Focussing on the needs and voice of the child

One of the key themes arising in the SCRs was on ensuring a focus on children’s needs and identifying vulnerable families. Specific recommendations have related to domestic abuse; disguised compliance; working with fathers; and specific groups of children such as those who are looked after or with chronic health needs. Many recommendations focused on ensuring children’s needs and views are central to investigations, child protection plans, and early intervention work.

‘Hearing the voice of the child’ requires safe and trusting environments for children to be seen individually, speak freely, and be listened to. This is particularly important when children display early signs of neglect or emotional abuse, but are unable to express their concerns. In a case involving a six month old, premature baby, who died as a SUDI within a family context of substance misuse, domestic abuse and neglect, engaging with the older sibling may have led to a better understanding of the family context:

“[The sibling] was anxious about explaining why there were absences and why they were often tired when they did come to school. [The sibling] was so anxious and embarrassed when arriving late at school and having to give an explanation, that staff had decided not to question the children as it caused them too much distress.” Professionals must consider how to enable children to express their views while taking account of the child’s age, development, and language. This will be compounded if the child is in any way threatened or coerced by an abusive parent, or if the child has other underlying developmental or communication needs. Previous research emphasises how children have extreme difficulty in expressing their concerns and that professionals

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should not expect children to disclose abuse (Cossar et al, 2013; Allnock and Miller, 2013).

The onus falls to the professionals and requires an interest in how children express themselves through their behaviour and what they say rather than seeing them as ‘difficult’ or ‘demanding’. This requires skill, creativity and resources such as play, to enable them to express themselves and to be able to interpret their behaviour

appropriately. Considerations must be made for children who do not communicate in English:

“Especially on occasions when [the child] was the particular focus of concern, there appeared to be an assumption that he was unable to express his wishes and feelings and that the use of interpreters would be ineffective, when this should have been tried. Potentially greater opportunities on other occasions with different professionals could have been taken to communicate through play or other

mediums.”

An active effort must be made to actually see children in their families. This is a lesson ‘so important that [it must] be re-emphasised and potentially relearnt as people,

organisations and cultures change’ (Sidebotham 2012, p.190):

“The feelings and wishes of the child and his siblings are not clearly captured and recorded in any agency chronology and it appears very little focused and specific direct work took place with the children to address the impact of domestic abuse and parental alcohol misuse. The feelings and wishes of the child and his siblings in respect of contact with their father are also not clearly captured.”

The following case demonstrates how police, while responding to domestic abuse, did not consider its impact upon the children concerned:

“Whilst the Police IMR confirmed that it was an expectation via the relevant domestic abuse policy that “children living in the location are physically seen and their welfare checked”, this was not always apparent. On some occasions there was no reference to the whereabouts of the children, and when they were seen, there were generalised comments such as the children being “none the wiser”, “safe and well” or “fine”.”

Supporting parents without losing sight of the children is particularly important for professionals whose primary focus is caring for adults:

“Whilst they did not observe any interaction that caused them to assess that the children were unsafe, they nevertheless focused on mother’s mental state rather than her reported aggression towards the children.”

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6.1.1 Recognising adolescent vulnerability

Voices of adolescents are of equal importance to those of younger children. Many may struggle to express their needs of feelings, or to engage effectively with services. There are dangers, particularly within health, of falling between child and adult services, as in this case of a 17 year old young man who died as a consequence of his underlying medical condition:

“Had [the young person] been under children’s paediatric services at this stage, the DNA (Did Not Attend or Was Not Brought) policy would have been triggered. The fact that he was being treated as an adult rather than a child therefore had an impact on the expectation of him to manage his own appointments and treatment. As the agency report for the [Health Trust] states ‘during the author’s meeting with the adult diabetic team, it was clear that the team had not considered [the young person] to be a child in terms of safeguarding. This appears to have arisen due to the practice that, within health, young people generally receive services from adult teams from the age of 17 years. Safeguarding Children policies were therefore not considered to be relevant by the adult diabetic team, essentially because [the young person] was within an adult service he was seen as an adult and not as a child’.” The difficulties surrounding engaging effectively with young people are outlined in the following cases of two young people with chronic health needs:

“[The young person] displayed challenging behaviour towards professionals and was also challenging for parents. Examples of this were…refusing to attend for health treatment being verbally abusive towards staff and other patients and causing disruption in health settings. Despite attempts from family to support sensible decision making [the young person] continued to make poor decisions about access to both health and education provision which was being offered.” “It was agreed by all those involved that [the young person] was competent and had sufficient capacity to make decisions about his health. What was also clear however was that he showed a degree of disguised compliance, as is common with

teenagers in respect of their health needs and treatments. This means he agreed to cooperate with his testing and insulin regime, but in reality did not comply.”

Achieving a balance between respecting the autonomy and wishes of adolescents while recognising their vulnerability is not an easy task for professionals to achieve:

“A real and difficult ethical dilemma arises for professionals when a young person, who is informed and understands about health care treatment and the

consequences of not accepting treatment, continues to refuse. Professionals can only continue to guide and advise the young person in question and need to be supported by their managers in so doing.”

134 Learning Points

 Be aware of ‘silent’ ways of telling through verbal and non-verbal emotional and behavioural changes in children

 Explore creative ways of engaging with children with regards to their age, communication skills and personal history to enable them to share their experiences

 Follow up concerns within families by ensuring each child is given an appropriate opportunity to talk

 Professionals need to recognise young people aged 16-17 years as still being vulnerable and to use appropriate children’s services and follow safeguarding procedures