SAFEGUARDING CHILDREN
Pharmacy Training
Facilitators:
Justine Yearwood, Named Nurse for Safeguarding Children
and
Rose Regan, Nurse Advisor for GP’s
Safeguarding Team
 Carmelita Street, Clinical Service Manager
 Justine Yearwood, Named Nurse for Safeguarding Children
 Keri Clay – Child Death Overview Co-ordinator
 Rose Regan – GP Nurse Advisor
 Annette Wilkin / Anne Martin – Paediatric Liaison Nurse Advisor
 Anne Martin / Deborah Lateef, Nurse Advisor for Initial Assessment Team
(Based within Children’s Services)
 Beverley Wilson, Named Nurse for Looked After Children
 Laura Mpansi, Nurse for Looked After Children
 Admin, Pat Weeks, Karleen Steward, Claire Young and Shimila Azam
Aim
To equip Pharmacists with the appropriate Safeguarding knowledge to
effectively identify suspected cases of significant harm to Children and
young People.
Learning Outcomes
 At the end of the session participants will be able to state their roles,
duties and responsibilities to safeguard and protect children.
 Develop an increased awareness of definitions, signs and symptoms
of abuse, relevant to their role.
 Demonstrate knowledge of the pathway they should follow and who
to contact for support and advice when there is a concern about the
welfare of a child.
Safeguarding Is Everyone’s Responsibility
 Whoever comes into contact with children in a professional capacity
has a duty of care to that child.
 The Children’s Act 2004 reinforced the message that all
organisations that work with children and families. Share a
commitment to safeguard and promote the welfare of children.
 ALL NHS agencies and those commissioned by the NHS have a
statutory duty towards safeguarding children.
What is Safeguarding?
 Protecting children from maltreatment.
 Preventing impairment of children‘s health or development.
 Ensuring that children grow up in circumstances consistent with the
provision of safe and effective care.
 Enabling those children to have optimum life chances and enter
adulthood life successfully.
Children: The Five Outcomes
Stay Safe.
Healthy.
Achieve Economic Wellbeing.
Positive Contribution.
Enjoy & Achieve.
Key Policies and Legislation
LEGISLATION
 Children’s Act 1989
 Adoption and Children Act 2002
 Education Act 2002
 Sexual Offences Act 2003
 Children’s Act 2004
GUIDANCE
 Every Child Matters. Change for
Children 2003
 Working together to safeguard children
2006
 London Child Protection Procedures (3rd
Edition 2007)
 Adoption and Children Act 2006  Local Safeguarding child
 Safeguarding Vulnerable
Groups Act 2006
manual/guidance
 The right to choose. Multi agency
statutory guidance for dealing with forced
marriage 2008, both children and adults
Child Safeguarding Statistics
 On average 1-2 children die each week as a result of abuse or
neglect.
 Every 10 days in England and Wales one child is killed at the hands
of their parent. In half of all cases of children killed at the hands of
another person, the parent is the principal suspect.
 1 child in 1000 under 4 years old suffer severe physical abuse.
 In 2008 a total of 2268 referrals were made to B&D Children’s
Services, of which 197 (8.69%) were deemed a child protection issue.
 There are between 70 – 120 referrals a day to B&D Children’s
Services
Local Safeguarding Children’s Board (LSCB)
 Children’s Act 2004.
 Statutory body made up of Partner agencies.
 Objective to co-ordinate and to ensure the effectiveness of their
member agencies in safeguarding and promoting the welfare of
children.
 Safeguarding Leads of all agencies.
 London LCSB Procedures 2007.
www.londonlscb.gov.uk
Definitions of Abuse
 Abuse is a violation of an individuals human and civil rights by any
other person or persons.
 Every Child and Young Person has a right to life free from abuse
(Article 19 UN Convention on he rights of the child.)
 Legal Definition Children’s Act 1989.
 The child is suffering or likely to suffer, significant harm and the harm
is attributable to lack of adequate parental care or control.
Neglect
 Neglect is the persistent failure to meet a child’s basic physical
and/or psychological needs, likely to result in the serious impairment of
the child’s health and development.
 Neglect can occur during pregnancy as a result of maternal
substance abuse.
 An inability to provide adequate food, clothing and shelter.
 An inability to protect a child from physical and emotional harm and
danger.
 Neglect can be lack of adequate supervision.
 Failing to access appropriate medical care.
Recognition of Neglect
 Evidence of neglect builds up over time.
 When professionals work in areas of high poverty and deprivation
they can become desensitised to some of the indicators of neglect.
 Children can fail to grow within normal limits or lose weight.
 Child thrives away from home environment.
 Child frequently absent from school.
