Section 9: Safeguarding Children In Specific Circumstances (R-Z)

44. Racial and religious harassment
45. Residential care
46. Residence Order made due to risk of significant harm
47. Restraint/Physical intervention by professionals
48. Self harming and suicide behaviour
49. Sexual abuse by children and young people
50. Sexually exploited children
51. Sexually active under age children and young people
52. Shaken baby syndrome
53. Spirit possession and religious beliefs
54. Surrogacy
55. Temporary accommodation
56. Trafficked and exploited children
57. Unborn babies
58. Whistle blowing
59. Working with interpreters
60. Working with unco-operative families
61. Young carers

9.44 Racial and religious harassment

The experience of racism/and or religious harassment is likely to affect the responses of the child and family to the assessment and enquiry processes.  All professionals involved with families who may be experiencing or who have in the past experienced racial or religious harassment should take account of race, culture and religion and the individual needs of the child and family. 

Failure to protect a child from racism (whether it originates from within or outside of the family) or take action when racism is being alleged is likely to undermine all other efforts being made to promote the welfare of the child.

Children and families may suffer racial and/or religious harassment sufficient in frequency and seriousness to undermine parenting capacity.  In responding to concerns about children in the family, full account needs to be taken of this context and every reasonable effort made to end the harassment.

9.45 Residential care

A child in residential care is vulnerable to physical, sexual or emotional abuse and / or neglect. If there are lapses in the care provided, the child can suffer to such a degree that it constitutes significant harm.

Good quality care

The welfare and safety of children living in residential care should be promoted and provided for at a minimum, in line with the relevant National Minimum Standards (see www.ofsted.gov.uk), in all residential care settings.

All commissioners and providers of residential care services for children are responsible for ensuring that children are safeguarded. Commissioner contracts and provider procedures should be comprehensive and unambiguous in setting out the responsibilities and processes for safeguarding and promoting children's welfare. Local Safeguarding Children Boards should monitor the welfare of children living in residential care.

The standards for children living in residential care include that:

• Children feel valued and respected and their self-esteem is promoted;
• There is an openness on the part of the residential care service to the external world and external scrutiny, including contact with families and the wider community;
• Residential care and support staff are trained in all aspects of safeguarding children, are alert to children's vulnerabilities and risks of harm, and are knowledgeable about how to implement safeguarding children procedures;
• Children who live in residential care are listened to and their views and concerns responded to;
• Children have ready access to a trusted adult outside the residential care setting (e.g. a family member, the child's social worker, independent visitor, children's advocate). Children should be made aware of the help they could receive from independent advocacy services, external mentors, and ChildLine
• Residential care and support staff recognise the importance of ascertaining the wishes and feelings of children and understand how individual children communicate by verbal or non-verbal means;
• There are clear procedures for referring safeguarding concerns about a child to the relevant children's social care service;
• In relation to complaints:
  • Complaints procedures should be clear, effective, user friendly and readily accessible to children and young people, including those with disabilities and those for whom English is not their preferred language;
  • Procedures should address all expressions of concern, including formal complaints. Systems that do not promote open communication about 'minor' complaints will not be responsive to major ones, and a pattern of 'minor' complaints may indicate more deeply seated problems in management and culture which need to be addressed;
  • Records of complaints should be kept by providers of children's services (e.g. there should be a complaints register in every boarding school which records all representations including complaints, the action taken to address them, and the outcomes);
  • Children should be genuinely able to raise concerns and make suggestions for changes and improvements, which are taken seriously.
• Bullying is effectively countered;
• Recruitment and selection procedures are rigorous and create a high threshold of entry to deter abusers;
• There is effective supervision and support, which extends to temporary staff and volunteers;
• The residential care service contract staff are effectively checked and supervised when on site or in contact with children;
• Clear procedures and support systems are in place for dealing with expressions of concern by residential care and support staff about other staff or carers;
• Organisations have a code of conduct instructing residential care and support staff on their duty to their employer and their professional obligation to raise legitimate concerns about the conduct of colleagues or managers. There should be a guarantee that procedures can be invoked in ways which do not prejudice the 'whistle-blower's' own position and prospects;
• There is respect for diversity and sensitivity to race, culture, religion, gender, sexuality and disability;
• Residential care and support staff are alert to the risks of harm to children in the external environment from people prepared to exploit the additional vulnerability of children living away from home.

Promoting and protecting a child's welfare

It is important that children have a voice outside the residential unit. Social workers are required to see children in residential units on their own (taking appropriate account of the child's wishes and feelings) at regular intervals and evidence of this should be recorded.

Residential carers should be provided with full information about the child and their family, including details of abuse or possible abuse and whether the child has harmed others, both in the interests of the child and of the staff and other children in the residential unit.

Residential carers should monitor the whereabouts of the children, including their patterns of absence and contacts. Residential carers should follow the recognised procedure of their agency on sharing general concerns about a child, and whenever a child is missing from the unit. This will involve notifying the placing authority and, where necessary, the police of any unauthorised absence by a child.

Residential carers should have guidance on sharing more general concerns (e.g. alerting other professionals, considering child behaviour around contact, absences, school, moods etc).

The local authority's duty to undertake s47 enquiries, when there is reasonable cause to suspect that a child is suffering, or is likely to suffer, significant harm, applies on the same basis to children in residential care as it does to children who live with their own families.

Such enquiries will consider the safety of any other children living in the residential unit. If child protection concerns are raised about the care in a residential unit, the local authority in which the child is living has the responsibility to convene a strategy meeting / discussion, which should include representatives from the responsible local authority which placed the child; a representative from Ofsted should also be invited. At the strategy meeting / discussion, it should be decided which local authority should take responsibility for the next steps, which may include a s47 investigation.

9.46 Residence order or Special Guardianship Order made due to risk of significant harm

At times a Residence Order or Special Guardianship Order (SGO) will be granted to a family member/other person following court proceedings where Children's Social Care have supported the making of the order because of the risk of significant harm if the child is in the care of the parent.

Any parent seeking to resume the care of children should be advised to make application to the Court and/or to hold discussions with Children's Social Care.  

Any practitioner who is aware of the likelihood or actuality of a child returning to live with a parent in these circumstances is to refer to Children's Social Care without delay.

