Child Safeguarding Update - PowerPoint Presentation

Slide1

Child Safeguarding Update

Dr David W Jones

Named GP for Child Safeguarding

Newcastle CCGsSlide2

Note of Caution

This subject may raise painful memories or associations

This is not a safe time to share personal memories

If required, seek advice from a professional outside of this meeting, or contact the NSPCC helpline 0808 800 5000Slide3

Subjects to be covered

Child safeguarding – a brief bit of background

Female Genital Mutilation (FGM)

Child

Sexual

Exploitation (CSE)

Child Death Review

CQC inspection

RCGP Child Safeguarding Toolkit

and

some ‘don’t forgets’!Slide4

What is child protection?

Child protection:

the activity taken

to protect children who are suffering or at risk of suffering significant harm

s47 Childrens Act

4 categories of abuse (from which children need protection):

Physical

(8%)Sexual (4%)Emotional (45%)Neglect (41%)*

If it makes you feel uncomfortable or uncertain - SHARE THE CONCERN

*Newcastle LSCB

2014Slide5

What is safeguarding?

Child safeguarding

: Arrangements to take all reasonable measures to ensure that risks of harm to children’s welfare are minimised. There are 2 main components;

protecting children

from maltreatment

preventing impairment

of children’s health or development, including;

ensuring that children are growing up in circumstances that are consistent with the provision of safe and effective careundertaking that role so as to enable those children to have optimum life chances and to enter adulthood successfullySlide6

Who needs safeguarding?

We want to help children move out to the edge

29,000 child subject to child protection plans

235,000 children in need*

4 million vulnerable children

11 million children

*s17 Children’s Act 2004 :They are unlikely to achieve or maintain or to have the opportunity of achieving or maintaining, a reasonable standard of health or development without the provision for him/her of services by a local authority.

Slide7

The child health and safeguarding vortexSlide8

What makes a child vulnerable?

Poverty

Stress within the family

Relationship problems

Mental Illness

Learning difficulties

Poor or absent parenting experience

Domestic ViolenceParental Substance MisuseHousing issuesPhysical illnessOn average at least 1 child a week is killed by someone known to themSlide9

The better we safeguard

the many,

The better we protect the fewSlide10

Why GPs are well-placed to safeguard children

GPs are the first point of contact for most health needs in children (and can examine)

GPs might be one of only a couple of professionals seeing a pre-school child

More generally,

GPs know the family – ‘the family doctor’

GPs have access to the complete medical record – (

Baby P

)GPs may have a ‘unique opportunity’* to safeguard the child *counsel for the GMC in the Baby P caseSlide11

Lord Laming said….

“Investigation and management of a case of possible harm to a child must be approached in the same systematic and rigorous manner as would be appropriate to the investigation and management of any other potentially fatal disease”

The Victoria Climbie Inquiry 2003: Lord Laming para. 11.53)Slide12

Case 1

A 10 year old Somalian girl is brought in by her mother (who speaks very little

english

) for immunisations - she is about to go on an extended holiday overseas

You are aware that the

family is not integrated into UK

society quite as much as other families have

An older sister who’s doing most of the talking appears anxious, and reluctant to give any details about the purpose of the trip.Slide13

What is FGM?

All procedures which involve the partial or total removal of the external genitalia or injury to the female genital organs whether for cultural or any other non-therapeutic reasons

The World Health Organisation

Female Genital MutilationSlide14

Who is at risk?

2 million girls around the world every year are

subject to FGM

Mainly African and Middle Eastern countries and alarmingly now in the immigrant population of Europe, America and Australia

It is estimated that as many as 20,000 girls are at risk of FGM within the UK every year

Any girl is at risk – usually between 4-14Slide15

Communities at risk

Djibouti – 98%

Somalia – 97%

Sierra Leone – 90%

Ethiopia - 79.9%

Sudan – 90%

Guinea – 98.6%

In Middle East – Egypt – 97% Slide16

Why FGM is carried out?

