5.3 Identifying, managing and preventing abuse of disabled children

For additional guidance, please see Safeguarding Disabled Children: Practice Guidance (issued by the DfE in July 2009).

See also Intimate Care Good Practice Guidelines.

1. Introduction

The available UK evidence on the extent of abuse among disabled children suggests that disabled children are at increased risk of abuse, and that the presence of multiple disabilities appears to increase the risk of both abuse and neglect (see Standards 5, 7 and 8 of the National Framework for Children, Young People and Maternity Services). It is known that children with disabilities are more likely to be abused than children without disabilities [1] yet there is evidence that they are less likely to be protected by the child protection system [2].

Research also indicates that as well as being the least protected, disabled children are also the least consulted in routine assessments.

The Norfolk Local Safeguarding Children Partnership (NSCP) seeks to address and challenge these practices by affirming its understanding of the issues facing disabled children and its commitment to removing the barriers that prevent disabled children from accessing their rights.  Best practice based on research evidence, recognises that the impact of abuse on disabled children’s psychological, emotional and physical health should always be addressed, regardless of whether at the time they understood what was happening to them. This should be applied to all children, including those with cognitive impairments.

Guidance has been issued to Local Safeguarding Children’s Boards regarding protecting children with disabilities [3]. This sets out issues that need to be taken into account when conducting S.47 enquiries. The following is adapted from the guidance.

[1] Sullivan P, Knutson JF (2000) ‘Maltreatment and disabilities; a population based epidemiological study.’ Child Abuse and neglect 24 (10)
[2] National Working group on child protection and Disability – It doesn’t happen to children with disabilities London, NSPCC
[3] Morris J, (2006) Safeguarding Children with disabilities; A resource for LSCB’s London DfES
www.everychildmatters.gov.uk/resources-and practice /lG0048

2. Information Gathering

Take time to gather information you require in order to understand the context of the concern, the nature of the child’s needs and the risks to the child’s welfare.

More time may be needed to gather information and you are likely to have to seek information from more people than in the case of a non-disabled child. It will be useful to gather information from:

• Carers – there may be carers additional to those usually involved with a non-disabled child
• Health professionals – as well as those routinely contacted during enquiries find out if the child is in regular contact with the school nurse / community or district nurse / physiotherapist / occupational therapist / dietician / speech and language therapist / clinical psychologist / complimentary health workers
• Pre-School Education and Schools – thought should be given to the wide range of people who may be in contact with a disabled child both within settings and wider i.e.  in playgroup, nursery or the classroom, lunchtime supervisors, taxi/mini bus drivers and escorts,  volunteers, students,  peripatetic teachers and other visiting professionals etc.

3. The Child

A child could be considered to be disabled if he or she has significant problems with communication, comprehension, vision, hearing or physical functioning.

Many factors can made a disabled child more vulnerable to abuse than a non-disabled child of the same age. Safeguarding disabled children demands a greater awareness of their vulnerability, individuality and particular needs.

Disabled children may be especially vulnerable to abuse for a number of reasons. Some disabled children may:

• Have fewer outside contacts than other children;
• Receive intimate care possible from a number of carers, which may increase the risk of exposure to abusive behaviour and make it more difficult to set and maintain physical boundaries;
• Have an impaired capacity to resist or avoid abuse;
• Have communication difficulties that may make it difficult to tell others what is happening;
• Be inhibited about complaining for fear of losing services;
• Be especially vulnerable to bullying and intimidation;
• Be more vulnerable than other children to abuse by their peers.

Additional factors may be:

• The child’s dependence on carers could result in the child having a problem in recognising what is abuse. The child may have little privacy, a poor body image or low self-esteem;
• Carers and staff may lack 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;
• Lack of access to ‘keep safe’ strategies available to others;
• Disabled children living away from home in poorly managed settings are particularly vulnerable to over medication, poor feeding and toileting arrangements, issues around control of challenging behaviour, lack of stimulations and emotional support;
• Parents’/carers’ own needs and ways of coping may conflict with the needs of the child;
• Some adult abusers may target disabled children in the belief that they are less likely to be detected;
• Signs and indicators can be inappropriately attributed to disability;
• Disabled children are less likely to be consulted in matters affecting them and as a result may feel they have no choice about whether to accept or reject sexual advances.