Where the following applies, irrespective of whether Children's Social Care have received a referral or they are anyway involved with the family, child protection procedures must be applied:

• A child is, or was previously, at any stage, the subject of a Child Protection Plan and;
• The Child Protection Plan was discontinued because the Conference believed the child would be cared for permanently by another person, through a Residence Order or SGO and;
• The parent(s) wishes for, or is found to have resumed, the care of the child.

A multi-agency Strategy Meeting (not a Strategy Discussion) must be held, with a specific request for the involvement of the Police Protecting Vulnerable Person's Unit and Health Named Nurse Child Protection and Education Child Protection Officer (where applicable).  

Unless there are exceptional circumstances whereby all involved agreed there is no need to proceed further, which should be clearly recorded and explained, it is expected that the outcome of the Strategy Meeting would be a Section 47 enquiry and core assessment.

An arrangement should be made, at this point, for a timely further Strategy Meeting at which a decision is to be made as to whether a return to a Child Protection Conference is necessary.

9.47 Restraint/ Physical intervention by professionals

NO CONTENT

9.48 Self harming and suicide behaviour

Any child or young person who self-harms or expresses thoughts about this or about suicide has to be taken seriously and appropriate help and intervention offered at that point.

Definitions and Meanings (National Inquiry 'Young People an Self-harm')

Suicide	Self-harm, resulting in death
Attempted Suicide	Self-harm with intent to take life, resulting in non-fatal injury
Deliberate Self-harm/Self-harm	In its broadest sense, self-harm describes a wide range of things that people do to themselves in a deliberate and usually hidden way, which are damaging."  For the purpose of the Inquiry the focus is: Cutting behaviours Other forms of self-harm, such as burning, scalding, banging, hair pulling Self-poisoning.

The difference between suicide and deliberate self-harm is not always so clear. For example, deliberate self-harm is a common precursor to suicide, also children and young people who deliberately self-harm may kill themselves by accident. 

Responding to the Child or Young Person

In every case, the practitioner who is made aware that a child or young person has self-harmed, or is contemplating this or suicide, should talk with them without delay and:  

• Ascertain if they have taken any substances, including tablets, or injured themselves (if so, the child or young person should receive urgent medical attention, even if they appear well, as harmful effects can sometimes be delayed);
• Try to find out what may be troubling them;
• Explore to what extent self-harm is likely or imminent or planned;
• Ascertain what help or support the child or young person would wish.

A supportive attitude, respect and understanding of the child or young person, along with a non-judgmental stance, is of prime importance.  Note also that a child or young person who has a learning disability will find it more difficult to express their thoughts.

Child or Young Person Requiring Hospital Treatment for Physical Harm

Where a child or young person requires hospital treatment in relation to physical self-harm, practice should be as follows, in line with the NICE 2004 guidance:  

• Triage, assessment and treatment for under 16's should take place in a separate area of the Emergency Department;
• There should be overnight admission to a Paediatric or Adolescent ward with detailed assessment the following day, with input from the CAMHS service;
• Assessment should be undertaken by healthcare practitioners experienced in this field;
• Assessment should follow the same principles as for adults who self-harm, but should also include a full assessment of the family, their social situation, family history and child protection issues
• Initial management should include advising carers of the need to remove all medications or other means of self-harm available to the child or young person who has self-harmed;

Any child or young person who refuses admission should be reviewed by a senior Paediatrician in Accident and Emergency and, if necessary, their management discussed with the on-call Child and Adolescent Psychiatrist.

Multi-agency Response

Duty/Access points in Children's Social Care can advise whether the particular child's circumstances warrant referral to Children's Social Care as a child in need or whether other forms of multi-agency working would be more appropriate.

Wherever there is a serious concern for a child or young person, a multi-agency planning meeting should take place, without delay.  Depending on the circumstances of the individual child, this may be arranged through, for example, hospital staff or by Children's Social Care if the child is considered to be in need.

The purpose of the meeting is to:

• Consider the concerns;
• Devise a care plan to support the young person in the community;
• Consider support services for the family;
• Agree plans for an inter-agency assessment and management of risk.

Where the Young Person is a Carer for a Child or Pregnant

Where a young person, who is a carer for a child or is pregnant, self-harms, or threatens this, a referral must be made to Children's Social Care in respect of the child/unborn baby.

Where Child/Young Person involved in Family Court Proceedings

Where the child or young person is currently the subject of Family Court Proceedings, whether public or private law, the Court must be informed of any self-harm or attempted suicide incident.

9.49 Sexual abuse by children and young people

Introduction

"Work with children and young people who abuse others – including those who sexually abuse/offend – should recognise that such children are likely to have considerable needs themselves, and also that they may pose a significant risk of harm to other children. Evidence suggests that children who abuse others may have suffered considerable disruption in their lives, been exposed to violence within the family, may have witnessed or been subject to physical or sexual abuse, have problems in their educational development, and may have committed other offences. Such children and young people are likely to be children in need, and some will in addition be suffering or at risk of significant harm, and may themselves be in need of protection. Children and young people who abuse others should be held responsible for their abusive behaviour, whilst being identified and responded to in a way which meets their needs as well as protecting others."  (Working Together to Safeguard Children 2006).

Definition

Sexually harmful behaviour by children includes a wide range of behaviours, in a variety of situations, and can be defined as:

A child or young person who commits any sexual act with a person of any age:

• Against the victim's will;
• Without consent;
• In an aggressive/exploitative manner.

Work with children and young people who display sexually harmful behaviour requires a co-ordinated multi-agency response.  It is important that all agencies work closely together to enhance communication and ensure consistency of approach.  The welfare of children is paramount and the primary objective is the prevention of future victims and perpetrators.

Application of the AIM Assessment Model

The AIM (Assessment, Intervention and Moving On) Assessment Model is applicable for a child or young person under the age of 18 years who has undertaken sexually harmful behaviour, against children, adolescents and adults, within the family or outside the family, including stranger abuse. AIM

The AIM assessment Model must always be applied to a child or young person, aged 10 years and over, who:

• Admits a relevant offence and whose behaviour is deemed so serious at the outset that the Police make an immediate decision to charge;
• Admits the offence and has previous offences and is therefore not eligible for the final warning and reprimand scheme and is immediately charged;
• Admits the offence and is likely to receive a reprimand or a final warning.

