Child Protection Enquiries

4.1 Section 47 of the Children Act 1989 confers a duty on the Local Authority that where a child in the area is:

• Subject of EPO / Police Protection or
• They have reasonable cause to suspect a child is suffering or is likely to suffer significant harm

The authority shall make or cause to be made necessary enquiries to decide whether they should take any action to safeguard or promote the child’s welfare.
Where enquiries are being made the authority should:

• Obtain access to him/her or ensure access is obtained by an authorised person.

Section 53 of the Children Act 2004 amends section 47 so that for the purposes of making a determination as to what action to take the authority shall:

• Ascertain the child’s wishes and feelings about such action.  And,
• Give due consideration to the child’s wishes and feelings.

4.2  The relevant Team Manager in Children’s Social Care must ensure that s.47 enquiries are initiated when:

• A referral has been received that meets the criteria for immediate enquiries under s.47 i.e. that a child is suffering or likely to suffer significant harm
• Another child in the family has died or has been seriously injured and abuse is suspected (see chapter 8, para 8.4)
• An initial assessment of a child in need identifies that the child is suffering or is likely to suffer significant harm
• During the process of a core assessment for a child in need concerns arise that the child is suffering or is likely to suffer significant harm

4.3 Once it has been decided that s.47 enquiries are required, the Team Manager should ensure that

• checks are carried out with all relevant local agencies in order to ascertain who might have relevant information to contribute to a strategy discussion
• the first strategy discussion takes place within 24 hours

4.4 Strategy discussions by telephone may occur:

• in less complex cases
• at the initial stages of the enquiry in complex cases where time is needed in order to clarify who should attend a strategy meeting. in this situation the meeting should take place within a maximum of 5 working days

4.5 Face to face Strategy Meetings should be held where:

• A joint investigation is likely
• There are allegations against staff, carers, volunteers or anyone professionally involved with the child
• In situations of complex abuse
• There is an allegation that a child has abused another child (separate meetings should be held for each child)
• The child is disabled
• Fabricated illness is possible
• There has been the unexplained death of a child.  In this instance, consideration should be given to the meeting being chaired by someone independent of the case.

4.6 The Team Manager responsible for convening a strategy meeting should ensure participants include

• Relevant staff from all agencies who may have information that will be of assistance in planning the enquiries e.g. police/health/education etc.
• Those who are sufficiently senior and able to contribute to the discussion of available information and make decisions on behalf of their agencies
• The member of the medical team, ideally the medical consultant responsible for the child’s healthcare, where a child is an in-patient or receiving services from a child development team
• The senior ward nurse, or a nurse with knowledge of the child, if the child is an in-patient

4.7 Strategy meetings should be chaired by an experienced professional from police or social care.

4.8 Complex abuse strategy meetings should be chaired by a senior member of staff who should notify the chair of the LSCB. Complex abuse may involve possible fabricated or induced illness, alleged professional abuse or networks of sexual offenders. In very complex situations more than one strategy discussion may be necessary.

4.9 The strategy discussion should:

• confirm details of the concerns
• evaluate content and urgency
• agree the conduct and timing of any criminal investigation led by police
• decide whether a core assessment under s.47 of The Children act 1989 should be initiated or continued if it has already begun
• agree whether the enquiry will be conducted solely by Children’s Social Care or jointly with the police (see 4.13)
• agree whether there is a need for medical assessment or treatment
• agree what action is needed immediately to safeguard and promote the welfare of the child and/or provide interim services and support. If the child is in hospital decisions should be made about how to secure the safe discharge of the child
• determine what information from the strategy discussion should be shared with the family
• determine if legal advice is required
• agree a plan for the core assessment including who should be interviewed and when and how the child’s wishes and feelings should be obtained
• consider the race and ethnicity of the child and family consider how this should be taken into account including establishing whether an interpreter is needed
• consider any impairment (child or family) determine particular needs including access and/or any assistance that will be required with communication
• consider the needs of other children who may be affected, for example, siblings and other children in contact with alleged abusers
• agree a contingency plan if a parent refuses consent for an interview or medical assessment of the child.

4.10 Where there are concerns about fabricated illness and it is decided to commence s.47 enquiries the strategy meeting should, in addition, agree:

• whether the child needs constant professional observation, and if so, whether the carer should be present
• the designation of a medical clinician to oversee and co-ordinate the medical treatment of the child and control the number of specialists and hospital staff the child may be seeing
• who should be responsible for collating the medical records of all family members, including children who may have died or no longer live with the family
• the nature and timings of police investigations, including analysis of samples and covert surveillance. Any covert surveillance will be police led and draw on advice from the National Crime Faculty
• how any required expert consultation will be obtained

4.11 Where there are concerns about domestic violence and it is decided to commence s.47 enquiries the strategy meeting should be aware of:

• The power and control of the perpetrator affecting the assessment process.
• The potential increase in risk to the victim and child(ren) as a result of the child protection enquiry.
• The psychological impact of living with domestic violence which can lead to the abuse of drugs, alcohol and the development of mental ill health.
• The strategy meeting should agree that information can be shared; however a woman’s safety could be compromised if her whereabouts are discussed.
• The safety of the family should be paramount
• Consideration should always be given to the safety of professionals involved in the enquiries
• The strategy discussion needs to include specialist domestic violence advice and guidance

4.12  Strategy discussions - recording

• Any information shared, all decisions reached, and the basis for those decisions should be recorded on the Record of Strategy Discussion
• The record of the discussion should be circulated within one working day to those who participated

S. 47 Enquiries and Associated Police Investigations – decision making about joint or single agency enquiries

4.13 Significant harm to children gives rise to both child welfare concerns and law enforcement concerns.  S.47 enquiries may therefore run concurrently with police investigations concerning possible associated crime(s).

