Disabled Children

Children with a disability are children first and foremost, and deserving of the same rights and protection as other children. By definition, any child with a disability should also be considered as a child in need. A child can be considered to be disabled if they have significant problems with learning, communication, comprehension, vision, hearing or physical functioning. The child may also have a diagnosis from a medical professional.

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. It is also important to see the child in the context of the whole family and community supports that are present.

Disabled children may be especially vulnerable to abuse for a number of reasons. Some disabled children may:

• Be isolated and have limited contact with others;
• Receive intimate care from a considerable 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 and no support around their Speech and Language difficulties;
• Be inhibited about complaining for fear of losing services and/or not aware services are abusive;
• Be especially vulnerable to bullying and intimidation (see Bullying Procedure) and more willing to accept bullying due to lack of recognition of those issues;
• Be more vulnerable than other children to abuse by their peers.

Attitudes and discrimination can mean that only their disability is seen rather than the full picture.

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, and may not be trained appropriately to meet the needs of the child;
• A lack of continuity in care or multi-disciplinary working which leads to an increased risk that behavioural changes may go unnoticed;
• Lack of access to 'keep safe' strategies available to others; and overprotectiveness of carers/services so the child or young person cannot identify what abuse is;
• Disabled children living away from home and community are not seen daily by others outside of the organisation they live in which can lead to badly managed settings and poor care and abuse can occur  such as issues around  are particularly vulnerable to over-medication, poor feeding regimes, toileting arrangements, issues around control of challenging behaviour, lack of stimulations and emotional support (see Children Living Away from Home Procedure);
• Parents'/carers' own needs and ways of coping may conflict with the needs of the child; pressure on family carers with limited support can be a risk factor for the disabled child;
• Some adult abusers may target disabled children in the belief that they are less likely to be detected; evidence indicates a disabled child or young person is less likely to be seen as a reliable witness when they do disclose;
• Signs and indicators can be inappropriately attributed to disability, such as normalisation or overuse of  restraint. Issues around abuse and mental health issues may be ignored or not seen due to the focus on disability;
• Services do not have the expertise to support a child with disabilities with other needs such as trauma, neglect etc;
• 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;
• Overprotectiveness of carers/services so the child or young person cannot identify what abuse is.

The UK Social Work Practice in Safeguarding Disabled Children and Young People report details some of the reasons why disabled children and young people are at greater risk and the reasons why, including where gaps in provision exist.

In addition to the universal indicators of abuse/neglect, the following abusive behaviours must be considered:

• Force feeding;
• Unjustified or excessive physical restraint;
• Rough handling;
• Extreme behaviour modification including the deprivation of food medication, or clothing;
• Misuse of medication, sedation, heavy tranquillisation;
• Invasive procedures against the child's will;
• Neglect of personal care needs;
• 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;
• Being denied access to education, play and leisure opportunities.

Remember that evidence of good quality care does not always mean there are no safeguarding issues.

Those who perpetrate abuse (both within and outside the child's home) may also be perceived as quality caregivers with good relationships with children, families and professionals. Their ability to engage successfully with children may be a necessity in securing the trust, privacy and opportunity which enables abuse to take place. This applies as much to disabled children, as to non-disabled children.

It should be remembered that children with disabilities 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. See Recognising Abuse and Neglect Procedure.

Where there are concerns about a child with disabilities a referral should be made in accordance with the Referrals Procedure.

Children with disabilities should not be left in situations where there is a high level of neglect or other forms of abuse, because a practitioner feels that the parent, carer or service "is doing their best". Carers will need to be challenged in the same way as carers of non-disabled children.

Throughout any Assessment (see Assessment Procedure), including a Section 47 Enquiry, all service providers must ensure that they communicate clearly with the child with the disability and the family and with one another as there is likely to be a greater number of services and practitioners 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.

Safeguards for disabled children are essentially the same as all other children:

• 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 Speech and Language support using the child's preferred method of communication; it may mean visiting a number of times;
• Recognise and utilise key sources of support including staff in schools, friends and family members where appropriate;
• 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;
• Ensure that guidance on good practice is in place and being followed in relation to: 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.

Additional care may need to be taken when receiving a telephone call or visit from a disabled child or adult. Professionals can unwittingly create barriers to communication when presented with someone whose method of communication, appearance or behaviour they are not familiar or comfortable with. If you do not understand what the person is trying to say, do not guess. Do not make assumptions based on communication method or difficulties, or on appearance or behaviour. Do not put the phone down too quickly, because someone may need extra time to speak. Find out if there are steps you can take to assist the person to communicate their concerns. Take into account that some environmental and other factors have particular significance for disabled children's risk of harm.

A failure to recognise disabled children's human rights can lead to abusive situations and practices. Needs relating to impairment, and discrimination against disabled children, can mean that particular effort is required to identify and meet disabled children's basic human rights. These areas include food and nutrition, appropriate levels of discipline or sanctions, finances, hygiene, physical comfort, social interaction, sexuality, liberty and sleep. These basic rights can be abused either through ignorance, lack of appropriate resources or support, or with intention to cause harm. Whether abuse of rights is unintentional or not, it is not acceptable for this to go unchallenged, as this does not promote children's welfare or safety. Moreover, when human rights are denied, children are vulnerable to further types of abuse.