In all other situations, the use of the AIM Assessment Model is highly recommended, although an adapted model will be required for children aged 9 years and under. 

Note that if a child or young person is subject to Family Court proceedings, the permission of the Court should be obtained before undertaking an AIM assessment.

Criminal Justice Process

Where a child or young person (10 years or over) admits an offence of sexually harmful behaviour and the police feel it is appropriate, s/he and their parents will be informed by the Police Officer that the young person is to be bailed for 28 days, to allow for an AIM assessment to be undertaken.

The processes below allow for the completed AIM assessment report to be duly considered by all involved within the 28 day bail period.

The investigating Police Officer will refer the child or young person to Children's Social Care.

The Police Officer will also refer the child/ young person to the Youth Justice Service.  This will trigger the AIM Assessment process, for which the Youth Justice Service Worker will take lead responsibility.  (The Youth Justice Service is also to immediately liaise to Children's Social Care). 

The completed AIM assessment report must be shared with the investigating Police Officer responsible for the bail arrangements within 21 days (15 working days) of the child protection Strategy Meeting.  

The AIM Assessment report will make a recommendation to the Police regarding disposal for the child or young person.  However, the Police maintain the right to make a final decision, having fully considered the recommendations and any other relevant information which has been collated. 

If there is a difference of opinion the final decision will be taken by the Detective Chief Inspector/Detective Inspector within 3 days.

It is desirable that an AIM assessment is completed on all young people before being sentenced by the Youth Court/Crown Court.  If necessary an adjournment must be requested in order to carry out the assessment, which will inform the pre-sentence report.

In those cases where a young person commits a further offence whilst on bail, the Police will review their bail status. If an immediate decision is made to charge the young person, the YJS worker who undertakes the AIM assessment will also complete the pre-sentence report.

Youth Justice Services and Children's Social Care

The Youth Justice Service, when notified about a child or young person, who is alleged to have sexually offended, is to immediately refer to Children's Social Care. 

Any other practitioner is also to refer to Children's Social Care any child or young person where there is reason to suspect that s/he has undertaken sexually harmful behaviour. 

In response, Children's Social Care are to convene a child protection Strategy Meeting, as opposed to a Strategy Discussion, and this is to take place within one working day. This is to be separate to any child protection Strategy Meeting/Discussion held in respect of the victim of the sexually harmful behaviour, except where the child or young person concerned and the victim are siblings/members of the same household/family.

It is essential that appropriate agency representatives are invited to the child protection Strategy Meeting.

Tasks of the Child Protection Strategy Meeting

The child protection Strategy Meeting is to produce a shared multi-disciplinary plan, which addresses as far as possible, on the available information:

• Child welfare concerns for this child/young person;
• The safety of potential victims including siblings;
• Risk management at home, in school and in the wider community;
• Future living arrangements for the young person;
• School attendance and related education issues;
• Support for this child/young person and their family;
• The needs of this child/young person;
• Relevant victim issues;
• Outlining roles, tasks and expectations for different professionals/agencies;
• Referral into the public protection system;
• Whether child protection enquiries (Section 47 enquiries) are necessary in respect of this child/young person.

In situations where the AIM framework must be applied, the Youth Justice Service Worker is to take the lead on the AIM assessment. Children's Social Care is to identify, or confirm, the name of the co-worker. 

In other situations, the child protection Strategy Meeting is to decide whether an AIM assessment is appropriate.  If not, the reason and the alternative model of assessment is to be agreed. 

A further meeting is to be arranged to consider the completed assessment report, which must be held within 21 days (15 working days) of the child protection Strategy Meeting.  This will be either:

• A Child Protection Conference – where this is necessary or;
• A Multi-disciplinary Meeting

Child Protection Conference

It is not an automatic step for a child or young person who has displayed sexually harmful behaviour, or is alleged to have done so, to be made the subject of a Child Protection Conference.  This is only to happen where, following any child protection enquiry (s.47 enquiry):

• The child/young person is identified as being at continuing risk of significant harm, separate to his or her own sexually harmful behaviour;
• A sibling/other child in family is at continuing risk of significant harm.

Where a Child Protection Conference is held, this must be within 15 working days of the last child protection Strategy Meeting.  The AIM assessment (or other) must be completed and the report made available for the Conference

This Conference replaces the first Multi-disciplinary Meeting.  It is also to undertake the tasks of the Multi-disciplinary Meeting in addition to normal requirements of a Conference.

If it is decided to make the child/young person subject to a the Child Protection Plan, a date will be set for a Review Conference within 3 months, with inter-agency Core Group meetings in between.  In this situation, the Core Group meetings are to replace Multi-disciplinary Meetings and to include the same tasks. 

If a  decision is made not to make the child the subject of a Protection Plan  or the Plan is subsequently withdrawn or discontinued, recommendations must include that Multi-disciplinary Review Meetings are held, for as long as necessary.

Multi-disciplinary Meeting

A Multi-disciplinary Meeting is to be held within 15 working days of the last child protection Strategy Meeting, unless a Child Protection Conference is being held.

The AIM assessment (or other) report should be made available for the Chair and those invited to attend the meeting, 3 working days prior to the date of the meeting. 

The assessors and any other relevant professionals such as Education and Health must attend the meeting.  In circumstances when the assessors cannot attend, a representative must be sent in their place.  Parents/carers and the young person are to be invited to attend the meeting following consultation with other agencies and at the discretion of the Chairperson.

Tasks of a Multi-Disciplinary Meeting

The first meeting is to consider the completed AIM (or other) Assessment Report and produce a shared multi-disciplinary plan which addresses:

• Child welfare concerns for the young person;
• The safety of potential victims including siblings;
• Risk management at home, in school and in the wider community;
• Future living arrangements for the young person;
• School attendance and related education issues;
• Support for the young person and their family;
• The needs of the young person;
• Relevant victim issues;
• Intervention/treatment issues/identification;
• Outlining roles, tasks and expectations for different professionals/agencies;
• Any need for further assessment;
• Whether there should be a referral into the public protection system

Further Multi-Agency Meetings

Further Multi-Agency Meetings are to be arranged between those involved, to oversee the ongoing implementation of the plan, review its effectiveness and make changes as necessary.  These meetings should be held as often as deemed necessary by those involved, based on the outcome of the AIM (or other) assessment.

