge or motivation;
• The degree of physical aggression, intimidation or bribery;
• The victim's experience of the behaviour and the impact it is having on their routines and lifestyle (e.g. not attending school, see section 5.28. Not in school);
• Attempts to ensure secrecy;
• Duration and frequency of behaviour.

• Having been seriously physically abused or being likely to seriously physically abuse another child or an adult;
• Having been seriously emotionally abused or being likely to seriously emotionally abuse another child or an adult;
• Having harmed another child or an adult.

Sexual abuse and serious physical and emotional abuse

Strategy meeting/discussion

• Social worker for the child who is suspected or alleged to have harmed another child / adult;
• Social worker for the child/ren alleged to have been abused;
• Social workers' first line manager;
• Police;
• Youth Offending Team representative, where the child who is alleged to have caused the harm is aged eight or over;
• School representative/s (particularly if the concerns suggest that other children in the school setting have been or may be at risk of being abused);
• School nurse or other health services staff, as required;
• Child and adolescent mental health services (CAMHS) representative;
• Representatives of fostering or residential care, as applicable;
• Consideration should also be given to inviting a local specialist voluntary agency and any other professional or agency involved with the child alleged to have caused the harm.

• The safety of all children concerned, with particular attention needing to be paid to living and contact arrangements while concerns are being investigated;
• Information relevant to the protection needs of the alleged victim is gathered;
• Any criminal aspects of the abuse are investigated;
• Any information relevant to abusive experiences and protection needs of the child who has harmed is gathered.

• Age of all children and adults who may be involved (both victims and children who have harmed);
• Whether the child who harmed was/is supported by other children;
• Seriousness of the alleged incident;
• Effect on the victim/s and their own view of their safety;
• The victim's parents' attitude and ability to protect their child/ren;
• The abuser's parents' response to their child's behaviour;
• Whether there is a suspicion that the child who is alleged to have harmed has also been abused;
• Whether there is reason to suspect that adults are also involved;
• The likelihood and desirability of criminal prosecutions taking place;
• The level of ability of the child and any communication problems that they may have;
• The mental state of the child and their capacity to be interviewed.

Criminal investigation

Outcome of enquiries

• Be informed by an assessment of the child's needs and the risk they pose to others;
• Set out who will have responsibility for what actions, including what course of action should be followed if the plan is not being successfully implemented; and
• Include a timescale for review of progress against planned outcomes.

Family Group Conferences may have a role to play in fulfilling these tasks. For information about Family Group Conferences see: Family Group Conferences: Principles and Practice Guidance (2002, Barnardo's / Family Rights Group / NCH).

Child protection conference

Criminal proceedings

Multi-agency planning meetings

• Share information;
• Agree to undertake:
  • An assessment of the needs of the victim/s;
  • An assessment of the needs and risks posed by the child with harmful behaviours;
• Agree to refer for a specialist assessment for either child, as required;
• Set a timetable for both assessments;
• Co-ordinate interim:
  • Support for the victim/s;
  • Risk management for the child with harmful behaviours;
• Allocate agency and professional roles, including which agency will take responsibility for the interim risk management plan.

Children moving into or re-entering a local authority area

Carrying of offensive weapons and gangs

• 'Made' could include a dagger or gun;
• 'Adapted' could include a broken bottle; and
• 'Intended' for such use could include a rock or stone.

Clearly many articles are capable of being an offensive weapon, but in the latter category there would need to be evidence of an intention to use that particular article as a weapon.

Children moving into or re-entering a local authority area

Significant harm is defined in section 4. Recognition and response as a situation where as a child the person suffered a degree of physical, sexual and / or emotional harm (through abuse or neglect), which was so harmful that there should have been compulsory intervention by child protection agencies into the life of the child and their family.

• 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;
• Criminal prosecution may be possible if sufficient evidence can be carefully collated.

Required response

• Inform the police at the earliest opportunity and establish if there is any information regarding the alleged abuser's current contact with children, irrespective of the wishes of the victim as to whether a police prosecution should take place;
• Inform the LA child protection adviser if the adult who has disclosed requests a police investigation or if the allegations involve organised and complex abuse (police involvement in an investigation will depend on a number of factors, including the victim's wishes and the public interest);
• Initiate a Child Protection Enquiry if the alleged abuser is known to be currently caring for children or has access to children. This must include making a referral to LA children's social care in the area where the alleged abuser is currently living.

Honour based violence is the term used to describe murders in the name of so-called honour, sometimes called 'honour killings'. These are murders in which predominantly women are killed for perceived immoral behaviour, which is deemed to have breached the honour code of a family or community, causing shame.

The Metropolitan Police definition of so-called honour based violence is: 'a crime or incident, which has or may been committed to protect or defend the honour of the family and/or community'.

Recognition

A child who is at risk of honour based violence is at significant risk of physical harm (including being murdered) and/or neglect, and may also suffer significant emotional harm through the threat of violence or witnessing violence directed towards a sibling or other family member. See section 4.3. Recognition of Abuse and Neglect.

Significant harm is defined in section 4. Recognition and response as a situation where a child is likely to suffer a degree of physical harm which is such that it requires a compulsory intervention by child protection agencies into the life of the child and their family.

The perceived immoral behaviour which could precipitate a murder include:

• Inappropriate make-up or dress;
• The existence of a boyfriend;
• Kissing or intimacy in a public place;
• Rejecting a forced marriage;
• Pregnancy outside of marriage;
• Being a victim of rape;
• Inter-faith relationships;
• Leaving a spouse or seeking divorce.

Incidents, in addition to those listed in 5.20.6 above, which may precede a murder include:

• Physical abuse;
• Emotional abuse, including:
  • house arrest and excessive restrictions;
  • denial of access to the telephone, internet, passport and friends;
  • threats to kill;
• Pressure to go abroad. Victims are sometimes persuaded to return to their country of origin under false pretences, when in fact the intention could be to kill them.

Where a child discloses fear of honour based violence, professionals in all agencies should respond in line with section 5.11 Domestic violence procedure and section 5.15 Forced marriage of a child procedure.; and the supplementary London procedure Safeguarding Children Abused Through Domestic Violence (London Board, 2007). The professional response should include:

• Seeing the child immediately in a secure and private place;
• Seeing the child on their own;
• Explaining to the child the limits of confidentiality;
• Asking direct questions to gather enough information to make a referral to LA children's social care and the police, including recording the child's wishes;
• Encouraging and/or helping the child to complete a personal risk assessment (see the proformas in the London procedure Safeguarding Children Abused through Domestic Violence);
• Developing an emergency safety plan with the child;
• Agreeing a means of discreet future contact with the child;
• Explaining that a referral to LA children's social care and the police will be made (see section 6. Referral and assessment);
• Record all discussions and decisions (including rationale if no decision is made to refer to LA children's social care).

See also section 6.4. Referral Criteria Procedure and the indicator table at 6.4.4, which provides guidance on the difference in LA children's social care between s47 / Core Assessment and an initial assessment.

Care must be provided in a safe environment which is child-friendly, healthy and well suited to the age and stage of development of the child/ren. Children should not be cared for on adult wards.  Wherever possible, children should be consulted about where they would prefer to stay in hospital and their views should be taken into account and respected.

