Action to be taken where a Child is Suffering or Likely to Suffer Significant Harm

1. Procedure

1.1 Child Protection Enquiries

A Section 47 Enquiry must always be commenced immediately when:

• There is reasonable cause to suspect that a child is suffering or likely to suffer significant harm in the form of physical, sexual, emotional abuse or neglect;
• Following an EPO or the use of police powers of protection is initiated.

The threshold criteria for a Section 47 Enquiry may be identified during an early assessment or it may become apparent at the point of referral, during multi-agency checks or in the course of a multi-agency assessment.

Local authority social workers have a statutory duty to lead enquiries under Section 47 of the Children Act 1989. The police, health professionals, teachers and other relevant professionals should support them in undertaking the enquiries.

A multi-agency assessment (see Bedford Single Assessment Procedure) is the means by which Section 47 Enquiries are carried out. The assessment will have commenced at the point of receipt of referral and it must continue whenever the criteria for Section 47 Enquiries are satisfied. The conclusions and recommendations of the Section 47 Enquiry should inform the assessment which must be completed within 45 working days of the date when the referral was received.

The enquiries and assessment should always involve separate interviews with the child and, in the majority of cases, the parents, and the observation of interaction between the parent and child. This will include interviews and observations of parents, any other carers and the partners of the parents.

1.2 Strategy Discussions/Meetings

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.

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.

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 a hospital in-patient;
• Where parents or adults in the household are experiencing problems such as domestic abuse, substance misuse, learning difficulties, mental illness or criminal behaviour, it will also be important to consider involving the relevant adult services professionals.

Strategy Meetings should be chaired by an experienced professional from police or Children's Social Care.

Complex abuse Strategy Meetings should be chaired by a senior member of staff who should notify the chair of the Local Safeguarding Children Partnership. 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.

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 an Assessment under Section 47 of the Children act 1989 should be initiated or continued if it has already begun;
• Agree when the child will be seen alone by the Lead Social Worker (unless inappropriate for the child);
• Agree whether the enquiry will be conducted solely by Children's Social Care or jointly with the police;
• 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 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) and 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.

Where there are concerns about fabricated illness and it is decided to commence Section 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.

Where there are concerns about domestic abuse and it is decided to commence Section 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 abuse 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 abuse advice and guidance.

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.

1.3 Section 47 Enquiries and Associated Police Investigations - Decision making about joint or single agency enquiries

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

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

The Strategy Meeting or Discussion must agree that single agency enquiries by Children's Social Care are appropriate.

1.4 Joint Agency Enquiries

Joint enquiries are those jointly conducted by Children's Social Care and the Police.

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 Police Single Agency Enquiries);
• 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.

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.

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 abuse.

1.5 Children's Social Care Single Agency Enquiries

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 where there are no other concerning features.

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.

1.6 Police Single Agency Enquiries

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.

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.

1.7 Section 47 Enquiries and the Assessment

The Assessment is the means by which a Section 47 Enquiry is carried out. The objective of the Section 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 Assessment will provide the framework for analysing risk, harm and need.

Children's Social Care has lead responsibility for the Assessment under Section 47, Children Act 1989. However, all agencies which have relevant information should assist the social worker throughout the assessment process.

The Assessment should be led by a qualified and experienced social worker and all workers undertaking Section 47 enquiries should have specialist training and experience in interviewing children. Children should always be seen and communicated with alone by the Lead Social Worker.

The assessment should be completed within 45 days of the decision to undertake an 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 Assessment to enable the conference to make a reasoned decision about the needs of the children.

The Assessment process / Section 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 LSCP 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.

The Children's Social Care Record for the child should set out clearly the date(s) on which the child was seen by the Lead Social Worker during the course of the enquiries, whether the child was seen alone and, if not seen alone, who was present and for what reasons.

In the event of parents choosing not to co-operate with the Section 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.

1.8 Section 47 Enquiries and Medical Assessments

See also Safeguarding Bedfordshire website.

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.

