Safeguarding children level 1

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Safeguarding Children Level 1
Safeguarding for non-clinical staff
working in a healthcare setting
This session is for ALL non-clinical staff working in a healthcare setting including for
example, Board level Executives and non-executives, lay members, receptionists,
administrative, caterers, domestics, transport, porters, community pharmacist counter
staff, and maintenance staff . It is basic safeguarding training.

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Introduction
Unfortunately, many children in the UK do not grow up in satisfactory conditions. Some children and their
families need extra help from government agencies or voluntary sector organisations to allow them to reach
their full potential. A smaller but crucially important number of children are being abused. Recent high profile
cases have highlighted just how cruelly some children can be treated by adults. 1-2 children die every week
due to parental/carer abuse or neglect.
Legislation and Child rights
The importance of protecting children from harm is universally recognised and legislation underpins the
government policy in the area of child abuse.
The legislative framework which underpins the child protection system in England and Wales has been in
force since 1880, however several high profile cases and inquiries have led to the child protection system
and the legal framework we have today.
 Children Act 1989 and 2004
 Sexual Offences Act 2003
In 1989 the United Nations Convention on the Rights of the Child (UNCRC) set out the basic human rights
that children should have worldwide. The UNCRC was ratified by the UK government in 1991, which brings
the responsibility to take all available measures to make sure children's rights are fulfilled, respected and
protected.

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Introduction
In 1989 the United Nations Convention on the Rights of the Child (UNCRC) set out the basic human rights
that children should have worldwide. The UNCRC was ratified by the UK government in 1991, which brings
the responsibility to take all available measures to make sure children's rights are fulfilled, respected and
protected.
The Convention applies to all children; whatever their race, religion or abilities, whatever they think or say,
and whatever type of family they come from. There are over 40 specific rights including:
 The right to survival
 The right to develop to the fullest
 The right to participate fully in family, cultural and social life
 The right to health and healthcare
 The right to protection from all forms of violence: Children have the right to be protected from being hurt
and mistreated, whether physically or mentally. Governments should ensure that children are properly
cared for and protect them from violence, abuse and neglect by their parents, carers or anyone else
who comes into contact with them.

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Introduction
All health organisations have a duty in law to ensure that they safeguard and promote the welfare of
children and young people, and this means that all staff have an important role to play.
This duty extends to all children and not just those children and young people who are patients receiving
treatment and care on our paediatric wards or in the community, it also includes
 Children of our patients
 Children who visit our hospital sites
 Child are anyone under the age of 18 years in law, and may be nursed on an adult ward
In order to carry out their duty to safeguarding children, all staff working in a healthcare setting needs to be
able to understand and recognise signs of abuse in children.
The term safeguarding and promoting the welfare of children is defined in Working Together (2015) as:
 protecting children from maltreatment;
 preventing impairment of children’s health or development;
 ensuring that children are growing up in circumstances consistent with the provision of safe and
effective care; and
 taking action to enable all children to have the best outcomes.

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Introduction
The abuse of children is distressing, so it is important that you know what to do if you are concerned that a
child or young person is suffering neglect or abuse.
If you are affected by this training and require any further support you may wish to contact occupational
health or your line manager. If you require advice or support around a safeguarding children matter you will
have information to help you know where to seek advice and support.
Learning Objectives
By the end of this session you will be able to:
 Describe the different forms of child maltreatment (physical, emotional, sexual abuse and neglect)
 Describe the risks associated with the internet and online social networking
 Identify what the term 'looked-after child' means
 Indicate a willingness to listen to children and young people and to act on their issues and concerns
 Show an awareness of the impact of FGM (Female Genital Mutilation),
 Recognise that domestic violence and a carer's mental/physical health may impact on a child

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Learning Objectives
 Show an awareness that vulnerable children and young people may be susceptible to radicalisation
(Prevent programme)
 Recognise possible signs of child maltreatment that you might come across in your work
 Describe how common child maltreatment is and the impact it can have on a child or young person
 Indicate what you should do if you do have concerns about child maltreatment; including knowledge of
local policies and procedures, who to contact and where to obtain further advice and support
 Identify what to do if you feel that your concerns are not being taken seriously or you experience any
other barriers when referring a child/family
 Identify the importance of sharing information and the consequences of failing to do so
 Identify what to do if you feel that your concerns are not being taken seriously or you experience any
other barriers when referring a child/family
 Identify how to seek appropriate advice, report concerns and feel confident that you have been listened
to

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Child abuse – an overview
Someone may abuse or neglect a child or young person by inflicting harm on them, or by failing to act in
preventing harm. This harm may be physical or psychological and will affect the child's or young person's
current and future well-being. Children and young people may be abused in a family, or in an institutional or
wider community setting.
The abuser(s) may be someone known to the child, or more rarely a stranger. More often than not the per-
son responsible for the abuse has a close relationship with the abused child, such as a family member, or
someone considered to be a friend, and in some cases this could be a professional.
Child abuse is described in four categories:
 Physical abuse
 Neglect
 Emotional abuse
 Sexual abuse
Whilst some level of emotional abuse is involved in all types of maltreatment, it may also occur alone.

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Child abuse – an overview
Other forms of harm inflicted on children and young people are:
 Bullying
 Internet abuse
 Living in a home where there is domestic violence or, in the case of teenagers; being involved in an
abusive relationship
 FGM (female genital mutilation)
 Radicalisation, which can put a young person at risk of significant harm

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Categories of Abuse
Each category of abuse will be considered separately. All definitions are taken from the Government
Statutory and Non-statutory Guidance DOH document, Working Together to Safeguard Children, 2015
https://www.gov.uk/government/publications/working-together-to-safeguard-children--2
Physical abuse
Physical abuse may involve hitting, shaking, throwing, poisoning, burning or scalding, drowning, suffocating,
or anything else that causes physical harm to a child.
Physical harm may also be caused when a parent or carer fabricates the symptoms of, or deliberately
induces, illness in a child .
How common is physical abuse?
NSPCC research by Cawson et al (2000) found that 7 per cent of young adults surveyed reported serious
physical violence from a parent or carer during childhood.

