Lewisham Safeguarding Children Partnership

Professionals

Welcome to the Professionals pages

safeguarding children

Welcome to the LSCP Professionals pages. Here you will find key information, resources and links to support you in work to safeguard children.

Visit our Training tab to find out about courses and learning events available to you

Visit our resource pages for front line professionals or managers for tools and documents you are likely to need in your work with children and families

Have you seen the latest LSCP Safeguarding Briefing?

LSCP Safeguarding Briefings Library

LSCP 7 Minute Briefing - Child Lilo October 2023

LSCP Safeguarding Briefing - Voice of the Child March 2023

LSCP Safeguarding Briefing - Effective Partnership Working February 2023

LSCP Safeguarding Briefing - Relationship Based Practice January 2023

LSCP 7 Minute Briefing - Child FA 2022

LSCP 7 Minute Briefing - Child EC July 2022

GSCB 7 Minute Briefing - Child DA November 2021

LSCP 7 Minute Briefing - Child DB October 2021

LSCP 7 Minute Briefing - Child DA October 2021

Tri-Borough 7 Minute Briefing - Fabricated & Induced Illness and Perplexing Presentations - August 2022

LSCP 7 Minute Briefing - National Referral Mechanism July 2021

LSCP 7 Minute Briefing - Child AA - January 20221

LSCP Safeguarding Briefing - Placements Available to Children & Young People by the Local Authority - November 2020

LSCP Safeguarding Briefing - Pre-Birth Assessments - October 2020

LSCP 7 Minute Briefing - Child X - September 2020

LSCB Safeguarding Briefing - May 2019 - Practice of Breast Ironing / Flattening

LSCB Safeguarding Briefing - April 2019 - Trauma Informed Approach

LSCB Safeguarding Briefing - March 2019 - Allegations Against Professionals

LSCB Safeguarding Briefing - February 2019 - Emotional Abuse

LSCB Safeguarding Briefing - January 2019 - Prevent Strategy

LSCB Safeguarding Briefing - December 2018 - Physical Abuse

LSCB Safeguarding Briefing - November 2018 - Professional Curiosity / Respectful Uncertainty

LSCB Safeguarding Briefing - October 2018 - Intra-Familial Child Sex Abuse

LSCB Safeguarding Briefing - September 2018 - Self-Harm & Suicide Ideation in Young People

LSSB Safeguarding Briefing - August 2018 - Escalation Policy, Resolving Professional Differences

LSCB Safeguarding Briefing - July 2018 - Allegations Against Professionals

LSCB Safeguarding Briefing - June 2018 - Contextual Safeguarding

LSCB Safeguarding Briefing - May 2018 - Neglect

LSCB Safeguarding Briefing - April 2018 - Domestic Violence & Abuse

LSCB Safeguarding Briefing - March 2018 - Child Sexual Exploitation

LSCB Safeguarding Briefing February 2018 - Female Genital Mutilation

LSCB Safeguarding Briefing February 2017: Harmful Cultural Practices

LSCB Safeguarding Briefing January 2016 - Modern Day Slavery & Child Trafficking

 

Allegations Against Professionals (LADO)

Making a referral to the Local Authority Designated Officer and Possible Outcomes

The LADO (Local Authority Designated Officer) provides advice and guidance to employers and other individuals/organisations who have concerns relating to an adult who works with children and young people (including volunteers, agency staff and foster carers) or who is in a position of authority and having regular contact with children (e.g. religious leaders or school governors).

There may be concerns about workers who have:

  • behaved in a way that has harmed or may have harmed a child
  • possibly committed a criminal offence against or related to a child
  • Behaved towards a child or children in a way that indicates they may pose a risk of harm to children;
  • behaved towards a child, or behaved in other ways that suggests they may be unsuitable to work with children

What should be referred to the LADO?

Any concern that meets the criteria above should be referred. Initially it may be unclear how serious the allegation is. If there's any doubt, the LADO or the designated safeguarding lead person in your agency should be contacted for advice.

What the LADO does:

The first step will be to offer an initial consultation about the concern. This may consist of advice and guidance regarding the most appropriate way of managing the allegation. The LADO will: 

  • help establish what the 'next steps' should be in terms of investigating the matter further
  • liaise with the police and other agencies, and arrange for an allegations meeting to be held if required; if the case is complex there may be a series of meetings
  • monitor and maintain an overview of cases which meet threshold to ensure they're dealt with as quickly as possible, consistent with a thorough and fair process
  • ensure child protection procedures are initiated where the child is considered to be at risk of significant harm
  • ensure the appropriate agencies are involved in the investigation
  • ensure advice is provided in relation to the adults remaining in post over the course of the investigation
  • ensure issues of sharing information with parents and other relevant individuals are considered
  • assist an employer in decisions about a person's suitability to remain in the children's workforce, and whether a referral should be made to the Disclosure and Barring Service (DBS) or the appropriate regulatory or professional body
  • In cases where the adult is unaware of the concern or allegation, it may not be appropriate to tell them immediately and may prejudice a potential police investigation. The LADO will provide advice.

Outcomes

 The outcomes from a LADO referral may include:

  • finding that the allegation is malicious
  • finding that the allegation is unsubstantiated
  • finding that the allegation is substantiated
  • finding that the allegation is false
  • finding that the allegation is unfounded
  • internal investigation by the employer including consideration of  disciplinary procedures
  • a police investigation
  • police prosecution
  • Where the adult is reinstated there may be recommendations in relation to additional support, monitoring or training.
  • Where an individual is dismissed from their post, a referral must be made to the DBS which makes decisions on whether individuals should be barred from working with children.
  • Compromise agreements are not an acceptable resolution to a concern, and even if someone resigns it should not prevent a full and thorough investigation into the matter.

LADO Procedure & Protocol - 2023

To make a referral to the Local Authority Designated Officer (LADO), please email a LADO Contact & Referral Form to LewishamLADO@Lewisham.gov.uk

Named Lewisham LADO: 

Eleanor Hargadon-Lowe, London Borough of Lewisham, 1st Floor Laurence House, 1 Catford Road, SE6 4RU

There is also a Deputy LADO system, as such you may speak with and be supported by a member of the team.

LADO Voicemail service:   020 8314 7280. Please note this is a manned voicemail, so please leave a clear message and the LADO or Deputy LADO will respond to you as soon as possible within 24 hours.  

LADO Annual Reports

LADO Annual Report 2022-2023

Useful Links

London Safeguarding Children Procedures

London Safeguarding Children's Partnership

Working Together to Safeguard Children 2023

Keeping Children Safe in Education 2023

Child Not Brought to Appointments

The following animation is aimed at raising awareness about the consequences of missing appointments and to ensure that children and adults get the medical care that they need.  This is a powerful reminder that children do not take themselves to appointments, and for practitioners to reflect on the impact of missed appointments on a child's wellbeing.  With thanks to Nottingham City CCG & Safeguarding Children Partnership.

Definitions:

Child Not Brought (CNB): Child was not brought to the appointment without cancellation.

Did Not Attend (DNA): Did not attend appointment without cancellation

No Access Visit (NAV): Not available at home to be seen for appointment.

Background

It is recognised that many children miss appointments in hospital and community settings, and are not available at home to be seen by staff working in different agencies.

Many Serious Child Safeguarding Practice Reviews (Serious Case Reviews) / Homicide Reviews both nationally and regionally have featured CNB, DNA and NAV as a precursor to serious child abuse and child death.

Key principles for Practice

Organisations

  • All agencies should have a policy and local guidance for managing CNB, DNA and NAVs which underpins both process and practice and reflects the differing needs of children and their families.
  • Services provided should be child and young person friendly and work in partnership with parents and other practitioners.

Practitioners

  • Practitioners should be child focussed and consider children and young people even when the CNB / DNA / NAV relates to the parent/carer, particularly when mental health or problematic substance misuse is featured.
  • Practitioners should ensure they are appropriately trained in the identification of child maltreatment to ensure effective judgements are made as to whether the child or young person’s health and development are subject to impairment.
  • Develop robust communication links with parents and other professionals or agencies working with the child and ensure that any outcome or consequence for the child or young person is explained.
  • Know when and with whom to share information when there are concerns about a child or young person’s welfare and where to get advice.
  • Document assessments, analysis, communications and actions taken in the child / young person or parent / carer record as relevant.
  • Parents / Carers may disengage with any agencies caring for themselves or their children.
  • Remember disengagement is a key risk factor for children and families and may be a precursor to something more serious happening.

Managing CNB/DNA/NAV

Assessment

  • Following CNB / DNA / NAV the responsibility for any assessment of the situation rests with the practitioner to whom the child has been referred in conjunction with the referrer (Laming 2003).
  • Consider the needs of the child and the parents / carers capacity to meet those needs.
  • Consider environmental context of the child’s situation.
  • Identify whether intervention is required to secure a child’s welfare.

 Communication

  • Verbal / written communication with the parents / referrer needs to outline consequence of CNB / DNA / NAV on the child.
  • Where there are clear child protection concerns, discuss these with your line manager and make a referral to the Multi-Agency Safeguarding Hub (MASH) mashagency@lewisham.gov.uk in accordance with Lewisham’s procedures.
  • Where there are concerns relating to children, information should be shared with the Line Manager, Named or Designated Safeguarding Lead / Lead Professional or other agency working with the family who can add to the information sharing process.

Record Keeping

  • The content of discussions should be clearly documented along with any actions and outcomes in the child or parent / carer record.
  • Analysis and conclusion should also be documented ensuring that any referral letters and context of previous records have been considered.

Action

  • Consider arranging another appointment, check addresses and other details for accuracy.
  • Ensure parents / carers are informed about the consequence(s) of further non-attendance for the child / young person and with whom information will be shared with should there be further CNB / DNA / NAV.
  • Repeated CNB / DNA / NAV should result in a Team Around the Family (TAF) meeting to agree the best course of action.
  • Unless there is a concern that a child / young person is likely to suffer significant harm then a referral should not be made to MASH until it is established the TAF has not worked. The referral will need to show what work has been attempted, by whom, and what is expected a referral to MASH will achieve.
  • An immediate referral to MASH should be made if it is established urgent medical attention has not been sought or delayed for a child or young person by a parent / carer.

Audit

  • Agencies should find ways to collect information in respect of CNB / DNA / NAV to increase the uptake of services in order to safeguard children and young people and improve their outcomes.

Audit Suggestions

  • Number of services CNB / DNA / NAVs under the age of 18 and include the outcome.
  • Number of service CNB / DNA for mental health, drug and alcohol services including outcomes of the CNB / DNA.
  • Number of NAVs including outcome of no access (all services).
  • GP’s should audit outcomes of CNB / DNA / NAV and consider the consequence of non-engagement in order to work with families to improve engagement.

Additional Policies

L&G NHS Trust – Child Was Not Brought / No Access Visit Policy December 2019

Useful Websites

www.londonscb.gov.uk

www.everychildmatters.gov.uk

 

 

 

Child Protection Conferences

Reports

The London Borough of Lewisham Multi-Agency Child Protection Conference Report Template was introduced in February 2022.  

ALL professional agencies must complete this report, even if they are unable to attend but are invited. This must be sent to the Quality Improvement Business Support Team (QISBusinessSupport@lewisham.gov.uk) within the following timescales:

  • Initial Child Protection Conference – 2 working days before
  • Review Child Protection Conference - 5 working days before

These reports must be shared with the families before the meeting – there should not be any information that the family do not know that will be shared in the meeting. If there is confidential information that cannot be shared with the family in the conference due to concerns that this will increase risk to children, then please alert the Chair to this before the meeting.

Structure of the Conference

The Conference is chaired by a Child Protection Chairperson, who is a qualified and experienced social work professional. Their responsibility in the meeting is to make decisions in respect of the level of risk faced by a child, and create a multi-agency plan that aims to keep the child safe.

The chair will endeavour to gather information (not already provided in the reports) and seek to focus on the key areas of risk/ harm to the child, and any examples or times where the risk has been managed and the child kept safe (this is called existing safety).

The Chair will speak with everyone in the conference to gather their views and analysis, as well as recommendation (see below).

Participation in the Conference

All relevant professionals who are involved with a child or their family are requested to attend a Child Protection Conference. The focus in the meeting will be around analysis of the harm and safety and what plan needs to be in place to address the key areas of danger and risk.

It is really important for professionals to keep their summaries brief in conference. If they have completed and shared their reports in advance of the conference meeting then this should mean they do not need to repeat the information in their report (the ‘detail’). The Conferences need to be a balance of pulling out the pertinent details about risk and existing examples of safety, and creating a multi-agency plan that is likely to keep the child safe. It is not meant to be an opportunity to share an exhaustive bullet point list of what is working well, and what is not.

Scaling, Recommendations and Categories

We use the Signs of Safety model in our conferences. One of the tools within this model is the scaling. We use a ‘Safety scale’ which means when scoring, we are considering how ‘safe’ the child is on a scale of 0-10. 10 is that the child is safe, 0 is that they are not (in very basic terms). The Chair should set the parameters of what 0 means and what 10 means to allow scoring to reflect the needs of the family. Professionals who haven’t yet been to a conference, or other social care meeting, can ask for some guidance around scoring, but there is no prescriptive way of doing this. It is for each professional to weight where they consider the child and situation is.

All professionals attending a conference are expected to scale and to make a recommendation in conference about whether a plan is required, and if a Child Protection Plan is recommended, what category that be under.

Categories can cause some anxiety for families and professionals alike. The four categories are Emotional Abuse, Physical Abuse, Sexual Abuse and Neglect. It’s important that the professionals are honest with their recommendation – if the parent has neglected their child’s needs even if unintentionally or due to their own issues, it is still neglect.

Attendance at Core Group Meetings

If a professional is identified as part of the Core Group of professionals around a child, then they are requested (and expected) to attend regular core group meetings every 6 weeks. Again, the focus of these meetings is ideally to share updates and review the efficacy of the plan, focus on the risk and safety for the children in question. Scaling is expected at the end of CGMs but no recommendation is considered necessary.

Further Reading

London Child Protection Procedures, Core Procedures, CP4

Working Together 2018 

Child Sexual Abuse (CSA) Pathway

CSA Pathway- v4 April 2024 final - page-1

CSA Pathway- v4 April 2024 final - page-2

CSA Pathway- v4 April 2024 final - page-3

Download the CSA Pathway v4 April 2024 pdf

Download the Barnardo's TIGER Poster for Professionals pdf

Children & Adolescent Mental Health Services (CAMHS)

Lewisham CAMHS Introduction Video : CAMHS Offer Available to Lewisham Children and Young People

CAMHS Infrastructure

Lewisham Child and Adolescent Mental Health Services (CAMHS) offers therapeutic interventions to children and young people up to the age of 18 who experience mild to serious/complex mental health concerns that impact on daily living.

The service is made up of professionals from different backgrounds working together to provide multi-disciplinary care. This may include:

  • Child and Adolescent Psychiatrists
  • Clinical Psychologists
  • Family Therapists
  • Cognitive Behaviour Therapists
  • Mental Health Nurses
  • Occupational Therapists
  • Psychotherapists
  • Therapeutic Social Workers
  • Child Wellbeing Practitioners
  • Educational Well Being Practitioners

Lewisham CAMHS Services Summary and Contact Information

Services are provided at three key community sites within Lewisham Borough:

Kaleidoscope

32 Rushey Green, London, SE6 4JF

Tel: 020 3228 1000 or 020 3228 1001

Lewisham Park 

78 Lewisham Park, London, SE13 6QJ

Tel: 020 3228 1001

Holbeach

9 Holbeach, London, SE6 4TW

Tel: 020 8314 9742

If you have any urgent concerns about a child or young person’s mental health or a referral query please contact the team at Kaleidoscope and ask to speak to a staff member on duty.

Tel: 020 3228 1000

Operating hours: Monday to Friday, 9am to 5pm (excluding bank holidays)

Emergencies out of hours: Please advise the parent, or carer to contact the child, or young person’s GP. In an emergency, if it is felt that the child or young person is not able to be kept safe, send them to their local A&E.

Crisis Support Line: South London and Maudsley NHS Foundation Trust operate a telephone support line that is available 24 hours a day if urgent help or advice is needed.

Tel: 0800 731 2864

Services at Kaleidoscope

Lewisham Generic Team (Horizon)

The Kaleidoscope Generic Team (Horizon) offers assessment, treatment and care for children and young people, up to the age of 18, who have significant emotional or mental health difficulties.

Crisis Service

The Child and Adolescent Crisis Service works with children and young people, up to the age of 18, who present at Lewisham University Hospital in crisis. The service also offers follow-up appointments in the community after discharge from hospital.

The Crisis Service also manages duty calls for urgent referrals, and in some cases can offer an appointment on the same day so that the child or young person does not need to attend A&E.

Child and Adolescent ADHD Team (Lewisham)

The Child and Adolescent ADHD Team provides treatment and care for children and young people with Attention Deficit/Hyperactivity Disorder (ADHD), up to the age of 18.

The team also provide guidance and consultation to professionals to discuss potential referrals and consultation to professionals who work with the young people in other settings such as schools.

Neuro-Developmental Team (NDT)

The Neuro-Developmental Team (NDT) offers assessment, treatment and care co-ordination for children and young people, up to the age of 18, with a significant learning disability and/or complex neurodevelopmental disorders.

The Lewisham CAMHS NDT supports children, young people, and their families, who may be experiencing anxieties around their health. The service is for children and young people who have had severe and complex problems for some time.

Child and Adolescent Paediatric Liaison Service

The Paediatric Hospital Liaison Service provides mental health input for children and young people children with acute illnesses, and those with chronic and life-limiting conditions.

The service co-ordinates psychological assessments for children and young people being cared for at University Hospital Lewisham. They can help manage the emotional impact of physical illness on children, young people and families, and improve their ability to manage the illness and its effects.

Child and Adolescent Schools Service (Lewisham)

The Child and Adolescent Schools Service (Lewisham) provides low-intensity, tier 2 assessment, treatment and care for children and young people, from 5 to 18 years old, who have mental health problems.

The service works mainly in Lewisham schools alongside education professionals; however, if necessary, they can offer home visits. Referrals are accepted from the Special Educational Needs and Disability (SEND) panel, New Woodlands School, the Outreach and Inclusion Service, and a small number of targeted schools.

Services at Lewisham Park

SYMBOL Team (Looked After Children)

The Symbol Therapy Team helps young people in local authority care in Lewisham who are struggling with mental health difficulties. The team also provide care for adopted young people living in Lewisham.

Symbol offer assessment, therapeutic intervention and care for young people, up to the age of 18, with moderate to severe emotional, behavioural and mental health problems. The team also offer a low-intensity service for young people leaving the care system, who are moving into adulthood.

The Lewisham Young People’s Service (LYPS)

The Lewisham Young People’s Service (LYPS) provide assessment and treatment for children and young people, up to the age of 18, who have ongoing severe and complex problems for some time that significantly affect their daily life.

LYPS also offers an early intervention service to young people who are experiencing psychosis.

Child and Adolescent Wellbeing Programme (Lewisham)

The Lewisham Children and Young People Wellbeing Practitioners (CWP) Team is a low-intensity, tier 2 service for children and young people who may not meet the threshold for mainstream CAMHS teams.

The CWP team provide short-term, low intensity, evidence-based, guided self-help interventions for children, young people and their parents. Treatment is available for mild to moderate anxiety, low mood, or mild behavioural difficulties.

 Services at Holbeach

 Adolescent Resource and Therapy Service (ARTS)

The Adolescent Resources and Therapy Service (ARTS) provide assessment, treatment and care for young people, up to the age of 18, who are known to a Youth Offending Service (YOS).

The ARTS team provide one to one and group treatment and care, and work with the police, the public protection unit, social services and our local Multi-Agency Public Protection Arrangement (MAPPA) team to support people in the community. The team also work with children and young people who exhibit sexually inappropriate behaviour.

Referrals

Please consult the CAMHS Referral Criteria for full information on services and referrals.

When making a referral to Lewisham CAMHS please use our CAMHS Referral Form.

Non urgent referrals for CAMHS teams based at Kaleidoscope can be emailed to: LewishamCAMHSAdmin@slam.nhs.uk

Lewisham CAMHS Safeguarding Children Infrastructure and Contact Information:

Safeguarding Lead

Rita Jacobs (rita.jacobs@slam.nhs.uk

Telephone: 020 3228 1000

Lead Safeguarding Doctor

Mosunmola Dorgu -  Mosunmola.Dorgu@slam.nhs.uk

Telephone: 020 3228 1000

Lewisham CAMHS Service Manager

Maryland Ocansey - Maryland.Ocansey@slam.nhs.uk

Telephone: 020 3228 1000

Useful links

Young Minds - children’s mental health charity, which offers a host of advice and resources

Kooth - free online service that offers emotional and mental health support for children and young people

Samaritans - Charity aimed at providing emotional support to anyone in emotional distress

MindEd - free educational resource on children and young people’s mental health for adults

Royal College of Psychiatrists - Professional medical body responsible for supporting psychiatrists

 

 

Difficult conversations with parents / carers

A guide for practitioners who work with children and their families.

The information in this guide is not exhaustive and it should be used as a reference alongside practitioners own safeguarding practices and in conjunction with appropriate supervision. 

Four factors to consider when preparing for a difficult conversation with a parent or carer:

  1. Principles – that underpin safeguarding children.
  2. Planning – how to plan or be prepared
  3. The Conversation – things to consider when having a conversation
  4. Examples – open questions and suggestions

1. Principles – to support safeguarding discussions with parents / carers

  • Always take time to plan the conversation before you speak to parents.
  • Be open and honest, use basic language, avoid jargon.
  • Ensure child protection policies are clear.
  • Include child protection issues in information you give out to parents you are working with.
  • Explain your statutory duty to safeguard children’s welfare, “duty of care” and requirement to report your concerns.
  • Ensure parents / carers sign to acknowledge they have read and understood your safeguarding policy and offer them a copy.
  • Use Early Help, refer to a children’s centre, or signpost to other support agencies, i.e. health visitor, parenting courses etc.

2. Planning

If you feel it’s too risky to talk to parents before speaking to Children’s Social Care, then don’t. Do not put yourself or a child at risk, e.g. if:-

  • There is suspected sexual abuse.
  • Parents could destroy evidence or hinder a police investigation.
  • It is possible the child could be silenced.

Otherwise it’s good practice to discuss concerns with parents/carers and tell them you are going to make a referral. Before your conversation:-

  • Plan how you are going to broach your concern and how to respond to different responses, e.g. anger, denial, emotional breakdown etc.
  • Choose a time and place to give full privacy.
  • Consider the timing of the meeting (e.g. a tired, crying baby, or collecting other children from school etc.) depending on the urgency of the concern.
  • Adapt your style to the parent, consider language barriers or learning difficulties.
  • Acknowledge your own anxiety about dealing with a difficult situation as it may affect your communication style.
  • Have the child’s key worker with you or nearby for support and as a witness (and vice versa) or get support from Children’s Social Care.
  • If previous experience of the parent/carer suggests they may pose a risk, make a full risk assessment and do not meet alone.

 3. The Conversation

Make sure members of staff know where you are and what you are doing before a meeting. Tips and ideas for having a difficult conversation:-

  • Consider your position in the room so nobody feels trapped.
  • Ensure children cannot overhear you and are occupied (provide toys etc.)
  • Frame the concern in a model of help and support.
  • Be straight forward – Tell the parent/carer a referral to the Multi-Agency Safeguarding Hub is going to be or has been made.
  • Tell them that “as a parent/carer they will want to get to the bottom of the matter”.
  • Give clear explanations.
  • Always remain confidential and professional.
  • Words are sometimes really hard to find when approaching a parent – use ‘active listening’.
  • Do not argue, interrupt, give advice, pass judgement, jump to conclusions or let the parent’s sentiment affect you.
  • Avoid excessive reassurance, it may not be all right.
  • Do encourage the parent to talk.
  • Clarify what the parent means.
  • Summarise what the parent has said.
  • Consider your communication style: tone, pitch, speed of voice, body language (body slightly to the side, with an open stance or sit) be clam, make eye contact and appreciate they may need to talk.
  • Consider the parents point of view which may be influenced by; bad experience of services, lack of trust, limited or distorted understanding of what is appropriate for children, learning difficulties, cultural and language barriers.
  • Explain the nature of your concern using tact and diplomacy, but be direct and use factual information “Jodie was not brought to the last 2 appointments, what is the reason for this?”
  • Do not use words such as child protection or child abuse, try words such as concerns, welfare, and duty of care.

Use your eyes and ears more than your mouth.

4. Examples

This is not an exhaustive list and you may want to use a technique of your own, following the general principle of open and probing questions:

  • Avoid using “I think” which indicates it could be your own opinion.
  • Avoid using jargon, try:-
    • “I need to talk to you about the injury to XY’s face, can you tell me what happened?”
    • “XY has been very lethargic today and says he has not slept, is there anything going on that might be troubling him?”
    • “XY’s behaviour has changed dramatically over the last few weeks, (s)he has gone from being a happy, outgoing child to a very quiet, withdrawn child. Have you any idea what could have caused this?”
    • “Whenever there is a worry about any child, or they something about being hurt we legally have to pass on that information to children’s services – you may have read this in the parent’s information/handbook when XY started?”
    • “XY told a member of staff he is slapped every night, and, because of what he has said I have informed Children’s Social Care. All settings are expected to talk to Children’s Social Care when children say things like this, and Children’s Social Care have asked me to talk to you about this. Can you tell me what happened?”

 Questions can start with the following:-

  • “is there any reason why……….”
  • “we need to have a chat………..”
  • “XY has said……………………..”
  • “I have noticed XY has seemed hungry in the mornings, is (s)he managing to have breakfast before he comes to school?”
  • XY has a bruise on his face but he can’t remember how it happened, do you know how he did it?”

Next steps?