These multi-agency meetings should not be confused with MAPPA (Multi-Agency Public Protection Arrangements), in which arrangements are made to protect the community from known potentially dangerous offenders.

9.50 Sexually exploited children

Referral to Children's Social Care

Children and young people, who are being sexually exploited through prostitution, or may be at risk of this, can come to the attention of any practitioner in any agency, including Health, Education, Voluntary Agencies, Housing, Street Angels etc.

Any child or young person in this situation is to be referred to Children's Social Care.  In all instances there is to be a response under Child Protection Procedures and a Strategy Meeting convened.

Child/Young Person Comes to Notice of Police

Police Officers coming into contact with children and young people who are being exploited through prostitution will take the child or young person to the local police station or victim suite (or equivalent).

Children's Social Care/Emergency Duty Team (or equivalent) will be contacted and asked to attend, within an hour, to undertake a joint risk assessment with the Police Officer and to identify a safe place where the child or young person can be taken.  (If resources do not allow Children's Social Care to send a member of staff within an hour it will at the discretion of the Police to decide if they can wait longer. If not, the Police will attempt to find a safe place for the child or young person to be taken and inform Children's Social Care that this has occurred).

The risk assessment should seek to identify any perpetrator(s) or further risks to the child or young person, in accordance with 'Achieving Best Evidence'.  This will help establish how best any offence may be investigated.  Any evidence that may assist in proving offences committed against the child or young person (e.g. CCTV, clothing, witnesses, medical, photographs, etc) should be secured.  Any further risks to the child or young person also need to be identified.

Any medical examination for the child or young person should be undertaken in line with local inter-agency child protection procedures.

In identifying a safe place for the child or young person, consideration should be given to possible provision of accommodation by friends, family, fostering or residential services, giving consideration to the possible impact of the child or young person's placement on carers, staff and other children and young people.

The Police Officer will share information with the local project (where these exist) that provides services for children and young people being sexually exploited. The Police Officer will also fax a written report giving details of the child or young person and the incident to the Police Protecting Vulnerable Person's Unit.

Child/Young Person Already Known to Children's Social Care

The child or young person concerned may currently have Children's Social Care involvement and be subject to some form of plan aimed at enabling the child or young person to exit the exploitation.  Where information comes to light that the child or young person is continuing to be exploited through prostitution a new referral is required to Children's Social Care. The Deputy Service Manager or Service Manager will decide whether to recall the core group for the child/young person or to convene a Strategy Meeting.

Strategy Meeting

Children's Social Care should convene a Strategy Meeting (as opposed to a telephone Strategy Discussion). This applies whether or not the referral was received from the Police. 

Representatives from Police, Health, Education, and others involved with the child or young person, should attend.  It is essential that a representative from any local specialist project, providing services to children and young people exploited through prostitution, be involved in the meeting.

In addition to the usual requirements of a Strategy Meeting, there should also be consideration of whether:

• A parent or carer is involved in, or is condoning, the exploitation, or knowingly failing to prevent it;
• The child or young person is living in an abusive environment e.g. a coercer's residence, brothel or place where the child or young person has regular contact with child abusers or coercers;
• The child or young person, or known acquaintance(s), have been moved into the region for the purpose of sexual exploitation, including the trafficking of children and young people;
• Any of the information is relevant to agencies outside the local authority area and if so, make arrangements for this to be passed on.

The Strategy Meeting should initiate an Action Plan, irrespective of any other outcomes of the Strategy Meeting.  

Action Plan (see following page for template)

Children's Social Care are responsible for ensuring that an Action Plan is in place.  It should be initiated at the Strategy Meeting and developed on the basis of ongoing enquiry/assessment.  At a maximum, an agreed robust inter-agency Action Plan should be in place within fifteen working days of referral. 

Where the child or young person is not subject to an Initial Child Protection Conference, the Action Plan should be confirmed or finalised via a multi-agency Planning Meeting, to be held within fifteen working days of referral.  Subsequent confirmation or revision of the Action Plan should take place at further Inter-agency Planning Meetings to review the situation of the child or young person.  These should be held on a three month basis or more often if necessary.

Where the child or young person is subject to an Initial Child Protection Conference, the Action Plan should be confirmed or finalised via the Conference and reviewed through Review Conference/Core Group arrangements.  If a Protection Plan is not made, the Action Plan should be confirmed or revised at three monthly Inter-agency Planning Meetings, or more often if necessary.

The child or young person should be involved as far as possible in planning in all of the above.

Children moving into or re-entering a local authority area

Children and young people with inappropriate sexual behaviour who are re-entering the community following a custodial sentence or time in secure accommodation, or who move into the area from another local authority, require the multi-agency response described above. The response should be initiated at the earliest opportunity.

Where a child has been convicted of sexual offences involving the abuse of other children is released into the community, the MAPPA must be invoked to ensure the safety of the community in line with Section 12 of these procedures.

Parents/Carers

It is essential that the role played by parents/carers be ascertained at an early point.  They may be able to provide valuable information about the behaviour of the child or young person and any associated adults.  They may be able to provide a key role in assisting the child or young person to exit the sexually exploitative situation and recover from its effects.  On the other hand, a parent/carer may be actively involved in the child or young person's exploitation or knowingly failing to prevent it. 

In situations where a child or young person has been trafficked into the country, there is a possibility that the presenting parents/family are not, in reality, the family of the young person.  Their identities and the nature of their relationship with the child or young person should be examined.

Child Protection Conference

Following child protection enquiries, a Child Protection Conference should be held if the child or young person is at continuing risk of significant harm.  Factors for consideration include:

• A parent or carer is involved in, or is condoning, the exploitation, or is knowingly failing to prevent it;
• The child or young person continues to live within an abusive environment e.g. a coercer's residence, brothel or other environment in which the child or young person has regular contact with child abusers or coercers;
• The child or young person's level of co-operation and engagement with services is nil or low;
• The child or young person has been moved into the region for the purpose of sexual exploitation, including the trafficking of children and young people into the country;
• It is thought by agencies involved that holding a Child Protection Conference is necessary in order to protect the young person.