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Physical abuse
How does physical abuse impact on a child?
 The child will feel immediate pain and suffering
 There may be medical problems caused by the physical injury
 The emotional pain will last long after the bruises and wounds have healed
 The longer physical abuse of a child occurs, the more serious the impact: chronic physical abuse or a
single episode of severe physical abuse can result in long term physical disabilities; including brain
damage, hearing loss or eye damage
 The child can die in the instance of severe physical abuse
 It may impact on how they behave towards others
What are the signs of physical abuse?
Some of the common signs can be:
 Bruising - especially in areas that are not usually injured in play such as soft tissue areas including the
cheek and buttocks, the ears, the chest

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Physical abuse
 Bruises in the shape of implements
 Cuts and scratches - especially in areas that are not usually injured
 Bite marks
 Burns and scalds in unusual areas such as the soles of the feet, the back of the hand
 Broken bones and fractures - without a good explanation that fits the injury
 Head injury or grip marks. Shaken babies may lead to abusive head trauma causing bleeding into the
brain so the baby may be unconscious or fitting
 Some signs of physical abuse can also be more subtle: a child may be fearful, shy away from touch, be
reluctant to change for PE or appear to be afraid to go home
This appears to be bruising from a human bite – it would
require specialist opinion to differentiate between a bite
from an adult or another child. It also needs to be
considered whether the child may have other injuries or
bite bruises on parts of the body that are covered.

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Physical abuse
What always needs to be taken into account?
 What is the child's age and stage of development? For example a baby or a child with disabilities who
can't sit up yet should not have bruises anywhere unless there is a clear history of trauma such as a car
accident; whilst a school aged child without mobility restriction will usually have a couple of bruises on
their shins caused during normal play (Children under the age of 6 months who have bruising should be
seen by a paediatrician regardless of the explanation related to the injury. Children of this age are not
usually independently mobile and bruising is associated with mobility, therefore this is unusual. It would
generally require a degree of force for the injury and a paediatric opinion is required to ensure they do
not have a significant injury, or a condition causing them to bruise which may require treatment, and this
helps to ensure they are safe. There is a local safeguarding procedure that staff should follow, please
note this would also apply to older children that are not mobile)
 How did the injury occur? What is the child's explanation (where this is possible) and the parent or
carer's explanation for the injury. In abuse, the parent's explanation may not fit with the injury seen, it
may seem very vague or change every time they are asked about the injury. The child may have been
'trained' to echo the parent's explanation. It is therefore important not only to document the explanation
but also the source of information when there are concerns relating to possible Non accidental injury
 Has the child deliberately been given a substance that has made them ill? e.g. medication prescribed
for another person such as methadone, or alcohol

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Physical abuse
Fabricated and Induced Illness (FII) – a form of Physical abuse
FII is where a parent or carer causes harm to their child through fabricating or inducing illness in the child.
This can range from exaggerating symptoms, to falsify documents or specimens, and in more severe cases
may lead to them inducting illness.
 Fabrication – can be making up or exaggerating symptoms leading to children having examinations,
X-rays, Scans, blood tests, medication and even surgery that they do not require
 Falsifying – this could be falsifying hospital letters, tampering with charts, and even providing false
specimens (eg providing false specimens such as parent adding their own blood to urine or stool
samples)
 Inducing- Induction of illness can be life threatening and can include acts such as incorrect usage of
prescribed medication (eg withholding or overdosing the medication), adding substances such as salt
to food, or even smothering a child in order to prove that the child has episodes of not breathing or fits
Often perpetrators of FII will have their children seen by many different health establishments, they are
often good attenders except for appointments which would define a diagnosis. They often appear very
knowledgeable about their child’s health. Often children will have or will previously have had a genuine
illness.

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Physical abuse
The most common perpetrators of FII are mothers or other significant female care givers. However there
may be male or even professional perpetrators.
Because of this FII is one of the situations where advice should be sought from the Safeguarding Children
Team and a referral to Children Social Care would not be discussed with the parent or carer as this may
increase the risk to the child.
Female Genital Mutilation (FGM)
The category of physical abuse is considered for young girls under the age of 18 who may be at risk from
FGM. The World Health Organization describes FGM as: "procedures that involve partial or total removal of
the external female genitalia, or other injury to the female genital organs for non-medical reasons" (WHO,
2013). FGM is practised in up to 42 African countries, and also in parts of the Middle East and Asia and it is
usually carried out on girls between infancy and age 15, with the majority of cases occurring between the
ages of 5 and 8. FGM practice is illegal in the UK, it is also illegal to aid FGM occurring in other countries
where this abusive practice is not illegal. There are no health benefits to FGM. It is unknown when, or
where, FGM originated. Numerous reasons are given to justify FGM but it is not demanded by any specific
religions

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Physical abuse
Mandatory reporting of FGM has been required since 2015 for FGM. Regulated health, social care profes-
sionals and teachers are required to report any cases of FGM in girls under 18 which they identify in the
course of their professional work to the police (using 101). This is the personal duty of the professional who
identifies FGM or who receives the disclosure, and they therefore must make the report.
The scope of mandatory duty includes all girls under 18 who disclose they had FGM ( using all acceptable
terminology ie cut, circumcised, sunna) or if signs or symptoms are identified and you have no reason to
believe it was for the girls physical or mental health or for purposes connected with childbirth or labour. This
duty extends to a duty to report genital piercings and tattoos in the under 18 girls for non medical reasons
If you are concerned or have information other young people may at risk a Safeguarding Children referral
should be made. For example You have not seen the child but the parent/guardian discloses that child has
had FGM or you believe a girl is at risk of FGM. You also may think a girl has had FGM but she has not
disclosed and you have not seen any signs/symptoms
Further guidance can be found here www.nhs.uk/fgmguidelines
Please contact the Safeguarding children team if you require further advice.

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Categories of Abuse
Sexual abuse
What is sexual abuse?
Sexual abuse involves forcing or enticing a child or young person to take part in sexual activities. It does not
necessarily involve a high level of violence, and the child may or may not be aware of what is happening.
The activities may involve physical contact, including assault by penetration (e.g. rape or oral sex) or non-
penetrative assault (e.g. masturbation, kissing, rubbing and touching outside of clothing).
Sexual abuse may also include non-contact activities, such as involving children in looking at or in the
production of sexual images, watching sexual activities, encouraging children to behave in sexually
inappropriate ways, or grooming a child in preparation for abuse (including via the internet).
Sexual abuse is not solely perpetrated by adult males; women can also commit acts of sexual abuse, as
can other children .

