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Section 9: Safeguarding Children In Specific Circumstances (L-P)

  1. Lack of parental control
  2. Left Alone
  3. Male circumcision
  4. Missing from home and care
  5. No access to a child
  6. Not attending school
  7. Parental mental illness
  8. Parents with learning disabilities
  9. Parents who misuse substances
  10. Power of entry: Police
  11. Pregnancy and motherhood of a child
  12. Pre-trial therapy
  13. Private fostering
  14. Prostitution: parental involvement in
  15. Psychiatric care of children
  16. Psychiatric wards and facilities (children visiting)
 

9.28 Lack of parental control

When a child is brought to the attention of the police or the wider community because of their behaviour, this may be an indication of vulnerability, poor supervision or neglect in its wider sense.  It is important to consider whether these are children in need and to offer them assistance and services that reflect their needs. This should be done on a multi-agency basis.

A range of powers should be used to engage families to improve the child's behaviour where engagement cannot be secured on a voluntary basis.

The Child Safety Order (CSO) is a compulsory intervention available below the threshold of the child being at risk of significant harm.  Children's Social Care can apply for a CSO where a child has committed an act that would have been an offence if s/he were aged 10 or above, where it is necessary to prevent such an act, or where the child has caused harassment, distress or harm to others (i.e. behaved anti-socially). It is designed to help the child improve his or her behaviour, and is likely to be used alongside work with the family and others to address any underlying problems.

A Parenting Order can be made alongside a CSO or when a CSO is breached. This provides an effective means of engaging with and supporting parents, while helping them develop their ability to undertake their parental responsibilities.

 

9.29 Left Alone

When a child is not ready to be left alone, it can be a sad, lonely, frightening and potentially dangerous experience.  There are many possible risks, both physical and emotional, which could affect the child.

There is no rule in law that specifies the age at which it is legal to leave children alone. The NSPCC advise that most children under 13 are not mature enough to cope in an emergency, and should not be left alone for more than a very short while.  While this recommendation does not have the force of law, it is suggested as a minimum age.  Children need a certain level of maturity to be safely left on their own. 

Babies and young children should never be left alone in the home, whether they are asleep or awake, not even for a very short time.

The law also does not state at what age a young person can babysit. However where a babysitter is under the age of 16 years, parents remain legally responsible to ensure that the child comes to no harm.

If a practitioner has reason to believe that a young child/ren is home alone, they are expected to use their judgement and respond, depending on the circumstances.

There should have been sufficient attempts to rouse the parent/carer and, for example, a check that the parent is not in the back garden.

If, for example, the practitioner believes the parent is actually at home but choosing not to answer, they should call through the door that they are contacting the Police as it appears the child has been left alone.

The practitioner should attempt to contact the parent immediately, by mobile phone, or other responsible family member.  If for example the parent is at a neighbour's and has left a child/ren alone, it should be made clear that the parent is to return immediately.  The practitioner should discuss with the parent, after their return to the home and ascertaining that the child/ren is alright, the seriousness of leaving a child alone.

If it is not possible to quickly find out where the parent is and for them to return to the home and there is concern about a child's immediate safety, the Police are to be contacted as they have a duty to take urgent protective action. 

In all situations, the Practitioner is expected to remain at the home or outside the home if there is no access, until the parent returns or other action is taken, such as through the Police.

If necessary, the Practitioner should seek immediate advice from their Manager and/or the Named Person.

 

2.30 Male circumcision

Male circumcision is the surgical removal of the foreskin of the penis. The procedure is usually requested for social, cultural or religious reasons (e.g. by families who practice Judaism or Islam). There are parents who request circumcision for assumed medical benefits.

There is no requirement in law for professionals undertaking male circumcision to be medically trained or to have proven expertise. Traditionally, religious leaders or respected elders may conduct this practice.

Circumcision for therapeutic / medical purposes

The British Association of Paediatric Surgeons advises that there is rarely a clinical indication for circumcision. Doctors should be aware of this and reassure parents accordingly.

Where parents request circumcision for their son for assumed medical reasons, it is recommended that circumcision should be performed by or under the supervision of doctors trained in children's surgery in premises suitable for surgical procedures.

Doctors / health professionals should ensure that any parents seeking circumcision for their son in the belief that it confers health benefits are fully informed that there is a lack of professional consensus as to current evidence demonstrating any benefits. The risks / benefits to the child must be fully explained to the parents and to the young man himself, if Fraser competent.

The medical harms or benefits have not been unequivocally proven except to the extent that there are clear risks of harm if the procedure is done inexpertly.

Non-therapeutic circumcision

Male circumcision that is performed for any reason other than physical clinical need is termed non-therapeutic circumcision.

The legal position on male circumcision is untested and therefore remains unclear. Nevertheless, professionals may assume that the procedure is lawful provided that:

  • It is performed competently, in a suitable environment, reducing risks of infection, cross infection and contamination;
  • It is believed to be in the child's best interests;
  • There is valid consent from family / parents and the child, if old enough, is Fraser competent.

If doctors or other professionals are in any doubt about the legality of their actions, they should seek legal advice.

Principles of good practice

The welfare of the child should be paramount, and all professionals must act in the child's best interests. Children who are able to express views about circumcision should always be involved in the decision-making process:

  • Even where they do not decide for themselves, the views that children express are important in determining what is in their best interests;
  • Parental preference alone does not constitute sufficient grounds for performing a surgical procedure on a child unable to express his own view. Parental preference must be weighed in terms of the child's interests;
  • When the courts have confirmed that the child's lifestyle and likely upbringing are relevant factors to take into account. Each individual case needs to be considered on its own merits.

An assessment of best interests in relation to non-therapeutic circumcision should include consideration of:

  • The child's own ascertainable wishes, feelings and values;
  • The child's ability to understand what is proposed and weigh up the alternatives;
  • The child's potential to participate in the decision, if provided with additional support or explanations;
  • The child's physical and emotional needs;
  • The risk of harm or suffering for the child;
  • The views of parents and family;
  • The implications for the child and family of performing, and not performing, the procedure;
  • Relevant information about the child and family's religious or cultural background.

Consent for circumcision is valid only where the people (or person) giving consent have the authority to do so and understand the implications (including that it is a non-reversible procedure) and risks. Where people with parental responsibility for a child disagree about whether he should be circumcised, the child should not be circumcised without the leave of a court.

Recognition of harm

Circumcision may constitute significant harm to a child if the procedure was undertaken in such a way that he:

  • Acquires an infection as a result of neglect;
  • Sustains physical functional or cosmetic damage as a result of the way in which the procedure was carried out;
  • Suffers emotional, physical or sexual harm from the way in which the procedure was carried out;
  • Suffers emotional harm from not having been sufficiently informed and consulted, or not having his wishes taken into account.

Harm may stem from the fact that clinical practice was incompetent (including lack of anaesthesia) and / or that clinical equipment and facilities are inadequate, not hygienic etc.

The professionals most likely to become aware that a boy is at risk of, or has already suffered, harm from circumcision are health professionals (GPs, health visitors, A&E staff or school nurses) and childminding, day care and teaching staff.

If a professional in any agency becomes aware, through something a child discloses or another means that the child has been or may be harmed through male circumcision, a referral must be made to Children's Social Care.

Role of community / religious leaders

Community and religious leaders should take a lead in the absence of approved professionals and develop safeguards in practice. This could include setting standards around hygiene, advocating and promoting the practice in a medically controlled environment and outlining best practice if complications arise during the procedures.

 

9.31 Missing from home and care

This procedure relates to all children and young people in North Yorkshire who run away and go missing from care or home. This includes children and young people looked after in both the public and independent sectors and those attending residential school. It is based on "Statutory guidance on children who run away and go missing from home and care: supporting local authorities to meet the requirements of National Indicator 71" (July 2009).

This procedure may be read alongside 9.23 Harbourers of missing children

This procedure does not provide for situations where a child has been abducted or forcibly removed from their place of residence. This is a "crime in action" and should be reported to the police immediately.

Risks faced by young people who go missing

Research shows that the main causes of young people running away are family conflict, including domestic violence or forced marriage, or personal problems such as substance misuse, bullying or relationship problems. Young people who run away from care are often unhappy or are influenced by others and do so to fit in with the group.

The risks faced by young people are the same regardless of how often they have run away from home. However younger children and those who runaway more often are more likely to face serious, long term problems.

The immediate risks associated with running away include:

  • No means of support or legitimate income - leading to high risk activities;
  • Possible involvement in criminal activities, e.g. prostitution;
  • Becoming a victim of crime, for example through sexual assault and exploitation;
  • Alcohol and substance misuse;
  • Poor of physical and mental health;
  • Loss of education and training.

Longer term risks include:

  • Long-term drug dependency;
  • Involvement in crime;
  • Homelessness.

North Yorkshire missing from home and care protocol: July 2009

The above protocol was agreed to support the local authority to meet the requirements of National Indicator 71. The protocol aims to ensure that:

  • All appropriate agencies and individuals are notified if children and young people are missing and/or return;
  • A clear plan of effective inter-agency action is taken to trace or return children and young people who run away or go missing;
  • Appropriate and effective actions are taken when children and young people return or are located. This includes provision of a return interview;
  • Processes are established to track children and young people who are missing from other authorities;
  • The Police are appropriately notified of children and young people who go missing;
  • Information is gathered to support the new national indicator and inform local practice;
  • Children and young people are positively encouraged to influence the outcome of any professional intervention.

Legal Issues

The law does not generally regard young people under the age of 16 as being able to live independently away from home. Relevant legal processes are outlined in LSCB Procedures, Harbourers of Missing Children, Section 9.23.

Definitions

The new statutory guidance makes provision for children and young people who are looked after to take "unauthorised absence". Within clear guidelines agreed between the Police and Children's Social Care, young people who are looked after no longer need to be reported as missing to the Police whenever they failed to return to their placement at agreed times. This allows foster carers and residential staff to involve the Police without the young person being reported as a missing person.

Unauthorised absence

Where children and young people looked after by North Yorkshire Children's Social Care are known are absent for a short period of time i.e. less than overnight, and after a careful and thorough risk assessment the absence does not raise concern for their immediate safety or that of the public. This is a single agency policy available for Children's Social Care staff on the NYCC Intranet.

Children who fall within this category of "unauthorised absence" must be the subject of continuous review by Children's Social Care whilst they remain absent.  During the absence the circumstances may change and social care staff need to be in a position to respond accordingly.  In this phase the local authority should take all reasonable and practical steps which a good parent would take to establish the whereabouts or destination of a child or young person, or the location of any persons with whom he or she is likely to be associating and arrange for those places to be checked. 

If the location of a child is known or suspected then it is the responsibility of the relevant carers to attempt to ensure the safe return of the child or young person.  However, if there are thought to be specific issues of safety of the public or public order difficulties involved in returning the child, an action should be agreed between Police and Children's Social Care staff.  These circumstances would mean the child should be categorised as "missing".

Where the child or young person has not returned within the parameters of the Children Social Care procedure, he or she must be reported as missing.