Once you have had a conversation or a series of discussions with the parent or carer, you may need to consider what actions, if any, you need to take. Consider the following:-

  • Professional curiosity – have you confirmed the response you have received from other agencies? Do you need to make further enquiries?
  • Trust your instincts – You have spoken to the parent/carer and you know the child – trust your instincts if you still have concerns.
  • Follow safeguarding procedures – ensure you check your agency safeguarding procedures and seek guidance from an appropriate person.
  • Pre and Post Supervision – agencies have varying supervision procedures; be sure to raise your concerns and get guidance and support before and after you have had a conversation with a parent/carer as this will give you a chance to reflect on what happened and discuss what needs to happen next (reflective practice).
  • Escalation – If you are still concerned about a decision or practice you can escalate your concerns; the LSCB recommend you follow our Resolving Professional Differences / Escalation Policy.
  • Referral – Following any discussion, if you are concerned about the safety of a child or you believe they are at risk of immediate danger – contact the police. If you believe the child is at risk of significant harm – seek guidance from the MASH team.
  • Early Help – You may want to contact Early Help or create a Team Around the Family.

What are we worried about? What’s working well? What needs to happen?

What words would you use to talk about this problem so that parents/carers understand?

Use plain language and avoid jargon.

Consider any problems the family might be having which are making this problem harder to deal with e.g. housing, finances, isolation, or family breakdown.

Example questions:-

  • I need to talk to you about the mark XY’s face, (s)he can’t remember how it happened, and do you know how (s)he did this?
  • XY’s behaviour has changed a lot in the last few weeks.   (S)he has gone from being happy and outgoing to quiet and withdrawn – have you any idea what might have caused this this?
  • We are having a lot of problems with XY, (s)he seems angry.   Is there anything happening at home which would help us to understand this?
  • I know we have talked about this before but I am still worried because XY is still quite dirty when she comes to school and other children have commented that (s)he smells. Do you have everything you need at home to wash clothes and to have a bath regularly?

Who are the people who care for the child? And what are the best things about how they care for them?

Who would the child say are the most important people in their lives? And how do they help them grow up well?

Example questions:-

  • It sounds like things are a bit difficult at the moment, is anyone supporting you?
  • What would XY say are the best things about his life?
  • You have been doing well to get XY to school with all that is happening, is there anything we can do to support you further?
  • Have you noticed this problem before? How was it sorted out in the past?

Now you have explored this more, how worried are you about this child? 10 is not worried; 0 is so worried you need to make a referral for support or safeguarding.

  • What would you need to see for it to be 10?
  • What do you think is the next step to getting this worry sorted out?
  • Have you done any direct work with the child?

Next steps:

  • Curiosity – verify any information with professionals or other family members.
  • Supervision – seek guidance before and after interaction with parents/carers to reflect on the information gathered.
  • Procedures – follow your agency safeguarding procedures.
  • Referral – If you are concerned about the safety of the child or young person.
  • Escalation – If you are not satisfied with the outcome of the referral and still have concerns.

Discharge & Safety Planning Protocol for Lewisham Children & Young People

For Children and Young People who present and require a multi-agency response to address

their safeguarding and mental health needs)

July 2022

Partners to the Protocol

  • Lewisham and Greenwich NHS Trust
  • London Borough Lewisham, Lewisham Children’s Social Care
  • South London and Maudsley NHS Foundation Trus

Purpose and Scope

The purpose of this protocol is to support multi-agency practitioners to make appropriate arrangements which support the safe and timely discharge of children and young people under 18 years of age.

The protocol is intended to ensure that all practitioners are clear about the steps to take to ensure that no child is discharged from hospital into an unsafe environment, where their health or well-being may be compromised or where further significant harm could occur.

The protocol applies to children and young people who require a multi-agency response to address their needs. A multi-agency response may be required due to:

  • Serious or complex mental health needs requiring hospital admission;
  • Self-harm or attempted suicide; or have expressed an intention to do either;
  • Safeguarding and other welfare concerns cover situations where there is known or suspected neglect or abuse;
  • Exploitation or neglect is known prior to admission, and this is recent or current, it would be expected that these children have an allocated social worker);
  • The child/young person is looked after;
  • Abuse, exploitation or neglect comes to light or is suspected during the hospital admission, Children subjected to Trafficking/FGM/ Modern Slavery;
  • Ward Staff raise concerns about the parent/child interaction, Parent/Carer whose understanding or concern for their child is lacking. Children or young people in Police custody or due to be arrested upon discharge.
  • Children or young people who have been the victim of physical or sexual assault;
  • The Child/Young Person says they do not want to return home;
  • This is not an exhaustive list and professionals should apply their professional judgement and consult with their named safeguarding leads if they have any concerns at all about a child/young person.

Principles

Any child or young person, who self-harms or expresses thoughts of self-harm or suicide, must be taken seriously and appropriate help and intervention, should be offered at the earliest point. Any practitioner, who is made aware that a child or young person has self-harmed, or is contemplating this or suicide, should talk with the child or young person without delay.

Most children who have been admitted with mental health needs will need on-going community care for a period of time after discharge. Follow up services for the young person’s mental health services could include, outreach sessions, liaison with local services, and outpatient therapy sessions and will be determined by the local CAMHS service following assessment.

Discharge planning is an essential part of care management in any hospital setting. It ensures that health and social care systems are proactive in supporting individuals and their families in the community. It needs to start early to anticipate problems, put appropriate support in place and agree service provision. Consideration should be given to the wider environment the child will be returning to, including siblings and other members of the household.

Children should not remain in hospital once they are well enough to leave. However, it is essential that when a child is in hospital and there are safeguarding concerns about the child, effective multi-agency planning between key professionals working with the child is undertaken before the child is discharged from hospital. Where there are safeguarding concerns, a referral must be made to Lewisham Children’s Social Care.

All agencies have a duty to share information and a joint responsibility to work together to protect children and promote their wellbeing and safety. Referrals to Lewisham Children’s Social Care must be made to MASH service who will determine the level of response by processing information through the multi-agency safeguarding hub.


Linked Policies and Procedures
The protocol should be read in conjunction with:

  • The London Child Protection Procedures
  • LGT Safeguarding Guideline for Paediatricians Algorithm for Safeguarding
  • LGT Safeguarding Children & Young People Policy

The Full Protocol Content

Lewisham Discharge Protocol for Children and Young People - July 2022

Domestic Abuse & MARAC

Domestic abuse is defined as “any incident or pattern of incidents of controlling, coercive, threatening behaviour, violence or abuse between those aged 16 or over who are, or have been, intimate partners or family members regardless of gender or sexuality”. The abuse can encompass, but is not limited to:

  • psychological
  • physical
  • sexual
  • financial
  • emotional

Domestic abuse can also include forced marriage and so-called “honour crimes”.

Controlling and coercive behaviour

Domestic abuse is often thought of as physical, such as hitting, slapping or beating, but it can also be controlling or coercive behaviour. This is important as what might look like an isolated incident of violent abuse could be taking place in a context of controlling or coercive behaviour.

Controlling behaviour is a range of acts designed to make a person subordinate and/or independent by isolating them from sources of support, exploiting their resources and capacities for personal gain, depriving them of the means needed for independence, resistance and escape and regulating their everyday behaviour.

Coercive behaviour is an act or a pattern of acts of assault, threats, humiliation and intimidation or other abuse that is used to harm, punish, or frighten their victim.

We know that the first incident reported to the police or other agencies is rarely the first incident to occur; often people have been subject to violence and abuse on multiple occasions before they seek help.

Learning resources to support health and social work in situations of coercive control 

A set of learning resources for social workers, safeguarding leads, and health and social care practitioners, provides information and guidance on how to recognise and respond to coercive and controlling behaviour in intimate or family relationships.

Supporting the non-abusing parent in a holistic way that acknowledges the impacts of coercive control is important in achieving good outcomes for children. Research showed that children also experience the impacts of coercive control of a parent; for example, becoming isolated from family and friends, finding it difficult to gain independence, and feeling disempowered. The resources, which include five detailed case studies, will support practitioners to improve their understanding of the dynamics of power and control that underpin domestic abuse, enabling them to build trusting relationships with children and survivors.

The examples, tools and videos bring together evidence from research, practitioner experience, and the voice of people using services, to enable professionals to put the law into practice and improve support for people who are experiencing coercive control.  

The Chief Social Worker’s Office at the Department of Health commissioned the materials, which were developed by Research in Practice for Adults and Women’s Aid.  http://coercivecontrol.ripfa.org.uk/

Safeguarding children exposed to domestic abuse

Children who live in families where there is domestic abuse can suffer serious long-term emotional and psychological effects. Even if they are not physically harmed or do not witness acts of violence, they can pick up on the tensions and harmful interactions between adults. Children of any age are affected by domestic violence and abuse. At no age will they be unaffected by what is happening, even when they are in the womb.

The physical, psychological and emotional effects of domestic violence on children can be severe and long-lasting. Some children may become withdrawn and find it difficult to communicate. Others may act out the aggression they have witnessed, or blame themselves for the abuse. All children living with abuse are under stress.

Professionals should:

  • Consider the presence of domestic abuse as an indicator of the need to assess a child’s need for support and protection
  • Make sure the child’s experiences and views are captured and included. In contexts where the safety of the adult victim is seen as the main priority this can dominate people’s immediate thinking and action, and children’s voices can be lost.

  • Use the Safe Lives Risk Checklist for the identification of high risk cases of domestic abuse, stalking and ‘honour’-based violence. 

Safe Lives, a national domestic abuse charity, has created a toolkit practitioners and front-line workers can use to identify high risk cases of domestic abuse, stalking and ‘honour’-based violence. The purpose of the checklist is to give a consistent and simple-to-use tool to practitioners who work with victims of domestic abuse in order to help them identify those who are at high risk of harm and whose cases should be referred to a MARAC meeting in order to manage the risk.

The toolkit has been endorsed by agencies such as the police (Association of Chief Police Officers), National Centre for Domestic Violence, and CAFCASS, who believe that the primary audience should be front line practitioners working with victims of domestic abuse who are represented at MARAC. This will include both domestic abuse specialists such as IDVAs and generic practitioners such as those working in a primary care health service or housing.

Locally, both the Adult’s Safeguarding Board and Children’s Safeguarding Partnership (LSAB / LSCP), as well as the Safer Lewisham Partnership (SLP) have agreed that all agencies in Lewisham working with, or supporting families at risk of domestic violence are expected to use the risk checklist. This is vitally important because using an evidence based risk identification tool increases the likelihood of the victim being responded to appropriately and therefore, of addressing the risks they face. The risk checklist gives practitioners common criteria and a common language of risk.

Safe Lives have produced an updated version of the RIC, which now includes comprehensive guidance explaining each risk question, how they can be asked, as well as practice points. There is also a frequently asked questions page with some useful tips on the checklist. The Safe Lives website has helpful resources about other ways your agency may access support, training or download the checklist in other languages. The Lewisham Safeguarding Children’s Partnership also offers training on the use of the checklist which is free for all professionals in the borough to attend, however, for more questions about the use of the RIC, access to training, and questions about domestic violence MARAC process, please visit www.lewisham.gov.uk/vawg or contact the Violence Against Women & Girls (VAWG) Programme Manager on vawg@lewisham.gov.uk

Safeguarding high-risk victims of domestic violence and abuse – referring to the MARAC

The Lewisham Domestic Violence Multi-Agency Risk Assessment Conference (MARAC) is a risk management meeting where professionals share information on high and very high risk cases of domestic violence or abuse and put in place a risk management plan. The aim of the meeting is to address the safety of the victim, children and agency staff and to review and co-ordinate service provision in high risk domestic violence cases. 

To be referred to the MARAC the individual must reside in the London Borough of Lewisham, be over the age of 16, be currently experiencing domestic violence or abuse (according to the cross Government definition of domestic violence)[1] and be assessed as being at high or very high risk of harm of domestic violence or abuse in accordance with the Lewisham MARAC referral risk criteria. In order to assess whether a case meets the risk threshold, the Safe Lives DASH MARAC risk indicator checklist should be completed by the referring agency.

A tailored action plan will be developed at the MARAC to reduce the risk to the victim, children, other vulnerable parties and any staff and to ensure that the risk the perpetrator presents is managed appropriately. Examples of actions that will be agreed include flagging and tagging of files, referral to other appropriate multi-agency meetings, prioritising of agencies’ resources to MARAC cases. 

Any service agency signed up to the MARAC Information Sharing Protocol may refer a case to the MARAC using the Lewisham MARAC Referral Form, and all agencies should be actively screening for domestic violence or abuse. Referrals should be submitted to each agency’s MARAC representative. Please contact your line manager to find out who your agency’s MARAC representative is. 

For more questions about the use of the MARAC, access to training, and questions about the process, please visit www.lewisham.gov.uk/vawg or contact the Violence Against Women & Girls (VAWG) Programme Manager on vawg@lewisham.gov.uk , or the MARAC Coordinator on dvmarac@lewisham.gov.uk

[1] https://www.gov.uk/guidance/domestic-violence-and-abuse

For further information

Letter to partners on the use of the DV risk assessment

visit www.saferlondon.co.uk/safer-lewisham

See the Domestic Violence information in our practice procedures

Useful Links:

Resources: http://imkaan.org.uk/resources

MOPAC VAWG Strategy 2018-2021

MOPAC Domestic and Sexual Violence Dashboard

Home Office Resources for Violence Against Women & Girls (VAWG)

Galop - The LGBT Anti-Violence Charity

Services Available to Lewisham Residents

Refuge, The Athena Service

The Athena service, run by Refuge provides confidential, non-judgmental support to those living in the London Borough of Lewisham who are experiencing gender-based violence. It opened its doors in April 2015 and provides outreach programmes, independent advocacy, group support, refuge accommodation and a specialist service for young women.

It provides the following services, all under one roof:

  • One-to-one confidential, non-judgmental, independent support
  • A specialist independent gender-based violence advocacy (IGVA) team to support clients at risk of serious harm
  • A specialist service for 13-19 year-old girls
  • Group support
  • A peer support scheme to help break isolation; build social networks and provide support clients regain control of their lives
  • Volunteering opportunities

Telephone: Athena Service on 0800 112 4052

Email: lewishamvawg@refuge.org.uk

Website: https://www.refuge.org.uk/our-work/our-services/one-stop-shop-services/athena/ 

African Advocacy Foundation

A community-led organisation working to promote better access to health, education and other opportunities for disadvantaged communities in the UK, Europe and parts of Africa.

​​African Advocacy provide practical support, policy work, advocacy, information, guidance and training to professionals and community members alike. African advocacy work to empower individuals and families experiencing multiple disadvantages and barriers including ill health, poverty, deprivation, violence, isolation and those relating to language, culture, faith and other social issues.

Location:

CATFORD (MAIN) OFFICES:

76 Elmer Road, Catford, London SE6 2ER

Telephone:

0208 698 4473

Website: https://www.africadvocacy.org/

BelEve UK

The purpose is to equip girls and young women with the right support, skills and confidence to make informed choices about their future; improve their educational, social and economic outcomes whilst taking control of their lives.

Location:
The Albany, Deptford, SE8 4AQ

Telephone:

0203 372 5779

Website: https://beleveuk.org/

Latin American Women’s Rights Service (LAWRS)

LAWRS has a zero tolerance policy of any form of Violence against Women and Girls (VAWG). Our team offers adviceadvocacy and practical support to Latin American women who are experiencing or have experienced Domestic Violence, Harmful practices or any other form of violence.

Location:

Tindlemanor, 52-54 Featherstone Street.
London, EC1Y 8RT

Telephone:

 020 7336 0888, 084 4264 0682

Website: http://www.lawrs.org.uk/

IKWRO – Women’s Rights Organisation

IKWRO are committed to providing non-judgmental support to women who speak Kurdish, Arabic, Turkish, Farsi, Dari, Pashtu and English.

Location:

IKWRO – Women’s Rights Organisation
PO Box 75229
LONDON
E15 9FX

Telephone:

0207 920 6460

Website: http://ikwro.org.uk/

Women and Girls Network (WGN)

WGN is a free, women-only service providing a holistic response to women and girls who have experienced, or are at risk of, gendered violence.

Telephone:

0808 801 0660

Website: http://www.wgn.org.uk/

WE Women (Women Empowering Women)

We Women is a collaboration of women which has been delivering community support to women since March 2017. In August 2018, we women became a constituted community group.

We Women are entirely volunteer run, and our aims are to:

  • Empower women to be more self-sufficient
  • Improve women’s health & well-being
  • Address the material impacts of poverty within the local community

Location:

Pepys Resource Centre Old Library Deptford Strand London
London
Greater London
SE8 3BA
United Kingdom

Telephone:

020 8691 3146

Website: https://www.lewishamlocal.com/places/united-kingdom/greater-london/london/lewisham-groups/we-women-women-empowering-women/

Early Years Alliance - Lewisham Children's and Family Centres

The Alliance is working together with Clyde Nursery School, Beecroft Garden School and Kelvin Grove/Eliot Bank and Downderry Children’s Centres to deliver a clear seamless borough wide children’s centre offer for families in the London Borough of Lewisham, working alongside health visiting, midwifery, schools and public health services.

Lewisham Children and Family Centres offer families access to a range of health, education, play, parenting, adult education, employment support and family support services right across the borough.

Website: https://www.lewishamcfc.org.uk/

National Stalking Helpline – Suzy Lamplugh Trust

The National Stalking Helpline is run by Suzy Lamplugh Trust. Their mission is to reduce the risk of violence and aggression through campaigning, education and support.

Telephone: 0808 802 0300

Website: https://www.suzylamplugh.org/

METRO

METRO is a leading equality and diversity charity providing health, community and youth services across London and the south-east, with some national and international projects. METRO promotes health, wellbeing and equality through youth services, mental health services and sexual health and HIV services and works with anyone experiencing issues related to gender, sexuality, diversity or identity.

Location: 141 GREENWICH HIGH ROAD, GREENWICH, SE10 8JA

Telephone: 020 8305 5000

Website: https://metrocharity.org.uk/

RASASC - Rape & Sexual Abuse Support Centre Rape Crisis South London

RASAC believe too many women have had to be silent for too long about the violence perpetrated against them.

They understand that it can be difficult to speak up, hard to find the words or to believe that anyone will listen.

RASAC will listen. They believe. They will stand up alongside you. You do not have to do this alone.

Telephone: 0808 802 9999

Postal Address:
PO BOX 383, Croydon, CR9 2AW

Website: http://www.rasasc.org.uk/contact/

Stonewall

Information and campaigning for LGBT rights. Got a question? A problem? Need support? Stone wall are here to help with any issues affecting LGBT people or their families. Whatever your situation, you’re not on your own. Stonewall will do what they can to help or point you in the right direction to someone who can.

Telephone: 0800 0502020

Write to Stonewall: Stonewall 192 St. John Street London EC1V 4JY

Website: https://www.stonewall.org.uk/help-advice/contact-stonewalls-information-service

Respect

Men and women working together to end domestic violence

Telephone: 0808 802 4040

Address: The Green House

244-254 Cambridge Heath Road

London

E2 9DA

Website: http://respect.uk.net/

The Deaf Health Charity – Sign Health

www.signhealth.org.uk/our-projects/deafhope-projects/

Text: 07970350366

Rights of women

www.rightsofwomen.org.uk

Respect Helpline for men

0808 8010327

www.respectphoneline.org.uk/help-for-domestic-abuse-victims  

Women's Aid live chat

This is an online chatting service which is ideal for victims who are self-isolating and do not want to be heard.

www.chat.womensaid.org.uk  

www.womensaid.org.uk

0117 944 44 11

NSPCC Helpline - 0800 028 3550 or fgmhelp@nspcc.org.uk

GALOP National LGBT+ Domestic Abuse Helpline

0800 999 5428

www.galop.org.uk/domesticabuse

Early Help & MASH

Information for professionals about assessing family and children's needs (early help assessment)

This information is for professionals working with families to complete an early help assessment (EHA).

About early help assessments

Professionals working with families can use an EHA to identify strengths and difficulties that they may be experiencing, and set strategies to minimise any negative impact on the child.

The EHA replaces the common assessment framework (CAF) for assessing children’s needs with parents and families.

Agencies should work together on an assessment to plan support for families and reduce the chance of concerns escalating to a point where statutory intervention is needed.

There is also an opportunity to capture the voice of the child and make sure that they are involved in the assessment, if appropriate.

How to complete an early help assessment

First of all, refer to our threshold of intervention document for information on how to identify difficulties and set interventions.

Then follow this step-by-step process:

  1. Gather and record information.

  2. Think about how this information impacts on the child and family.

  3. Plan a course of action.

When you’ve completed it, give the family concerned a copy of the early help assessment.

Logging early help assessments

If you complete an EHA at Level 2 of our continuum of need, you should log it with the lead professional’s agency.

EHAs that were allocated by the early help panel will be logged in the children’s social care system.  

After you complete an EHA

After you meet with the family and complete an EHA, you should hold a team around the family meeting within six weeks.

Find out more

Contact us for support and advice about completing the EHA on 020 8314 7333 or 020 8314 6660, email mashagency@lewisham.gov.uk

Getting consent

If you are making a referral for assessment, you must get consent for the assessment to take place.

It is your duty to fully explain consent to the family you are working with and give them the option to consent fully or to particular areas. They must give consent for the lead professional to consult with:

  • parents

  • carers

  • children and young people in the family

  • other family members

  • appropriate friends

  • any professionals involved with the family.

Each of these people will hold different pieces of information which will contribute to the whole assessment.

Explain to families that they will get better support if they consent to having their information shared with other services and professionals. Reassure them that all data will be stored securely.

Find out more about getting consent.

For more information regarding the use of your personal data, you can view our privacy policy.

Emotional Abuse of Children & Young People

Working Together 2018 Definition

The persistent emotional maltreatment of a child such as to cause severe and persistent adverse effects on the child’s emotional development.

It may involve, include, or be conveyed to a child:-

  • They are worthless or unloved.
  • Inadequate.
  • Valued only insofar as they meet the needs of another person.
  • Not giving the child opportunities to express their views, deliberately silencing them or “making fun” of what they say or how they communicate.
  • Age or developmentally inappropriate expectations being imposed on children. These may include interactions that are beyond a child's development capability, as well as an overprotection and limitation of exploration and learning, or preventing the child participating in normal social interaction.
  • Seeing or hearing the ill-treatment of another.
  • Serious bullying (including cyber bullying),
  • Causing children frequently to feel frightened or in danger
  • Exploitation or corruption of children.

Other forms of emotional abuse may be:-

  • Ignoring, e.g. withdrawal of attention or rejection.
  • Belittling, e.g. telling the child he or she is 'no good', 'worthless', 'bad', or 'a mistake'.
  • Shamming, humiliating or name-calling
  • Using extreme forms of punishment, such as confinement to a closet or dark room, tying to a chair for long periods of time etc. 
  • Emotional abuse is the 2nd most common reason for children needing protection from abuse in the UK.
  • Some level of emotional abuse is involved in all types of maltreatment of a child, though it may not occur alone.

Passive Emotional Abuse

NSPCC. When a parent / carer denies their child the love and care they need in order to be healthy and happy. It’s known as passive abuse.

Five categories of passive emotional abuse have been identified (Barlow and Shrader McMillan 2010).

  1. Emotional unavailability
    where a parent or carer is not connected with the child and cannot give them the love that they deserve and need.
  2. Negative attitudes
    such as having a low opinion of the child and not offering any praise or encouragement.
  3. Developmentally inappropriate interaction with the child
    either expecting the child to perform tasks that they are not emotionally mature enough to do or speaking and acting in an inappropriate way in front of a child.
  4. Failure to recognise a child’s individuality
    this can mean an adult relying on a child to fulfil their emotional needs and not recognising that the child has needs.
  5. Failure to promote social adaptation
    not encouraging a child to make friends and mix among their own social peers.

Why Might Emotional Abuse Happen? 

Periods of high stress and tension, such as money worries or unemployment, can take a parent(s)/carer(s) focus away from providing the emotional support that a child needs.  Additionally to the above they may be emotionally unavailable, because they’re not around or too tired. Forget to offer praise or encouragement. Expect a child to take on too much responsibility for their age, for example caring for other family members (refer to Lewisham Young Carers).  If a parent had a bad experience when they was a child or has bad role models around them now, then this can affect how they look after their own children.

Short & Long Term Effects of Emotional Abuse

A child experiencing emotional abuse may develop social withdrawal, aggressive behaviour, may appear withdrawn may regress in their behaviour, develop sleep disorders, have nightmares, and self-harm. If unresolved these conditions can continue into adulthood and lead to more maltreatment, eating disorders, mental health issues and substance misuse disorders.

Action to take

  1. Be alert to the signs of emotional abuse.
  2. Try to speak to the child or young person alone to seek further information and clarification about what they are experiencing and how they are feeling.
  3. If the child or young person reports they are being emotionally abused you should listen to them, take their allegations seriously, and reassure them you will take action, including what the actions will be.  If the child is worried about any of your actions, including speaking to the parent / carer, explain why and how you are going to help make it better for them and discuss their concerns to reassure them.
  4. If you are not the Designated Safeguarding Lead (DSL), report your concerns to your appointed DSL. If you are the DSL you should talk to the parent / carer and explain the concerns raised and inform them of the action you are going to take, i.e. make a referral to the MASH Team.

Make a Referral to MASH

If a child is in immediate risk call 999, otherwise contact the MASH Team by telephone and follow up your referral in writing within 24 hours.

MASH Team Telephone: 020 8314 6660

Email mashagency@lewisham.gov.uk

NSPCC & ChildLine

The NSPCC have had a 200% increase in 7 years in reports of emotional abuse, receiving 27 calls a day on average from children and young people.

It is important that children and young people feel safe and know who they can talk to when they are experiencing any kind of abuse.