Hospital admission data should include the age of children so hospitals can monitor whether they are being given appropriate care in appropriate wards.

Discharging Children from Hospital

As part of the plan:

• LA children's social care must assess and establish that the child's home environment is safe;
• The health professionals must ensure their concerns have been fully addressed and any plan for discharge of the child must be authorised by the child's consultant;
• The plan must provide for the ongoing promotion and safeguarding of that child's welfare;
• There must be follow-up arrangements to monitor compliance with the plan.

Transition for Children with Long Term Conditions

Children admitted to these hospitals can present with complex safeguarding and child protection issues. They may have sustained serious and life threatening non-accidental injuries or there may be concerns related to fabricated or induced illness (see section 5.12 Fabricated or induced illness). These children may have experienced, or be at risk of, Significant Harm through physical, sexual and Emotional Abuse and / or neglect (see section 4.3. recognition of abuse and neglect). Furthermore, if there are lapses in the care provided for the child, s/he can suffer significant harm whilst in hospital.

Significant harm is defined in section 4. Recognition and response as a situation where a child is suffering, or is likely to suffer, a degree of physical, sexual and / or emotional harm (through abuse or neglect) which is so harmful that there needs to be compulsory intervention by child protection agencies into the life of the child and their family.

Most specialist hospitals have links with their local LA children's social care, who may be able, dependent upon local arrangements, to liaise with the child's home authority (see section 11.9.2. Definition of home and host authorities) in child protection cases.

Some specialist hospitals offering tertiary care to children have children's social care teams on site, provided in partnership with the local children's social care service. In child protection cases, their role is to act as liaison with the home authority, except where they would be the lead agency - such as, when:

• The child is resident in the specialist hospital's local authority area;
• Incidents occur on the specialist hospital site;
• There are allegations against members of staff of the specialist hospital's Trust.

Protocols should outline responsibilities and necessary actions in accordance with legal duties, procedures and accepted good practice:

• Case responsibility for the child rests with the home authority (see section 11.9.2. Definition of home and host authorities), and the home authority should work in partnership with the Trust and with the host authority children's social care service. If a difference of opinion occurs, this should be resolved by discussion between managers (see section 18. LSCBs, quality assurance and conflict resolution);
• Where the child is already known to the home authority, and child protection concerns exist, the child should have an allocated social worker who should make contact with the relevant hospital social work department;
• Where a child protection concern which is already known to the home authority exists, relevant child protection plans (which also detail any action the relevant hospital trust staff may need to take to protect the child) should be immediately passed to the hospital social work department or, if out of hours, the Trust's out of hours lead for inclusion in hospital and social work records;
• Where a child protection concern arises, or a pre-existing concern changes on or after admission, the home authority should act immediately, in line with procedures for a s47 enquiry, to ensure the child is appropriately protected. Where necessary, a Strategy Meeting / discussion should be held in line with procedural timescales. This may be held at the hospital and chaired by a LA children's social care manager from the home authority;
• To ensure the safety of the child, members of the strategy meeting / discussion must consider and agree, in discussion with relevant Trust and social work management, the need for a legal framework to be put in place by the home authority. Any dispute should immediately be referred to senior management within the home authority and the Trust;
• A written care plan for the child must be immediately faxed or emailed to the hospital social work department. Similarly, strategy meeting / discussion minutes, any decisions (which must be in writing) and a copy of any legal orders must be sent to the relevant hospital trust (to the social work department during working hours and if there is one, or the Trust out-of-hours lead if out of hours) for inclusion in the child's records at the hospital;
• The care plan should be regularly reviewed, as appropriate, in a multi-agency / disciplinary meeting usually held at the hospital and chaired by the relevant person from the home authority;
• Where there are concerns about unauthorised removal of the child or unsupervised visiting by the parents to a child with injuries of a non-accidental nature, the senior hospital staff and senior staff from the home authority should discuss whether an immediate legal order is required to protect the child. If an order is required, the senior hospital staff and senior staff from the home authority should decide whether the home or host authority will make the application and on what grounds. If the risk to the child is potentially life threatening and the need for protection is immediate, the local police should be contacted to consider using their powers of police protection to ensure that the child is not removed from the hospital;
• The home authority needs to work in partnership with the specialist hospital;
• Where the child is admitted to the hospital from outside the UK, the child's home authority is the local authority in which the child has a temporary address (this could be an embassy address where an embassy has negotiated the contract with the hospital);
• A visiting non-UK citizen child should receive the same duty of care as a child resident in the UK (i.e. checks made, assessments completed, care plan initiated and reviewed).

Serious case reviews

Recognition and response

The impact on a child of ICT-based sexual abuse is similar to that for all sexually abused children (see section 4.3.19. Recognising sexual abuse). However, it has an additional dimension of there being a visual record of the abuse.

ICT-based sexual abuse of a child constitutes Significant Harm through sexual and Emotional Abuse. See section 4.3. Recognition of abuse and neglect.

Significant harm is defined in section 4. Recognition and response as a situation where a child is suffering, or is likely to suffer, a degree of physical, sexual and / or emotional harm (through abuse or neglect) which is so harmful that there needs to be compulsory intervention by child protection agencies into the life of the child and their family.

Professionals in all agencies working with children, adults and families should be alert to the possibility that:

• A child may already have been / is being, abused and the images distributed on the internet or by mobile telephone;
• An adult or older child may be grooming a child for sexual abuse, including for involvement in making abusive images. This process can involve the child being shown abusive images;
• An adult or older child may be viewing and downloading child sexual abuse images.

Concern about particular child/ren

Concern about an adult

Allegations against colleagues

Supplementary guidance

Impact on children

Children have great difficulty in talking about their abuse, some denying that it is their image even when there is categorical proof. The reasons for this include that children:

• Can experience intense feelings of powerlessness, knowing that there is nothing they can do about others viewing pornographic pictures / films of themselves (and sometimes their coerced sexual abuse of others) indefinitely;
• Express concerns over how pornography will be viewed (i.e. that they enjoyed it or were complicit in its production);
• Are aware that the sexual abuse they endured to produce the pornography can be distributed commercially or non-commercially for the arousal of others. They are also aware that it can be used to groom and abuse other children;
• Suffer in the knowledge that there is a permanent record of their sexual abuse and this knowledge has implications for the need for long-term support and treatment of the children to reflect the harm that indefinite circulation can cause.

