15.16 Safeguarding children with disabilities

Safeguarding disabled children’s welfare is everybody’s responsibility, and given that we know that disabled children are more vulnerable to   than non-disabled children, awareness amongst professionals about safeguarding disabled children and what constitutes best practice, is essential.

It is a fundamental principle that disabled children have the same right as non-disabled children to be protected from harm and abuse. In order to ensure that the welfare of disabled children is safeguarded and promoted, it needs to be recognised that additional action is required. This is because disabled children have additional needs related to physical, sensory, cognitive and/or communication requirements and many of the problems they face are caused by negative attitudes, prejudice and unequal access to things necessary for a good quality of life.

Disabled children are likely to have poorer outcomes across a range of indicators including low educational attainment, poorer access to health services, poorer health outcomes and more difficult transitions to adulthood. They are more likely to suffer family break up and are significantly over-represented in the populations of looked after children and young offenders.

Where disabled children are looked after they are more likely to be placed in residential care rather than family settings, which in turn increases their vulnerability to abuse.

Families with disabled children are more likely to experience poverty and children with special educational needs are more likely to be excluded from school, (70% of all permanent exclusions are of pupils with Education Health and Care Plans).

Research evidence suggests that disabled children are at increased risk of abuse and neglect, and the presence of multiple disabilities appears to increase the risk of both abuse and neglect, yet they are underrepresented in safeguarding systems. They are often found to be less likely to be consulted in routine assessments.  Disabled children can be abused and neglected in ways that other children cannot and the early indicators suggestive of abuse and neglect can be more complicated for disabled children.

Whilst the practice guidance does not identify specific groups of disabled children, particular reference is made to children with speech, language and communication needs. This includes those who use non-verbal means of communication as well a wider group of children who have difficulties communicating with others.

The guidance emphasises the critical importance of communication with disabled children including recognising that all children communicate preferences if asked in the right way by those who understand their needs and have the skills to listen to them.

Various definitions of disability are used across agencies and professionals. Whatever definition of 'disabled' is used, the key issue is not what the definition is but the impact of abuse or neglect on a child's health and development, and consideration of how best to safeguard and promote the child's welfare.

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)

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.

All practitioners and agencies working with disabled children should have regard to Safeguarding Disabled Children: Practice Guidance (DCSF 2009).

Disabled children may be especially vulnerable because of a number of risk factors:

• Multiple care arrangements and a lack of continuity in care, leading to an increased risk that behavioural changes may go unnoticed.
• Many disabled children are at an increased likelihood of being socially isolated with fewer outside contacts than children without a disability; Carers may work with disabled children in isolation
• Their physical dependency on parents and carers for practical assistance in daily living, including intimate personal care with consequent reduction in ability to be able to stop abuse, increases their risk of exposure to abusive behaviour;
• They have an impaired capacity to resist or avoid abuse
• They may have speech, language and communication needs which may make it difficult to tell others what is happening. Some disabled children are unable to understand keeping safe strategies.
• They often do not always have access to someone they can trust to disclose that they have been abused; and/or
• They are especially vulnerable to bullying, intimidation and exploitation;
• 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
• Parents, carers and/or professionals may be fearful or reluctant to highlight safeguarding concerns due to concerns this may impact on any short break respite or formal funded arrangements. 

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; 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 aid
• Not getting enough help with feeding leading to malnourishment
• Poor toileting arrangements
• Lack of stimulation
• Unwillingness to try to learn a child's means of communication
• Misappropriation/misuse of a child’s finances;
• Not allowing a child to develop and have social and educational opportunities;
• Undignified age or culturally inappropriate intimate care practices
• Parents may fabricate and induce illness in their disabled children see Fabricated or induced illness (FII) and Perplexing Presentations (including FII by carers)
• A bruise in a site that might not be of concern on an ambulant child, such the shin, might be a concern on a non-mobile child. 

Some disabled children live, or receive short breaks away from home and this is recognised as likely to increase their vulnerability.

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.

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

Disabled children must be responded to as individuals with their own specific needs, feelings, thoughts and opinions. Disabled children are subject to the same procedures for initiating a strategy discussion, as non-disabled children. Where there are concerns about a child with disabilities a referral should be made in accordance with  Making a Referral

The procedures in Section 6 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.

As with all section 47 enquiries, the need for accurate, detailed, contemporaneous recording of information is essential.

When responding to concerns about the welfare of disabled children it is important that there is liaison and a close working relationship between staff working in the duty assessment teams and those in the disabled children’s service.

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).

Each child should be assessed carefully, and helped and supported to participate in the criminal justice process when this is in thier best interest and the interests of justice. 

In criminal proceedings witnesses aged under 17 are automatically eligible for assistance with giving their evidence. Special measures may include screens around the witness box so they do not see the defendant; video recorded evidence in chief and live video links so they may not have to go into the courtroom at all, and intermediaries and aids to communication to facilitate good communication. Achieving Best Evidence in Criminal Proceedings (Ministry of Justice) - includes comprehensive guidance on planning and conducting interviews with children and a specific section about interviewing disabled children.

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.