ChildLine Number          0800 1111

Website:                       www.childline.org.uk

How Safe Are Our Children?  NSPCC Annual Report

The NSPCC have completed the most comprehensive overview of Child Protection in the UK in 2018 in their annual report. It compiles and analysis data from the across the UK to show the current child protection landscape.

Key Findings:-

  • An increase in police-recorded child sexual offences across the UK.
  • Increases in child cruelty and neglect offences in all UK nations except Scotland.
  • Increased numbers of children on child protection plans and registers over the last decade.

To read the full report click here NSPCC How Safe Are Our Children 2018

Guidance & Resources

Escalation Policy - Resolving Professional Differences

Having different professional perspectives within safeguarding practice is a sign of a healthy and well-functioning partnership. These differences of opinion are usually resolved by discussion and negotiation between the professionals concerned. It is essential that where differences of opinion arise they do not adversely affect the outcomes for children and young people, and are resolved in a constructive and timely manner.

Differences could arise in a number of areas of multi-agency working as well as within single agency working. Differences are most likely to arise in relation to;

  • Criteria for referrals
  • Outcomes of assessments
  • Roles and responsibilities of workers
  • Service provision
  • Timeliness of interventions
  • Information sharing and communication

If you have difference of opinion with another professional, remember:

  • Professional differences and disagreements can help us find better ways improve outcomes for children and young people
  • All professionals are responsible for their own cases, and their actions in relation to case work
  • Differences and disagreements should be resolved as simply and quickly as possible, in the first instance by individual practitioners and /or their line managers
  • All practitioners should respect the views of others whatever the level of experience. Remember that challenging more senior or experienced practitioners can be hard
  • Expect to be challenged; working together effectively depends on an open approach and honest relationships between agencies
  • Professional differences are reduced by clarity about roles and responsibilities and the ability to discuss and share problems in networking forums

Where immediate resolution cannot be found, professionals should make accurate records of discussions and correspondence and follow the LSCP Inter-Agency Escalation Policy.  When making a referral to the LSCP please email safeguardingpartnership@lewisham.gov.uk.

Female Genital Mutilation / Cutting

 Between April 2022 and June 2022 there were 745 newly recorded women and girls presenting at

Health settings in London,where FGM was identified or a procedure of FGM was undertaken.

NHS Digital FGM Annual Report April 2022-June 2022

What is FGM?

FGM is a form of violence against women and girls (VAWG). It comprises of all procedures involving partial or total removal of the external female genitalia for non-medical reasons. It may be carried out at any time in a girls life, from baby to womanhood. It can be seen as a pathway to womanhood and can also be a condition of marriage. Some communities believe that if a girl has not had it done she is deemed unhealthy, unclean, or unworthy. Parents can have very strong beliefs, genuinely thinking they are doing the right thing for their daughter, and in communities where all females have the procedure it can seem normal, then making it very difficult for girls to challenge this tradition.  However, not every mother who has had FGM will put their daughter(s) through the same procedure. Each case should be assessed carefully and sensitively.

It is sometimes also known as female circumcision. Other local terms are:  Tahoor, Absum, Halalays, Khitan, Ibi, Sunna, Gudnii, Bondo, Kutairi. It is important to let the female refer to the term she understands it to be called. FGM is sometimes incorrectly believed to be an Islamic practice. This is not the case and the Islamic Shari’a Council, the Muslim College and the Muslim Council of Britain (MCB) have condemned the practice of FGM.  The majority of cases of FGM are thought to take place between the ages of 5 and 8 and therefore girls within that age bracket are at a higher risk.

Mandatory Reporting Duty - What are ‘known cases?

Known cases are those where either a girl informs the person that an act of FGM – however described – has been carried out on her, or where the person observes physical signs on a girl appearing to show that an act of FGM has been carried out and the person has no reason to believe that the act was, or was part of, a surgical operation within section 1(2)(a) or (b) of the FGM Act 2003. The duty applies to all regulated professionals working within health or social care, and teachers. There is mandatory requirement to report to police cases of ‘visually identified’ or ‘verbally disclosed’ cases of FGM in girls under 18. The mandatory reporting does not apply to suspected cases or where a child might be ‘at risk’ of FGM. The mandatory reporting is for ‘known’ cases only.

It is Illegal

In the UK, anyone found guilty of an FGM offence or of helping somebody commit one, faces up to 14 years in prison, a fine, or both, regardless of where in the world the FGM takes place. Anyone found guilty of failing to protect a girl from risk of FGM faces up to 7 years in prison, a fine, or both.  Lewisham has secured 1 FGM Protection Order.

Recognising Signs & Symptoms of Possible FGM Cases

A girl may;

  • Say an older female relative is coming especially to see her.
  • Say that she is being taken "home" for a special visit to become a woman (right of passage).
  • become withdrawn following this "holiday" and/or there may be a change in her behavior.
  • Run away from home, or start truanting from school.
  • Have difficulty standing or sitting.
  • Spend longer in the toilet than usual; because of bleeding and/or infection.
  • Have frequent vaginal, urinal, or pelvic infections.
  • Blood born infections, including Hepatitis B & C, and HIV.
  • She may be reluctant to undergo any medical examinations.
  • May ask for help, but not be explicit about the problem due to fear or embarrassment
  • Develop emotional and mental health problems.
  • Self harm, or be showing signs of child abuse.

Long Term Health Effects

Many girls and women are not aware of the lifetime effects FGM can have on them; with difficulty in child birth (sometimes ending in death), infertility, sexually difficulties, vaginal infections, painful periods, cysts and abscesses, and difficulty controlling her bladder. This is a procedure that cannot be reversed. FGM also involves a long term emotional impact including, anxiety, depression, and post traumatic stress disorder.

FGM is classified into four categories:

  • Clitoridectomy: partial or total removal of the clitoris and, in very rare cases, only the prepuce
  • Excision: partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora
  • Infibulation: narrowing of the vaginal opening through the creation of a covering seal. The seal is formed by cutting and repositioning the inner, or outer, labia, with or without removal of the clitoris
  • Other: all other harmful procedures to the female genitalia for non-medical purposes, e.g. pricking, piercing, incising, scraping and cauterizing the genital area

Language & Image Guide  - Please refer to the current language and image guidance to use when talking to survivors of FGM.

The following are terms used by different nationality's to describe FGM.  You will need to consider that a survivor may not recognise FGM or Cutting to describe what they have experienced.

  • Egypt: Thara / Khitan / Khifad
  • Ethopia: Megrez / Absum
  • Eritrea: Mekhnishab
  • Kenya:   Kutairi / Kutairi was ichana
  • Nigeria:   Ibi / Ugwu / Sumna
  • Sierra Leone:   Sunna / Bondo / Bondo Sonde
  • Somalia:   Gudiniin / Halalays / Qodiin
  • Sudan:   Khifad / Tahoor
  • CHAD:   Bagtne / Gadja
  • Guinea-Bissau:   Fanadu di Mindjer / Fanadu di Omi
  • Gambia:   Niaka / Kuyango / Musolula Karoola

Procedure in Lewisham 

The LSCP Partnership has endorsed a local FGM Guidance to assist you with your responsibilities.

At-Risk Cases of FGM

Situations whereby the female child is at risk of FGM being performed, suspected of being performed, or suspected of having been performed, normal safeguarding procedures and existing pathways would apply. You should consult with your appointed safeguarding lead and you should report it to MASH on 020 8314 6660 and email mashagency@lewisham.gov.uk.

An FGM Protection Order offer a legal means to protect and safeguard victims and potential victims of FGM.  Please see the Fact Sheet for more information.

Reporting Known Cases in Lewisham

In London the only reporting gateway for mandatory reports is via 101.   You should also inform MASH and your appointed safeguarding lead of your report. 

The duty applies to all regulated professionals working within health or social care, and teachers. There is mandatory requirement to report to police cases of ‘visually identified’ or ‘verbally disclosed’ cases of FGM in girls under 18. The mandatory reporting does not apply to suspected cases, or where another person (including the mother) discloses that FGM has taken place, or where a child might be ‘at risk’ of FGM. The mandatory reporting is for ‘known’ cases only, and this can be any girl of any nationality.

Home Office Mandatory Reporting Procedural Guidance

Government Safeguarding women and girls at risk of FGM: FGM Safeguarding Pathway, Quick Guide for Health Professionals and templates.

Multi-Agency Statutory Guidance FGM

Support is Available for Girls and Women at Risk

You can obtain a Statement Opposing Female Genital Mutilation for girls and women. It is in a variety of languages on the GOV.UK website.  Girls and Women can also contact;

  1. Athena VAWG Service on 0800 112 4052, email lewishamvawg@refuge.org.uk, website www.refuge.org.uk/Athena
  2. African Advocacy Foundation on 020 8698 447, website http://www.africadvocacy.org/
  3. NSPCC FGM Helpline on 0800 028 3550, email fgmhelp@nspcc.org.uk
  4. FGM Every Bodys Biz website provides advice, support and a forum to hear the voice of the girl/woman. You can also obtain up-to-date information on FGM Health Specialists and organisations working on FGM, http://fgm-every-bodys-biz.co.uk/ 
  5. If a girl or woman has been taken abroad phone the Foreign & Commonwealth Office immediately on 020 7008 1500. 

Specialist FGM Clinics for Survivors of FGM

African Well Women’s Clinic

Guy’s & St Thomas’ Hospital, 8th Floor, c/o Antenatal Clinic, Lambeth Palace Road, London SE1 7EH

Tel:   020 7188 6872

Open Monday-Friday, 9am to 4pm.

Contact:   Confort Momoh MBE, FGM / Public Health Specialist 07956 542 576

Action African Well Women Centre

Self Referral for free confidential services

Contact:   Julia Albert – Midwife or Hayat Arteh – Health Advocate

Tel: 020 8383 8761 or 07956 001 065

or 07730 970 738

Manor Gardens Clinic

The project works with volunteer FGM Community Champions, delivers training, provide workshops and 1:2:1 support through the Dahlia project (Specialist therapeutic service for women who have undergone FGM).

E-Learning

For further information on FGM we would encourage all professionals to view the excellent Home Office training package on FGM which can be found at:  www.fgmelearning.co.uk/

Useful Links & Guidance:

NHS England Posters & Guidance

National FGM Centre

FGM Map by Country & Origin and their Practice  

FGM Health Passport- Statement opposing FGM guidance in different languages.

Links to information about FGM Orders:- 

National FGM Centre

Courts of Justice - Family Procedure Rules

What to do if you are worried about the Safety of a child – professionals

Female Genital Mutilation - An Overview (leaflet)

Fabricated or Induced Illness and Perplexing Presentations Guidance

MULTI-AGENCY GUIDANCE FOR THE MANAGEMENT OF

PERPLEXING PRESENTATIONS, OR, SUSPECTED FABRICATED OR INDUCED ILLNESS

1. Introduction

This guidance is written to support multi-agency frontline practitioners to make appropriate decisions on how to safeguard children who present with perplexing presentations (PP) and Fabricated or Induced Illness (FII), additionally advise practitioners on how to recognise these issues, how to assess risk and how to manage these types of presentations in order to obtain better outcomes for children.

This guidance is based on the Royal College of Paediatrics and Child Health (RCPCH) 2021 guidance Perplexing Presentations (PP)/Fabricated or Induced Illness (FII) in children – guidance – RCPCH Child Protection Portal  as well as learning from Serious Case Reviews, and aims to put the RCPCH 2021 document in context for practitioners working in Lewisham.

Whilst mainly applicable to health practitioners, this multiagency guidance is applicable to all frontline staff working with children, young people, and their families.

The term ‘children' or ‘child’ applies to all children and young people who have not yet reached their 18th birthday as per the Children Act 1989. The fact that a child has reached 16 years of age; is living independently or is in further education; is a member of the armed forces; is in hospital; in prison or in a young offender's institution, does not change his or her status or entitlement to services or protection under the Children Act 1989.

2. Purpose

The purpose of this policy is to:    

  • Provide Lewisham frontline practitioners with a single consistent approach in the management of PP, or suspected FII.
  • Advise safeguarding partnerships of a single consistent approach across local providers and staff in the management of PP, or suspected FII.
  • Provide staff with the information and guidance they need to fulfill their statutory duties to safeguard and protect children and young people when there is suspected PP or FII.
  • Clearly define roles and responsibilities so that the process is transparent, and staff understand the complexities involved and have realistic expectations about the timeframes within which any given case can be managed.

3. Descriptions

    Medically Unexplained Symptoms (MUS)

    The symptoms which the child complains, and which are presumed to be genuinely experienced are not fully explained by any known pathology. These may be psychosocial and may be part of PP or FII.

    Perplexing presentations (PP)

    The term Perplexing Presentations (PP) has been introduced to describe the commonly encountered situation when there are alerting signs of possible FII not yet amounting to likely or actual significant harm, when the actual state of the child’s physical, mental health and neurodevelopment is not yet clear, but there is no perceived risk of immediate serious harm to the child’s physical health or life. The essence of alerting signs is the presence of discrepancies between reports, presentations of the child and independent observations of the child, implausible descriptions and unexplained findings or parental behaviour.

    4. Considerations if there are Alerting signs

    Examples of Alerting Signs may include:

    • Symptoms only witnessed by parent or carer
    • The reporting of multiple unrelated sets of symptoms, often alarming in nature
    • Parent/carer frequently speaks for the child or refuses for the child to be seen alone
    • A history of changing GPs or visiting different hospitals for treatment
    • The child has limited / interrupted school attendance and education;
    • The child’s normal daily life activities are limited (not able to join in PE for example);
    • The child assumes a sick role (e.g., with the use of unnecessary aids, such as wheelchairs);
    • Physical examination and results of medical investigations do not explain reported symptoms and signs;
    • There is an inexplicably poor response to prescribed medication and other treatment;
    • New symptoms are reported on resolution of previous ones.
    • Excessive use of any medical websites, jargons, or alternative opinions.
    • Parents may object to communication between professionals and may make frequent complaints about professionals

    Fabricated and Induced Illness (FII)

    FII is a clinical situation in which a child is, or is very likely to be, harmed due to parent(s) behaviour and action, carried out to convince doctors that the child’s state of physical and/or mental health and neurodevelopment is impaired (or more impaired than is the case). FII results in physical and emotional abuse and neglect, because of parental actions, behaviours, or beliefs and from doctors’ responses to these. The parent does not necessarily intend to deceive, and their motivations may not be initially evident.

    It is important to distinguish the relationship between FII and physical abuse / non-accidental injury (NAI). In practice, illness induction is a form of physical abuse (and in Working Together to Safeguard Children, fabrication of symptoms or deliberate induction of illness in a child is included under Physical Abuse). For this physical abuse to be considered under FII, evidence will be required that the parent’s motivation for harming the child is to convince doctors about the purported illness in the child and whether there are recurrent presentations to health and other professionals. This particularly applies in cases such as suffocation or poisoning.

    Frontline Response to Alerting signs   

    Alerting signs are not evidence of FII. However, they are indicators of possible FII (if not amounting to likely or actual significant harm). There may be several explanations for these circumstances, and each requires careful consideration and review.

    At the point of alerting signs being identified, the concerns need to be escalated. The response is dependent on setting. At this stage, professionals should refrain from using FII terminology, as the state of the child’s health has not yet been assessed

    Community settings

    If the initial concerns arise from non-health community settings such as school, social services, or police, they should explain to parents the need to involve health. It is then appropriate for either the parents or education to contact health (GP, Consultant Paediatrician or Consultant Child Psychiatrist depending on who is already involved.)

    If the parents do not agree to a health assessment and the sharing of information about the child, the setting will need to escalate to safeguarding leads within their own organisations to decide what action they should take following their safeguarding guidance.

    Health Settings

    If the initial concerns arise in or have been escalated to health settings, the doctor for the specified team is termed the ‘Responsible Clinician’. This could be the GP, Consultant Child Psychiatrist, Consultant Paediatrician, or any specialty in which the child is being seen.

    Health response to Alerting signs should be escalation to the Named Doctor for their organisation. This is usually the Named GP for Safeguarding Children in Primary Care or the Named Doctor for the hospital trust.

    If the child is not known to any secondary services, primary care clinicians should refer to a Consultant Paediatrician or Psychiatrist (depending on the presentation of the child) following initial discussions with Named GP for Safeguarding Children in Primary Care. The Consultant Paediatrician or Consultant Child Psychiatrist will be the ‘Responsible Clinician’.

    5. Imminent Risk to Life / Health (FII)

    Frontline response when there is an imminent risk to life/health

    • If there is immediate risk of serious harm identified, the professional should escalate to their line manager and the Safeguarding Leads of their organization. They should be supported to make urgent referrals to the police and MASH. This should lead to a strategy discussion and ensuring the child is in a place of safety. The safety of siblings should also be considered.

    • Examples of immediate risk may include evidence of illness induction, evidence of frank deception such as interfering with specimens, contamination of feed bottles or poisoning.

    • Concerns regarding the possibility of FII must not be shared with parents/carers as this may increase the risk to the child and this should be reiterated as part of the discussion.

    • In accordance with London Safeguarding Children Procedures, the strategy meeting should take place within one working day. All involved health professionals, the safeguarding team, children social services, police and education should be represented. The strategy meeting should be prioritised by all professionals. If they are not able to attend, they should send a fully briefed substitute. It is important for the substitute to be able to make decisions on behalf of the professional. All professionals are expected to attend the meeting fully prepared and able to discuss their concerns and understand that concerns should not be shared with the parents at this stage. There should be multi-agency agreement about the safeguarding response, and when and who should inform the parents.
    • In very rare cases, covert video surveillance may be used as part of multi-agency decision-making and is led by the police.

    • If at any time any practitioner considers their concerns are not being taken seriously or responded to appropriately; s/he should discuss this with the Named safeguarding Doctor of their organization , or the Designated Safeguarding Children professionals within the ICB. Concerns should be escalated in accordance with the Lewisham LSCP Escalation Policy - Resolving Professional Differences.

    • The Responsible Clinician, with the support of the Safeguarding leads within their organisation, should prepare a chronology (see appendix 3).

    • All practitioners involved with the child should continue to record their concerns and observations accurately and objectively in the child's health record so that other clinicians have access to the information. In such cases parent/carers access to the record will need to be restricted, with a clear note to reflect this, if there would be risk to the child.

    • The Responsible Clinician should arrange a follow up Professionals’ Meeting with the Named Safeguarding doctor of the organisation and all other involved healthcare professionals for feedback of the outcome and any further action required. Professionals meeting should be within six weeks to allow time to gather any further information if needed and prior to discharge from CSC oversight. See Flow Chart in Appendix 1.

    6. Perplexing Presentations and Management

      Secondary Care Management of Probable FII without Immediate Risks

      1. The essence of management is establishing, as quickly as possible, the child’s actual current state of physical and psychological health and functioning, and the family context.

      2. If the child is not known to any secondary services, primary care clinicians should refer to a Consultant Paediatrician or Consultant Child Psychiatrist (depending on the presentation of the child) following initial discussions with Named GP for Safeguarding Children in Primary Care.
      3. This referral should reiterate the need not to alert the parents/carer to the possibility of FII at this stage.

      The Consultant Paediatrician or Consultant Child Psychiatrist will be the ‘Responsible Clinician’

      1. The Responsible Clinician will arrange for a medical evaluation to take place as appropriate. Identification of probably FII can be a difficult and protracted task and may require a multi-agency approach and expertise. It can involve relatively long periods of observation.

      2. Information gathering is usually needed to understand if this is Probable FII, Perplexing presentations or Medically Unexplained Symptoms as the management is very different.
      3. Following information gathering and review of the child, If concerns persist about probable FII, but it is still unclear whether this meets the threshold for referral to children’s social care, the Responsible Clinician should arrange a Professional’s Meeting. This meeting should take place within 10 working days, or earlier if required. All professionals involved in the care of the child, including health, education, and social care should be invited to the meeting.

      4. The professionals meeting should explore the facts, hear from all professionals involved and come to a consensus agreement regarding whether:

        1. If this is ‘Probable FII’ with immediate serious risk to the child’s health or life (see flowchart below), or
        2. It should be managed as a perplexing presentation.
        3. In addition, the meeting should also consider if there are any other safeguarding risks to the child or siblings.

      5. A detailed chronology should be completed by all involved practitioners regarding their own involvement with the child (see appendix 3) within 10 working days (or sooner if necessary) and returned to the Responsible Clinician for the case for collation within health in conjunction with the Named Doctor and Nurse for Safeguarding children for the organisation. The composite chronology will be shared with the Named Safeguarding professionals for the organisation.

      6. The Responsible Clinician will chair the meeting. Clear terms of reference and records of the meeting must be made available at the time, the arrangement of these made by the Chair.

      7. Whilst professionals should in general, discuss any concerns with the family and, where possible, seek agreement to making referrals to Children's Social Care, this should only be done where such discussion and agreement-seeking will not place a child at increased risk of significant harm, and for probable FII should only be shared after agreement at the multiagency strategy discussion.

      8. At this stage any referral to social care and police as appropriate should lead to a strategy discussion with key professionals involved with the child.

      9. If there is no obvious deception, illness induction and no serious immediate risk, in which case the clinical management should be managed as for PP as below.

      Secondary Care Management of Perplexing Presentations

      1. Alerting signs are present and escalated from the community as described above or identified in secondary care.

      2. Responsible Clinician will arrange for a medical evaluation to take place as appropriate.

      3. The responsible clinician should obtain a history and observations from caregivers, explore parental views, family functioning and support and any need for/previous early help or social care involvement. (A chronology will be helpful, see chronology template in appendix 3)

      4. The child’s view should be explored alone, to find out their views and beliefs as well as worries, mood and wishes. Consideration will need to be given if the child is non-verbal, has special education needs, and or disabled. The Three Houses tool https://www.mefirst.org.uk/ is useful to explore their views, or RCPCH tools referenced in the 2021 guidance.

      5. There needs to be an assessment of immediate risk. If there is no immediate risk, then the responsible clinician along with a colleague will involve parents in the assessment plan.

      6. There may be safeguarding, or welfare needs that are unmet, and these must be considered separately to the clinical picture.
      7. The Responsible Clinician’s role is to maintain clinical oversight, collate information and make medical decisions in relation to the child’s care.
      8. The Named doctor for Safeguarding Children in the same organization should maintain safeguarding oversight. Safeguarding and Clinical care roles should be kept separate by two different clinicians.

      9. Following information gathering and evaluation of concerns, a professionals meeting should be arranged as described in Section 6. The panel should come to a consensus agreement, discuss management plans, and review the needs of the whole family.

      10. The Responsible Clinician should meet with the parents to share the consensus and plan which should be negotiated with the young person if possible

      11. To enable return to education, the Responsible clinician should call a Team around the Child (TAC) meeting with the school, GP and any other professionals needed to facilitate a smooth return.
      12. Referral to the Police and MASH may be
      13. The child’s GP should always be kept informed as it is important to recognize the needs of the whole family.

      14. Parents and young people should be informed of the outcomes of professional meetings if it is safe to do so.

      7. Considerations for Medical Evaluation   

      1. All signs and symptoms must be subject to careful medical evaluation for a range of possible diagnoses.

      2. All tests and their results should be fully and accurately recorded, including those with a negative result. It is important that the child's records are not tampered with, or test results altered in the child's notes.

      3. If the child is not currently in hospital, consider whether a planned admission with careful observation would help to elucidate the clinical diagnosis.

      4. Carefully consider whether any immediate investigations or further opinions are likely to assist in the diagnosis.

      5. Stop any harmful treatments or invasive procedures unless they are clearly indicated. It is unacceptable to cause a child further harm from medical actions, whilst the diagnosis of FII is being considered.

       

      1. If there is risk of immediate harm, do not wait to confirm the diagnosis before referring to children's social care as a delay may be detrimental to the child.

      2. Chronology of health involvement from ALL agencies should be prepared to provide an overall picture and comprehensive information for submission to Children’s Social Care.

      8. Considerations for MASH on receipt of referral

      1. Imminent or probable risk to a child’s health/ life from FII or another cause should involve an urgent strategy discussion. All involved health clinicians, education and safeguarding professionals should be invited. No information should be shared with the parents.

      2. MASH will notify the responsible clinician of referral outcome within 3 working days of referral receipt.

      3. In accordance with Lewisham LSCP Escalation Policy, escalation should occur if there are concerns regarding the MASH referral decision.

      4. In the event of likely / experienced harm, at any stage, a referral can be made by the involved professional and will be managed through the usual MASH process.

      9. Record Keeping 

      1. Medical records should be kept in accordance with the Data Protection Act 1998. Practitioners should also follow the principles of record keeping set out in guidance documents supplied by their Professional bodies.

      2. Detailed, accurate and informative medical records are pivotal to the management of a suspected FII case. If a child moves between clinical teams or between organisations, it is best practice for the notes to follow the child. This may not always be possible and so a clinical summary must accompany the child.

      3. It is essential that the records include a health chronology of the child's medical presentation, including aspects which may indicate FII. It is crucial to record the source of information, e.g., whether a symptom or sign was independently observed by staff or reported by a parent / carer.

      4. If FII is suspected, requests by a child's parent / carer to access their records under the Data Protection Act 1998 may be refused if:
        1. The disclosure would be likely to cause serious harm to the physical or mental health or condition of the child
        2. The child has provided the information in the expectation that it would not be disclosed to the parent / carer
        3. The data was obtained because of an examination or investigation to which the child consented in the expectation that the information would not be so disclosed
        4. The child has expressly indicated that the information should not be so disclosed.

      10. Training and Supervision Requirements  

      1. All staff who have contact with children or their families should have appropriate safeguarding training and an understanding of PP and FII. Those specialising in the care of children or families need additional training to ensure a higher level of awareness and understanding of PP and FII.

      2. Staff will need support and supervision in dealing with cases of PP or suspected FII. Staff support should be an integral part of a health professional's contract. It is important that line management and professional supervision and mentorship arrangements are explicit so that staff know how to access additional support when it is needed. The facilitation of debriefing sessions can be helpful in providing support for all members of the team.
         