Definition and legislation

The UK laws which relate to child abuse images are:

• Protection of Children Act 1978 (England and Wales) as amended by the Criminal Justice and Public Order Act 1994
• Civic Government Act, 1982 (Scotland)
• Sexual Offences Act 2003: Key Changes (England and Wales) 
• Memorandum of Understanding: Section 46 Sexual Offences Act 2003

Chat room grooming and off-line abuse

Child Exploitation and On-line Protection Centre (CEOP)

Local Safeguarding Children Boards

Responses to situations

In any case, if immediate protection of the child is assessed to be necessary, professionals should: (bullets reordered 10.01.2008)

• Either under police protection or EPO, take the child to a suitable place and arrange a placement (amended 10.01.2008);
• If entry cannot be gained to an unsupervised child, obtain police assistance by contacting the police CAIT or the local police station:
  • When an Emergency Protection Order is made, a warrant authorising any constable to assist in entering and searching the named premises can be obtained (Children Act 1989, s48).
  • In dire emergencies, the police can exercise their powers under s17(1)e of the Police and Criminal Evidence Act 1984 to enter and search premises without a warrant for the purposes of saving life and limb. If this action is taken, the police may consider it appropriate for the child/ren to be placed in police protection (Children Act 1989, s46).
• Leave a note for the parent or responsible adult, giving all information regarding the action to be taken and the reason, and advising them of what to do. If English is not the first language the note should be translated;
• Collect the child's immediate necessities and familiar toys. Ensure the child understands as far as is possible what is happening, recognising that being taken away from home by unknown adults (one of whom may be in uniform) may be understandably more frightening to the child than being left alone;

If immediate protection is assessed as not necessary, professionals should:

• Establish the child's understanding of the whereabouts of the parent or responsible person and of the arrangements made;
• If the parent can be located, reunite parent and child and advise the parent of the dangers of leaving children alone;
• If the parent or responsible person seems likely to return shortly, wait with the child;
• If the parent or responsible adult has not returned within 30 minutes, either arrange for another responsible person to take responsibility for the child, or remove the child. A suitably responsible person could be a neighbour, relatives, someone with Parental Responsibility or a residence order, or friends known to and trusted by the child and professionals.

Subsequent action

Child left alone in a public place

Bed and breakfast accommodation

Messages for parents

Circumcision for therapeutic / medical purposes

Non-therapeutic circumcision

Legal position

The legal position on male circumcision is untested and therefore remains unclear. Nevertheless, professionals may assume that the procedure is lawful provided that:

• It is performed competently, in a suitable environment, reducing risks of infection, cross infection and contamination;
• It is believed to be in the child's best interests;
• There is valid consent from family / parents and the child, if old enough, is Gillick Competent.

Principles of good practice

The welfare of the child should be paramount, and all professionals must act in the child's best interests. Children who are able to express views about circumcision should always be involved in the decision-making process:

• Even where they do not decide for themselves, the views that children express are important in determining what is in their best interests;
• Parental preference alone does not constitute sufficient grounds for performing a surgical procedure on a child unable to express his own view. Parental preference must be weighed in terms of the child's interests;
• When the courts have confirmed that the child's lifestyle and likely upbringing are relevant factors to take into account. Each individual case needs to be considered on its own merits.

An assessment of best interests in relation to non-therapeutic circumcision should include consideration of:

• The child's own ascertainable wishes, feelings and values;
• The child's ability to understand what is proposed and weigh up the alternatives;
• The child's potential to participate in the decision, if provided with additional support or explanations;
• The child's physical and emotional needs;
• The risk of harm or suffering for the child;
• The views of parents and family;
• The implications for the child and family of performing, and not performing, the procedure;
• Relevant information about the child and family's religious or cultural background.

Doctors' response

Poorly performed circumcisions have legal implications for the doctor responsible. In responding to requests to perform male circumcision, doctors should follow the guidance issued by the:

• General Medical Council:
• British Medical Association in respect of responding to requests to perform male circumcision.
• Royal College of Surgeons: Statement on Male Circumcision

Recognition of harm

Circumcision may constitute Significant Harm to a child if the procedure was undertaken in such a way that he:

* Acquires an infection as a result of neglect;

* Sustains physical functional or cosmetic damage;

* Suffers emotional, physical or sexual harm from the way in which the procedure was carried out;

* Suffers emotional harm from not having been sufficiently informed and consulted, or not having his wishes taken into account.

See section 4.3. recognition of abuse and neglect.

Significant harm is defined in section 4. Recognition and response as a situation where a child is likely to suffer a degree of physical, sexual and / or emotional harm (through abuse or neglect) which is so harmful there needs to be compulsory intervention by child protection agencies in the life of the child and their family.

Multi-agency response

Role of community/religious leaders

Recognition and referral

Professionals in local agencies should be alert to the possibility that an expectant mother / family missing appointments or repeatedly being unavailable for home visits may indicate that a child or unborn child is at risk of, or is experiencing, Significant Harm. This could be physical, sexual or Emotional Abuse, and / or neglect. See section 4.3. recognition of abuse and neglect.

Significant harm is defined in section 4. Recognition and response as a situation where a child is likely to suffer a degree of physical harm which is such that it requires a compulsory intervention by child protection agencies into the life of the child and their family.

Professionals should involve all the agencies with current or recent contact with the expectant mother / family to assess the child/ren's or unborn child's vulnerability. Professionals should consider questions such as:

• Is there good reason to believe that the expectant mother / family may be the victim of a crime?
• Has there been a pre-birth conference for the child and is the unborn child subject to a pre-birth child protection assessment?
• Are any of the children the subject of child protection plans?
• Is the family currently subject to a s47 enquiry?
• Is the mother a child herself, or is she Looked After by the local authority?
• Is there a person present in the household or visiting the mother with previous convictions for an offence against children, or other person who poses a risk of harm to children?
• Is it clear that the expectant mother / family is missing, whereabouts unknown?

Immediate action

Strategy meeting/discussion

When the expectant mother/family is found

When an expectant mother / family is found, there should, if practicable, be a Strategy Meeting / discussion between previously involved agencies within one working day, to consider:

• Immediate safety issues;
• Whether to instigate a s47 enquiry and any police investigation;
• Who will interview the expectant mother / family;
• Who needs to be informed of the expectant mother / family being found (locally and nationally).

Significant harm is defined in section 4. Recognition and response as a situation where a child is suffering, or is likely to suffer, a degree of physical, sexual and / or emotional harm (through abuse or neglect), which is so harmful that there needs to be intervention by child protection agencies into the life of the child and their family.

Prevention, recognition and response

Referral and assessment

Strategy meeting / discussion

Independent interviews

Looked after children

• A social care risk assessment record should be completed - see appendix 3 of Safeguarding Children Missing from Care and Home (London Board, 2006);
• The child's parents should be informed;
• A police investigation must be initiated.

• Children who are registered with schools and who are or go missing from school, and give rise to concern about their welfare (these children may be classified as missing, whereabouts unknown);
• Children who are poor attendees at school or who have interrupted school attendance;
• Children of school age who are not registered with a school;
• Children of school age who are educated at home but where there are concerns about their welfare.

Child registered at school who goes missing

Initial response

Children with poor, irregular or interrupted school attendance

Initial response

Children who are vulnerable or at risk of harm

Significant harm is defined in section 4. Recognition and response as a situation where a child is suffering, or is likely to suffer, a degree of physical, sexual and / or emotional harm (through abuse or neglect) which is so harmful there needs to be intervention by child protection agencies into the life of the child and their family.

Children who are absent or missing from school may also be missing from care or home. See section 5.27. Missing from care and home.

• There is good reason to believe the child may be the victim of a crime;
• The child is subject of a Child Protection Plan (see section 8. Child protection conferences and section 9. Implementation of child protection plans);
• The child is a Looked After Child (see section 5.17. Foster care and section 5.37. Residential care);
• The child is privately fostered child (see section 5.34 Private fostering);
• There is planned or current LA children's social care or adult social care involvement (e.g. a child protection [s47 enquiry] investigation);
• There is a person present in or visiting the family who poses a risk of harm to children.