Missing children and young people

Children and young people who have gone missing independently from their families.  Where concern is raised about the child or young person's absence because their location is unknown; the reason for their absence is unknown; they are vulnerable and and/or there is a potential danger to the public.

Designated responsibilities within the missing from home and care processes

The Local Authority and Police have a named senior manager in charge of missing children issues. The named manager in the Police has responsibility for:

  • Improving links with local services for runaways;
  • Developing specialist skills and knowledge about running away;
  • Providing a more consistent and efficient response to runaways

These senior managers within the Police and local authority are accountable for ensuring the processes agreed as part of the protocol are followed.

The Local Authority and Police will also ensure that there is a process in place to manage the exchange of notifications of missing children and young people between the two agencies in a timely way and that information is collated in line with PF1 71.

Multi agency working

Running away is a clear risk factor making young people vulnerable to negative outcomes. Key triggers for running away are:

  • Young people feeling they have no one to talk to;
  • Young people not knowing what else they can do;
  • Young people not knowing where they can go for help;
  • The help they require not being available or accessible.

The Common Assessment Framework will allow agencies to share information and more easily identify early warning signs when young people are at risk of running away. Agencies in contact with young people should consider the use of a risk assessment to determine:

  • What is the risk that the young person might run away?
  • What risks might they face if they ran away?
  • With whom is it permissible for them to stay overnight and in what circumstances?

A risk assessment is used by the police when children run away. A risk assessment tool incorporated into a common assessment can help to establish a wider package of support and is under development through the DCSF.

Where a child needs support from several agencies, a Lead Professional should help ensure coordination of services.

However where the child or young person is potentially a Child in Need or a Child in Need of Protection a referral should then be made directly to Children's Social Care through the Customer  Services Centre. In such circumstances a common assessment should not be started/ completed if already underway.

Such criteria for a referral to Children's Social Care would include:

  • Where a child has developed a repeated pattern of running;
  • Where the child is, or is likely to have experience of significant harm, including sexual exploitation;
  • Where the parent appears unable, or unwilling, to work to support and meet the needs of the child;

Action to take when a child runs away or is missing

  • Attempt to locate - contact friends/school etc., check bedroom and known locations where person attends;
  • Establish if the child is subject to a care order, court order or contact order is privately fostered and who has parental responsibility;
  • Contact the Police noting whether the child is missing or whether this is an unauthorised absence (for children in care).

A child is classed as missing if their location or reason for absence is unknown and there is a cause for concern because of their vulnerability or their potential danger to the public.

If the location of the child is known they should not be reported to the Police as a missing person. However if there is concern for their safety they may be reported as a child or young person at risk of harm. For example where parents report their teenage child staying over and refusing to leave a house where there is known drug misuse.

When young people missing from home are located but have not been reported missing to the Police by their families, further investigation might be warranted. It may be necessary to inquire into whether there are any continuing safeguarding concerns or whether the young person should be offered family support services.

Role of the Police

The priorities of the police in responding to reports of missing persons are:

  • To ensure that every report of a missing person is risk assessed so that missing persons who may be vulnerable or represent high risk are immediately identified;
  • To investigate reports of missing persons;
  • To adopt a proactive multi agency approach in dealing with missing persons;
  • To support the needs of the family, those close to the missing person and the community.

Action to be taken by the Police

A risk assessment will be carried out in every case. The outcomes of the risk assessment will be the guide for the police response and the level of enquiries undertaken. The missing young person will be classified as low, medium or high risk based on the professional judgement of the reporting officer.

Enquiries will continue as required until the child or young person is located.  A Police Supervisor will review action taken daily. Contacts with relevant agencies will be made and all information recorded by the Police.

The Police will advise the media and request their assistance after appropriate consultation with parents/guardians and/or the local authority in certain circumstances after a thorough risk assessment has been conducted.

The Police Safe and Well Check

When a missing child or young person is found, the police officer should physically see and interview them as soon as possible. The objects of the interview are to:

  • Determine the reasons why the child went missing and in particular, if they have been subject to violence, abuse or bullying;
  • To establish if they have committed crime whilst missing;
  • To discover where and by whom they have been harboured;
  • To obtain information which may lead to their early discovery should they disappear again;
  • To put in place any support and preventative measures to avoid such a recurrence;
  • To inform the child and their family that either a referral has been made to Children's Social Care for an assessment of need, or a return interview will be arranged with an agency the young person is familiar with.

The Police should also see and interview the child or young person's parent/s or carers to satisfy themselves that the child or young person is safe for the time being.

The police will ensure that notifications are passed to the Police Missing Persons Coordinator the day of the child's return. They will include/ attach brief details of the interview with the child/young person for every young person that has been missing. This will allow a timely exchange of information with the local authority.

Where a young person goes missing frequently, it may not be practicable to see them every time they return. In these cases, the reasonable decision should be taken about the frequency of such checks. This will mainly apply to young people missing from care who will have other people responsible for their welfare to check this. This decision should be agreed and recorded as part of the plan for the young person.

The Return Interview

Police Safe and Well Checks are not designed to explore the causes of why children go missing or run away. All children and young people must now be offered a more in-depth interview on their return.

It is recommended that this interview takes place within 72 hours of the young person being located or returning from absence. It is especially important that a Return Interview takes place when a child or young person:

  • Has been missing for over 24 hours;
  • Has been missing on two or more occasions;
  • Has engaged or is believed to have engaged in criminal activities during their absence;
  • Has been hurt or harmed whilst they have been missing ( or this is believed to be the case);
  • Has known mental health issues;
  • Is at known risk of sexual exploitation;
  • Has contact with persons posing a risk to children.

The return interview should be undertaken by the professional agency or person that the child or young person has identified with.

The purpose of the return interview is to:

  • Give the child or young person the chance to talk about why they ran away;
  • Assess need including risk of future running away.  This assessment should take the form of the Common Assessment Framework where Children's Social Care are not involved;
  • Help the young person to find ways of dealing with their problems.

The assessment should consider:

  • Whether the provision of advice, information and support from the interviewing agency is sufficient to meet the young person's needs;
  • Whether it is appropriate to link the child and/or family to an alternative service such as family support or drug and alcohol services;
  • Whether a referral to Children's Social Care is required for those living at home.

Agreement should be reached with the child or young person about when and where to undertake the interview.  Parents, carers and those with parental responsibility should be told if appropriate. Notice that an interview has been completed should be sent to the NYCC Missing Person's Coordinator for PI 71 audit purposes.

Out of hours responses

If there is concern a young person may be at risk if returned home, they should be referred to Children's Social Care to assess their needs and make appropriate arrangements for their accommodation.

National guidance requires that the local authority makes available an effective form of emergency accommodation for young people who need somewhere safe to go so they are not put at even greater risk and that this accommodation can be accessed at any time of the day or night.

Police stations are not an appropriate place to accommodate children even for a short time and bed and breakfast accommodation should never be used for unaccompanied children aged under 15 years. No 16 or 17 year old should be placed in B&B accommodation by housing services or CYPS except in an emergency where this is the only available alternative to rooflessness. In these exceptional cases, B&B accommodation should be used for the shortest time possible and support offered to the young person during their stay.

Additions when vulnerable children and young people are missing

For all children (other than looked after children), the following process must take place where assessment deems that the young person is vulnerable and/or considered at increased risk of harm.

If the child or young person has not been traced within 48 hours, a strategy meeting must be held. This meeting must take place within 5 working days of the date of the child/young person going missing at the latest.  Members of the meeting will need to consider:

  • If the young person is thought to have travelled to another area whether to circulate their details to other local authority and other agencies in that area;
  • Notifying national authorities and agencies including social security, the benefits agency and child benefit agency;
  • If there is cause to believe that the child/young person may be removed from UK jurisdiction any legal measures to be taken.

Further to the strategy meeting, a review child protection conference must be brought forward for any child with a child protection plan, remaining missing for 7 days or more.

When the child is located a strategy meeting/ discussion between the agencies involved should take place within the same working day to consider:

  • Any immediate safety issues and whether to start a S.47 enquiry;
  • Who will interview the child if not part of a S.47 enquiry;
  • Who needs to be informed of the child's return (both locally and nationally).

If a child or young person has a Child Protection Plan, Children's Social Care must consult with Core Group members to consider the effectiveness of the current Child Protection Plan and decide and record whether to hold a review child protection conference.

Children missing from care

Every "missing" child who returns to the care of the local authority will be interviewed.  This will normally be conducted by an independent person not involved with the line management of the home or foster home. This may be the child's Social Worker, IRO or another social worker.  Children's Social Care will ensure that there are a range of options to consider when the child returns.

All looked after children will have information regarding the independent advocacy service, NYAS contracted to work in North Yorkshire. Where a young person requests to speak with an independent advocate, this will be supported.

Planning for return

Each children's home must have written procedures that must be followed when a child is missing.  These must be compatible with the protocols for responding to missing persons agreed between the police and the local authority in the area where the home is located and with the "National Minimum Standards and Regulations for Children's Homes and Fostering Services Regulations (2002)".

Planning and assessment of young people in care by staff and carers should include a risk assessment of whether the child or young person may run away from their placement.  This should be revised and updated regularly.

Whenever possible prior to the return of a looked after child or young person whose absence falls within the definition of ‘missing', their Social Worker should commence planning for when the child is located.  These plans should include:

  • Will the child or young person return to their previous placement?
  • How will she/he be taken to the placement?
  • Do the Police wish to make further enquiries before the child or young person returns to the placement?
  • Who will be the appropriate "independent person" to talk to the child or young person after her/his return?
  • Is it appropriate to apply for a recovery order?

Care Planning

Looked after reviews provide an opportunity to check that a child's care plan has been amended to address the reasons why they were absent and may include a strategy to prevent reoccurrence should the child go missing in the future.

Alongside the care plan, the Placement Information Record (PIR) should be completed. The PIR should describe how the foster carer or residential staff will meet the child's needs. It will include detail of any specific behaviour-management strategies that the provider is expected to follow to prevent where possible the young person going missing. This is essential where there is already an established pattern of running away.

Children missing from a residential school

The processes for looked after children are applicable to all children and young people who are missing or having unauthorised absence from residential school. This is regardless of whether it is believed the young person is making their way to their family home as the distances involved place that child or young person in danger.

National Indicator 71 (Missing from home and care) requires that:

  • Local information about running is gathered;
  • Local needs analysis-based information gathered about the levels or causes of running are in place;
  • Local procedures to meet the needs of runaways agreed;
  • Protocols for responding to urgent/ out of hours referral from the Police or other agencies are in place:
  • Local procedures to support effective prevention and early intervention work.
 

9.32 No access to a child

Meaning of ‘No Access'

‘No Access' is a term which describes the following situations, in a context where there are concerns for the physical safety of a child:

  • Admittance to the house is not obtained for a visit that has been made by appointment and there is not a plausible reason for this;
  • There is no response to a visit to the home, whether or not by appointment, and there is reason to believe that the lack of response is due to non-cooperation;
  • Once in the home, access to the child/ren in the house is unreasonably denied;
  • An appointment made to see the children, whether in the home or elsewhere, is not kept.