 Child left with inappropriate carers.
 Child left with adults who are drunk or violent.
 Child left alone for excessive periods.
Sexual Abuse
Sexual abuse involves forcing or enticing a child or young
person to take part in sexual activities, including prostitution,
whether or not the child is aware of what is happening. The
activities may involve physical contact, including penetrative
(e.g. rape, buggery or oral) or non-penetrative acts. They
may include non-contact activities, such as involving children
in looking at, or in production of, sexual online images,
watching sexual activities or encouraging children to behave
in sexually inappropriate ways.
Physical Abuse
 Hitting
 Biting
 Shaking
 Hair Pulling
 Throwing
 Licking
 Poisoning
 Slapping
 Burning
 Or otherwise causing physical
 Drowning
 Suffocating
 Strangling
harm to a child
 Physical harm can also be caused
when a parent fabricates the
symptoms or deliberately induces
illness in a child
Emotional Abuse
 Emotional Abuse can be difficult to recognise, as the signs are usually
behavioural rather then physical.
 The indicators are often associated with other forms of abuse.
Indicators can be:
 Developmental Delay.
 Withdrawn or seen as a loner.
 Abnormal attachment between a child
 Playing on community and cultural
and parent.
fears.
 Aggressive behaviour towards others.
 Overcritical .
 Scapegoat within the family.
 Shouting / Swearing.
 Low self esteem and lack of confidence.
 Humiliation.
Common Sites For Accidental Injury
FOREHEAD
NOSE
BONY SPINE
CHIN
FOREARM
ELBOWS
HIP
KNEES
SHINS
Concerning Injuries
SKULL - fracture or bleeding under
skull (from shaking)
EYES - bruising,
black (particularly
both eyes)
EARS - Pinch or slap
marks, bruising
CHEEK/SIDE OF FACE bruising, finger marks
NECK -bruising, grasp marks
UPPER & INNER ARM - bruising,
grasp marks
MOUTH - torn
frenulum
CHEST - bruising, grasp marks
SHOULDERS - bruising, grasp
marks
BACK
GENITALS - bruising
}
BUTTOCKS }
KNEES - grasp marks
THIGHS
}
Linear bruising. Outline of
belt/buckles. Scalds/burns
Sexual Offences Act 2004
 Aim of Act
 To protect children and families from Sexual Abuse.
 Key Points of the Act
 Tougher sentences for adults.
 Closer monitoring of Sex Offenders.
 New and updated offences.
 Clarification regarding sexual activity in the under 16’s.
Consent and the Under 16’s
 The legal age for consent to sex is still 16.
-(Whether straight, gay or bisexual)
 Specific laws protect children under 13, who cannot legally give their
consent to any form of sexual activity. There is no defence of mistaken
belief about the age of the child as there is in cases involving 13 -15 year
olds.
Home Office Guidance
 ‘The Law is not intended to prosecute mutually agreed teenage
sexual activity . . .unless it involves abuse or exploitation’
 ‘Young people still have the right to confidential advice on
contraception, condoms, pregnancy and abortion, even if they are
under 16’
LCPC Protocol on Disclosure
If a young person under the age of 13 years discloses
that they have engaged in or intend to engage in a
penetrative sexual act or other intimate sexual activity
there should be a presumption (within the constraints of
Professional Codes of Conduct), that the case will be
reported to Children’s Services P&A Team.
LCPC Protocol
A comprehensive Risk Assessment
for under 16’s engaged in Sexual Activity includes . . .
 Confidentiality assessed using the Fraser Guidelines.
 Sexual partners of 13-16 year olds checked with the Police as part of
the risk assessment.
 The presumption of reporting to the Police and Children’s Services
any under 13’s engaged in sexual activity.
Frazer Guideline
 The young person understands the advice and has sufficient maturity
to understand what is involved.
 The young person would be very likely to begin, or continue to have
sexual intercourse with or without contraception treatment.
What to do next
 Where (in line with NMC,BMA or GMC Codes of Professional Conduct)
that there is reasonable cause to suspect that a child is suffering or likely to
suffer significant harm, the Duty Social Worker should be contacted via a
Multi Agency Referral Form (MARF).
 If the young person already has a Social Worker the referral should go to
them. Children’s Services will arrange a Strategy Meeting/Discussion with
you as the referrer, and the Police.
 In deciding whether to make a referral, the child’s best interests must be
the overriding consideration.
 All cases involving under 13’s must be fully documented, including giving
reasons where a decision is taken not to share information.
Purpose of the Strategy Meeting
 The purpose of the Strategy Meeting/Discussion will be to:
 Review the nature of the incident;
 Share background Information;
 Determine future actions;
 Consider whether the information /evidence indicates that a crime might
have been committed.