• There has been LA children's or adult's social care or criminal justice system involvement in the past;
• There is a history of mobility;
• There are immigration issues;
• The parents been subject to proceedings in relation to attendance;
• There is a history of poor attendance;
• There is information which suggests the child may be subject to:
  • A forced marriage (see section 5.15. Forced marriage of a child);
  • Honour based violence (see section 5.20. Honour based violence);
  • Female genital mutilation (see section 5.13. Female genital mutilation); or
  • Sexual exploitation (see section 5.40. Sexually exploited children) and / or trafficking (see section 5.43. Trafficked and exploited children.)

Reasonable enquiry

Day one

Days two to twenty-eight

More than four weeks

Children of school age who are not registered with a school

In particular, this process should be implemented for children whose stay may originally be temporary but where they are privately fostered. See section 5.34 Private fostering.

Children of school age who are educated at home but where there are concerns about their welfare

Significant harm is defined in section 4. Recognition and response as a situation where a child is likely to suffer a degree of physical harm which is such that it requires a compulsory intervention by child protection agencies into the life of the child and their family.

• Who features within parental delusions;
• Who is involved in his / her parent's obsessional compulsive behaviours;
• Who becomes a target for parental aggression or rejection;
• Who has caring responsibilities inappropriate to his / her age (see section 5.44 Young carers);
• Who may witness disturbing behaviour arising from the mental illness (e.g. self-harm, suicide, uninhibited behaviour, violence, homicide);
• Who is neglected physically and / or emotionally by an unwell parent;
• Who does not live with the unwell parent, but has contact (e.g. formal unsupervised contact sessions or the parent sees the child in visits to the home or on overnight stays);
• Who is at risk of severe injury, profound neglect or death;

Or s/he could be an unborn child:

• Of a pregnant woman with any previous major mental disorder, including disorders of schizophrenic, any affective or schizo-affective type; also, severe personality disorders involving known risk of harm to self and / or others.

• History of mental health problems with an impact on the sufferer's functioning;
• Unmanaged mental health problems with an impact on  the sufferer's functioning;
• Maladaptive coping strategies;
• Misuse of drugs, alcohol, or medication;
• Severe eating disorders;
• Self-harming and suicidal behaviour;
• Lack of insight into illness and impact on child, or insight not applied;
• Non-compliance with treatment;
• Poor engagement with services;
• Previous or current compulsory admissions to mental health hospital;
• Disorder deemed long term 'untreatable', or untreatable within time scales compatible with child's best interests;
• Mental health problems combined with domestic abuse and / or relationship difficulties;
• Mental health problems combined with isolation and / or poor support networks;
• Mental health problems combined with criminal offending (forensic);
• Non-identification of the illness by professionals (e.g. untreated post-natal depression can lead to significant attachment problems);
• Previous referrals to LA children's social care for other children.

Importance of working in partnership

• Social exclusion;
• Having a disabled child (see section 5.10. Disabled children);
• Experiencing domestic violence (see section 5.11 Domestic violence);
• Having poor mental health (see section 5.29 Parental mental illness);
• Having substance misuse problems (see section 5.31 Parents who misuse substances);
• Having grown up in care (see section 5.17 Foster care and section 5.37 Residential care).

Significant harm is defined in section 4. Recognition and response as a situation where a child is suffering, or is likely to suffer, a degree of physical, sexual and / or emotional harm (through abuse or neglect) which is so harmful that there needs to be compulsory intervention by child protection agencies into the life of the child and their family.

• Children of parents with learning disabilities are at increased risk from inherited learning disability and more vulnerable to psychiatric disorders and behavioural problems, including alcohol / substance misuse and self- harming behaviour;
• Children having caring responsibilities inappropriate to their years placed upon them, including looking after siblings (see section 5.44 Young carers);
• Neglect leading to impaired growth and development, physical ill health or problems in terms of being out of parental control;
• Mothers with learning disabilities may be targets for men who wish to gain access to children for the purpose of sexually abusing them.

• Accessible information;
• Advocacy;
• Peer support;
• Multi-agency and multi-disciplinary re/assessments;
• Long-term home-based and other support.

Significant harm is defined in section 4. Recognition and response as a situation where a child is likely to suffer a degree of physical harm which is such that it requires a compulsory intervention by child protection agencies into the life of the child and their family.

Maternal substance misuse in pregnancy

Newborn babies and children

• Substance misuse affecting their parent/s' practical caring skills: perceptions, attention to basic physical needs and supervision which may place the child in danger (e.g. getting out of the home unsupervised);
• Substance misuse may also affect control of emotion, judgement and quality of attachment to, or separation from, the child;
• Parents experiencing mental states or behaviour that put children at risk of injury, psychological distress (e.g. absence of consistent emotional and physical availability), inappropriate sexual and / or aggressive behaviour, or neglect (e.g. no stability and routine, lack of medical treatment or irregular school attendance);
• Children are particularly vulnerable when parents are withdrawing from drugs;
• The risk is also greater where there is evidence of mental ill health, domestic violence and when both parents are misusing substances;
• There being reduced money available to the household to meet basic needs (e.g. inadequate food, heat and clothing, problems with paying rent [that may lead to household instability and mobility of the family from one temporary home to another]);
• Exposing children to unsuitable friends, customers or dealers;
• Normalising substance use and offending behaviour, including children being introduced to using substances themselves;
• Unsafe storage of injecting equipment, drugs and alcohol (e.g. methadone stored in a fridge or in an infant feeding bottle). Where a child has been exposed to contaminated needles and syringes (see also section 5.4 Blood-borne viruses);
• Children having caring responsibilities inappropriate to their years placed upon them (see section 5.44 Young carers);
• Parents becoming involved in criminal activities, and children at possible risk of separation (e.g. parents receiving custodial sentences);
• Children experiencing loss and bereavement associated with parental ill health and death, parents attending inpatient hospital treatment and rehab programmes;
• Children being socially isolated (e.g. impact on friendships), and at risk of increased social exclusion (e.g. living in a drug using community);
• Children may be in danger if they are a passenger in a car whilst a drug / alcohol misusing carer is driving.

Importance of working in partnership

Significant harm is defined in section 4. Recognition and response as a situation where a child is likely to suffer a degree of physical harm which is such that it requires a compulsory intervention by child protection agencies into the life of the child and their family.

Mother under 16 years

Mother over 16 years

• Make an assessment of the risk of harm to the baby, consulting their agency's child protection adviser as appropriate;
• Assess the risk of harm to the mother through her relationship with the father / current partner.

• Keeping the child's interests paramount;
• Taking the child's wishes and feelings into account;
• On a multi-agency basis;
• In consultation with the child's parent/s;
• Taking the potential impact on criminal proceedings into account.

Crown Prosecution Service

• Whether therapeutic work has been undertaken;
• If so, whether the witness said anything inconsistent with the disclosure to the police;
• What sort of therapeutic work was undertaken.

Therapeutic services

Pre-trial planning meeting

• Parents (unless implicated in the alleged abuse);
• The child, if of sufficient age and understanding;
• Other relevant professionals.