Practitioners must also be aware of possible attempts to delay or avoid contact, such as requests to re-arrange a planned visit, particularly also when the re-arranged appointment is not kept.

‘No access' may occur at any point.

‘Closure'

In considering the meaning of any difficulties in making contact or seeing children whose physical safety may be at risk, which includes situations of domestic violence, account should be taken of the work of Reder Duncan & Gray (1993) who identified a process they termed ‘closure'.

 ‘Closure' is defined by tightening of boundaries within the family in order to exclude outside intervention and influence.   Closure could present, for example, as parental refusal to the child/ren being seen, non-attendance or decreasing attendance at nursery/school, failure to attend or to be available for pre-arranged appointments etc. and can show in physical signs such as curtains being consistently closed.

Closure may be partial, intermittent, persistent or terminal in nature and is due to an attempt to regain a perceived loss of control.  It may signal an increase of stress within a family and an escalation of abuse towards the child/ren.  Within families where there is domestic violence, no access may be linked to coercion, threats or intimidation by the perpetrator.  

Any pattern to indicate that a form of closure is taking place, in a situation where there are concerns for a child's safety, must be taken seriously, particularly where there is a history of child abuse, as closure can be considered to have potential fatal consequences for the child.

‘No Access' Visits

There can be a simple explanation for a ‘No Access' visit which does not indicate any increased concern for the child.  On the other hand, such a visit may indicate increased concerns.  In each case a careful judgement should be made.

Where there is a ‘No Access' visit to a child and the appointment had been arranged and there are known indicators of risk, including domestic violence, which give cause for concern for the safety of the child, the Social Worker should:

  • Leave a note/letter giving a further early appointment i.e. the same or next working day and contact details;
  • Attempt to contact the parent by phone;
  • Attempt to find out the whereabouts of the child and parents;
  • Liaise with other practitioners involved to ascertain if they have seen the child or parents;
  • Make the Team Manager aware so that the facts of the case can be judged and a decision made as to whether further action is necessary that day.

Where there is a second ‘No Access' visit, no plausible reason as to why that should be and there are concerns for the child's safety, the Social Worker should:

  • Leave a strongly worded note to stress the importance of being able to see the child;
  • Attempt to contact the parents and other family members;
  • Liaise with others involved;
  • Discuss the case further with the Deputy Service Manager/ Service Manager who should make a decision as to whether further action is necessary.

Depending on the seriousness of the situation, irrespective of whether it is a first or subsequent ‘No Access' visit, there may be a need to seek Police assistance. Alternatively, where s47 enquiries are being frustrated by the lack of access, it may be appropriate to apply for an Emergency Protection Order.

Where this relates to a child who is subject to a Child Protection Plan, there should also be liaison with the Chair of the Child Protection Conference.

 

9.33 Not attending school

A minimum standard of safety should be afforded to children not attending school. This includes four groups of children:

  • Children who are registered with schools and who are or go missing from school, and give rise to concern about their welfare (these children may be classified as missing, whereabouts unknown);
  • Children who are poor attendees at school or who have interrupted school attendance;
  • Children of school age who are not registered with a school;
  • Children of school age who are educated at home but where there are concerns about their welfare.

Child registered at school who goes missing: Initial response

On the first day a child is not in school without a valid reason (e.g. a telephone call or letter from the parent giving a valid explanation), a staff member trained to do so should telephone the child's parent / home to seek reasons for the absence and reassurance from a parent that the child is safe at home.

If contact is made with the parent and the child is missing, the staff member should advise the parent to contact all family and social contacts, the police and services such as the local accident and emergency departments and the child's GP.

If contact cannot be made with the parent or the staff member is concerned about the response they receive (e.g. the parent not informing the people listed above), the staff member should consider, with the school's Designated Person for Child Protection, the degree of vulnerability of the child to decide on whether any further action is required at this stage. Any decision not to act should be reviewed on each subsequent day the child is absent.

Children with poor, irregular or interrupted school attendance: Initial response

On the first day a child is not in school, the procedures outlined above should be followed.

If contact is made with the parent and the child is not missing from home, the member of staff will follow their school procedures for children who are absent. However, if they are concerned about the welfare of the child (and this is likely to be the case if there is any reason to doubt the reason given by the parent for the child's absence from school), the staff member should discuss the case with the school's Designated Person for Child Protection.

Schools must have systems for monitoring attendance, and where children are attending irregularly the education welfare service should be notified to ensure the child is safe. The Government threshold for concern about school attendance is that 20 per cent plus non-school attendance raises concern about a child's education. Most education services therefore use this threshold for referral to education welfare and school attendance services. The local authority has a range of legal powers to enforce school attendance, including the prosecution of parents who fail to ensure that their children attend school regularly.

If a parent fails to comply with local authority efforts to ensure regular school attendance for a child, this must be viewed as a child welfare matter and a referral made Children's Social Care.

Children who are vulnerable or at risk of harm

When a child is absent or missing from school, they could be at risk of significant harm through physical or sexual abuse. The child may be absent or missing because they are suffering physical, sexual or emotional abuse and / or neglect.

Children who are absent or missing from school may also be missing from care or home.

Teachers, in consultation with the Designated Person for Child Protection at the school, should make an immediate referral to Children's Social Care if:

  • There is good reason to believe the child may be the victim of or involved in a crime;
  • The child is subject of a child protection plan;
  • The child is a looked after child;
  • The child is privately fostered child;
  • There is planned or current Children's Social Care or adult social care involvement (e.g. a child protection [s47 enquiry] investigation);
  • The child is subject to serious concerns about their health, safety or welfare;
  • There is a person present in or visiting the family who poses a risk of harm to children.

The family may be avoiding contact and therefore the quicker the response the more likely they will be traced. Delay may increase the risk of harm to the child.

Additional concerns may be caused if:

  • There has been children's or adult's social care or criminal justice system involvement in the past;
  • There is a history of mobility;
  • There are immigration issues;
  • The parents been subject to proceedings in relation to attendance;
  • There is a history of poor attendance;
  • There is information which suggests the child may be subject to a forced marriage, honour based violence, female genital mutilation or sexual exploitation.

Reasonable enquiry

Day one

The process of ‘reasonable enquiry' starts with the questions above as soon as the child is discovered to be missing (i.e. on the first day). After school staff have exhausted the avenues of enquiry open to them, the education welfare service should continue checking databases within the local authority and other databases (e.g. housing, health and the police) with agencies known to be involved with the family, with the local authority the child moved from originally, and with any local authority to which the child may have moved.

Days two to twenty-eight

If the judgement on the first day of absence is that there is no reason to believe the child is at risk of harm and the school delays further action, the process of reasonable enquiry should be repeated and enhanced, including reviewing the responses to the causes for concern for up to four weeks. This should be undertaken jointly between the school and the education welfare officer.

More than twenty school days

If a child continues to be absent from school for more than twenty school days and both the school and Education Services have made reasonable enquiries to locate them, it is permissible under current regulations for the child's name to be removed from the school roll. Their details may also be uploaded to the DCSF Lost Pupil Database at: www.teachernet.gov.uk/management/ims/datatransfers/. However, this would be very unusual in these circumstances.

If concerns remain in relation to the welfare of the child, the education welfare service and / or Children's Social Care should continue to pursue reasonable enquiries in accordance with Missing from Home and Care, (LSCB Procedures, Section 9.32).

Children of school age who are not registered with a school

Children of school age who are not registered with a school share the same vulnerabilities as those outlined in section above.

Educational achievement contributes significantly to children's well-being and development; all children have a right to education and young children who reach school age or children already in education who move home should be supported to enrol in a new school as seamlessly as possible. This is particularly because children who move frequently are often already vulnerable through being looked after or in temporary accommodation.

Where parents appear not to have taken steps to ensure their child is registered with a school or receiving an appropriate education, the education welfare or service should make urgent enquiries about the child's welfare, and interview the child. If the parent fails to comply with local authority efforts to place the child in school or to receive education in some other way and there are concerns that the child is suffering or is likely to suffer significant harm, this must be referred to Children's Social Care as a child protection matter. 

This process should be initiated for all children, including those who are likely to remain in the county only temporarily or whose stay in the UK is intended to be temporary (other than if a child is visiting for a short holiday). In particular, this process should be implemented for children whose stay may originally be temporary but where they are privately fostered.

Any professional encountering a child of school age who does not appear to be in a school should ask the parent about this and, if the child is not on a school roll or they are concerned that the parent may be evasive about this issue, they must contact their agency's nominated child protection advisor to discuss whether to make a referral to the education welfare or service.

Children of school age who are educated at home but where there are concerns about their welfare

The law allows parents of children in England and Wales to educate their child however they wish. The local authority has limited powers to intervene or even to be informed about this.

If a parent never registers their child at a school, they are not obliged to inform the local authority.

If a parent registers their child at an independent sector school and then withdraws their child from school to educate them at home, they are not obliged to inform the local authority. Nor is the independent school obliged to inform the local authority. Independent schools however in North Yorkshire are recommended to inform the Senior Education Social Worker who will support them in attempting to locate the child.

If the parent registers their child at a state school and then withdraws their child to educate them at home, they are not obliged to inform the local authority. However, they are obliged to inform the state school, which in turn is obliged to inform the local authority within two weeks of removing the child from the school roll. Parents should be encouraged to ask the new school to confirm the child's attendance when they start and if this is not forthcoming within two weeks, the local authority will follow internal missing from school procedures.

Where the local authority is informed of a parent's desire to educate their child at home, they have limited powers but the parent is required to assure them about the nature and quality of the education they are giving to the child.

However, there may be circumstances where the parent is seeking to avoid agency intervention in the child's life to conceal abuse or neglect or where, however well meaning, their desire to educate their child at home may give rise to general concerns about the child's welfare. In these circumstances, it may be necessary for Children's Social Care to conduct an assessment into whether the child's needs are being met or whether they are at risk of significant harm.

Further detail of the North Yorkshire Education Procedure "Children who may be missing or lost from school" is available through the Education Welfare Service (Contacts, LSCB Procedures, Appendix 2). The legal framework is outlined in LSCB Procedures, Appendix 6.

 

9.34 Parental mental illness

Parental mental illness does not necessarily have an adverse impact on a child's care and developmental needs, however, a study of 100 child deaths through abuse or neglect showed clear evidence of parental mental illness in one-third of cases (Falkov, 1996). 

Where a parent has enduring and/or severe mental ill-health, children in the household are more likley to be at risk of, or experiencing, significant harm. A child at risk of significnat harm or whose well being is affected could be a child:

  • Who features within parentsl delusions;
  • Who is involved in his/ her parent's obsessional compulsive behaviours;
  • Who becomes a target for parental aggression ro rejection;
  • Who has caring responsibilities inappropriate to his/ her age;
  • Who may witness disturbing behaviour arising from the mental illness (e.g, self harm, suicide, uninhibited behaviour, violence, homicide);
  • Who is neglected physically and/ or emotionally by an unwell parent;
  • Who does not live with the unwell parent, but has contact (e.g, formal unsupervised contact sessions or the parent sees the child in visits to the home or on overnight stays);
  • Who is at risk of severe injury, profound neglect or death. 