4.14 When joint enquiries take place, the police have the lead for the criminal investigation, and Children’s Social Care have the lead for the s.47 enquiries and the child’s welfare.

4.15 The strategy meeting or discussion must agree that single agency enquiries by children’s services are appropriate.

Joint Agency Enquiries

4.16 Joint enquiries are those jointly conducted by Children’s Social Care and the police.

4.17 A joint enquiry must always take place when there is an allegation or reasonable suspicion that one of the criminal offences below has been committed:

• Any suspected sexual abuse committed against a child aged up to eighteen years, except in situations of stranger abuse (see 4.22).
• Serious neglect or ill-treatment or emotional harm.
• Serious physical abuse to a child aged up to eighteen years old; this includes murder, manslaughter, any assault involving actual or grievous bodily harm, repeated assaults involving minor injury.
• Allegations involving organised or institutional abuse.
• Allegations which involve unusual circumstances, such as the presentation of bizarre behavioural/ medical conditions including suspected illness induced or fabricated by carers with parenting responsibilities,
• Allegations relating to the forced marriage of a child,
• Allegations against professionals who work with children
• Adults who are accessing indecent images of children who have regular direct contact with the children.

4.18 A joint enquiry must be considered in cases of:

• Minor injuries to a child subject to a child protection plan or looked after by the local authority
• Injury to a pre-mobile child,

4.19 For other cases of minor injury the following factors where known must be considered in determining the seriousness of the allegation or concern and therefore, whether the threshold for a joint investigation has been met:

• The vulnerability of the child (including age, impairment)
• Any previous history of minor injuries
• The intent of the assault
• The use of a weapon
• Previous concerns from a caring agency
• The consistency with and clarity or credibility of the child’s accounts of the injuries
• Other predisposing factors about the alleged perpetrator e.g. criminal convictions, alcohol / drug misuse. Mental health difficulties and domestic violence.

Children’s Social Care Single Agency Enquiries

4.20 The criteria for single agency enquiries are where the available evidence suggests

• Emotional abuse alone
• Physical abuse resulting in minimal or no injury (except pre mobile babies)
• Neglect insufficient for prosecution
• Over sexualised behaviour of a child and there are no other concerning features.

4.21 If, at any point during the enquiries, it becomes apparent that the joint enquiry criteria are met, contact should be made with the police and a joint enquiry started.

Police Single Agency Enquiries

4.22 These will usually be appropriate where:

• An adult makes an allegation about abuse in childhood
• The alleged offender is not known to the child or the child’s family (i.e. stranger abuse).  In this situation Children’s Social Care must be made aware of the investigation and a joint decision made by the first line managers in each agency as to whether the child’s needs should be assessed.

4.23 On occasions the police may conduct a single agency investigation out of hours reflecting their duty to respond and take initial action to protect either a child or criminal evidence.  If this occurs, Children’s Social Care must be informed as soon as possible and a joint enquiry commenced if appropriate.

S.47 Enquiries and the Core Assessment

4.24 The core assessment is the means by which a s.47 enquiry is carried out. The objective of the s.47 assessment is to determine whether action is required to safeguard and promote the welfare of the child or children who are the subjects of the enquiries.  The Core Assessment will provide the framework for analysing risk, harm and need.

4.26 The core assessment should be led by a qualified and experienced social worker and all workers undertaking s.47 enquiries should have specialist training and experience in interviewing children.

4.27 The assessment should be completed within 35 days of the decision to undertake a core assessment. This will not be within the timescale of an initial child protection conference if one is required. Where it has been decided to hold a conference sufficient progress should have been made with the core assessment to enable the conference to make a reasoned decision about the needs of the children.

4.28 The core assessment process / s.47 enquiries should always:

• Be carried out in such a way that distress to the child is minimised
• Involve separate interviews with the child who is the subject of concern, and interviews with parents and/or caregivers, and observation of the interactions between parents and children. A child who is competent to take the decision can decide that they do not wish the parent to be involved and exceptionally, it may be agreed between Children’s Social Care and the Police that, in order to ensure the best possible evidence, it may be necessary to speak to a suspected child victim without the knowledge of the parent or the caregiver. If parental consent for an interview is refused, the Team manager in Children’s Social Care must be immediately informed and legal advice sought as a matter of urgency
• Include other children in the family being seen/considered for interview
• Treat families sensitively and with respect. The LSCB leaflet Child Protection Enquiries should be given to families at the start of the process.
• Use the Framework for the Assessment of Children in Need and Their Families to collect and analyse information and before completion cover all dimensions in the Assessment Framework
• Give consideration to conducting interviews with all those who are personally or professionally connected with the child, and/or their parents and caregivers
• Ensure a commissioned interpreter is provided where a child or parent speaks a language other than that spoken by the interviewer.  Wherever possible, this interpreter should be trained or briefed in safeguarding issues.
• Ensure children and parents with disabilities are provided with help with communication as required.
• Use alternative means of understanding the child’s perspective  including observation if a child is unable to take part in an interview because of age or understanding
• Avoid using leading or suggestive communication where possible, although it must be recognised that some communication systems used by children with disabilities are leading in nature.  This should not prevent the child’s views being ascertained.
• At all stages of the enquiry the child’s views, wishes and feelings should be ascertained and recorded.