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Sexual abuse
How common is sexual abuse of children and young people?
Many children do not tell anyone about sexual abuse so it is difficult to know the true number of children and
young people affected. Between 5% and 10% of girls and 1% to 5% of boys are exposed to penetrative
sexual abuse during childhood, although figures that include any form of sexual abuse are much higher, up
to 25%.
What is the impact of sexual abuse on a child or young person?
The commonest reaction that a child feels is shame or embarrassment. They may have tried to tell
someone but may not have been believed. They may have even been blamed for what has happened.
Many sexually abused children wait until they are much older to tell anyone what has happened to them, or
they sometimes never tell. Young children may not recognise what has happened to them is abusive.
The child may have physical trauma to the genital area and be in pain, they may also experience other
complications. Emotional pain will almost certainly be associated with the abuse.
Many young people who are sexually abused by their partner are afraid to tell friends and family.
All disclosures should always be taken seriously even if they are later retracted.

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Sexual abuse
What are the characteristics of a child sex abuser?
Usually the abuser is a family member or someone known to the child, such as a family friend. For teenag-
ers it may be a boyfriend or girlfriend. Child sex abusers can come from any professional, racial or religious
background, and can be male or female.
Abusers may act alone or as part of an organised group. After the abuse, they may put the child under great
pressure not to tell anyone about it. They may go to great lengths to get close to children and win their trust,
such as choosing employment that brings them into contact with children, or by pretending to be children in
internet chat rooms intended for children and young people. Child sex abusers are sometimes referred to as
'paedophiles' or 'sex offenders', especially when they are not family members or intimate partners in teen-
age relationships.
Due to the fact that sexual abuse is more often perpetrated by someone known to the child sexual abuse is
another instance where concerns are not shared with the parent or carer at the time of the referral as this
may place the child or others at greater risk. It may also lead to the perpetrator destroying evidence which
may be required to pursue a criminal case.

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Sexual abuse
What are the signs of sexual abuse?
Many children (boys and girls) who have a history of sexual abuse, or present with an allegation do not have
any physical signs when examined by a specialist doctor. This may be because the abuse may have taken
place sometime before the examination and injuries to the genital area heal very quickly or because the
abuse was non–penetrative (e.g. kissing or inappropriate touching).
A child’s behaviour may suggest abuse, for example if he or she:
 Becomes anxious about going to a particular place or seeing a particular person
 Suddenly starts having behaviour problems such as being aggressive
 Suddenly starts having extreme mood swings such as brooding, crying or fearfulness, presents as
angry or defiant
 Has a sudden deterioration in school results
 Displays unexpectedly explicit sexual knowledge for their age, including inappropriate sexualised be-
haviour
 Starts wetting the bed again, (having previously been dry by night), or soiling
 Becomes unkempt which may be to deter further attention from the perpetrator
 Is secretive about online activity

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Sexual abuse
 Presents( including mobile phones), money, substances, any of which they won’t account for how they
have accessed them and couldn’t otherwise afford
 Increased risk taking behaviours such as substance misuse, self harm behaviours
Adolescent victims of sexual abuse in the home or with an intimate partner or gang, are more likely to:
 Underachieve at school
 Abuse alcohol or drugs
 Self harm
 Have unprotected sex with numerous partners
 Continue the patterns of violence into future relationships
 Go missing from home and education
Physical signs in all age groups may include
 Injury to the genital areas, other injuries which may be suggestive of force such as grip marks, bruising
of inner thighs or buttocks, oral injuries
 Sexually transmitted infections
 Pregnancy

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Sexual abuse
Child Sexual Exploitation (CSE)
CSE is a type of sexual abuse where the child or young person receives something (e.g money, food,
shelter, drugs, gifts) in return for sexual activities. There is a power imbalance between the perpetrator and
victim- this may for example, be an age difference, physical power, financial control, a difference in learning
capacity.
Young people over the age of sexual consent can be exploited and may not be aware this is happening to
them, for example if they are drugged, or led to believe they are in a loving relationship.
Watch the following training clip and think about this young girls relationship – The story of Jay , NSPCC
This story depicts how the young girl was groomed into what she identified as a loving relationship.
Throughout the clip it depicts how this became an exploitive situation whereby the girl was isolated from
support networks and abused. It is important to remember that the capacity for consent should always be
considered when substance misuse is evident. Young people over the age of sexual consent may also be
exploited, an added difficulty is that CSE can be difficult to identify as the victim may not recognise they are
being abused.
https://www.youtube.com/watch?v=w6vYbZSUL5U

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Sexual abuse
Common Signs of CSE
 Missing from home, or care.
 Physical injuries including unusual or concerning bruising
 Drug or alcohol misuse.
 Involvement in offending, this may be to fund their substance misuse.
 Repeat sexually-transmitted infections, pregnancy and terminations.
 Absent from school.
 Change in physical appearance.
 Evidence of sexual bullying and/or vulnerability through the internet and/or social networking sites.
 Estranged from their family.
 Receipt of gifts from unknown sources.
 Recruiting others into exploitative situations.
 Poor mental health.
 Self-harm and suicidal thoughts

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Sexual abuse
National and Local CSE information
There has been much media coverage of CSE in places such as Rochdale, Oxford and Rotherham. Often
this has linked CSE to gang crime of particular ethnicity. Its important to recognise CSE can be perpetrated
by gangs or single perpetrators. Perpetrators and victims can be male or female and from any race or eth-
nicity. Middlesbrough has a Barnados project known as SECOS (Sexually Exploited Children On the
Streets) and from that service we have some information regarding the local profile for CSE.
 The average age for young people who are sexually exploited and being abused in Middlesbrough is
between 12 and 13 years old.
 Barnardo’s has worked with children as young as 10 who have been sexually exploited.
 87% of the exploited children were involved in drugs, 55% were regularly missing from home and 53%
were engaging in self harming behaviours and criminal behaviours.