Or s/he could be the unborm child of a pregnant woman which any previous majore mental disorder, including disorders of schizophrenic, any affective or schizo-affective type; also severe personality disorders involving known risk or harm to self and/ or others.

The following factors may impact upon parenting capacity and increase concerns that a child may have suffered or be at risk of suffering significnat harm:

  • History of mental haelth problems with an impact on the sufferer's functioning;
  • Unmanaged mental health problems with an impact on the sufferer's functioning;
  • Maladaptive coping strategies;
  • Misuse of drugs, alcohol or medication;
  • Severe eating disorders;
  • Self harming or suicidal behaviour;
  • Lack of insight into illness and impact on the child, or insight is not applied;
  • Non-compliance with treatment;
  • Poor engagement with services;
  • Previous or current compulsory admissions to mental health units;
  • Disorder deemed long-term "untreatable", or untreatable within timescales compatible with the child's best interests;
  • Mental haelth problems combined with domestic abuse and/ or relationship difficulties;
  • Mental health problems combined with isolation and/ or poor support networks;
  • Mental health problems combined with criminal offending ( forensic);
  • Non-identification of the illness by professionals ( e.g, untreated post-natal depression can lead to significant attachment problems);
  • Previous referrals to Children's Social Care for other children.

Adult mental health services should have named nurses/ doctors/ professionals for safeguarding children within their agency and seek advice from them if necessary.

Importance of working in partnership

Adult mental health professionals must identify those service users who are pregnant and those who are parents or who may have access to children, whether they reside with children or not. Professionals should consider the needs of all children as part of their Care Programme Approach ( CPA) assessments.

When adult mental health services and Children's Social Care are both involved with a family, joint assessments should be carried out to assess the support parents need and the risk of harm to the children in line with Section 5, LSCB Procedures.

Where approproate, children should be given an opportunity to contribute to assessments as they often have good insight into the patterns and manifestations of the parent's mental ill- health.

CPA assessments and meetings for any adult who is a parent must include ongoing monitoring of the needs and risk factors for the children concerned. Children's Social Care should be invited to contribute if they are involved with the family or where risks and needs have been identified that justify their involvement.

Mental health profesisonals must be ncluded in strategy meetings, child protection conferences or associated meetings if a mental health service user is involved.

Mental health inpatient services should have written policies regarding the welfare of children and particularly the visiting of inpatients by children.

LSCBs are responsible for taking full account of the challenges and complexities of work in this area by ensuring  that inter-agency/ disciplinary protocols are in place to clarify arrangements for co-ordination of assessment, support and collaboration. 

 

 

9.35 Parents with learning disabilities

Parental learning difficulties do not necessarily have an adverse impact on a child's developmental needs but it is essential to always assess the implications for each child in the family.  Learning disabled parents may need support to develop the understanding, resources, skills and experience to meet the needs of their children. Such support is particularly necessary where the parent/s experience the additional stressors of:

  • Social exclusion;
  • Having a disabled child;
  • Experiencing domestic abuse;
  • Having poor mental health;
  • Having substance misuse problems;
  • Having grown up in care.

In most cases it is these additional stressors, when combined with a parents learning disability, that are most likely to lead to concerns about the care their child/ren may receive. If a parent with learning difficulties appears to have difficulty meeting their child/ren's needs, a referral must be made to Children's Social Care, who have a responsibility to assess the child's needs and offer supportive and protective services as appropriate.

 Where a parent has enduring and/ or severe learning difficulties, children in the household are more likley to be at risk of, or experiencing, significant harm through emotional abuse and/or neglect, but also through physical and/ or sexual abuse. The following factors may contribute to a child having suffered or being at risk of suffering significant harm:

  • Children of parents with learning difficulties are at increased risk from inherited  learning disability and more vulnerable to psychaitric disorders and behavioural problems, including alcohol or substance misuse and self- harming behaviour;
  • Children having caring responsibilities inappropriate to their years placed upon them, including looking after siblings;
  • Neglect leading to impaired growth and development, physical ill health or problems in terms of being out of parental control;
  • Mothers with learning disabilities may be targets for men who wish to gain access to children for the purpose of sexually abusing them.

Children's Social Care, Health and Adult Services and other agency services must undertake a multi-disciplinary assessment using the Assessment Framework, including specialist learning disability and other assessments, to determine whether or not parents with learning disabilities require support to enable them to care for their children. Such assessment will also assist in considering whether the level of learning disability is such that it may impair the health or development of the child for an adult with learning disabilities to be the primary carer.

All agencies must recognise that their primary duty is to ensure the promotion of the child's welfare, including their protection from any risk of harm.

LSCBs are responsible for taking full account of the challenges and complexities of work in this area by ensuring inter-disciplinary/ agancy protocols are in place for the co-ordination of assessment and support, and for close collaboration between all local children's and adult's services.

Vulnerable adults services should ensure eligibility criteria for service provision is such that parent's with learning disabilities who need help in order to be able to care for their children can benefit from support provided under the NHS and Community Care Act 1990.

Group education combined with home-based support increases parenting capacity. Supported parenting should include:

  • Accessible information;
  • Advocacy;
  • Peer support;
  • Multi-agency and multi-disciplinary re/assessments;
  • Long-term home-based and other support.

For further information see Good practice guidance on working with parents with a learning disability ( DH/DfEs 2007).

 

 

9.36 Parents who misuse substances

Refer to LSCB Practice Guidance: Available on the LSCB Website.

Although there are some parents who are able to care for and safeguard their children despite their dependence on drugs or alcohol, parental substance misuse can cause significant harm to children at all stages of their development. A thorough assessment is required to determine the extent of need and level of risk of harm for each child in the family.

Where a parent has enduring and/ or severe substance misuse problems, children in the household are likely to be at risk of, or experiencing, significant harm primarily through emotional abuse or neglect.

Maternal substance misuse in pregnancy

Maternal substance misuse in pregnancy can have serious effects on the health and development of the child before and after birth.  Many factors affect pregnancy outcomes, including poverty, poor housing, poor maternal health and nutricion, domestic violence and mental health. Assessing the impact of parental substance misuse must take account of such factors. Pregnant women (and their partners) must be encouraged to seek early antanatal care and treatment to minimise the risks to themselves and their unborn child.

Newborn babies and children

Newborn babies may experience withdrawal symptoms (e.g, high pitched crying and difficulties feeding), which may interfere with the parent/ child bonding process. Babies may also experience a lack of basic health care, poor stimulation and be at risk of accidental injury.

The risk to children may arise from:

  • Substance misuse affecting the parent/s practical caring skills: perceptions, attention to basis physical needs and supervision which may place the child in danger (e.g, getting out of the home unsupervised);
  • Substance misuse may also affect control of emotion, judgement and quality of attachment to, or separation from the child;
  • Parents experiencing mental states or behaviour that put children at risk of injury, psychological distress (e.g, absence of consistent emotional and physical availability), inappropriate sexual and/ or aggressive behaviour, or neglect (e.g, no stability and routine, lack of medical treatment or irregular school attendance);
  • Children are particularly vulnerable when parents are withdrawing from drugs;
  • The risk is also greater where there is evidence of parental mental ill health, domestic violence and when both parents are misusing substances;
  • There being reduced money available to the household to meet basic needs ( e.g, adequate food, heat and clothing, problems with paying rent ( that may lead to household instability and mobility of the family from one temporary home to another));
  • Exposing children to unsuitable friends, customers or dealers;
  • Normalising substance misuse and offending behaviour, drugs and alcohol (e.g, methodone stored in the fridge or in an infant feeding bottle). Where a child has been exposed to contaminated needles and syringes;
  • Children having caring responsibilities innappropriate to thier years placed upon them;
  • Parents becoming involved in criminal activities, and children at possible risk of separation (e.g, parents receiving custodial sentences);
  • Children experiencing loss and bereavement associated with parental ill health or deat, parents attending inpatient hospital treatment and rehab programmes;
  • Children being socially isolated ( e.g, impact on friendships), and at risk of increased social exclusion (e.g, living in a drug using community);
  • Children maybe in danger if they are a passanger in a car whilst a drug/ alcohol misusing carer is driving.

Children whose parents are misusing substances may suffer impaired growth and development  or problems in terms of behaviour and/ or mental/ physical health, including alcohol/ substance misuse and self-harming behaviour.

See the Mational Patient Safety Alert ( November 2009) Preventing harm to children from parents with mental health needs.

Importance of working in partnership

Substance misuse professionals msut identify those adults who are parents, or who have regular care giving access to children, and share the information with Children's Social Care as early as possible.

Children's Social Care, substance misuse services and other agency services must undertake a multi-disciplinary assessment using the Assessment Framework (including specialist substance misuse/ other assessments) to determine whether or not parents with substance misuse problems can care adequately for thei child/ren. Such assessment should include whether they are willing and able to lower or cease their substance misuse, and what support they need to achieve this.

Professionals in all agencies must recognise that their primary duty is to safeguard and promote the welfare of the child/ren.

All care programme meetings for adults who are a parent must include ongoing assessment of the needs or risk factors for the child/ren concerned. Children's Social Care should be invited to such meetings if appropriate and contribute.

Strategy meetings, child protection conferences and core group meetings must include professionals from any drug and alcohol service involved with the subject and their family.

LSCBs are responsible for taking full account of the challenges and complexities of work in this area by ensuring that inter-disciplinary/ agency protocols and training are in place for the co-ordination of assessment and support and for close collaboration between all local children's and adult's services.

 

9.37 Power of Entry: Police Powers

Whenever concern is expressed to the Police abpout a child, officers should take positive steps to see the child to establish the child's welfare.

This concern may come from an incident that the Police are dealing with or it may be a request from a partner agency. It is important to note that there are a number of agencies and professionals who work in partnership with the Police to safeguard children e.g, social workers and health visitors. They will only ask for Police assistance when absolutely necessary. Police should deal with such requests positively remembering that these professionals do not have the same powers of entry as Police Officers do.

 

Checking on a child's welfare should be with the consent of the parent or carer where possible. If an offence is reasonable suspected or there is reasonable suspicion of harm an officer will be acting legally in obtaining entry with or without consent. It may be that refusal to allow entry by a parent or carer arouses suspicion that a child has been harmed and indicates an intention to conceal the harm.

The exercise of powers of entry in order to protect children and respond to suspicions of child abuse should generally be considered reasonable within the Human Rights Act 1998.Police Officers should record in their notebook their reasons for taking action.

 

 

9.38 Pregnancy and motherhood of a child

Mother under 16 years but over 13 years of age

Professionals who come into contact with this age group should refer to Section 9.51 for guidance on factors that may necessitate a referral to Children's Social Care. If additional support is needed but there are no concerns, then a referral can be made to the local Children's Centre but only with the young person's consent.

 

Mother under 13 years

Section 9.51, LSCB procedures also clearly states the legal situation regarding sexual activity in this young age group. When a professional becomes aware of a girl under 13 years who is pregnant then a referral to Children's Social Care must be made.

