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Section 4: Recognition of abuse and neglect

4.1 Concept of significant harm

Some children are in need because they are suffering, or likely to suffer, significant harm. The Children Act 1989 introduced the concept of significant harm as the threshold that justifies compulsory intervention in family life in the best interests of children, and gives Local Authorities a duty under Section 47 of the Children Act 1989, to make enquiries to decide whether they should take action to safeguard or promote the welfare of a child who is suffering, or likely to suffer, significant harm.

There are no absolute criteria on which to rely when judging what constitutes significant harm. Consideration of the severity of ill-treatment may include the degree and the extent of physical harm, the duration and frequency of abuse and neglect, the extent of premeditation, and the presence or degree of threat, coercion, sadism and bizarre or unusual elements.

Working Together Online defines significant harm as:

“… any Physical, Sexual, or Emotional Abuse, Neglect, accident or injury that is sufficiently serious to adversely affect progress and enjoyment of life.  Harm is defined as the ill treatment or impairment of health and development.”

This definition was clarified in section 120 of the Adoption and Children Act 2002 (implemented on 31 January 2005) so that it may include, "for example, impairment suffered from seeing or hearing the ill treatment of another”.

Sometimes, a single traumatic event may constitute significant harm (e.g. a violent assault, suffocation or poisoning).  More often, significant harm is a compilation of significant events, both acute and longstanding, which interrupt, change or damage the child's physical and psychological development.

Some children live in family and social circumstances where their health and development are neglected.  For them, it is the corrosiveness of long-term neglect, emotional, physical or sexual abuse that causes impairment to the extent of constituting significant harm.

4.2 Definitions of child abuse and neglect

Abuse

Working Together (2013) defines abuse as:

“A form of maltreatment of a child. Somebody may abuse or neglect a child by inflicting harm, or by failing to act to prevent harm. Children may be abused in a family or in an institutional or community setting by those known to them or, more rarely, by others (e.g. via the internet). They may be abused by an adult or adults, or another child or children.

Physical abuse

Working Together (2013) defines abuse as:

"Physical abuse is a form of abuse which may involve hitting, shaking, throwing, poisoning, burning or scalding, drowning, suffocating, or otherwise causing physical harm to a child Physical harm may also be caused when a parent or carer fabricates the symptoms of, or deliberately induces, illness in a child."

See Section 9.16 Fabricated or Induced Illness for further information.

Emotional abuse

Working Together (2013) defines emotional abuse as:

“The persistent emotional maltreatment of a child such as to cause severe and persistent adverse effects on the child's emotional development.

It may involve conveying to a child that they are worthless or unloved, inadequate, or valued only insofar as they meet the needs of another person. It may include not giving the child opportunities to express their views, deliberately silencing them or 'making fun' of what they say or how they communicate.

It may feature age or developmentally inappropriate expectations being imposed on children. These may include interactions that are beyond a child's developmental capability, as well as overprotection and limitation of exploration and learning, or preventing the child participating in normal social interaction

It may involve seeing or hearing the ill-treatment of another. It may involve serious bullying (including cyber bullying), causing children frequently to feel frightened or in danger, or the exploitation or corruption of children.

Some level of emotional abuse is involved in all types of maltreatment of a child, though it may occur alone.”

Sexual abuse

Working Together (2013) defines sexual abuse as:

Involves forcing or enticing a child or young person to take part in sexual activities, not necessarily involving a high level of violence, whether or not the child is aware of what is happening.

The activities may involve physical contact, including assault by penetration (for example, rape or oral sex) or non-penetrative acts such as masturbation, kissing, rubbing and touching outside of clothing. They may also include non-contact activities, such as involving children in looking at, or in the production of, sexual images, watching sexual activities, encouraging children to behave in sexually inappropriate ways, or grooming a child in preparation for abuse (including via the internet).

Sexual abuse is not solely perpetrated by adult males. Women can also commit acts of sexual abuse, as can other children.”