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Sexual abuse
What can you do if you have concerns about CSE victims or possible perpetrators?
Contact the Safeguarding Children Team for further advice. Information can be shared about young people
who may be being exploited. Information can also be shared if a potential perpetrator is identified and this
can be investigated appropriately. In Redcar and Cleveland and Middlesbrough Local Authorities concerns
are referred to VEMT, which is a confidential forum for a multi-agency risk assessment of young people who
may be Vulnerable, Exploited, Missing or Trafficked. Further information and links to Safeguarding proce-
dures for North Yorkshire and Teeswide can be found on the CSE page of the Safeguarding Children web-
site.
Associated risks
Trafficking
“The recruitment, transportation, transfer, harbouring or receipt of a child for the purpose of exploitation shall
be considered 'trafficking in human beings'.” (Definition ratified by UK Government, 2008)

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Sexual abuse
The victims of trafficking are controlled by physical, sexual and emotional abuse. Children who are trafficked
are likely to be physically and emotionally neglected, however they may also be sexually abused.
Whilst we may associate trafficking with a person being moved from country to country or town to town, it is
important to remember trafficking can also happen from street to street whereby young people may be
drugged or plied with alcohol before being moved to another property to be abused.
Risks from online technology, social network sites and mobile phones.
Watch one of the following training clips which demonstrates online risk to young people
Girls Think U Know – CEOP video (a young girls story)
https://www.youtube.com/watch?v=vp5nScG6C5g
Matt thought he knew - CEOP video (an adolescent male story)
https://www.youtube.com/watch?v=9JpyO5XlfCo

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Sexual abuse
It is important to remember that whilst technology has many benefits for young people, they can also have
risks to their safety
 Social Network Sites- grooming
 Webcams- can lead to inappropriate images being viewed or saved
 Mobile phones – sexting, camera and internet connections (often parents/carers don’t set parental/
privacy settings as they would on a computer)
 Bullying and exploitation
 Access to online porn, child abuse images
 Dangerous websites encouraging self-harm, eating disorders
 Gambling, running up debt
 Inappropriate gaming sites or access to games which are not age appropriate
 Sharing inappropriate material by technology may also lead to young people receiving a caution or be-
ing prosecuted for a sexual offence.

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Sexual abuse
Bullying
Bullying may be defined as deliberately hurtful behaviour, usually repeated over a period of time, often
where it is difficult for those bullied to defend themselves.
It can take many forms, but the three main types are physical (e.g. hitting, kicking, theft), verbal (e.g. racist
or homophobic remarks, threats, name calling) and emotional (e.g. isolating an individual from the activities
and social acceptance of their peer group). There is increased recognition of "peer on peer" abuse - which
can occur in varied settings such as school, youth groups, gangs or friendship groups. This may include a
combination of emotional, physical and sexual intimidation.
The damage inflicted by bullying can frequently be underestimated. It can cause considerable distress to
children to the extent that it affects their health and development or, at the extreme, cause them significant
harm (including leading to self-harm). All settings in which children are provided with services or are living
away from home should have in place rigorously enforced anti-bullying strategies.

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Neglect
Neglect is the persistent failure to meet a child's basic physical and/or psychological needs, likely to result in
the serious impairment of the child’s health or development. This may or may not be deliberate.
Neglect may involve a parent or carer failing to:
 Provide adequate food, clothing and shelter (including excluding them from home or abandonment)
 Protect a child from physical and emotional harm or danger
 Ensure adequate supervision (including the use of inadequate care-givers)
 Ensure access to appropriate medical care or treatment
 It may also include neglect of, or unresponsiveness to, a child's basic emotional needs
 An unborn baby may suffer neglect due to maternal substance misuse or failure to access ante-natal
care.
How common is neglect?
1in 10 children or young people have been neglected at some point in their childhoods (Radford et al,2011).
Of all the children who are subject to a Protection Plan Neglect is the category most often seen used both
nationally and locally.

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Neglect
How does neglect impact on a child or young person?
Watch the following training clip and identify the neglect that Susan is exposed to.
https://www.youtube.com/watch?v=ROIGfGGx80U
Examples:
 Susan often feeling hungry, and having an inadequate, inconsistent diet. This can lead to children not
growing properly or obesity
 Susan was rejected at school by other children because of her dirty clothes and smell. Sometimes chil-
dren lack treatment for skin conditions or head infestations. They may wear clothes that don’t fit, or are
inappropriate for the weather
 Susan required dental care which was not responded too. Some children don’t receive medical care
when they need it because the parent does not have capacity to recognise the illness, therefore the
child or infant is presenting very late into an illness. Some parents are focussed on their own needs and
neglect their children’s basic health, including non attendance for immunisations, dental, eye care or
they miss important health appointments

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Neglect
 Susan was not properly supervised. Children require appropriate supervision, failing to provide this can
lead to increased risk of accidental harm, abuse from other people, children can access harmful
materials
Other types of neglect
 The child is not stimulated or educated due to lack
of appropriate toys, socialisation and schooling
 The child may be living in a filthy house without a
clean bed to sleep in, dirty toilet and kitchen
conditions, animal faeces in the home which is not
cleaned up

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Neglect
What are the signs of neglect?
Physical signs:
 Ill-fitting, dirty clothes and shoes
 Not dressed warmly enough in cold weather
 Appearing very dirty, with matted and unwashed hair or smelling bad
 Untreated or delayed treatment for illnesses and physical injuries
 Change in physical appearance, losing or gaining weight
 Poor home conditions

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Neglect
What are the signs of neglect?
Behavioural signs:
 Unsupervised young children playing outside
 Left alone at home
 Frequently late for school or poor attendance
 Troublesome, disruptive behaviour, or withdrawn and passive
 Running away from home – in the case of adolescents
 Increased risk taking behaviours
 Searching for food
Within health children may be neglected through
 Children not having access to free universal services due to parents not accessing – immunisations, op-
tician, dentist, screening programme
 Parents/carers failure to respond to their child’s deteriorating health, this can lead to children being in
pain, may give serious concern about their presentation or in extreme cases can lead to death

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Neglect
One of the ways that neglect can be evidenced is when a child is not brought for health appointments. It is
important to recognise that some parents may appear to engage by cancelling and re booking
appointments, however this still can mean that the child still doesn’t get seen for their health needs.
The safeguarding children policy for the trust gives guidance for the action to take when a parent fails to
present children for appointments (see page 5 and appendices A to D of G55 – safeguarding children policy
http://stas16/intranet/services-a-z/safeguarding/safeguarding-children/policies-procedures-report-forms/ -
only viewable within the trust.)
If a child that resides in the Middlesbrough or Redcar and Cleveland Local Authority, is already subject to
safeguarding children procedures there will be an alert marker on CAMIS and also a purple safeguarding
child memo will be filed within the body of the health records, this memo gives further information to which
category that the child is subject to a plan. If the non-attendance for a health appointment may have a
significant impact on a child’s health or development a safeguarding referral should be considered.
All relevant and available health information should be included where there are safeguarding concerns.