      3. Staff to be aware that children with disabilities/ special needs are equally at risk this must be considered when there are concerns of PP or suspected FII.

      11. Monitoring

      This guidance and application will be reviewed annually by the Designated Safeguarding Children Professionals in collaboration with the Named Safeguarding Children professionals in health provider organisations.  

      12. Equality and diversity statement

      NHS Southeast London ICB is committed to equality of opportunity for its employees and members and does not unlawfully discriminate based on their “protected characteristics” as defined in the Equality Act 2010 - age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex, and sexual orientation. An Equality Impact Assessment has been completed for this policy. 

      If members or employees have any concerns or issues with the contents of this policy or have difficulty understanding how this policy relates their role, they are advised to contact the Chief Operating Officer.

      13. Links to other Policies/Documents and Guidance

      This guidance is to be used in conjunction with: 

      • RCPCH (2021) PP or Fabricated Induced Illness in Children guidance
      • Working Together to Safeguard Children 2018

      14. References

      LSCP Multi-agency Guidance for the management of Perplexing Presentations, or, suspected Fabricated or Induced Illness

      Appendix 1 : Generic flow chart when there are alerting signs

      Appendix 2 : Spectrum of cases where FII concerns may arise (RCPH, 2013)

      Appendix 3 : Sample of chronology template

      Appendix 4 : Health and education rehabilitation plan template

      Tri-Borough 7 Minute Briefing : Fabricated & Induced Illness and Perplexing Presentations

      Forced Marriage - Right to Choose

      This document sets out the duties and responsibilities of agencies with the aim of protecting children and adults facing forced marriage. It does not attempt to replicate existing safeguarding guidance but should form part of all the existing child and adult protection structures, policies and procedures.

      The document highlights specific arrangements that may inadvertently place a victim at risk of harm. These include failure to share information appropriately between agencies, the involvement of families, breaches of confidentiality and all forms of family counselling, mediation, arbitration and reconciliation.

      Full Guidance:            The right to choose: government guidance on forced marriage - GOV.UK (www.gov.uk)

      Free E-Learning:         Awareness of Forced Marriage

      Learning outcomes:

      • Recognise the warning signs of forced marriage.
      • Take the right actions to help protect the potential victim.
      • Cooperate effectively with other agencies.

      Harmful Sexual Behaviour

      Lewisham logo South-London-Maudsely-NHS-Trust-logo-Lambeth-IAPT

      Lewisham CAMHS ARTS Team HSB/AIMS Flow Chart

      HSB/AIMS top of chart

      HSB/AIMS bottom of chart

      HSB: Harmful Sexual Behaviour; CSC: Children's Social Care; NFA: No Further Action, MASH: Multi-Agency Safeguarding Hub; AIM: Assessment Intervention & Moving on; YOS: Youth Offending Service; CAMHS: Child & Adolescent Mental Health Service.

      NEW HARMFUL SEXUAL BEHAVIOUR PATHWAY / MONTHLY CONSULATION PANEL IN THE LONDON BOROUGH OF LEWISHAM +

      ARTS (Adolescent Resource Therapy) TEAM +

      Who are the ARTS team?

      The service aims are to:

      • Assess and treat the mental health needs of young people in the criminal justice system (CJS) and those whose offending behaviour could lead them into the criminal justice system.
      • Work with young people involved in the CJS or Children’s Social Care (Lewisham) showing signs of sexually inappropriate behaviour.
      • Ensure through integrated working that all YOS interventions are trauma informed.

      What the ARTs Team provide flyer

      What is Harmful Sexual Behaviour (HSB)? +

      Children and adolescents display a range of different sexualised behaviours. However harmful sexual behaviour (HSB) is developmentally inappropriate sexual behaviour displayed by young adults and adolescents, which may be violent and abusive (Hackett, 2014). To help professionals working with young people to distinguish between developmentally typical sexual behaviours from sexual behaviours that are problematic, and how to respond, the Hackett’s Model of HSB is a helpful tool to use (shown below)

      Hackett\'s Model of HSB chart

      Here is a video by NSPCC learning on why HSB’s a safeguarding concern and child protection concern: https://www.youtube.com/watch?v=hnLQFUi6uWk

      Many young people referred into mental health services for HSB have experienced abuse, trauma (Hackett et al., 2013), and have several other psychosocial complex needs. Young people who display HSB may also develop further behavioural problems, for instance, poor self-regulation/coping skills, post- traumatic stress disorder (PTSD), depression, anxiety disorders, poor attachments and self-esteem, deficits in social skills, and have poorly defined personal boundaries sometimes on the background of neurodevelopmental difficulties (Hollis, 2017; Rich, 2011). Given the complexity of these cases a thinking space should be provided to consider risk factors in order to appropriately target the intervention and prevent future occurrences.

      Further to this, the NICE guidelines explicitly state as part of their recommendations that “children’s social care services should identify services employing staff with the skills to undertake a specialist assessment of risk for children and young people displaying HSB” this includes child health services such as CAMHS.

      The forum aims to:

      • Have multi-agency representation when considering harmful sexual behaviour (HSB) cases.
      • Act as a steering group.
      • Act as the referral route for Lewisham CAMHS Forensic Team.
      • Act as a source of knowledge, expertise and support for the practitioner presenting the case at the forum.

      **For any HSB behaviours that fall within the inappropriate category on the Hackett’s model, practitioners and clinicians should seek a referral with the Safer London Team**

      Aims & Objectives of the Monthly Consultation Panel +

      In the borough of Lewisham, multi-agencies aim to work together to provide a specialist service to children and young people who have engaged in harmful sexual behaviour (HSB). This includes harm to other children, young people, and themselves.

      **Please note this consultation space will not be attempting to formulate the HSB behaviour but provide a reflective space to all presenting practitioners, and give consideration to the safety planning and risk management **

      Purpose of the panel +

      HSB Consultation panel graph

      The consultation panel consists of multi-agency practitioners who are knowledgeable in the subject matter and may also be trained in the specialist AIM3 model.

      What is A.I.M? +

      The AIM (Assessment Intervention Moving on) project developed an assessment framework model in Manchester in 2000. The Framework was revised into AIM3 in 2007 and again in 2012, based on further research and evidence of young people aged 12-18 years. It is not an actuarial risk assessment tool, but an assessment framework designed to assist practitioners in the task of assessing HSB within the context of multiple domains of a young person’s life and identify the needs it is meeting. AIM3 has identified five domains: sexual behaviour, non-sexual behaviour developmental, environmental/family, and self-regulation.

      AIM3 intends to be dynamic and responsive to developmental, systemic, and behavioural change.

      More information about the assessment framework can be found here: https://aimproject.org.uk

      Panel members +

      Arts Team

      Dr Lovedeep Rai, Clinical Psychologist
      Dr Lovedeep Rai,
      Senior Clinical Psychologist
      Delores McPherson Clinical Service Lead
      Delores McPherson,
      Clinical Service Lead
      Dr Philip Collins, Child and Adolescent Forensic Consultant Psychiatrist
      Dr Philip Collins,
      Child and Adolescent Forensic Consultant Psychiatrist
      non gender image
      Judah Paterson,
      Dramatherapist

      Our agency partners & Panel members: +

      Lewisham Youth Justice Service

      non gender image
      Alena Redwood
      Advanced Practitioner,
      Youth Justice Service

      Lewisham Children Social care

      Tom Hatton, Team Manager in Lewisham family Support and Safeguarding service
      Tom Hatton,
      Team Manager in Lewisham
      Family Support and Safeguarding service
      non gender image

      Justine Mortlemans,
      Group Manager in Lewisham
      Family Support and Safeguarding service


      South East London Integrated Care System (SEL ICS), Lewisham

      non gender image

      Abimbola Adeyemi,
      (Consultant Community Paediatrician & Designated Doctor for Safeguarding Children, South East London ICS Lewisham)


      Primary Education

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      Julie Loffstadt,
      Kilmorie Primary school


      MET Police: Child Abuse Investigative Team (CAIT)

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      Keely Furness

      Frequency of Panel Meetings +

      The panel will meet every last Friday of the month at minimum (subject to change as the forum develops and service demands change).

      Referrals +

      Referrals will be considered from targeted and specialist agencies that are concerned about a young people who meets the criteria below.

      Inclusion criteria for referrals concerning young people:

      • Who have engaged in HSB resulting in significant harm to another child or young person.
      • Are assessed as being likely to engage in HSB that would result in significant harm to themselves or others.
      • All children under the age of 18 years for assessment and/or interventions.
      • Panel may provide discretionary consultation for younger children.

      Exclusion criteria for referrals concerning young people:

      • Young people over the age of 18 years.
      • No mention of HSB as the primary source of concerning behaviour.
      • The HSB incident or the case has not been raised with Lewisham Children’s social care services.
      • If the case is Child Sexual Exploitation in nature.
      • Who are the victims of HSB?

      Referrals will be:

      • Submitted to the Chair via secure email by the beginning of the 3rd week of the month.
      • Lead practitioners to provide a succinct written summary of the case and current safety plan for the young person and family.
      • The ARTs team will have sole discretion over whether a referral is accepted or not into the forum. Where a referral is not accepted, the ARTs team will provide explanation as to why it is not accepted and signpost to other relevant services.
      • In CAMHS cases, it will be expected that the referring practitioner will act as care co-ordinator for the case and team acting to support their work, with a more specialised assessment of risk and intervention
      • Cases that are accepted for an AIM3 assessment, lead practitioners are expected to send the ARTs team appropriate assessment reports.
      • AIM3 assessment will be carried out by two practitioners, which may be decided in the forum or between the ARTs team and other relevant agencies.

      HSB Forum Consultation Request Form

      Meeting Structure +

      All presentations to the panel will be made by the lead practitioner. If the lead practitioner is unable to attend, their manager is expected to present the case on their behalf. To allow for an in-depth discussion each case will be allocated 60 minutes (subject to change as the forum develops). Once introductions have been completed, practitioners will have 10 to 15 minutes to present the case to the forum (i.e., what they would like to achieve from this consultation space, a brief overview of the presenting problem, family dynamics, what agencies are involved, and what the current safety plan is). The panel members will be invited to ask any clarifying questions, share reflections, identify any gaps in the case that need further consideration or what relevant information should be collated, and suggest possible interventions.

      Quality assurance +

      The ARTs team aim to audit the forum by keeping a log of cases discussed and collecting qualitative feedback from all lead practitioners who have presented at the forum via a Google feedback form.

      Regular feedback will also be sought from the panel members to help improve the service design and delivery. The panel is dedicated to collecting and acting on feedback to ensure that the panel is a useful space to think about HSB cases with external partners and agencies.

      Contact details +

      For all referrals, inquiries or further information please email: artsteam@slam.nhs.uk

      More information & Support +

      HARMFUL SEXUAL BEHAVIOUR TRAINING FOR ALL PROFESSIONALS +

      A 5-year licence for the Brook Traffic Light Tool has been purchased (2023-2028).  The licence allows us to access online training to ensure the tool is used effectively and is available to every professional working with children and young people in the borough.  YOU MUST REGISTER BEFORE APRIL 2024 

      In order to maximise effectiveness, it is essential that partner agencies prioritise any staff members working with young people and their families to access this training at the earliest opportunity.

      The instructions for logging on and links to access are below. If you have any questions, please contact Natasha Orumbie, Safeguarding & Inclusion Manager, Lewisham Council at natasha.orumbie@lewisham.gov.uk

      Please follow the link below to create an account. When adding your username just use your first and last name in lower case with no spaces. Once you have created an account you will receive a verification email. Please watch the instructions video created by Natasha.

      Brook Traffic Light Tool – link to join 

      Brook Traffic Light Tool – instructions video 

      Information Sharing & Consent

      Contents

      1. Introduction
      2. London Multi-Agency Safeguarding Data Sharing Agreement for Safeguarding & Promoting the Welfare of Children - January 2021
      3. Principles of Information Sharing and Consent
      4. What is the Legal Framework that supports information sharing?
      5. Consent from a Young Person (Gillick Competence and Fraser Guidelines of Consent)

        Appendix 1 – Data Protection Act 2018 Principles of Information Sharing
        Appendix 2 – Information Sharing Flow Chart

      Introduction

      In order to ensure that safeguarding decisions are made with timely, necessary and proportionate interventions and support, decision makers require full information concerning children, their parents, carers and their circumstances to be available to them. Information viewed alone or in silos is unlikely to give the full picture or identify the true risks.

      All relevant information from various agencies involved in their care or support, needs to be available and accessible in one place. A Multi-Agency Safeguarding Hub (MASH) helps ensure this and aids communication between all safeguarding partners, thus ensuring that the team quickly identifies those who are subject to or at risk of harm.

      Information should only be shared within the MASH for the purposes of safeguarding and promoting the welfare of children, and for the prevention and detection of related crime.

      HM Government advice on Information Sharing (March 2015) states that:

      “Sharing information is an intrinsic part of any front-line practitioner’s job when working with children and young people. The decisions about how much information to share, with whom and when, can have a profound impact on individuals’ lives. It could ensure that an individual receives the right services at the right time and prevent a need from becoming more acute and difficult to meet. At the other end of the spectrum it could be the difference between life and death.”

      Poor or non-existent information sharing is a factor repeatedly highlighted as a theme in Child Safeguarding Practice Reviews / Serious Case Reviews carried out following the death of, or serious injury to, a child. 

      Fears about sharing information cannot be allowed to stand in the way of the need to safeguard and promote the welfare of children at risk of abuse or neglect. No practitioner should assume that someone else will pass on information which may be critical to keeping a child safe.

      A public authority such as Lewisham Council has some legal power enabling it to share the information. We must consider on a case by case basis whether information will be shared with or without consent, through considering what is reasonable, necessary and proportionate.

      London Multi-Agency Safeguarding Data Sharing Agreement for Safeguarding & Promoting the Welfare of Children - January 2021 +

      Local Safeguarding Partners are responsible for ensuring that relevant information is shared in a timely and proportionate way, both within the local area and across local authority boundaries. Local Safeguarding Partnerships should promote the use of the “London Multi-Agency Safeguarding Data Sharing Agreement for Safeguarding and Promoting the Welfare of Children” which sets out the legal basis for sharing information between agencies in London.

      FAQs for Sharing Data Sharing Agreements

      London Multi-Agency Safeguarding Data Sharing Agreement for Safeguarding & Promoting the Welfare of Children  

      Data Protection Impact Statement

      7 Golden Rules

      1.GDPR and DPA 2018 is not a barrier to sharing information.

      2.Be Open and Honest.

      3.Seek Advice.

      4.Share with Consent where appropriate.

      5.Consider Safety & Wellbeing.

      6.Necessary, Proportionate, Relevant, Accurate, Timely and Secure

      7.Keep a Record, including the date, time, purpose and with whom you have shared the information.  Equally if you decide not to share information, record your rationale.

      Definitions

      Personal Information/Data is:

      • Information/Data which relates to a living, individual who can be identified from the data or other data/information that the organisation holds.
      • Could be single elements or a combination e.g. names, addresses, occupation, date of birth etc.it could also include opinions about them and intentions towards them.

      Sensitive Personal Information/Data is:

      • Physical or mental health, racial or ethnic origin, political opinions, TU membership, sexual life, criminal allegations or record.

      Principles of Information Sharing & Consent +

      The principles set out below are intended to help practitioners working with children, young people, parents and carers share information between organisations. Practitioners should use their judgement when making decisions on what information to share and when and should follow organisation procedures or consult with their manager if in doubt. The most important consideration is whether sharing information is likely to safeguard and protect a child. 

      Necessary and proportionate 

      When taking decisions about what information to share, you should consider how much information you need to release. The Data Protection Act 2018 requires you to consider the impact of disclosing information on the information subject and any third parties. Any information shared must be proportionate to the need and level of risk. 

      Relevant 

      Only information that is relevant to the purposes should be shared with those who need it. This allows others to do their job effectively and make sound decisions. 

      Adequate

      Information should be adequate for its purpose. Information should be of the right quality to ensure that it can be understood and relied upon. 

      Accurate 

      Information should be accurate and up to date and should clearly distinguish between fact and opinion. If the information is historical then this should be explained.

      Timely 

      Information should be shared in a timely way to reduce the risk of harm. Timeliness is key in emergency situations and it may not be appropriate to seek consent for information sharing if it could cause delays and therefore harm to a child. Practitioners should ensure that sufficient information is shared, as well as consider the urgency with which to share it.

      Secure 

      Information should be shared in the most secure way available.  Practitioners must always follow their organisation’s policy on security for handling personal information. 

      Record 

      Information sharing decisions should be recorded whether or not the decision is taken to share. If the decision is to share, reasons should be cited including what information has been shared and with whom, in line with organisational procedures. If the decision is not to share, it is good practice to record the reasons for this decision and discuss them with the requester. Information should be kept In line with each organisation’s retention policy.

      What Information can I share?

      Share the information which is necessary for your purpose. It may not be necessary to give all agencies access to all the information you hold.  Make sure what you provide is up to date, accurate and relevant.  

      When and how to share information 

      When asked to share information, you should consider the following questions to help you decide if and when to share. If the decision is taken to share, you should consider how best to effectively share the information.

      When?

      Q: Is there a clear and legitimate purpose for sharing information? 

      • Yes – see next question
      • No – do not share information

      Q: Does the information enable an individual to be identified? 

      • Yes – see next question
      • No – you can share but should consider how

      Q: Is the information confidential? 

      • Yes – see next question
      • No – you can share but should consider how

      Q: Do you have consent? 

      • Yes – you can share but should consider how
      • No – see next question

      Q: Is there another reason to share information such as to fulfil a public function or to protect the vital interests of the individual? 

      • Yes – you can share but should consider how
      • No – do not share

      Who?

      • Which agencies need to be involved in the sharing?
      • Who do we need information about in order to make the decision – child, parent, carer, others? Is it sensitive personal information?  Do we have their consent? 

      How?

      • Ensure you are giving the right information to the right person, and that it is shared securely.
      • Identify how much information to share
      • Distinguish fact from opinion
      • Ensure that you are giving the right information to the right person
      • Inform the individual that the information has been shared if they were not aware of this, as long as this would not create or increase risk of harm

      Consent to Share Information

      Check you have consent from all people whose information is to be shared unless the safeguarding concerns put the child at risk of significant harm or would prevent the child from being harmed. Ensure information shared is relevant and proportionate.

      Agencies should be advised where possible to obtain consent before referring a case to the MASH Service. If this happens, individuals will have an understanding and expectation of how their information is going to be used, with whom and why. Where consent has not been obtained, reasons for this will be documented on both the agency and MASH records. 

      Where sensitive personal information is being shared explicit consent is expected, this may be written e.g. consent form or a clear record of verbal consent obtained stating the date, time and what information is to be held/shared.  

      In some cases, the work of the MASH might be obstructed if Partners were to seek consent. In such cases the disclosing Partner must consider other lawful basis for processing the information.

      The decision whether or not to share information must be recorded by each partner agency.

      Consider the following before sharing information - if in doubt seek advice from a manager

      Consent  

      Do you have consent to share this information for this purpose? Consent is particularly important for sensitive personal information. The Privacy Notice (a statement that indicates consent to hold and share information see consent form) relating to the collection of information should identify the purposes for which it was collected. Does this say it would be shared? Otherwise consent should be obtained wherever possible before sharing information. 

      Partial Consent

      Where consent has been given to share information with some, but not all, agencies, does this include the agency you want to share it with?  If you do have consent, then the paragraph above applies.  If you do not have consent, then the paragraph below applies.

      Sharing without consent

      If you are not seeking consent, the reason must be proportionate and you must weigh up the important legal duty to seek consent and the damage that might be caused by sharing the information. This should be balanced against the type and extent of any harm that might be caused (or not prevented) by seeking consent. It is good practice to obtain consent before sharing information.  If consent is not obtained, the decision should always be reasonable, necessary and proportionate, and should always be recorded together with the rationale.

      If the need to share is urgent, and seeking consent will lead to unjustified delay in making enquiries about allegations of significant harm to a child, or if safeguarding is paramount, take immediate action and share the information without consent, but remember to record the reason for the decision.

      Sharing information when consent has been refused

      There may be times when consent is sought and refused. This does not mean that information cannot be shared. The refusal of consent should be considered in conjunction with other concerns and, if it is considered justifiable, then information can and MUST be shared. If professionals consider it justifiable to override the refusal in the interests of the welfare of the child then they can do so. This decision must be proportionate to the harm that may be caused by proceeding without consent.

      Public Interest

      It is possible to disclose personal information without consent if this is in the defined category of “Public Interest”. The principles of the DPA [Section 2 above] would still apply in such cases.

      The Public Interest Criteria include the:

      • Protection of vulnerable members of the community
      • Administration of justice
      • Maintaining of public safety
      • Apprehension of offenders
      • Prevention of crime and disorder
      • Detection of crime
      • Protection of vulnerable members of the community

      When judging the public interest, it is necessary to consider the following:

      • Is the intended disclosure proportionate to the intended aim?
      • What is the vulnerability of those who are at risk?
      • What is the impact of disclosure likely to be on the individual to whom the shared information pertains?
      • Is there another equally effective means of achieving the same aim?
      • Is the disclosure necessary to prevent or detect crime and uphold the rights and freedoms of the public?
      • Is it necessary to disclose the information, to protect others?

      The rule of proportionality should be applied to ensure that a fair balance is achieved between the public interest and the rights of the individual’s information.

      What is the Legal Framework that supports information sharing? +

      The main legal framework relating to the protection of personal information is set out in:

      There is no general power to obtain, hold or process information and there is no statutory power to share information. Where information is held it should be processed in accordance with the Data Protection Act principles.

      However, some Acts of Parliament do give statutory public bodies express or implied statutory powers to share information under some circumstances. There are a number of pieces of legislation. Some of these are relevant to all members of the Family Safeguarding Teams. Others relate to specific organisations.

      Legislation allows the lawful sharing of personal information and is covered in this guide using the following legislative frameworks.

      Working Together 2018 states that:-

      1. Effective sharing of information between practitioners and local organisations and agencies is essential for early identification of need, assessment and service provision to keep children safe.  Serious Case Reviews (SCRs) have highlighted that missed opportunities to record, understand the significance of and share information in a timely manner can have severe consequences for the safety and welfare of children.
      2. Practitioners should be proactive in sharing information as early as possible to help identify, assess and respond to risks or concerns about the safety and welfare of children, whether this is when problems are first emerging, or where a child is already known to local authority Children's Social Care (e.g. they are being supported as a child in need or have a child protection plan).  Practitioners should be alert to sharing important information about any adults with whom that child has contact, which may impact the child's safety or welfare.
      3. Information sharing is also essential for the identification of patterns of behaviour where a child has gone missing, where multiple children appear associated to the same context or locations of risk, or in relation to children in the secure estate where there may be multiple local authorities involved in a child's care.  It will be for local safeguarding partners to consider how they will build positive relationships with other local areas to ensure that relevant information is shared in a timely and proportionate way.
      4. Fears about sharing information must not be allowed to stand in the way of the need to promote the welfare, and protect the safety, of children, which must always be the paramount concern.  To ensure effective safeguarding arrangements:
      • All organisations and agencies should have arrangements in place that set out clearly the processes and the principles for sharing information.  The arrangement should cover how information will be shared within their own organisation/agency and with others who may be involved in a child's life.
      • All practitioners should not assume that someone else will pass on information that they think may be critical to keeping a child safe.  If a practitioner has concerns about a child's welfare and considers that they may be a child in need or that the child has suffered or is likely to suffer significant harm, then they should share the information with local authority children's social care and/or the police.  All practitioners should be particularly alert to the importance of sharing information when a child moves from one local authority to another, due to the risk that knowledge pertinent to keeping a child safe could be lost.
      • All practitioners should aim to gain consent to sharing information, but should be mindful of situations where to do so would place a child at increased risk of harm.  Information may be shared without consent if a practitioner has reason to believe that there is a good reason to do so, and that the sharing of information will enhance the safeguarding of a child in a timely manner.  When decisions are made to share or withhold information, practitioners should record who has been given the information and why.
      1. Practitioners must have due regard to the relevant data protection principles which allow them to share personal information, as provided for the Data Protection Act 2018 and the General Data Protection Regulation (GDPR).  To share information effectively:
      • all practitioners should be confident of the processing conditions under the Data Protection Act 2018 and the GDPR which allow them to store and share information for safeguarding purposes, including information which is sensitive and personal, and should be treated as 'special category personal data'.
      • Where practitioners need to share special category personal data, they should be aware that the Data Protection Act 2018 contains safeguarding of children and individuals at risk as a processing condition that allows practitioners to share information.  This includes allowing practitioners to share information without consent, if it is not possible to gain consent.  It cannot be reasonably expected that a practitioner gains consent, or if to gain consent would place a child at risk

      Myth Busting Guide

      Sharing information enables practitioners and agencies to identify and provide appropriate services that safeguard and promote the welfare of children.  Below are common myths that may hinder effective information sharing:-

      Data Protection legislation is a barrier to sharing information

      1. NO. The Data Protection Act 2018 and GDPR do not prohibit the collection and sharing of personal information, but rather provides a framework to ensure that personal information is shared appropriately.  In particular, the Data Protection Act 2018 balances the rights of the information subject (the individual whom the information is about) and the possible need to sharing information about them.

      Consent is always needed to share personal information

      NO      You do not necessarily need consent to share personal information.  Wherever possible, you should seek consent and be open and honest with the individual from the outset as to why, what, how, and with whom, their information will be shared.  You should seek consent where an individual may not expect their information to be passed on.  When you gain consent to share information, it must be explicit, and freely given.  There may be some circumstances where it is not appropriate to seek consent, or because to gain consent would put a child’s or young person’s safety at risk.