Sexual abuse includes abuse of children through sexual exploitation.  Penetrative sex where one of the partners is under the age of 16 is illegal, although prosecution of similar age, consenting partners is not usual.  A child is under the age of 13 is not legally able to consent to any sexual activity and therefore this would constitute rape under Section 5 of the Sexual Offences Act 2003.

Neglect

Working Together (2013) defines neglect as:

Neglect is the persistent failure to meet a child's basic physical and / or psychological needs, likely to result in the serious impairment of the child's health or development.
Neglect may occur during pregnancy as a result of maternal substance abuse.

Once a child is born, neglect may involve a parent or carer failing to:

  • Provide adequate food, clothing and shelter (including exclusion from home or abandonment);
  • Protect a child from physical and emotional harm or danger;
  • Ensure adequate supervision (including the use of inadequate care-givers);
  • Ensure access to appropriate medical care or treatment.

It may also include neglect of, or unresponsiveness to, a child's basic emotional needs.

4.3 Recognition of abuse and neglect

The factors described below are frequently found in cases of child abuse or neglect. Their presence is not proof that abuse has occurred, but:

  • Must be regarded as indicators of the possibility of significant harm;
  • Indicates a need for careful assessment and discussion with the agency's nominated child protection lead;
  • May require consultation with and/or referral to the LA children's social care and / or the police.

The absence of such indicators does not mean that abuse or neglect has not occurred.

In an abusive relationship the child may:

  • Appear frightened of the parent or carer;
  • Act in a way that is inappropriate to their age and development.

The parent/carer may:

  • Persistently avoid routine child health services and/or treatment when the child is ill;
  • Have unrealistic expectations of the child;
  • Frequently complain about / to the child and may fail to provide attention or praise (high criticism / low warmth environment);
  • Be absent or leave the child with inappropriate carers;
  • Have mental health problems which they do not appear to be managing;
  • Be misusing substances;
  • Persistently refuse to allow access on home visits;
  • Persistently avoid contact with services or delay the start or continuation of treatment;
  • Be involved in domestic abuse;
  • Fail to ensure the child receives an appropriate education.

Professionals should be aware of the potential risk of harm to children when individuals (adults or children), previously known or suspected to have abused children, move into the household.

4.4. Recognising physical abuse

Indicators of concern:

  • An explanation which is inconsistent with an injury;
  • Several different explanations provided for an injury;
  • Unexplained delay in seeking treatment;
  • The parent(s)/carer(s) are uninterested or undisturbed by an accident or injury;
  • Parents or carers are absent without good reason when their child is presented for treatment;
  • Repeated presentation of minor injuries (which may represent a 'cry for help' and if ignored could lead to a more serious injury);
  • Frequent use of different doctors and accident and emergency departments;
  • Reluctance to give information or mention previous injuries.

Bruising

Children can have accidental bruising, but the following must be considered as indicators of harm unless there is evidence or an adequate explanation provided. Only a paediatric view around such explanations will be sufficient to dispel concerns listed below:

  • Any bruising to a pre-crawling or pre-walking baby;
  • Bruising in or around the mouth, particularly in small babies which may indicate force feeding;
  • Two simultaneous bruised eyes, without bruising to the forehead or nose, (rarely accidental, though a single bruised eye can be accidental or abusive and simultaneous bruised eyes can occur when a child has a forceful injury to the nose, including breaking the nose);
  • Repeated or multiple bruising on the head or on sites unlikely to be injured accidentally e.g., soft tissue bruising;
  • Variation in colour possibly indicating injuries caused at different times;
  • The outline of an object used (e.g. belt marks, hand prints or a hair brush);
  • Bruising or tears around, or behind, the earlobe(s) indicating injury by pulling or twisting;
  • Bruising around the face;
  • Grasp marks on small children;
  • Bruising on the arms, buttocks and thighs may be an indicator of sexual abuse.