If a Child Protection Conference is held and the child or young person is made subject to a Protection Plan, this should include the Action Plan.  If there is a decision that a Protection Plan is not necessary, the Action Plan should be confirmed/completed nonetheless.

Prosecution of the Child or Young Person

Police powers to prosecute the child or young person should not be invoked unless there is a persistent, voluntary return to prostitution.  The Police should consult with the other agencies involved before a decision is made to prosecute, or caution, the child or young person.

Case Closures and Transfers

Children's Social Care should continue with their involvement until the risk of actual or likely harm to the child or young person has been reduced, support needs have been addressed and recommendations from an inter-agency review (e.g. Child Protection Conference or inter-agency planning meeting) have been considered.

At the point of case closure by Children's Social Care or transfer to another area, Children's Social Care should ensure that other involved professionals are informed, including those who were involved in the Strategy Meeting/Discussion.

If the child or young person moves permanently to another local authority area in the UK, Children's Social Care should make a referral to the Children's Social Care in the new area and make formal arrangements to hand over case responsibility.

If the child or young person leaves the UK, Children's Social Care should provide the Children's Social Care or equivalent in the receiving country with information in relation to the child protection/child in need concerns for that child or young person. 

9.51 Sexually active under-age children and young people

This procedure has been devised with the understanding that most young people under the age of 18 will have a healthy interest in sex and sexual relationships.  It is designed to assist those working with young people to identify relationships which may be abusive and where young people may need protection or additional services.

Safeguarding children includes the provision of sexual health education and support, whilst protecting the child or young person from inappropriate or abusive sexual contact.  It is therefore essential that children and young people are not deterred from accessing sexual health services and that a balance is struck that promotes a child or young person's welfare.

Identifying cause for concern

All young people, regardless of gender, who are believed to be engaged in, or planning to be engaged in, sexual activity should have their needs for health education, support and/or protection assessed by the agency which has contact with them.

If you have concerns that a young person may be at risk of sexual exploitation through prostitution, please refer to Section 9.50 of these procedures.

For staff involved in giving contraceptive treatment to a young person should adhere to Fraser competences.

Fraser Guidelines

Workers should follow the Fraser guidelines when discussing personal or sexual matters with a young person under 16. The Fraser guidelines are law and give guidance to doctors, social care and health professionals in England and Wales on providing advice and treatment to young people under 16 years of age. These hold that sexual health services can be offered without parental consent providing that:

• The young person understands the advice that is being given.
• The young person cannot be persuaded to inform or seek support from their parents, and will not allow the worker to inform the parents that contraceptive advice is being given.
• The young person is likely to begin or continue to have sexual intercourse without contraception.
• The young person's physical or mental health is likely to suffer unless they receive contraceptive advice or treatment.
• It is in the young person's best interest to receive contraceptive advice and treatment without parental consent.

Ongoing consideration should be given as to whether a young person's circumstances have changed and/or if further information is given which may lead to the need for referral or re-referral.

In working with young people, it must always be made clear to them that absolute confidentiality cannot be guaranteed, and that there will be some circumstances where the needs of the young person can only be safeguarded by sharing information with others.

This discussion with young person may prove useful as a means of emphasising the gravity of some situations.

A Child Under 13

"A child under 13 is not legally capable of consenting to sexual activity.  Any offence under the Sexual Offences Act 2003 involving a child under 13 is very serious and should be taken to indicate a risk of significant harm to the child". Working Together to Safeguard Children, 2006.

Any practitioner who becomes aware of a child under the age of 13 involved in sexual activity should:

• Consult with their agency designated child protection officer/line manager/named professional to consider fully issues surrounding consent and confidentiality;
• Make a referral to Children's Social Care;
• Record fully information given and action taken.

A referral should be made to Children's Social Care who are to apply child protection procedures and arrange a Strategy Meeting.

When a girl under 13 is found to be pregnant, a referral to Children's Social Care must be made, they will hold a strategy meeting and a multi agency support package should be formulated.

In cases of concern where sufficient information is known about the sexual partner/s the agency concerned should give this information to Children's Social Care when referring who will check with the police and other agencies as appropriate.

A Young Person Over 13 and Under 16

 "Sexual activity with a child over 13 and under 16 is also an offence.  Where it is consensual it may be less serious than if the child were under 13, but may nevertheless have serious consequences for the welfare of the young person or child".  Working Together to Safeguard Children, 2006.

Consideration should be given in every case of sexual activity involving a young person aged 13–15 as to whether there should be a discussion with other agencies and whether a referral should be made to Children's Social Care. Within this age range, the younger the young person, the stronger the presumption must be that sexual activity will be a matter of concern. Cases of concern should be discussed with the Named Person for child protection in the agency and subsequently with other agencies if required. Where confidentiality needs to be preserved, a discussion can still take place as long as it does not identify the young person (directly or indirectly).

The member of staff should try to engage and advise the young person of appropriate supportive and sexual health services.

Any decision not to share information must be recorded detailing the reasons for the decision.

The following factors should be taken into account when assessing the extent to which the young person may be suffering or at risk of harm:

• The age of the young person, sexual activity at a young age is an indicator that there are risks to the welfare of the child (whether boy or girl) and possibly others;
• The level of maturity and understanding of the young person;
• What is known about the young person's living circumstances or background;
• Age imbalance, in particular where there is a significant age difference;
• Overt aggression or power imbalance;
• Coercion or bribery;
• Familial child sex offences;
• Behaviour of the young person, e.g. Withdrawn, anxious;
• The misuse of substances, including alcohol;
• Whether the young person's own behaviour, e.g. because of the misuse of substances, places him/her at risk of harm so that s/he is unable to make an informed choice about any activity;
• Whether any attempts to secure secrecy have been made by the sexual partner, beyond what would be considered usual in a teenage relationship;
• Whether the young person denies, minimises or accepts concerns;
• Whether the methods used are consistent with grooming and;
• Whether the sexual partner/s is/are known by one of the agencies.

On the basis of careful assessment of the above factors a decision should be made about whether there is reasonable cause to suspect that significant harm has occurred or might occur.  If there is reasonable cause a referral should be made to Children's Social Care who are expected to apply child protection procedures and hold a Strategy Meeting to discuss appropriate next steps.