Religion is NOT a basis for FGM

Cultural identity – A tribal initiation into adulthood

Gender Identity – Moving from girl to woman – enhancing femininity

Sexual control – believed to reduce the woman’s desire for sex and therefore the possibility of sex outside marriage

Hygiene/cleanliness – unmutilated women are regarded as unclean and not allowed to handle food or waterSlide17

How FGM is carried out

Varies from community to community but generally by an elder woman in the community using non-sterile, blunt instruments without anaesthetic

UK girls are taken on “holiday” to become a woman, it is seen as a celebration

Communities in the UK are believed to have their own practitioners here

Some doctors will do this under anaestheticSlide18

Female Genital Mutilation Act 2003

Offence to commit FGM

Offence to aid, abet, counsel or procure a girl to commit FGM

Offence for someone in the UK to aid, abet, counsel or procure FGM outside of UK that is carried out by a person who isn’t a UK national or resident

Any act done outside UK by UK National or residentSlide19

Indications FGM is about to take place

The family come from a community that is known to practise FGM

Parents state they will take the child out of the country for a prolonged period

A child may talk about a long holiday to a country where the practice is prevalent

A child may confide that she is to have a “special procedure” or celebrationSlide20

How should we respond?

You should discuss any concerns with the practice lead for safeguarding / Named GP

You must consider making a referral to the Local Authority Children’s Social Care or police if urgent

Follow local multi

agency

pathway/guidanceSlide21

What can we do about it?

Been trained

http://www.fgmelearning.co.uk/

Aware of FGM during examinations

Awareness around requests for immunisation for travel purposes in children

Alert to

a

dverse consequences of FGM (physical and psychological)Information about FGM could be made part of any ‘welcome pack’ given to a practice’s new patients.Slide22

Case 2

A 14 year old girl presents requesting contraception. She appears to be

Gillick

competent.

She describes some symptoms suggestive of a sexual transmitted infection and wants treatment for that too.

She has evidence of ‘cutting’ on her arm when you check her blood pressureSlide23

Child Sexual Exploitation

Sexual

exploitation of children and young people

under 18 involves exploitative situations, contexts and relationships where young people (or a third person or persons) receive ‘something’ (e.g. food, accommodation, drugs, alcohol, cigarettes, affection, gifts, money) as a result of them performing, and/or another or others performing on them, sexual activities.

“

For children over 10, sexual exploitation is the

most pressing and hidden child protection issue in this country.” (Barnardo’s)Slide24

Rotherham Inquiry

The Rotherham Inquiry

into

CSE in

Rotherham found that

a

pproximately

1400 children were sexually exploited over the full Inquiry period, from 1997 to 2013There is a current ongoing investigation in Newcastle (Operation Sanctuary) into the same issue of sexual abuse of children and young people.Slide25

What did we learn from the Rotherham Inquiry?

Of

the children who were victims of CSE;

50% had misused alcohol or other substances (this was typically part of the grooming process)

33% had mental health problems (again, often as a result of abuse) and two thirds had emotional health difficulties

parental addiction was present in 20% of cases and parental mental health issues in over a third of cases

there was a history of domestic violence in 46% of cases

truancy and school refusal were recorded in 63% of cases and 63% of children had been reported missing more than oncemany were Looked After ChildrenSlide26

Recommendations

1) All staff need to be aware of the problem of child sexual

exploitation -

check LSCB online learning

2

) All clinicians should be aware of the possibility of CSE when discussing contraception with young

people

GMC guidance 0-18 para 64-69:3) All staff should be aware of the locally agreed flowchart for managing cases of suspected CSE (included at the end of this alert, from Northumbria Police) – see handout4) Do not allow issues of race or culture to obscure decision-making in the safeguarding of children - consider equality and diversity trainingSlide27

GMC guidance 0-18

You should usually share information about abusive or seriously harmful sexual activity involving any child or young person, including that which involves:

(

a)

a young person too immature to understand or consent

(

b)

big differences in age, maturity or power between sexual partners (c) a young person’s sexual partner having a position of trust (d) force or the threat of force, emotional or psychological pressure, bribery or payment, either to engage in sexual activity or to keep it secret (e) drugs or alcohol used to influence a young person to engage in sexual

activity when they otherwise would not (f) a person known to the police or child protection agencies as having had abusive relationships with children or young people” Para 64-69Slide28

Case 3

You receive a letter from the hospital about

a

14 year old boy has

DNAed

several appointments in the hospital asthma clinic.