When the medical examination takes place out of the area, the Strategy Discussion/Meeting should ensure the medical report is available.

In other circumstances the Strategy Discussion/Meeting will ensure that the need and timing of a medical assessment is agreed with the appropriate paediatrician.

A medical assessment should always be considered when there is disclosure or suspicion of any form of Physical Abuse 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.

1.9 Consent for Medical Assessments or Medical Treatment

The following may give consent to a medical assessment:

• A child of sufficient age and understanding (often referred to as Gillick Competent). 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 (Section 8 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 Section 20 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 which 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.

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.

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.

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.

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

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.

1.10 The Process of Medical Assessment

See also Safeguarding Bedfordshire website.

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

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.

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.

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 Proceedings 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.

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.

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.

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

• It may be necessary for the assessment to be carried out jointly by a forensic medical examiner (FME) and a paediatrician. If a FME is not available, two paediatrician's 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) (which can be found at Royal College of Paediatrics and Child Health website);
• 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.

1.11 Recording the Medical Assessment

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.

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

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

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.

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

1.12 Section 47 Enquiries and Police Investigative Interviews

The Strategy Meeting will have decided who needs to be interviewed and who will conduct the interview(s).

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

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

The police will be primarily responsible for interviewing the alleged perpetrator(s). They must keep Children's Social Care 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.

1.13 Action Following Section 47 Enquiries

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

• Not substantiated; although consideration should be given to whether the child may need services as a child in need;
• Substantiated and the child is judged to be suffering, or likely to suffer, significant harm and an initial child protection conference should be called.

Where concerns about the child suffering, or likely to suffer, Significant Harm are not substantiated:

Social workers with their managers should:

• Discuss the case with the child, parents and other professionals;
• Determine whether support from any services may be helpful and help secure it; and
• Consider whether the child's health and development should be re-assessed regularly against specific objectives and decide who has responsibility for doing this.

All involved professionals should:

• Participate in further discussions as necessary;
• Contribute to the development of any plan as appropriate;
• Provide services as specified in the plan for the child; and
• Review the impact of services delivered as agreed in the plan.

The Children's social care manager must authorise the decision that no further action is necessary, having ensured that the child, any other children in the household and the child's carers have been seen and spoken with.

Arrangements should be noted for future referrals, if appropriate.

At this stage it may be appropriate to hold a Family Group Meeting to engage the parents and wider family group in developing and implementing a Child in Need Plan.

Where concerns are substantiated and the child is judged to be suffering, or likely to suffer 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 Child Protection Enquiries Procedure, should be followed before a Child Protection Conference is convened.

Consideration should be given by the date of the Initial Child Protection Conference where one is convened to whether the Assessment has been completed or what further work is required before it is completed.

Feedback on all child protection enquiries, whatever their outcome will be provided by the social worker to:

• Their line manager;
• The child/ren where appropriate;
• Parents and/carers who will receive a copy of the 'Record of Outcome of Section 47 Enquiries' (DOH 2002) and 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 the 'Record of Outcome of Section 47 Enquiries' and a copy of the Assessment;
• If consulted during the child protection enquiry, the Independent Chair should receive feedback on the outcome.

2. Practice Guidance - Action to be taken where a child is suffering or likely to suffer significant harm

2.1 Communicating With Children Through the Section 47 Enquiry / 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 (Jones, D., (2003) Communicating with Vulnerable Children London: Gaskell) 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 an Assessment/Section 47 Enquiry. 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 interview

• 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.

2.2 Section 47 Enquiries / 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 (Reder, P., Duncan, S., & Gray, M. (1993) Beyond Blame: Child Abuse Tragedies Revisited London: Routledge) and professionals becoming 'stuck', not seeing evidence which challenges their ideas about a family (Munro, E (2001) Effective Child Protection London: Sage) and at times finding ways to minimise their involvement (Bridge Child Care Consultancy (1995) Paul: Death through Neglect London: Bridge Consultancy Services).

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 care giving 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 (Turney, D., & Tanner, K. (2005) Understanding and Working with Neglect - London: DFES). 

