Safeguarding Disabled Children and Young People

The term “disabled children and young people” is a broad and inclusive term to include any child or young person who have physical, sensory, learning disability or a significant health condition. Children and young people who are disabled are at increased risk of discrimination, abuse and neglect (lifelong risk for some people).

Wherever it is safe and suitable, parents/carers should be viewed as partners. Parents of children and young people with disability are usually the experts in their child’s care needs and will be the constant for their child as they transition into adult life (see “harm doesn’t stop at 18”). National guidance Safeguarding Disabled Children – provides a framework for collaborative multi-agency responses to safeguarding disabled children.

Disabled children are children first and they are deserving of the same rights and protection as other children.

The Discrimination (Jersey) Law 2013 prescribes disability as a protected characteristic, “A person has the protected characteristic if the person has one or more long term physical, mental, intellectual or sensory impairments which can adversely affect a person’s ability to engage or participate in any activity in respect of which an act of discrimination is prohibited under this law”.

A disabled person may have mobility, visual, hearing, dexterity impairments, learning disability, learning difficulties, long term physical and/or mental health. A child or young person is considered disabled if he or she has significant problems with learning, communication, comprehension, vision, hearing, or physical functioning. This is classified as long term if the impairment is expected to last for longer than 6 months and can be for the rest of the individual’s life (see The Discrimination (Disability) Jersey) Regulations 2018). The child or young person may have a diagnosable medical condition, and this means the needs of children and young people with long term illness are addressed in this definition.

Research indicates children with disability are more vulnerable to significant harm through physical, sexual, emotional abuse, neglect and exploitation than non-disabled children. The available UK evidence on the extent of the abuse among disabled children suggests that disabled children are at this increased risk, and that the presence of multiple disabilities increases the risk further.

What works for Children Social Care (2022) found the abuse Children and Young People experienced often goes unnoticed, where they are often invisible to services and there is not enough support to protect them or help them recover after they have experienced abuse. They found it was important to see the child or young people in the context of the whole family and community supports that are present.

Significant harm is defined as a situation where a child is suffering or is likely to suffer, a degree of physical, sexual and/or emotional harm (through abuse or neglect) which is so harmful that there needs to be compulsory intervention by child protection agencies into the life of the child and their family.

Safeguarding disabled children demands a greater awareness of their vulnerability, their individuality and particular needs, (see SPB Recognising Signs of Abuse, Neglect and Exploitation).

The Statutory Guidance states “it is essential that all appropriate measures are taken to ensure that children and young people are protected against all forms of unlawful discrimination”.

Disabled children and young people are at an increased risk of harm due to the likelihood of being:

• Socially isolated with fewer outside contacts than non-disabled children;
• Dependent on carers for practical assistance in daily living, including intimate personal care which increases their risk of exposure to abusive behaviour and makes it more difficult for them to set their own physical boundaries;
• Less able to resist or avoid abuse;
• Less able to communicate or disclose what is happening, where they have communication needs which make it difficult to tell others what is happening.;
• Less likely to have access to someone they can trust to disclose that they have been abused;
• More likely to experience bullying, child on child abuse, discrimination and intimidation where the experience can be prolonged due to lack of recognition;
• Dependant on service provision with fear complaining may lead to a loss of service.

Additional factors may be:

• The child may have little privacy, a poor body image and/or low self-esteem;
• Carers and staff may lack the ability to communicate adequately with the child and may not have adequate training or understanding around their behaviours;
• A lack of continuity in care leading 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 (see SPB Jersey Children Looked After or other children Living Away from Home) in poorly managed settings are particularly vulnerable to poor care and institutional abuse, and are particularly vulnerable to being over-medicated, poorly fed, with poor toileting arrangements;
• At increased risk of institutional abuse, deprivation of liberty, inappropriate control of challenging behaviour and use of restraint, (see Capacity and Self Determination (Jersey) Law 2016 and commensurate Code of Practice);
• A lack of stimulation and emotional support at home or in care settings;
• Their Parents’/carers’ own needs and ways of coping may conflict with the needs of the child;
• Poverty and pressures on family carers with limited support increases their risk of abuse and neglect;
• Some adult abusers may target disabled children in the belief that they are less likely to be detected;
• Signs and indicators of abuse and neglect inappropriately attributed to their disability;
• Issues around abuse and mental health ignored due to the focus on the presenting disability;
• Disabled children and young people are less likely to be consulted in matters affecting them;
• Disabled children and young people are at risk of sexual abuse and sexual exploitation.