You invite him to attend for asthma reviews at the surgery but he DNAs those too.

He doesn’t come for his flu jabHe comes home from school one day and asks him mother where his inhaler isWithin minutes he’s has had a respiratory arrest and diesSlide29

Why Children Die

Every year it is estimated that

2,000

additional children– around 5 a day – die in the UK compared to Europe’s best performing country for child mortality, Sweden.Slide30

All cause mortality in children aged 0-14 years in European countries

Wolfe et al.

Improving child health services in the UK: insights from Europe and their implications for the NHS reforms

BMJ2011;342:d1277Slide31

Over

half of deaths in childhood occur during the first year of a child’s life

, and are strongly influenced by pre-term delivery and low birth weight; with risk factors including maternal age, smoking and disadvantaged circumstances.

Suicide remains a leading cause of death in young people in the UK,

and the number of deaths due to intentional injuries and self-harm have not declined in 30 years. 

After the age of one, injury is the most frequent cause of death;

over three quarters of deaths due to injury in the age bracket of 10-18 year olds are related to traffic incidents.Slide32

Why Children Die

The

report;

h

ighlights the

importance of

access

to high quality healthcare for children and young peoplecalls for a reduction in preventable deaths through better training of healthcare professionals to enable confident, competent, early identification and treatment of illnessrecommends better use of tools such as epilepsy passports, asthma plans and coordinated care between hospitals and schoolsrecommends all frontline health professionals involved in the acute assessment of children and young people should utilise resources such as the ‘Spotting the sick child’ web resourceaction against the wider determinants of child health and deathSlide33

Child Death Review

1. A rapid response by a group of key

professionals (

sometimes known as a rapid response

team) who

come together for the purpose of enquiring into and evaluating each unexpected death

of a

child;2. An overview of all child deaths (under 18 years) in the local safeguarding children board (LSCB) areaLessons learnt are disseminatedSlide34

Child Death Overview Panel Report

The North of Tyne CDOP identified

m

odifiable

factors were identified in four

out of ten recent cases

. The factors

were:Co-sleepingConsanguinitySmoking and health issues in pregnancy Co-sleeping with maternal and postnatal smoking by both parents incorporated with alcohol and drug use.Slide35

What lessons might we learn in this case?

Proactive response to C+YP who

DNA

appts

Development of asthma management plans

More young people friendly services

Better links with school nursing teams

We need to address issues of poverty and inequalitySlide36

Care Quality CommissionSlide37

CQC Inspection of Children’s Services

CQC will inspect general practices as part of a citywide inspection of children’s services

They will announce a visit on a Thursday and expect to be looking at notes early the following weekSlide38

CQC

As a bare minimum, all practices should;

have a child safeguarding

lead

have a child safeguarding

policy

, that is up to date, and that all staff can locate

ensure all staff members are suitably trainedappropriately code safeguarding concerns on your computer system? In particular, can you identify the following vulnerable children; a child subject to a child protection plan 13Iv (XaOnx) a Looked After Child 13IB (13IB) a child considered a ‘cause for concern’ 13If (

XaMzr)regularly meet with Health Visitors to discuss all children of concern?share (or explain) your concerns, and respond to requests for information for child protection proceedings e.g. case conferences?Lead, policy, train; code

, meet, explain!Slide39

RCGP Child Safeguarding ToolkitSlide40

RCGP Child Safeguarding Toolkit

What’s new?

More detail on FGM, CSE, trafficking, DVA, forced marriage, radicalisation as a form of abuse,

etc

Updated Child Safeguarding Policy

Self-assessment tool

Requirements of an ‘annual practice report’

More emphasis on ‘whistle-blowing’ Section of what happens after a CSC referralMore focus on early intervention/CIN/CAFsSlide41

RCGP Child Safeguarding ToolkitSlide42

And don’t

forget….Slide43

… some key facts!

Those that don’t cruise rarely bruise

Disclosure of DVA occurs after the 36

th

incident (on average)

Consider parental explanations of unusual symptoms or signs of disease/injury with ‘respectful uncertainty’

Consider safeguarding issues when assessing a child whose behaviour is causing concern

Actively engage in child protection procedures