Abuse of Disabled Children

The available UK evidence on the extent of abuse among disabled children suggests that disabled children are amongst the most vulnerable in society and at increased likelihood of abuse. Furthermore, the presence of multiple disabilities increases the risk of both abuse and neglect.

Children with disabilities are children first and foremost and deserving of the same rights and protection as other children. Under the Children Act 1989, any child with a disability should also be considered as a 'Child in Need'. A child can be considered to be disabled if they have significant challenges with communication, comprehension, vision, hearing or physical functioning.

Disabled children are more vulnerable to abuse and neglect than a non-disabled child of the same age. This can be for a number of reasons, including that some disabled children may:

• Have fewer outside contacts than other children;
• Receive intimate personal care, possibly from a number of carers, which may both increase the risk of exposure to abusive behaviour, and make it more difficult to set and maintain physical boundaries;
• Have little or no choice about who provides them with intimate care;
• Have an impaired capacity to resist or avoid abuse;
• Have communication difficulties which may make it difficult to tell others what is happening;
• Experience the misuse or manipulation of the method by which they communicate, so that they either cannot express concerns or do not have the opportunity to express concerns;
• Be particularly fearful of disclosing a perpetrator who is also a carer;
• Be especially vulnerable to bullying and intimidation;
• Be more vulnerable than other children to abuse by their peers;
• Not understand or be aware of what is or is not appropriate behaviour; and also
• Be worried about complaining because of a fear of losing services.

The mistaken assumption that disability protects children from abuse contributes to the vulnerability of disabled children. Because of increased vulnerability it is particularly important that practitioners remain child focused, and gain a clear perception of the individual child's experience of life and are mindful not to collude with, or be over sympathetic to, parents/carers. This is especially pertinent when considering chronic forms of abuse such as neglect.

Additional factors which increased vulnerability to abuse or neglect may be:

• The child's dependence on carers could result in the child having a problem in recognising what abuse is. The child may have little privacy, a poor body image or low self-esteem;
• Carers and staff may lack the ability to communicate adequately with the child;
• Be isolated and have limited contact with others;
• A lack of continuity in care which can lead to an increased risk that behavioural changes may go unnoticed;
• Lack of access to 'keep safe' strategies available to others;
• Disabled children living away from home in badly managed settings are particularly vulnerable to over-medication, poor feeding and toileting arrangements, issues around control of challenging behaviour, lack of stimulations and emotional support;
• Parents'/carers' own needs and ways of coping may conflict with the needs of the child;
• The behaviour of children with special needs can sometimes be difficult for parents/carers to manage, and support may be required for use of appropriate management strategies;
• Some adult abusers may target disabled children in the belief that they are less likely to be detected;
• Signs and indicators can be inappropriately attributed to disability; and
• Disabled children are less likely to be consulted in matters affecting them and as a result may feel they have no choice about whether to accept or reject sexual advances;
• Have communication difficulties that may make it difficult to tell others what is happening and no support around their Speech and Language difficulties;
• Attitudes and discrimination can mean that only their disability is seen rather than the full picture.

Disabled children may not be believed when they report what has happened to them or may not understand what is and is not acceptable intervention by their carers. They may be less likely to disclose abuse, particularly sexual abuse, and are more likely to delay disclosure, compared with other children. There are also barriers for disabled children in child protection processes, including:

• A failure to recognise abuse or apply appropriate thresholds;
• A lack of holistic assessment;
• A lack of communication with the child and maintaining a focus on their needs despite improvements;
• A lack of effective multi-agency working.

Where children are unlikely or unable to disclose abuse, practitioners and other responsible adults need to be able to spot the signs of abuse and take appropriate action.

Providers of services (statutory and voluntary) must have:

• An explicit commitment to understanding disabled children's needs, ensuring safe practices and promoting a culture of openness;
• Guidelines and training for staff on: good practice in intimate care; working with children of the opposite sex; dealing with challenging behaviour, consent to treatment, e-safety and anti-bullying strategies, sexuality and sexual behaviour among young people and the vulnerabilities of those living away from home; and
• Have clear guidelines about the administration of drugs and medication.