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Emotional abuse
What is emotional abuse?
Emotional abuse is the persistent emotional maltreatment of a child that causes severe and persistent ad-
verse effects on the child’s emotional development. This can include:
 Conveying to children that they are worthless, unloved, inadequate, or valued only when they meet the
needs of another person
 Not giving the child opportunities to express their views, silencing them or ‘making fun’ of what they say
or how they communicate
 Age or developmentally inappropriate expectations being imposed on children such as: limitation of ex-
ploration and learning or interactions that are beyond the child’s developmental capability
 Overprotection and preventing the child participating in social interaction
 Serious bullying (including cyber bullying) which causes children to feel frequently frightened or in dan-
ger
 Exploitation or corruption of children
 Emotional impact (short or long term) of witnessing domestic abuse, or other violent acts

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Emotional abuse
How common is emotional abuse?
Parents from all types of backgrounds may emotionally abuse their children. About 7% of children in the UK
experience frequent and severe emotional maltreatment during childhood. All types of maltreatment will in-
volve some level of emotional abuse but emotional abuse may also occur in isolation. Nationally and locally
this is the second most frequently used category for children with a protection plan. In England on the 31st
March 2015 over 11,000 children in England had a protection plan for emotional abuse (NSPCC: Child
abuse and neglect in the UK today )
How does emotional abuse impact on a child?
The child or young person may feel:
 That he or she is not worthy of being loved by anyone
 A poor sense of well-being, self-image and self-esteem
 A poor sense of security, and difficulty in trusting others
 It is hard to feel happy
 Responsible for the abusive parent's displeasure or unhappiness

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Emotional abuse
What are the signs of emotional abuse?
It's not always easy to identify when a child is being emotionally abused. Some of the ways children react to
emotional abuse are:
 Having low self-confidence and a poor self-image
 Verbalising that they are unhappy
 Being withdrawn, unable to trust others and having difficulty when forming relationships
 Being delayed emotionally, socially or academically
 Becoming anxious, depressed, demanding, aggressive, destructive or even cruel
 Display increased risk-taking behaviour
What actions of a parent/carer are emotionally abusive?
NSPCC The $h*! Kids say
https://www.youtube.com/watch?v=LagGSTiSnto
What are the signs of emotional abuse in this training clip? (*Please note STHFT policies must be followed
for any concerns about a child identified within your role at the trust).

37. 37
Emotional abuse
In emotionally abusive situations parents or carers may:
 Say things to the child over and over again until the child believes he or she is 'no good', 'worthless',
'bad' or 'a mistake'
 Speak to the child in a terrifying way such as shouting, swearing, threatening or bullying
 Humiliate the child by making sarcastic comments, negative comparisons to others, or shame a child in
private or public
 Terrorize the child, e.g. threatening to use a knife or other means in order to hurt, torture or kill a pet, a
loved one or the child themselves
 Force a child to watch violent acts, threaten him or her with abandonment or place the child in danger-
ous situations
 Reject the child, withhold affection or refuse to acknowledge the child's presence and accomplishments.
The abusing adult may communicate dislike for the child who also may become the 'scapegoat' for
family problems

38. 38
Emotional abuse
 Isolate the child by restricting contact with others and preventing him or her from forming friendships.
Normal family interactions are restricted; a child may be required to stay in his or her room or in the
closet, basement or attic for extended periods of time, or be put outside the home
 Corrupt the child by encouraging antisocial or delinquent behaviour. Corruption exists when children are
given alcohol or other drugs, encouraged to commit crimes or are exposed to cruelty toward animals or
other human beings
 Adolescents may be emotionally abused by peers at school or intimate partners
 Abusers may create an environment of fear and intimidation in the home through domestic abuse

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Other forms of risk - Radicalisation - Awareness of PREVENT
PREVENT is the Government Strategy aiming at stopping people becoming terrorists or supporting
terrorism
Three main objectives
 respond to the ideological challenge of terrorism and the threat we face from those who promote it;
 prevent people from being drawn into terrorism and ensure that they are given appropriate advice and
support
 work with sectors and institutions where there are risks of radicalisation that need to be assessed
The Government have determined that Healthcare workers are well placed to support objectives 2 and 3.
Please watch the following video;
https://www.youtube.com/watch?v=J8Og6q1AF3E

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Assessing Risk for children
What makes some children more vulnerable or at risk of being abused?
The following are all Risk factors. As with all risk factors, it is often the accumulation of a number of factors
that increases the risk to the children. These can be categorised into child, environmental and parental
factors.
Factors about Children that may increase their vulnerability
 Age – children under the age of 1 year are the most vulnerable age group as they are dependent for all
their basic needs. The second most vulnerable age group are adolescents as they are more
independent. Example- baby under 1 who is being neglected cannot feed, clothe, change, or assess
risk to self therefore they are more likely to become ill or come to harm than other children. Teenagers
who are neglected may not have boundaries in place, they are vulnerable to those who may wish to
harm them and are more likely to engage in risk taking behaviours
 Unsettled Babies, Premature babies, children with complex health needs, children with
behavioural issues- this can increase the stress within the household as the children may require more
care.

41. 41
Assessing Risk for children
 Children with disabilities- children with disabilities are 3-4 times more likely to be abused than other
children. This can be due to communication problems, mobility problems, learning disabilities that
prevent them recognising their own abuse, reliance on others for their intimate care
 Looked After Children- these children may be Looked After due to their disability e.g.: for respite care.
Other children who are Looked After may have been abused or neglected previously, they may seek
affection leaving them vulnerable to exploitation, they do not have a trusted adult they can seek advice
from, they may have behaviours because of their previous abuse that can raise stress within the care
environment they live in
 Youth offenders- may be offending to fund substance misuse, they may also put themselves at risk of
harm with criminal behaviours
Factors that can lead to an insecure Environment
 Poverty and deprivation – neglect may more often be associated with areas of high deprivation and
poverty, however as with sexual, physical and emotional abuse , neglect can occur across all classes in
society e.g. children left home alone due to parental lifestyle or employment, neglect due to substance
misuse, domestic violence.

42. 42
Assessing Risk for children
 Chaotic nomadic lifestyle- families that are nomadic may be difficult for agencies to assess when
there are concerns. Some nomadic families do not access services or will have sporadic engagement
with agencies such as health and education leading to their children’s needs being unmet
 Unsuitable or unsafe accommodation – can relate to poor home conditions. However it also can
relate to lack of suitable safety equipment in the home or private tenancies which are not meeting
standards
 Not attending school- when children attend school they are usually in a safe environment, if children
are not attending school this should be raised as a concern unless it is known they are home schooled.
 Social isolation- this can be due language or cultural differences, family breakdown, limited social
contacts (for example families who move due to work, for example those in the forces may be
constantly moving and may not have a trusted person to care for their children in times of need).