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 affect 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 to Safeguard Children 2010 (now archived) 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."

2.3 Section 47 Enquiries / 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. See for example Calder, M. (2000) Complete Guide to Sexual Abuse Assessments, Lyme Regis: Russell House;
• Factors associated with the non-abusing carer's capacity to protect the child. Smith, G. (1995) Assessing Protectiveness in Cases of Child Sexual Abuse in Reder, P., & Lucey, C., (eds) Assessment of Parenting London: Routledge;
• 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;
• Premeditated 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 (Jones, D., & Ramchandani, P (1999) Child Sexual Abuse: Informing Practice from Research Lyme Regis: Radcliff):

• 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

See also, Safeguarding Children from Sexual Abuse

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.

2.4 Section 47 Enquiries / 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, research (Dale, Greene, & Fellows (2002) What really happened: child protection case management of infants with serious injuries and discrepant explanations London. NSPCC) has indicated that there are additional factors to consider, and that good assessments will:

Avoid intuitive judgements

Munro (Munro, E. (2002) Effective child protection London: Sage) 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?

2.5 Section 47 Enquiries / Assessments and Children With Disabilities

It is known that children with disabilities are more likely to be abused than children without disabilities (Sullivan, P., Knutson, J. F. (2000) 'maltreatment and disabilities: a population based epidemiological study' Child Abuse and neglect 24 (10)) yet there is evidence that they are less likely to be protected by our child protection system (National Working group on child protection and Disability It doesn't happen to children with disabilities London NSPCC).

Guidance has been issued to Local Safeguarding Children Partnerships regarding protecting children with disabilities (Safeguarding Disabled Children: Practice Guidance London DFES). This sets out issues that need to be taken into account when conducting Section 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 than 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 is more likely to receive care from a number of adults and this is a risk factor in itself.

This means Section 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, for example:

• 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 gastronomy 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 children with disabilities. 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 need, 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 someone 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.

For additional guidance, please see Safeguarding Disabled Children: Practice Guidance (issued by the DCSF in July 2009).

2.6 Section 47 Enquires / 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 stresses such as having a child with disabilities, domestic abuse, 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 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 (McGaw, S & Newman, T (2005) What works for parents with learning disabilities London: Barnados) 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.

2.7 Section 47 Enquiries / 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 result in a child suffering or likely to suffer 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.

2.8 Section 47 Enquiries/Assessments - Issues to Consider in Situations of Domestic Abuse

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

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

• Asking direct questions about domestic abuse;
• Checking whether domestic abuse 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 abuse 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 abuse 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 abuse 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 (Hester, M., Pearson, C., and Harwin, N., (2000) Making an Impact- children and domestic abuse, London: Jessica Kingsley)

• 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 does 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?

2.9 Section 47 Enquiries / Assessments - Assessing the Impact of Parental/Carer Alcohol and/or Drug use

There is now considerable research evidence that parental substance misuse, particularly when combined with domestic abuse (Cleaver, H., Unell, I., & Aldgate, J (1999) Children's Needs- Parenting capacity. The impact of parental mental illness, problem alcohol and drug use and domestic abuse on children's development. London: The Stationery Office) 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.

Parenting Capacity

Forrester (Forrester, D. (2004) 'Social work assessments with parents who misuse drugs or alcohol' Children exposed to parental substance misuse. London BAAF) 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 below should be used to assist the enquiry process.

Child's Developmental Needs

1. Effect of parental exposure to drugs and impact on child's health before and after birth;
2. Subsequent special health needs as a result of the above;
3. Access or exposure to drugs/alcohol and related equipment;
4. Effect on school attendance and ability to learn?
5. Impact on quality of attachment and feeling valued;
6. Experience of loss/bereavement or separation;
7. Child's attitude to drug use and associated lifestyle/behaviour;
8. Sibling relationships and exposure to sibling drug use;
9. Are the children exposed to stigma, social exclusion and secrecy that may inhibit them from forming friendships and seeking social support?
10. Are the children engaged in age appropriate activities?
11. Are there indications that children are taking on a parental role? (Caring for siblings, excessive household responsibility or anxiety about parents?)
12. Are the child's emotional needs being adequately and consistently met?