Considerations at the pre-trial therapy meeting

• Confirm that therapeutic intervention is in the best interests of the child (including taking into account the child's right to justice);
• Agree the parameters and nature of any proposed therapeutic support, ensuring that the process is subject to regular review;
• Agree lines of communication between the professional who will undertake the work and other professionals.

• Therapeutic support is on an individual basis (i.e. no joint or group sessions are normally acceptable because of the increased risk of contamination of evidence);
• Where joint or group sessions are already in progress, the implications for continuing must be considered, and in addition the particular implications for recording what takes place;
• Therapeutic support may be subject to challenge at court. Therefore, it is better that only one worker provides the support.

Therapy

• Listen and acknowledge what has been said;
• Not seek clarification or ask probing or investigative questions;
• Consider whether there is new or additional allegations or information which require urgent discussion with the police / social worker.

• Date and location of session;
• Duration of session;
• Details of the professional undertaking the work with the child;
• Details of child;
• Details of other professionals present;
• Confirmation that records of the therapy sessions have been made.

Confidentiality not guaranteed

Problem resolution

The period for which the child is cared for and accommodated by the private foster carer should be continuous, but that continuity is not broken by the occasional short break.

• Children sent from abroad to stay with another family, usually to improve their educational opportunities;
• Asylum seeking and refugee children;
• Teenagers who, having broken ties with their parents, are staying in short term arrangements with friends or other non-relatives;
• Children of prisoners placed with distant relatives;
• Language students living with host families;
• Trafficked children (see also section 5.43. Trafficked and exploited children).

Significant harm is defined in section 4. Recognition and response as a situation where a child is suffering, or is likely to suffer, a degree of physical, sexual and / or emotional harm (through abuse or neglect) which is so harmful that there needs to be compulsory intervention by child protection agencies into the life of the child and their family.

• They become aware of a private fostering arrangement which is not likely to be notified to the local authority; or
• They have doubts about whether a child's carers are actually their parents, and there is any evidence to support these doubts (including concerns about the child/ren's welfare (see also section 5.43. Trafficked and exploited children).

It is likely that LA children's social care will not have been notified of most private fostering arrangements. See also section 6. Referral and assessment and section 7. Child protection enquiries.

• Satisfy themselves that the welfare of children who are privately fostered within their area is being satisfactorily safeguarded and promoted;
• Ensure that such advice as appears to be required is given to private foster carers;
• Visit privately fostered children at regular six weekly intervals in the first year and 12 weekly in subsequent years;
• Satisfy themselves as to the suitability of the private foster carer, and the private foster carer's household and accommodation. The local authority has the power to impose requirements on the foster carer or, if there are serious concerns about the arrangement, to prohibit it;
• Promote awareness in the local authority area of the requirement to notify, advertise services to private foster carers and ensure that relevant advice is given to privately fostered children and their carers;
• Monitor their own compliance with all the duties and functions in relation to private fostering, and to appoint an officer for this purpose.

See also the National Service Framework for children, young people and maternity services (Children's NSF) which sets out standards for hospital services in respect of individual children's safety and well-being.

See also section 5.18. Harming others.

Significant harm is defined in section 4. Recognition and response as a situation where a child is suffering, or is likely to suffer, a degree of physical, sexual and/or emotional harm through abuse or neglect, which is so harmful that there needs to be compulsory intervention by child protection agencies into the life of the child and their family.

Visiting patients in psychiatric wards

• Place child welfare at the heart of professional practice for all staff involved in the assessment, treatment and care of patients;
• Take account of the needs and wishes of children as well as patients;
• Address the whole process, including pre-admission assessment, admission, care planning, discharge and aftercare;
• Assess the desirability of contact between the child and patient, identify concerns and assess the potential risks of harm to the child in a timely way;
• Establish an efficient procedure for dealing with requests for child visits in those cases where concerns exist;
• Establish a process for child visits which is:
  • Not bureaucratic;
  • Supportive of both the child and the adult;
  • Does not cause delay in arranging contact;
  • Maximises the therapeutic value of the visit;
  • Ensures the child's welfare is safeguarded.
• Set and maintain standards for the provision of facilities for child visiting;
• Ensure that staff are competent to manage the process of child visits.

Pre-visit arrangements

Compulsory admission

Expected visit by a child

Unexpected visit by a child

Patients admitted informally

Identifying concerns

• Consideration of the child's best interests;
• The patient's history and family situation;
• The patient's current mental state (which may differ from an assessment made immediately prior to or on admission);
• The response by the child to the patient's illness;
• The wishes and feelings of the child;
• The developmental age and emotional needs of the child;
• The views of those with parental responsibility;
• The nature of the service and the patient population as a whole;
• Availability of a suitable environment for contact.

See also section 5.29 Parental mental illness.

Decisions to refuse a child's visits

• Consulting with the patient, the child (depending on age and understanding), those with Parental Responsibility and, if different, person/s with day to day care for the child, advocates and, where relevant, the LA children's social care;
• Communicating the decision to the patient, other family members, the child and those with parental responsibility;
• Reviewing any decision and the means of communicating this to the patient, advocate or other person or agency involved in the decision;
• Enabling a patient and others with parental responsibility to make representation against any decision not to visit, including access to assistance and independent advocacy. Such a system should be consistent with the Trust's overall complaints procedure and should contain an independent element.

Making arrangements for visits

Visiting patients in the special hospitals: Ashworth, Broadmoor and Rampton

• The interests of the child;
• The service user's offending history;
• The clinical history of the service user;
• The conditions under which the visit will take place.

The only exception to this is where there is a Contact Order made under the Children Act 1989 which specifies that the child may visit the patient in the special hospital. In such cases, visits should be allowed except where there are concerns about the patient's mental state at the time of the proposed visit, such that the nominated officer decides the visit would not be in the child's best interests (see 5.36.40).

Request for a child to visit

• Convicted of murder or manslaughter, or an offence which leads to them being identified (by probation / youth offending services, police or health services, individually or via the Multi-Agency Public Protection Arrangements) as posing an ongoing risk to a child; or
• Found unfit to be tried or not guilty by reason of insanity, in respect of a charge of murder or manslaughter or an offence which leads to them being identified (by probation / youth offending services, police or health services, individually or via the Multi-Agency Public Protection Arrangements) as posing an ongoing risk to a child,

In these circumstance, the child must be within the permitted categories of relationship set out in The Directions and associated guidance to Ashworth, Broadmoor and Rampton Hospital Authorities (HSC 1999/160) (see 5.36.41).

• Obtain written permission from the patient to contact those with Parental Responsibility for the child;
• Write to the person/s with parental responsibility for the child:
  • Explaining that a request for a visit has been made;
  • Asking for confirmation of the relationship between the patient and the child;
  • Requesting consent for the child to visit the patient;
  • Explaining that before a visit can proceed, LA children's social care will be asked to assess whether the visit is in the child's best interests.
• Write to any person/s without parental responsibility but with day-to-day care for the child (e.g. a grandparent), explaining that a request for a visit has been made and that the person with parental responsibility will be contacted.