43. 43
Assessing Risk for children
Factors impacting on parental capacity
 Domestic Violence and Abuse. Domestic violence is a pattern of behaviour which is characterised by
the exercise of control and the misuse of power by one person , over another, within the context of a
current or former intimate or family relationship. The abuse can be physical, sexual, emotional ,
psychological and financial and it can also include making a person become socially isolated. Its
important to recognise that both Males and females can be either perpetrators or victims of Domestic
Violence and Abuse.

44. 44
Assessing Risk for children
Children and young people can suffer as a consequence of domestic abuse occurring within their
household. They may experience direct physical, sexual or emotional abuse, and there is also the abusive
impact of witnessing or being aware of abuse to a parent or other family member (often their mother). It is
important to recognise Domestic Violence can also present in relationships with other family members , e.g.
between an adult child and their parent, or between different generations living in the household.
Recent UK research found that 12 per cent of under 11 year olds, 17.5 per cent of 11–17s and 23.7 per cent
of 18–24s had been exposed to domestic abuse between adults in their homes during childhood.
It is increasingly recognised that physical, sexual, or psychological/emotional abuse can occur within
teenage relationships. It can occur both in person and electronically, and may occur between a current or
former partner or may be gang related. This tends to be called "intimate partner violence" in the UK. This
form of abuse is common: In a recent study about 25% of adolescent girls and 18% of boys in the UK had
experienced some form of physical abuse from their partner.

45. 45
Assessing Risk for children
Support services for anyone suffering Domestic Violence can be found on this link http://stas16/intranet/
services-a-z/safeguarding/safeguarding-children/domestic-violence/ - only viewable within the trust.
In some cultures the family and community may take actions that are abusive to prevent shame being
brought on their family beliefs. Specialist guidance and support services are available to support victims of
Forced Marriage, Honor Based Violence and Female Genital Mutilation. Contact numbers can be found for
the Halo project on the Domestic Violence and Abuse link above.

46. 46
Assessing Risk for children
 Drug and/or alcohol abuse – parents who substance misuse may not be able to appropriately care for
their children whilst under the influence/ or whilst withdrawing from the substance. Finances may be di-
rected to procurement of the substance leading to poverty. Parents may be fixated on meeting their own
needs which can lead to the neglect of their children’s basic and emotional needs. Children may be ex-
posed to additional risk of accidental ingestion of substances where safe storage isn’t present. Children
may not be supervised by parents. For young babies there are additional risks around safe sleep. Risks
to the unborn baby where substances used in pregnancy.
 Young/inexperienced parents- may have difficulties understanding and caring for their children's basic
needs
 Mental health issues- Mental illness can vary in severity and therefore the impact on children can vary.
The Trust uses tools which can assist in assessing the impact of mental illness on children (including
self harming behaviours) . The PAMIC tool and Self Harm pathway can be found on this link http://
stas16/intranet/services-a-z/safeguarding/safeguarding-children/accident-and-emergencyurgent-care-
centres/ - only viewable within the trust.

47. 47
Assessing Risk for children
 Parents with learning disabilities- Disabilities can vary in severity therefore the impact on the child will
differ and will also depend on the age of the child. The parents own vulnerability can impact on the child
through the parents own decision making relating to personal relationships. People with learning
disabilities may neglect their own health and basic needs and they may therefore lack understanding of
their child’s basic and health needs. Some parents may have difficulties supporting education and may
avoid school. Often as children become older the parent has difficulty setting boundaries and may
neglect supervision. They may also fail to educate adolescents about physical and emotional issues-
including puberty and risk taking
 Physical Ill Health- children may become a young carer for parents who have health problems. This
should be considered if children are attending health appointments with their parent or carer in school
time, undertaking carer role inappropriate to their age,or staying at home to care for their carer or
siblings and this impacts on their own needs being met eg missing education, socialisation.
Where children are brought up in an environment being exposed to parental
 Domestic violence
 Parental Mental illness
 Parental drug or alcohol misuse
the outcomes are usually poor for children unless agencies and services intervene to support the children.
This is known as the toxic trio.

48. 48
Assessing Risk for children
Common themes for the impact of these adult behaviours/health issues on the parent
 Lack of routines – sleep, meal times
 Lack of motivation/ poor self esteem
 Social isolation
 Stigmatisation
 Financial difficulties
 Housing problems
 Difficulty being emotionally available
 Vulnerable to being abused
 Focus on their own needs

49. 49
Assessing Risk for children
Common themes for the impact of these adult behaviours/health issues on the child
 Neglect of their basic needs, including supervision
 Lack of routines and blurred boundaries
 Inconsistent parenting
 Emotional difficulties including attachment issues, self-harm, anxiety related problems
 Poor access to services, education, health
 Young carers of parents or siblings
 Avoid being at home
 Increased risk of engaging in risk taking behaviour
 Increased risk of being exploited or abused

50. 50
Effects of child abuse
Abuse and neglect can have major effects on all aspects of a child's health, development and well-being.
The impact of any abuse will vary from child to child depending on the:
 Nature of the abuse
 Duration of the abuse
 Age of the child
 Individual child’s reaction to the abuse
 Home/family environment
 Impact and speed of any intervention
 Consequences of the intervention
 Professional response and support
Many children experience more than one form of abuse. All forms of abuse, including domestic violence, re-
sult in emotional harm to the child and can be considered as emotional abuse.

51. 51
Effects of child abuse
Abuse and neglect during childhood increases the later risk (in adolescence and adulthood) of:
 Drug and alcohol misuse
 Poor mental health
 Early and multiple sexual relationships and teen pregnancy
 Risk of perpetrating or being a victim of domestic violence
 Difficulty with job performance
 Relationship problems
On the positive side, many children and young people, despite having suffered from abuse, overcome this
adversity and go on to enjoy successful and contented lives.