It should be remembered that disabled children are children first and foremost, and have the same rights to protection as any other child. People caring for and working with disabled children need to be alert to the signs and symptoms of abuse.

Disabled children must be responded to as individuals with their own specific needs, feelings, thoughts and opinions.

In addition to the universal indicators of abuse/neglect listed in the Recognition of Significant Harm Procedure, the following abusive behaviours must be considered:

• Force feeding;
• Unjustified or excessive physical restraint;
• Rough handling;
• Extreme behaviour modification including the deprivation 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;
• Non compliance with programmes or regimes;
• Failure to address ill-fitting equipment e.g. callipers, sleep boards which may cause injury or pain, inappropriate splinting;
• Misappropriation/misuse of a child’s finances.

Where a child is unable to tell someone of the abuse they may convey anxiety or distress in some other way, e.g. behaviour or symptoms and carers and staff must be alert to this.

A child with disabilities is more likely to receive care from a number of adults and this could be a risk factor in itself.

This means that S47 enquiries may be more complex. These difficulties need thorough consideration at the Strategy Discussion to ensure all risk factors are identified and contamination of evidence is avoided. Consideration should be given to all carers in all settings where the disabled child receives care.

Disabled children may also have care provided by young carers who may be part of the immediate or extended family. This should also be clarified at the Strategy Discussion stage

4. Specialist Advice

Recognise that you may need to seek specialist advice and information in order to make judgements about whether a child is suffering or likely to suffer Significant Harm and what action should follow.

Initial consultations should be sought from professionals with experience in the area relating to the child’s particular disability i.e. complex health needs, severe learning difficulties, sensory impairments etc.

5. Human Rights

A failure to recognise children with disabilities’ human rights can lead to abusive situations and practices.

Basic human rights include issues relating to food nutrition, appropriate levels of discipline or sanctions, finances, hygiene, physical comfort, social interaction, sexuality, liberty and sleep. These basic rights can be abused either through ignorance, lack of appropriate resources or support, or with intention to cause harm. Whether abuse of rights is unintentional or not, is unacceptable or not, it is inappropriate  for this to go unchallenged. We need to promote children’s welfare or safety at all times. When disabled children’s human rights are denied, they are more vulnerable to further abuse.

Denial of rights together with poor care practice can become pervasive in institutions and can have more significant consequences for some children with disabilities than for non disabled children. Whereas poor care practices for a non disabled child may affect their development, this could be life threatening for a child with a disability.

6. The Safeguards

Safeguards for disabled children are essentially the same as all other children. Particular attention should be paid to promoting a high level of awareness of the risks of harm and to high standards of practice, and strengthening the ability of children and families to help themselves.

Measures should:

• Make it common practice to enable disabled children to make their wishes and feelings known in respect of their care and treatment;
• Ensure that disabled children receive appropriate personal, health and social education (including sex education);
• Make sure that all disabled children know how to raise concerns and give them access to a range of adults with whom they can communicate. This could mean using interpreters and facilitators who are skilled in using the child’s preferred method of communication;
• Recognise and utilise key sources of support including staff in schools such as support workers, friends and family members where appropriate;
• Ensure that there is an explicit commitment to and understanding of disabled children’s safety and welfare among all providers of services used by disabled children;
• Develop the safe support services that families want, and a culture of openness and joint working with parents and carers on the part of services;
• Provide guidelines and training for staff on good practice in intimate care; working with children of the opposite sex; managing behaviour that challenges families and services; issues around consent to treatment; anti-bullying and inclusion strategies; sexuality and safe sexual behaviour among young people; monitoring and challenging placement arrangements for young people living away from home.

7. Concerns

Concerns about the welfare of a disabled child should be acted upon in the same way as any other child in accordance with the Referrals Procedure. The same thresholds for action apply.