      Personal information collected by one organisation / agency cannot be disclosed further

      NO      This is not the case, unless the information is to be used for a purpose incompatible with the purpose to which it was originally collected.  In the case of children in need, or children at risk of significant harm, it is difficult to foresee circumstances where information law would be a barrier to sharing personal information with other practitioners.  Practitioners looking to share information should consider which processing condition in the Data Protection Act 2018 is most appropriate for use in the particular circumstances of the case.  This may be the safeguarding processing condition or another relevant provision.

      The common law duty of confidence and the Human Rights Act 1998 prevent the sharing of personal information

      NO      This is not the case.  In addition to the Data Protection Act 2018 and GDPR, practitioners need to balance the common law duty of confidence and the Human Rights Act 1998 against the effect on individuals and others of not sharing the information.

      IT systems are often a barrier to effective information sharing

      NO      IT systems, such as the Child Protection Information Sharing project (CP_IS), can be useful for information sharing.  IT systems are most valuable when practitioners use the shared data to make more informed decisions about how to support and safeguard a child.

      Data Protection Act 2018

      Everyone responsible for using personal data has to follow strict rules called ‘data protection principles’. They must make sure the information is:

      • used fairly, lawfully and transparently
      • used for specified, explicit purposes
      • used in a way that is adequate, relevant and limited to only what is necessary
      • accurate and, where necessary, kept up to date
      • kept for no longer than is necessary
      • handled in a way that ensures appropriate security, including protection against unlawful or unauthorised processing, access, loss, destruction or damage

      There is stronger legal protection for more sensitive information, such as:

      • race
      • ethnic background
      • political opinions
      • religious beliefs
      • trade union membership
      • genetics
      • biometrics (where used for identification)
      • health
      • sex life or orientation

      There are separate safeguards for personal data relating to criminal convictions and offences.

      Data Protection Act (DPA) 2018: The principles of the DPA 2018 provide a framework within which to consider the lawful basis for sharing information under this agreement.  Data Protection Act Key Principles can be read by CLICKING HERE or viewed on Appendix A at the end of this page.

      Each partner agency may have a different reason for holding and processing the information it needs to fulfil its legal duties. Some common considerations have been included here, but it is impossible to cover all possible situations.  Partner agencies must obtain their own assurance and be satisfied that they have a lawful basis for sharing the information they hold.

      DPA Section 29 This section provides certain exemptions when personal information is used for the prevention and detection of crime and/or for the apprehension and prosecution of offenders.  For example, telling individuals how their information will be processed or shared could prejudice the purpose. Note that information processed for this purpose is exempt from disclosure in response to a Subject Access Request.

      Children Act 2004

      Sections 10 and 11 of the Children Act 2004 place obligations upon agencies including local authorities, police, clinical commissioning groups and NHS England to co-operate with other partners in promoting the welfare of children and ensuring that they act safeguard and promote the welfare of children in their area.

      Well‐being is defined by the Act as relating to a child’s:

      • Physical and mental health and emotional well‐being
      • Protection from harm and neglect
      • Education, training and recreation
      • The contribution made by them to society
      • Social and economic well‐being

      ‘Children’ in terms of the scope of this Act means those up to the age of eighteen.

      Children Act 1989

      For children and young people, the nature of the information that will be shared within the MASH may fall below a statutory threshold of Section 47 (children in need of protection) or even Section 17 (children in need of services).

      Crime and Disorder Act 1998

      Provides a legal basis for sharing information with a relevant authority where the disclosure is necessary or expedient for the purposes of any provision of the Crime and Disorder Act 1998. Relevant authorities include: Police, Probation, Local Authorities, CCGs and certain NHS statutory bodies

      Human Rights Act 1998

      Gives force to the European Convention on Human Rights and, amongst other things, places an obligation on public authorities to protect people’s “right to life” and “right to be free from torture or degrading treatment”. 

      There needs to be a balance between the desire to share and a person’s right to privacy under “the right to respect for private and family life, home and correspondence”.  The local authority cannot interfere with this right except such as is necessary in the interests of national security, public safety or for the prevention of disorder or crime, for the protection of health and wellbeing, or for the protection of the rights and freedoms of others.

      The Mental Capacity Act (MCA) 2005

      Under the Mental capacity Act 2005 staff are required to apply five principles in their assessments to decide whether to share information without consent in a person’s best interests.

      The MCA Code of Practice states that “it is important to balance people's right to make a decision with their right to safety and protection when they can't make decisions to protect themselves. The starting assumption must always be that an individual has the capacity, until there is proof that they do not”.

      Under the Mental Capacity Act 2005 there would have to be good reasons not to undertake an assessment of mental capacity regarding the decision to share information without consent.  These reasons would need to be documented carefully.

      Counter-Terrorism and Boarder Security Act 2019

      The Counter Terrorism and Security Act 2015 places a duty on “specified authorities” to have “due regard to the need to prevent people from being drawn into terrorism”. Specified authorities include County and District/Borough Councils, Schools; Police; National Probation Service and Community Rehabilitation Companies; NHS Trusts and NHS Foundation Trusts.  

      Prevent Duty Guidance

      The Prevent Strategy has three specific strategic 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; and
      • Work with sectors and institutions where there are risks of radicalisation that we need to address.

      There is an expectation that authorities will work in partnership and share information where appropriate, for example to ensure someone at risk of radicalisation is supported.  

      Duty of Confidence Information shared by agencies as part of the MASH assessment process may have been gathered where a Duty of Confidence is owed.  A duty of confidence arises when one person discloses information to another in circumstances where it is reasonable to expect that the information will not be further disclosed. Duty of Confidence is not an absolute bar to disclosure, as information can be shared where there is a strong enough public interest to do so. 

      When overriding the Duty of Confidence in the absence of consent, MASH must seek the views of the person representing the organisation that holds the Duty of Confidence and take these into account in relation to breaching the confidence. The originating Partner will be the final arbiter as to whether information is disclosed or not. The Partner may wish to seek specialist or legal advice if there is lack of clarity around justifiable disclosure of information. All disclosures must be relevant and proportionate to the intended aim of the disclosure and must be fully documented as an unjustified disclosure could lead to a claim for damages against the disclosing party.

      All staff must be particularly mindful of their professional and ethical obligations and the public interest of confidence in the confidentiality of their services. 

      It may be necessary to seek advice on professional conduct as well as legal advice before sharing information without consent, especially for information related to the treatment of mental illness. All staff should ensure the need to protect children takes into account the children’s rights as well as those of the adults concerned. Decisions will be reported to the MASH Executive Group for periodic review.

      Consent from a Young Person (Gillick / Fraser Competence extracts from the NSPCC +

      Gillick competency and Fraser guidelines help people who work with children to balance the need to listen to the children’s wishes with the responsibility to keep them safe.

      When practitioners are trying to decide whether a child is mature enough to make decisions about things that affect them, they often talk about whether the child is “Gillick competent” or whether they need the “Fraser guidelines”. 

      Although the two terms are frequently used together and originate from the same legal case, there are distinct differences between them. 

      Both Gillick competency and Fraser guidelines refer to a legal case from the 1980s which looked at whether doctors should be able to give contraceptive advice or treatment to young people under 16-years-old without parental consent.

      Applying Gillick competence and Fraser Guidelines

      The Fraser guidelines still apply to advice and treatment relating to contraception and sexual health.  But Gillick competency is often used in a wider context to help assess whether a child has the maturity to make their own decisions and to understand the implications of those decisions.  Practitioners should always encourage a child to tell their parents or carers about the decisions they are making.  If they don’t want to do this, you should explore why and, if appropriate, discuss ways you could help them inform their parents or carers.  For example, you could talk to the young person’s parents or carers on their behalf.

      If the young person still wants to go ahead without their parents’ or carers’ knowledge or consent, you should consider the Gillick and Fraser guidelines. 

      Gillick Competence

      Gillick competency applies mainly to medical advice but it is also used by practitioners in other settings.  For example, if a child or young person:-

      • Would like to have counselling or therapeutic support but doesn’t want their parents or carers to know about it.
      • Is seeking confidential support for substance misuse.
      • Has strong wishes about their future living arrangements which may conflict with their parents’ or carers’ views.

      Medical professionals need to consider Gillick competency if a young person under the age of 16 wishes to receive treatment without their parents’ or carers’ consent or, in some cases, knowledge.

      If the young person has informed their parents of the treatment they wish to receive but their parents do not agree with their decision, treatment can still proceed if the child has been assessed as Gillick competent.

      Assessing Gillick Competence

      There is not set of defined questions to assess Gillick competency.  Professionals need to consider several things when assessing a child’s capacity to consent, including:

      • The child’s age, maturity and mental capacity
      • Their understanding of the issue and what it involves – including advantages, disadvantages and potential long-term impact.
      • Their understanding of the risks, implications and consequences that may arise from their decision.
      • How well they understand any advice or information they have been given.
      • Their understanding of any alternative options, if available.
      • Their ability to explain a rationale around their reasoning and decision making.

      Remember that consent is not valid if a young person is pressured or influenced by someone else.

      Children’s capacity to consent may be affected by different factors, for example stress, mental health conditions and the complexities of the decision they are making.  The same child may be considered Gillick competent to make one decision but not competent to make a different decision.

      If you don’t think a child is Gillick competent or there are inconsistencies in their understanding, you should seek consent from their parents or carers before proceeding.

      In complex medical cases, such as those involving disagreements about treatment, you may wish to seek the opinion of a colleague about a child’s capacity to consent (Care Quality Commission 2019)

      Young people also have the right to seek a second opinion from another medical professional (General Medical Council, 2020).

      Refusal of Medical Treatment

      Gillick competency can be used when young people wish to use medical treatment.  However, if a young person refuses medical treatment which may lead to their death or severe permanent harm, their decision can be overruled.  More information about this is available in the Guidance for Medical Professionals in each UK nation – see case history and legislation on the NSPCC website.

      Child Protection Concerns

      The child’s safety and wellbeing is paramount. 

      When you are assessing Gillick competency if you have any concerns about the safety of the young person you should check whether previous child protection concerns have been raised, and explore any factors that could put them at risk of abuse.

      You must always share child protection concerns with the relevant agencies, even if this goes against a child’s wishes. (Find out more on Recognising & Responding to Abuse, NSPCC).

      Fraser Guidelines

      The Fraser guidelines apply specifically to advice and treatment about contraception and sexual health.  They may be used by a range of healthcare professionals when working with under 16 year-olds, including doctors and nurse practitioners.

      Following a legal ruling in 2006, Fraser guidelines can also be applied to advice and treatment for sexually transmitted infections and the termination of pregnancy (Axton v the Secretary of Stage for Health, 2006).

      Using the Fraser guidelines

      Practitioners using the Fraser guidelines should be satisfied of the following:

      • The young person cannot be persuaded to inform their parents or carers that they are seeking this advice or treatment (or to allow the practitioner to inform their parents or carers).
      • The young person understands the advice being given.
      • The young person’s physical or mental health (or both) are likely to suffer unless they receive the advice or treatment.
      • It is in the young person’s best interests to receive the advice, treatment or both without their parents’ or carers’ consent.
      • The young person is very likely to continue having sex with or without contraceptive treatment.

      Child Protection Concerns

      When using Fraser guidelines for issues relating to sexual health, you should always consider any potential child protection concerns:

      • Underage sexual activity is a possible indicator of child sexual exploitation and children who have been groomed may not realise they are being abused.
      • Sexual activity with a child under 13 should always result in a child protection referral.
      • If a young person presents repeatedly about sexually transmitted infections or the termination of pregnancy this may be an indicator of child sexual abuse or exploitation.

      Professionals should always consider any previous concerns that may have been raised about the young person and explore whether there are any factors that may present a risk to their safety and wellbeing.

      You must always share child protection concerns with the relevant agencies, even if a child or young person asks you not to.

      Appendix 1 – Data Protection Act 2018 Principles of Information Sharing +

      CHAPTER 2 Principles Overview and general duty of controller

      (1)This Chapter sets out the six data protection principles as follows—

      (a) section 35(1) sets out the first data protection principle (requirement that processing be lawful and fair);

      (b) Section 36(1) sets out the second data protection principle (requirement that purposes of processing be specified, explicit and legitimate);

      (c) Section 37 sets out the third data protection principle (requirement that personal data be adequate, relevant and not excessive);

      (d) Section 38(1) sets out the fourth data protection principle (requirement that personal data be accurate and kept up to date);

      (e) Section 39(1) sets out the fifth data protection principle (requirement that personal data be kept for no longer than is necessary);

      (f) Section 40 sets out the sixth data protection principle (requirement that personal data be processed in a secure manner).

      (2) In addition—

      (a) Each of sections 35, 36, 38 and 39 makes provision to supplement the principle to which it relates, and

      (b) Sections 41 and 42 make provision about the safeguards that apply in relation to certain types of processing.

      (3) The controller in relation to personal data is responsible for, and must be able to demonstrate, compliance with this Chapter.

      The first data protection principle

      (1) The first data protection principle is that the processing of personal data for any of the law enforcement purposes must be lawful and fair.

      (2) The processing of personal data for any of the law enforcement purposes is lawful only if and to the extent that it is based on law and either—

      (a) The data subject has given consent to the processing for that purpose, or

      (b) The processing is necessary for the performance of a task carried out for that purpose by a competent authority.

      (3) In addition, where the processing for any of the law enforcement purposes is sensitive processing, the processing is permitted only in the two cases set out in subsections (4) and (5).

      (4) The first case is where—

      (a) The data subject has given consent to the processing for the law enforcement purpose as mentioned in subsection (2)(a), and

      (b) At the time when the processing is carried out, the controller has an appropriate policy document in place (see section 42).

      (5) The second case is where—

      (a) The processing is strictly necessary for the law enforcement purpose,

      (b) The processing meets at least one of the conditions in Schedule 8, and

      (c) At the time when the processing is carried out, the controller has an appropriate policy document in place (see section 42).

      (6) The Secretary of State may by regulations amend Schedule 8—

      (a) By adding conditions;

      (b) By omitting conditions added by regulations under paragraph (a).

      (7) Regulations under subsection (6) are subject to the affirmative resolution procedure.

      (8) In this section, “sensitive processing” means—

      (a) The processing of personal data revealing racial or ethnic origin, political opinions, religious or philosophical beliefs or trade union membership;

      (b) The processing of genetic data, or of biometric data, for the purpose of uniquely identifying an individual;

      (c) The processing of data concerning health;

      (d) The processing of data concerning an individual’s sex life or sexual orientation.

      The second data protection principle

      (1)The second data protection principle is that—

      (a) The law enforcement purpose for which personal data is collected on any occasion must be specified, explicit and legitimate, and

      (b) Personal data so collected must not be processed in a manner that is incompatible with the purpose for which it was collected.

      (2) Paragraph (b) of the second data protection principle is subject to subsections (3) and (4).

      (3) Personal data collected for a law enforcement purpose may be processed for any other law enforcement purpose (whether by the controller that collected the data or by another controller) provided that—

      (a) The controller is authorised by law to process the data for the other purpose, and

      (b) The processing is necessary and proportionate to that other purpose.

      (4) Personal data collected for any of the law enforcement purposes may not be processed for a purpose that is not a law enforcement purpose unless the processing is authorised by law.

      The third data protection principle

      The third data protection principle is that personal data processed for any of the law enforcement purposes must be adequate, relevant and not excessive in relation to the purpose for which it is processed.

      The fourth data protection principle

      (1) The fourth data protection principle is that—

      (a) Personal data processed for any of the law enforcement purposes must be accurate and, where necessary, kept up to date, and

      (b) Every reasonable step must be taken to ensure that personal data that is inaccurate, having regard to the law enforcement purpose for which it is processed, is erased or rectified without delay.

      (2) In processing personal data for any of the law enforcement purposes, personal data based on facts must, so far as possible, be distinguished from personal data based on personal assessments.

      (3) In processing personal data for any of the law enforcement purposes, a clear distinction must, where relevant and as far as possible, be made between personal data relating to different categories of data subject, such as—

      (a) Persons suspected of having committed or being about to commit a criminal offence;

      (b) Persons convicted of a criminal offence;

      (c) Persons who are or may be victims of a criminal offence;

      (d) Witnesses or other persons with information about offences.

      (4) All reasonable steps must be taken to ensure that personal data which is inaccurate, incomplete or no longer up to date is not transmitted or made available for any of the law enforcement purposes.

      (5) For that purpose—

      (a) The quality of personal data must be verified before it is transmitted or made available,

      (b) In all transmissions of personal data, the necessary information enabling the recipient to assess the degree of accuracy, completeness and reliability of the data and the extent to which it is up to date must be included, and

      (c) If, after personal data has been transmitted, it emerges that the data was incorrect or that the transmission was unlawful, the recipient must be notified without delay.

      The fifth data protection principle

      (1) The fifth data protection principle is that personal data processed for any of the law enforcement purposes must be kept for no longer than is necessary for the purpose for which it is processed.

      (2) Appropriate time limits must be established for the periodic review of the need for the continued storage of personal data for any of the law enforcement purposes.

      The sixth data protection principle

      The sixth data protection principle is that personal data processed for any of the law enforcement purposes must be so processed in a manner that ensures appropriate security of the personal data, using appropriate technical or organisational measures (and, in this principle, “appropriate security” includes protection against unauthorised or unlawful processing and against accidental loss, destruction or damage).

      Safeguards: archiving

      (1) This section applies in relation to the processing of personal data for a law enforcement purpose where the processing is necessary

      (a) For archiving purposes in the public interest,

      (b) For scientific or historical research purposes, or

      (c) For statistical purposes.

      (2) The processing is not permitted if—

      (a) It is carried out for the purposes of, or in connection with, measures or decisions with respect to a particular data subject, or

      (b) It is likely to cause substantial damage or substantial distress to a data subject.

      42Safeguards: sensitive processing

      (1) This section applies for the purposes of section 35(4) and (5) (which require a controller to have an appropriate policy document in place when carrying out sensitive processing in reliance on the consent of the data subject or, as the case may be, in reliance on a condition specified in Schedule 8).

      (2) The controller has an appropriate policy document in place in relation to the sensitive processing if the controller has produced a document which—

      (a) Explains the controller’s procedures for securing compliance with the data protection principles (see section 34(1)) in connection with sensitive processing in reliance on the consent of the data subject or (as the case may be) in reliance on the condition in question, and

      (b) Explains the controller’s policies as regards the retention and erasure of personal data processed in reliance on the consent of the data subject or (as the case may be) in reliance on the condition in question, giving an indication of how long such personal data is likely to be retained.

      (3) Where personal data is processed on the basis that an appropriate policy document is in place, the controller must during the relevant period—

      (a) Retain the appropriate policy document,

      (b) Review and (if appropriate) update it from time to time, and

      (c) Make it available to the Commissioner, on request, without charge.

      (4) The record maintained by the controller under section 61(1) and, where the sensitive processing is carried out by a processor on behalf of the controller, the record maintained by the processor under section 61(3) must include the following information—

      (a) Whether the sensitive processing is carried out in reliance on the consent of the data subject or, if not, which condition in Schedule 8 is relied on,

      (b) How the processing satisfies section 35 (lawfulness of processing), and

      (c) Whether the personal data is retained and erased in accordance with the policies described in subsection (2)(b) and, if it is not, the reasons for not following those policies.

      (5) In this section, “relevant period”, in relation to sensitive processing in reliance on the consent of the data subject or in reliance on a condition specified in Schedule 8, means a period which—

      (a) Begins when the controller starts to carry out the sensitive processing in reliance on the data subject’s consent or (as the case may be) in reliance on that condition, and

      (b) Ends at the end of the period of 6 months beginning when the controller ceases to carry out the processing.

      Appendix 2 – Information Sharing Flow Chart +

      information sharing flow chart - June 2023

      Keeping Babies Safe

      We aim to raise awareness and encourage discussions with parents and care givers around safe sleeping arrangements and preventing injuries in babies.  Even if this is not your service target age group, good practice suggests that where we notice a pregnant mother or infant of 0-2 we have an opportunity to talk about keeping babies safe.  

      Please also see our Parents Safe Sleep Advice Page (information provided  by the Lullaby Trust).  This is transferable to all known languages using the Google Language tool at the top of the website.

      Preventing Sudden Unexplained Death in Infancy (SUDI) +

      A number of Child Safeguarding Practice Reviews centre around infants aged 0-2 years who have died by way of Sudden Unexplained Death in Infancy (SUDI).

      Safe Sleep for Babies

      Preventing Sudden Infant Death Syndrome / Sudden Unexplained Death in Infants

      230 SIDS claims the lives of approximately 230 babies every year in the UK

      14 Babies died with an initial diagnosis of SUDI in Bexley, Greenwich and Lewisham between December 2020 and December 2022.

      These are previously healthy babies - please help prevent the tragic deaths of children by making sure you know the Key Facts when discussing safe sleeping with parents

      Below provides some insight to SUDI Deaths and their Associated Risk Factors in Lewisham from 2008 to 2022, with the Tri-Borough numbers being included from October 2019.

      • 24 Boys and 11 Girls have died of Sudden Unexpected Death in Infancy (SUDI) / Sudden Infant Death Syndrome (SIDS) since 2008
      • Room temperature above 20 °C was noted in 79% of cases where room temperature was measured.
      • Room temperature was not being measured routinely in a high number of earlier SUDI’s, though that has now been rectified. In the 19 SUDI cases where room temperature was measured, 15 found a room temperature of above 20 °C.  (the recommended temperature is between 16-20 °C)
      • Poverty / Overcrowding (57%)
      • Excess Bedding-pillows, duvets (53%)
      • Bed sharing with at least 1 other risk factor (48%)
      • Parental Smoking (37%)
      • Baby put to sleep or found on side or prone position (32%)
        • The number of babies laid to sleep on their side or prone has increased in the last year
      • Low birth rate of under 2.5kgs (26%)
      • Parental Alcohol (20%)
      • Language and Communication Issues, Learning Disability / Ability. (17%)
      • Pre-Term Baby <37 weeks gestation. (17%)
      • Mother is 20 years old or younger. (14%)
      • Sofa Sleeping (9%)
      • Parental use of Cannabis (6%)
      • No cases of SUDI when mother was exclusively breastfeeding and bed sharing with no other risk factors.

      Tri-Borough Public Health : Key Facts

      Things parents can do to help prevent SUDI/SIDS:

      Things to avoid:

      green check mark image

      Always place baby on their back to sleep-if they roll on to tummy, move them back

      red arrow image

      Avoid letting your baby get too hot. The room temperature should be between 16-20 degrees. If your baby is sweating or their tummy feels hot to the touch, take off some of the bedding or clothing.

      green check mark image

      Breastfeed your baby if you can as breastfeeding is highly protective

      red arrow image

      Never sleep on a sofa or armchair with your baby-this is particularly unsafe and significantly increases the risk of a SUDI death

      green check mark image

      Keep your home and therefore your baby smoke free in pregnancy and afterwards

      red arrow image

      Don’t cover your baby’s face or head whilst sleeping

      green check mark image

      Place your baby to sleep in a separate cot or Moses basket in the same room as you for the first six months.

      red arrow image

      Don’t sleep in the same bed as your baby if either of you have smoked, have been drinking any alcohol, have taken drugs, are extremely tired or if your baby was born prematurely or was of low birth-weight (under 5lbs 8oz)

      green check mark image

      Place your baby in the "feet to foot" position (with their feet at the end of the cot or Moses basket)

      red arrow image

      Parents/carers smoking increase risks to babies and children-ask Midwife/Health Visitor/GP/online for support to quit

      green check mark image

      Use a firm, flat waterproof mattress in good condition-remove any plastic covering

      red arrow image

      Remove all pillows, duvets, cot bumpers and soft toys from the cot and sleeping area

      green check mark image

      If you are planning to visit friends/relatives or stay away from home, make a plan as to how you will keep the baby’s sleep area safe

      Check Understanding!

      demonstrate, not just articulate

      We have had a significant number of deaths in cases where either the mother speaks and understands limited English or where she is dyslexic or described as having a, ‘mild learning disability’.

      • It is important to use an interpreter when discussing safe sleep if English is not a parents first language.
      • Consideration should also be given if the mother or father has information processing issues, ask her/him to show you and explain back to you how to sleep the baby safely.
      • You can use the LSCP Safe Sleep for Babies web page,   The website can be transferred into all known languages and can be a useful tool.

      There are good resources for parents, including visual aids and information in 16 different languages on the following website www.lullabytrust.org.uk

      Professionals working with new or expectant  parent(s) should be mindful of the impact of  financial pressures on family budgets (poverty, low income, cost of living increases, child care costs) and how this may impact on the parent(s) ability to accesses equipment for babies.  

      All agencies should consider what resource’s they can access to support families who need help to get necessary baby equipment,this can include direct support or referring to other organisations including the voluntary sector.   

      Resources for parents who may need support or equipment for their baby 

      1. Parents who need extra support can obtain a free thermometer from their Midwife.
      2. The Lewisham Donation Hub, Unit D Place Ladywell, 261 Lewisham High Street, SE13 6AY Lewisham Donation Hub – Supporting our community since 2020
      3. Little Village. the referral must be made by a professional Home - Little Village (littlevillagehq.org)
      4. Apply to BBC Children in Need fund Grants - BBC Children in Need
      5. Home - Buttle UK

      Awareness Resources / Posters to Support the Campaign

      To support the Keeping Babies Safe Campaign, the LSCP have developed a public facing Safe Sleep poster for partners to place in prominent areas.  You can download the LSCP Poster HERE.  

      Additionally, the Lullaby Trust have a series of public facing posters that can be placed in public facing areas.  Please use as many as you can, or rotate them periodically. 