The Age of Consent for Heterosexual Sex
England and Wales
The age of consent to any form of sexual activity is 16 for both men and
women.
The Sexual Offences Act 2003 introduced a new series of laws to protect
children under 16 from sexual abuse. However, the law is not intended to
prosecute mutually agreed teenage sexual activity between two young
people of a similar age, unless it involves abuse or exploitation.
Specific laws protect children under 13, who cannot legally give their
consent to any form of sexual activity. There is a maximum sentence of life
imprisonment for rape, assault by penetration, and causing or inciting a
child to engage in sexual activity. There is no defence of mistaken belief
about age of the child, as there is in cases involving 13-15 year olds.
Under 16’s:
Consent and confidentiality in sexual health services
Any competent young person in the United Kingdom can consent to
medical, surgical or nursing treatment, including contraception and
sexual and reproductive health.
Young people are owed the same duties of care and confidentiality as
adults. Confidentiality may only be broken when the health, safety or
welfare of the young person, or others, would otherwise be at grave
risk.
Contraception and Under 16’s
Health professionals in the UK may provide contraceptive advice and
treatment to young people under 16 if, in their clinical judgement, they
believe it is in the young person’s best medical interests and they are
able to give what is considered to be informed consent.
Every Child Matters:
Change For Children (2004)
 Pharmacists and pharmacy technicians can help to improve all five
outcomes by providing good quality information, advice, support and
signposting to appropriate services when a need is identified.
Working Together to Safeguard Children (2006)
 Those professionals who work directly with children should ensure
the safeguarding and promoting their welfare forms an integral part of
all stages of the care they offer.
 Those professionals who come into contact with children, parents
and carers in the course of their work also need to be aware of their
safeguarding responsibilities.
Hidden Harm
 Parental mental illness does not necessarily have an adverse effect
on a child but it is essential to always assess its implications for each
child in the family.
 Where a parent has a enduring and/or severe mental illness, children
in the household are more likely to be at risk of, or experiencing
significant harm.
 A pregnant woman may have previous severe mental disorders e.g.
schizophrenia or personality disorder involving risk of harm to self or
others.
Fabricated Illness / Induced Illness
 Parent/carer reports signs/symptoms not explained by a medical
condition.
 Poor response o prescribed medication and/or treatment.
 New symptoms are reported on resolution of previous ones.
 Child’s normal activities are restricted by parent due to the perceived
illness.
 Repeated presentations to a variety of doctors with a variety of
problems
Further information on www.doh.gov.uk
Barriers to Safeguarding
Concerns about relationship with family.
Fear of getting it wrong.
Lack of experience.
Pressure of workload.
Familiarity with service user.
Fear of reprisal / complaint.
Unresolved personal feelings.
Information Sharing Guidance
Sharing information is essential to enable early intervention for people
who need additional services to achieve positive outcomes.
It is vital for providing effective and efficient services that are coordinated
around the needs of the individual and for safeguarding and protecting
the welfare of individuals.
It is important that practitioners understand why,when,and how they
should share information, so they can do so confidently and appropriately
as part of their day-to-day practice.
Information Sharing Practitioners Guide (2006)
This was the first cross-government guidance for practitioners
across the whole of the children’s workforce.
Most decisions to share information require professional
judgement.
The guidance seeks to provide clarity on the legal framework for
information sharing at the front line and to develop practitioners
understanding and confidence in sharing information professionally
and lawfully.
Common Assessment Framework
(CAF)
Is a key part in delivering frontline services that are integrated and
focused around the needs of the child.
It is a key component in the Every Child Matters :change for
children programme
It is a standardised tool used to conduct an assessment of a child’s
additional needs and help practitioners decide how these needs
should be met.
For Discussion
What information is classed as confidential in you work as a
Pharmacist ?
What is normally required before disclosing confidential
information?
Describe as many types of circumstances you can think of where
you either must or could disclose confidential information without
consent.
Common Law
Common Law is the basis for civil Rights Law and Human Rights
Laws.
Because there is a professional obligation to respect confidentiality
this becomes part of the ‘duty of care’expected of Pharmacists
under common law.
The pharmacist who discloses confidential information because he
or she believes a child is at risk of significant harm is very unlikely
to be challenged in court.
You are more likely to be challenged for NOT sharing information in
the case of a child.
What to you have concerns
Speak to other health care professionals e.g. health visitor or GP
Seek advice from Children’s Services 0208 227 3852
Seek advice from Safeguarding Team CHS 0208 522 9640
NSPCC will give advice 0808 800 5000
Managing a Disclosure of Abuse
Take the allegation seriously.
