Recognising Abuse and Neglect

1. Introduction

These Bedford, Central Bedfordshire and Luton LSCP Child Protection Procedures set out how agencies and individuals should work together to safeguard and promote the welfare of children and young people. The target audience is practitioners (including unqualified staff and volunteers) and front-line managers who have particular responsibilities for safeguarding and promoting the welfare of children, and operational and senior managers, in:

• Agencies responsible for commissioning or providing services to children and their families and to adults who are parents;
• Agencies with a particular responsibility for safeguarding and promoting the welfare of children.

Many children, especially some of the most vulnerable children and those at greatest risk of social exclusion, will need co-ordinated early help services from health agencies such as GPs and health visiting, educational establishments such as schools and colleges, Children's Centres, local authority Children's Social Care, youth justice services and the voluntary, charity, social enterprise, faith-based organisations and private sectors. Some services will be provided as universal services whilst others may be more targeted to meet specific needs, whatever the circumstances of the child.

Working Together to Safeguard Children provides that all agencies and practitioners should:

• Have an applied understanding of what constitutes a child suffering actual or likely significant harm;
• Be alert to potential indicators of abuse, neglect and exploitation, and listen carefully to what a child says, how they behave, and observes how they communicate if non-verbal (due to age, special needs and/or disabilities, or if unwilling to communicate);
• Consider the severity, duration and frequency of any abuse, degree of threat, coercion, or cruelty, the significance of others in the child’s world, including all adults and children in contact with the child (this can include those within the immediate and wider family and those in contexts beyond the family, including online), and the cumulative impact of adverse events;
• Try to understand the child’s personal experiences and observe and record any concerns;
• Communicate in a way that is appropriate to the child’s age and level of understanding and use evidence-based practice tools for engaging with children, including those with special educational needs and disabilities;
• When practitioners have concerns or information about a child that may indicate a child is suffering or likely to suffer significant harm, share them with relevant practitioners and escalate them if necessary, and update colleagues when they receive relevant new information;
• Never assume that information has already been shared by another professional or family member and always remain open to changing their views about the likelihood of significant harm.

Working Together to Safeguard Children defines Safeguarding as:

• Protecting children from maltreatment, whether the risk of harm comes from within the child’s family and/or outside (from the wider community), including online;
• Preventing impairment of children's mental and physical health or development;
• Ensuring that children grow up in circumstances consistent with the provision of safe and effective care; and
• Taking action to enable all children to have the best outcomes.

2. The Concept of Significant Harm

Some children are in need because they are suffering, or likely to suffer, significant harm. The Children Act 1989 introduced the concept of significant harm as the threshold that justifies compulsory intervention in family life in the best interests of children, and places a duty on local authorities to make enquiries (Section 47) to decide whether they should take action to safeguard or promote the welfare of a child who is suffering, or likely to suffer, significant harm.

Additionally, a Court may only make a Care Order or Supervision Order in respect of a child if it is satisfied that:

• The child is suffering, or is likely to suffer, significant harm; and
• The harm, or likelihood of harm, is attributable to a lack of adequate parental care or control (Section 31).

In addition, 'harm' is defined as the ill treatment or impairment of health and development. Harm can be determined 'significant' by "comparing a child's health and development with what might be reasonably expected of a similar child. (Children Act 1989, S31).

There are no absolute criteria on which to rely when judging what constitutes significant harm. Consideration of the severity of ill-treatment may include the degree and the extent of physical harm, the duration and frequency of abuse and neglect, the extent of premeditation, and the presence or degree of threat, coercion, sadism and bizarre or unusual elements.

Each of these elements has been associated with more severe effects on the child, and/or relatively greater difficulty in helping the child overcome the adverse impact of the maltreatment.

Sometimes, a single traumatic event may constitute significant harm (e.g. a violent assault, suffocation or poisoning). More often, significant harm is a compilation of significant events, both acute and longstanding, which interrupt, change or damage the child's physical and psychological development.