52. 52
Your role in safeguarding children and young people
As a staff member in a healthcare setting you may frequently come into contact with children, young people
and their families or carers. You have a responsibility to play your part in keeping children safe.
By acting on your concerns you may help to prevent abuse, or further neglect, of a child from continuing. It
may be that your action results in early intervention and provision of support to the child and his/her family
or carers, so that the child does not suffer long-lasting harm.
Therefore it is necessary to know how to seek help and advice when you are concerned that a child is being
abused.
It helps to understand how the safeguarding children system works, and also who else is involved in
safeguarding children, e.g. social workers, the police and teachers, and also how the safeguarding children
system works.
Everyone working with children and their families or carers in society has a responsibility to work together to
try to stop and prevent the maltreatment of children and young people. This includes all people working in
healthcare settings, schools, the police, social workers and many others. Key members in your local child
safeguarding team outside the healthcare setting are:
 Social workers in children's social care
 Teachers
 Police officers
 Staff in voluntary agencies such as the National Society for the Prevention of Cruelty to Children

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What to do if you are concerned a child is being abused
Remember that no one needs to (or should) act alone when they have concerns about child abuse.
 You should discuss your concern with your line manager, or the person who is providing care for the
child or family
 You can contact the Safeguarding Children Team for advice or support regardless of your role in the
Trust
 Outside of the Safeguarding Team hours you can seek advice from Children Social Care. Out of hours
this is known as the Emergency Duty Team
 In an emergency situation where a child needs immediate safeguarding you can contact the police e.g.:
child left unsupervised, parent driving under influence of a substance with child in car, child being
exposed to violence
Where you have had concerns about a child or young person this must be clearly documented along with
the action you have taken.

54. 54
Consent and Referrals
There are two types of referral that can be made when there are concerns about a child’s health, develop-
ment or safety.
Child in Need (CIN)
 This is Section 17 of the Children Act
 It is unlikely the child will achieve or maintain a reasonable standard of health without the provision of
services by the local authority
 The child’s health or development is likely to be impaired without the provision of such services
 Children who are disabled are entitled to a Child in Need assessment. Respite care can be arranged
through Child in Need assessment

55. 55
Consent and Referrals
Parental consent is required for a Child in Need referral.
The common themes for CIN referral are
 Family dysfunction
 Child disability or illness
 Acute stress in family
 Parental disability/illness
 Absent parenting
 Socially unacceptable behaviour
 Abuse or Neglect not meeting threshold of significant harm
Child Protection Referral
 This is Section 47 of the Children Act
 There is reasonable cause to suspect that the child is suffering or is likely to suffer significant harm

56. 56
Consent and Referrals
Parents do not need to consent for a child protection referral but they must be informed except in cases of
 Sexual abuse
 Fabricated/induced illness
 If seeking consent will increase the risk to child, another adult or yourself
If parents are not informed of the referral the reason should be clearly documented on the referral form.
A copy of all referrals must also be sent to the Safeguarding Children Team and if the referral relates to a
patient a copy should be kept with the medical records. Where safeguarding concerns are shared verbally
with Children Social Care this must be followed up in writing and faxed or sent by secure email to Children
Social Care.

57. 57
Escalating Concerns
If you are not happy with a decision made around the Safety or Wellbeing of a child by another professional
or agency and this is not resolved by a discussion with the decision maker, then you should contact the
Safeguarding Children Team to discuss this further and seek advice
Safeguarding Children Named Professionals for STHFT
•Named Doctor : Dr Thwaites
•Named Nurse : Elaine Sherrick
•Named Midwife : Yvonne Regan

58. 58
Consent and Referrals
Policies and procedures
Trust policy relating to Safeguarding children can be found on this link http://stas16/intranet/services-a-z/
safeguarding/safeguarding-children/ - only viewable within the trust.
The Local Safeguarding Children Board (LSCB) has multi-agency policies and procedures relating to
Safeguarding Children. Every local authority is required to have a LSCB. Each LSCB is made up of relevant
organisations, for example; the Police and NHS trusts and NHS foundation trusts. The LSCB has a range of
roles and statutory functions which includes co-ordinating local work to safeguard and promote the welfare
of children ,developing the local safeguarding policy and procedures, provision of multi-agency training and
to undertake serious case reviews. LSCB policies and procedures can be found on this link http://stas16/
intranet/services-a-z/safeguarding/safeguarding-children/lscb-procedures/ - only viewable within the trust.

59. 59
Scenario
Case example part one
It is visiting time in a hospital ward. A woman and her two young children (a boy aged about 5-years-old and
a girl aged about 2-years-old) come to visit the woman's elderly father who has a heart condition.
The ward clerk notes that the children are scruffily dressed and seem very subdued. The mother asks to
take the 5-year-old boy to the toilets. The ward clerk passes the toilets herself and hears the mother speak
very nastily to her son and then observes her hitting him on the back. When she sees the ward clerk the
mother looks embarrassed and bursts into tears before pulling her son back to her father’s bed.
What should the ward clerk do?
A. Comfort the mother and do no more about it.
B. Pretend not to notice; think the mother is probably upset about her own father and do nothing.
C. Accuse the mother of harming her child.
D. Ring the police.
E. Refer the girl to social services.
F. Discuss her concerns with her line manager or the senior nurse on duty.
G. Ring Child Line or the NSPCC.

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Scenario
Case example part one
Answer: The ward clerk should immediately discuss her concern with the senior nurse on duty
Case example part two
The senior nurse for the patient approaches the patient’s bed and notes the children are sitting quietly; the
mother has stopped crying and is talking to her father.
What should she do next?
1. The line manager should reassure the ward clerk that it was just a one-off and do nothing
2. Contact the Trust's safeguarding team and discuss the case with them
3. Ask the mother to leave
Answer: The Senior Nurse contacts the Trust Safeguarding Children Team for advice

61. 61
Scenario
Case example – what happens next?
The nurse contacts a member of the Trust safeguarding team who advises her to talk to the mother in
private environment. The mother reveals that her father's illness is causing her a lot of stress as she is
worried that her father is terminally ill and she is a single mother who relies on him for support.
The nurse discusses with the mother the witnessed hitting of her 5-year-old son and the concerns about
both children seeming very subdued and unkempt. The nurse suggests that perhaps the mother is
struggling to keep up with things and that she would benefit from additional support.
The nurse explains to the mother they are professionally obliged to refer the family to Children's Social
Care, but that the main reason for this is to obtain the right support for the mother and her two children.
Other helpful people for support in this case might be:
 GP
 Health visitor/School nurse
 Voluntary bodies

62. 62
Scenario
What happens next?
Children’s Social Care will assess the circumstances around this family to ascertain whether or not the chil-
dren are at risk of harm. This assessment may involve talking to all agencies involved with the family in or-
der to find out what the family's strengths and weaknesses are. These agencies include:
 School
 GP
 Health visitor
Sharing information in this way is a key part of safeguarding.