• Contact the Director of Children's Services for the LA children's social care service where the child resides to request advice on whether the visit is in the best interests of the child;
• Include in the request a copy of the hospital's assessment and any other any relevant information about the patient, to assist LA children's social care to assess whether the proposed visit is in the child's best interests;
• Include in the request any information about other LA children's social care services which have relevant information about the child or the child's family;
• Inform the parents of the child that LA children's social care have been asked to make contact with the family.

LA children's social care response

• The child's legal relationship with the named patient;
• The quality of the child's relationship with the named patient, prior to hospitalisation and currently;
• Whether there has been past abuse of the child, alleged or confirmed, by the patient;
• The likelihood of future risks of Significant Harm to the child if the visits took place;
• The child's wishes and feelings about the visit, taking account of their age and understanding;
• The views of those with Parental Responsibility and, if different, person/s with day-to-day care for the child;
• If it is known the child has lived in other LA children's social care areas, what other relevant information is known about the child and family;
• The frequency of contact that would be appropriate.

• If the child is known to LA children's social care, it could make its report on the basis of the information it has already but make clear that the information is not up to date and does not take account of the wishes and feelings of the child;
• If LA children's social care holds no information about the child, it should inform the hospital that it is unable to make any report.

The visit

• Take place in an appropriate atmosphere and setting (i.e. child-centred and child-friendly), taking account of the age of the children (as advised by the LA children's social care service local to the hospital) whilst maintaining the required level of security;
• Be properly supervised throughout the visit, with sufficient staff present (of an appropriate grade and with requisite knowledge and understanding and enhanced Criminal Record Bureau checks - for children, not just vulnerable adults) to supervise the children's visits at all times and to prevent unauthorised contacts;
• Allow the child contact with only the named patient for whom a visit has been approved. No children are to visit on the ward areas.

Refusing a visit

• The relationship between the patient and the child is not within the permitted categories of relationship as set out in paragraph 2(2)(b) of the Directions (see section 5.36.41). The nominated officer must notify the patient of the decision and reasons for it in writing. However, the patient has no right to make representations against this decision.
• The person/s with Parental Responsibility responds to the nominated officer stating that they do not agree to the child visiting the patient. The decision and the reasons for the decision must be put in writing to the patient.
• The hospital's assessment indicates that the patient's mental health state and/or risk to children is such (in the immediate or longer-term) that it would not be appropriate for the child to visit the patient. The decision to refuse the visit must be put in writing to the patient and the person with parental responsibility and include details of the complaints procedure.
• The relevant LA children's social care service concludes that a visit is not or may not be in the child's best interests. The decision to refuse the visit must be put in writing to the patient, the child (if appropriate), those with parental responsibility, person/s with day to day care for the child, if different, and LA children's social care. Details of the review procedure should be given.
• There are concerns about the patient's mental state at the time of the visit. The reasons for the refusal should be explained to the patient, those with parental responsibility, person/s with day to day care for the child, if different, and, if appropriate, the child.

Significant harm is defined in section 4. Recognition and response as a situation where a child is suffering, or is likely to suffer, a degree of physical, sexual and / or emotional harm (through abuse or neglect) which is so harmful that there needs to be compulsory intervention by child protection agencies into the life of the child and their family.

Good quality care

• Children feel valued and respected and their self-esteem is promoted;
• There is an openness on the part of the residential care service to the external world and external scrutiny, including contact with families and the wider community;
• Residential care and support staff are trained in all aspects of safeguarding children, are alert to children's vulnerabilities and risks of harm, and are knowledgeable about how to implement safeguarding children procedures;
• Children who live in residential care are listened to and their views and concerns responded to;
• Children have ready access to a trusted adult outside the residential care setting (e.g. a family member, the child's social worker, independent visitor, children's advocate). Children should be made aware of the help they could receive from independent advocacy services, external mentors, and ChildLine (see section 2.24.12. NSPCC);
• Residential care and support staff recognise the importance of ascertaining the wishes and feelings of children and understand how individual children communicate by verbal or non-verbal means;
• There are clear procedures for referring safeguarding concerns about a child to the relevant LA children's social care service;
• In relation to complaints:
  • Complaints procedures should be clear, effective, user friendly and readily accessible to children and young people, including those with disabilities and those for whom English is not their preferred language;
  • Procedures should address all expressions of concern, including formal complaints. Systems that do not promote open communication about 'minor' complaints will not be responsive to major ones, and a pattern of 'minor' complaints may indicate more deeply seated problems in management and culture which need to be addressed;
  • Records of complaints should be kept by providers of children's services (e.g. there should be a complaints register in every boarding school which records all representations including complaints, the action taken to address them, and the outcomes);
  • Children should be genuinely able to raise concerns and make suggestions for changes and improvements, which are taken seriously.
    
    See section 18. LSCBs, quality assurance and conflict resolution.
• Bullying is effectively countered (see section 5.6. Bullying);
• Recruitment and selection procedures are rigorous and create a high threshold of entry to deter abusers (see section 17. Safer recruitment );
• There is effective supervision and support, which extends to temporary staff and volunteers (see section 16. Supervision and training);
• The residential care service contract staff are effectively checked and supervised when on site or in contact with children;
• Clear procedures and support systems are in place for dealing with expressions of concern by residential care and support staff about other staff or carers (see section 15. Allegations against staff);
• Organisations have a code of conduct instructing residential care and support staff on their duty to their employer and their professional obligation to raise legitimate concerns about the conduct of colleagues or managers. There should be a guarantee that procedures can be invoked in ways which do not prejudice the 'whistle-blower's' own position and prospects;
• There is respect for diversity and sensitivity to race, culture, religion, gender, sexuality and disability;
• Residential care and support staff are alert to the risks of harm to children in the external environment from people prepared to exploit the additional vulnerability of children living away from home.

Promoting and protecting a child's welfare

For further details on this see section 15. Allegations against staff, section 6. Referral and assessment, including section 6.4. Referral criteria and the indicator table at 6.4.4, which provides guidance on the difference in LA children's social care between s47 / Core Assessment and an initial assessment; and section 7. Child protection enquiries.

Significant harm is defined in section 4. Recognition and response as a situation where a child is suffering, or is likely to suffer, a degree of physical, sexual and / or emotional harm (through abuse or neglect) which is so harmful that there needs to be compulsory intervention by child protection agencies into the life of the child and their family.

Professionals should base the assessment on the Assessment Framework (see section 6. Referral and assessment and appendix 5 for a summary and diagram of the Assessment Framework).

Recognition and referral

Significant harm is defined in section 4. Recognition and response as a situation where a child is suffering, or is likely to suffer, a degree of physical, sexual and / or emotional harm (through abuse or neglect) which is so harmful that there needs to be compulsory intervention by child protection agencies into the life of the child and their family.