Bruising is strongly related to mobility:

  • Once children are mobile they sustain bruises from everyday activities and accidents;
  • Bruising in a baby who is not yet crawling, and therefore has no independent mobility, is very unusual;
  • Only one in five infants who is starting to walk by holding on to the furniture has bruises. Infants who are pulling to stand may bump and bruise their heads, usually the forehead;
  • Most children who are able to walk independently have bruises;
  • Bruises usually happen when children fall over or bump into objects in their way;
  • Children have more bruises during the summer months;
  • The shins and the knees are the most likely places where children who are walking, or starting to walk, get bruised;
  • Most accidental bruises are seen over bony parts of the body, e.g. knees and elbows, and are often seen on the front of the body;
  • Fractures are not always accompanied by bruises.

There are some patterns of bruising that may mean physical abuse has taken place, including:

  • Abusive bruises often occur on soft parts of the body, e.g. cheeks, abdomen, back and buttocks;
  • The head is by far the commonest site of bruising in child abuse;
  • Clusters of bruises are a common feature in abused children. These are often on the upper arm, outside of the thigh, or on the torso;
  • As a result of defending themselves, abused children may have bruising on the forearm, face, ears, abdomen, hip, upper arm, back of the leg, hands or feet;
  • Abusive bruises can often carry the imprint of the implement used or the hand;
  • Non-accidental head injury or fractures can occur without bruising.

A practitioner who offers a definitive estimate of the age of a bruise in a child by assessment with the naked eye is doing so from their own experience without adequate published evidence. A bruise should never be interpreted in isolation and must always be assessed in the context of the child's medical and social history, developmental stage and explanation given.

It should also be noted that there is a condition called 'Mongolian Blue Spot' which can look like bruising but is not bruising. This condition is common among darker-skinned children, particularly those of Asian, East Indian and African descent.  The 'spots' are flat, pigmented lesions with unclear borders and irregular shape.  They appear commonly at the base of the spine, on the buttocks and back.  They may also appear as high as the shoulders and elsewhere.  They are not associated with any illness or abuse.  It would require paediatric assessment to confirm that such a condition was present in a child about whom apparent bruising was thought to be indicative of physical abuse.

Bite marks

Bite marks can leave clear impressions of the teeth. Human bite marks are oval or crescent shaped.  Those over 3cm in diameter are more likely to have been caused by an adult or older child.

A medical opinion should be sought where there is any doubt over the origin of the bite.

Bites are a relatively common injury in children. Approximately 1 per cent of all Accident and Emergency attendances are due to bites, and around one in 600 children attending Emergency Departments have been bitten. When an adult bites a child sufficiently hard to leave a mark, it is an assault. An adult bite on a child is the only physical injury where there is the potential to identify exactly who has attacked the child.

A bite leaves an oval or circular mark, consisting of two symmetrical, opposing, u-shaped arches separated at their base by an open space. The arcs may include puncture wounds, indentations or bruising from the marks of individual teeth. These marks are what make bites unique.

Dogs and other carnivores, e.g. ferrets or rats, tend to tear the skin and leave deep puncture wounds. These are also much narrower bites than human ones.

Children often bite one another and they may also be bitten by animals. The challenge, therefore, is to recognise when an injury is a human bite and whether caused by an adult.

Burns and scalds

It can be difficult to distinguish between accidental or non-accidental burns and scalds and this will always require experienced medical opinion. 

Further clarification should be sought in respect of any burn(s).  These include: Circular burns which may be caused by burns from cigarettes (but these may be friction burn if along the bony protuberance of the spine);

  • Linear burns which may be burns from hot metal rods or electrical fire elements;
  • Marks which indicate a burn from an iron;
  • Burns of uniform depth over a large area;
  • Scalds that have a line, such as those caused by immersion in hot water, for example 'sock' or 'glove' scalds (a child getting into hot water of his/her own accord will struggle to get out and cause uneven splash marks);
  • Old scars indicating previous burns / scalds which did not have appropriate treatment or adequate explanation.

Scalds to the buttocks of a small child, particularly in the absence of burns to the feet, are indicative of dipping into a hot liquid or bath.