Seek advice and support.
Actively listen but DO NOT
press for information.
Inform them what you will do
next.
Record Keeping.
Refer to Social Services.
Think of your safety and the
safety of the child.
Follow policy and procedure.
 Don’t manage the disclosure
on your own.
 Don’t ignore the allegation.
 Don’t promise to keep a secret.
 Don’t ask leading questions.
 Don’t investigate yourself.
 Don’t panic
If you suspect What Should YOU Do?
1.
If safe to do so, ask the individual the direct question.
(Unless Child Sexual abuse)
2.
If possible, get consent to share information.
3.
Inform the designated member of staff about your concerns immediately.
4.
Document what is said accurately – be specific about what you’ve seen;
what the victim said – using the victim’s words; what you said; note the
context – time and date on your record; and sign it; avoid judgments and
opinions.
5.
Refer.
6.
Be professional – do not discuss the matter with people who do not need
to know.
7.
Ensure that records are held securely and in accordance with data
protection.
8.
Take responsibility for following up progress.
It’s all in here!
Accountability for Practitioners
Accountability is an integral part of practice, as in the course of
practice you have to make judgements in a wide variety of
circumstances.
Whatever decision / judgement you make you must be able to justify
your action and always remember that the “welfare of the child is
paramount.” Children Act 1989
Professional Accountability
“You are professionally accountable for your practice. This means that
you are answerable for your actions and omissions, regardless of
advice or directions from another professional.”
NMC Code of Professional Conduct, 2002
Decision Making
Is an integral part of practice
Weighing up the best interests of the child
Using professional knowledge, judgement and skills top decide
What interventions will achieve the desired outcomes?
Information Sharing
 Information Sharing is vital to safeguarding and promoting the welfare
of children & young people
 It is important that practitioners understand the circumstances when,
why and how they should share information.
Case Reviews / Inquires
A key factor in many serious case reviews has been a failure to
record information
To take appropriate action in relation to known or suspected abuse
or neglect
To make a referral to social services and to share information
appropriately
To understand the significance of the information shared
Confidentiality & Consent
The Data Protection Act is not a barrier to sharing information
It is in place to ensure that personal information is shared
appropriately
Information Sharing: Practitioners’ Guide
Dfes 2006
Record Keeping
Good record keeping is an integral part of good practice.
The quality of your record keeping is also a reflection of the
standard or your practice.
Good record keeping is a mark of the skilled and safe practitioner,
whilst careless or incomplete record keeping often highlights wider
problems with the individual’s practice
Content & Style
Be factual, consistent and accurate
Contemporaneous, be written as soon as possible after the event
Written clearly and legibly
No jargon or abbreviations
Accurately dated, timed and signed
Signature – print name
Human Rights Act 1998
Strengthens the rights of the individual to expect confidentiality and
privacy in matters in which regard as private.
However these rights are not absolute and can be overriden by
either the public interest or the prevention of a crime, for the
protection of health or for the protection of rights and freedom of
others.
Therefore in situations of abuse , the rights of the child override
those of the adult in respect of the private family life
Continuum of Needs and Services
Statutory or specialist
assessment from this point
I = Identification and
action
T = Transition
N = Needs met
When do I refer?
Level 1 No additional needs
-No referral. Child’s needs met by universal services
Level 2 Identified additional needs
 Common Assessment Framework
-Referral for targeted/specialist services
Level 3 Identified Complex Needs
 National Assessment Framework
-Referral for statutory/specialist intervention (MARF)
National Assessment Framework
History,
Housing,
Employment
Income
Integration
Family &
Environmental
Factors
Basic care
Safety
Emotional
warmth
Stimulation
Health
Emotional
Behavioral
Education
Identity
Child
Developmental
Needs
Parents/Carers Capabilities
Has
Children
Safeguarding
referral
(revisited)
If no
response
after 3
days ring
Social Worker
should
acknowledge
receipt
Concerns
Discuss with
Manager &
Lead
Professional
If concerns agreed,
refer to CFS using
MARF in 48 hours
Free Training, Advice & Information
Multi-agency LSCB training (includes DV training).
NHS B&D and CHA training.
LSCB London Procedures and Safeguarding Manual
www.domesticviolencelondon.nhs.uk
Advice from named nurse, safeguarding teams and strategic leads (DV
and Safeguarding Adults)
DV leaflets available from Strategic Lead and LBBD DV Team
TRAINING IS ESSENTIAL TO SAFEGUARDING ITS YOUR’S AND
YOUR MANAGER’S RESPONIBILTY TO ENSURE YOU RECEIVE
THE RIGHT TRAINING FOR YOUR ROLE