Some children live in family and social circumstances where their health and development are neglected. For them, it is the corrosiveness of long-term neglect, emotional, physical or sexual abuse that causes impairment to the extent of constituting significant harm.

Sometimes 'significant harm' refers to harm caused by one child to another (which may be a single event or a range of ill treatment), which is generally referred to as 'child-on-child abuse'.

Some children have pre-existing vulnerabilities which may make them more susceptible to further and ongoing abuse. Children with learning difficulties, mental health challenges and who are socially isolated are more likely to be victims of online abuse and may find it difficult to disclose what is happening to them.

3. Early Help

Working Together to Safeguard Children Chapter 3 Section 1 sets out national guidance on early help. Early help means providing support as soon as a problem emerges at any point in a child's life that improves a family’s resilience and outcomes or reduces the chance of a problem getting worse. It is not an individual service, but a system of support delivered by local authorities and their partners working together and taking collective responsibility to provide the right provision in their area. Some early help is provided through 'universal services', such as education and health services. They are universal services because they are available to all families, regardless of their needs. Other early help services are coordinated by a local authority and/or their partners to address specific concerns within a family and can be described as targeted early help. Examples of these include parenting support, mental health support, youth services, youth offending teams and housing and employment services. Early help may be appropriate for children and families who have several needs, or whose circumstances might make them more vulnerable. It is a voluntary approach, requiring the family’s consent to receive support and services offered. These may be provided before and/or after statutory intervention.

The Early Help System Guide provides a toolkit to assist local strategic partnerships responsible for their early help system in their area. Effective provision relies upon local organisations and agencies working together to:

• Identify children and families who would benefit from early help;
• Undertake an assessment of the need for early help which considers the needs of all members of the family;
• Ensure good ongoing communication, for example, through regular meetings between practitioners who are working with the family;
• Co-ordinate and/or provide support as part of a plan to improve outcomes. This plan will be designed together with the child and family, and updated as and when the child and family needs change;
• Engage effectively with families and their family network, making use of family group decision-making, such as family group conferences, to help meet the needs of the child.

Any child may benefit from early help, but practitioners should, in particular, be alert to the potential need for early help for a child who:

• Is disabled and has specific additional needs;
• Has special educational needs (whether or not they have a statutory Education, Health and Care Plan);
• Is a young carer;
• Is bereaved;
• Is showing signs of being drawn in to anti-social or criminal behaviour, including being affected by gangs and county lines and organised crime groups and/or serious violence, including knife crime;
• Is frequently missing/goes missing from care or from home;
• Is persistently absent from education, including persistent absences for part of the school day;
• Is at risk of modern slavery, trafficking, sexual and/or criminal exploitation;
• Is at risk of being radicalised;
• Is viewing problematic and/or inappropriate online content (for example, linked to violence), or developing inappropriate relationships online;
• Is at risk of so-called 'honour'-based abuse or Forced Marriage;
• At risk of Female Genital Mutilation (FGM);
• Is in a family circumstance presenting challenges for the child, such as drug and alcohol misuse, adult mental health issues and domestic abuse;
• Is misusing drugs or alcohol themselves;
• Is suffering from mental ill health;
• Has returned home to their family from care;
• Is a privately fostered child;
• Has a parent/carer in custody;
• Is missing education, or persistently absent from school, or not in receipt of fulltime education;
• Has experienced multiple suspensions and is at risk of, or has been permanently excluded.

A lead practitioner should co-ordinate the activity around the family, ensure the assessment and the family plan responds to all needs identified, and lead on ensuring the family co-produce the plan. The plan might include the family network. The time commitment to deliver this role will vary family by family depending on the complexity of their needs. Where appropriate, local authorities should engage families, including children, to have a say in who their lead practitioner is, and have a process in place to collate feedback on their relationship with them. The lead practitioner role could be held by a range of people. More details about which practitioners may act as a lead practitioner, their roles and responsibilities along with additional guidance, are provided in the Early Help System Guide.