4.29 In the event of parents choosing not to co-operate with the s.47 enquiry  – but concerns about  the child’s safety are not so urgent as to require an Emergency Protection Order - a local authority may apply to court for a Child Assessment Order. In these circumstances, the court may direct the parents/caregivers to cooperate with an assessment of the child, the details of which should be specified. The order does not take away the child’s own right to refuse to participate in an assessment, for example, a medical examination, so long as he or she is of sufficient age and understanding.

[ DoH (2000) Framework for the Assessment of Children in Need and Their Families. London: The Stationery Office ]

S.47 enquiries and medical assessments

4.30 The first consideration should be whether the child needs urgent medical attention, in which case they should be taken to the nearest A & E department.

4.31 When the medical examination takes place out of the area, the strategy discussion/meeting should ensure the medical report is available.

4.32 In other circumstances the strategy discussion or meeting will ensure that the need and timing of medical assessment is agreed with the appropriate paediatrician.

4.33 A medical assessment should always be considered when there is disclosure or suspicion of any form of physical or sexual abuse or neglect. Additional considerations are the need to:

• provide reassurance for the child and family where appropriate
• secure forensic evidence
• obtain medical documentation

Consent for medical assessments or medical treatment

4.34 The following may give consent to a medical assessment:

• A child of sufficient age and understanding. This should generally be assessed by the doctor with advice from others as required. A young person aged sixteen or seventeen has an explicit right {s8 Family Law Reform Act 1969} to provide consent to surgical, medical or dental treatment and unless grounds exist for doubting their mental health no further consent is required
• Any person with parental responsibility
• The local authority when the child is subject of a Care Order (though the parent/carer should be informed)
• The local authority when the child is accommodated under s20 of The Children Act 1989 and the parent/carers have abandoned the child or are physically or mentally unable to give such authority. When a parent or carer has given general consent authorising medical treatment for the child legal advice must be taken as to whether this provides consent for a medical assessment for child protection purposes
• The High Court has inherent jurisdiction
• A Family Proceedings Court as part of a direction attached to an Emergency Protection Order, an Interim Care Order or a Child Assessment Order.

4.35 A child who is of sufficient age and understanding may refuse some or all of the medical assessment though refusal can potentially be overridden by the court.

4.36 Wherever possible the permission of a parent for a child under 16 should be obtained prior to any medical assessment and/or other medical treatment even if the child is judged to be of sufficient understanding. If this is not possible or appropriate, then the reasons should be clearly recorded.

4.37 Where circumstances do not allow permission to be obtained and the child needs emergency treatment then:

• The medical practitioner may decide to proceed without consent
• The medical practitioner may regard the child to be of an age and level of understanding to give her/his own consent

4.38 In these circumstances parents must be informed as soon as possible and a full record made at the time.

4.39 In non-emergency situations when parental permission is not obtained, the social worker and their line manager must obtain legal advice and consider where it is in the child’s best interest to seek a court order.

The process of medical assessment

4.40 In the course of s.47 enquiries, appropriately trained and experienced practitioners must undertake all child protection medical assessments.

4.41 Only doctors may physically examine the whole child, but other staff must note any visible marks or injuries on a body map and document details in their recording.

4.42 Referrals for a medical assessment will be made by the social worker, police officer or their manager, depending on the child’s needs and local provision, to the local community paediatric department.  This department is likely to provide much of the service where children do not need hospital treatment on investigation.  In urgent situations, the child should be taken to the local A&E or Paediatric Hospital Unit.

4.43 In planning the examination, the social worker, the police officer, their managers and the relevant doctor must consider whether it might be necessary to take photographic evidence for use in care or criminal proceedings. Where such arrangements are necessary, the child and parents must be informed and prepared and careful consideration given to the impact on the child.

4.44 The social worker should (unless this would cause undue delay) consult parents or a child of sufficient age and understanding about the gender of the medical practitioner prior to the examination being conducted.  However, no guarantees about this can be given, and it should be given undue emphasis.  It is most relevant to older children when examination for sexual abuse is needed.

4.45 In cases of severe neglect, physical injury or recent penetrative sexual abuse where there is a possibility of forensic evidence being available, the assessment should be undertaken on the day of referral, giving due consideration to the welfare of the child.

In non acute sexual abuse, less severe neglect, emotional abuse and some cases of minor physical injury (in the latter, only after consultation with a paediatrician), assessment should take place as a planned appointment, not necessarily on that day.  However, if it is considered that the protection plan for the child might be altered by the outcome of assessment, this should take place on the day of referral.

4.46 In cases of suspected sexual abuse when forensic evidence may be available, GPs must not perform a detailed examination. In such cases:

• It may be necessary for the assessment may be carried out jointly by a forensic medical examiner (FME) and a paediatrician. If a FME is not available, two paediatricians may carry out the assessment provided they meet the core skills set out in the Royal College of Paediatrics and Association of Police Surgeons Child Health Guidelines (2004).

• The police officer leading the enquiry should ensure that doctors are briefed and possession is taken of evidential items.

• Single examinations should only be undertaken if the person has the requisite skills and equipment.

• The need for a specialist assessment by a child psychiatrist or psychologist should be considered.

Recording the medical assessment

4.47 The paediatrician must agree with the referrer an appropriate timescale for the provision of an initial report. This must be provided to the social worker, police officer (if involved) and GP.  In most cases, it will be appropriate to provide at least an initial report within 24 hours, to be followed up by a more detailed report as soon as practicable.  In some cases, further investigation or assessment may mean it takes longer to provide a definitive opinion.