Children under 13 years

Children 13 to 16 years

Assessment of risk

• Whether the child is competent to understand, and consent to, the sexual activity they are involved in (children under 13 are not legally capable of consenting to sexual activity);
• What the child/ren in the relationship's living circumstances are, whether they are attending school, whether they or their siblings are receiving services from LA children's social care or another social care agency etc;
• The nature of the relationship between those involved, particularly if there are age or power imbalances;
• Whether overt aggression, coercion or bribery was or is involved, including misuse of alcohol or other substances as a disinhibitor;
• Whether the child's own behaviour (e.g. through misuse of alcohol or other substances) places them in a position where they are unable to make an informed choice about the activity;
• Any attempts to secure secrecy by the sexual partner beyond what would be considered usual in a teenage relationship;
• Whether methods used to secure a child's compliance, trust and / or secrecy by the sexual partner are consistent with grooming for sexual exploitation. Grooming is likely to involve efforts by a sexual predator (usually older than the child) to befriend a child by indulging or coercing them with gifts / treats (i.e. money or drugs), developing a trusting relationship with the child's family, developing a relationship with the child through the internet etc in order to abuse the child;
• Whether the sexual partner is known by one of the agencies as having, or previously having had, other concerning relationships with children (which presupposes that checks will be made with the police);
• Whether the child denies, minimises or accepts the concerns held by professionals.

Requests for police information

• Receive the information;
• Search relevant indices and pass the results to legitimate enquirers;
• Only record the request and details provided for intelligence purposes (such requests will not be treated as allegations of crime referrals);

Depending on the result, the enquirer may then make a subsequent referral. 

LA management decision

Criminal action against a child

Disabled children

Children 16 and 17 years

• Pull factors: children exchanging sex for attention, accommodation, food, gifts or drugs;
• Push factors: children escaping from situations where their needs are neglected and there is exposure to unsafe individuals;
• Control, brain washing, violence and threats of violence by those exploiting the child.

Significant harm is defined in section 4. Recognition and response as a situation where a child is suffering, or is likely to suffer, a degree of physical, sexual and / or emotional harm (through abuse or neglect) which is so harmful that there needs to be compulsory intervention by child protection agencies into the life of the child and their family.

• Going missing frequently and / or from a young age;
• Bullying in or out of school;
• Previous and sometimes current sexual abuse, neglect and physical abuse, and domestic violence within the family;
• Family involvement in sexual exploitation, drugs or alcohol;
• Drug and alcohol use themselves;
• Emotional symptoms, including eating disorders, mood swings and self harm (sometimes very extreme, e.g. genital cutting);
• Involvement in theft, shoplifting, deception etc. often organised by the person exploiting them;
• A preoccupation with their mobile phone which indicates the child is being controlled (e.g. possession of multiple phones, extreme distress when one is lost or not working);
• Having limited freedom of movement;
• Showing signs of sexual activity / abuse, including STDs, terminations and pregnancy scares;
• Possession of money and goods not accounted for;
• Having an older "boyfriend" - in some cases the "boyfriend" drives them about.

Referral and assessment

Risk Assessment Framework

• Category 1 (at risk): a vulnerable child who is at risk of being targeted and groomed for sexual exploitation;
• Category 2 (medium risk): a child who is targeted for opportunistic abuse through the exchange of sex for attention, accommodation, food, gifts and drugs. The likelihood of coercion and control is significant;
• Category 3 (high risk): a child whose sexual exploitation is habitual, often self defined and where coercion / control is implicit.

• A child is at immediate risk of Significant Harm and has other additional vulnerabilities;
• The sexual exploitation may be being facilitated by a child's parent;
• The sexual exploitation may be being facilitated by a child's parent failing to protect;
• A related or unrelated adult in a position of trust or responsibility to a child may be organising or encouraging the sexual exploitation.

Response

Multi-agency planning (MAP) meeting

• The risks to other children in the household or placement;
• Whether the child should remain at home or in their present placement; and
• The feasibility of controlling the child's movements, and the likely effects of doing so.

Looked after children

Role of the police

• The age and vulnerability of the child;
• The return to sexual exploitation must be considered genuinely voluntary, with no evidence of physical, mental or emotional coercion;
• The child has been told, and understands, that criminal proceedings may take place, and the implications of this for them now and in the future.

See also section 2.24.22 Faith communities.

Significant harm is defined in section 4. Recognition and response as a situation where a child is suffering, or is likely to suffer, a degree of physical, sexual and / or emotional harm (through abuse or neglect) which is so harmful that there needs to be compulsory intervention by child protection agencies into the life of the child and their family.

• Physical abuse: beating, burning, cutting, stabbing, semi-strangulating, tying up the child, or rubbing chilli peppers or other substances on the child's genitals or eyes;
• Emotional abuse: in the form of isolation (e.g. not allowing a child to eat or share a room with family members or threatening to abandon them). The child may also be persuaded that they are possessed;
• Neglect: failure to ensure appropriate medical care, supervision, school attendance, good hygiene, nourishment, clothing or warmth;
• Sexual abuse: within the family or community, children abused in this way may be particularly vulnerable to sexual exploitation.

Reasons for the abuse

• Belief in evil spirits: this is commonly accompanied by a belief that the child could 'infect' others with such 'evil'. The explanation for how a child becomes possessed varies widely, but includes through food that they have been given or through spirits that have flown around them;
• Scapegoating because of a difference: it may be that the child is being Looked After by adults who are not their parents (i.e. privately fostered), and who do not have the same affection for the child as their own children. A child can also be viewed as being different because of disobedience, rebelliousness, over-independence, bedwetting, nightmares, illness or because they have a perceived or physical abnormality or a disability;
  
  Disabilities involved in documented cases included learning disabilities, mental ill health, epilepsy, autism, a stammer and deafness;
• Changes and / or complexity in family structure or dynamics: there is research evidence (see Stobart, Child Abuse linked to Accusations of Spirit Possession [DfES 2006]) that children become more vulnerable to accusations of spirit possession following a change in family structure (e.g. a parent or carer having a new partner or transient or several partners). The family structure also tended to be complex so that exact relationships to the child were not immediately apparent. This may mean the child is living with extended family or in a private fostering arrangement (see section 5.34. Private fostering). In some cases, this may even take on a form of servitude;
• Change of family circumstances for the worse: a spiritual explanation is sought in order to rationalise misfortune and the child is identified as the source of the problem because they have become possessed by evil spirits. Research evidence is that the family's disillusionment very often had its roots in negative experiences of migration:
  • In the vast majority of identified cases in the UK to date, the families were first or second generation migrants suffering from isolation from extended family, a sense of not belonging or feeling threatened or misunderstood. These families can also have significantly unfulfilled expectations of quality of life in the UK;
• Parental difficulties: a parent's mental ill health appears to be attributed to a child being possessed in a significant minority of cases. Illnesses typically involved include post-traumatic stress disorder, depression and schizophrenia.

Recognising child abuse or neglect linked to spirit possession

• A child's body showing signs or marks, such as bruises or burns, from physical abuse;
• A child becoming noticeably confused, withdrawn, disorientated or isolated and appearing alone amongst other children;
• A child's personal care deteriorating, for example through a loss of weight, being hungry, turning up to school without food or food money or being unkempt with dirty clothes and even faeces smeared on to them;
• It may also be directly evident that the child's parent does not show concern for or a close bond with them;
• A child's attendance at school becoming irregular, or being taken out of school all together without another school place having been organised;
• A child reporting that they are or have been accused of being evil, and / or that they are having the devil beaten out of them.