The UK Social Work Practice in Safeguarding Disabled Children and Young People Report (2022) details some of the reasons why disabled children and young people are at greater risk, including where gaps in service provision exist.

Children who are looked after and are disabled, are vulnerable to all the same factors that exist for all children living away from home (see SPB Jersey Children Looked After or other children Living Away from Home). But are particularly susceptible to abuse because of their additional dependency on residential and hospital staff for the day-to-day care to meet their basic needs.

In addition to the universal indicators of abuse/neglect (see SPB Recognising Signs of Abuse, Neglect and Exploitation), there are added risks of:

• Force feeding;
• Unjustified or excessive physical restraint;
• Rough handling;
• Extreme behaviour modification including the deprivation of food medication, or clothing;
• Misuse of medication, sedation, heavy tranquillisation;
• Invasive procedures against the child’s will;
• Deliberate failure to follow medically recommended regimes;
• Miss application of programmes or regimes;
• Failure to address ill-fitting equipment e.g. callipers, sleep boards which may cause injury or pain, inappropriate splinting;
• Misappropriation/misuse of a child’s finances;
• Lack of cultural awareness, undignified age or culturally inappropriate care practices;
• Indicators of Sexual Abuse which are more likely to be demonstrated in behaviour as opposed to through disclosure (as with all children, see SPB Sexual Abuse in the family environment).

See also the Continuum of Children’s Needs.

Where there are concerns about the health, development or welfare of a child or young person who may be at risk of harm or significant harm a referral must be made in accordance with the Children and Young Person Safeguarding Referrals Procedure with referral to the Children and Families HUB. (Practitioners may call the Children and Families HUB for consultation and guidance if they are unsure of how concerned they should be about a child).

National best practice guidance is given in the Safeguarding Disabled Children – Practice 
Guidance 2009, and where practitioners in Jersey must follow the Children and Young People (Jersey) Law, and corresponding Statutory Guidance.

The JCF Framework has helpful tools for practitioners to use to support their practice, all disabled children and young people should have a multi-agency JCF Chronology which records incidents, actions and outcomes over the duration of the child’s life. Practitioners should use the Continuum of Children’s Needs to assess levels of risk (see Statutory Guidance – Levels of Need).

Children with disabilities should not be left in situations where there is neglect or other forms of abuse, because a practitioner feels that the parent, carer or service “is doing their best.” There is organisational responsibility to adapt service provision in line with the needs of parents/carers to enable them to keep their children safe and cared for.

Throughout any Assessment (see SPB Jersey Assessment), including an Article 42 Enquiry, all service providers must ensure that they communicate clearly - with the child or young person with the disability, with the family and with each other - as there is likely to be a greater number of services and practitioners involved than for a non-disabled child.

The Statutory Guidance (page 52) states “it is important that children who are pre-verbal, and children and young people who are non-verbal, or whose ability to communicate verbally is limited, have the same opportunities to meaningfully share their views on matters affecting them”.

Under the Children and Young People Law 2022, there will be a requirement to appoint independent advocates for a range of children and young people, (draft regulations are in progress and will be added). Appropriately trained interpreters for parents/carers and advocacy for the children and young people required as a best practice standard.

Where a child or young person has communication impairments, particular attention must be paid to the communications needs of the child to ascertain the child’s perception of events and his or her wishes and feelings. This means being responsive and adapting services to enable accessibility to ensure children and young people can communicate their views. Where in-house skills do not match the needs of the child or young person, specialist advocacy support should be sought. Where all steps should be taken to avoid confusion so that the welfare and protection of the child remains the focus to ascertain the child’s perception of events and his or her wishes and feelings (see SPB Jersey Respecting and Capturing the voice of the child).

Safeguards for disabled children require more focus, time and specialist service provision with trusted and known adults to meet the individual needs of the child or young person.

Organisations and practitioners should:

• Make it widespread practice disabled children and young people are enabled to make choice and have wishes and feelings known in respect of their care and treatment;
• There is an understanding of what needs a child is communication through their behaviours;
• Children and young people may require more visits than non-disabled children, adapting these to their needs so they may require longer or shorter visits. Where possible at least some of these at their home to understand what home looks like for them;
• Ensure disabled children and young people receive appropriate personal, health and social education (including sex education);
• Make sure that all disabled children and young people know how to raise concerns and give them access to a range of trusted adults with whom they can communicate.

This could mean using interpreters and advocacy, and the use of facilitators who are skilled in using the child’s preferred method of communication.