Parenting Capacity

1. Is there an alcohol/drug free parent/carer, supportive partner or relative?
2. The role of drugs in parental relationship and previous experience of parenting;
3. Does the person move between alcohol and drug use?
4. What is the nature and pattern of use and impact on parental health, behaviour and mood?
5. If there is drug use, does it also involve the use of alcohol and/or other medications?
6. Are levels of childcare different when a parent/carer is using alcohol and/or drugs?
7. Consistency and reliability - Prioritise parenting and childcare over and above drug use;
8. Is there any evidence of co-existence of mental health problems and/or domestic abuse alongside the alcohol or drug use?
9. What is the parent's physical and emotional availability to the child and is this impaired by their use of substances or are they being adequately and consistently met?
10. Does the parent demonstrate strategies to protect the child from the impact of the drug/alcohol and its negative personal/social consequences?
11. Is there adequate supervision of the children? Are they left alone whilst parents/carers secure their drugs or are children being taken or sent to places where they could be at risk?
12. Do the parents or carers see their alcohol/drug use as harmful to themselves or their children?
13. Are parents/carers aware of the potential consequences of their behaviour? (e.g. child safeguarding procedures, statutory powers).

Family and Environmental Factors

1. Past and current history of treatment, engagement and motivation - Contact must be made with the treatment service, to establish frequency and chronology of contact;
2. Does the use of drugs and/or alcohol result in offending behaviour which impacts on the child through directly placing them in situations of risk or results in periods of separation;
3. Who knows about the drug and/or alcohol use? Are they supportive?
4. Will parent/carers accept help from friends, extended family, relatives and agencies?
5. Adequacy of material resources - Stability of money and housing - Is the housing shared? Does the family remain in one area or move frequently?
6. Is the home exposed to risky adult behaviour, activities or paraphernalia? Do they see drug taking/violence (e.g. conflict and exposure to criminal activity)?
7. If parent/carers are using drugs illicit/prescribed and or injecting equipment are kept on the premises, are they kept securely away from children?
8. Is there evidence of social isolation and are parents excluded from family, friends and the community due to their drug/alcohol use or has it become normalised as a way of life within that group?
9. Are the children able to access a support network outside the home, from extended family, other adults, carers, professionals, school/community or support groups?
10. Is there adequate food, clothing and warmth for the children and are the household utilities being paid for.

2.10 Section 47 Enquiries / 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 child's 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 likely to suffer 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 abuse.

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 (Falcov, A. (1996) A Study of Working Together 'Part 8' reports Fatal Child Abuse and Parental Psychiatric Disorder, DoH ACPC Series 1 London).

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

The following table may assist in the assessment process (Duncan, S., & Reder, P. (2000) "Children's experiences of disorder in their parents" in Reder, R., McClure, M., Jolley, A. (eds) (2000) Family Matters, Routledge: London):

Parental Behaviour	Parental Impact on Children (in addition to attachment problems)
Self-preoccupation	Neglected
Emotional unavailability	Depressed, anxious, neglected
Practical unavailability	Out-of-control, self-reliant, neglected, exposed to danger
Frequent separations	Anxious, perplexed, angry, neglected
Threats of abandonment	Anxious, inhibited, self-blame
Unpredictable/chaotic planning	Anxious, inhibited, neglected
Irritability/over-reactions	Inhibited, physically abused
Distorted expressions of reality	Anxious, confused
Strange behaviour/beliefs	Embroiled in behaviour, shame, perplexed, physically abused
Dependency	Caretaker role
Pessimism/blames self	Caretaker role, depressed, low self-esteem
Blames child	Emotionally abused, physically abused, guilt
Unsuccessful limit-setting	Behaviour problem
Marital discord and hostility	Behaviour problem, anxiety, self-blame
Social deterioration	Neglect, shame