Fractures

Fractures may cause pain, swelling and discolouration over a bone or joint, and loss of function in the limb or joint.

Non-mobile children rarely sustain fractures.

Further clarification should be sought if:

  • The history provided is vague, non-existent or inconsistent with the fracture type;
  • There are associated old fractures;
  • Medical attention is sought after a period of delay when the fracture has caused symptoms such as swelling, pain or loss of movement;
  • There is an unexplained fracture in the first year of life.
  • Any fracture in a non-mobile child.

The NSPCC and Cardiff University reported in 2012 that fractures are a normal part of growing up, with up to 66 per cent of boys and around 40 per cent of girls sustaining a fracture by their 15th birthday. 85 per cent of accidental fractures are seen in children over five years of age.  However, they can also be indicative of a serious assault on a child.

  • Fractures occur in a significant proportion of physically abused children; studies
  • record figures ranging from 11-55 per cent;
  • 80 per cent of these fractures are in children under 18 months;
  • Any bone in the body can be broken as a result of child abuse;
  • Many abusive fractures are not clinically obvious unless x-rays are taken, especially in infants under two years;
  • Fractures, particularly rib fractures, may not be accompanied by bruising;
  • Fractures in very young children may present with non-specific symptoms and may only be revealed by x-ray or other radiological tests;
  • Fractures may not be obvious even on x-ray immediately after the injury and they are easier to identify once the bones show some signs of healing;
  • Abused children frequently have multiple fractures and these may be of different ages.

Although a recent fracture can be distinguished from an old fracture radiologists can estimate the age only in weeks, not days. Despite fractures showing predictable x-ray features over time as they heal, dating of fractures in abused children can be difficult if:

  • No accurate description of the cause or timing of the injury has been given;
  • Further injury to an already broken bone occurs;
  • The bone has not been immobilised, which may alter the rate of healing.

A fracture, like any other injury, should never be interpreted in isolation. It must always be assessed in the context of the child’s medical and social history, developmental stage and explanation given. Any child with unexplained signs of pain or illness should be seen promptly by a doctor.

In the following situations there should be a careful evaluation to exclude child abuse:

  • children under 18 months with a fracture
  • children whose fracture is inconsistent with their developmental stage
  • multiple fractures, particularly of different ages, in the absence of an adequate explanation
  • rib fractures in children with normal bones and no history of major accidents
  • A fractured femur in a child who is not yet walking.

Mouth and Teeth Injuries

The NSPCC and Cardiff University identified that up to 50 per cent of children sustain an injury to the mouth by the time they leave school  (source: Core-Info: Oral Injuries and Bites on Children (2012)). Most of these are accidental and, in older children, often caused by falls and sporting accidents.  However, in cases of physical abuse, the head and face are the areas of the body most commonly injured. Cuts and bruises to the lips are the commonest recorded abusive injury to the mouth.

All areas of the mouth can be injured in physical abuse, for example, teeth may be displaced or broken and there may be cuts, abrasions or bruises to the inside of the lips, the roof of the mouth, the tongue or the lingual frenulum (underneath the tongue). Injuries to the mouth, including the teeth, can cause considerable pain and discomfort and, if left untreated, may well affect a child's appetite and growth.

It is very difficult to tell if there has been an injury to the mouth. However, a child may complain of a pain in their mouth or have difficulty eating, or the teeth may be discoloured (brown or grey), which may mean that there is an old injury. A broken tooth may be recognised only because of a subtle grey discolouration. Abusive injuries to the mouth are not always obvious and, unless a child discloses abuse, will come to light only if it is noticed that permanent teeth are inexplicably missing.

It has been thought for some time that a torn frenum was diagnostic of physical abuse.  A frenum (often also called a frenulum) is the fold of tissue inside the mouth that joins the upper or lower lip to the gums.  A torn frenum can also occur accidentally if a toddler or young child falls on their face, catches their mouth on low-level furniture or receives an accidental blow to the face, e.g. by a swing. Any injury of this type must be assessed in the context of the explanation given, the child's developmental stage, a full examination and other relevant investigations as appropriate. It is of note that frenum, when torn, usually bleed profusely, therefore if the parents/carers of the child cannot 'remember' how the tear occurred, this should be seen as suspicious.