• Wherever it is safe and appropriate to do so, parents should be treated as partners;
• Recognise and utilise key sources of support including parents, carers, staff in schools, friends and family members where appropriate;
• Develop the safe support services families want, who have a culture of openness. 
  Organisations should have guidance on good practice in place with the ability to gather evidence to understand these are being followed. For example:
• The use of the JCF Chronologies for all disabled children and young people which capture outcomes;
• Documentation which evidences the capture of the views, wants and wishes of children and young people in their care and in their care planning (See SPB Respecting and capturing the voice, experience and expertise of children and young people);
• Transparent plans on how to reduce and manage challenging behaviour, with staff trained in the use of accepted methods to contain behaviour such as MAYBO;
• Understanding what a child or young person is communicating in their behaviours, is crucial to understanding if they are at risk of abuse or neglect;
• Documented evidence of professional curiosity around the “messages” a child or young person may be communicating in their behaviour (See SPB Training);
• Training for staff in Capacity and Deprivation of Liberty (Jersey) Law (See SPB Training);
• Clear Anti-bullying and Inclusion strategies (see SPB Jersey Bullying);
• Evidence of open conversations, teaching and support for disabled children and young people to understand their sexual development (See SPB Jersey Children and Young People’s Sexual Development, Consent and Risk);
• Evidence of the use of the Brook Traffic Light Tool and an outcomes based care plan where a disabled child or young person presents with problematic or harmful sexualised behaviours (See SPB Jersey Harmful Sexualised Behaviours);
• Evidence of statutory regulation and monitoring of placement arrangements for children and young people living away from home, (Jersey Care Commission (JCC)).

This list is not exhaustive.

Parents and carers are relied upon as a source of information about their disabled children and young people and this in the main is positive and supportive. Parents and carers are partners for practitioners in the care of children and young people with disability and they are best placed to interpret and explain behaviour changes, or new symptoms and help to support practitioners care for their child. This can reduce the child or young person’s vulnerability to all forms of abuse, neglect and exploitation.

Practitioners must not make assumptions about the inability of a disabled child or young person to describe what is happening to them, as with any other child a disabled child may not disclose abuse until they are with someone safe to do so and are enabled to communicate their needs in their own individual way.

Disabled children and young people can give credible evidence and can withstand the rigours of the court process if they are supported appropriately to do so. Intermediary support should be provided from first contact with the police to the end of process. Appropriately trained intermediaries can make recommendations about the ways interviews and witness statements can best be collected, in line with the child or young person’s communication, emotional and sensory needs. Where the court process can be adapted to meet the child or young person’s communication needs.

Where a criminal offence has been committed, each child or young person should be assessed carefully and supported to enable them to participate in the criminal justice system, when this is in their best interests as set out in Achieving Best Evidence in Criminal Proceedings:  Guidance on interviewing victims and witnesses, and a guidance on using special measures (Ministry of Justice 2011). This document includes comprehensive guidance on planning and conducting interviews with children and a specific section about interviewing disabled children (Section E page 172).

Participation in all forms of meetings such as Child Protection Conferences and Core Groups must be encouraged and facilitated with the use of specialist advocacy services for children, parents or both. This might also include adaptations to usual processes such as a shorter or more frequent meeting, visual guides to key information before, during and after meetings. Thinking about ways to reduce the number of people in meetings, allowing breaks, easy read information (list is not exhaustive).

Where a child or young person presents with perplexing presentation (PP) or fabricated or induced illness (FII) practitioners should follow guidance on how to address the concern (See SPB Jersey PP or FII).

The Children (Jersey) Law 2002 and Children and Young People (Jersey) Law 2022 creates a general duty for all services to safeguard and promote the welfare of children. So far is consistent with this law children and young people should be where possible brought up within their families (See Statutory Guidance on Levels of Need - page 20).

Ofsted thematic inspection: Protecting Disabled Children

Safeguarding Disabled Children: Practice Guidance

Disabled Children and Young People and those with Complex Health Needs

Family Nursing & Home Care Children’s Palliative Care Pathway - The Children’s Palliative Care Pathway (CPCP) provides an active and total approach to care for children aged 0-18 years old, from the point of diagnosis or recognition of a life-limiting or life threatening condition. A holistic assessment enables care planning to embrace physical, emotional, social and spiritual elements, with a focus on enhancing quality of life for the child and family.  It includes the management of symptoms, and care throughout life, death and bereavement. A child may have many practitioners involved in their care so to facilitate effective planning and prevent duplication or overwhelming the family, the pathway follows a ‘team around the child’ (TAC) approach. This provides the opportunity for the child, parents, carers and practitioners to meet as required, share information, and create a unified action plan that integrates all the strands of support.