Safeguarding & Protecting Children and Young People
Conference
30th September 2004, London
The importance of recognising
and responding effectively to
maltreatment
Victoria Climbié
• ‘Abandoned, unheard, unnoticed’
My presentation will …
• Briefly outline some ‘facts and figures’ and current challenges
Child Protection: some key
‘facts and figures’
• ‘Maltreatment now the single biggest cause of morbidity in children’
• 1:10 of all children may be affected at some time during their childhood • 2-4 children die each week in the UK
from abuse or neglect
In a double-decker bus going
home at the end of a school day
• 7 children will be going home to a family that is not loving or close
• 10 children will be shouldering a double-burden of housework/caring for parents who are
incapacitated by their own health/social problems • two or three will be going home in fear of the
frequent violence between their parents
• two or three will be returning to a life of regular beatings or denigration
• There is often progression from ‘mild’ to ‘severe’ maltreatment over time
• Milder abuse is more pervasive – in terms of numbers of children affected and
negative impact on health and development
• Fatal or severe abuse features
Impact on health ..
• Babies in violent families are ‘incubated in terror’
• Brains of abused children are significantly smaller (limbic system, hippocampus)
• No other childhood factor, physiological,
cognitive, environmental, or familial, predicts more of the variation in adult anti-social
• Increasing evidence of the links between ‘ongoing’ abusive and
neglectful situations and long term health problems and premature
Complex relationship between
attitudes to the treatment of children and experience of abuse … children experiencing serious assault often do not rate their treatment as
Current challenges
• A number of studies point to a failure to report child maltreatment,
especially neglect – why?
• What helps to ensure that child maltreatment is reported?
• How can we attract high-quality
Overview of research findings
• Professional hierarchies/dominance of medical viewpoint
• Closed systems of working • Recruitment difficulties
• Lack of training (especially GPs and mental health professionals)
• Lack of supervision
• Lack of continuing professional development
• A reluctance to refer due to time pressures
• A belief that the referral will not benefit the child and family
• An interruption of an established ‘therapeutic relationship’
• Transference (guilt, fear, shame, sympathy)
• Concern about own safety
RCPCH survey of paediatricians
• 14% had been subject to a complaint in relation to their CP work
• Numbers of complaints had increased from <20 in 1995 to >100 in 2003
• Of the complaints that had gone to the GMC none have been upheld
• One third of those who had received complaints said they were less willing to become involved in CP work in the future
What helps?
• Being younger • Being female
• Personal experience of maltreatment
Perceived severity
Certainty of ‘diagnosis’
Previous history of maltreatment
Presence of more than just one injury
Repeated attendances for health care
• Age of child – younger more likely to refer
• Socio-economic status • Ethnicity
• Referrals more likely where informed consent has been obtained
• Policy and guidance is largely based on failures in child protection – rather than successes
• Most of the one billion pounds spent on
maltreatment each year in the UK is spent on response to the problem
• Whilst MANY children in the UK are
successfully protected from maltreatment by systems which are fundamentally
Standard Five: Children’s NSF
All agencies work to prevent children suffering harm and to promote their welfare, provide them with the
services they require to address
• Rationale
• Interventions • Strategy
Rationale
• Children see being safe as a priority
• Children want their views taken into account when key decisions are made about their lives • All adults have a responsibility to ensure that
children and young people do not suffer harm. • Provision of universal and targeted services • Agencies and staff need to work together to
ensure that they identify serious child protection issues and have adequate recording and
Interventions
• Strategic inter-agency working (NB explicit role of housing, service users and members of the local
community)
• Commitment to safeguarding and promoting welfare of children
Strategy
• Safeguarding and promoting welfare included in Children and Young
People’s Plan
• Effective ACPC/LSCB
representation and working • MAPPA partnerships
• Explicit systems for children and young people in special circumstances [looked after,
care-leavers, homeless, children exposed to DV, children of substance misusing parents]
• Children with disabilities
• Children and young people abused through prostitution
• Mobile children, young people and families • Children living away from home
• Young people in prison
PCT roles and responsibilities
• Clinical governance and audit
• Named public health professional to input into issues as necessary
• Named Nurse and Doctor professional lead across Trust • Designated Nurse and Doctor over-arching responsibility
across PCT area
• Funds, accountability
• Ensure staff are alert to potential indicators of abuse
• Ensure all families in resident community are registered with a GP
• Access to experienced paediatricians
NHS Trusts
• Named nurse and doctor – to lead on internal reports for serious case reviews (unless substantial involvement)
• Ambulance Trusts, NHS Direct and NHS Walk-in Centres
Promoting welfare of children
• Promote awareness of UNCRC (Article 19) through public education campaigns
• Single and multi-agency polices and procedures that are in tune with legislation, regulations and guidance
• Safe recruitment
• Robust complaints and whistle-blowing policies • Recording and supervision
• Measuring outcomes