Scars

A large number of scars or scars of different sizes or ages, or on different parts of the body, may suggest abuse.

4.5 Recognising emotional abuse

The indicators of emotional abuse are often also associated with other forms of abuse. Professionals should therefore be aware that emotional abuse might also indicate the presence of other kinds of abuse.

The following may be indicators of emotional abuse:

  1. Developmental delay;
  2. Abnormal attachment between a child and parent or carer (e.g. anxious, indiscriminate or no attachment);
  3. Indiscriminate attachment or failure to attach;
  4. Aggressive behaviour towards others;
  5. Appeasing behaviour towards others;
  6. Scapegoated within the family;
  7. Frozen watchfulness, particularly in pre-school children;
  8. Low self-esteem and lack of confidence;
  9. Non organic failure to thrive
  10. Withdrawn or seen as a 'loner' – difficulty relating to others.

There is increasing evidence of the adverse long-term consequences for children's development where they have been subject to sustained emotional abuse. Emotional abuse has a significant impact on a developing child's mental and physical health, behaviour and self-esteem. It can be especially damaging in infancy.

Underlying emotional abuse may be as important, if not more so, than other more visible forms of abuse in terms of its impact on the child. Domestic violence, adult mental health problems and parental/carer substance misuse may be features in families where children are exposed to such abuse.

4.6 Recognising sexual abuse

Sexual abuse can be very difficult to recognise and reporting sexual abuse can be an extremely traumatic experience for a child. If a child makes an allegation of sexual abuse, it is very important that they are taken seriously. Allegations can often initially be indirect as the child tests the professional's response. There may be no physical signs and indications are likely to be emotional / behavioural.

Behavioural indicators which may help professionals identify child sexual abuse include:

  1. Inappropriate sexualised conduct;
  2. Sexually explicit behaviour, play or conversation, inappropriate to the child's age;
  3. Contact or non-contact sexually harmful behaviour;
  4. Continual and inappropriate or excessive masturbation;
  5. Self-harm (including eating disorder), self-mutilation and suicide attempts;
  6. Involvement in sexual exploitation or indiscriminate choice of sexual partners;
  7. An anxious unwillingness to remove clothes for e.g. sports events (but this may be related to cultural norms or physical difficulties).

Physical indicators associated with child sexual abuse include:

  1. Pain or itching of genital area;
  2. Blood on underclothes;
  3. Pregnancy in a child;
  4. Physical symptoms such as injuries to the genital or anal area, bruising to buttocks, abdomen and thighs, sexually transmitted disease, presence of semen on vagina, anus, external genitalia or clothing.

Sex offenders have no common profile, and it is important for professionals to avoid attaching any significance to stereotypes around their background or behaviour. While media interest often focuses on 'stranger danger', sexual offending also occurs in the context of a known relationship, e.g. family, acquaintance or colleague.

4.7 Recognising neglect

It is rare that an isolated incident will lead to agencies becoming involved with a neglectful family. Evidence of neglect is built up over a period of time. Professionals should therefore compile a chronology and discuss concerns with any other agencies which may be involved with the family, to establish whether seemingly minor incidents are in fact part of a wider pattern of neglectful parenting.

Professionals should also be sensitive to becoming desensitised to some of the indicators of neglect. These include:

  1. Failure by parents or carers to meet essential physical needs (e.g. adequate or appropriate food, clothes, warmth, hygiene and medical or dental care);
  2. Failure by parents or carers to meet essential emotional needs (e.g. to feel loved and valued, to live in a safe, predictable home environment);
  3. A child seen to be listless, apathetic and unresponsive with no apparent medical cause;
  4. Failure of child to grow within normal expected pattern, with accompanying weight loss;
  5. Child thrives away from home environment;
  6. Child frequently absent from school;
  7. Child left with inappropriate carers (e.g. too young, complete strangers);
  8. Child left with adults who are intoxicated or violent;
  9. Child abandoned or left alone for excessive periods.
  10. Child has very poor dental health.