4.48 Where medical assessment is carried out cross border, the appropriate cross border protocols should be followed.

4.49 Disclosure to the parents of the information contained in the report should be agreed in consultation with the social worker and police officer.

4.50 The report should include

• Date, time and place of examination
• Those present
• Who gave consent and how (child/parent written/verbal)
• A verbatim report of the carer’s and child’s spontaneous accounts of injuries and concerns noting any discrepancies or changes in account
• Documentary findings in both words and diagrams
• Site, size, shape and where possible age of any marks or bruises
• Other findings relevant to the child e.g. squint, hearing problems, learning or speech problems
• Confirmation of the child’s developmental progress (especially important in cases of neglect)
• Time the examination ended
• A medical opinion of the likely cause of any injury or harm.

4.51 All reports and diagrams should be signed and dated by the doctor undertaking the examination.

S.47 enquiries and police investigative interviews

4.52 The strategy meeting will have decided who needs to be interviewed   and who will conduct the interview(s).

4.53 Visually recorded interviews will be conducted in accordance with the guidance set out in Achieving Best Evidence.

4.54 Where a child is deemed to be particularly vulnerable and/or has a communication impairment, consideration should always be given as to whether an intermediary should be involved at the early stages of the investigative process.

4.55 The police will be primarily responsible for interviewing the alleged perpetrator(s). They must keep children’s social services informed about the progress of the investigation in order to ensure that the child remains adequately protected once the alleged perpetrator hears the allegations against them or if, having been charged with the offence, they are subsequently released on bail.

[ Achieving Best Evidence in Criminal proceedings: guidance for vulnerable or intimidated witnesses including children (2001) Home Office Publications ]

Action following S.47 enquiries

4.56 Section 47 enquiries will result in one of the following outcomes:

• Concerns not being substantiated
• Concerns being substantiated but the child is not judged to be at continuing risk of significant harm
• Concerns being substantiated and the child is judged to be at continuing risk of significant harm.

4.57 Where concerns about the child being at risk of or suffering significant harm are not substantiated

• The core assessment should be completed
• A Child In Need meeting should be held in order to consider with the family what support and/or services maybe helpful
• In some cases, concerns may remain about significant harm, despite there being no real evidence.  It may be appropriate to put in place an arrangement to monitor the child’s welfare, but this should never be used as a means of deferring or avoiding difficult decisions. Where it has been decided that monitoring is required:
• The purpose of monitoring should be clear – what is being monitored, why, in what way and by whom
• Parents should be informed about the nature of any on-going  concern
• A date should be set for a discussion or meeting to review the monitoring arrangements

• At this stage it may be appropriate to hold a Family Group Conference/ Meeting to engage the parents and wider family group in developing and implementing a child in need plan.

4.58 Where concerns are substantiated, but the child is not judged to be at continuing risk of significant harm, there may be sound reasons, based on analysis of evidence obtained through s.47 enquiries, for judging that a child is not at continuing risk of significant harm. In these circumstances a child protection conference may not be required.

4.59 A child protection conference may not be required in the following circumstances for example:

• The family’s circumstances have changed; e.g. the perpetrator of the abuse has permanently left the house and does not have contact with the child
• Where significant harm was incurred as a result of an isolated abusive incident unlikely to occur again e.g. abuse by a stranger
• The agencies most involved judge that a parent or caregiver, or members of the child’s wider family, are willing and able to co-operate with actions to ensure the child’s safety and welfare. This judgement must be based on a soundly based assessment of the likelihood of successful intervention, based on clear evidence and mindful of the dangers of misplaced professional optimism.

4.60 Where concerns are substantiated and the child is judged to be at continuing risk of significant harm:

• In all situations where a child is judged to be at continuing risk of harm Children’s Social Care should convene a child protection conference
• Where risk of harm is immediate the steps outlined in para 3.15-3.24 above (immediate protection) should be followed before a child protection conference is convened.

• Their line manager
• The child/ren where appropriate
• Parents and/carers who will receive a copy of the record of outcome of s. 47 enquiries (DOH 2002) and core assessment when completed
• Professionals who have contributed to the enquiries but who are not likely to have ongoing involvement with the child and family. They should receive notification of the outcome of enquiries
• Professionals who were involved in the enquiries and who have ongoing involvement with the child and family. They should receive a copy of record of outcome of s. 47 enquiries (DOH 2002) and a copy of the core assessment.
• If consulted during the child protection enquiry, the Independent Chair should receive feedback on the outcome.

Practice Guidance
Action to be taken where a child is at risk of significant harm

Communicating With Children Through the S.47/Core Assessment Process

Communicating with children is an essential part of the enquiry process.

Where a crime is thought to have been committed, the guidance on investigative interviewing is set out in Achieving Best Evidence.

Jones on behalf of the Department of Health reviewed the research evidence and implications for best practice where an investigative interview is not required but an in-depth interview is needed with a child as part of a core assessment/s. 47 enquiries. Below is a summary of some of the key findings. It is recommended that all practitioners undertaking such interviews should consult the main text.

Summary of the principal implications from research for practitioners undertaking in-depth interviews.

