Responding to Domestic Abuse - Guidelines for Health Care Workers in NHSScotland

RESPONDING TO DOMESTIC ABUSE - GUIDELINES FOR HEALTH CARE WORKERS IN NHSSCOTLAND

PART 3: PROTECTING CHILDREN

This section is based on national guidance on child protection PROTECTING CHILDREN - A SHARED RESPONSIBILITY: Guidance on Inter-agency Co-operation (1998)

Research indicates that many children at risk of harm live in families in which domestic violence, social exclusion, mental illness or misuse of drugs or alcohol are significant factors. Good health care, education and family support are essential services to safeguard and promote children's welfare and strengthen the capacity of families under stress to meet the needs of their children before problems escalate to abuse or neglect.

It is estimated that in around 90% of cases, children will be in the same or adjacent room to where domestic abuse is occurring. They may try to intervene and there may be a high risk that they may also be assaulted. Children and young people suffer in many ways when living with and witnessing domestic abuse. They may experience emotional disturbance, physical disorders and disruptions to lifestyle, such as:

• feelings of anger, guilt, isolation, fear;

• anxiety, self harm, low self esteem, depression, withdrawal;

• asthma, eczema, bedwetting, tiredness, injury;

• homelessness, poverty, disruption to schooling, social exclusion;

• loss of family, friends, pets, possessions.

Some groups of children are particularly vulnerable or have additional needs, and agencies should consider their circumstances with special care. These include children affected by disability, children from minority ethnic groups or who do not have English as a first language and children in homeless families.

Working together to protect children

Child abuse and neglect have implications for child welfare, criminal justice and other agencies' responsibilities. Each agency makes a distinctive contribution to safeguarding children's welfare within a context of collaboration and shared understanding. No one agency should be seen as solely responsible for the protection of vulnerable children. Child protection is one aspect of services geared towards meeting children's wider developmental needs and should not be seen as a separate activity.

Co-operation in child protection is underpinned by joint procedures prepared by inter-agency Child Protection Committees, to which all relevant agencies contribute, and appropriate inter-agency training. These procedures should deal with the arrangements for responding to and sharing of information about allegations of child abuse, and accessing specialist advice or expertise. All agencies should have arrangements in place for selecting suitable staff, and for supervising, training and supporting them to carry out their tasks.

• Agencies need to understand the causes and be alert to signs of child abuse and neglect, and be willing to provide help and support at an early stage.

• Informed responses to reports of abuse from a child or any other person should not pre-empt or prejudice child protection inquiries or criminal investigation.

• Local authorities should plan child protection inquiries in close consultation with the police and other agencies, in particular health and education.

• Evidence should be gathered in ways which ensure the effective prosecution of crimes against children.

• Legal measures to protect children are available through the Courts in emergencies or when families are unwilling to assist.

• All agencies should contribute to assessments and decisions about how to protect children from abuse, and give priority to helping children recover from the trauma of child abuse or neglect.

• Agencies should work in partnership with families, by informing and involving them in decisions and enabling them to participate actively in plans.

When information is received which suggests a child may be in need of compulsory measures of supervision, the local authority social work service will make inquiries and pass their findings on to the Reporter to the Children's Panel. Some children who experienced abuse or neglect will need continuing support from their local authority, including specialist services and counselling. Some may need to be looked after by the local authority.

Providing practical and emotional support is a major factor in influencing how children survive and cope with abuse. There are specially trained people who can help children and young people to talk about their experiences, make sense of their fears and worries, gain mutual support and self esteem and feel happier.

Agencies should provide sufficient help at an early stage to reduce the need for compulsory intervention in families' lives. But where a family is not able to care for their child safely, agencies must act promptly and with skill, to protect the child. In doing so they should avoid causing the child undue distress or adding unnecessarily to any harm already suffered by the child. The welfare of the child is the paramount consideration when his or her needs are considered by Courts, Children's Hearings and local authorities.

Sharing information to protect children

Personal information about children and families given to professional agencies is confidential and should be disclosed only for the purposes of protecting children. Nevertheless the need to ensure proper protection for children requires that agencies share information promptly and effectively when necessary. Ethical and statutory codes for each agency identify those circumstances in which information held by one professional group may be shared with others to protect a child. Agencies should not disclose information given in confidence for any other purpose without consulting the person who provided it.

In child protection cases where children are at risk or alleged to have been harmed, when recording their intervention and activity, health care staff should take contemporaneous notes wherever possible, and should complete records as soon as possible after an event or interview. Original notes and case records, drawings or other written material should be retained even if information is condensed into summary reports, as these original notes are regarded as 'best evidence' by the courts. All maternity records need to be retained for 25 years.

The Child Protection Register

Registration is an administrative system for alerting workers to the fact that there is sufficient professional concern about a child to warrant an inter-agency child protection plan. It ensures that the plans for these children are reviewed at least every six months. Local authorities are responsible for maintaining a Register of all children who are the subject of an inter-agency child protection plan, which provides a central point of rapid enquiry for professionals who are concerned about a child's development, welfare or safety. The decision to place a child's name on the Child Protection Register is taken by a multi-disciplinary case conference.

Joint investigation

Joint investigation describes the process whereby social work, police and health professionals plan and carry out their respective tasks together when responding to complex or substantial child protection referrals. All referrals of child sexual abuse should be considered for joint investigation.

The police and social work service should share and jointly evaluate all relevant information at an initial planning meeting or discussion, involving health services wherever possible. Planning should consider the needs of and risk to the child, as well as the conduct of child protection inquiries and any criminal investigation. Medical information and assessment may assist the planning and management of any inquiries.

National guidance on child protection

The executive has issued national guidance on inter-agency co-operation in child protection and agency specific guidance for health professionals. ⁵ These should help agencies and professionals to understand each other's roles and functions, and make the best use of their experience and expertise in safeguarding children.

DOMESTIC ABUSE - GOOD PRACTICE IN SCOTLAND In Fife the Child Protection Training Programme has also begun to incorporate women's protection.

Fig 1: AN OVERVIEW OF THE CHILD PROTECTION PROCESS

Fig 2: MEDICAL ASSESSMENT AND CARE OF CHILDREN WITH SUSPECTED ABUSE/NEGLECT

CARE PATHWAY FOR RESPONDING TO A WOMAN EXPERIENCING DOMESTIC ABUSE