The practitioners in Bedford, Central Bedfordshire and Luton are supported through training and supervision to understand their role in identifying emerging problems, so that they:

• Know when to share information with other practitioners and what action to take to support early identification and assessment;
• Are able to identify and recognise all forms of abuse, neglect, and exploitation;
• Have an understanding of domestic and sexual abuse, including controlling and coercive behaviour as well as parental conflict that is frequent, intense, and unresolved;
• Are aware of new and emerging threats, including online harm, grooming, sexual exploitation, criminal exploitation, radicalisation, and the role of technology and social media in presenting harm;
• Are aware that a child and their family may be experiencing multiple needs at the same time.

The agencies in Bedford, Central Bedfordshire and Luton have agreements in place such as the Threshold document which provide effective ways to identify emerging problems and potential unmet needs for individual children and families as well as clear guidance and procedures for all practitioners, including those in universal services and those providing services to adults with children. The provision of early help services should form part of a continuum of support to respond to the different levels of need of individual children and families.

The local Threshold document includes information as follows:

• The process for early help assessments and the type and level of early help and targeted early help services to be provided;
• The criteria, including the level of need, for when a child should be referred to Bedford, Central Bedfordshire and Luton children's social care for assessment and for statutory services under:
• Section 17 of the Children Act 1989 (children in need, including how this applies for disabled children);
• Section 47 of the Children Act 1989 (reasonable cause to suspect a child is suffering or likely to suffer significant harm);
• Section 31 of the Children Act 1989 (care and supervision orders);
• Section 20 of the Children Act 1989 (duty to accommodate a child); and
• Clear procedures and processes for cases relating to:
• The abuse, neglect and exploitation of children;
• Children managed within the youth secure estate;
• Disabled children.

4. Definitions of Child Abuse and Neglect

The following definitions are based on those identified in Working Together to Safeguard Children and Keeping Children Safe in Education:

Abuse

A form of maltreatment of a child. Somebody may abuse or neglect a child by inflicting harm or by failing to act to prevent harm. Harm can include ill treatment that is not physical as well as the impact of witnessing ill treatment of others. This can be particularly relevant, for example, in relation to the impact on children of all forms of domestic abuse, including where they see, hear, or experience its effects. Children may be abused in a family or in an institutional or extra-familial contexts by those known to them or, more rarely, by others. Abuse can take place wholly online, or technology may be used to facilitate offline abuse. Children may be abused by an adult or adults or another child or children.

Physical Abuse

Physical abuse may involve hitting, shaking, throwing, poisoning, burning or scalding, drowning, suffocating, or otherwise causing physical harm to a child.

Physical harm may also be caused when a parent or carer fabricates the symptoms of, or deliberately induces illness in a child.

Emotional Abuse

Emotional abuse is the persistent emotional maltreatment of a child such as to cause severe and persistent adverse effects on the child's emotional development, and may involve:

• Conveying to children that they are worthless or unloved, inadequate, or valued only insofar as they meet the needs of another person;
• Not giving the child opportunities to express their views, deliberately silencing them or 'making fun' of what they say or how they communicate;
• Imposing age or developmentally inappropriate expectations on children. These may include interactions that are beyond the child's developmental capability, as well as overprotection and limitation of exploration and learning, or preventing the child participating in normal social interaction;
• Seeing or hearing the ill-treatment of another e.g. where there is domestic abuse;
• Serious bullying (including cyber-bullying);
• Causing children frequently to feel frightened or in danger;
• Exploiting and corrupting children.

Some level of emotional abuse is involved in all types of maltreatment of a child, though it may occur alone.

Children from more affluent families may suffer childhood neglect in less visible ways. It can be more difficult to spot, as the type of neglect experienced is often emotional.

Sexual Abuse

Sexual abuse involves forcing or enticing a child or young person to take part in sexual activities, not necessarily involving a high level of violence, whether or not the child is aware of what is happening. The activities may involve physical contact, including assault by penetration (for example rape or oral sex) or non-penetrative acts such as masturbation, kissing, rubbing and touching outside of clothing.