Mother over 16 years

If professionals have child welfare concerns for either the baby or the mother where the mother is over 16 years, they should consult with their designated child protection lead and make a referral to Children's Social Care if appropriate.

 

9.39 Pre-trial therapy

One or more assessment interviews should be conducted in order to determine whether and in what way the child is emotionally disturbed, and also whether therapeutic treatment is needed. This could be as part of an assessment undertaken using the Assessment Framework.

The decision about the need for therapeutic support (separate from formal court preparation of a child witness) should be considered:

  • Keeping the child's interests paramount;
  • Taking the child's wishes and feelings into account;
  • On a multi-agency basis;
  • In consultation with the child's parent/s;
  • Taking the potential impact on criminal proceedings into account.

The decision should normally be made following a professional assessment of the child's need for therapy, and may be taken as part of a strategy meeting or in a child protection conference, or, if the child is not subject to child protection processes, in a multi-agency meeting arranged for this purpose.

If there is a demonstrable need for the provision of therapy and it is possible that the therapy will prejudice the criminal proceedings, consideration may need to be given to abandoning those proceedings in the interests of the child. Alternatively, there may be some children for whom it will be preferable to delay therapy until after the criminal case has been heard, to avoid the benefits of the therapy being undone.

While some forms of therapy may undermine the evidence given by the witness, this will not automatically be the case. Multi-agency advice must be sought on the likely impact on the evidence of the child receiving therapy.

An assessment may be needed to inform a decision on whether a child with special needs (e.g. disabled children and those with learning disabilities, hearing and speech impairments etc) can, with the appropriate assistance, be a competent witness.

Therapeutic support may be sought / offered through a number of routes. Professionals who provide therapeutic support to children must be aware of the guidance Provision of Therapy for Child Witnesses (Home Office / CPS / DoH 2001, available at www.cps.gov.uk and the implications for the criminal process in terms of both disclosure and contamination of evidence.

The initial joint investigative interview with the child, including any visually recorded interview, should be undertaken prior to any new therapeutic work in order that the original disclosure is not undermined.

Where it becomes apparent that a child is already receiving therapeutic support at the point of the criminal investigations and child protection enquiries, there must be discussion as to how the work should proceed. The fact that therapeutic work is already underway will not necessarily prevent a case proceeding before a criminal court. Prosecutors may need to be made aware of the contents of the therapy sessions, as well as other details specified in the above paragraph, when considering whether or not to prosecute and their duties of disclosure.

Crown Prosecution Service

The police should inform the Crown Prosecution Service as soon as therapeutic support is recommended, using a named contact point for the case relating to the child. Direct consultation between the professionals may be advisable in some cases and should be arranged through the police officer in the case.

The Crown Prosecution Service should advise the police of the potential impact of any proposed therapeutic support on criminal proceedings in each individual case. It is the responsibility of the reviewing crown prosecution lawyer to seek confirmation from the police as to:

  • Whether therapeutic work has been undertaken;
  • If so, whether the witness said anything inconsistent with the disclosure to the police;
  • What sort of therapeutic work was undertaken.

Therapeutic services

Professionals who provide therapeutic support to children must have appropriate training according to the level of work to be undertaken, as well as a thorough understanding of the effects of abuse. They must be a member of an appropriate professional body or have other recognised competence. They must also have a good understanding of how the rules of evidence for witnesses in criminal proceedings may require modification of techniques.

Pre-trial planning meeting

Where it is considered that therapeutic intervention is appropriate and has been commissioned, a pre-trial planning meeting should be convened.

Where Children's Social Care is involved with the child, the Deputy Service Manager/ Service Manager should convene and chair the meeting, and arrange for a formal record of it to be made. Where Children's Social Care is not involved, the therapeutic service commissioned to undertake work, or already involved with the child, should convene the meeting. A formal record of the meeting should be made, and it should be noted that this may be disclosed in criminal proceedings.

Pre-trial planning meetings will involve relevant professionals from Children's Social Care, police and the service offering therapeutic work. They may also include:

  • Parents (unless implicated in the alleged abuse);
  • The child, if of sufficient age and understanding;
  • Other relevant professionals.

Considerations at the pre-trial therapy meeting

The purpose of the pre-trial meeting is to:

  • Confirm that therapeutic intervention is in the best interests of the child (including taking into account the child's right to justice);
  • Agree the parameters and nature of any proposed therapeutic support, ensuring that the process is subject to regular review;
  • Agree lines of communication between the professional who will undertake the work and other professionals.

In deciding on what therapeutic support is appropriate to pursue pre-trial, the following considerations apply:

  • Therapeutic support is on an individual basis (i.e. no joint or group sessions are normally acceptable because of the increased risk of contamination of evidence);
  • Where joint or group sessions are already in progress, the implications for continuing must be considered, and in addition the particular implications for recording what take place.
  • Therapeutic support may be subject to challenge at court.

Therefore, it is better that only one worker provides the support.

Therapy

The professional providing therapeutic support must be able to demonstrate professional competence or a sufficient level of supervision if called in a subsequent trial.

If, during a therapeutic session, a child refers to the abuse they have suffered, the worker should:

  • Listen and acknowledge what has been said;
  • Not seek clarification or ask probing or investigative questions;
  • Consider whether there is new or additional allegations or information which require urgent discussion with the police / social worker.

The professional who will provide therapeutic support should be given sufficient information about the nature of the abuse alleged by the child to be able to judge if the child begins to make new or additional allegations within a session.

Care should be taken in the recording of therapeutic sessions (videos, tapes and written records). Immediate, factual, concise and accurate notes must be made for each session, which must be retained in their original format so that they can be produced at a later date if required. Any notes, visual or audio recordings, pictures etc. used during the therapeutic sessions must be similarly maintained.

A pro-forma document will be completed following each session and will include:

  • Date and location of session;
  • Duration of session;
  • Details of the professional undertaking the work with the child;
  • Details of child;
  • Details of other professionals present;
  • Confirmation that records of the therapy sessions have been made.

The pro-forma documents will be copied prior to any criminal trial and the original document forwarded to the Crown Prosecution Service via the police.

Confidentiality not guaranteed

The professional undertaking therapeutic work needs to ensure that parents and any child of sufficient age and understanding are told that records are kept and that confidentiality cannot be guaranteed.

Any disclosure of new allegations by the child, or any material departure from or inconsistency with the original allegations should be reported to the Police Protecting Vulnerable Persons Unit and to the child's social worker.

In newly arising allegations, therapy should not usually take place before a witness has provided a statement or, if appropriate, before a video-recorded interview has taken place. A further pre-trial planning meeting will be convened at the earliest opportunity to determine and agree the best course of action in the light of the new information or allegations.

Problem resolution

Any dissatisfaction should be resolved as simply as possible. This would normally be via discussion between the social worker, the professional providing the therapeutic support and the police officer in the criminal case. Where disputes remain, a further pre-trial planning meeting should be convened with the Crown Prosecution Service, and involving appropriately senior agency representatives.

 

9.40 Private Fostering

Private fostering is when children and young people are cared for on a full time basis by a person who is not their parent, a person with parental responsibility or a "relative". Private fostering arrangements are those where it is intended for the placement to be of 28 days or more. They are generally made with the agreement of the child's parent, but this may not necessarily be the case.

A child under the age of 16, who is a pupil at an independent school and lives at the school during school holidays for a period of more than two weeks, will also be treated as privately fostered unless any exemptions applies.

Private fostering only applies to children under 16 years, or under 18 if they are disabled.

Private foster carers can be part of the child's wider family, a friend of the family, the parents of the child's boyfriend or girlfriend or someone unknown but willing to foster a child. Relatives, as defined by the Children Act 1989 to include a grandparent, brother, sister, uncle or aunt (whether of full or half blood or by marriage), or a step-parent, are not private foster carers. Note that the unmarried partner of a parent is not a "step-parent" for this purpose and will be considered to be a private foster carer.

A large range of children can be covered by these arrangements, including:

  • children (sometimes very young) where a parent is unable to care for them because of chronic ill health or where there are alcohol, drug or mental health issues. Sometimes the parent may be in prison;
  • adolescents temporarily estranged from their parents;
  • children in services families where parents are posted overseas;
  • children from overseas where parents are not resident in this country;
  • children from abroad who attend a language school or mainstream school in England, staying with host families.

The statutory responsibility for private fostering lies with the local authority, North Yorkshire Children and Young People's Service.  The General Manager in Children's Social Care has been appointed as the Responsible Officer for private fostering.

The Chair of the North Yorkshire Safeguarding Children Board will receive a report from the local authority every year about how the welfare of privately fostered children is safeguarded and promoted, including how they cooperate with other agencies in this area.

International Aspects

Any person who has limited leave to remain in the United Kingdom must leave the country before his or her leave expires or apply to extend that leave. If he does not do so, he will automatically become an overstayer, which is a criminal offence (except for children under age 10), and will be liable to removal from the United Kingdom.

Parents may make an application to the Home Office Immigration and Nationality Directorate for an extension of leave to remain, whether in relation to themselves or their children. It should be noted that any application for an extension of leave to remain must be made before the child’s current leave expires; and that there is no provision in the Immigration Rules for a person who was admitted for 6 months as a visitor to be granted further leave to remain as a visitor or a student.

A person born in the United Kingdom prior to 1 January 1983 is a British citizen and is not therefore subject to immigration control. A child born in the United Kingdom after that date will be a British citizen if at the time of his birth his father or mother is a British citizen or lawfully settled in the United Kingdom. A new born child who is found abandoned in the United Kingdom is assumed to meet the above requirements unless the contrary is shown i.e. the child will be assumed to be a British Citizen.

The social worker should check a privately fostered child’s passport to in order to ensure the child’s immigration status, in particular that the child is lawfully present in the UK. This should be done on the first occasion that the child is seen following notification that a private fostering arrangement is in place. This simple, practical step is also an important means of confirming the child’s identity. For children who are UK citizens, it is recognized that they may not hold a passport. A local authority or private foster carer who is in any doubt about a child’s immigration or nationality status should advised to consult the Home Office Immigration and Nationality Directorate at the earliest opportunity. The local authority can also seek assistance from the authorities in the country of origin or the International Social Service (ISS) with a view to tracing the child’s parents and arranging for the child to be returned to them. In most cases, the ISS is able to provide for the exchange of medical and educational histories of a child, as well as to ascertain whether there would be any reasonable grounds not to return the child to his parents and whether parental responsibility has been terminated or circumscribed by any overseas authority, or to make arrangements for the reunification of the child with his parents overseas.

EEA Nationals

EEA national children who come to the UK as students, and who are not accompanied by their parents, have the same rights to education as British citizens.  Non-EEA children of EEA parents who are not accompanied by their parents do not have this right.

Non-EEA Nationals

Holders of passports describing them as British Dependent Territories Citizens or British Overseas Citizens have no automatic right of abode in the UK, nor do other non-EEA nationals.

Entitlement to Health Service for Children from Overseas

A child from overseas, who is resident in the UK lawfully and for a settled purpose, may apply to register with a General Practitioner, or their parent or private foster carer may do so on their behalf.