Providers and individual practitioners should always ensure that all disabled children are helped to:

• Make their wishes and feelings known in respect of their care and treatment;
• Receive appropriate personal, health, and social education (including e-safety and sex education); and
• Know how to raise concerns and are provided with access to a range of trusted adults with whom they can communicate.

The UK Social Work Practice in Safeguarding Disabled Children and Young People report details some of the reasons why disabled children and young people are at greater risk and the reasons why, including where gaps in provision exist.

The indicators for abuse and neglect among disabled children are the same as they are for the wider population, however the child's reaction or response may be less overt. Where children are observed to have bruising or other injuries it is important to consider all the possibilities, and not to assume that it is a result of their disability.

Similarly, when disabled children display behaviours that would cause concern in other children it is important not to make assumptions about any connection with their disability.

Where a child is unable to tell someone of their abuse they may convey anxiety or distress in some other way, for example behaviour or symptoms. Carers and staff must be alert to this and be aware of the possibility that challenging behaviour may be caused by something other than the disability. Particular attention must be paid to changes in behaviour which may indicate distress. Effective multi-agency/multi-disciplinary information sharing is essential, particularly where the child accesses several different environments such as school, residential home, respite care etc.

Adults who may pose a risk to children may target disabled children in the belief that they are less likely to be detected and there may be more opportunities to groom disabled children.

Examples of the specific abuse of disabled children may include:

• Force feeding;
• Unjustified or excessive physical restraint;
• Rough handling;
• Extreme behaviour modification including the deprivation of liquid, medication, food or clothing;
• Misuse of medication, sedation, heavy tranquilisation;
• Invasive procedures carried out against the child's will;
• Deliberate failure to follow or misapplication of medically recommended regimes or programmes;
• Not attending appointments or not collecting prescriptions;
• Ill-fitting or poorly maintained equipment which may cause injury or pain;
• Not having their holistic developmental needs as children recognised or met due to excessive focus on disability; and
• Misappropriation/misuse of a child's finances.

Safeguards for disabled children are essentially the same as for non-disabled children. Where there are concerns about the welfare of a disabled child, their emerging vulnerabilities and needs should be assessed and met in the same way as with any other child.

Where a disabled child has communication impairments or learning disabilities, special attention should be paid to communication needs, and to ascertaining the child's perception of events and their wishes and feelings. This should be done with sufficient time and in a way that enables them to express themselves clearly. Sometimes this will require someone who knows the child and their individual style of communication well.

Disabled children are entitled to an assessment of their needs. Their family carers are also entitled to a carer's assessment. Agencies and practitioners should refer to the Derby City and Derbyshire Threshold Document (see Documents Library, Guidance Documents) to support them in their decision making about the child's needs and the appropriate assessment and interventions.

For disabled children with low level needs the Early Help Assessment may be used by any agency as a means of working with the child, family and other service providers to identify and meet emerging needs which could enable the child to achieve a satisfactory level of health and/or development. For further information please see the Providing Early Help Procedure.

Other disabled children will have more serious or complex needs and are unlikely to reach or maintain a satisfactory level of health or development; these children are entitled to receive assessment as a Child in Need. Where there are serious or complex needs Children's Social Care will carry out an Assessment to determine whether the child is in need, the nature of any services required, and whether any further specialised assessments are needed.

In Derby, the Integrated Disabled Children's Service is a multi-agency team which offers a range of support services for children with disabilities. An Early Help Assessment can be submitted to the weekly Vulnerable Children's Meetings at the Integrated Disabled Children's Service and referrals should be made to The Lighthouse via the Single Point of Access (SPA) Clerk. When the child and their family are known to other agencies, a completed Early Help Assessment Action Plan and the details of the Lead Professional should be submitted in support of the referral. If the criteria for assessment are not met, the Integrated Disabled Children's Service will re-direct referrals as appropriate

In Derbyshire, referrals to Starting Point will be screened, and if it appears that the terms of reference for the Disabled Children's Services are met, the referral will be passed to the Disabled Children's Team. To meet the terms of reference, a child or young person will have:

1. A significant, permanent and enduring physical disability which leads to dependence on aids and adaptations to support daily living and /or a significant sensory impairment (if the child or young person's needs cannot be met via the Community Sensory Team) that requires significant multi-agency support;
2. Autistic Spectrum Disorder (diagnosed by a relevant professional) which requires a significant and complex multi-agency support plans. In addition, the child will be displaying associated challenging behaviours linked to autism and significant communication difficulties. Please note Attention Deficit Hyperactivity Disorder is not an autistic spectrum disorder;
3. A severe/significant global learning disability that is diagnosed by professionals and/or complex health needs.