• A child’s free account is preferable to answers obtained from specific questions, because it is likely to be fuller and more accurate.
• If direct questions are used, they should not be leading in type, repeated frequently during the interview, or associated with any other type of pressure from the professional. They should be followed by open ended questions or invitations to the child to say more
• Practitioners should avoid bias and supposition
• Interviews should normally be planned in advance. This enables clear identification of the purpose of the interview
• It is useful to prepare children for in-depth interviews, so that they know what to expect and in order to involve them in the process
• In-depth interviews should normally have an introductory rapport building phase
• A flexibly employed structure to the session is useful
• Interviews should be recorded carefully in the most appropriate way for the individual circumstances
• The practitioner should remember that false or erroneous accounts can emanate from children, adult carers or from professional practice
• Any interviews with children should be based on established principles of professional good practice
• It is essential to listen to and understand the child
• It is essential to convey genuine empathic concern
• It is essential to covey the view that it is the child who is the expert, not the professional
• It is easier for practitioners to develop and maintain the qualities and competencies outlined above if they work within an environment that encourages critical review of practice, if they seek frequent updates on research findings and consensus statements, and if they have the opportunities for continuing professional development.

S. 47 Enquiries/Core Assessments And Neglect

Concerns about neglect may come to light suddenly, but, more often enquiries will be commenced following involvement with the family by a number of agencies over time. There is evidence that such situations may result in information becoming fragmented and professionals becoming ‘stuck’, not seeing evidence which challenges their ideas about a family , and at times finding ways to minimise their involvement.

It is therefore important that during the process of enquiries:

• Information is gathered from all those who may have had contact with the child and family including voluntary agencies and adult services
• There is the opportunity for those involved to reflect with their supervisor on the impact that working with the family has had on them and whether this has led them to have become ‘stuck’ and miss important information.

When making enquiries in cases of neglect consideration should always be given as to whether a medical assessment is required in order to determine the impact of the caregiving environment on a child’s development.

Research has shown that in order to adequately assess situations of possible neglect it is important to use an ecological framework.  Enquiries must therefore gather information about:

• The child and their current development (including their views)
• The family history and network including both parents history of being parented and how this might effect their parenting capacity and relationship with the child(ren)
• The environment / community within which the family are living including stressors and supports
• The impact of the wider societal values and beliefs including the impact of such factors as racism or disablism.

Once the above information has been gathered the assessment should focus on the way in which the factors interact and the impact that this has on the likely developmental outcomes for the child both in the short term and the long term.

Throughout the enquiries it must be remembered the impact that neglect can have on the developing child. Working Together states:
Severe neglect of young children has adverse effects on a child’s ability to form attachments and is associated with major impairment of growth and intellectual development. Persistent neglect can lead to serious impairment of health and development, and long term difficulties with social functioning, relationships and educational progress. Neglected children may also experience low self esteem, feelings of being unloved and isolated. Neglect can also result in extreme cases, in death. The impact of neglect varies depending on how long children have been neglected, the children’s age, and the multiplicity of neglectful behaviours children have been experiencing.

S.47 Enquiries/Core Assessments And Sexual Abuse

Enquiries into situations of alleged sexual abuse should be carried out by professionals who have training in this specific area of work.  It is likely that enquiries will be conducted jointly by police and social care in line with procedures set out in this chapter.

Enquiries and assessments should include consideration of:

• The nature of sexual offending, i.e. how sexual offenders operate; the possibility of professionals being “groomed”, as well as children and families, and ways in which children may be silenced by their abusers.
• Factors associated with the non-abusing carer’s capacity to protect the child.
• Alleged sexual abuse within the whole family context and the possible association with other forms of abuse
• The impact of sexual abuse on children and the support they are likely to need throughout the assessment process.

The severity of impact on the child will increase:

• The longer the abuse continues
• The more extensive the abuse
• The older the child

Other features associated with severity of impact are:

• A close relationship between the abuser and the child
• Pre-meditated abuse
• The degree of threat and coercion, sadism, bizarre and unusual elements

Effective assessments

An overview of research has shown that the following are important in enquiries into allegations of child sexual abuse:

• The initial approach is extremely important and sets the tone for the remainder of the investigation
• Parents found that professionals who treated them personally with care and respect, and who listened to their perspectives and were generally non-judgemental, were the most help
• Children were especially sensitive to being patronised or kept in the dark, and wanted information and openness from the practitioner
• There is a need for specialist help to be available for minority ethnic children, or those with particular needs
• It may be hard to evaluate the potential for a parent to be supportive to his/her child, and easy to misinterpret the parent’s first reactions.  This may require further evaluation by the professional in order to clarify parental reactions and responses
• In cases where partnership is initially difficult with parents, perhaps because of the need to take immediate child protective action, it may still be possible to work in partnership despite early difficulties
• Parents benefit from direct information and instructions as to how best to help and respond to their child, particularly when they themselves are in a state of crisis and have reduced coping ability as adults.

Sexual abuse by children and young people

Where the potential abuser is a young person themselves, an assessment of their needs should be carried out separately and should include:

• The nature and extent of the abusive behaviours. Expert professional judgement may be required, within the context of knowledge about normal childhood sexuality
• The context of the abusive behaviours
• The child’s development, and family and social circumstances
• Needs for services, specifically focusing on the child’s harmful behaviour as well as other significant needs; and
• The risks to self and to others, including other children in the household, extended family, school peer group or wider social network. This risk is likely to be present unless: the opportunity to further abuse is ended, the young person has acknowledged the abusive behaviour and accepted responsibility and there is agreement by the young abuser and his/her family to work with relevant agencies to address the problem

Decisions following the assessment will include:

• The most appropriate action within the criminal justice system, if the child is above the age of criminal responsibility
• Whether the young abuser should be subject of a child protection conference
• What plan of action should be put into place to address the needs of the young abuser, detailing the involvement of all relevant agencies

S.47 Enquiries/Core Assessments Following Serious Injuries to Infants

Where an infant has sustained serious injury it is vital that the procedures set out at the beginning of this chapter are followed. It will be particularly important to work closely with medical colleagues and ensure that the immediate protection of the child is secured.