A child who is being privately fostered may or may not be chargeable for NHS hospital treatment, depending on the exact circumstances of their stay in the UK. A child who, for example, enters the UK on a visitor’s visa, but then remains beyond the validity of that visa, being privately fostered while his parents return to their home country, would not be here legally and could, therefore, be charged for NHS hospital treatment.

Making arrangements

Any parent proposing to have their child looked after by someone other than a close relative for more than 28 days, or a carer who is proposing to look after someone else's child, must notify Children's Social Care at least 6 weeks before the arrangement is due to begin or as soon as arranged if less than six weeks. 

A person who proposes to accommodate a child or children at school in circumstances in which some or all of them will be treated as private foster children must give written notice of his or her intention to the Local Authority, stating the estimated number of children, not less than 2 weeks before the arrangements begin.

Notification should be made initially to the CSC customer support centre, followed by written confirmation.  For all private fostering arrangements the standard notification form should be used.  This form is available the North Yorkshire County Council Customer Service Centre, the contact details of which are available from the link below:

http://www.northyorks.gov.uk/contactus

This is known as a proposed arrangement. In these circumstances the Contact Centre should be contacted in writing and the referral will be passed on to the relevant geographical social work team.


The social work team will make arrangements to see the child, the child's parents (if possible), the carers and other members of the carer's household. An assessment will be made about the suitability of the proposed arrangements, including Enhanced Criminal Record Disclosure with a Barred List Check for working with children on all members of the household aged over 16 years.

Where a private fostering arrangement is made or is an emergency arrangement has been put in place the carer or parent must tell Children's Social Care within 48 hours of receiving the child. A social worker will visit within 7 working days to see the child, the child's parents (if possible), the carers and other members of the carer's household. An assessment will be made about the suitability of the arrangements, as in the paragraph above.

Limit on the number of foster children

In cases where a person is privately fostering, or proposes to foster privately, more than three children who are not siblings at any one time, then that person needs an exemption from the local authority.

If a private foster carer exceeds the usual fostering limit or, where exempted, privately fosters a child not named in the exemption and in so doing exceeds the usual fostering limit he shall be treated as carrying on a children’s home. Any person who carries on a children’s home without being registered in respect of the home under the Care Standards Act 2000 is guilty of an offence (see section 11 of that Act).

Where arrangements are suitable

Where the decision is taken that the arrangements are suitable a social worker will visit the child every 6 weeks during the first year and then every 12 weeks thereafter. Their role is to promote the welfare of the child and check that arrangements are still suitable. The social worker will also provide advice and support to the carers and the parents.

The social worker should make sure the child's racial, cultural, linguistic and religious needs are being met. The social worker should see the child alone on each visit and will write a record of each visit.

If there are any changes in circumstances the private foster carer should inform the social worker. Likewise the carer or parent (person with parental responsibility) must notify Children's Social Care immediately about any change in circumstances, including if the child changes address, someone living in the household is convicted of an offence, or someone joins or leaves the household.

Notification of change of circumstances

A private foster carer must notify the Local Authority of:

  • any change of their address
  • any further offence of which they or any person who is part of or employed at their household has been convicted
  • any further disqualification imposed on them or a person who is part of or employed at their household under section 68 of the Children Act 1989
  • any person who begins to be part of or employed at their household, and any offence of which that person has been convicted, and any disqualification or prohibition imposed on him under section 68 or 69 of the Children Act 1989 or under any previous enactment of either of those sections; and
  • any person who ceases to be part of or employed at their household.

The requirement to notify of the change of circumstances exists for the duration of the private fostering arrangement.

Notification must me given in advance where practicable and not more than 48 hours after the change of circumstances.

If the private foster carer’s new address is in the area of another local authority, or the local authority is in Scotland, Wales or Northern Ireland, the Local Authority will pass on to the authority for the area:

  • the name and new address of the private foster carer
  • the name of the child who is being fostered privately; and
  • the name and address of the child’s parents or any other person who has parental responsibility for the child

The parent of a privately fostered child, and any other person who has parental responsibility for the child, who knows that the child is being fostered privately, must notify the Local Authority of any change of their own address.

Where arrangements are suitable with prohibitions

The role of the local authority is to ensure suitable arrangements are in place to promote the safeguarding and welfare of privately fostered children, and to prevent unsuitable persons privately fostering a child in premises that would not safeguard and promote the child’s welfare. 

In some circumstances, the placement of a child may not be suitable or may be suitable with modifications.  Where North Yorkshire County Council carries out an assessment and identifies that a placement would be suitable with modifications, they may impose a prohibition on that person.

Any prohibition must be sent in writing to the person on whom it is being imposed, specifying the reasons and contain information about the person’s right of appeal and the time in which they may do so.

Cancellation of prohibitions

North Yorkshire County Council may cancel a prohibition if they are satisfied that the prohibition is no longer justified. This power enables the Local Authority to respond appropriately to matters raised during the process of conducting enquiries into:

  • the capacity of the proposed or actual private foster carer to look after the child
  • the suitability of their household and premises; or
  • to changes notified by that person

Where arrangements are not suitable

Where the assessment identifies that the private fostering arrangements are not suitable, Children's Social Care has a number of powers, in addition to their existing powers, to take action to safeguard and promote the child's welfare. Steps may need to be taken to secure the care and accommodation of the child. Actions can include stopping someone from privately fostering children or setting limits on the number of children/young people being privately fostered at any one time.

Unless it is identified that it would not be in the best interest of the child who is (or proposed to be) privately fostered, the authority will take such steps that are reasonably practicable to secure the care and accommodation of the child undertaken by:

  • their parent(s)
  • any person who is not a parent but who has parental responsibility for the child/young person, or
  • is a relative

The authority will consider the extent to which (if at all) they should exercise any of their functions in respect of the child.

Appeals

Where the local authority makes a decision to:

  • impose a requirement or prohibition,
  • refuse to cancel a prohibition,
  • refuse to exempt a person from the fostering limit of 3 under Schedule 7 (or impose a condition on an exemption or a variation or cancellation of such an exemption), or
  • refuse to consent to allow a person who is disqualified to privately foster a child,

An appeal may be made to the family proceedings court within 14 days of notification of that decision.  

The roles of other professionals

Wherever professionals become aware of an existing or proposed private fostering arrangement they should encourage the child's parent or carer to notify Children's Social Care.

Professionals who come into contact with privately fostered children - such as teachers, religious leaders, doctors and health visitors - are required to tell Children's Social Care about the private fostering arrangement so that Children's Social Care can carry out their duty to safeguard the child. Professionals should refer the privately fostered child through the Contact Centre.

All private foster carers will be allocated a Social Worker from the Fostering Service to support the private foster carers as well as a social worker for the child.

Notification of the end of a private fostering arrangement

Any person who ceases to privately foster a child must notify the appropriate local authority within 48 hours and must include in the notification the name and address of the person into whose care the child was received and that person’s relationship with the child.  The requirement to notify the Local Authority of the cessation of the arrangement does not apply where the private foster carer intends to resume the private fostering arrangement after an interval of not more than 27 days unless:

(a) they subsequently abandons their intention; or

(b) the interval expires without his having given effect to his intention,

In such circumstances the private foster carer must notify the local authority within 48 hours of abandoning their intention to continue the arrangement, or the expiry of the interval.

Death of a child who is privately fostered

Where a person ceases to privately foster a child because of the death of the child, they must notify the Local Authority within 48 hours.

The Local Authority will ensure that the parent is notified as soon as possible of the death of the child.  The local authority may need to assist the private foster carer with the formalities and in any event will need to consider the implications of what has happened.  Where a child has died, the Local Authority must follow the Child Death procedures outlined within the North Yorkshire Safeguarding Children Board’s procedures.

Further information and procedures

For further information in relation to private fostering please see the North Yorkshire County Council website at the following address:

http://www.northyorks.gov.uk/privatefostering

9.41 Prostitution: Parental involvement in prostitution

Involvement of family members in prostitution does not necessarily mean children will suffer significant harm. 

Where there is a concern for a child whose parent or carer is involved in prostitution the following factors should be considered when undertaking an Assessment:

  • Any exposure of the child to unsuitable adults and sexual activity or materials especially where the parent works from home;
  • Any emotional, physical or sexual abuse of the parent or any behaviour in another adult which leaves the parent involved in prostitution in fear;
  • Child left unattended or being left with the responsibility of younger siblings;
  • Factors associated with substance misuse and/or mental health difficulties;
  • Inconsistent care.

Where there is a concern for a child whose parent is involved in prostitution, the Assessment should always consider the child's development in the context of parenting capacity and family and environmental factors.

 

9.42 Psychiatric care of children

Psychiatric care for children

This section provides additional guidance to section 5.21 Hospitals and section 5.22 Hospitals (specialist), and the sections should be read in conjunction with each other. See also the National Service Framework for children, young people and maternity services (Children's NSF) which sets out standards for hospital services in respect of individual children's safety and well-being.

Children who require treatment as an in-patient in a psychiatric setting will usually be admitted on a voluntary basis, otherwise the Mental Health Act 1983 or the Children Act 1989 will apply. The admission criteria will differ, such as acute (crisis or short term), for eating disorders or challenging behaviour. Age ranges can vary considerably and some children may be admitted to an adult psychiatric setting. Catchment areas for some hospitals may cover a regional or national area depending on the specialism.

Where consent for treatment is required, it should be clarified by the lead professional (e.g. Children's Social Care, child and adolescent mental health services (CAMHS)) whether this is being carried out under the Mental Health Act 1983 or the Children Act 1989.

If any child who is considered to be Gillick competent is unwilling to remain as an informal patient consideration should be given to use the Mental Health Act 1983. For children under 16 where a Gillick competent child wishes to discharge him or herself as an informal patient from hospital, the contrary wishes of those with parental responsibility will ordinarily prevail. Where there is dispute consideration should be given to use the Act.  Similarly if a 16 or 17 year old in unwilling to remain in hospital as an inpatient, consideration may need to be given whether he or she should be detained under the Act.

Children in psychiatric settings may need to be isolated from other patients or require control and restraint on occasions, and staff should be appropriately trained to meet their needs and safeguard their welfare. When a child is admitted to psychiatric settings where adults are inpatients, a risk assessment must be undertaken to avoid the child being placed in vulnerable situations.

Children admitted to psychiatric settings may disclose information about abuse or neglect concerning themselves or others. Disclosures may be made when the child feels it is safe to talk or when the child is angry, distressed or anxious. All allegations should be treated seriously and usual procedures followed.

Children visiting psychiatric wards and facilities

Visits by children to psychiatric wards or hospitals should be undertaken to maintain a positive relationship for the child with the patient, who will usually be their parent or more rarely a family member such as a sibling. A visit by a child should only take place if it is in their best interest.

This section applies to children visiting all patients receiving in-patient treatment and care from specialist psychiatric services, whether or not they are detained under the Mental Health Act 1983. This includes children visiting detained adolescent patients and adolescents who are being cared for in adult facilities.

