Non-fatal harm

Of the 293 serious case reviews included in this triennial study, 96 related to non-fatal cases. The median age of these 96 children was two and a half years, with a range from new-born to 18 years. Just under half (43%) were aged under one year at the time of the serious injury or harm. Over half (58%) of the children were female, and 23% were of non-white ethnicity. The majority of the reviews (81%) related to harm within the family context, the other fifth to harm in the wider community, and from people not in the immediate family circle.

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Twenty-nine of the children were, or had been, on a child protection plan (30% of the 96) and, where children’s social care involvement was known from the available final reports, 42% were open cases prior to the incident, 31% had been closed, 10% had been

referred but not reached the level for opening, and 17% had never been known.

The non-fatal cases were categorised according to the classification system used in our previous biennial analyses (Brandon et al, 2010, 2012). A new category has been added to capture the cases of child sexual exploitation (CSE), which have been a relatively new area of concern in serious case reviews (Table 21), although there were two cases involving CSE, where young women in care went missing, in our first biennial review of cases from 2003-05.

Table 21: Categories of serious harm in non-fatal cases

Each category is explored in turn, relying on data from the CPD notification for all cases, and on final reports, where available, for details of children’s social care involvement and the likely perpetrator of the harm.

3.2.1 Non-fatal physical harm

There were 50 cases of non-fatal physical abuse, accounting for 52% of non-fatal cases. The ages of these children ranged from new-born to 17 and a half years (median 3 months) at the time of their injury; three quarters (74%) were aged under one year. Half of the children were boys and 21% were non-white ethnicity. All the incidents took place within a family context.

Number of incidents 2007-09 (n=116) Number of incidents 2009-11 (n=60) Number of incidents 2011-14 (n=96) Non-fatal physical assault 66 (57%) 31 (52%) 50 (52%)

Neglect 14 (12%) 6 (10%) 14 (15%)

Sexual abuse intra-familial 8 (7%) 6 (10%) 13 (14%) Sexual abuse extra-familial 12 (10%) 6 (10%) 5 (5%)

Sexual exploitation 5 (5%)

Risk-taking / violent behaviour by YP

9 (8%) 8 (13%) 8 (8%)

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Of the 50 children in these serious cases reviews, six had a current child protection plan at the time of the assault, and five had had a plan in the past; the majority (39) had never had a plan. In the sub-set of 27 reviews, where the final reports were available, 20 of the children (74%) were known to children’s social care. Of these, 11 (41%) were open cases, six (22%) were closed cases, and three (11%) had not reached the level for opening when referred. The other seven children had never been referred to CSC.

From the sub-set of final reports relating to non-fatal physical assault it appeared that the perpetrator was the mother (37% of the cases), the father (22%), mother’s partner (7%), or both parents (19% of cases), with 15% of reports being unclear as to the source of harm to the child.

There was evidence in the final reports that domestic abuse was a characteristic in half (50%) of the families. Physical assaults often occur in a context of chronic, neglectful care, and in these fifty serious case reviews (where a serious physical assault was the main focus) there was evidence of neglect in 43% of the cases. It is important to

remember that for many children and young people multiple types of abuse may co-exist.

3.2.2 Neglect

Neglect was given as the primary incident cause in 14 non-fatal serious case reviews. The median age of these 14 children was six years, with a range in age from new-born (no medical assistance at birth at home, and the baby testing positive for heroin) to 17 years of age. Nine of the 14 children (60%) were boys, and all incidents took place within a family context.

Two of the children were on a CP plan at the time of the incident, and a further four had been in the past. For eight children where information on their children’s social care history could be determined from the final report, seven (87%) were known to children’s social care; two being open cases and five being closed cases. In the case of the eighth child, a sibling was in receipt of a service from children’s social care.

However the extent of neglect is likely to be underestimated by looking solely at the notified primary cause of harm. Instead, a detailed examination of all non-fatal final reports found evidence that neglect was apparent in the lives of nearly two thirds (62%) of the children and young people. This was evidenced by there being a child protection plan under the category of neglect; neglect being given as the primary category of the incident or a case characteristic on the notification form; or neglect being discussed in the final report as an important, and often long-standing feature of the child’s life. Similar findings regarding the extent of neglect in previous biennial reviews were discussed in section 2.4.4 above.