Disabled children and young people can be particularly vulnerable to neglect due to the increased level of care they may require.

Although neglect can be perpetrated consciously as an abusive act by a parent or carer, it is rarely an act of deliberate cruelty. Neglect is usually defined as an omission of care by the child's parent or carer, often due to one or more unmet needs of their own. These could include domestic violence, mental health issues, learning disabilities, substance misuse, or social isolation / exclusion, this list is not exhaustive.

While offering support and services to these parents or carers, it is crucial that professionals maintain a clear focus on the needs of the child.

4.8 Potential risk of harm to an unborn child

In some circumstances, agencies or individuals are able to anticipate the likelihood of significant harm with regard to an expected baby (e.g. domestic violence, parental substance abuse or mental ill health).

These concerns should be addressed as early as possible before the birth, so that a full assessment can be undertaken and support offered to enable the parent(s)/carer(s) (wherever possible) to provide safe care.

See Section 9.57 for further information about pre-birth assessments and Section 7.16 about Pre-Birth Protection Conferences.

4.9 Professional Response

Professionals in all agencies who come into contact with children, who work with adults who are parents or carers or who gain knowledge about children through working with adults, should:

  • Be alert to potential indicators of abuse or neglect;
  • Be alert to the risks which individual abusers or potential abusers, may pose to children;
  • Be able to gather and analyse information as part of a common assessment.

The law empowers anyone who has actual care of a child to do all that is reasonable in the circumstances to safeguard their welfare.  Accordingly, professionals in all agencies should take appropriate action wherever necessary to ensure that no child is left in immediate danger, e.g. a teacher, foster carer, child-minder or any professional should take all reasonable steps to offer a child immediate protection (including from an aggressive parent or carer).

Child protection support for professionals

All agencies should have child protection procedures which are compliant with the North Yorkshire Safeguarding Children Board’s Procedures. Agency procedures must provide instruction to professionals in:

  • Identifying potential or actual harm to children;
  • Discussing and recording concerns with a first line manager / in supervision;
  • Assessing concerns by completing a common assessment;
  • Discussing concerns with the agency’s nominated safeguarding children adviser (able to offer advice and decide upon the necessity for a referral to Children’s Social Care).

Professionals in all agencies should be sufficiently knowledgeable and competent to contact l LA children’s social care or the police about their concerns directly and to complete the appropriate referral form.

A formal referral to LA children’s social care, the police or accident and emergency services (for any urgent medical treatment) must not be delayed by the need for consultation with management or the nominated safeguarding children adviser, or completion of a common assessment.

Duty to co-operate and refer

All professionals in agencies with contact with children and members of their families must make a referral to Children’s Social Care if there are signs that a child or an unborn baby:

  • Is suffering significant harm through abuse or neglect;
  • Is likely to suffer significant harm in the future.

The timing of such referrals should reflect the level of perceived risk of harm, not longer than within one working day of identification or disclosure of harm or risk of harm.

In urgent situations, out of office hours, the referral should be made to the Children’s Social Care Emergency Duty Team.

Listening to the child

Whenever a child reports that they are suffering or have suffered significant harm through abuse or neglect, or have caused or are causing physical or sexual harm to others, the initial response from all professionals should be limited to listening carefully to what the child says to:

  • Clarify the concerns;
  • Offer re-assurance about how the child will be kept safe;
  • Explain what action will be taken.

The child must not be pressed for information, led or cross-examined or given false assurances of confidentiality, as this could prejudice police investigations, especially in cases of sexual abuse.

If the child can understand the significance and consequences of making a referral to LA children’s social care, they should be asked their view.

However, it should be explained to the child that whilst their view will be taken into account, the professional has a responsibility to take whatever action is required to ensure the child’s safety and the safety of other children.