Visiting patients in psychiatric wards

When children visit adult patients, all psychiatric in-patient settings should:

  • Place child welfare at the heart of professional practice for all staff involved in the assessment, treatment and care of patients;
  • Take account of the needs and wishes of children as well as patients;
  • Address the whole process, including preadmission assessment, admission, care planning, discharge and aftercare;
  • Assess the desirability of contact between the child and patient, identify concerns and assess the potential risks of harm to the child in a timely way;
  • Establish an efficient procedure for dealing with requests for child visits in those cases where concerns exist;
  • Establish a process for child visits which is:
    • Not bureaucratic;
    • Supportive of both the child and the adult;
    • Does not cause delay in arranging contact;
    • Maximises the therapeutic value of the visit;
    • Ensures the child's welfare is safeguarded.
  • Set and maintain standards for the provision of facilities for child visiting;
  • Ensure that staff are competent to manage the process of child visits.

Compulsory admission

When a compulsory admission is planned for an adult who is a parent, the approved social worker must assess the child/ren's needs and the suitability of arrangements for their care. If there are concerns about the safety or care arrangements of the child/ren, the approved social worker must request that Children's Social Care undertakes an assessment. Children's Social Care should make a recommendation to the hospital about the suitability of the children visiting their parent.

The approved social worker should, wherever possible, provide the hospital with the child/ren's assessment information. This may, as appropriate, include the recommendation made by Children's Social Care when the patient was admitted, together with the views of those with parental responsibility about the child/ren visiting the patient in hospital.

Expected visit by a child

The ward manager is responsible for the decision to allow a visit by a child. When a visit by a child is expected, the ward manager should consider the available information about the child, alongside the assessment of the patient's needs for treatment and care and an assessment of the current state of the patient's mental health. The ward manager should then make the decision in consultation with other members of the multi-disciplinary hospital team.

The ward manager must make their decision on the basis of the interests of the child being paramount, superseding those of the adult patient.

Unexpected visit by a child

If a child visits unexpectedly, the ward manager is responsible for deciding  whether it is feasible, whilst they wait, to consider the available information 18 The Guidance on the Visiting of Psychiatric Patients by Children HSC 1999/222; and LAC (99) 32: Mental Health Act 1983 code of practice : guidance on the visiting of psychiatric patients by children about the child, alongside the assessment of the patient's needs for treatment and care and an assessment of the current state of the patient's mental health. The ward manager should then make the decision in consultation with other members of the multi-disciplinary hospital team. If this is not feasible, the visit must be refused.

Patients admitted informally

Most patients are admitted informally. When a patient has been admitted on an informal basis, nursing staff should seek out information about children who may be visiting. When nursing staff are aware that a patient has a child, and there is a LA children's social worker or adult mental health care coordinator working with the patient, nursing staff should check with the social worker / care co-ordinator about the desirability of children visiting and the arrangements which have been made. Such discussions should be clearly documented.

If there are concerns about the safety or care arrangements of the child/ren and there is no LA children's social worker involved, the ward manager must request that Children's Social Care undertake an assessment. Children's Social Care should make a recommendation to the hospital about the suitability of the child/ren visiting the patient.

Where Children's Social Care has been asked to undertake such an assessment, their report should be sent back within one week of receipt of the written request / referral from the ward manager in order to avoid delay in arrangements for the child.

The ward manager is responsible for the decision to allow a visit by a child, and must follow the same decision making process for informal admissions and for compulsory admission.

In the vast majority of cases where no concerns have been identified, arrangements should be made to support the patient and child and to facilitate contact.

Identifying concerns

Concerns about the desirability of a child visiting may arise in a number of areas. These could relate to:

  • Consideration of the child's best interests;
  • The patient's history and family situation;
  • The patient's current mental state (which may differ from an assessment made immediately prior to or on admission);
  • The response by the child to the patient's illness;
  • The wishes and feelings of the child;
  • The developmental age and emotional needs of the child;
  • The views of those with parental responsibility;
  • The nature of the service and the patient population as a whole;
  • Availability of a suitable environment for contact.

The hospital multi-disciplinary team may use the Framework for Assessing Children in Need and their Families to consider the best interests of the child in these situations.

A range of options may present themselves when concerns are identified in any of the areas above, and the concerns need not automatically result in a refusal of visiting. The hospital multi-disciplinary team must obtain a balance between the management of risk of harm and the interests of the child/ren and patients.

It may be helpful for the Hospital Trust to consider whether or not to provide a service to facilitate contact. Research has highlighted the dangers of loss of contact with children for people who are psychiatric in-patients in hospital. Decisions to refuse a child's visits.

The ward manager may refuse to allow a child to visit if they have reason to believe it is not in the best interest of the child or patient.

The decision to prohibit a visit should be regarded as a serious interference with the rights of the patient and should only be taken in exceptional circumstances.

Decisions to refuse visits should be given verbally and confirmed in writing. They must be supported by clear evidence of concerns and the difficulties of managing them.

Policies should clearly set out the steps to be taken in making the decision to refuse visiting, including the process for:

  • Consulting with the patient, the child (depending on age and understanding), those with parental responsibility and, if different, person/s with day to day care for the child, advocates and, where relevant, the Children's Social Care;
  • Communicating the decision to the patient, other family members, the child and those with parental responsibility;
  • Reviewing any decision and the means of communicating this to the patient, advocate or other person or agency involved in the decision;
  • Enabling a patient and others with parental responsibility to make representation against any decision not to visit, including access to assistance and independent advocacy. Such a system should be consistent with the Trust's overall complaints procedure and should contain an independent element.

Making arrangements for visits

The hospital or mental health trust providing the service must ensure that the hospital contains facilities for all patients to have contact with their children in a venue which is conducive to the child's safety and good quality contact for both child and patient.

Children should have appropriate supervision according to their age and need when they are visiting mental health service users. They should normally be accompanied by someone who has parental responsibility for their care and well being.

In some cases, it may be better for arrangements to be made for visiting away from the hospital. In the case of detained patients, this will require due consideration of the need for leave. Staff must be aware of the child protection and child welfare issues in granting leave of absence under s.17 of the Mental Health Act 1983.

Visiting patients in the special hospitals:

Ashworth, Broadmoor and Rampton Specialist hospitals must have procedures for child visiting that have been developed specifically for that service. Decisions about whether to permit a child to visit a unit must always be based on:

  • The interests of the child;
  • The service user's offending history;
  • The clinical history of the service user;
  • The conditions under which the visit will take place.

A hospital may not allow a child to visit any patient unless the hospital's authority has approved the visit in accordance with the directions pertaining to the patient's admission (see 5.36.41 and The Directions and associated guidance to Ashworth, Broadmoor and Rampton Hospital Authorities (HSC 1999/160)) and in particular is satisfied that the visit is in the child's best interests. The only exception to this is where there is a contact order made under the Children Act 1989 which specifies that the child may visit the patient in the special hospital. In such cases, visits should be allowed except where there are concerns about the patient's mental state at the time of the proposed visit, such that the nominated officer decides the visit would not be in the child's best interests.

Request for a child to visit

There may be cases where the patient has been:

  • Convicted of murder or manslaughter, or an offence which leads to them being identified (by probation / youth offending services, police or health services, individually or via the Multi-Agency Public Protection Arrangements) as posing an ongoing risk to a child; or
  • Found unfit to be tried or not guilty by reason of insanity, in respect of a charge of murder or manslaughter or an offence which leads to them being identified (by probation / youth offending services, police or health services, individually or via the Multi-Agency Public Protection Arrangements) as posing an ongoing risk to a child, In these circumstance, the child must be within the permitted categories of relationship set out in The Directions and associated guidance to Ashworth, Broadmoor and Rampton Hospital Authorities (HSC 1999/160).

If the patient's circumstances are not those in section or the child is within the permitted categories of relationship, the nominated officer should:

  • Obtain written permission from the patient to contact those with parental responsibility for the child;
  • Write to the person/s with parental responsibility for the child:
    • Explaining that a request for a visit has been made;
    • Asking for confirmation of the relationship between the patient and the child;
    • Requesting consent for the child to visit the patient;
    • Explaining that before a visit can proceed, Children's Social Care will be asked to assess whether the visit is in the child's best interests.

• Write to any person/s without parental responsibility but with day-to-day care for the child (e.g. a grandparent), explaining that a request for a visit has been made and that the person with parental responsibility will be contacted.

In the case of a child who is looked after by the local authority and subject to a care order (with parental responsibility shared by the local authority and the parent/s), Children's Social Care has responsibility for providing consent (following consultation with those with parental responsibility). Where a child is looked after by the local authority but not subject to a care order, the person with parental responsibility is required to give their consent.

If those with parental responsibility state that they are prepared to allow their child to visit the patient, the nominated officer should arrange for the patient's clinical team to undertake an assessment. This assessment is to judge the level of risk, if any, presented by the patient to children and to the particular child for whom the visit request has been made. Procedures for undertaking this type of assessment should be agreed with both the relevant Children's Social Care service and Local Safeguarding Children Board for the hospital.

If the hospital's assessment of the risk of harm posed by the patient to the child does not rule out a visit, the nominated officer must:

  • Contact the Director of Children's Services for the Children's Social Care service where the child resides to request advice on whether the visit is in the best interests of the child;
  • Include in the request a copy of the hospital's assessment and any other any relevant information about the patient, to assist Children's Social Care to assess whether the proposed visit is in the child's best interests;
  • Include in the request any information about other Children's Social Care services which have relevant information about the child or the child's family;
  • Inform the parents of the child that Children's Social Care have been asked to make contact with the family.

Children's Social Care response

On receipt of the request from the hospital, Children's Social Care should contact those with parental responsibility (and those caring for the child if they are different) to arrange to undertake an assessment to establish:

  • The child's legal relationship with the named patient;
  • The quality of the child's relationship with the named patient, prior to hospitalisation and currently;
  • Whether there has been past abuse of the child, alleged or confirmed, by the patient;
  • The likelihood of future risks of significant harm to the child if the visits took place;
  • The child's wishes and feelings about the visit, taking account of their age and understanding;
    • The views of those with parental responsibility and, if different, person/s with day-to-day care for the child;

If it is known the child has lived in other Children's Social Care areas, what other relevant information is known about the child and family; the frequency of contact that would be appropriate.

Children's Social Care should send the completed assessment report to the nominated officer, advising whether the visit would be in the best interests of the child.

If Children's Social Care advises that a visit would be in the child's best interests, the nominated officer should discuss this with Children's Social Care and make a decision about the visit, taking account of any potential risk posed by the patient and the potential risk of significant harm being suffered by the child.

If the person/s with parental responsibility refuses to co-operate with the LA  Children's Social Care assessment, Children's Social Care should consider its legal position:

  • If the child is known to Children's Social Care, it could make its report on the basis of the information it has already but make clear that the information is not up to date and does not take account of the wishes and feelings of the child;
  • If Children's Social Care holds no information about the child, it should inform the hospital that it is unable to make any report.