The Police should normally share required information about the sexual partner without beginning an investigation.

The Strategy Meeting must consider issues of consent and confidentiality in respect of informing parents/carers without the young person's consent, seeking legal advice as appropriate.

A Child/Young Person 16 or 17 Years Old

Sexual activity involving a 16- or 17-year-old, though unlikely to involve an offence, may still involve harm or the risk of harm. Professionals should bear in mind the considerations and processes outlined above in this guidance in assessing that risk, and should share information as appropriate.

It should also be remembered that it is an offence for a person to have a sexual relationship with a 16- or 17-year-old if that person holds a position of trust or authority in relation to them.

Sharing information with parents

Decisions to share information with parents will be taken using professional judgement and in consultation with the Child Protection Procedures.  Decisions will be based on the level of risk involved.

9.52 "Shaken baby syndrome"

Terminology

Various terms are in use to describe babies or young children with a possible inflicted head or brain injury.  These include:

• Shaken Baby Syndrome
• Inflicted Traumatic Brain Injury
• Battered Child Syndrome
• Inflicted Head Trauma
• Shaken Impact Syndrome
• Shaking Injury
• Whiplash Infant Syndrome
• Whiplash-shaking injury

The above terms refer to the internal head injuries a baby or young child sustains from being violently shaken or thrown. This can cause a range of serious injuries to a baby or small child, which are often fatal. These injuries are mainly to the head but there may also be injuries to the body.

From a medical, social care and judicial perspective, the main interest is the consequence of any non-accidental injuries in terms of treatment, investigation, identifying who may be responsible and safeguarding the child and any siblings from further harm.

Initial Possible Signs

The child is in a collapsed state and presenting some or a combination of the following:

• Lethargy
• Irritability
• Abnormal movements or seizures
• Drowsiness
• Increased or decreased muscle tone
• Vomiting
• Poor feeding
• Irregular breathing
• Apnoea (stopping breathing)

Child Protection Considerations for Hospital Staff

• A history/explanation should be sought from the parents/carers;
• The history/explanation given by the parents/carers should be assessed for consistency with the injuries;
• If there is any doubt a Paediatric opinion should be sought;
• When injuries follow genuine accidents, the child is normally presented promptly and there is a clear history of an accident;
• When injuries are non-accidental, there may be delay in seeking medical advice (although on occasion a delay may follow an accident where the parents had initially thought the infant was alright);
• When injuries are non-accidental, the history may be vague.

Account should also be taken of associated risk factors, which include:

• Child or siblings subject to a Child Protection Plan;
• Previous history of sudden infant death or apparent life threatening events in the family;
• Very young parents;
• Parents suffering from addictive behaviours;
• Parents showing odd behaviour, for example, very aggressive;
• A history of domestic violence;
• If the child appears to be failing to thrive.

If at any point during the course of admission, examination, treatment or tests etc., there is reason to suspect that the injuries to the child are non-accidental, an immediate referral is to be made to Children's Social Care, irrespective of the time or day. The referral should be followed in writing to Children's Social Care within 48 hours.

9.53 Spirit possession and religious beliefs

The belief in 'possession' and 'witchcraft' is widespread.  It is not confined to new immigrants, particular countries, culture or religions. 

Whilst the number of known cases of child abuse linked to 'possession' or 'witchcraft' or other spiritual beliefs is small, children involved can suffer considerable harm. 

A parent or carer who views a child as being 'possessed' or a parent who is involved in 'witchcraft' can abuse a child in many different ways, including attempts exorcise the child which can involve severe abuse.  

Staff in all agencies should be alert to indicators of child abuse linked to spiritual or religious beliefs and refer to Children's Social Care.

See also 'Safeguarding Children from Abuse Linked to a Belief in Spirit Possession' DCSF 2007.

9.54 Surrogacy

Surrogacy is legal in the UK, with reasonable expenses only being paid to the surrogate mother. Surrogacy arrangements are not legally enforceable.

It is illegal to advertise for a surrogate in the UK. Most people have a family member or friend willing to carry the child, others join a surrogacy organisation.

Partial surrogacy uses the egg of the surrogate mother and the sperm of the intended father, thus the baby is biologically related to the intended father and the surrogate mother. This can make it difficult for the surrogate mother to give up her own biological child, but also for the intended mother to accept a child which her husband has fathered with another woman.

Total surrogacy uses the egg of the intended mother combined with the sperm of her husband or donor sperm. A baby conceived by this method has no biological connection to the surrogate mother.

A professional in any agency may become aware of the surrogacy arrangement and have concerns about:

• The suitability of the intended parents to care for the child;
• Conflict between the adults in a surrogacy arrangement e.g. that the surrogate mother is under pressure to relinquish the child against her will (see, as appropriate, section 5.11. Domestic violence); and / or
• The amount being paid for the child.

In these circumstances, all staff have a responsibility to safeguard and promote the welfare of the unborn or newborn child, and professionals should follow the procedures for referral to Children's Social Care.

Children's Social Care responses should be proportionate to what are likely to be very individual circumstances, and legal advice should be sought.

9.55 Temporary accommodation

Any placement in temporary accommodation can be stressful to children and families.  Any professional who becomes aware of a child living in temporary accommodation must make every effort to ensure that the child is registered with a GP, is in receipt of all other appropriate health services and in the case of a school aged child is attending a school.

Where there is concern that a child is not in receipt of social, health and education services as necessary to promote their health and development, the child should be considered, in the first instance, to be a child with additional needs. 

Where there is concern that a child who is in temporary accommodation is in need, or in need of protection the appropriate referral should be made.

9.56 Trafficking and exploited children

A Growing Problem

Trafficking is defined as 'the recruitment, transportation, transfer, harboring or receipt of children by means of threat, force or coercion for the purpose of sexual or commercial sexual exploitation or domestic servitude' (AFRUN/NSPCC).

It is a rapidly growing global problem and is a violation of human rights affecting all communities. There is evidence that large numbers of children and young people, from different parts of the world, are subject to such exploitation within the UK or that the UK is used as a step in the process, with children and young people arriving here and at a later point being trafficked to another part of the world.