      For more resources of leaflets, easy read cards and posters visit www.lullabytrust.org.uk

      Safer sleep for babies flyer

      Preventing Non-Accidental Injuries and Shaken Baby Syndrome in Infant Years +

      A father\'s statement

      Overview

      A number of Child Safeguarding Practice Reviews centre around infants aged 0-2 years, who have died or suffered significant harm, by way of non-accidental injury / shaken baby. 

      Over recent years, the Tri-Borough have identified a number of children who have attended A&E where either of these have been a factor.

      Additionally, in relation to this the NSPCC have also published a report “The Myth of Invisible Men: Safeguarding children under 1 from non-accidental injury caused by male carers”.

      We aim to raise awareness and encourage discussions with parents and carers around coping with crying and non-accidental injuries to infants. 

      ICON logo large

      Parents & Carers can download the ICON Cope Application on their App Store / Google Play Store on their device(s)

      Awareness Resources / Posters

      ICON have a series of public facing posters.  Please use as many as you can, or rotate them periodically.

      For more resources of leaflets, easy read cards and posters visit www.iconcope.org

      The Myth of Invisible Men: Safeguarding children under 1 from non-accidental injury caused by male carersKEY FINDINGS

      • Perinatal neonaticides (homicides within 24hrs of birth) are almost exclusively perpetrated by birth mothers.
      • Between 2000 and 2015 in England and Wales, 122 babies were killed by fathers (11 of these by step-fathers) giving an average of eight infants per year killed. Of these, 31 died as a consequence of shaking.
      • In the only UK analysis we found, covering convicted homicides in England and Wales over the period 1997-2006, infants were more likely to be killed by a father (as the main perpetrator) than by a mother in the approximate ratio 2:1.9
      • Biological fathers are more likely to kill infants than stepfathers in ratios ranging from 5:1 to 26.1 in the first year of life in the UK, USA, Australia and New Zealand.
      • The ratio of biological fathers to ‘stepfathers’ (including mothers’ non-cohabiting and short-term partners) where babies have been killed in England and Wales is 10:1. This increases to 15:1 when shaking is the cause of death.
      • However, when factoring in the very small proportion of infants with a stepfather, the evidence suggests that stepfathers are associated with greater risk than birth fathers. The numbers are lower but the risks are greater.
      • The ratio of biological fathers to ‘stepfathers’ evened out or reversed for father-perpetrated homicide of older babies and pre-school children aged 1 to 5 years in England and Wales.
      • When the research scope was broadened to look at non-fatal NAI, a clear picture emerges. Fathers outnumbered mothers as perpetrators of identified abuse head trauma (AHT), and this is a consistent finding in international data with the fathers to mothers ratio ranging from 2:1 to 10:1.
      • There is also noteworthy data about the gender of babies abused. A consistent and well-evidenced finding from the literature review is that sons are more likely than daughters to be victims of father-perpetrated NAI. The one large international study that includes this data found that boys outnumbered girl victims 56% to 44%; even where mothers had been the identified perpetrator, boys were more likely to be victims than girls (53% boys compared to 47% girls).
      • In the cohort of cases for this review, 57% were boys and 43% were girls. In the much smaller sample of men that were interviewed boy victims outnumbered girls 2:1. At this stage, and without further research, it is not possible to draw any specific conclusions, but the difference is of note and warrants further enquiry.

          Concealed Pregnancy +

          A concealed pregnancy is when a woman knows she is pregnant but does not tell any agency / professional; or when she tells another professional but conceals the fact that she is not accessing antenatal care; or when a pregnant woman tells another person or persons and they conceal the fact from all health agencies.

          Where there is a strong suspicion of a concealed pregnancy it is necessary to share this, irrespective of whether consent has been given, with other agencies known to have involvement with the mother so that a fuller assessment of the available information and observations can be made.

          Risks

          The potential risks to a baby through the concealment of a pregnancy are difficult to predict and wide-ranging.  One key implication is that there is no obstetric history or record of antenatal care prior to the birth of the baby. 

          Some women may present late for booking (after 24 weeks of pregnancy) and these pregnancies need to be closely monitored to assess future engagement with health professionals, particularly midwives and whether or not referral to another agency is indicated. 

          In a case of denied pregnancy the effects of going into labour and giving birth can be traumatic.

          The reason for the concealment will be a key factor in determining the risk to the child and that reason will not be known until there has been a systemic multi-agency assessment / Pre-Birth Assessment.

          Possible implications

          • Concealed pregnancy can lead to a fatal outcome (for both mother and/or baby), regardless of the mothers intention. The lack of antenatal care can mean that any potential risks to mother and baby may not be detected.
          • Concealment may indicate uncertainty towards the pregnancy, immature coping styles and a tendency to disassociate, all of which are likely to have a significant impact on bonding and parenting capacity.
          • An unassisted delivery can be dangerous for both mother and baby, due to complications that can occur during labour and delivery.
          • Lack of maternal willingness / ability to consider the baby’s health needs, or lack of emotional attachment to the child following birth.
          • Where concealment is a result of alcohol or substance misuse there can be risks for the child’s health and development in utero as well as subsequently.
          • There may be implications for the mother revealing a pregnancy due to fear of the reaction of family members or members of the community.

          When concealment is revealed

          • In some circumstances, agencies or individuals are able to anticipate the likelihood of Significant Harm with regard to an expected baby which must be addressed as early as possible to maximise time for full assessment, enabling a healthy pregnancy and supporting parents so that (where possible) they can provide safe care.
          • The circumstances leading to a concealed pregnancy need to be explored individually as there may be potentially serious child protection outcomes as a result of a concealed pregnancy and a detailed interagency assessment should be undertaken.

          All agencies should ensure that information about the concealment is shared with other relevant agencies, to ensure its significance is not lost and to ensure that potential future risks can be fully assessed and managed.

          Pre-Birth Assessments

          • Where agencies or individuals anticipate that perspective parents may need support services to care for their baby or that the baby may have suffered, or likely to suffer, significant harm, a referral to the local authority children’s social care must be made as soon as the concerns are identified. See Responding to Concerns of Abuse and Neglect Procedure, Potential risk to an unborn child.
          • The importance of conducting pre-birth assessments has been highlighted by numerous research studies and case / practice reviews which have shown that children are most at risk of fatal and severe assaults in the first year of life, usually inflicted by their carer givers.
          • It is important to consider the circumstances of BOTH prospective parents, not just the mother. Where possible, information should be obtained directly from each perspective parent rather than relying on a third party account.

          Circumstances which might indicate an increased risk

          • A child has previously sustained non-accidental injuries in the care of either parent / carer (this includes sudden, unexpected death of a child where safeguarding concerns were raised).
          • Previous children have been removed from the care of the parent(s) either by a private arrangement or by a court order.
          • A child in the household is the subject of a Child In Need or Child Protection Plan, or is a Looked After Child.
          • Either parent is the subject of a Child in Need or Child Protection Plan, or is a Looked After Child or Care Leaver.
          • The mother is a child under the age of 16 who is found to be pregnant.
          • A parent or another adult in the household, or regular visitor, has been identified as posing a risk to children.
          • There is concerns about the parent(s) ability to protect the baby.
          • There are concerns regarding domestic violence and abuse.
          • Either or both parents have mental health problems that might impact on the care of a child.
          • Either or both parents have a learning disability that might impact on the care of the child.
          • Either or both parents abuse substances, alcohol or drugs.
          • Any other concerns exist that the baby may be at risk of Significant Harm, including a parent previously suspected of fabricating or inducing illness in a child.
          • If the pregnancy is denied or concealed.

          This list is not exhaustive, and professionals will need to apply their professional judgement.

          Key Resources

          NB: all LSCP website pages are transferable to all known languages.  Please select the language from the front page.  (RSS feeds G Select Language)

          Lewisham Threshold Document - Continuum of Need (2023-25)

          This document sets out our approach to keeping children safe and protected, and underpins our local vision to provide the right support for children in Lewisham, at the earliest opportunity. This document is aligned to the London Safeguarding Children: Threshold Document: Continuum of Help and Support.

          Lewisham Threshold - Continuum of Need known as \'The Windscreen\'

          In Lewisham we know that the majority of children, young people and their families can be supported through a range of universal services. These services include education, early years, health, housing, and services provided by voluntary organisations. However, some children have more complex needs and may require access to specialist and/or targeted services to support them.  

          As safeguarding partners, the Lewisham Safeguarding Children Partnership is required to publish a local threshold document that sets out our criteria for providing effective help and support to children, young people, their parent/s families and carers. Our approach to promoting welfare, safeguarding and child protection is based on the London Continuum of Need, which outlines four levels of need. In Lewisham, we recognise, that levels of need are
          not rigid and should be considered as a continuum with flexibility across all levels to ensure our children and young people receive the correct help at the earliest opportunity, and at the right level to help them meet their full potential.

          This document provides a framework to support all professionals and agencies who work with children and young people, from or in the Borough of Lewisham, to identify when help or protection is needed through a graduated response from universal, early help, targeted early help or specialist and statutory services. Its purpose is to develop shared guidance and understanding that sets out the local partnership arrangements for the planning and
          provisional of services.

          The document should be read alongside statutory guidance and the framework for supporting children in need as outlined in the London Safeguarding Children: Threshold Document: Continuum of Help and Support. This was published and updated by the London Safeguarding Children Partnership in February 2023, and provides a Threshold - Continuum of Need Matrix to consider specific indicators.

          NB. Agencies in the London Borough of Lewisham should also comply with additional LSCP local protocols and practice guidance that are published on the LSCP website.

          Lewisham Threshold Document - Continuum of Need (2023-25)

          Multi-Agency Child Exploitation (MACE) Strategy & Resources

          It is recognised that procedures and systems developed to safeguard children and young people from risks within the home environment or family can be less effective in addressing extra familial harm. In the last decade Local Authorities began to introduce MACE (multiagency sexual exploitation panels) and many police forces introduced Child Sexual Exploitation (CSE) Teams .

          The MACE panel’s focused on CSE and were introduced in response to  learning form a number of  serious case reviews concerning children that had suffered significant harm due to being sexually exploited. As adolescent safeguarding practice developed over the last  decade, professionals, agencies and the public developed a greater awareness of how extra familiar harm impacted on children and young people.  The multi-faceted nature of adolescent risk became apparent to Local Authorities and safeguarding partners, in addition to child sexual exploitation it was recognised that children & young people were also at risk of criminal exploitation, youth violence and online exploitation. Agencies began to learn more about specific forms of exploitation such as county lines. 

          In response to the changing nature of extra familial harm, many Local Authorities across the country began to expand the remit of their MACE panels to cover all forms of child criminal exportation. This development happened at the local level, while there was a common theme of including all forms of extra familial harm, each Local Authority across London developed slightly different processes and procedures, for example Lewisham introduced the Concern Hub in 2019.

          There was an expansion of MACE style panels across London following a review in 2020, London wide guidance (2021) was issued and recommended that Local Authorities set up MACE (multi-agency child exploitation) panels and structures. The London guidance recognises that Local Authorities need to respond to local challenges and issues, however provides some common guidance and structure. This will provide some cross Borough consistency and is particularly welcomed by agencies who operate across a number of London Boroughs.

          New MACE arrangement for Lewisham

          In response to London guidance, the Lewisham partnership reviewed our local arrangements (Concern Hub). In January 2022 we started to transition from the Concern Hub model to a MACE structure based on the new London guidance. In order to ensure that we develop a MACE structure which met Lewisham’s specific needs the partnership has taken an agile approach to the development and implementation Lewisham’s MACE.  

          The Lewisham MACE provides a strategic, tactical and operational response to extra familial harm to children and young people across   Lewisham. The definition of extra familial the purpose MACE includes sexual exploitation, criminal exploitation, county lines, serious youth violence and harmful sexual behaviour. The strategic approach  to exploitation in Lewisham encompasses 4 key strands  Pursue , Prevent, Protect and Restore.  In developing a Lewisham MACE, the partnership has taken into account some of the unique and innovative aspects that the Concern Hub embodied. The Lewisham MACE considered young people up to the age of 25 and maintains a strong focus on community safety and addressing serious youth violence.

          The MACE terms of reference and procedures were signed off by the LSCP executive in August 2022 and are in the final stages of implementation. 

          MACE Structure

          The partnership have developed a 3 tiered MACE structure, to support partnership working across key agencies to address the multifaceted nature of extra familial harm to children and young people within the local context.

          1. Pre—MACE, This is a bi-weekly operational meeting co-chaired by police and children social care. The purpose is to review referrals, ensure appropriate safeguarding with the MACE risk rating. The pre-mace identifies high risk cases or thematic issues to be escalated to the monthly MACE .
          2. MACE (tactical) this is a monthly panel including key safeguarding partners and co-chaired by a Senior Police Officer and a Senior Children Social Care Manager. The panel review high risk cases escalated by pre-mace, to ensure that all agencies are working effectively together and using all powers and resources at their disposal to ensure that the child or young person is safeguarded. The panel review exploitation related data from a number of sources and thematic issues raised by partners to ensure there is an appropriate multiagency tactical response.
          3. MACE Strategic. The strategic panel is made up of senior managers from across the partnership and is chaired by the police. The strategic mace is responsible for the implementation of the Child Exploitation Strategy and Action Plan. The Strategic MACE reports directly to the LSCP Executive.

          The MACE does not in any way replace established statutory safeguarding procedures and professional should always follow up the established safeguarding pathway. If any professional, individual or family member is concerned for the welfare or safety of a child they should make a MASH referral or in the case of the child with an allocated social worker contact the social worker directly. If it is believed that the child is in imminent risk of harm, the advice is to contact emergency services on 999 before contacting children social care.

          Referral pathway.

          It is encouraged that Social Work Teams convey a Strategy Meeting prior to referring to pre-mace, this is to ensure that all immediate safeguarding actions are taken and information is shared with key agencies. It is the responsibility of the Social Work Team to make a pre-mace referral if they believe the child or young person they are working with is at risk of sexual exploitation, criminal exploitation, serious youth violence or harmful sexualised behaviour. All pre-mace referrals concerning children should be made by the allocated social worker or lead professional.

          In the case of young adults aged 18 to 25, if they are Care Leavers it is the responsibility of the personal advisor, to complete a pre-mace referral. If the young person aged 18 to 25 is not a care leaver any can make a referral directly into the young adults pre-mace.

          Lewisham Child Exploitation Strategy

          Appendix A Forms of Child Exploitation

          Appendix B Child Exploitation Key Indicators

          Appendix C Best Practice - Safeguarding & Child Exploitation Processes

          Appendix D Local and National Child Exploitation Resources

          Appendix E MACE Terms of Reference

          Appendix F MACE Performance Outcomes

          Appendix G Pre-MACE Chairs Reporting Template

          Appendix H MACE Agenda Template

          Appendix I Data Sharing Agreement

          Appendix J MACE Referral Pathway

          Appendix K MACE Referral Form

          Appendix L Strategic Business Plan

          Modern Slavery & Child Trafficking

          The Modern Day Slavery Act 2015 came into force in October 2015.

          The Act

          Part 1. Consolidates and clarifies the existing offences of slavery and human trafficking whilst increasing the maximum penalty for such offences. For offences of slavery, servitude and forced or compulsory labour, or for offences of human trafficking any person found guilty is liable to life imprisonment.

          Part 2. Provides for two new civil preventative orders, the Slavery & Trafficking Prevention Order, and the Slavery & Trafficking Risk Order. Request of a Chief Officer of Police, Immigration Officer, or NCA can prevent foreign travel, protect potential victims, and prevent further offences.

          Part 3. Provides for new maritime enforcement powers in relation to ships.

          Part 4. Establishes the office of Independent Anti-Slavery Commissioner and sets out the functions of the Commissioner. To encourage good practice in investigation / victim care.

          Part 5. Introduces a number of measures focussed on supporting and protecting victims, including a statutory defence for slavery or trafficking victims and special measures for witnesses in criminal proceedings. Child trafficking advocates, non prosecution of victims compelled to commit crime, presumption of under 18 until appropriate age assessment. Public body has a duty to notify suspected victim of trafficking.

          Part 6. Requires certain businesses to disclose what activity they are undertaking to eliminate slavery and trafficking from their supply chains and their own business.

          Part 7. Requires the Secretary of State to publish a paper on the role of the Gangmasters Licensing Authority and otherwise relates to general matters such as consequential provision and commencement.

          The typology of 17 types of modern slavery offences in the UK

          Labour Exploitation

          Victims exploited for multiple purposes in isolated environments

          Victims who are often highly vulnerable are exploited for labour in multiple ways in isolated rural locations. Victims live on offenders' property in squalid conditions, are subject to repeated abuse and are very rarely paid.

          Victims work for offenders

          Victims are forced to work directly for offenders in businesses or sites that they own or control (some offenders may be gangmasters). The main method of exploitation is not paying or illegally underpaying victims.

          Victims work for someone other than offenders

          Victims are employed in a legitimate and often low-skilled job, with legal working conditions, by an employer unrelated to the offenders. Most or all wages are taken by offenders often through control of the victims' bank accounts.

          Domestic Servitude

          Exploited by partner

          Victims are forced to undertake household chores for their partner and often their partner's relatives. If married, the marriage may have been arranged or forced and the servitude often occurs alongside domestic abuse and sexual exploitation.

          Exploited by relatives

          Victims live with and exploited for household chores and childcare by family members, usually extended family. Many victims are children.

          Exploiters not related to victims

          Victims live with offenders who are often strangers. Victims are forced to undertake household chores and are mostly confined to the house.

          Sexual Exploitation

          Child sexual exploitation – group exploitation

          Children are sexually exploited by groups of offenders. This is usually for personal gratification, but sometimes the exploitation involves forced sex work in fixed or changing locations and will include characteristics of types 9 and 10. Offenders frequently transport victims to different locations to abuse them.

          Child sexual exploitation – single exploiter

          Similar to type 7, often involves the grooming of children and transporting them for the purposes of sexual exploitation, although the offending is carried out by one individual.

          Forced sex work in fixed location

          Victims are trafficked and exploited in established locations set up specifically for sex work. This can include brothels or rooms in legitimate business premises (e.g. massage parlour).

          Forced sex work in changing location

          Victims are forced into sex work where the location of exploitation frequently changes. Locations include streets, clients' residence, hotels or 'pop-up' brothels in short-term rented property. Victims are frequently advertised online.

          Trafficking for personal gratification

          Victims are trafficked to residential sites controlled by offenders and sexually exploited for the offenders' own gratification. Some victims may be confined to the site for a long period of time.

          Criminal Exploitation

          Forced gang-related criminality

          Victims are forced to undertake gang related criminal activities, most commonly relating to drug networks. Victims are often children who are forced by gangs to transport drugs and money to and from urban areas to suburban areas and market and coastal towns.

          Forced labour in illegal activities

          Victims are forced to provide labour to offenders for illegal purposes. The most common example is victims forced to cultivate cannabis in private residences.

          Forced acquisitive crime

          Victims are forced by offenders to carry out acquisitive crimes such as shoplifting and pickpocketing. Offenders may provide food and accommodation to victims but rarely pay them.

          Forced begging

          Victims are transported by offenders to locations to beg on the streets for money, which is then taken by offenders. Victims are often children vulnerable adults.

          Trafficking for forced sham marriage

          Traffickers transport EU national victims to the UK and sell these victims to an exploiter in a one-off transaction. Exploiters marry victims to gain immigration advantages and often sexually abuse them.

          Financial fraud (including benefit fraud)

          Victims are exploited financially; most commonly their identity documents are taken and used to claim benefits. This type often occurs alongside other types.

          Possible Risk Indicators

          A child cannot give consent to being exploited, even if they have agreed to being moved/believe they have consented, it is not "informed consent". Any child transported for exploitative reasons is considered to be a trafficking victim. All practitioners should use professional curiosity to support your ability to identify the risk factors.

          • Physical symptoms, i.e. pregnant, STI's, sexual or physical assault, poor dental health. May show signs of physical or psychological abuse, look malnourished or unkempt, or appear withdrawn.
          • Victims may rarely be able to travel on their own, seem under the control or influence of others, rarely interact, or appear unfamiliar with their neighborhood or where they work.
          • Involved in criminal activity, i.e. cannabis factory, begging, pick pocketing.
          • Foreign national child. Brought or moved from another country. Has false documentation, or no passport or ID.
          • With an adult, but unclear what the relationship is.
          • Concerns about the relationship between the parent and child.
          • With an adult who speaks for the child.
          • Orphaned or separated from family or main carers.
          • Possesses money or goods not accounted for.
          • Has not been registered with a GP.
          • May or may not be enrolled at a school.
          • Homeless child.
          • An unrelated or new child discovered at an address.
          • Found in a brothel or sauna.
          • May be working in catering, nail bars, caring for children, cleaning etc.
          • Links to adult(s) with offending history.
          • Missing child. There is a strong possibility the child will be re-trafficked within 24-48 hours of being placed in care.

          Procedure in Lewisham

          Child Trafficking and Slavery are Child Protection issues and the normal procedures apply. You can make a referral to the Multi-Agency Safeguarding Hub by telephone 020 8314 6660 or by email mashagency@lewisham.gov.uk or complete a MASH Referral Form

          Useful Contacts

          • Athena Service lewishamvawg@refuge.org.uk 0800 112 4052
          • NSPCC Child Trafficking Advice Centre (CTAC): 0808 800 5000 ctac@nspcc.org.uk
          • UK Human Trafficking Centre: 0844 778 2406, UKHTC@nca.x.gsi.gov.uk
          • Refugee Council Advice Line: 020 7346 1134
          • ECPAT UK: 020 7233 9887 ecpat.org.uk
          • Coram Legal Centre: www.childrenslegalcentre.com
          • Children and Families Across Boarders (CFAB) 020 7735 8941 cfab.uk.net
          • Foreign & Commonwealth Office: 020 7008 1500
          • CEOP 020 7238 2320/2307 ceop.gov.uk
          • Home Office http://www.crimereduction.homeoffice.gov.uk/toolkits/tp01.htm

          Additional Guidance

          Resources & Publications

          A typology of modern slavery offences in the UK  October 2017

          Home Secretary Amber Rudd announces new measures to improve identification and support for victims of modern slavery.   October 2017

          Home Office Resources

          ACPO Guidance

          CPS

          Trafficking Toolkit

          Human Trafficking Strategy

          London Safeguarding Children Board - Trafficked Children toolkit and guidance

          Safeguarding Children who may have been trafficked (2011) DfE

          Home Office UK Border Code of Practice for Keeping Children Safe from Harm

           

          Neglect

          There are many factors that influence and shape the development of a child. Some are within the child, such as genetic factors, and others are from external sources such as physical, psychological and family influences, as well as the wider neighbourhood and cultural aspects. 

          Neglect is therefore often complex and not always immediately recognised. The impact will vary according to type, severity and length of time, making it difficult for those working with children and families to manage.  Professional uncertainty, differences of opinion or undue optimism regarding levels of need and the criteria for significant harm can lead to long term exposure which substantially increase the risk to children. 

          Neglect of children remains one of the Lewisham Safeguarding Children Partnership (LSCP) key priorities. This strategy has been developed with multi-agency partners to set out Lewisham’s approach to PREVENT RESPOND to AND REDUCE child neglect in Lewisham.

          This strategy should be viewed alongside the following key strategies, policies and procedures and government guidance in relation to neglect:

          The Definition

          Working Together to Safeguard Children (2018) describes neglect as:

          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. Neglect may occur during pregnancy as a result of maternal substance abuse. Once a child is born, neglect may involve a parent or carer failing to:

          1. provide adequate food, clothing and shelter (including exclusion from home or abandonment)
          2. protect a child from physical and emotional harm or danger
          3. ensure adequate supervision (including the use of inadequate care-givers)
          4. ensure access to appropriate medical care or treatment

          It may also include neglect of, or unresponsiveness to, a child’s basic emotional needs.’

          Why is this important in Lewisham?

          Neglect is the most common reason for a child to be the subject of a child protection plan in the UK. In Lewisham, neglect is one of the highest risk factor indicators.

          What do professionals need to do?

          Although you may be worried about a child, it’s not always easy for professionals to identify neglect. There’s often no single sign or incident that a child or family need help. It is more likely that there will be a series of concerns over a period of time that, taken together, demonstrate the child is at risk. If you think a child may be experiencing neglect, don’t wait:

          • Gather all relevant information about the child, including the parenting capacity and family and environmental factors in order to form a professional judgment on strengths, risks and harmful factors
          • Use professional curiosity to understand the child and families lived experiences.
          • Use our newly developed Signs of Safety Neglect Screening Tool to help you identify concerns about whether the child’s needs are being neglected. This will assist with the early identification of neglect or in coordinating support for families in need of additional help. The checklist can also be used to track improvements, deterioration, or ‘drift’
          • Regularly review progress using the screening tool below and update the multi-agency plan accordingly.
          • Where there are concerns about a child’s needs or their needs are unclear, a Common Assessment (CAF) should be considered in line with LSCP - Lewisham Threshold Document - Continuum of Need (2023-25)

          Signs of Safety Neglect Screening Tool

          Signs of Safety Neglect Screening Tool Guidance Framework

          Introduction to the Signs of Safety Neglect Screening Tool video - Alex Campbell, Lewisham Workforce Development Group

          LSCP Multi-Agency Neglect Strategy 2023-2026

          LSCP Neglect Strategic Action Plan 2023-2026

          On-line Safety

          The internet is a great way for children and young people to connect with others and learn new things. As interactions between people are increasingly taking place on-line it is essential that we safeguard children as robustly in the virtual world as we do in the real one. We can do this through:

          • Promoting safe on-line behaviour to children, young people and their families
          • Taking children, young people and their families’ on-line actions and networks into account when providing support

          Children, young people and their families go online for a variety of reasons, including:

          • To search for information or content on search engines
          • Share images and watch videos through websites or mobile apps
          • Use social networking websites
          • Write or reply to messages on forums and message boards
          • Play games along or with others through websites, apps or games consoles
          • Chat with other people through on-line, games, messenger apps, games consoles, webcams, social network, and other instant communication tools
          • Find new friends and partners

          There are lots of benefits in going on-line, and also some risks. These include:

          • Exposure to and sharing of explicit material (including sexting)
          • Grooming
          • Radicalisation
          • Exploitation
          • Identity theft
          • Cyber-bullying
          • Cyber-hacking

          It’s important that as professionals you are confident in talking with children, young people and their families about their on-line choices and interactions. This includes tablets, lap-tops, phones etc, for example:

          • Personal information shared on-line: checking privacy settings, sharing contact details, geotagging
          • Images shared and online communication: on-line support networks, inappropriate images (e.g. sexting), online bullying or harassment
          • On-line relationships: safe online friendships, meeting up with on-line friends or potential partners

          LSCP E-Safety Guidance - June 2017

          Advice and resources

          CEOP Thinkuknow  provides advice for parents and carers, children and young people, and those that work with them.