Professional response

• How to build a relationship of trust with the child, and whether there is another professional who already has a trusting relationship with the child;
• Whether to involve the family. A belief that the child is possessed may mean they are stigmatised in their family. If the child has been labelled as possessed, professionals should find out how this affects the child's relationship with others in the extended family and community;
• What the beliefs of the family are;
• Where to obtain expert advice about cultures or beliefs that are not their own;
• What pressures the family are under. These cases of abuse will sometimes relate to blaming the child for something that has gone wrong in the family. Professionals should consider whether there is anything that can or should be done to address relevant pressures on the family;
• That the abuser may have a deeply held belief that they are delivering the child of evil spirits and that they are not harming the child but actually helping them. Holding such a belief is no defence or mitigation should a child be abused.

• Whether these beliefs are supported by others in the family or in the community, and whether this is an isolated case or if other children from the same community are being treated in a similar manner.
• Whether there is a faith community and leader which the family and the child adhere to:
  • As a minimum, the full details of the faith leader and faith community to which the family and child adhere to should be obtained;
  • The exact address of the premises where worship or meetings take place should be obtained;
  • Further information should be obtained about the belief of the adherents and whether they are aligned to a larger organisation in the UK or abroad (websites are particularly revealing in terms of statements of faith and organisational structures).
• The family structure:
  • The roles of the adults in the household should be clarified (e.g. who the child's main carer is, whether the child is being privately fostered);
  • Whether the abuse relates to the arrival of a new adult into the household or the arrival of the child, perhaps from abroad;
  • If the child has recently arrived, what their care structure in their country of origin was. What the child's immigration status is;
  • The identities and relationships of all members of the household. These should be confirmed with documentation; it may be appropriate to consider DNA testing;
• Whether there are reasons for the child to be scapegoated (e.g. the child's behaviour or physical appearance may be different from other children in the family or community, the child may be disabled or their parents labelled as possessed);
• Whether an interpreter is required. If working with a very small community, the professional should assure themselves that the interpreter and the family are not part of the same social network.

Working with places of worship and faith organisations

• A lack of priority is given to the protection of children and there is a reluctance of some leaders to get to grips with the challenges of implementing sound safeguarding policies or practices;
• Assumptions exist that 'people in our community' would not abuse children or that a display of repentance for an act of abuse is seen to mean that an adult no longer poses a risk of harm;
• There is a denial or minimisation of the rights of the child or the demonisation of individuals;
• There is a promotion of mistrust of secular authorities.

Children being taken out of the UK

• Why the child is being taken out of the UK;
• Whether the care arrangements for the child in the UK allow the local authority to discharge its safeguarding duties;
• What the child's immigration status is. Professionals should also consider whether the child recently arrived in the UK, and how they arrived;
• What the proposed arrangements are for the child in their country of destination, and whether it is possible to check these arrangements;
• Whether the arrangements appear likely to safeguard and promote the child's welfare;
• That taking a child outside of the UK for exorcism or deliverance type procedures is likely to cause Significant Harm.

See section 5.43. Trafficked and exploited children.

• The suitability of the intended parents to care for the child;
• Conflict between the adults in a surrogacy arrangement e.g. that the surrogate mother is under pressure to relinquish the child against her will (see, as appropriate, section 5.11. Domestic violence); and / or
• The amount being paid for the child.

Significant harm is defined in section 4. Recognition and response as a situation where a child is suffering, or is likely to suffer, a degree of physical, sexual and / or emotional harm (through abuse or neglect) which is so harmful that there needs to be compulsory intervention by child protection agencies into the life of the child and their family.

Significant harm is defined in section 4. Recognition and response as a situation where a child is suffering, or is likely to suffer, a degree of physical, sexual and / or emotional harm (through abuse or neglect) which is so harmful that there needs to be compulsory intervention by child protection agencies into the life of the child and their family.

Recognition

• Not in possession of their own travel documents;
• Excessively afraid of being deported;
• Known to have had their journey or visa arranged by someone other than themselves or their family;
• In possession of false papers, and these have been provided by another person;
• Unable to confirm which adult is going to accept responsibility for them;
• Accompanied / controlled by a person who has applied for visas on behalf of many others, or acts as guarantor for other visa applications;
• Travelling on a visa application that has been guaranteed by a person who has acted for other visitors who have not returned to their countries of origin on the expiry of the visa;
• Being cared for by adult/s who are not their parents (see section 5.34 Private fostering), or the quality of the relationship between the child and their adult carers is not good;
• Scantily dressed, or have the labels cut out of their clothes;
• Required to earn a minimum amount of money every day;
• Required to pay off an exorbitant debt, perhaps for the travel costs, before being able to have control over their own earnings;
• Handing over a large part of their earnings to another person;
• Presenting a history with missing links and unexplained moves;
• Working in various locations;
• Known to beg for money.

Children at port of entry

Children already in the UK

Responding to concerns

• Obtain as much information as possible from the referrer (see also section 5.45. Accessing information from abroad);
• Verify that the child is living at the address;
• In the case of a referral from a school or education department, obtain the list of documentation provided at admission;
• Complete a Home Office check to clarify the status of the child/ren and the adult/s caring for them.

• An initial assessment to gather more information (see section 6. Referral and assessment);
• Accommodation of the child under s20 Children Act 1989, e.g. if:
  • The child is lost or abandoned, or there is no person with Parental Responsibility for the child (i.e. the child is an unaccompanied minor);
  • The person who has been accommodating the child is prevented, for whatever reason, from providing suitable accommodation or care;
  • There is reasonable cause to believe that the child is suffering or likely to suffer Significant Harm, an Emergency Protection Order may be sought. Consideration should be given to police powers of protection in an emergency;
• A s47 and a core assessment of need in line with section 6. Referral and assessment. See also section 6.4. Referral criteria, which provides guidance on the difference within LA children's social care between a s47 / core assessment and an initial assessment.
• No further action.

LA children's social care should advise the referrer which plan is in place.

Interviewing the child and adults

Issues to consider when working with trafficked children

• Safe accommodation if they are victims of an organised trafficking operation;
• Legal advice about their rights and immigration status;
• Their whereabouts to be kept confidential;
• Discretion and caution to be used in tracing their families;
• A risk assessment to be made into the danger they face if they are repatriated;
• Support and protection against reprisals if acting as a witness.

Criminal prosecution

Local Safeguarding Children Boards

• Professionals' and volunteers' ability to recognise a trafficked and exploited child;
• Multi-agency working to protect and promote the welfare of such children.

At ports of entry, they should maintain close relationships with local immigration services.

• Social isolation;
• A low level of school attendance;
• Some educational difficulties;
• Impaired development of their identity and potential;
• Low self-esteem;
• Emotional and physical neglect;
• Conflict between loyalty to their family and their wish to have their own needs met.

Significant harm is defined in section 4. Recognition and response as a situation where a child is suffering, or is likely to suffer, a degree of physical, sexual and / or emotional harm (through abuse or neglect) which is so harmful there needs to be intervention by child protection agencies into the life of the child and their family.

• Unlikely to achieve or maintain a reasonable standard of health or development because of their caring responsibilities;
• At serious risk of harm through abuse or  neglect;
• Providing intimate body care.

• Be recently immigrant into the UK, with or without their parents, and for whom there are concerns of harm, including through accusations of spirit possession or witchcraft (see section 5.41 Spirit possession or witchcraft);
• Have been, or is su