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

• Making it common practice to help disabled children make their wishes and feelings known in respect of their care and treatment;
• Ensuring that disabled children receive appropriate personal, health, and social education (including sex education);
• Where the parents of a disabled child have a disability themselves, arrangements also need to be put in place to accommodate their needs throughout the investigation/assessment process
• Making sure that all disabled children know how to raise concerns, and giving them access to a range of adults with whom they can communicate. Those disabled children with communication impairments should have available to them at all times a means of being heard;
• An explicit commitment to, and understanding of disabled children’s safety and welfare among providers of services used by disabled children and a culture of openness to ensure that concerns are properly followed up;
• Close contact with families, and a culture of openness on the part of services;
• Guidelines and training for staff on good practice in intimate care; working with children of the opposite sex; handling difficult behaviour; consent to treatment; anti-bullying strategies; and sexuality and sexual behaviour among young people, especially those living away from home
• LADO must be involved when an allegation is made about a professional
• Guidelines and training for staff working with disabled children aged 16 and over to ensure that decisions about disabled children who lack capacity will be governed by the Mental Health Capacity Act 2005 once they reach the age of 16;
• The number of carers involved with the child should be established as well as where the care is provided and when. A disabled child’s network of carers could include short break foster carers, volunteer befrienders, sitters, personal assistants, community support workers, residential care staff, independent visitors and learning support assistants.
• Children who receive overnight short breaks and residential school should have their care plan reviewed by an Independent Reviewing Officer (IRO).

The needs of disabled people who have been abused as children, to be able to access therapeutic services should also be given consideration. 

Assessment should be undertaken by professionals who are both experienced and competent in child protection work, with additional input from those professionals who have knowledge and expertise of working with disabled children.

A good question when assessing a disabled child is: Would I consider that option if the child were not disabled?

Extra resources may be necessary especially where the child has speech, language and communication needs. For example it may be necessary to obtain an assessment from a teacher and speech and language specialist as to the best way of working with the child.

The child's preferred method of communication must be given the utmost priority.

The following questions should be asked when a referral is received concerning a disabled child:

• What is the disability, special need or impairment that affects the child? Ask for a description of the disability or impairment
• Make sure that you spell the description of an impairment correctly
• How does the disability or impairment affect the child on a day-to-day basis?
• How does the child communicate? If someone says the child cannot communicate, simply ask the question: 'How does the child indicate he or she wants something?
• How does the child show s/he is unhappy?
• Has the disability or condition been medically diagnosed?

The number of carers involved with the child should be established as well as where the care is provided and when.

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."

The Children Act 1989 (Section 17) clarified the position of disabled children as children in need and defined disability using a National Assistance Act 1948 definition as ‘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’. The Children Act 1989 lays down a general duty on local authorities to safeguard and promote the welfare of children in their area and so far is consistent with that duty to promote the upbringing of such children by their families by providing a range and level of services appropriate to those children’s needs.

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.

It is recommended that where children require intimate care, good practice guidelines are drawn up within the establishment and disseminated to all staff. Parents / carers should also be made aware of how intimate care for their child will be managed. These guidelines should be viewed as expectations upon staff, which are designed to protect both children and staff alike. In situations where a member of staff potentially breaches these expectations, other staff should be able to question this in a constructive manner.

Staff should be advised that if they are not comfortable with any aspect of the agreed guidelines, they should seek advice within the establishment. For example, if they do not wish to conduct intimate care on a 1 to 1 basis, this should be discussed, and alternative arrangements considered. For example, it may be possible to have a second member of staff in an adjoining room or nearby so that they are close to hand but do not compromise the child’s sense of privacy.

The following is an example of good practice guidelines from Chailey Heritage, a nationally recognised centre for the education, assessment, treatment and support of children with physical and multiple disabilities. Whilst these are considered to be “best practice”, individual establishments may wish to adapt them to suit their particular circumstances.  Guidelines for good practice (adapted from the Chailey Heritage centre)

Advice to Parents / Young Person

Where those with parental responsibility wish to employ a personal assistant through the use of direct payments to support a disabled child (or when a 16/17 year old disabled person wishes to employ an assistant), they should be advised to:

• Obtain an Enhanced check from the Disclosure and Barring Service (DBS) via Local Authority Children’s Services;
• Work with an advocacy service in taking up references and interview processes;
• Avoid employing an under 18 year old as s/he cannot be held legally responsible for harm befalling a child in their care;
• Avoid employing anyone about whom they have doubts;
• Consider recruiting someone else if they are unhappy with the person working for them.

Disclosure and Barring Service Checks

The potential employee should submit their application for Disclosure and Barring (DBS) checks to Local Authority Children’s Services. The potential employee should be advised that the results of this check will be shared with the young person / parent.

Whilst this is carried out, potential users of direct payments who are already in receipt of services commissioned by the local authority, should continue to receive existing support.

If a DBS check has been requested, but has not been received by the time the personal assistant is required to start work, the parent/carer/young person should be advised that the personal assistant should not be left alone with the child/young person they are providing care to until DBS clearance is received.

Consideration should be given to asking the parent/carer to enter into a written agreement to confirm the personal assistant will not be left alone with the child/young person until the DBS clearance has been obtained. It is preferable if the employment of a PA can wait until clearance is received (providing this is appropriate), as it avoids action being taken to terminate employment if the DBS is unsatisfactory.

Local authorities must be satisfied that a direct payment used for this service will safeguard and promote the welfare of the child (see A Guide to Receiving Direct Payments from your Local Council, DH September 2009). Once the check is received the responsible manager must decide whether the direct payment can be progressed.

If the person is deemed to be unsuitable, the direct payment should be declined, pending a more suitable candidate. The practitioner would discuss the circumstances with the parent or young person (possibly with their advocate).

DBS checks should be updated every three years.

If Parent / Young Person Decline to Pursue DBS Checks

If the parent / young person decline to pursue DBS checks, Children Services may be unable to agree to Direct Payments as they would need to check that the a potential employee is suitable by ensuring that they do not have a criminal record which may indicate they may pose a risk to children. If Children Services  declines a direct payment on these grounds, reasons should be sensitively shared with the young person / parent and clearly recorded.

If the young person and/or parent decline to pursue a DBS check, they (or an advocate) should be asked to sign a disclaimer.