Neglect may have been apparent to professionals often through a combination of poor growth, non-attendance at health appointments, including routine surveillance, or poor school attendance. Further issues identified in some of the reports included children

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coming to school inadequately dressed, or with poor hygiene, and through food-seeking behaviour. In some cases, indicators such as these were known to professionals, but not necessarily identified as indicative of neglect.

3.2.3 Sexual abuse

There were 23 serious case reviews undertaken which related to sexual abuse or sexual exploitation, of which just one review related to a young man, who was in his mid-teens at the time. While the median age was 14 when the incident(s) occurred, or came to light, there were four victims aged five or younger.

The 13 children who were subjected to intra-familial abuse had a median age of 10 years, and four were aged five or under. All were female. The perpetrator, where known from the final report, was the mother’s partner (38% of cases), the father (25%), a male relative (one instance), the mother (one instance) or both parents (one instance). Two of the children were on a child protection plan at the time, and five had been previously. In the eight instances where the detailed child’s social care history was available, all had been known to children’s social care; three were open cases at the time of the incident, four were closed cases at the time, and one had not reached the level for assessment at the time of referral.

The five children abused by someone outside the family had a median age of 15 years, and all were aged 13 or over. One child was on a CP plan at the time, and one further child had been in the past. Both these cases were open to children’s social care at the time of the incident(s); a further child’s case had not reached the level for opening at the time of referral. In the five cases of extra-familial sexual abuse the perpetrator was known, but not related.

The young people involved in sexual exploitation were all aged 13 or over, with a median age of 15. However these SCRs related to groups of teenagers, who themselves were often representative of much larger numbers of young people, so that the background and characteristics of the ‘index child’ is not necessarily a helpful way to consider these much larger groups of young people. Child sexual exploitation is considered in some detail in Chapter 5.

Sexual abuse will also be a factor in the lives of some of the children and young people where the focus of the serious case review was primarily on neglect, or a physical assault. The extent of sexual abuse being suffered by the children and young people is therefore under-estimated by focussing solely on the children where the primary category of harm was sexual abuse. A closer analysis of all 96 non-fatal serious case reviews indicates sexual abuse occurred in 32 (33%) of the cases. In addition a further two reviews related to the perpetrators of sexual assault. An even starker picture emerges if babies under one year are excluded from this calculation. In the remaining 55 cases, relating to children of one year and over, there was evidence of sexual abuse in 29 (53%) of the cases.

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In addition to these non-fatal cases, sexual abuse was also noted as a background factor in ten of the 37 cases (27%) of suicide, while two other deaths in adolescents appeared to have occurred in the context of sexual exploitation or a sexual assault.

3.2.4 Risky behaviour

Eight serious case reviews were held where the focus of the review was risky behaviour by the child or young person, including substance misuse, self-harm and three instances where the young person was the perpetrator of harm to another child or adult. Six of these young people were aged 15 years or over at the time of the incident(s) which led to the review, although two were under the age of ten. There were five young men and three young women, and most of the incidents (six out of the eight) took place within a community context.

Two of the young people had been on a child protection plan, although none were at the time of the incident(s) which led to the review. In the sub-set of five reviews, where the final reports were available, all five young people were known to children’s social care; four being open cases, and one a closed case.

Learning Points

 Non-fatal physical harm took place in a family setting, and three-quarters of the children assaulted were aged under one year. Such assaults often took place in a context of domestic abuse, and chronic, neglectful care of the child

 Where neglect was the primary reason for the SCR it occurred within a family context, with the child ranging in age from new-born to 17 years. The child was likely to have already been known to children’s social care at the time of the harm which prompted the review

 For many children and young people multiple types of abuse co-existed; two thirds suffered neglectful care, irrespective of the primary category of abuse identified by the SCR

 Victims of sexual abuse, all but one of whom were girls, ranged in age from under one year to 17 years. Those abused by a family member were

generally younger than those abused by someone, or a group of people, outside the family

 Sexual abuse often co-existed with other types of harm; there was evidence of sexual abuse in 53% of cases relating to children who were at least one year of age

 The eight young people engaged in risky or violent behaviour ranged in age from 7 to 17 years, although six of them were aged 15 or above. They were

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likely to be male rather than female, and most incidents took place in a community rather than family setting