8.17 Safeguarding children with disabilities

Children and young people with disabilities should be seen as children first. Having a disability should not and must not mask or deter an appropriate enquiry where there are child protection concerns. (Safeguarding Disabled Children Practice Guidance DCSF 2009 and Working Together 2018)

The Disability Discrimination Act 2005 (DDA) and the Equality Act 2010 define a person with a disability as someone who has: "a physical or mental impairment which has a substantial and long term adverse effect on their ability to carry out normal day to day activities."

This means that the needs of children with long term conditions and life-limiting or life-shortening conditions should also be considered as although not thought of as having a disability the vulnerabilities may be similar.

Any child with a disability is, by definition, a 'Child in Need' under Section 17 of the Children Act 1989.

Research suggests that children with a disability may be generally more vulnerable to Significant Harm through physical, sexual, emotional abuse and/or neglect than children who do not have a disability. Disabled Children and those with complex health needs 2004 and The national guidance Safeguarding Disabled Children - Practice Guidance (DCSF 2009)

A child with a disability, if abused, suffers the same consequences as any other. There are many reasons why children with a disability may be more vulnerable to abuse and require additional vigilance.

The level of risk may be raised by:

• A lack of continuity in care, leading to an increased risk that behavioural changes may go unnoticed.
• Where a child is unable to tell someone of their 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.
• Carers may work with the child in isolation; children with a disability are at an increased likelihood of being socially isolated with fewer outside contacts than children without a disability.
• Physical dependency including intimate personal care with consequent reduction in ability to be able to stop abuse;
• Lack of access to 'keep safe' strategies available to others; They often do not have access to someone they can trust to disclose that they have been abused.
• Children with a disability may have speech, language and/or communication needs which may make it difficult to tell others what is happening.
• Parents'/carers' own needs and ways of coping may conflict with the needs of the child;
• Parents/carers' needs dominating professional intervention leading to the needs of a child with a disability becoming overlooked
• Fear of complaining in case services are withdrawn.
• Some sex offenders may target children with disabilities in the belief that they are less likely to be detected.

Looked after children with a disability are not only vulnerable to the same factors that exist for all children living away from home but are particularly susceptible to possible abuse because of their additional dependency on residential and hospital staff for day to day physical care needs. 

In addition to the universal indicators of abuse/neglect listed in Recognition of Abuse and Neglect, the following abusive behaviours must be considered:

• Force-feeding;
• Unjustified or excessive physical restraint; 8.50 Restrictive Physical Intervention Policy
• Rough handling
• Extreme behaviour modification including the deprivation of fluid, medication, food or clothing;
• Misuse of medication, sedation, heavy tranquillisation;
• Invasive procedures against the child's will;
• Deliberate failure to follow medically recommended regimes;
• Misapplication of programmes or regimes;
• Ill-fitting equipment e.g. callipers, sleep board which may cause injury or pain, inappropriate splinting;
• Removing or lack of maintenance of communication aids.

Consideration should be given to Unexplained injuries to young children which includes guidance on Bruising/injuries in Children who are Not Independently Mobile (NIM)

The procedures in Section 4 of this manual, Response to Child Protection Referrals apply equally to children with a disability, as well as the guidance contained in Information Sharing and Confidentiality.

The Local Authority should ensure that those receiving initial contact queries concerning children with a disability are aware of safeguarding issues for these children. It is a statutory responsibility for local authority Children’s Social Care to have lead responsibility for assessing a child’s welfare and undertaking section 47 enquiries. It is the responsibility of all other agencies involved to be aware of what constitutes a safeguarding concern and to know to whom, when and how to report such concerns. Whilst section 47 enquiries are being carried out, the first responsibility, as with any investigation into allegations of abuse and/or neglect is to ensure that the child is safe.

As part of the response, the Local Authority has a duty to meet the needs of parents and carers of children with a disability (under the Carers and Disabled Children Act 2000), and this should be included as part of an assessment of the child. If a local authority considers that a parent carer of a child may themselves have support needs, it must carry also carry out an assessment, if the parent/carer requests one. Such an assessment must consider whether it is appropriate for the parent carer to provide, or continue to provide, care for the child, in light of the parent carer’s needs and wishes - Working Together to Safeguard Children.

When undertaking investigations/assessments into allegations of abuse concerning children with a disability, practitioners need to take into account the following considerations:

• Ensure throughout the process of referral and allocation clear channels of communication are established within all agencies involved with the child. Children with a disability are very likely to be in contact with many different agencies and are more likely to be involved with health workers and a range of therapists. Particular attention needs to be paid to information sharing around a children’s needs, their method of communication, consideration of their vulnerability and concerns about their safety and welfare. (see also Use of Interpreters, Signers or Others with Communication Skills Procedure)
• Where there are abuse allegations relating to a child with a disability, the safeguarding needs of any siblings living in the family home also need to be considered.
• Where there are allegations of abuse and a child with a disability is the alleged perpetrator, investigations need to be handled with particular sensitivity. A duty of care should be shown to both the victim and the alleged perpetrator.
• The collating of medical information concerning the health needs of the child is important as it may have a bearing on the outcome of any enquiry/investigation.
• Where there is a need for a medical examination, consideration needs to be given to the most appropriate medical professional who should undertake the examination, the venue, timing and the child’s ability to understand the purpose of the medical procedure.

Any assessments undertaken should ensure that the child remains the focus of these, be them initial or ongoing. Professionals should never assume that a child with a disability is unable to share their views and participate in an assessment process, including child protection and the criminal justice system.  Agencies must consider using appropriate communication methods throughout the assessment process including when a child with a disability requires support to give credible evidence within the assessment and court processes (see also Use of Interpreters, Signers or Others with Communication Skills Procedure).

Throughout all discussions (including strategy discussions, section 47 enquiries/core assessments, the initial child protection conference and any subsequent child protection review conferences), all service providers must ensure that they communicate clearly with the child and family, and with one another, as there is likely to be a greater number of professionals involved with a child with a disability. Following any section 47 enquiries, the need for the child and their family to be provided with ongoing support should be recognised.