1.4.1 Abuse of Disabled Children
For additional guidance, please see Safeguarding Disabled Children: Practice Guidance (issued by the DfE in July 2009).See also Intimate Care Good Practice Guidelines.
The available UK evidence on the extent of abuse among disabled children suggests that disabled children are at increased risk of abuse, and that the presence of multiple disabilities appears to increase the risk of both abuse and neglect (see Standards 5, 7 and 8 of the National Framework for Children, Young People and Maternity Services).
Research also indicates that as well as being the least protected, disabled children are also the least consulted in routine assessments.
The West Yorkshire Consortium seeks to address and challenge these practices by affirming its understanding of the issues facing disabled children and its commitment to removing the barriers that prevent disabled children from accessing their rights.
2. The Child
A child could be considered to be disabled if he or she has significant problems with communication, comprehension, vision, hearing or physical functioning.
Many factors can made a disabled child more vulnerable to abuse than a non-disabled child of the same age. Safeguarding disabled children demands a greater awareness of their vulnerability, individuality and particular needs.
Disabled children may be especially vulnerable to abuse for a number of reasons. Some disabled children may:
- Have fewer outside contacts than other children;
- Receive intimate care possible from a number of carers, which may increase the risk of exposure to abusive behaviour and make it more difficult to set and maintain physical boundaries;
- Have an impaired capacity to resist or avoid abuse;
- Have communication difficulties that may make it difficult to tell others what is happening;
- Be inhibited about complaining for fear of losing services;
- Be especially vulnerable to bullying and intimidation;
- Be more vulnerable than other children to abuse by their peers.
Additional factors may be:
- The child's dependence on carers could result in the child having a problem in recognising what is abuse. The child may have little privacy, a poor body image or low self-esteem;
- Carers and staff may lack the ability to communicate adequately with the child;
- A lack of continuity in care leading to an increased risk that behavioural changes may go unnoticed;
- Lack of access to 'keep safe' strategies available to others;
- Disabled children living away from home in poorly managed settings are particularly vulnerable to over medication, poor feeding and toileting arrangements, issues around control of challenging behaviour, lack of stimulations and emotional support;
- Parents'/carers' own needs and ways of coping may conflict with the needs of the child;
- Some adult abusers may target disabled children in the belief that they are less likely to be detected;
- Signs and indicators can be inappropriately attributed to disability;
- Disabled children are less likely to be consulted in matters affecting them and as a result may feel they have no choice about whether to accept or reject sexual advances.
It should be remembered that disabled children are children first and foremost, and have the same rights to protection as any other child. People caring for and working with disabled children need to be alert to the signs and symptoms of abuse.
Disabled children must be responded to as individuals with their own specific needs, feelings, thoughts and opinions.
In addition to the universal indicators of abuse/neglect listed in the Recognising Abuse and Neglect Procedure, the following abusive behaviours must be considered:
- Force feeding;
- Unjustified or excessive physical restraint;
- Rough handling;
- Extreme behaviour modification including the deprivation liquid, medication, food or clothing;
- Misuse of medication, sedation, heavy tranquillisation;
- Invasive procedures against the child's will;
- Deliberate failure to follow medically recommended regimes;
- Non compliance with programmes or regimes;
- Failure to address ill-fitting equipment e.g. callipers, sleep boards which may cause injury or pain, inappropriate splinting;
- Misappropriation/misuse of a child's finances.
Where a child is unable to tell someone of the abuse they may convey anxiety or distress in some other way, e.g. behaviour or symptoms and carers and staff must be alert to this.
3. The Safeguards
Safeguards for disabled children are essentially the same as all other children. Particular attention should be paid to promoting a high level of awareness of the risks of harm and to high standards of practice, and strengthening the ability of children and families to help themselves.
- Make it common practice to enable disabled children to make their wishes and feelings known in respect of their care and treatment;
- Ensure that disabled children receive appropriate personal, health and social education (including sex education);
- Make sure that all disabled children know how to raise concerns and give them access to a range of adults with whom they can communicate. This could mean using interpreters and facilitators who are skilled in using the child's preferred method of communication;
- Recognise and utilise key sources of support including staff in schools such as support workers, friends and family members where appropriate;
- Ensure that there is an explicit commitment to and understanding of disabled children's safety and welfare among all providers of services used by disabled children;
- Develop the safe support services that families want, and a culture of openness and joint working with parents and carers on the part of services;
- Provide guidelines and training for staff on good practice in intimate care; working with children of the opposite sex; managing behaviour that challenges families and services; issues around consent to treatment; anti-bullying and inclusion strategies; sexuality and safe sexual behaviour among young people; monitoring and challenging placement arrangements for young people living away from home.
Concerns about the welfare of a disabled child should be acted upon in the same way as any other child in accordance with the Referrals Procedure. The same thresholds for action apply.
Expertise and resources in both safeguarding and promoting the welfare of children and in working with disability have to be brought together to ensure that disabled children receive the same levels of protection from harm as other children. Other specialist workers or teams may become involved in the investigative process, therefore, for example Disabled Children's Teams, in accordance with local arrangements.
5. Challenging Carers
Carers are relied upon (whether family or paid carers) as a source of information about disabled children and to interpret and explain behaviour or symptoms.
Professional staff can potentially feel out of their depth in terms of knowledge of a disabled child's impairment, where the familiar developmental milestones may not apply.
When assessing risks to a disabled child, an additional/different approach is required because of their vulnerability.
Disabled children should not be left in situations where there is a high level of neglect or other forms of abuse, because a professional feels the parent, carer or service "is doing their best".
Carer will need to be challenged in the same way as carers of non-disabled children.
Throughout the Single Assessment process, including a Section 47 Enquiry, all service providers must ensure that they communicate clearly with the disabled child and the family and with one another as there is likely to be a greater number of services and staff involved than for a non-disabled child. All steps must be taken to avoid confusion so that the welfare and protection of the child remains the focus.
Where there are communication impairments or learning difficulties, particular attention should be paid to the communications needs of the child to ascertain the child's perception of events and his or her wishes and feelings.
The Children's Social Care Services and the Police should be aware of non-verbal communication systems and should know how to contact suitable interpreters and facilitators.
Agencies must not make assumptions about the inability of a disabled child to give credible evidence, or to withstand the rigours of the Court process.
Each child should be assessed carefully and supported where relevant to participate in the criminal justice system when this is in their interests as set out in Achieving Best Evidence which includes comprehensive guidance on planning and conducting interviews with children and a specific section about interviewing disabled children.
Participation in all forms of meetings such as Child Protection Conferences and Core Groups must be encouraged and facilitated and take into account any issues about access.
The full range of service providers and carers must be represented at all meetings.