Sexual abuse may also include non-contact activities, such as involving children in looking at or in the production of sexual images, watching sexual activities, encouraging children to behave in sexually inappropriate ways or grooming a child in preparation for abuse. Sexual abuse can take place online, and technology can be used to facilitate offline abuse. Sexual abuse is not solely perpetrated by adult males. Women can also commit acts of sexual abuse, as can other children.

In addition; Sexual abuse includes abuse of children through sexual exploitation which occurs where an individual or group takes advantage of an imbalance of power to coerce, manipulate or deceive a child or young person under the age of 18 into sexual activity (a) in exchange for something the victim needs or wants, and/or (b) for the financial advantage or increased status of the perpetrator or facilitator. The victim may have been sexually exploited even if the sexual activity appears consensual. Child sexual exploitation does not always involve physical contact; it can also occur through the use of technology.

A child under the age of 13 is not legally capable of consenting to sex (it is statutory rape) or any other type of sexual touching;

• Sexual activity with a child under 16 is also an offence;
• It is an offence for a person to have a sexual relationship with a 16 or 17 year old if they hold a position of trust or authority in relation to them;
• Where sexual activity with a 16 or 17 year old does not result in an offence being committed, it may still result in harm, or the likelihood of harm being suffered;
• Non-consensual sex is rape whatever the age of the victim; and
• If the victim is incapacitated through drink or drugs, or the victim or their family has been subject to violence or the threat of it, they cannot be considered to have given true consent; therefore offences may have been committed.

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 or development.

Neglect may occur during pregnancy as a result of maternal substance misuse, maternal mental ill health or learning difficulties or a cluster of such issues. Where there is domestic abuse towards a carer, the needs of the child may be neglected.

Once a child is born, neglect may involve a parent failing to:

• Provide adequate food, clothing and shelter (including exclusion from home or abandonment);
• Protect a child from physical and emotional harm or danger;
• Ensure adequate supervision (including the use of inadequate care-givers);
• Ensure access to appropriate medical care or treatment.

It may also include neglect of, or unresponsiveness to, a child's basic emotional, social and educational needs.

Childhood obesity alone is a concern but not usually a child protection concern. This can change in the context of escalating health concerns when the parents are not engaging with or seek to undermine the support being offered to them. Obesity usually exists in a wider context of concerns about neglect or emotional abuse so practitioners should consider what else is going on in the child's life.

These definitions are used when determining significant harm and children can be affected by combinations of maltreatment and abuse, which can be impacted on by for example domestic abuse in the household or a cluster of problems faced by the adults.

Domestic Abuse

The Domestic Abuse Act 2021 says that behaviour is 'abusive' if it consists of any of the following:

• Physical or sexual abuse;
• Violent or threatening behaviour;
• Controlling or coercive behaviour;
• Economic abuse;
• Psychological, emotional or other abuse.

and it does not matter whether the behaviour consists of a single incident or a course of conduct. The perpetrator of the abuse and the victim of the abuse have to be aged 16 or over and ‘personally connected’ as intimate partners, ex-partners, family members or individuals who share parental responsibility for a child. There is no requirement for the victim and perpetrator to live in the same household.

Types of domestic abuse include intimate partner violence, abuse by family members, teenage relationship abuse and child to parent abuse. Anyone can be a victim of domestic abuse, regardless of sexual identity, age, ethnicity, socio-economic status, sexuality or background and domestic abuse can take place inside or outside of the home.

Domestic abuse has a significant impact on children and young people. Children may experience domestic abuse directly, as victims in their own right, or indirectly due to the impact the abuse has on others such as the non-abusive parent.

Domestic abuse in teenage relationships is just as severe and has the potential to be as life threatening as abuse in adult relationships.

See Children living within a household where they are exposed to or experience Domestic Abuse may suffer or are likely to suffer significant harm.