          NSPCC Online Safety has further advice and tools.

          Child Exploitation & Online Protection (CEOP)

          CEOP is there to support young people, parents and carers while surfing online, and offers help and advice on topics such as:

          • cyberbullying
          • hacking
          • harmful content

          It also enables people to immediately report anything on-line which they find concerning, such as harmful or inappropriate content, or possible grooming behaviour.

          For more information, or to report concerns, simply click on the CEOP Icon

          CEOP

          Prevent Strategy

          What is CONTEST and the Prevent Strategy?

          The Prevent Strategy is one of the key elements of CONTEST, the Government's counter- terrorism strategy and it aims to stop people from being drawn into terrorist-related activity. Prevent has strong links to safeguarding because vulnerable children and adults can be susceptible to radicalisation and recruitment into violent extremist and terrorist organisations.

          CONTEST has four strands:

          1. Protect: Strengthen our protection against terrorist attack.
          2. Prepare: Mitigate the impact of an attack.
          3. Pursue: Stop a terrorist attack.
          4. Prevent: Stop people from becoming terrorists or supporting terrorism by:
            • responding to the ideological challenge of terrorism and the threat we face from those who promote it,
            • preventing people from being drawn into terrorism and ensuring that they are given appropriate advice and support,
            • working with sectors and institutions where there are risks of radicalisation that we need to address.

          What does the Prevent Duty mean for Statutory Organisations in Lewisham?

          Since 2015, statutory agencies have a duty under the Counter Terrorism & Security Act "to have due regard to the need to prevent people from being drawn into terrorism". This means that local authorities should:

          • Establish strategic and operational links with other specified authorities,
          • Facilitate the assessment of risk for specified authorities, including providing advice and sharing threat assessments based on the Counter Terrorism Local Profiles (CTLP),
          • Provide a range of training products (including but not limited to Workshops to Raise Awareness of Prevent - WRAP) to all specified authorities,
          • Understand the full range of bodies affected by the new duties, and ensure they understand their responsibilities,
          • Embed Prevent into commissioning, procurement, and grant funding processes,
          • Embed Prevent into Safeguarding Policies and ensure all providers are signed up to local Safeguarding arrangements.In Lewisham, work has been taking place to ensure that all relevant agencies are complying with their obligations under the 2015 Counter Terrorism & Security Act. This includes delivering briefings, training and advice.

          Compliance in Lewisham

          In Lewisham, work has been taking place to ensure that all relevant agencies are complying with their obligations under the 2015 Counter Terrorism & Security Act. This includes delivering briefings, training and advice.

          Prevent in Lewisham operates a Strategic Board – the Prevent Delivery Group – and a Multi-Agency Safeguarding Panel – Channel.

          Lewisham Prevent Service

          LBL Prevent are available to assist agencies in complying with their Counter Terrorism Act duties. The support offer includes: 

          • The provision of Workshops to Raise Awareness of Prevent (WRAP training for frontline staff),
          • Management briefings regarding Prevent Duty compliance,
          • Coordination of strategic and operational groups,
          • The provision of Prevent-related resources and dissemination of relevant information.

          Safeguarding children and young people against radicalisation and extremism

          Islamist extremism remains the dominant UK terror threat, however the fastest-growing UK terrorist threat is from the Far Right.

          There have been several cases where extremist groups have attempted to radicalise vulnerable children. This can include justifying political, religious, sexist, or racist violence, or to steer individuals towards an ideology of extremism and intolerance. A young person might be groomed and radicalised into carrying out acts of violence and cause significant harm to others.

          There are several ways in which children and young people can be at risk of radicalisation

          • They can be groomed either online or in person by people seeking to draw them into extremist activity.
          • Young people can be radicalised online via peer networks or online chat platforms.
          • Grooming of a young person can also be carried out by those who hold harmful, extremist beliefs, including parents/carers and siblings and even wider family members who have an influence over the young person's life.
          • Young people can be exposed to violent, anti-social, extremist imagery and narratives which can lead to normalising intolerance of others and extremist ideology.

          As with other forms of safeguarding strategies, early intervention is essential. All agencies working with children and young people, along with families and communities can play a vital role in ensuring young people and their communities are safe from the threat of radicalisation, extremist ideologies and terrorism.

          If you are concerned that a child, young person and/or parents/carers or other family members may hold extremist views or are at risk of being radicalised, it is important to ensure that they receive support to protect them from being drawn into terrorism.

          Making a Referral

          If you are worried about a child or a young person you should follow your own organisation’s child protection procedures without delay.

          If a child is in immediate risk call 999.

          MASH Team Telephone: 020 8314 6660 Email mashagency@lewisham.gov.uk

          If you have any questions regarding Prevent in Lewisham you can contact the Prevent Manager by email prevent@lewisham.gov.uk or 07710 387 930

          Training:

          Prevent Referrals

          The training is for anyone who has been through the Prevent awareness eLearning or a Workshop to Raise Awareness of Prevent (WRAP), and so already understands Prevent and of their role in safeguarding vulnerable people. 

          The package shares best practice on how to articulate concerns about an individual and ensure that they are robust and considered.

          It is aimed at anyone who may be able to notice signs of vulnerability to radicalisation and seeks to give them confidence in referring on for help if appropriate. It is also designed for those (for example line managers) who may receive referrals and need to consider how to respond, whether that be establishing more context, or reaching out to partner agencies for support. A link to the training is below. 

          E-Learning

          Prevent Home Office awareness eLearning

          The Prevent awareness eLearning has recently been refreshed. This includes updates to reflect the recommendations from the Parsons Green review, updated information following the change in threat and recent attacks, and new case studies. A link to the training is below. 

          Prevent E-Learning

          http://www.elearning.prevent.homeoffice.gov.uk

          Prevent Referrals E-Learning

          https://www.elearning.prevent.homeoffice.gov.uk/preventreferrals

          Channel Awareness

          This training package is for anyone who may be asked to contribute to, sit on, or even run a Channel Panel. It is aimed at all levels, from a professional required to input and attend a Channel Panel meeting for the first time, to a member of staff new to their role and organising a panel meeting. It covers an introduction to what Channel is, how it operates in the local area, and how to organise a Channel Panel for the first time. In response to feedback, it also covers information sharing, including how, when and with whom to share information of a Channel case. A link to the Channel Panel training is below.  

          https://www.elearning.prevent.homeoffice.gov.uk/channelawareness

          Public Advice

          • If you see or hear anything that could be terrorist-related, trust your instincts and call the Anti-Terrorist Hotline on 0800 789 321.
          • If you think you have seen a person acting suspiciously, or if you see a vehicle, unattended package or bag which might be an immediate threat, move away and call 999.
          • If you are involved in an incident follow police advice to: 'RUN, HIDE AND TELL'   
          • Download the citizenAID App , which provides safety and medical advice from Google Play, Apple App or the Windows Store, for free.  

          Guidance

          Resources for parents and practitioners

              General online safety guidance

                Safeguarding Vulnerable Children & Young People from Extremism (Workshop to Raise Awareness of Prevent (WRAP))

                Target Group:  All professionals working with children, young people and adults in the Borough of Lewisham.

                The session is intended to:

                • Develop an understanding of the Prevent Strategy & roles within it
                • Develop existing expertise and professional judgement in relation to extremism and radicalisation or recruitment to extremist groups
                • Increase awareness of the national / international picture of extremism and terrorism
                • Raise awareness of the links between online risks and radicalisation
                • Improve confidence to raise concerns.
                • Raise awareness of the Channel interventions, safeguarding the individual
                • Increase the whole organisations capacity to prevent extremism and safeguard
                • vulnerable people.

                The webinars will include an introductory presentation and Q&A session.

                Hosted by the Lewisham Prevent Team

                Private Fostering Arrangements

                Lewisham logo   Somebody else\'s child logo

                What is Private Fostering?

                Private fostering is when children and young people under the age of 16 years or under 18 if they are disabled, are cared for on a full time basis by a person who is not their parent, who does not have parental responsibility or who is not a close relative for 28 days or more.  A relative is defined in the Children Act 1989 as a grandparent, uncle or aunt (whether by full-blood, half-blood or by marriage or civil partnership), sibling or step-parent.

                Who are not close relatives?

                Family friends, cousins, great aunts and great uncles do not count as close relatives (As defined in the Children Act 1989). There are many circumstances in which an unmarried partner becomes the carer for a child. A parent’s unmarried partner is not a step-parent in this context. It is a common misunderstanding and parents/carers are often unaware of the legal requirements to notify the local authority of a private fostering arrangement.

                Caring for someone else's child is not private fostering when the arrangement is made by the Local Authority, or when the person looking after a child is an approved foster carer.

                What are examples of private fostering arrangements? 

                The fostering arrangement is made privately between the parent and the person looking after the child or young person.

                Lots of different situations count as private fostering, including:

                • A child or young person whose parent (s) cannot look after them because of illness, work or study long or antisocial hours;
                • A child or young person are living with a friend’s family because of parental separation, divorce or arguments at home
                • A child or young person are living with their partner’s family;
                • A child from abroad sent to stay with another family in the UK for education or heath care by their birth parents;
                • An asylum seeking or refugee child;
                • Children who may have been trafficked into the country
                • A child or young person who, having broken ties with their family, is staying with friends or other non-relatives usually on a short term basis;
                • A language student living with a host family; or
                • A child or young person staying with a family while attending a school away from home.

                 Who needs to tell us about a private fostering arrangement?

                You should encourage parents/carers to notify Lewisham Multi-agency Safeguarding Hub (MASH) Team. If you feel that we have not been made aware by parents/carers, then you should notify Lewisham MASH Team: 

                Email: mashagency@lewisham.gov.uk

                Phone: 020 8314 6660

                What happens next?

                • When the private fostering team have this information a social worker will contact the parents and carers to arrange a visit to explain the legal requirements and procedures for private fostering.
                • The Private Fostering Social Worker must visit the child and private foster family within 7 days of being notified.
                • The Private Fostering Social Worker will do safeguarding checks on the host family and complete a private fostering assessment in regards to the carers’ suitability to look after that child within 42 days, this is not a Single Assessment.
                • If the private fostering assessment is suitable and proves to promote child’s welfare, subsequent visits must be carried out in the 1st year of the arrangement at intervals of 6 weeks, in the 2nd & subsequent years, visits must take place every 12 weeks and more often if required not necessarily with parental consent.
                • Private fostering assessments and visit reports must be completed after every visit & authorised/signed off at a managerial level however this remains a private arrangement.

                 Important things to note

                • Parents retain Parental Responsibility (PR) and their consent will be needed for everything done for that child including medical appointments, haircuts etc. If Early Help is deemed to be appropriate, parental consent will be needed for this. The Private Fostering Social Worker may liaise with parents in some circumstances in order to help facilitate this type of consent being given.
                • If Social Care say that it is not suitable for that child to return to their family home at any stage, then this is not a Private Fostering case and Children’s Social Care involvement will be necessary.
                • If a child already has a Social Worker and is open to Lewisham Children’s social care, you will need to inform their Social Worker of the child’s new living arrangements. The Social Worker will then notify the Private Fostering team so they can assess the private foster family, the child’s allocated Social Worker will retain full case responsibility.
                • If the arrangements are unsuitable, it will be necessary to consult with the Service Manager who may seek legal advice, with a view to considering initiating prohibiting procedures. Parents will be advised to make alternative arrangements for their child and a further referral made to MASH if necessary.

                Where can I find more information?

                Private Fostering social worker: Anna Luckock

                Tel: 07392 286612

                Email: SG.support@lewisham.gov.uk 

                Lewisham council website: https://lewisham.gov.uk/myservices/socialcare/children/fostering/private-fostering

                Lewisham Multi-agency safeguarding hub (MASH) Team

                Email: mashagency@lewisham.gov.uk

                Telephone: 020 8314 6660

                Coram baaf: https://corambaaf.org.uk/practice-areas/kinship-care/information-kinship-carers/what-private-fostering

                Practitioners should, in particular, be alert to the potential need for early help for a child who are privately fostered – Working Together to Safeguard Children (2018, p13)

                Questions to consider asking to help you identify a child who is Privately Fostered

                • Do you suspect that a child may be privately fostered?
                • Has the child mentioned that they are no longer living at home / living with someone else?
                • Is the child accompanied to school/nursery/clinic by someone other than a parent/recognised carer?
                • Is the carer vague about the child’s routines/needs?
                • Has a patient turned up at the GP surgery with a new child/ series of different children?
                • Has a child in class at school disappeared?
                • Is there anything unclear on files/records about the child’s living arrangements?
                • Is the child under the age of 16 (or 18 if disabled)?
                • Is the child living with someone other than a parent, someone with parental responsibility or a close relative (A relative is defined in the Children Act 1989 as a grandparent, uncle or aunt (whether by full-blood, half-blood or by marriage or civil partnership), sibling or step-parent.)
                • Do you know what the child’s living arrangements are (who with, for what purpose)?
                • Is it clear who the child is living with, and what relation the person is to the child?
                • Has the child been living, or is likely to live, away from home for more than 28 days?
                • Has the child come from overseas? Do you know the reason for the child’s entrance to the UK?
                • Is the child in the UK for the purpose of education?
                • Is the child an unaccompanied asylum seeker?
                • Do you think that the child may have been trafficked?

                Private Fostering graph

                Additional Information for Professionals:

                How is private fostering different to foster care?

                Foster care

                Foster care is when children are placed with foster carers through arrangements made by Local Authorities. All foster carers have been approved by a Local Authority or independent fostering service provider prior to caring for any children.

                Private fostering

                Private fostering arrangements are made without the involvement of the Local Authority – they are usually made by the parents of the child or another adult or on some occasions by young people themselves. Although the Local Authority is not involved in making these arrangements, it is important that they are notified about them.

                Why should a Local Authority be made aware of private fostering arrangements?

                Safeguarding the child

                Privately fostering a child is always a big responsibility, and the Local Authority has a duty to oversee the arrangements to promote the welfare of the child and to ensure they are protected. It is important that the carer has a good understanding of the child's needs.
                Providing support

                Taking on the care of someone else's child is not often straightforward. Misunderstandings and conflicts can easily arise, even between friends. Living away from their parents for any length of time can present challenges to children and their carers, and the Local Authority can support them both.

                Further information can be found from the Lewisham council website: https://lewisham.gov.uk/myservices/socialcare/children/fostering/private-fosteringwebsite.

                Coram BAAF: https://corambaaf.org.uk/practice-areas/kinship-care/information-kinship-carers/what-private-fostering?gclid=EAIaIQobChMI0MG26pmM-AIVgQsGAB2ZsATwEAAYAiAAEgJuJvD_BwE 

                Professional Curiosity & Challenge

                Nurturing professional curiosity and challenge are a fundamental aspect of working together to keep children and young people safe.

                In this resource we will raise awareness of the need for respectful uncertainty; help practitioners spot the signs of when a parent or carer may be using disguised compliance; and advise where and how to access help and services.

                What is professional curiosity?

                Professional curiosity is the capacity and communication skill to explore and understand what is happening within a family rather than making assumptions or accepting things at face value.

                This has been described at the need for practitioners to practice ‘respectful uncertainty’ – applying critical evaluation to any information they receive and maintaining an open mind. In safeguarding the term ‘safe uncertainty’ is used to describe an approach which is focused on safety but that takes into account changing information, different perspectives and acknowledges that certainty may not be achievable.

                Professional curiosity can require practitioners to think ‘outside the box’, beyond their usual professional role, and consider families’ circumstances holistically.

                Professional curiosity and a real willingness to engage with children, adults and their families or carers are vital to promoting safety and stability for everyone.

                Much has been written about the importance of curiosity during home visits and the need for authentic, close relationships of the kind where we see, hear and touch the truth of their experience of ‘daily life’ and are able to act on it and to achieve similar closeness with parents or carers.

                Practitioners will often come into contact with a child, young person, adult or their family when they are in crisis or vulnerable to harm. These interactions present crucial opportunities for protection. Responding to these opportunities requires the ability to recognise (or see the signs of) vulnerabilities and potential or actual risks of harm, maintaining an open stance of professional curiosity (or enquiring deeper), and understanding one’s own responsibility and knowing how to take action.

                Children in particular, but also some adults, rarely disclose abuse and neglect directly to practitioners and, if they do, it will often be through unusual behaviour or comments. This makes identifying abuse and neglect difficult for professionals across agencies. We know that it is better to help as early as possible, before issues get worse. That means that all agencies and practitioners need to work together – the first step is to be professionally curious.

                Curious professionals will spend time engaging with families on visits. They will know that talk, play and touch can all be important to observe and consider. Do not presume you know what is happening in the family home – ask questions and seek clarity if you are not certain. Do not be afraid to ask questions of families, and do so in an open way so they know that you are asking to keep the child or adult safe, not to judge or criticise. Be open to the unexpected, and incorporate information that does not support your initial assumptions into your assessment of what life is like for the child or adult in the family.

                Thinking the unthinkable

                Safeguarding is everyone’s responsibility, and where practitioners are concerned each and every agency has a role to play in safeguarding and protecting children.

                The following factors highlight the need for all of us to strive to improve professional curiosity and professional courage:

                • the views and feelings of children and some adults are actually very difficult to ascertain
                • practitioners do not always listen to adults who tried to speak on behalf of a child or another adult and who may have important information to contribute
                • parents or carers can easily prevent practitioners from seeing and listening to a child or another adult
                • practitioners can be fooled with stories we want to believe are true
                • effective multi-agency work needs to be coordinated
                • challenging parents or carers (and colleagues) requires expertise, confidence, time and a considerable amount of emotional energy.

                What is disguised compliance?

                Professional curiosity or respectful uncertainty is needed when working with families who are displaying disguised compliance. Disguised compliance involves parents or carers giving the appearance of co-operating with agencies to avoid raising suspicions and allay concerns.

                There is a continuum of behaviours from parents or carers on a sliding scale, with full co-operation at end of the scale, and planned and effective resistance at the other. Showing your best side or ‘saving face’ may be viewed as ‘normal’ behaviour and therefore we can expect a degree of disguised compliance in all families; but at its worst superficial cooperation may be to conceal deliberate abuse; and many case reviews highlight that professionals can sometimes delay or avoid interventions due to parental disguised compliance.

                The following principles will help front line practitioners deal with disguised compliance more effectively:

                • focus on the needs, voice and ‘lived experience’ of the child, young person or adult
                • avoid being encouraged to focus to extensively on the needs and presentation of the adults or carers – whether aggressive argumentative or apparently compliant
                • think carefully about the ‘engagement’ of the adult or carers and the impact of this behaviour on the practitioners view of risk
                • focus on change in the family dynamic and the impact this will have on the life and well-being of the child or adult – this is a more reliable measure than the agreement of adults or carers in the professionals plan
                • there is some evidence that an empathetic approach by professionals may result in an increased level of trust and a more open family response leading to greater disclosure by adults and children
                • practitioners need to build close partnership style relationships with families whilst being constantly aware of the child needs and the degree to which they are met
                • there is no magic way of spotting disguised compliance other than the discrepancy between an adult or carer’s accounts and observations of the needs and accounts of the child. The latter must always take precedent.

                Communication - the key to good multi-agency working

                Top tips:

                • speak to other practitioners on a regular basis – don’t wait for meetings
                • when assessing and managing a case, input from two, three or four sources is better than one
                • sometimes the most important relationship to trust is yourself – if you feel there is a risk that is not being managed and no one is hearing you what do you do, how do you escalate this?
                • try to be flexible with meetings to fit around all involved practitioners availability
                • don’t use jargon – talk to colleagues and families using language they understand and relate to
                • include families in decisions about their own lives
                • be mindful of personal optimistic bias (wishful thinking) when reviewing the families’ progress
                • make sure care plans are multi-agency and SMART
                • self-assessments tools can promote honest discussion
                • team managers should attend training for providing effective supervision and reflective practice in managing safeguarding
                • use quality assurance and audit framework such as quality standards to review case records to support good practice that keeps children safe and aids staff continuous professional development (CPD).

                Information sharing:

                • to support good communication, a formal information sharing arrangement should be in place between all agencies with the purpose and content about requesting and sharing information explicitly agreed
                • fears about jeopardising the relationship with the family should not be a barrier to the sharing of information
                • principles from "the seven golden rules for information sharing" should be followed
                • information should be shared in a timely manner and the family included where it does not increase risk
                • all involved agencies should be given ample notice when invited to case review meetings to enable them to provide reports and feedback to contribute to ongoing assessment and review of family progress
                • a group of practitioners should maintain contact with each other and make the times of meetings flexible to enable optimal attendance of practitioners.

                Difficult conversations with parents and carers

                Open discussion with parents and carers when there are welfare concerns about a child often provokes anxiety in practitioners. Professional challenge is part of good child protection practice.

                To increase practitioners’ confidence we have published a "How to have difficult conversations with parents/carers" guide.

                The information in this guide is not exhaustive and it should be used as a reference tool alongside practitioners own safeguarding practices and in conjunction with appropriate supervision.

                Four factors to consider when preparing for a difficult conversation with a parent or carer are:

                1. Principles – that underpin safeguarding children
                2. Planning – how to plan or be prepared
                3. The conversation – things to consider when having a conversation
                4. Examples – open questions and suggestions.

                Professional challenge - having different perspectives

                Differences of opinion, concerns and issues can arise for practitioners at work and it is important they are resolved as effectively and swiftly as possible.

                Having different professional perspectives within safeguarding practice is a sign of a healthy and well-functioning partnership. These differences of opinion are usually resolved by discussion and negotiation between the practitioners concerned. It is essential that where differences of opinion arise they do not adversely affect the outcomes for children and young people and are resolved in a constructive and timely manner.

                Differences could arise in a number of areas of multi-agency working as well as within single agency working. Differences are most likely to arise in relation to:

                • criteria for referrals
                • outcomes of assessments
                • roles and responsibilities of workers
                • service provision
                • timeliness of interventions
                • information sharing and communication.

                If you have difference of opinion with another practitioner, remember:

                • professional differences and disagreements can help us find better ways improve outcomes for children, adults and families
                • all professionals are responsible for their own cases and their actions in relation to case work
                • differences and disagreements should be resolved as simply and quickly as possible, in the first instance by individual practitioners and /or their line managers
                • all practitioners should respect the views of others whatever the level of experience – remember that challenging more senior or experienced practitioners can be hard
                • expect to be challenged; working together effectively depends on an open approach and honest relationships between agencies
                • professional differences are reduced by clarity about roles and responsibilities and the ability to discuss and share problems in networking forums.

                Please see our Resolving Professional Differences / Escalation Policy

                Professional curiosity and culturally competent safeguarding practice

                The issue of safeguarding within BAME communities is widely debated among policy makers and practitioners.

                BME/BAME – Black and Minority Ethnic, or Black, Asian and Minority Ethnic is the terminology normally used in the UK to describe people of non-white descent (according to the www.irr.org.uk)

                There is evidence that culturally competent safeguarding practice enhances children’s and adults well being and an understanding of how variations in child rearing and caring practices are understood by BAME families and practitioners could contribute to prevention and early intervention.

                Interventions have the potential to be as a result of stereotyping, lack of awareness among practitioners of how various categories of abuse are manifested in BAME communities, coupled with a general lack of awareness of cultural practices.

                It is important therefore that practioners are sensitive to differing family patterns and lifestyles and to child rearing and caring patterns that vary across different racial, ethnic and cultural groups. At the same time they must be clear that child or adult abuse cannot be condoned for religious or cultural reasons.

                All practitioners working with children, young people, vulnerable adults and their parents, carers or families whose faith, culture, nationality and possibly recent history differs significantly from that of the majority culture, must be professionally curious and take personal responsibility for informing their work with sufficient knowledge (or seeking advice) on the particular culture and/or faith by which the child, young person, adult and their family or carers lives their daily life.

                Practitioners should be curious about situations or information arising in the course of their work, allowing the family to give their account as well as researching such things by discussion with other practitioners, or by researching the evidence base. Examples of this might be around attitudes towards, and acceptance of, services e.g. health; dietary choices; education provision or school attendance.

                In some instances reluctance to access support stems from a desire to keep family life private. In many communities there is a prevalent fear that social work practitioners will ‘take your children away’. There may be a poor view of support services arising from initial contact through the immigration system, and, for some communities – particularly those with insecure immigration status – an instinctive distrust of the state arising from experiences in their country of origin.

                Practitioners must take personal responsibility for utilising specialist services’ knowledge. Knowing about and using services available locally to provide relevant cultural and faith-related input to prevention, support and rehabilitation services for the child, young people or adults (and their family) will support practice.

                This includes:

                • knowing which agencies are available to access
                • having contact details to hand
                • timing requests for expert support and information appropriately to ensure that assessments, care planning and review are sound and holistic.

                Often for BAME communities, accessing appropriate services is a consistent barrier to them fully participating in society, increasing their exclusion and potential for victimisation.

                The Safeguarding Lead in your agency should be able to signpost you to appropriate support available within your organisation.