Indicators

A number of factors identified by the initial assessment may indicate that a child or young person has been trafficked. In all such cases the first priority is to ensure the safety of the child or young person.

• The child or young person may present as unaccompanied;
• Child or young person may go missing;
• Multi use of the same address may indicate that this is a sorting house;
• Contracts, consent and financial inducement with parents may become apparent;
• The child or young person may hint at threats to family in their country of origin;
• Talk of financial bonds and the withholding of documents;
• Befriending of a vulnerable child or young person;
• False hopes of improvement in their lives;
• The child or young person may present as unaccompanied;
• Child or young person may go missing;

Some children and young people are also trafficked for the purpose of domestic labour.

These may be less obvious but may be picked up during a private fostering assessment or because someone notices that a child or young person is not in school.  Children and young people who enter the country apparently as part of re-unification arrangements can be particularly vulnerable to domestic exploitation

Action

If any suspicions are raised that a child or young person is being trafficked, or at risk of this, immediate action to safeguard the child or young person is required. This includes urgent liaison with the Police.  Planning of the investigations should be within a Strategy Meeting, for the immediate protection of the child or young person and to address possible crimes having been committed.

Any child or young person from abroad who goes missing should be reported to the Police and Immigration Department immediately.  Inter-agency procedures in respect of missing children/young people are to be applied. 

Risk of Being Trafficked for Child or Young Person Looked After

Where a child or young person from abroad becomes the responsibility of Children's Social Care, the degree of risk to the child or young person of possible abduction should be assessed and should inform placement choice. Foster carers/residential staff should have an understanding of the child/young person's situation and of the risk of exploitation and trafficking and be clear about what is expected of them to ensure the safety of the child or young person.

Anyone approaching Children's Social Care and claiming to be a potential carer, friend or member of the family of the child or young person should be thoroughly investigated. The immigration services should be contacted for any relevant information they may have.  The possibility that the child or young person is, or may be, vulnerable to exploitation or trafficking must be considered and checked out.  Agreement from appropriate Managers and Panels should be sought before allowing the child or young person to transfer to the person's care.

The "Trafficked Children Toolkit" produced by the London Safeguarding Board (January 2009) provides detailed guidance to professionals and volunteers from all agencies in safeguarding children who have been trafficked or exploited. This guidance can be accessed at www.londonscb.gov.uk/procedures

9.57 Unborn babies

Referring an Unborn Baby to Children's Social Care

Where an unborn baby is likely to be in need of services from Children's Social Care when born, a referral is to be made to Children's Social Care. 

Wherever possible, the referrer should share their concerns with the prospective parent(s) and seek to obtain agreement to refer to Children's Social Care, unless this action may place the unborn child at risk, for example, through termination of the pregnancy or the parent(s) possibly making their whereabouts unknown.  

These circumstances include:

• Where concerns exist regarding the mother's ability to protect
• Where alcohol or substance abuse is thought to be affecting the health of the expected baby, and is one concern amongst others;
• Where the expectant parent(s) are very young and a dual assessment of their own needs as well as their ability to meet the baby's needs is required;
• Where a previous child in the family have been removed because they have suffered harm or been at risk of significant harm;
• Where a person who has been convicted of an offence against a child, or is believed by child protection professionals to have abused a child, has joined the family;
• Where there are acute professional concerns regarding parenting capacity, particularly where the parents have either severe mental health problems or learning disabilities;
• Where the child is believed to be at risk of significant harm due to domestic violence.

In any of the above circumstances, or where there are other factors which meet the criteria for services, the referral is to be accepted and a pre-birth assessment is to be undertaken, led by Children's Social Care.  In these circumstances, the referral must never be redirected into, for example, a Common Assessment Framework system or similar.

Timing of Referral

Referrals about unborn babies should be made by the 18th week of the pregnancy, unless it has not been possible to meet this timescale, for example, because the pregnancy has been concealed. 

Referring at this time: 

• Provides sufficient time for a full and informed assessment;
• Avoids initial approaches to parents in the latter stages of pregnancy, as this is already an emotionally charged time;
• Enables parents to have more time to contribute their own ideas and solutions to concerns and increases the likelihood of a positive outcome;
• Enables the provision of support services so as to facilitate optimum home circumstances prior to the birth;
• Provides sufficient time to make adequate plans for the baby's protection, where this is necessary.

Initial Multi-disciplinary Planning Meeting

An initial multi-disciplinary planning meeting is to be held to plan the pre-birth assessment.  A pre-birth assessment must be based on a robust assessment model, such as that given in Section Two.  

The meeting, to be convened by Children's Social Care, is to be held during the 19th or 20th week of pregnancy.  

Agencies/professionals who should be invited include:

• Children's Social Care Team Manager and Social Worker
• Identified Midwife
• The likely Health Visitor
• The family GP
• A representative of any local family centre or equivalent, where appropriate.
• Any other professional involved with the family.

Relevant information held by the Police and by the Named Nurse/Senior Nurse for Child Protection should be obtained.

Parents should throughout be involved in planning as far as possible.

A date should be set for a further multi-disciplinary planning meeting (which is to take the form of a child protection strategy meeting if the assessment outcome indicates the baby is likely to be at risk of significant harm).

Pre-birth Assessment led by Children's Social Care

A pre-birth assessment is always to be undertaken in the following circumstances:

• Where concerns exist regarding the mother's ability to protect;
• Where alcohol or substance abuse is thought to be affecting the health of the expected baby, and is one concern amongst others;
• Where the expectant parent(s) are very young and a dual assessment of their own needs as well as their ability to meet the baby's needs is required;
• Where previous children in the family have been removed because they have suffered harm or been at risk of significant harm;
• Where a person who has been convicted of an offence against a child, or is believed by child protection professionals to have abused a child, has joined the family;
• Where there are acute professional concerns regarding parenting capacity, particularly where the parents have either severe mental health problems or learning disabilities;
• Where the child is believed to be at risk of significant harm due to domestic violence.

The assessment is to be completed within core assessment timescales of 35 working days from being commissioned.   

A pre-birth assessment must be thorough and robust, covering all relevant areas. 

