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5.11 Disabilities and Learning Difficulties

RELATED NATIONAL GUIDANCE

Chapter 1: Assessing need and providing help, Working Together to Safeguard Children 2015

Safeguarding Disabled Children Practice Guidance published by the Department for Children, Schools and Families, in July 2009

Mental Health and Behaviour in Schools (DfE)

RELATED CHAPTERS

Use of Interpreters, Signers or Others with Communication Skills Procedure

AMENDMENT

This chapter was extensively updated in November 2017 and should be read throughout.


Contents

  Introduction
  Practice Guidance for Professionals


Introduction

  1. It is a fundamental principle that children with disabilities and learning difficulties have the same right as children without disabilities and learning difficulties to be protected from harm and abuse and that standard procedures should be followed for Referrals, Single Assessment and, when appropriate, Strategy Discussions/Meetings (local processes for including disability and learning difficulty specialists in the safeguarding processes will vary). 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 in particular assessing and addressing their equality needs in line with the Equality Act duties. This is because children with disabilities and learning difficulties 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.
  2. Children with disabilities and learning difficulties 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.
  3. Where children with disabilities and learning difficulties 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.
  4. 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 for pupils with SEND).
  5. Research evidence suggests that children with disabilities and learning difficulties are at increased risk of abuse and neglect, and that the presence of multiple disabilities and difficulties appears to increase the risk of both abuse and neglect, yet they are underrepresented in safeguarding systems. Children with disabilities and learning difficulties 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 children with disabilities. Research evidence also indicates that the indicators of abuse and neglect for children with disabilities and learning difficulties can sometimes be confused with their conditions leading to delays in identifying abuse or neglect.
  6. Whilst the practice guidance does not identify specific groups of children with disabilities or learning difficulties, 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.
  7. The guidance emphasises the critical importance of communication with children with disabilities and learning difficulties 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. Research evidence suggests that overreliance on the preferences communicated by parents/carers rather than through communicating with the child or observations can make it more difficult to identify and assess whether a child is suffering from abuse or neglect.
  8. Various definitions of disability and learning are used across agencies and professionals. Agreement between specialists on diagnosing a condition and it’s of level of severity can make it more difficult to understand and provide for the additional needs the child may have. Whatever definition of 'disability' or ‘learning difficulty’ 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 definition of abuse and neglect is universal.


Practice Guidance for Professionals

  1. The reasons why children with disabilities and difficulties are more vulnerable to abuse are summarised below:
    • Many children with disabilities and learning difficulties are at an increased likelihood of being socially isolated with fewer outside contacts than children without disabilities and learning difficulties;
    • Their dependency on parents and carers for practical assistance in daily living including intimate personal care and medical/medicine management increases their risk of exposure to abusive behaviour;
    • They have an impaired capacity to resist or avoid abuse;
    • They may have impairments in their cognitive ability to understand the abuse or neglect;
    • 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 and learning difficulties 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.
  2. Where there are safeguarding concerns about a children with disabilities and learning difficulty, 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 or learning difficulty is not allowed to mask or deter the need for an appropriate investigation of child protection concerns. Best practice recommends that specialists who work with children with disabilities and learning difficulties seek advice from practitioners that regularly assess abuse and neglect; safeguarding specialists and social workers in turn should seek advice from specialists in children’s disabilities and learning difficulties (across the whole range of specialists that would be required to meet the child’s needs) when assessing abuse and neglect.
  3. The following are some indicators of possible abuse or neglect:
    • Bruises, injuries or pressure sores in a site that might not be of concern on an ambulant child, but might be a concern on a non-mobile child or child with restricted ability to move;
    • 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, over feeding/over medication;
    • 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;
    • Patterns of missed appointments with medical and social care specialists (including consistently refusing assistance or parents/carers not being available to professionals) leaving the child with unaddressed needs;
    • Parents showing hostility towards professionals or withdrawing their child from services when challenged with indicators of unmet need.
  4. These indicators are not exhaustive and as each child’s disability and learning difficulty will vary by severity requiring sometimes a whole range of specialists to diagnose and provide advice on management making it difficult to determine levels of unmet need. The definition for abuse or neglect does not vary from child to child and a multitude of persistent unmet needs is likely to indicate a child is suffering or likely to suffer significant harm.
  5. 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 child with disabilities and learning difficulties;
    • A lack of knowledge about the impact of disability and learning difficulties 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.
  6. 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. Children’s Services will have access to specialist teams in social care and education that routinely provide services to children with disabilities and learning difficulties and practitioners screening and assessing referrals should seek their advice in making decisions. Health specialists in the Multi-Agency Safeguarding Hubs(MASH) will have good knowledge and contacts with the range of specialists in community and in hospital settings that can also provide advice on disabilities and learning difficulties to understand the specific needs of a child.
  7. 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 and learning difficulties (education and health). Where assessing a teenage child there may be an additional need to include adult services across health and social care into the assessment, planning and review processes.
  8. A good question when assessing a child with disabilities is: Would I consider that option if the child did not have a disability or learning difficulty?
  9. 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.
  10. The child's preferred method of communication must be given the utmost priority.
  11. The following questions should be asked when a referral is received concerning a child with disabilities:
    • 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?
  12. The number of carers involved with the child should be established as well as where the care is provided and when.
  13. 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. See also Use of Interpreters, Signers or Others with Communication Skills Procedure.
  14. Where an interview with the child with disabilities or learning difficulty is required, 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.
  15. All those involved in an investigation must ensure that they communicate clearly with the child with disabilities and the family as well as with each other as there are likely to a greater number of professionals involved.
  16. Professionals should be advised to refer to the appendices of the government's guidance for a list of helpful resources and more detailed assessment tools and research literature.
  17. In assessing whether a child with disabilities and learning difficulties is being abused or neglected, the Single Assessment must be fully informed by an Equalities Assessment. All public bodies (and services provided through public service commissions) have duties under the Equality Act 2010 and organisations will have appointed an Equalities Lead who can advise on completing equality impact assessments. For some children they may have a number of protected characteristics (see Diversity Procedure) and each must be equally assessed. Working Together guidance is clear that the rights of the child are paramount and so where a parent/carer equally has diversity needs, the child’s rights must take priority to ensure they are safeguarded effectively.
  18. Understanding and responding to abuse and neglect in children with disabilities and learning difficulties can be difficult for the different reasons outlined above. Practitioners should seek regular support and supervision to assist them in their roles, including specialist safeguarding supervision. Addressing the needs of a child with disabilities and learning difficulties is not a single agency response and there must be frequent and purposeful multi-agency working across planning processes like CAF, EHCP, CiN, CP, LAC, Leaving Care etc. Multi-agency working will also involve very different disciplines (in health, social care, education, child or adult services, legal services in different providers, commissioners and providers) that talk different professional languages and supervision and support should also be used across the different disciplines to ensure misunderstandings do not arise and there are no gaps in the child’s unmet needs.

End