Organisational culture and 'custom and practice' can contribute to institutional abuse or harm. Do not underestimate the power of tradition or how poor practice can become pervasive in influencing staff to behave inappropriately. Unreflective practice and risk aversive approaches from staff members can significantly reduce the quality of life for young people. Such cultures can also become ideal contexts for determined abusers to manipulate both children and adults. Good quality services readily seek the views of young people, parents and other professionals in reviewing their practice. For example, staff must refer any concerns about the behaviour of a staff member, volunteer, taxi driver, etc. which may constitute Significant Harm/gross misconduct towards a child in their care to their school's designated teacher. See also Allegations Against Staff or Volunteers who Work with Children Procedure. They will then refer to the LA School Safeguarding Adviser who will liaise with the statutory agencies.

The significance of poor practice should be assessed in the context of the impact on the particular child. For example, if insufficient time is given for a child with restricted arm and hand movement to have adequate lunch, the child could experience hunger or dehydration. A one off experience like this may not be very damaging, but consider the impact of such an experience if it is repeated over a few days or weeks.

In considering these factors, be aware that poor care practices can have more significant consequences for some disabled children than for non-disabled children. Poor care practices that, for a non-disabled child, may affect their emotional and physical development, may be life-threatening for a disabled child.

The intimacy of the care needed by many disabled children also means that a lack of privacy and dignity can be abusive.

If children are competent and able to give consent for themselves, you should seek consent directly from them. However, it is still good practice to encourage competent children to involve their families in decision-making unless you believe it is not in their best interests to do so.

You should never automatically assume that a child with learning disabilities is not competent to take his or her own decisions; many children will be competent if information is presented in an appropriate way and they are supported through the decision-making process.

In England and Wales, the starting point in assessing whether a young person is able to make decisions about all aspects of their care and treatment is the Mental Capacity Act 2005. The Mental Capacity Act starts with the premise that all individuals over the age of sixteen have the capacity to make decisions for themselves, unless they can be shown to lack capacity. The Acts sets out a single clear test for assessing whether a person lacks capacity to make a decision at a particular time. The Code of Practice outlines a two stage test of capacity:

• Does the person have an impairment of the mind or brain?
• If so, does that impairment or disturbance mean that the person is unable to make the decision in question at the time it needs to be made?

In assessing an individual's ability to make a decision the following areas need to be explored:

• Does the person have a general understanding of what decision they need to make and why they need to make it?
• Does the person have a general understanding of the likely consequences of making, or not making, this decision?
• Is the person able to understand, retain, use and weigh up the information relevant to this decision?
• Can the person communicate their decision? (by talking, using sign language or any other means).

Before coming to a decision that a young person lacks capacity, appropriate steps must be taken to try and enable the young person to make the decision themselves. In circumstances when a young person lacks capacity, as defined by the Mental Capacity Act 2005, practitioners will be able to make decisions in relation to a young person's care and treatment, if such decisions are in the young person's best interests and otherwise carried out in accordance with the principles and provisions of the Act.

When assessing the young person's best interests, the person providing care or treatment must consult those involved in the young person's care and anyone interested in their welfare, if it is practicable and appropriate to do so. This may include the young person's parents. Care should be taken not to unlawfully breach the young person's right to confidentiality. When disagreements about the treatment, care or welfare of a young person aged sixteen or seventeen arise, the case may be heard in either the Court of Protection or the Family Courts, depending on the particular circumstances of the case.

Not all of the provisions of the Mental Capacity Act apply to under 18 years olds. It is to note that the Mental Capacity Act Deprivation of Liberty Safeguards, 2009, only applies to over 18 years olds. However where there are concerns that a young person is being deprived of their liberty the views of the Court of Protection can be sought.

See also resources on Mental Capacity and Deprivation of Liberty

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.

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'.

Worries about carers of disabled children will be shared with carers in the same way as carers of non-disabled children.

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.

Children's social care and the Police should be aware of non-verbal communication systems and should 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 in Criminal Proceedings: Guidance on Vulnerable and Intimidated Witnesses (Home Office 2011) 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. The use of specialist advocates should be considered.

The Children Act 1989 Section 17(1) creates a general duty on children's services authorities to safeguard and promote the welfare of children within their area who are 'in need'. So far as is consistent with this duty, children's services authorities must promote the upbringing of such children by their families.

The definition of 'children in need' is to be found at CA 1989 Section 17(10), which provides that a child is to be taken as 'in need' if:….

(c) he is disabled.

At subsection (11) the definition of 'disabled' for the purposes of CA 1989 Part III is given as follows:

'For the purposes of this Part, a child is disabled if he is blind, deaf or dumb or suffers from mental disorder of any kind or is substantially and permanently handicapped by illness, injury or congenital deformity or such other disability as may be prescribed'.

Ofsted thematic inspection: Protecting Disabled Children

Safeguarding Disabled Children: Practice Guidance

See Local Resources:

Gateshead

Newcastle

North Tyneside

Northumberland (see Resources (Briefings and Reports) – 7 Min Briefings and Guides)

South Tyneside

Sunderland