Whilst the Framework for the Assessment of Children in Need will form the basis of the enquiries, researchhas indicated that there are additional factors to consider, and that good assessments will:

Avoid intuitive judgements
Munro has noted that there is a tendency to interpret child protection situations on an intuitive and emotional basis rather than a rational analytical one. When this happens there is a danger that information that does not fit the views of the worker will not be sought. In situations of serious injury to infants it is important that all possible explanations are identified and forensically examined.

Pay attention to detail
Those conducting enquiries must develop a detailed understanding of what exactly happened, when and where, who was present, what happened next? These questions may be a vital key to establishing the roles of parents/carers and will help in assessing the veracity and consistency of accounts and the probability of explanations.

Be neutral
Certain overt professional opinions and single minded advocacy (for or against a parent) should be avoided. When neutrality is lost, parents experience some professionals as ‘on their side’ and others who are ‘against’ them. This is unlikely to lead to good outcomes.

Neutrality involves the open-minded and systematic exploration of alternative hypotheses regarding the cause and circumstances of a serious suspicious injury to a child.

Consider probability
The focus of the enquiry should be on systematically establishing a level of probability in relation to an injury being caused as described. For example given that a self inflicted fracture to a six week old baby may conceivably be possible but extremely unusual – how probable are the alternative explanations?

S.47 Enquiries/Core Assessments and Children with Disabilities

It is known that children with disabilities are more likely to be abused than children without disabilities yet there is evidence that they are less likely to be protected by our child protection system.

Guidance has been issued to LSCBs regarding protecting children with disabilities. This sets out issues that need to be taken into account when conducting s. 47 enquiries. The following is adapted from the guidance.

Take time to gather information you require in order to understand the context of the concern, the nature of the child’s needs and the risks to the child’s welfare

More time may be needed to gather information and you are likely to have to seek information from more people then in the case of a non-disabled child
It will be useful to gather information from:
            Carers – there may be carers additional to those usually involved with a non-disabled child
            Health professionals – as well as those routinely contacted during enquiries
            find out whether the child is in regular contact with the

• School nurse
• Community/district nurse
• Physiotherapist
• Occupational Therapist
• Dietician
• Speech and Language Therapist
• Clinical Psychologist
• Psychiatrist
• Complementary Health workers

Education and schools – thought should be given as to the wide range of people who may be in contact with a disabled child including

• Special educational needs co-ordinators or inclusion co-ordinator
• Classroom/lunchtime assistants
• Transport drivers and escorts
• Volunteers
• Peripatetic teachers

A child with disabilities child is more likely to receive care from a number of adults and this is a risk factor in itself

This means s. 47 enquiries may be more complex. There may be more adults to be interviewed and more potential perpetrators. These difficulties need thorough consideration at the strategy discussion to ensure all risk factors are identified and contamination of evidence is avoided.

Recognise that you may need to seek specialist advice and information in order to make judgements about whether a child is suffering significant harm and what action should follow.

Examples of significant harm which may arise for children with disabilities may fall outside your previous experience. e.g.

• Failure to meet the communication needs of a hearing impaired child to the point where their development is impaired
• Misuse of medication
• Being denied mobility, communication and other equipment
• Being denied access to medical treatment including, for example, parents not agreeing to a gastrostomy where the child is receiving inadequate nutrition and/or oral eating is unsafe.

A failure to recognise children with disabilities human rights can lead to abusive situations and practices

Basic human rights include issues relating to food 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, is unacceptable or not, it is not acceptable for this to go unchallenged as it does not promote children’s welfare or safety. Moreover when human rights are denied children are vulnerable to further types of abuse.

Abuse of rights and poor practice can become pervasive in institutions and poor care practices can have more significant consequences for some children with disabilities than for non disabled children. Poor care practices that for a non disabled child may affect their development might be life threatening for a disabled child.

Medical and health issues have particular implications for identifying significant harm

The potential to abuse or neglect children through medical or health issues is greater than with children who are not as reliant on specific health needs being met. Main areas of concern that should be considered during enquiries are:
The misuse of medication:….for example

• To restrict liberty
• To control emotion and behaviour; and
• To impair physical and emotional capacity to resist abuse

The neglect of health needs:…..for example

• Poor equipment adaptations and aids, which may result in harm. Is this an issue of lack of service provision or have the parents/carers failed to allow appropriate services?
• Tampering with equipment to restrict liberty
• Basic health care needs not being met
• Denying or restricting access to food and nourishment

Experiences such as these can inhibit children’s ability to reach their full potential and can also affect their ability to resist abusive behaviours towards them, making them more vulnerable to further abuse.

If some one tells you that a child’s injury or behaviour is a normal part of their disability make sure you verify this opinion
A previous occurrence should not automatically act as a verification of ‘normality’ and it may be necessary to seek medical or other specialist advice.

Take care to address any barriers to communicating with a disabled child
Children with disabilities may have different communication needs. They may use other communication systems such as British Sign Language, symbols or hand gestures (e.g. Makaton, Rebus).  The child might have very limited communication with only a hand or sign movement that indicates yes and another to indicate no. This does not mean that the child cannot understand or is not able to communicate what has happened to them.

If a parent or professional tells you that a child cannot communicate, explore further what they mean. Ask how do they know when the child is in pain? Hungry? Hot / cold? Or does not like something? This will inform you of how the child communicates.