Extra-familial Harm

Children may be at risk of or experiencing physical, sexual, or emotional abuse and exploitation in contexts outside their families.

Extra-familial contexts include a range of environments outside the family home in which harm can occur. These can include peer groups, school, and community/public spaces, including known places in the community where there are concerns about risks to children (for example, parks, housing estates, shopping centres, takeaway restaurants, or transport hubs), as well as online, including social media or gaming platforms.

Working Together to Safeguard Children recognises that, whilst there is no legal definition for the term extra-familial harm, it is widely used to describe different forms of harm that occur outside the home. Children can be vulnerable to multiple forms of extra-familial harm from both adults and/or other children. Examples of extra-familial harm may include (but are not limited to): criminal exploitation (such as county lines and financial exploitation), serious violence, modern slavery and trafficking, online harm, sexual exploitation, child-on-child (nonfamilial) sexual abuse and other forms of harmful sexual behaviour displayed by children towards their peers, abuse, and/or coercive control, children may experience in their own intimate relationships (sometimes called teenage relationship abuse), and the influences of extremism which could lead to radicalisation.

Technology Assisted Abuse

Technology is a significant component in many safeguarding and wellbeing issues. Children are at risk of abuse and other risks online as well as face to face. In many cases abuse and other risks will take place concurrently both online and offline.

Children can also abuse other children online, this can take the form of abusive, harassing, and misogynistic/misandrist messages, the non-consensual sharing of indecent images, especially around chat groups, and the sharing of abusive images and pornography, to those who do not want to receive such content. Children can also be groomed online and through social media by people coercing or manipulating them to sexually or criminally exploit them or seeking to radicalise them.

See Online Safety.

Child on Child Sexual Violence and Sexual Harassment

Keeping Children Safe in Education Part five: Child on Child Sexual Violence and Sexual Harassment sets out how schools and colleges should respond to all signs, reports and concerns of child-on-child sexual violence and sexual harassment, including those that have happened outside of the school or college premises, and/or online.

Sexual violence and sexual harassment can occur between two or more children of any age and sex, from primary through to secondary stage and into college. It can occur also through a group of children sexually assaulting or sexually harassing a single child or group of children. Sexual violence and sexual harassment exist on a continuum and may overlap; they can occur online and face-to-face (both physically and verbally) and are never acceptable.

Sexual Violence

Child on child sexual violence refers to sexual offences under the Sexual Offences Act 2003 as described below:

Rape: A person (A) commits an offence of rape if: he intentionally penetrates the vagina, anus or mouth of another person (B) with his penis, B does not consent to the penetration and A does not reasonably believe that B consents.

Assault by Penetration: A person (A) commits an offence if: s/he intentionally penetrates the vagina or anus of another person (B) with a part of her/his body or anything else, the penetration is sexual, B does not consent to the penetration and A does not reasonably believe that B consents.

Sexual Assault: A person (A) commits an offence of sexual assault if: they intentionally touches another person (B), the touching is sexual, B does not consent to the touching and A does not reasonably believe that B consents.

NOTE- Schools and colleges should be aware that sexual assault covers a very wide range of behaviour so a single act of kissing someone without consent, or touching someone's bottom/breasts/genitalia without consent, can still constitute sexual assault.

Sexual Harassment

Child on child sexual harassment means 'unwanted conduct of a sexual nature' that can occur online and offline and both inside and outside of school/college. Sexual harassment is likely to: violate a child's dignity, and/or make them feel intimidated, degraded or humiliated and/or create a hostile, offensive or sexualised environment.

Sexual harassment can include:

• Sexual comments, such as: telling sexual stories, making lewd comments, making sexual remarks about clothes and appearance and calling someone sexualised names;
• Sexual 'jokes' or taunting;
• Physical behaviour, such as: deliberately brushing against someone, interfering with someone's clothes. Schools and colleges should be considering when any of this crosses a line into sexual violence - it is important to talk to and consider the experience of the victim;
• Displaying pictures, photos or drawings of a sexual nature;
• Upskirting (this is a criminal offence); and
• Online sexual harassment.