If these terms of reference are not met, the usual screening process, with advice from the Disabled Children's Team if needed, should be followed to re-direct the referral as appropriate.

If at any point a practitioner becomes concerned that a disabled child is suffering or likely to suffer Significant Harm, they should consult with their designated lead for child protection and make a referral to Children's Social Care. Concerns should be discussed with a parent prior to making a referral unless it is judged that this action will jeopardise the child's safety. Referrals to Social Care should be made using the same processes as making a referral for any child; see Making a Referral to Social Care Procedure.

In Derby, this is via contact with the Initial Response Team.

In Derbyshire, this is via contact with Starting Point.

Where there are concerns that a disabled child is suffering or is likely to suffer Significant Harm, Children's Social Care will convene a Strategy Discussion/Meeting. The Social Worker, their manager, a health professional and a police representative should as a minimum be involved in the strategy discussion. It is also important to include other relevant practitioners involved in the child's care. See Child Protection Section 47 Enquiries Procedure, Strategy Discussions / Meetings.

In addition to considering whether or not the threshold for a Section 47 Enquiry has been met, a strategy discussion must also look at appropriate multi-agency interventions early in the process and seek to minimise risk.

The strategy discussion / meeting should give particular consideration to:

• Ensuring that there is sufficient information about the impact and the context of the specific disability on the child;
• Enabling the child to communicate effectively, sometimes this will require someone who knows the child and their individual style of communication well. They can advise whether the usual method of communication can be used; and
• Whether specialist advice should be sought, who should undertake the investigation, where and how it will take place.

Given the potentially complex nature of Section 47 Enquiries it may be appropriate to hold additional strategy discussions to ensure that informed decisions are made. Expertise in both safeguarding children and promoting the welfare of the disabled child must be brought together to ensure that disabled children receive the same levels of protection from harm as other children.

Possible indicators of abuse or significant harm may prove difficult to separate from the effects of a child's impairment therefore, a multi-agency approach involving all practitioners who work with the child is essential and expert advice may be needed.

It is usual for a practitioner from the Disabled Children's Social Work teams to take the lead in any Section 47 Enquiry involving a child already known to them.

Where the concern is about abuse or neglect within the family home, all other children in the household should also be subject to enquiry in the normal way. Sometimes the same Social Worker will undertake the enquiry about all the children though they will need to liaise closely with other practitioners involved with the family. Usually the Social Worker based in the Children's Disability Team will undertake the enquiry jointly with a worker from another team.

In Derby, if it is a disabled child who has allegedly been harmed and where the child is closed or not known to Children and Young People's Services, the Integrated Disabled Children Service will investigate and take to Initial Child Protection Conference. However, when the investigations are about a sibling group and there are more non-disabled children in the family, responsibility will be with the Locality Teams. When children are subject to child protection plans, the Locality Teams will only take responsibility if there are more non-disabled children subject to a plan than disabled children.

In relation to safeguarding for disabled children who meet the terms of reference for a service from the Derbyshire Disabled Children's Service, management responsibility of the enquiry will lie with the Disabled Children's Service. The Disabled Children's team will undertake all Section 47 enquiries, assessments and legal proceeding in respect of these children. Where a disabled child who meets the criteria is part of a sibling group, the Disabled Children's Team will undertake Single Assessments for all the children. Following this a decision will be taken as to which is the most appropriate team to support the children further. This decision will be made following a discussion between the Team Managers in the Disabled Children's Team and District Team.

Intermediary support can be provided if a disabled child need support with communication at court or in a tribunal hearing.

Please see Government website around how to access an intermediary service - HMCTS intermediary services - GOV.UK (www.gov.uk).