For some children their only way of communicating with you will be through changes in their behaviour. It is very important therefore to maximise the use of observation and reports from those in contact with the child. For example, where a child’s response to personal care changes suddenly; or where they express fear or aversion to a particular carer.

If it is possible that there will be a criminal prosecution always consider whether an intermediary should be used at an early stage in the enquiries.

Do not think that because a child has a different ability to understand the world that they will not be affected by being harmed or neglected.
Abuse and neglect are as harmful for children with disabilities as they are for non children with disabilities.

Best practice based on research evidence, recognises that the impact of abuse on children’s psychological, emotional and physical health should always be addressed, regardless of whether at the time they understood what was happening to them. This should be applied to all children, including those with cognitive impairments.

S.47 Enquires/ Core Assessments – Issues To Consider Where Parents Have Learning Disabilities

Where a parent has a learning disability it does not automatically follow that they will be unable to care for their child.  However, parents with learning disabilities may lack the understanding, resources, skills and experience to meet the needs of their children. Moreover, they frequently experience additional stressors such as having a child with disabilities, domestic violence, poor physical and mental health, substance misuse, social isolation, poor housing, poverty and a history of growing up in care.

Children of parents with learning disabilities are at increased risk from learning disability and more vulnerable to psychiatric disorders and behavioural problems. They may also assume the role of carer for their parents and other siblings. Unless parents with learning disabilities are comprehensively supported, for example by a capable non abusing relative, such as their own parent or partner their children’s health and development is likely to be impaired.  A further risk of harm to children arises because mothers with learning disabilities may be attractive targets for men who wish to gain access to children for the purpose of sexually abusing them.
Where there are concerns about significant harm it is important that care is taken to:

• Use the ecological model underpinning the core assessment process to gather information about the child’s development, the relationship between the child and their parents and the support systems available to the family both from within their own family network and the wider community. Those conducting the enquiries should also be alert to the possible discrimination faced by the family and how their own attitudes and values regarding parents with learning disabilities might affect their assessment.
• Plan the enquiries carefully paying particular attention to understanding the nature of the learning disability. What is each parent’s level of functioning?  It will be important to use colleagues in adult services to assist in the enquiries and it may also be possible to gain further information regarding the parents capabilities via past school records.
• Make sure that the parent(s) fully understand the enquiry process. Do they need a supporter?  Are written materials adapted to be accessible to them?

An overview of the research literature in relation to parents with learning disabilities should assist those undertaking enquiries. This noted:

• While the association is ambiguous, there is strong evidence for a genetic link between parental learning disability and child developmental delay.
• Where families receive insufficient support, genetic vulnerability to developmental delay in children may be compounded by a paucity of environmental stimulation.
• Behavioural problems, particularly in boys, and corresponding difficulties in parental management may arise when the child’s intellectual capacity exceeds that of their parents.
• The prevalence of childhood abuse is likely to be greater among parents with learning disabilities than the general population, and this may impact on their ability to parent and safeguard.
• In the absence of adequate support, a maternal IQ <60 can be considered a factor predictive of inadequate parenting.
• The main predictor of competent parenting is an adequate structure of professional and informal support.

S.47 Enquiries/ Core  Assessments And Black And Minority Ethnic Children And Their Families

Children from all cultures are   subject to abuse and neglect.  However, in order to make sound professional judgements those conducting enquiries should

• Be sensitive to differing family patterns and lifestyles and to the child rearing patterns that vary across different racial ethnic and cultural groups
• Be aware of the broader social factors that serve to discriminate against black and minority ethnic people
• Be committed to equality in meeting the needs of all children and families and to understand the effects of racial harassment, racial discrimination and institutional racism, as well as cultural misunderstanding and misinterpretation

The process of enquiries should:

• Maintain a focus on the needs of the individual child
• Include consideration of the way in which religious beliefs and cultural traditions in different racial, ethnic and cultural groups influence their values, attitudes and behaviour and the way in which family and community life is structured and organised
• Ensure that cultural factors are not used to explain or condone acts of omission or commission which place a child at risk of significant harm
• Guard against myths and stereotypes both positive and negative.

Anxiety about being accused of racist practice should not prevent the necessary action being taken to safeguard and promote a child’s welfare.

S.47 Enquiries/Core Assessments – Issues To Consider In Situations Of Domestic Violence

All assessments should take place in line with local protocols and involve relevant local agencies.

Working Together to Safeguard Children (2006) identifies the following which should be taken into consideration in responding to situations where domestic violence may be present.

• Asking direct direct questions about domestic violence
• Checking whether domestic violence has occurred whenever child abuse is suspected and considering the impact of this at all stages of assessment, enquiries and intervention;
• Identifying those who are responsible for domestic violence in order that relevant family law or criminal justice responses may be made;
• Taking into account there may be continued or increased risk of domestic violence towards the abused parent and/or child after separation, especially in connection with pose-separation child contact arrangements;
• Providing women with full information about their legal rights and the extent and limits of statutory duties and powers;
• Assisting women and children to get protection from violence by providing relevant practical and other assistance;
• Supporting non-abusing parents in making safe choices for themselves and their children; and
• Working separately with each parent where domestic violence prevents non-abusing parents from speaking freely and participating without fear of retribution.

In assessing safety and risk to the child the following information should be obtained

• When was the most recent incident of violence/abuse
• What were the details of the incident?
• Were any weapons used or threatened to be used? Have any weapons been used or threatened to be used in the past?
• Was the mother locked in a room or prevented from leaving the house? Have either of these things happened before?
• Was there any substance abuse involved?
• How often do violent incidents/abuse occur?
• Have the police ever come to the house? What happened?
• What does the child do when there is violence? Does the child try and intervene? What happened?
• Where were the child’s siblings during the violence?