The visit

Any visits by children must:

  • Take place in an appropriate atmosphere and setting (i.e. childcentred and child-friendly), taking account of the age of the children (as advised by the Children's Social Care service local to the hospital) whilst maintaining the required level of security;
  • Be properly supervised throughout the visit, with sufficient staff present (of an appropriate grade and with requisite knowledge and understanding and enhanced Criminal Record Bureau checks - for children, not just vulnerable adults) to supervise the children's visits at all times and to prevent unauthorised contacts;
  • Allow the child contact with only the named patient for whom a visit has been approved. No children are to visit on the ward areas.

The nominated officer must ensure that a child's contact with a patient within the hospital takes place at a frequency which is in the child's best interests, taking account of advice from Children's Social Care. All visits by children shall be specifically authorised by the nominated officer.

Refusing a visit

There are five circumstances in which the nominated officer must refuse to allow a child to visit. These are if:

  • The relationship between the patient and the child is not within the permitted categories of relationship as set out in paragraph 2(2)(b) of the Directions. The nominated officer must notify the patient of the decision and reasons for it in writing. However, the patient has no right to make representations against this decision;
  • The person/s with parental responsibility responds to the nominated officer stating that they do not agree to the child visiting the patient. The decision and the reasons for the decision must be put in writing to the patient;
  • The hospital's assessment indicates that the patient's mental health state and/or risk to children is such (in the immediate or longer term) that it would not be appropriate for the child to visit the patient. The decision to refuse the visit must be put in writing to the patient and the person with parental responsibility and include details of the complaints procedure;
  • The relevant Children's Social Care service concludes that a visit is not or may not be in the child's best interests. The decision to refuse the visit must be put in writing to the patient, the child (if appropriate), those with parental responsibility, person/s with day to day care for the child, if different, and Children's Social Care.

Details of the review procedure should be given.

  • There are concerns about the patient's mental state at the time of the visit. The reasons for the refusal should be explained to the patient, those with parental responsibility, person/s with day to day care for the child, if different, and, if appropriate, the child.
  • The Directions and associated guidance to Ashworth, Broadmoor and Rampton Hospital Authorities (HSC 1999/160) sets out the assessment process to be followed when deciding whether a child can visit a named patient in these hospitals; and LAC(99)23 sets out local authority duties and responsibilities assist the hospital by assessing whether it is in the interests of the child to visit the patient.
 

9.43 Psychiatric wards and facilities (children visiting)

Visits by children to psychiatric wards or hospitals should be undertaken to maintain a positive relationship for the child with the patient, who will usually be their parent or more rarely a family member such as a sibling. A visit by a child should only take place if it is in their best interest.

When a child visits a psychiatric ward or hospital, they could be at risk of significant harm through physical, sexual and/or emotional harm.

This section applies to children visiting all patients receiving in-patient treatment and care from specialist psychiatric services, whether or not they are detained under the Mental Health Act 1983. This includes children visiting detained adolescent patients and adolescents who are being cared for in adult facilities.

Visiting patients in psychiatric wards

When children visit adult patients, all psychiatric in-patient settings should:

  • Place child welfare at the heart of professional practice for all staff involved in the assessment, treatment and care of patients;
  • Take account of the needs and wishes of children as well as patients;
  • Address the whole process, including preadmission assessment, admission, care planning, discharge and aftercare;
  • Assess the desirability of contact between the child and patient, identify concerns and assess the potential risks of harm to the child in a timely way;
  • Establish an efficient procedure for dealing with requests for child visits in those cases where concerns exist.
  • Establish a process for child visits which is:
    • Not bureaucratic;
    • Supportive of both the child and the adult;
    • Does not cause delay in arranging contact;
    • Maximises the therapeutic value of the visit;
    • Ensures the child's welfare is safeguarded.
  • Set and maintain standards for the provision of facilities for child visiting;
  • Ensure that staff are competent to manage the process of child visits.

Pre-visit arrangements

Compulsory admission

When a compulsory admission is planned for an adult who is a parent, the approved social worker must assess the child/ren's needs and the suitability of arrangements for their care. If there are concerns about the safety or care arrangements of the child/ren, the approved social worker must request that Children's Social Care undertakes an assessment.

Children's Social Care should make a recommendation to the hospital about the suitability of the children visiting their parent. The approved social worker should, wherever possible, provide the hospital with the child/ren's assessment information. This may, as appropriate, include the recommendation made by Children's Social Care when the patient was admitted, together with the views of those with parental responsibility about the child/ren visiting the patient in hospital.

Expected visit by a child

The ward manager is responsible for the decision to allow a visit by a child. When a visit by a child is expected, the ward manager should consider the available information about the child alongside the assessment of the patient's needs for treatment and care and an assessment of the current state of the patient's mental health. The ward manager should then make the decision in consultation with other members of the multi-disciplinary hospital team. The ward manager must make their decision on the basis of the interests of the child being paramount, superseding those of the adult patient.

Unexpected visit by a child

If a child visits unexpectedly, the ward manager is responsible for deciding whether it is feasible, whilst they wait, to consider the available information about the child alongside the assessment of the patient's needs for treatment and care and an assessment of the current state of the patient's mental health. The ward manager should then make the decision in consultation with other members of the multi-disciplinary hospital team. If this is not feasible, the visit must be refused.

Patients admitted informally

Most patients are admitted informally. When a patient has been admitted on an informal basis, nursing staff should seek out information about children who may be visiting. When nursing staff are aware that a patient has a child, and there is a children's social worker or adult mental health care coordinator working with the patient, nursing staff should check with the social worker / care co-ordinator about the desirability of children visiting and the arrangements which have been made. Such discussions should be clearly documented.

If there are concerns about the safety or care arrangements of the child/ren and there is no children's social worker involved, the ward manager must request that Children's Social Care undertake an assessment. Children's Social Care should make a recommendation to the hospital about the suitability of the child/ren visiting the patient.

Where Children's Social Care has been asked to undertake such an assessment, their report should be sent back within one week of receipt of the referral from the ward manager in order to avoid delay in arrangements for the child.

The ward manager is responsible for the decision to allow a visit by a child, and must follow the same decision making process for informal admissions and for compulsory admission. In the vast majority of cases where no concerns have been identified, arrangements should be made to support the patient and child and to facilitate contact.

Identifying concerns

Concerns about the desirability of a child visiting may arise in a number of areas. These could relate to:

Consideration of the child's best interests;

The patient's history and family situation;

The patient's current mental state (which may differ from an assessment made immediately prior to or on admission);

  • The response by the child to the patient's illness;
  • The wishes and feelings of the child;
  • The developmental age and emotional needs of the child;
  • The views of those with parental responsibility;
  • The nature of the service and the patient population.

A range of options may present themselves when concerns are identified in any of the areas above, and the concerns need not automatically result in a refusal of visiting. The hospital multi-disciplinary team must obtain a balance between the management of risk of harm and the interests of the child/ren and patients.

Decisions to refuse a child's visits

The ward manager may refuse to allow a child to visit if they have reason to believe it is not in the best interest of the child or patient.

The decision to prohibit a visit should be regarded as a serious interference with the rights of the patient and should only be taken in exceptional circumstances. Decisions to refuse visits should be given verbally and confirmed in writing. They must be supported by clear evidence of concerns and the difficulties of managing them.

Policies should clearly set out the steps to be taken in making the decision to refuse visiting, including the process for:

  • Consulting with the patient, the child (depending on age and understanding), those with parental responsibility and, if different, person/s with day to day care for the child, advocates and, where relevant, the Children's Social Care;
  • Communicating the decision to the patient, other family members, the child and those with parental responsibility;
  • Reviewing any decision and the means of communicating this to the patient, advocate or other person or agency involved in the decision;
  • Enabling a patient and others with parental responsibility to make representation against any decision not to visit, including access to assistance and independent advocacy. Such a system should be consistent with the Trust's overall complaints procedure and should contain an independent element.

Making arrangements for visits

The hospital or mental health trust providing the service must ensure that the hospital contains facilities for all patients to have contact with their children in a venue which is conducive to the child's safety and good quality contact for both child and patient.

Children should have appropriate supervision according to their age and need when they are visiting mental health service users. They should normally be accompanied by someone who has parental responsibility for their care and well being.

In some cases, it may be better for arrangements to be made for visiting away from the hospital. In the case of detained patients, this will require due consideration of the need for leave. Staff must be aware of the child protection and child welfare issues in granting leave of absence under s.17 of the Mental Health Act 1983.

Visiting patients in the special hospitals: Ashworth, Broadmoor and Rampton

Specialist hospitals must have procedures for child visiting that have been developed specifically for that service. Decisions about whether to permit a child to visit a unit must always be based on:

  • The interests of the child;
  • The service user's offending history;
  • The clinical history of the service user;
  • The conditions under which the visit will take place.

A hospital may not allow a child to visit any patient unless the hospital's authority has approved the visit in accordance with the directions pertaining to the patient's admission (see 5.36.41 and The Directions and associated guidance to Ashworth, Broadmoor and Rampton Hospital Authorities (HSC 1999/160)) and in particular is satisfied that the visit is in the child's best interests.

The only exception to this is where there is a contact order made under the Children Act 1989 which specifies that the child may visit the patient in the special hospital. In such cases, visits should be allowed except where there are concerns about the patient's mental state at the time of the proposed visit, such that the nominated officer decides the visit would not be in the child's best interests.

Request for a child to visit

There may be cases where the patient has been:

  • Convicted of murder or manslaughter, or an offence which leads to them being identified (by probation / youth justice, police or health services, individually or via the Multi-Agency Public Protection Arrangements) as posing an ongoing risk to a child; or
  • Found unfit to be tried or not guilty by reason of insanity, in respect of a charge of murder or manslaughter or an offence which leads to them being identified (by probation / youth justice services, police or health services, individually or via the Multi-Agency Public Protection Arrangements) as posing an ongoing risk to a child,

In these circumstances, the child must be within the permitted categories of relationship set out in The Directions and associated guidance to Ashworth. If the patient's circumstances are not those sections above or the child is within the permitted categories of relationship, the nominated officer should:

  • Obtain written permission from the patient to contact those with parental responsibility for the child;
  • Write to the person/s with parental responsibility for the child:
  • Explaining that a request for a visit has been made;
  • Asking for confirmation of the relationship between the patient and the child;
  • Requesting consent for the child to visit the patient;
  • Explaining that before a visit can proceed, Children's Social Care will be asked to assess whether the visit is in the child's best interests.

Write to any person/s without parental responsibility but with day to day care for the child (e.g. a grandparent), explaining that a request for a visit has been made and that the person with parental responsibility will be contacted.

In the case of a child who is looked after by the local authority and subject to a care order (with parental responsibility shared by the local authority and the parent/s), Children's Social Care has responsibility for providing consent (following consultation with those with parental responsibility).

Where a child is looked after by the local authority but not subject to a care order, the person with parental responsibility is required to give their consent.

If those with parental responsibility state that they are prepared to allow their child to visit the patient, the nominated officer should arrange for the patient's clinical team to undertake an assessment. This assessment is to judge the level of risk, if any, presented by the patient to children and to the particular child for whom the visit request has been made.

Last updated 7 January 2014

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