                Supervision, curiosity and understanding families

                For many agencies, the use of effective supervision is a means of improving decision-making, accountability, and supporting professional development among practitioners. Supervision is also an opportunity to question and explore an understanding of a case.

                Group supervision and Reflective Practice Groups can be even more effective in promoting curiosity and safe uncertainty, as practitioners can use these spaces to think about their own judgments and observations. It also allows teams to learn from one another’s experiences, and the issues considered in one case may have echoes in other workloads.

                Tips for practice:

                • present alternative hypotheses
                • present cases from the child, young person, adult or another family member’s perspective.

                Care and activity settings - sensitivity, curiosity and persistence

                Care setting practitioners are perhaps best placed to notice how children are because they have contact with the same child on a regular basis. Practitioners can see changes in appearance, behaviour, alertness or appetite and provide a degree of monitoring of the child’s welfare; in effect, they can be the ‘eyes’ for other professionals working with them. This will also apply to volunteers and workers who run groups and clubs for children, young people or adults.

                There are many examples of good practice in care staff where alert to concerns and were able to demonstrate professional curiosity and awareness of possible maltreatment and cumulative risk.

                Being professionally curious enables practitioners to challenge a child’s vulnerability or risk while maintaining an objective, in a professional and supportive manner. This is not an easy balance.

                Domestic Violence & Abuse and professional curiosity

                Many Domestic Homicide Reviews and Serious Case Reviews refer to a lack of professional curiosity or respectful uncertainty. Practitioners need to demonstrate a non-discriminatory approach and explore the issues to formulate judgments that translate into effective actions in their dealings with families.

                In particular it is vital that professionals understand the complexity of domestic abuse and are curious about what is happening in the child, adult and perpetrator’s life.

                Professional curiosity is much more likely to flourish when practitioners:

                • are supported by good quality training to help them develop
                • have access to good management, support and supervision
                • ‘walk in the shoes’ (have empathy) of the child and/or adult to consider the situation from their lived experience
                • remain diligent in working with the family and developing the professional relationships to understand what has happened and its impact on all family members
                • always try to see all parties separately.

                Working with families where there is domestic violence & abuse can be very challenging and practitioners should not take everything they are told at face value. This is particularly so when a victim is not being seen alone and we should also be alert to the following behaviours which should provoke our professional curiosity:

                • the victim waits for her/his partner to speak first
                • the victim glances at her/his partner each time they speak, checking her/his reaction
                • the victim smooths over any conflict
                • the suspected perpetrator speaks for most of the time
                • the suspected perpetrator sends clear signals to the victim, by eye/body movement, facial expression or verbally, to warn them
                • the suspected perpetrator has a range of complaints about the victim, which they do not defend.

                If these signals are present, the practitioner should find a way of seeing the suspected victim alone. Practitioners must be mindful to the needs of young people who may be experiencing inequality and/or violence in their relationships. Practitioners, however curious, cannot protect children and adults by working in isolation. Domestic abuse requires a multi-agency response and families and communities also have a vital role to play in protecting children and adults.

                Education settings - curiosity and listening

                Education staff are perhaps best placed to notice how children and young people are because they have contact with them on an almost daily basis. School staff can see changes – such as in appearance, behaviour, alertness or appetite – and provide a degree of monitoring of the child’s welfare; in effect, they can be the ‘eyes’ for other practitioners working with the young person. 

                There are many examples of good practice in education where staff were alert to concerns and were able to demonstrate professional curiosity and awareness of possible maltreatment and cumulative risk.

                Being professionally curious enables practitioners to challenge parents and explore a child’s vulnerability or risk while maintaining an objective, professional and supportive manner. This is not an easy balance.

                It can be difficult for children to express concerns about their own well being, so practitioners have a responsibility to create an environment in which they can do so. Schools should be careful of ‘organisational deafness’ which minimises the chances of really hearing what young people are saying, for example in relation to concerns about their friends.

                Professionals (particularly school staff) should be curious and give sufficient credence to occasions when information is shared by young people.

                Health practitioners - authoritative practice and professional curiosity

                Authoritative practice and professional curiosity are vital in responding to the often highly complex cases that are characteristic of Reviews, where multiple risks and vulnerabilities may extend over considerable periods of time.

                An important aspect of authoritative practice is that every practitioner ‘takes responsibility for their role in the safeguarding process’. Authoritative practice needs to be underpinned by a culture of supportive supervision and service leads and managers have a responsibility to foster such cultures and model authoritative practice in their own leadership by:

                • encouraging all health practitioners to take responsibility for their role in safeguarding process, while respecting and valuing the role of others
                • allowing practitioners to exercise their professional judgement in the light of the circumstances of a particular case
                • encouraging a stance of professional curiosity and challenge from a supportive base.

                Example: Supporting engagement – moving from Did Not Attend (DNA) to Child Not Brought (CNB)
                In a large number of reviews there was evidence of poor engagement with health and social care services. Parents or carers who do not engage present a challenge to practitioners, but this challenge also provides an opportunity for protection.

                When working with vulnerable people and families, health practitioners and services should maintain ‘consistent support for the family’ and curiosity and vigilance towards meeting the vulnerable child’s needs – and be persistent in pursuing non-engagement.

                Non-compliance may be a parent/carer’s choice, but it is not the vulnerable child’s. Health service administrators and practitioners should treat repeated cancellations and rescheduling of appointments with curiosity and with the same degree of concern as repeated non- attendance. In doing so, it is essential to recognise families’ vulnerabilities and be flexible in accommodating their needs.

                A shift away from the term DNA (did not attend) to CNB (child not brought) would help ‘maintain a focus on the child’s ongoing vulnerability and dependence, and the carers’ responsibilities to prioritise the child’s needs’.

                Tips for health professionals to Be Curious!

                • know who the named professionals are for your area and that you fully understand their roles – promoting good professional practice and providing advice and expertise for fellow professionals
                • ensure that safeguarding is addressed within your clinical supervision
                • be aware of the relevant Lewisham safeguarding procedures
                • be aware of the need to always have ‘professional curiosity’
                • be prepared to be both challenged and challenging within your own professional sphere
                • ensure you know how to escalate safeguarding concerns. 

                Police & Criminal Justice Agencies - "don't take things at face value"

                Developing and maintaining an open stance of professional curiosity supports police (and other staff) to consider the possibility of maltreatment, and to challenge and explore issues while maintaining an objective and supportive approach. 

                Given that criminal justice agencies often deal with specific incidents, supervising individual offenders or investigating stand-alone crimes, there is a risk of seeing an individual or a family only through one lens. Protecting children, young people or vulnerable young adults  involves understanding their lives and experiences and making professional judgments.

                Children, young people are unlikely to readily disclosure abuse or neglect, this means practitioners have to be able to spot the signs and create a suitably safe and trusting listening environment.

                There are examples of police and other professionals focusing on offenders behaviours and not their underlying vulnerabilities.

                Children or vulnerable young adults repeatedly going missing should trigger police officers’ professional curiosity, it is vital to consider what is motivating their behaviour.

                Practitioners and managers need to be curious, to be sceptical, to think critically and systematically but to act compassionately.

                Physical Abuse of Children & Young People

                Dfe campaign logo   Dfe campaign website

                Definition

                To use physical force that results in an injury, physical pain, or impairment.   This may include hitting, beating, pushing, shoving, throwing, shaking, slapping that leaves a mark, kicking, pinching, punching, suffocation, pulling hair out, burning, or striking with an object, hands, or feet.   Being made to swallow something that hurts or causes illness, i.e. forcing the taking of medicine when a child is not ill - Also known as Fabricated Induced Illness. Being made to sit or stand in uncomfortable positions or locked in small spaces.

                What is the Law?

                In the UK it is unlawful for a parent or carer to smack their child, except where this amounts to "reasonable punishment". This defence is laid down in Section 58 of the Children Act 2004.

                Whether a smack amounts to reasonable punishment will depend on the circumstances of each case, taking into consideration factors like the age of the child and the nature of the smack. There are strict guidelines covering the use of reasonable punishment and the Director of Public Prosecutions for England and Wales has produced a charging standard of categorisation in order to assist prosecutors to determine the appropriate charging offence. It will not be possible for a parent/carer to rely on this defence if the physical punishment amounts to wounding, actual bodily harm, grievous bodily harm or child cruelty.

                Cultural tradition or adults perceived ideas of parental rights to use physical force as a way of discipline must not stand in the way of protecting a child from physical abuse.

                Current Statistics

                The NSPCC report that although exact numbers of physical abuse are not known, it is estimated that 1 in 4 children have been physically abused. Disabled children are 3 times more likely to be abused than non-disabled children. In 2016-17 over 6,800 children were identified as needing protection from physical abuse, with 11,000 children contacting help lines for support - 22% of those cases were referred to the Police. In 2017 7,000 ChildLine counselling sessions were about physical abuse.

                Signs & Symptoms of Physical Abuse

                The child may have:-

                • Regular bruising anywhere on the body, including defensive bruises to the arms or bruises shaped like an instrument or hand.
                • Bruises with dots of blood under the skin.
                • A bruised scalp and swollen eyes from the hair being pulled violently.
                • Broken bones or fractures.
                • Burns or scalds, including small round burns from a cigarette or sharp edged burns.
                • Bite marks usually round or oval shaped.

                You may notice:-

                • The child may regularly avoid taking part in sports activities or reluctant to get changed in front of others.
                • Becomes withdrawn, flinches, is anxious, clingy, or suddenly behaves differently.
                • May be depressed, or develop obsessive behaviour.
                • Have problems sleeping, frequent nightmares, bed wetting, or soils clothes.
                • There may be changes in the child's eating habits or the child may develop an eating disorder.
                • The child may bully or hurt other children and become aggressive.
                • They may develop risky behaviours, i.e. taking drugs, alcohol, self-harm, or have thoughts about suicide.
                • The child may regularly miss nursery or school. Children have accidents, trips and falls. However, if a child regularly has injuries, you notice a pattern, or the explanation does not match the injury you should use professional curiosity and investigate to ascertain if a child is being physically abused and make a referral to Children's Social Care. Adults who physically abuse children may have emotional or behavioural problems such as difficulty controlling their anger. They may have family or relationship problems or have experienced abuse as a child. They may have parenting difficulties including unrealistic expectations of children, they may not have an understanding of a child’s needs, or have no idea how to respond to a child.

                Effects of Shaking a Baby

                If a baby is shaken or thrown, they may suffer non-accidental head injuries. Shaking a baby can cause fractures, internal injuries, long-term disabilities and even death.

                The most serious consequence of a non-accidental head injury (NAHI) is a brain injury which can lead to learning problems, seizures, hearing and speech impairment, visual impairment or blindness, behaviour problems or changes in personality, severe brain damage, long-term disability, or even death. Babies may suffer other injuries from the abuse such as broken bones or fractures.

                Good Advice to Parents/Carers on How to Discipline Without Smacking

                  • Provide love and emotional warmth as much as possible.
                  • Have clear simple rules, boundaries and explain actions to the child so they understand what is expected of them.
                  • Be a good role model.
                  • Praise good behaviour so it will increase, and ignore behaviour which is not to be repeated.
                  • Criticise behaviours and not the child.
                  • Reward good behaviour with hugs and kisses.
                  • Distract young children or use humour.
                  • Young children often respond well to a wall chart marking good behaviour, setting targets and agree on a small reward.
                  • Allow children some control, make joint decisions and give choices.
                  • If punishment is necessary, remove privileges, or take time out.
                  • Have a strategy in place and think about your reactions before feelings escalate.
                  • Seek support from the local Children's Centre or Parent Support Group.

                Long Term Effects of Physical Abuse

                The long term impact of child abuse is far reaching, some studies indicate that without the right support, the effects of childhood abuse can last a lifetime. These effects can be characterised by frequent crisis, failed relationships or difficulty maintaining family relationships, chaotic lifestyles, and are highly likely to have a psychiatric disorder such as depression, anxiety, personality disorders, or eating disorders.

                Procedure in Lewisham

                If you become aware or suspect a child is being physically abused, has an injury that is not consistent with the explanation provided, or a disclosure is made by a child, you must immediately contact the MASH Team on:-

                Telephone Number:  020 8314 6660

                Email:              mashagency@lewisham.gov.uk

                If a child is in immediate danger call 999.

                You have a duty of care to seek medical attention for the child if necessary.

                Children’s Centres

                Children’s Centres are able to offer a range of support for parent(s) who may be struggling to cope. You can contact your local Children’s Centre for any one of the services below:-

                • Family and parenting support, including family learning and parenting courses.
                • Advice on early-years education and childcare, including eligibility for free education and childcare for 2–4-year-olds.
                • Child and family health services, including baby hubs and breastfeeding support.
                • Volunteering and employment support, including links to Jobcentre Plus.
                • Information and advice about children’s services and schools.
                • Drop-in services covering health, education and a range of other areas such as debt management, counselling and SENDIASS.

                Useful Links

                  • DfE, Together we can tackle child abuse
                  • NSPCC

                  Self-Harm & Suicide Ideation in Young People

                  Introduction

                  Mental health problems affect around 1 in 10 children and young people. This includes depression, anxiety, and conduct disorder, and are often a direct response to what is happening in their lives.

                  Self-harm is when someone hurts themselves on purpose and is a way of expressing deep distress, a way of communicating what cannot be put into words, with very difficult feelings that could build up inside. It is not attention seeking behaviour.

                  Self-Harm is a very common behaviour in young people and affects around one in 12 young people.  

                  Warning signs of Self-Harm

                  • People who self-harm may suffer mood swings and become withdrawn.
                  • Unexplained wounds.
                  • Have a lack of motivation.
                  • There may be changes in their eating habits.
                  • They may cover up their body (even in warm weather).

                  Warning signs of Suicide Ideation

                  They may be:

                  •  Quiet, brooding, or withdrawn.
                  • Feeling exhausted and distant.
                  • Feeling cut off from those around them.
                  • Not making eye contact.
                  • Agitated, irritable or rude.
                  • Talking about suicide or saying it’s all hopeless.
                  • Desperate for help but afraid to ask.

                  They may also:

                  • Be busy, chirpy, laughing and joking, talking about future plans, and telling you not to worry about them.

                  The safest way to know if someone is thinking about suicide is to ask them. If a person is suicidal the idea is already there. If they aren’t suicidal it won’t do any harm. Saying something is safer than saying nothing.

                  Risk Factors of Self-Harm & Suicide Ideation

                  • Stressful life events.
                  • Isolation.
                  • Low self-esteem.
                  • On-going family relationship problems.
                  • Being bullied at school.
                  • Bereavement.
                  • Mental health problems – depression and delusional thoughts.
                  • Substance and alcohol misuse.
                  • Family circumstances.
                  • Stress and worry – academic pressure.
                  • Experience of abuse – physical, emotional, sexual abuse, sexual exploitation, and forced marriage.
                  • Feelings of being rejected in their lives.

                  Types of Self-Harm

                  • Cutting of the skin with objects (e.g. razor blades, scissors, pens, bottle tops etc.)
                  • Scratching the skin.
                  • Picking wounds or interfering with healing.
                  • Burning.
                  • Ingesting toxic substances.
                  • Excessive drug or alcohol intake.
                  • Hitting or punching themselves.
                  • Head banging or biting themselves.
                  • Pulling hair out.
                  • Swallowing or inserting objects.
                  • Taking an overdose.
                  • Staying in an abusive relationship.
                  • Taking risks too easily.
                  • Restricting their eating.Young people can self-harm in a variety of body locations, i.e. arms, legs, abdomen, etc.

                  Responding to Self-Harm in Lewisham

                  If a child or young person overdoses or there is a serious self-harm incidence they should be taken to A&E in the first instance. An assessment will be undertaken which may involve a referral to the Children & Adolescent Mental Health Service (CAMHS).

                  If you become aware of a young person who is self-harming or having suicidal thoughts. Explore their feelings with them and talk about the help available:-

                  Share what you know with the child’s parents / carers.

                  Tips for talking with young people

                  Tips for Talking with Young People - Print The Poster!

                  Services 

                  Young Minds

                  • Parents Helpline 0808 802 55 44
                  • Advice for professionals

                  GP

                  • Ask the parent / carer to make an appointment.

                  CAMHS

                  Kooth

                  • Online chat support for young people

                    Papyrus Hopeline 0800 068 41 41

                    • Confidential advice for young people
                    • Advice for parents / carers.
                    • Advice for professionals

                    ChildLine – 0800 11 11

                    • Confidential advice for young people
                    • Advice for professionals

                    Place2Be

                    • Individual one to one, drop in counselling for children and young people experiencing emotional wellbeing issues at 10 schools in Lewisham

                      National Self-Harm Network

                      • UK charity offering moderated support forum for self-harm

                      NHS Choices - Moodzone

                      • Online and audio resources to improve mental wellbeing and information about available treatments

                      MindEd

                      • Online training for anyone working with 0-18 year olds

                      Resources

                      Coping with Self-Harm, A Guide for Parents & Carers

                      Calm Harm App.

                      Down load this from your AppStore or GooglePlay. The app offers activities to comfort, distract, express yourself, Release, Random and Breathe.

                      Signs of Safety Practice Framework

                      Introduction

                      In Lewisham we use the Signs of Safety practice framework across the whole of children’s services in our work with children and families. We use this model because it helps Professionals and families to think through problems and solutions together rather than families feeling that everything is being dictated to or done for them.

                      No matter how difficult a family’s situation there will always be existing strengths, resources and abilities they can draw on; the Signs of Safety approach helps professionals to help families and children identify and build on these existing resources for themselves.

                      The Signs of Safety assessment and planning process is designed to bring professionals and families together using four core questions:

                      1. What are we worried about?
                      2. What’s working well?
                      3. What needs to happen?
                      4. Where would you rate things for the child on a scale of 0 to 10 where ten means the child is safe and professionals can close the case and 0 means the situation is dangerous for the child and they very likely need to live away from their parents until things change?

                      Partner Briefings

                      To familiarise partners with Signs of Safety we provide regular half day briefings, the aim of which is:-

                      • To develop an understanding of the Signs of Safety principles and practice framework and how it is applied within Children’s Services
                      • To gain a working knowledge of the Signs of Safety mapping assessment framework
                      • How to use the framework to make effective contributions to multi-agency meetings such as child protection conferences and Child in need Reviews/Core Groups
                      • Writing pre-conference reports or making referrals to MASH using the mapping framework
                      • Supporting the process of safety planning with the family and network
                      • Ensuring the voice of the child and their lived experience is heard/understood
                      • The skilful use of authority and maintaining positive working relationship with family and professionals

                      To View and Book please follow this link: https://www.safeguardinglewisham.org.uk/events/event/signs-of-safety-partnership-briefing 

                      Signs of Safety Toolkit

                      The following tools include:

                      1-4: Templates for the mapping assessment framework for Signs of Safety/Aspiration/Success/Wellbeing with prompt questions.

                           1. Mapping Framework Guide and Prompt Questions

                           2. Signs of Aspiration of Success Mapping Framework Guide with Prompt Questions

                           3. Signs of Wellbeing Mapping Framework Guide and Prompt Questions

                           4. SoS Mapping Framework including Contextual Factors and Questions

                      5&6: A guide and Template for using the My Three Houses tool for gathering information from a child.

                           5. My 3 Houses Templates

                           6. My 3 Houses Practice Guidance. 

                      7: The Harm Matrix tool which provides questions to help you unpick your worries around a child and identify exactly what the harm they are suffering looks like and how worrying it is.

                           7. Harm Matrix Tool

                      For more information

                      A short video introducing Signs of Safety by one of its creators – Andrew Turnell

                      Web site: https://www.signsofsafety.net/

                      For further advice or consultation

                      Alex Campbell   alex.campbell@lewisham.gov.uk

                      Signs of Safety Practice Lead, Lewisham Workforce Development Team

                      South London Care Proceedings Project

                      The South London Care Proceedings Project (SLCPP) is an initiative in South East London prompted in 2013 by the wish to reduce unnecessary delay for children in care proceedings.  It aimed to have proceedings completed within 26 weeks, though monitoring closely the progress of each case, identifying and tracking together the causes of delay, and sharing lessons about good social work and judicial practice.

                      The partnership comprises the main agencies involved in care proceedings brought by the neighbouring London Boroughs of Greenwich, Lambeth, Lewisham and Southwark - hence the common reference to SLCPP as "The Quad".  The other SLCPP members are the local authority link judges at the Central Family Court, CAFCASS and family lawyers acting for children and parents.

                      SLCPP is one of several initiatives that were modelled on the Tri-Borough Care Proceedings Pilot in West London that started in April 2012.

                      Please see the reports below for further reading:-

                      Toolkits & Resources

                      The attached are listed here for ease of access, however, we recommend you refer to the full strategy, policy, process, or guidance if you are not experienced in undertaking an assessment or completing a toolkit. 

                      Toolkits

                      SafeLives Dash Risk Check List & Quick Start Guidance

                      Contextual Safeguarding - Safety Mapping Exercise

                      Multi-Agency Child Protection Conference Report 

                      Resources

                      LSCP Child Safeguarding Practice Review Process Chart 2021

                      LSCB Anti-Bullying Resource January 2018

                      CAMHS Referral Criteria & Referral Form

                      Continuum of Need Levels and Guidance

                      Early Help Assessment Form

                      E-Safety Guidance

                      Plan, Review & Closure Form

                      Protocol for the management of actual or suspected bruising in infants who are not independently mobile

                      Resolving Professional Differences Protocol

                      Services for Children & Families Leaflet - December 2017

                      Young Carers Leaflet and Young Carers Referral Form and Guidelines

                      See the London procedures for child protection policies and procedures

                      Research Papers

                      National Guidance and Local Protocols

                      Useful Reports and Links

                      The Alan Wood Review of new Multi-Agency Safeguarding Arrangements - Published May 202

                      The National Review Panels Annual Report

                      Case Recording & Report Writing - Useful Online Presentation

                      Professional Curiosity - 10 Pitfalls and How to Avoid Them, what research tells us, NSPCC

                      Child Neglect - Be Professionally Curious, Action for Children

                      Let Children Know You're Listening - The importance of an adults interpersonal skills in helping to improve a child's experience of disclosure.

                      Worried about a child suffering from harm?

                      What to do if you are worried about a child suffering from harm

                      If you are concerned that a child has suffered harm, neglect or abuse, please contact Lewisham Multi Agency Safeguarding Hub (MASH) who can discuss this with you:

                      • During office hours (Monday – Friday):
                        Lewisham’s MASH 020 8314 6660 
                      • Out of Office hours:
                        Emergency Duty Team – 020 8314 6000

                      If a child is at immediate risk of harm, call the Police on 999.

                      The MASH is multi agency and brings together services such as from social care, education, health, police and children centres. The MASH aims to work together to offer the right help at an early stage to families who need support.

                      Consent to share

                      You should seek, in general, to discuss concerns with the family and, where possible seek the family’s agreement to making a referral unless this may, either by delay or the behavioural response it prompts or for any other reason, place the child at increased risk of Significant Harm.

                      • A decision by any professional not to seek parental permission before making a referral to Children’s Social Care Services must be approved by their manager, recorded and the reasons given
                      • Where a parent has agreed to a referral, this must be recorded and confirmed on the relevant referral form
                      • Where the parent is consulted and refuses to give permission for the referral, further advice and approval should be sought from a manager or the Designated Senior Person or Named Professional, unless to do so would cause undue delay. The outcome of the consultation and any further advice should be fully recorded

                      All recording with regards to consent to share information should be included in the inter-agency referral form and kept on individual organisation’s record systems.

                      Protocol for the management of actual or suspected bruising in infants who are not independently mobile

                      Please see the London Child Protection Procedures

                      Child Exploitation & Online Protection (CEOP)

                      CEOP is there to support, help and advise young people, parents and carers and the professionals who work with them

                      It also enables people to immediately report anything online which they find concerning, such as harmful or inappropriate content, or possible grooming behaviour. See our On-line safety page to find out more

                      For more information, or to report concerns, simply click on the CEOP Icon

                      CEOP

                      Young Carers

                      GUIDELINES FOR PROFESSIONALS / AGENCIES / PARENTS

                      These guidelines are intended for any parent, professional or agency wishing to make a referral to Lewisham Young Carers Service on behalf of a child or young person within a caring role. Please read these guidelines carefully before completing the attached referral forms.

                      Who can you make a referral for?

                      Any Young Carer between the ages of 5 and 18 can be referred to our services that are residents or their cared for is someone who lives within the borough of Lewisham:

                      • Providing care or support for someone with a physical disability, long term illness, mental ill health or substance misuse.
                      • Is affected by the condition of their cared for.

                      Service availability

                      We will prioritise the service to young carers with the highest need as a result of the significant impact of the caring role and level of caring responsibilities.

                      The level of priority for each Young Carers may fluctuant throughout the lifetime of their involvement in the service due to sudden changes in their caring situation.  

                      How to make a referral?

                      Please complete all the pages of our Referral Form and send to:

                      Carers Lewisham logo

                      Waldram Place, Forest Hill

                      London, SE23 2LB

                      Tel: 0208 699 8686 | Fax: 0208 699 0634

                      Email: info@carerslewisham.org.uk

                      What happens now?

                      On receipt of the referral we will look at the information you have given us and prioritise the need for assessment. The outcome will be either: 

                      1. Young carer does not meet the criteria for a young carer and no assessment will take place.
                      2. Young carer is allocated to a member of the young carers team for a home visit.
                      3. Further information is needed from the referrer before processing any further.

                      Referrers will be informed of the outcome via telephone or email within 4 weeks. If you have not heard from us please contact us on 0208 699 8686.

                      Assessment Process

                      If allocated for assessment, a young carers support officer will make contact with the family to arrange a home visit to gain better understanding about the young carer’s family’s situation and decide on what support services they will be offered.   

                      If you have any questions throughout the referral or assessment process, please do not hesitate to contact us.

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