Parental/Carer Consultation

Where practicable, concerns should be discussed with the parent/person with parental responsibility and agreement sought for a referral to Children’s Social Care unless seeking agreement is likely to place the child at risk of significant harm through delay or the parent’s actions or reactions.

Where a professional decides not to seek parental permission before making a referral to Children’s Social Care, the decision must be recorded in the child’s file with reasons, dated and signed and confirmed in the referral to Children’s Social Care.

A child protection referral from a professional cannot be treated as anonymous, so the parent will ultimately become aware of the identity of the referrer. Where the parent refuses to give permission for the referral, unless it would cause undue delay, further advice should be sought from a manager or the nominated child protection adviser and the outcome fully recorded.

If, having taken full account of the parents’ wishes it is still considered that there is a need for referral:

  • The reason for proceeding without parental agreement must be recorded;
  • The parent’s withholding of permission must form part of the verbal and written referral to Children’s Social Care;
  • The parent should be contacted to inform them that, after considering their wishes, a referral has been made.

Urgent medical attention

If the child is suffering from a serious injury, the professional must seek medical attention immediately from accident and emergency services and must inform Children’s Social Care, and the duty consultant paediatrician at the hospital.

Where abuse is alleged, suspected or confirmed in a child admitted to hospital, the child must not be discharged until:

  • Children’s Social Care local to the hospital and the child’s home address (may be two different LA children’s social care) are notified by telephone that there are child protection concerns;
  • Hospital professionals have completed the appropriate referral form and sent it to Children’s Social Care within 48 hours;
  • A strategy meeting / discussion has been held including relevant hospital and other agency professionals.

Except in cases where emergency treatment is needed, Children’s Social Care and the police should initiate any medical examinations required as part of a child protection enquiry.

Initiating the referral

Referrals should be made to Children’s Social Care for the area where the child is living or is found.

Where specific arrangements are made, or exist, for another area to undertake an enquiry, the home LA Children’s Social Care will advise accordingly and ensure that the referral process outlined in Section 5 - Referral and Assessment, is followed.

Where available, the following information should be provided with the referral (but absence of information must not delay referral):

  • Full names, date of birth and gender of the subject child(ren);
  • Family address;
  • Identity of those with parental responsibility;
  • Names, date of birth and gender of all household members;
  • Ethnicity, first language and religion of children and parents/carers;
  • Any need for an interpreter, signer or other communication aid;
  • Any special needs of child(ren);
  • Any significant / important recent events / incidents in child’s or family’s life;
  • Cause for concern including details of any allegations, their sources, timing and location;
  • Child’s current location and emotional and physical condition;
  • Referrer’s relationship and knowledge of child and parents/carers;
  • Known current or previous involvement of other agencies / professionals;
  • Information regarding parental/carer knowledge of, and agreement to, the referral.

The referrer should confirm verbal and telephone referrals in writing, within 48 hours.  Children’s Social care should respond to the referrer indicating what course of action has been taken regarding the referral within one working day.

Where a common assessment has been completed prior to referral, these details should also be conveyed at the point of referral.

Children’s Social Care should acknowledge referrals within one working day of receipt.

Recording

The referrer should keep a formal record of:

  • Discussions with child;
  • Discussions with parent/carer;
  • Discussions with their managers;
  • Information provided to Children’s Social Care;
  • Decisions taken (with time and date clearly noted, and signed).

The referrer should keep a copy of the written referral, confirming the verbal and telephone referral.

4.10 Adult services responsibilities in relation to children

All agencies where professionals offer services to adults who may be parents or carers or have close contact with children and/or or families, should have procedures and protocols in place for safeguarding and promoting the welfare of children. Adult services and professionals working with adults need to be competent in identifying the client or patient’s role as a parent. They need to be able to consider the impact of the adult’s condition or behaviour on:

  • A child’s development;
  • Family functioning;
  • The adult’s parenting capacity.

  This should also include early help and CIN.



Last Updated 4 March 2014
Next Scheduled Review: 4 March 2015

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