Safeguarding Children with Disabilities: Practice Guidance

It is a fundamental principle that children with disabilities have the same right as non-disabled children to be protected from harm and abuse. However in order to ensure that the welfare of children with disabilities is safeguarded and promoted, it needs to be recognised that additional action is required. This is because they have additional needs related to physical, sensory, cognitive and/or communication requirements and many of the problems they face are caused by negative attitudes, prejudice and unequal access to things necessary for a good quality of life.

Children with disabilities are likely to have poorer outcomes across a range of indicators including low educational attainment, poorer access to health services, poorer health outcomes and more difficult transitions to adulthood. They are more likely to suffer family break up and are significantly over-represented in the populations of looked after children and young offenders.

Where disabled children are looked after they are more likely to be placed in residential care rather than family settings, which in turn increases their vulnerability to abuse.

Families with children with disabilities are more likely to experience poverty and children with special educational needs are more likely to be excluded from school, (70% of all permanent exclusions are if pupils with SEN).

Research evidence suggests that children with disabilities are at increased risk of abuse and neglect, and that the presence of multiple disabilities appears to increase the risk of both abuse and neglect, yet they are underrepresented in safeguarding systems. Children with disabilities can be abused and neglected in ways that other children cannot and the early indicators suggestive of abuse and neglect can be more complicated than for non-disabled children.

Whilst the practice guidance does not identify specific groups of children, particular reference is made to children with speech, language and communication needs. This includes those who use non-verbal means of communication as well a wider group of children who have difficulties communicating with others.

The guidance emphasises the critical importance of communication with children with disabilities including recognising that all children communicate preferences if asked in the right way by those who understand their needs and have the skills to listen to them.

Various definitions of disability are used across agencies and professionals. Whatever definition of 'disabled' is used, the key issue is not what the definition is but the impact of abuse or neglect on a child's health and development, and consideration of how best to safeguard and promote the child's welfare.

The reasons why children with disabilities are more vulnerable to abuse are summarised below:

• Many children with disabilities are at an increased likelihood of being socially isolated with fewer outside contacts than non-disabled children;
• Their dependency on parents and carers for practical assistance in daily living including intimate personal care increases their risk of exposure to abusive behaviour;
• They have an impaired capacity to resist or avoid abuse;
• They may have speech, language and communication needs which may make it difficult to tell others what is happening;
• They often do not have access to someone they can trust to disclose that they have been abused;
• They are especially vulnerable to bullying and intimidation;
• Looked after children with disabilities are not only vulnerable to the same factors that exist for all children living away from home but are particularly susceptible to possible abuse because of their additional dependency on residential and hospital staff for day to day physical needs.

Where there are safeguarding concerns about a disabled child, there is a need for greater awareness of the possible indicators of abuse and/or neglect as the situation is often more complex. It is crucial that the disability is not allowed to mask or deter the need for an appropriate investigation of child protection concerns.

The following are some indicators of possible abuse or neglect:

• A bruise in a site that might not be of concern on an ambulant child, such as the shin, might be a concern on a non-mobile child;
• Not getting enough help with feeding leading to malnourishment;
• Poor toileting arrangements;
• Lack of stimulation;
• Unjustified and/or excessive use of restraint;
• Rough handling, extreme behaviour modification e.g. deprivation of liquid, medication, food or clothing;
• Unwillingness to try to learn a child's means of communication;
• Ill-fitting equipment e.g. callipers, sleep boards, inappropriate splinting, misappropriation of a child's finances;
• Invasive procedures which are unnecessary or are carried out against the child's will.

If insufficient time is given for a child with restricted arm and hand movement to have an adequate lunch, the child could experience hunger or dehydration. The impact of such an experience is repeated over a number of days could be considerable.

Removing batteries out of an electric wheelchair to restrict liberty solely for the convenience of staff might equate to a non-disabled child being locked in a room or having their legs tied.

Professionals may be reluctant to act on concerns because of a number of factors that include:

• Over identifying with the child's parents/carers and being reluctant to accept that abuse or neglect is taking or has taken place, or seeing it as being attributable to the stress and difficulties of caring for a disabled child;
• A lack of knowledge about the impact of disability on the child;
• A lack of knowledge about the child, e.g. not knowing the child's usual behaviour;
• Not being able to understand the child's method of communication;
• Confusing behaviours that may indicate the child is being abused with those associated with the child's disability;
• Denial of the child's sexuality;
• Behaviour, including sexually harmful behaviour or self-injury, may be indicative of abuse;
• Being aware that certain health/medical complications may influence the way symptoms present or are interpreted. For example some particular conditions cause spontaneous bruising or fragile bones, causing fractures to be more frequent.

Those in Children's Social Care who are likely to receive initial contacts and/or referrals concerning children with disabilities should have received appropriate training to equip them with the knowledge and awareness to assess the risk of harm to the child and know what action to take.

Assessment should be undertaken by professionals who are both experienced and competent in child protection work, with additional input from those professionals who have knowledge and expertise of working with children with disabilities.

A good question when assessing a disabled child is: Would I consider that option if the child were not disabled?

Extra resources may be necessary especially where the child has speech, language and communication needs. For example it may be necessary to obtain an assessment from a teacher and speech and language specialist as to the best way of working with the child.

The child's preferred method of communication must be given the utmost priority.

The following questions should be asked when a referral is received concerning a disabled child:

• What is the disability, special need or impairment that affects the child? Ask for a description of the disability or impairment;
• Make sure that you spell the description of an impairment correctly;
• How does the disability or impairment affect the child on a day-to-day basis?
• How does the child communicate? If someone says the child cannot communicate, simply ask the question: 'How does the child indicate he or she wants something?
• How does the child show s/he is unhappy?
• Has the disability or condition been medically diagnosed?

The number of carers involved with the child should be established as well as where the care is provided and when.

At the Strategy Discussion, consideration should be given to appoint a support worker to consider any complex issues arising from the disability. If a facilitator or interpreter is required, he or she should be involved when planning the investigation.

Where an interview with the disabled child is to take place, consideration should be given to whether any additional equipment or facilities are required and whether someone with specialist skills in the child's preferred method of communication should be involved.

All those involved in an investigation must ensure that they communicate clearly with the disabled child and the family as well as with each other as there are likely to be a greater number of professionals involved.

Practitioners should be advised to refer to the appendices of the government's guidance for a list of helpful resources and more detailed assessments tool and research literature.