63. 63
Sharing Information
 Remember the data protection is not a barrier to sharing information but provides a framework to
ensure it is shared appropriately
 Be open and honest with the family about why, what, how and with whom you are going to share infor-
mation.
 Seek advice if you are in any doubt
 Share with consent where appropriate.
 Consider safety and wellbeing of those affected
 Necessary, proportionate, relevant, accurate, timely and secure.
 Keep a record of your decision to share and reason for it.
In the previous case example it would not be appropriate to share heath information about the male patient
who is the grandfather of the child. It would be appropriate to state in the referral that the mother was visit-
ing a relative who was normally a supportive person to the mother and child, and that it appeared the ill
health of this relative was having a significant negative impact on the mother being able to cope at present.
Any additional health information would require the persons consent to share.

64. 64
Sharing Information
By sharing information, agencies are able to assess the level of risk the child might be exposed to. They can
then together decide what the next steps will be; either supporting the child and family, or if there is a
greater risk; to taking action to protect the child from further harm.
 Children Social Care will take a lead in the investigation and management of child protection cases.
They will know whether or not child and/or family has been previously involved with children's social
care.
 The Police will have knowledge of any previous criminal involvement of child/ parents/carers and
records of call-outs to the family house regarding incidents of domestic abuse. They can share
information relating to potential risks to the child.
 The health staff will be aware of issues relating to health and development of the child/young person
and may be aware of issues affecting other children and/or parents in the family. The midwife may have
information relating to the unborn baby. The GP may well have a knowledge of the whole family, e.g.
parental mental health or substance abuse issues
 Educational staff will have a good knowledge of the child's day to day demeanour and developmental/
academic strengths and weaknesses, and attendance.
 Other agencies may include housing department, mental health team, substance abuse team, etc. may
also provide vital information.

65. 65
Sharing Information
The information you may have about the child in a healthcare setting is only one part of the 'jigsaw'. When it
is shared with other agencies involved in the child's life, all concerned are better able to build up a picture of
what is happening in that child's life.
Remember there is a duty of care to the child, even if an adult is the patient, to share what others need to
know to keep a child safe- necessary and proportionate information.
Most children stay with their parents after a child protection investigation. They are often closely monitored
for a variable period of time to ensure that the support offered to the children and parents/carers is making a
positive difference to the child's life.
For some children they may require care from other carers due to abuse or neglect, these children are
referred to as Looked After Children.
Looked After Children are those looked after by the Local Authority in a variety of circumstances. Children
may be subject to a care order following a legal process and court proceedings.
 93,000 children were in Local Authority care within the UK March 2014
 Parental Responsibility is shared with the Local Authority.
 Whilst looked after children may be placed with a foster carers or in a residential placement, they may
still be vulnerable and at risk of abuse and/or neglect.
 Foster carers do not usually have parental responsibility for the child

66. 66
Sharing Information
Private Fostering
This is different to Looked After Children living in Foster Care which is overseen by the Local Authority. It
 Occurs when a child under the age of 16 (or under 18 if the child has disabilities) is cared for and pro-
vided with accommodation for more than 28 days by someone other than
 A parent
 A person who has parental responsibility for him/her
 A close relative of his/hers i.e. aunt/uncle/step parent/grandparent/sibling (but NOT cousins or a great
aunt/uncle)
Where a private fostering arrangement is identified a referral should be made to Children Social Care to en-
sure the child is not at risk, and to identify if any further support is required.
(For further information see the Looked After Children page on Safeguarding Children website http://stas16/
intranet/services-a-z/safeguarding/safeguarding-children/what-is-a-looked-after-child/ - only viewable within
the trust.)

67. 67
Safeguarding Children Support and Advice
If you have concerns about the safety or well-being of a child you should share concerns with someone who
can protect the child. You may
 Discuss with your line manager or the person responsible for the patients care
 Contact the Safeguarding Children Team for advice and support ext. 55601
 Contact Children Social Care. This would be in the Local Authority that the child lives.
 Contact the Emergency Duty Team if out of hours.
 Contact the police if immediate Safeguarding of the child is required (emergency situations)
All contact numbers, referral forms and links to both Trust and Local Safeguarding Children Board Policies
and Procedures can be found on Safeguarding Children page on the Intranet. http://stas16/intranet/services
-a-z/safeguarding/safeguarding-children/ - only viewable within the trust.

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Session key points
 All children have the right to grow up in a secure and loving environment that caters for all aspects of
their development including physical, intellectual, social, emotional, behavioural and sexual
development
 Child abuse is the maltreatment of a child through action or lack of proper care by parents or adult
carers
 There are four categories of child abuse: physical abuse; emotional abuse; neglect; sexual abuse
 Domestic abuse damages children and may indicate that there are other types of child abuse occurring
 Multiple forms of abuse may be affecting the child
 Any type of abuse can cause long term damage to a child both during childhood and when they have
grown up
 All staff in healthcare settings coming into contact with children need to be aware of their responsibilities
to safeguard children

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Session summary - learning objectives
Having completed this session you will be able to:
 Describe the different forms of child maltreatment (physical, emotional, sexual abuse and neglect)
 Describe how common child maltreatment is and the impact it can have on a child or young person
 Indicate what you should do if you do have concerns about child maltreatment; including local policies
and procedures, who to contact and where to obtain further advice and support
 Identify the importance of sharing information and the consequences of failing to do so
 Identify what to do if you feel that your concerns are not being taken seriously or you experience any
other barriers when referring a child/family
 Describe the risks associated with the internet and online social networking
 Identify what the term 'looked-after child' means
 Recognise possible signs of child maltreatment that you might come across in your work
 Identify how to seek appropriate advice, report concerns and feel confident that you have been listened
to
 Indicate a willingness to listen to children and young people and to act on their issues and concerns
 Show an awareness of the impact of FGM (Female Genital Mutilation), domestic violence and a carer's
mental/physical health on a child
 Show an awareness that vulnerable children and young people may be susceptible to radicalisation
(Prevent programme)

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Safeguarding Children Level 1
This completes your Level 1 Safeguarding Children Training.
Evaluation form
Please click here to complete an evaluation form.
https://www.surveymonkey.co.uk/r/LRISafeguardingChildren
References
 DOH, Working Together to Safeguard Children, 2015 https://www.gov.uk/government/publications/
working-together-to-safeguard-children--2
 Gilbert R, Spatz Widom C, Browne K et al. Burden and consequence of child maltreatment in high-
income countries, The Lancet 2009;373:68-81
 NSPCC: Child abuse and Neglect in the UK today
 NSPCC : Domestic Violence
 Think You Know
 World Health Organisation. Factsheet 241: Female Genital Mutilation
 For more training on FGM visit https://fgmelearning.vctms.co.uk