Expertise and resources in both safeguarding and promoting the welfare of children and in working with disability have to be brought together to ensure that disabled children receive the same levels of protection from harm as other children. Other specialist workers or teams may become involved in the investigative process, therefore, for example Disabled Children’s Teams, in accordance with local arrangements.

8. Medical and Health Issues

Medical and health issues have particular implications for identifying significant harm. The potential to abuse or neglect children through medical or health issues is greater than with children who are not as dependant on their specific health needs being met. The main areas of concern that should be considered during enquiries are:

• The misuse of medication (over medication in particular);
• The restriction of liberty and the right to make personal choices;
• Physical and emotional capacity to resist abuse including inappropriate restraint;
• Inappropriate use of, or failure to use, specialist equipment, adaptations and aids that minimise disabilities and enable disabled children;
• Basic health care needs not being met;
• Denying or restricting access to appropriate food and nourishment.

Experiences such as these can inhibit disabled children’s ability to reach their full potential and can also affect their ability to resist abusive behaviours towards them, making them more vulnerable to further abuse.

Where a disabled child has an injury or is presenting with behaviour which is seen as different to their norm, verification must be sought from others familiar with the child and not just be accepted as part of the child’s disability

A previous occurrence should not automatically act as verification of ‘normality’ and it may be necessary to seek medical or other specialist advice.

9. Challenging Carers

Carers are relied upon (whether family or paid carers) as a source of information about disabled children and to interpret and explain behaviour or symptoms.

Professional staff can potentially feel out of their depth in terms of knowledge of a disabled child’s impairment, where the familiar developmental milestones may not apply.

When assessing risks to a disabled child, an additional/different approach is required because of their vulnerability.

Disabled children should not be left in situations where there is a high level of neglect or other forms of abuse, because a professional feels the parent, carer or service “is doing their best”.

Carer will need to be challenged in the same way as carers of non-disabled children.

10. Communications

Consideration should be given to address any barriers in communicating with a disabled child.

Children with disabilities may have different communication needs. They may use other communication systems such as symbols or Signalong. The child might have very limited communication with only a hand, sign or even eye pointing  movement that indicates yes and another to indicate no. This does not mean that the child cannot understand or is able to communicate what has happened to them.

If a parent or professional tells you that that a child cannot communicate, explore further what they mean. All children with a disability have the ability to communicate and it is up to professionals to identify how. Consider who would be the best person to ask

Many disabled children effectively communicate their needs through their behaviour. It is very important therefore to maximise the use of observation and reports from those in contact with the child. For example, where a child’s response to personal care changes suddenly, or where they express fear or aversion to a particular carer.

If it is likely that there will be a criminal prosecution, always consider whether an intermediary/supporting professional should be used at an early stage in the enquiries.

Do not think that because a child has a different ability to understand the world that they will not be affected by being harmed or neglected.

Abuse and neglect are as harmful, if not more so for children with disabilities as they are for non disabled children. Disabled children frequently have to put their trust in adults or in any person caring for them therefore any abuse is a significant betrayal of that trust.

Throughout any Social Work Assessment process, including a Section 47 Enquiry, all service providers must ensure that they communicate clearly with the disabled child and the family and with one another as there is likely to be a greater number of services and staff involved than for a non-disabled child. All steps must be taken to avoid confusion so that the welfare and protection of the child remains the focus.

Where there are communication impairments or learning difficulties, particular attention should be paid to the communications needs of the child to ascertain the child’s perception of events and his or her wishes and feelings.

The Children’s Social Care Services and the Police should be aware of non-verbal communication systems and should know how to contact suitable interpreters and facilitators.

Agencies must not make assumptions about the inability of a disabled child to give credible evidence, or to withstand the rigours of the Court process.

Each child should be assessed carefully and supported where relevant to participate in the criminal justice system when this is in their interests as set out in Achieving Best Evidence which includes comprehensive guidance on planning and conducting interviews with children and a specific section about interviewing disabled children.

Participation in all forms of meetings such as Child Protection Conferences and Core Groups must be encouraged and facilitated and take into account any issues about access.

The full range of service providers and carers must be represented at all meetings.