Assessment re Parental Substance Misuse, including Alcohol Misuse

'Substance' refers to both legal and illicit substances, for example heroin, cocaine, crack, amphetamines, benzodiazepines, LSD, methadone, ecstasy, prescription drugs, solvents and problematic alcohol use.

Parental substance misuse can particularly impact on the health and development of the child before birth and very seriously affect the life chances and future health and development of the child. 

Practitioners must ensure a thorough assessment of risk to the baby, both before and after the birth. 

Professionals must remember that substance misuse may be one significant feature amongst others, such as domestic abuse, previous harm to a child etc. and should therefore not be the only focus for assessment.

Professionals undertaking this assessment are expected to use the SCODA questionnaire/ assessment tool given in Appendix 8.

Further Multi-disciplinary Planning Meeting or Strategy Meeting

The completed pre-birth assessment report should be considered at a further multi-disciplinary planning meeting. 

If it is clear from the Pre-birth Assessment Report that there is reasonable cause to believe the baby will be at risk of significant harm when born, this meeting should be replaced by a strategy meeting held under child protection procedures.

Either meeting is to be held by the end of the 28th week of the pregnancy.

The purpose of either meeting is to consider the findings and recommendations from the report and make plans about next steps in relation to support and any necessary intervention to protect the baby. 

Where a Strategy Meeting is being held, it should include those already involved and Named Nurse for the appropriate area of the county.  The Police Protecting Vulnerable Person's Unit should also be invited and relevant information sought.

If the Strategy Meeting/Discussion concludes that it is likely the baby will be at risk of significant harm when born, arrangements are to be made for a Pre-birth Child Protection Conference. This applies whether or not there is an intention to take legal proceedings in respect of the child when born.

Pre-birth Child Protection Conference

The procedures regarding a Pre-birth Child Protection Conference are given in Section 24 of these Safeguarding Procedures.

9.58 Whistle blowing

Every employee working with children has a duty and responsibility to disclose any concerns about the conduct of another professional.  Whistle blowing will be seen as a protective disclosure and, if made in good faith, should not result in any form of detriment to the worker. 

If the concerns relate to a person/persons in the same agency, that agency's reporting procedures must be followed.

If the concerns relate to a person/persons from another agency, the person raising the concerns must contact a senior manager within his/her own agency, and a decision be made as to how the concern will be addressed, and by whom. It is the responsibility of the senior manager within the agency of the person raising the concern to ensure that a response is received from the agency to which the concern relates.

The person raising the concern and his/her senior manager must maintain a written record of events which give rise to the concern and of subsequent actions and responses.

9.59 Working with interpreters, signers or others with special communication skills

All agencies need to ensure they are able to communicate fully with parents and children.

When either making or receiving a referral staff must establish the communication needs of the child, parents and other significant family members.  Relevant specialists may need to be consulted, e.g. a speech and language therapist, teacher of hearing impaired children, paediatrician etc.

The use of accredited interpreters, signers or others with special communication skills must be considered whenever undertaking an assessment or enquiries involving children and/or family members:

• For whom English is not the first language (even if reasonably fluent in English, the option of an interpreter should be available when dealing with sensitive issues);
• With a hearing or visual impairment;
• Whose disability impairs speech;
• With learning difficulties;
• With a specific language or communication disorder;
• With severe emotional and behavioural difficulties;
• Whose primary form of communication is not speech.

Family members and children should not be used as interpreters within interviews although can be used to arrange appointments and establish communication needs.

Interpreters used for assessment and child protection work should have been subject to references and CRB checks.  Wherever possible, they should be used to interpret their own first language.  There should be a written agreement regarding confidentiality. 

Interpreters are expected to have undertaken relevant child protection training and this should be ascertained.

Staff need to first meet with the interpreter to explain the nature of the assessment/enquiries and clarify:

• The interpreter's role in translating direct communications between professionals and family members;
• The need to avoid acting as a representative of the family;
• When the interpreter is required to translate everything that is said and when to summarise;
• That the interpreter is prepared to translate the exact words that are likely to be used – especially critical for sexual abuse;
• When the interpreter will explain any cultural issues that might be overlooked (usually at the end of the interview, unless any issue is impeding the interview);
• The interpreter's availability to interpret at other interviews and meetings.

9.60 Working with uncooperative families

There can be a wide range of unco-operative behaviour by families towards professionals. From time to time all agencies will come into contact with families whose compliance is apparent rather than genuine, or who are more obviously reluctant, resistant or sometimes angry or hostile to their approaches.

In extreme cases, professionals can experience intimidation, abuse, threats of violence and actual violence. The child's welfare should remain paramount at all times and where professionals are too scared to confront the family, they must consider what life is like for a child in the family.

Guidance for working with uncooperative families is included on the NYSCB website - Best Practice

9.61Young carers

A young carer is a young person under the age of 18 who has a responsibility for caring on a regular basis for a relative or friend who has an illness or disability.  This is usually a parent, grandparent, sometimes a sibling or occasionally a friend. This can be primary or secondary caring and can lead to a variety of losses for the young carer.  Young carers can experience:

• Low level of school attendance;
• Some educational difficulties;
• Social isolation;
• Conflict between loyalty to their family and their wish to have their own needs met;
• High levels of anxiety;
• High level of demands leading to tiredness and loss of concentration.

Professionals in all agencies should be alert to a child being a young carer. Where a young carer is identified, professionals should in the first instance refer the child to Children's Social Care as a "child in need". Wherever possible, the young carer's consent and the consent of their parent should be sought, through a discussion of why the referral must be made and the possible outcomes.

There are circumstances in which a young carer can be suffering, or at risk of suffering, significant harm through emotional abuse and / or neglect. This should be made clear in the referral. Where a young carer or parent does not give consent, but it is still considered necessary to refer to Children's Social Care, both the child and parent should be kept informed of all decisions made and offered support throughout.

Professionals in all agencies should enquire through Adult and Community Services whether the family is receiving all their entitlements under the provisions of the Carers (Recognition and Services) Act 1995.

Where a young carer is caring for another child, each individual child should be subject to an initial assessment as a child in need.

Agencies that work with young carers such as schools, should implement policies outlining the support services available to these children. See the National Strategy for Carers (Chapter 8, Young Carers) (DOH, 1999), available at www.doh.gov.uk

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