This may be standalone, or part of a wider pattern of sexual harassment and/or sexual violence. It may include:

• Consensual and non-consensual sharing of nude and semi-nude images and/or videos. Taking and sharing nude photographs of under 18s is a criminal offence. UKCIS Sharing nudes and semi-nudes: advice for education settings working with children and young people provides detailed advice for schools and colleges;
• Sharing of unwanted explicit content;
• Sexualised online bullying;
• Unwanted sexual comments and messages, including, on social media;
• Sexual exploitation; coercion and threats; and
• Coercing others into sharing images of themselves or performing acts they're not comfortable with online.

It is essential that all victims are reassured that they are being taken seriously and that they will be supported and kept safe. A victim should never be given the impression that they are creating a problem by reporting sexual violence or sexual harassment. Nor should a victim ever be made to feel ashamed for making a report.

See also: Addressing Child-on-child Abuse: a Resource for Schools and Colleges (Farrer and Co.) which is intended to be used as a resource and reference document for practitioners.

See Harmful Sexual Behaviour Procedure.

5. Potential Risk of Harm to an Unborn Child

In some circumstances, agencies or individuals are able to anticipate the likelihood of significant harm with regard to an expected baby (e.g. where there is information known about domestic abuse, parental substance misuse or mental ill health).

These concerns should be addressed as early as possible before the birth, so that a full assessment can be undertaken and support offered to enable the parent/s (wherever possible) to provide safe care to the baby.

6. Recognising and Responding to Concerns

All practitioners, whether paid or voluntary, in all agencies and organisations, where they come in to contact with children and young people, or similarly, all those who work in some way with adults, who may be parents or carers, should:

• Be alert to potential indicators of abuse or neglect;
• Be alert to the risks which individual abusers or potential abusers, may pose to children;
• Be alert to the impact on the child of any concerns of abuse or maltreatment;
• Be able to gather and analyse information as part of an assessment of the child's needs.

Each agency and the Bedford, Central Bedfordshire and Luton Safeguarding Children Partnership have child protection procedures in place to support and provide information about how and what action to take when there are concerns about a child. Those child protection procedures will include information about how to:

• Identify potential or actual harm to children; whether this is when problems are first emerging, or where a child is already known to local authority children's social care;
• Discuss and record concerns with a first line manager / in supervision;
• Analyse concerns by completing an assessment;
• Discuss concerns with the agency's designated safeguarding children advisor (able to offer advice and decide upon the necessity for a referral to LA Children's Social Care).

Practitioners in all agencies should use their knowledge and agency resources to contact local children's social care or the police about their concerns directly and to complete the appropriate referral form, if there are urgent concerns.

There are additional duties for schools to safeguard and promote the welfare of children and young people (Keeping children safe in education: Statutory guidance for schools and colleges). In essence these require all school staff to have knowledge of the signs and symptoms of abuse and an understanding of the local early help and child protection arrangements.

Schools also have additional responsibilities in cases of suspected Female Genital Mutilation (FGM), child-on-child abuse and children at risk of exploitation. In addition patterns identified in schools may also be reflective of the wider issues within a local area and it would be good practice to share emerging trends with safeguarding partners.

In any case circumstances a formal referral to LA Children's Social Care, the police or accident and emergency services (for any urgent medical treatment) must not be delayed by the need for consultation with management or the nominated safeguarding children adviser, or the completion of an assessment.

All practitioners working in agencies with contact with children and members of their families must make a referral to LA Children's Social Care if there are signs that a child or an unborn baby:

• Is suffering significant harm through abuse or neglect;
• Is likely to suffer significant harm in the future.

The timing of such referrals should reflect the level of perceived risk of harm, not longer than within one working day of identification or disclosure of harm or risk of harm.

In urgent situations, out of office hours, the referral should be made to the LA Children's Social Care emergency duty team / out of hour's team.