S.47 Enquiries/Core Assessments – Issues To Consider In Situations Of  Parental Substance Misuse

There is now considerable research evidence that parental substance misuse, particularly when combined with domestic violence can have an adverse effect on outcomes for children.

During enquiries it will be important to use the expertise of professionals in substance misuse teams.

Assessing the impact of parental substance misuse on children.

Forrester suggests the following assessment principles:

• Focus on the child.

Do not become overly concerned about pattern of use as there is no simple relationship between what is taken, how much is taken, the behaviour of the carer and the effect on the child.

• Adults’ management of their own lives is a good indicator of their ability to look after a child

Are the parents causing themselves harm through their failure to manage their own lives? If they are, then this indicates concern about their own ability to manage their child’s life.

• The best predictor of future behaviour is past behaviour

It is important to collect an accurate chronology through working with the parents and children rather than just collating this from files.

• Information from a variety of sources is better than information from one

As well as working with professionals in the network it will be important to consider information that may exist within the wider family. The family network and particularly grandparents, often take on a caring role in relation to children of parents who misuse drugs or alcohol. Including them in the assessment (with permission) is important as they can provide both valuable sources of strength and support for children as well as vital evidence for the assessment.

In addition to the above principles the DrugScope (previously SCODA) below should be used to assist the enquiry process.

Parental drug use

• Is there a drug-free parent, supportive partner or relative?
• Is the drug use by the parent: Experimental?  Recreational?  Chaotic? Dependent?
• Does the user move between categories at different times? Does the drug use also involve alcohol?
• Are levels of child care different when a parent is using drugs and when not using?
• Is there evidence of co-existence of mental health problems alongside the drug use?  If there is, do the drugs cause these problems, or have problems led to the drug use.

Accommodation and the home environment

• Is the accommodation adequate for children?
• Are the parents ensuring that the rent and bills are paid?
• Does the family remain in one area or move frequently; if the latter, why?
• Are other drug users sharing the accommodation?  If they are, are relationships with them harmonious, or is there conflict?
• Is the family living in a drug-using community?
• If parents are using drugs, do children witness the taking of the drugs, or other substances?
• Could other aspects of the drug use constitute a risk to children (e.g. conflict with or between dealers, exposure to criminal activities related to drug use)?

Provision of basic needs

• Are there adequate food, clothing and warmth for the children?
• Are the children attending school regularly?
• Are children engaged in age-appropriate activities?
• Are the children’s emotional needs being adequately met?
• Are there any indications that any of the children are taking on a parenting role within the family (e.g. caring for other children, excessive household responsibilities, etc.)?

Procurement of drugs

• Are the children left alone while their parents are procuring drugs?
• Because of their parent’s drug use, are the children being taken to places where they could be “at risk”?
• How much are the drugs costing?
• How is the money obtained?
• Is this causing financial problems?
• Are the premises being used to sell drugs?
• Are the parents allowing their premises to be used by other drug users?
• Are children being used to procure drugs for their parents

Health risks

• If drugs and/or injecting equipment are kept on the premises, are they kept securely?
• Are the children aware of where the drugs are kept?
• If parents are intravenous drug users: 
• do they share injecting equipment?
• do they use a needle exchange scheme?
• How do they dispose of the syringes?
• Are parents aware of the health risks of injecting or using drugs?
• If parents are on a substitute prescribing programme, such as methadone: 
• are parents aware of the dangers of children accessing this medication? 
• do they take adequate precautions to ensure this does not happen?
• Are parents aware of, and in touch with, local specialist agencies who can advise on such issues as needle exchanges, substitute prescribing programmes, detox and rehabilitation facilities?  If they are in touch with agencies, how regular is the contact?

Family social network and support systems

• Do parents and children associate primarily with:
• other drug users?
• non-users?
• both?
• Are relatives aware of the drug use?  Are they supportive of the family?
• Will parents accept help from the relatives and other professional or non-statutory agencies?
• The degree of social isolation should be considered particularly for those parents living in remote areas where resources may not be available and they may experience social stigmatisation.

Parents’ perception of the situation

• Do the parents see their drug use as harmful to themselves or to their children?
• Do the parents place their own needs before the needs of the children?
• Are the parents aware of the legislative and procedural context applying to their circumstances (e.g. child protection procedures, statutory powers)?

S. 47 Enquiries/Core Assessments – Issues To Consider In Situations Of Parental Mental Ill Health

Mental illness in a parent or carer does not necessarily have an adverse impact on a developmental needs, but, during Section 47 enquiries where a parent or carer has a mental illness, its impact on each child in the family should be assessed. This will mean using the expertise of colleagues working in adult mental health who will be able to give important information regarding the likely behaviours associated with the particular mental health problem.

Factors associated with positive outcomes for children where a parent has a mental illness are:

• Mild parental problems lasting only a short time
• Minimal family disharmony and generally stable family relationships
• One parent or family member able to respond to the child’s needs

Children most at risk of significant harm are those:

• Who feature within parental delusions
• Who become targets for parental aggression or rejection
• Who are neglected as a result of parental mental illness
• Where mental illness is combined with domestic violence.

A study of 100 reviews of child deaths where abuse and neglect had been a factor in the death showed clear evidence of parental mental illness in a third of the cases.

It is not necessary to have a formal diagnosis in order to complete the assessment.  Section 47 enquiries/core assessments should focus on identifying parental behaviours and considering their potential impact on the child.

The following table may assist in the assessment process:

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