It is important that practitioners are aware the Data Protection Act 2018 and the UK GDPR place duties on organisations and individuals to process personal information fairly and lawfully and to keep the information they hold safe and secure. The Data Protection Act 2018 contains 'safeguarding of children and individuals at risk' as a processing condition that allows practitioners to share information. This includes allowing practitioners to share information without consent, if it is not possible to gain consent, it cannot be reasonably expected that a practitioner gains consent, or if to gain consent would place a child at risk.

Note: The Data Protection Act 2018 and UK GDPR do not prevent, or limit, the sharing of information for the purposes of keeping children safe. Fears about sharing information must not be allowed to stand in the way of the need to promote the welfare and protect the safety of children. See Information Sharing Procedure.

7. Hearing and Observing the Child

Whenever a child reports that they are suffering or have suffered significant harm through abuse or neglect, or have caused or are causing physical or sexual harm to others, the initial response from all practitioners should be to listen carefully to what the child says and to observe the child's behaviour and circumstances to:

• Clarify the concerns;
• Offer re-assurance about how the child will be kept safe;
• Explain what action will be taken and within what timeframe.

The child must not be pressed for information, led or cross-examined or given false assurances of absolute confidentiality, as this could prejudice police investigations, especially in cases of sexual abuse.

If the child can understand the significance and consequences of making a referral to LA Children's Social Care, they should be asked for their views.

It should be explained to the child that whilst their view will be taken into account, the practitioner has a responsibility to take whatever action is required to ensure the child's safety and the safety of other children.

8. Parental Consultation

Concerns which have been raised, should, where practicable, be discussed with the parent and agreement sought for a referral to LA Children's Social Care unless seeking agreement is likely to place the child at risk of significant harm through delay or from the parent's actions or reactions; For example in circumstances where there are concerns or suspicions that a serious crime such as sexual abuse, domestic abuse or induced illness has taken place.

Where a practitioner decides not to inform the parents before making a referral to LA Children's Social Care, the decision must be clearly noted in the child's records with reasons, dated and signed and confirmed in the referral to LA Children's Social Care. Practitioners should consult with their line manager/designated safeguarding advisor, if at all practicable, for advice.

When a referral is deemed to be necessary in the interests of the child, and the parents have been consulted and are not in agreement, the following action should be taken:

• The reason for proceeding without parental agreement must be recorded;
• The parent's withholding of permission must form part of the verbal and written referral to LA Children's Social Care;
• The parent should be contacted to inform them that, after considering their wishes, a referral has been made.

A child protection referral from a professional cannot be treated as anonymous and where any court proceedings may follow, whether criminal or family court, the information may be made available.

9. Urgent Medical Attention

If the child is suffering from a serious injury, the practitioner must seek medical attention immediately from accident and emergency services and must inform LA Children's Social Care, and the duty consultant paediatrician at the hospital.

Where abuse is alleged, suspected or confirmed in a child admitted to hospital, the child must not be discharged until:

• LA Children's Social Care local to the hospital and the child's home address (may be two different LA Children's Social Care) are notified by telephone that there are child protection concerns;
• A strategy meeting/discussion has been held, which should then include relevant hospital and other practitioner from other relevant agencies.

10. Making a Referral

Referrals should be made to LA Children's Social Care for the area where the child is living or is found.

If the child is known to have an allocated social worker, the referral should be made to them or in their absence to the social worker's manager or a duty children's social worker. In all other circumstances referrals should be made to the duty officer.

The referred should confirm verbal and telephone referrals in writing, within 48 hours.

Where an assessment has been completed prior to referral, these details should also be conveyed at the point of referral.

LA Children's Social Care should within one working day of receiving the referral make a decision about the type of response that will be required to meet the needs of the child, and feedback the decision to the referrer. If this does not occur within three working days, the referrer should contact these services again and, if necessary, ask to speak to a line manager to establish progress.

11. Concerns Raised by a Member of the Public

When a member of the public telephones or approaches any agency with concerns about the welfare of a child or an unborn baby, the practitioner who receives the contact should always:

• Gather as much information as possible, to be able to make a judgement about the seriousness of the concerns;
• Take basic details:
  1. Name, address, gender and date of birth of child;
  2. Name and contact details for parent/s, educational setting (e.g. nursery, school), primary medical practitioner (e.g. GP practice), practitioners providing other services, a lead practitioner for the child.
• Discuss the case with their manager and the agency's designated safeguarding children advisor to decide whether to:
  1. Make a referral to LA Children's Social Care;
  2. Make a referral to the lead practitioner, if the case is open and there is one;
  3. Make a referral to a specialist agency or practitioner e.g. educational psychology or a speech and language therapist;
  4. Undertake an assessment.

Record the referral contemporaneously, with the detail of information received and given, separating out fact from opinion as far as possible.

The opportunity for a face to face meeting or interview should be offered to the member of the public to clarify information and offer advice, if needed.

The member of the public should also be given the number for their Bedford, Central Bedfordshire and Luton LA Children's Social Care and encouraged to contact them directly. The agency receiving the initial concern should always make a referral to Bedford, Central Bedfordshire and Luton LA Children's Social Care and to the lead practitioner if there is one, in case the member of the public does not follow through (which can happen).

Some people may prefer not to give their name to LA Children's Social Care, or they may disclose their identity but not wish for it to be revealed to the parent/s of the child concerned. Wherever possible, practitioners should respect the referrer's request for anonymity. However absolute anonymity cannot be guaranteed, as there are certain limited circumstances in which the identity of a referrer may have to be given (e.g. the court arena). Consideration for the referrer's safety may be an issue in some cases.

Referrals should not be deemed malicious without a full and thorough multi-agency assessment, including talking with the referrer and agreement with the appropriate manager. Referrals should also not be described as malicious in professional conclusions, due to the risks associated with this language.

12. Non-recent / Historical Abuse

Allegations of child abuse are sometimes made by adults and children many years after the abuse has occurred. There are many reasons for an allegation not being made at the time including fear of reprisals, the degree of control exercised by the abuser, shame or fear that the allegation may not be believed. The person becoming aware that the abuser is being investigated for a similar matter or their suspicions that the abuse is continuing against other children may trigger the allegation.

Reports of historical allegations may be complex as the alleged victims may no longer be living in the situations where the incidents occurred or where the alleged perpetrators are also no longer linked to the setting or employment role. Such cases should be responded to in the same way as any other concerns and the Referral chapter should be followed (see Section 10, Making a Referral). It is important to ascertain as a matter of urgency if the alleged perpetrator is still working with, or caring for, children.

Organisational responses to allegations by an adult of abuse experienced as a child must be of as high a standard as a response to current abuse because:

• There is a significant likelihood that a person who abused a child/ren in the past will have continued and may still be doing so;
• Criminal prosecutions can still take place despite the fact that the allegations are historical in nature and may have taken place many years ago.

13. Adult Services Responsibilities in Relation to Children

Adult services and practitioners working with adults need to be competent in identifying the service user's or patient's role as a parent. They need to be able to consider the impact of the adult's condition and / or behaviour on:

• A child's welfare and development;
• Family functioning;
• The adult's parenting capacity.

Where a practitioner working with adults has concerns about the parent's capacity to care for the child and considers that the child is likely to be harmed or is being harmed, they should immediately refer the child to the police or LA Children's Social Care, in accordance with their agency's child protection procedures.

Requests for information about a child, which are often made to health practitioners such as GPs or specialist services for mental health or substance misuse, by LA children's social care should be directed to the correct practitioner and not dealt with by administrative staff or intermediaries.

Adult Services, whether commissioning and provider organisations, employ safeguarding children practitioners to take the lead on safeguarding children matters. The roles and responsibilities of designated and named safeguarding children practitioners should be clear and accessible to all staff and made known to partner agencies to assist in the process of sharing information.

14. Schools and Educational Establishments