Children with a Disability and Child Abuse

Children/young people with a disability are children first and foremost and deserving of the same rights and protection as other children/young people. By definition, any child/young person with a disability should also be considered as a child/young person in need (section 17 of the Children Act 1989). A child/young person can be considered to be disabled if he or she has significant problems with learning, communication, comprehension, vision, hearing or physical functioning. The child/young person may also have a diagnosis from a medical professional. In addition, disabled children and young people may have a number of plans including an Education, Health and Care (EHC) plan.

The Equality Act 2010 makes it unlawful to discriminate against a disabled person in relation to the provision of services. This includes making a service more difficult for a disabled person to access or providing them with a different standard of service.

UK evidence (cited in Working Together to Safeguard Children 2010 now archived) suggests that disabled children/young people are at increased risk of abuse and that the presence of multiple disabilities appears to increase the risk of both abuse and neglect. Advice about vulnerability associated with living away from home provided the Children Living Away from Home Procedure is also relevant.

The disabled child/young person may be especially vulnerable due to:

• A need for practical assistance in daily living, including intimate care from what may be a number of carers;
• Carers and staff lacking the ability to communicate adequately with her/him;
• A lack of continuity in care leading to an increased risk that behavioural changes may go unnoticed;
• Carers working with the child/young person in isolation;
• Physical dependency with consequent reduction in ability to be able to resist abuse;
• An increased likelihood that the child/young person is socially isolated;
• Lack of access to 'keep safe' strategies available to others;
• Communication or learning difficulties preventing disclosure;
• Parents'/ carers' own needs and ways of coping may conflict with the needs of the child/young person;
• Bullying and intimidation;
• Abuse by peers;
• Fear of complaining in case services withdrawn;
• Some sex offenders may target disabled children/young people in the belief that they are less likely to be detected.

Additional factors may be:

• The child/young person's dependence on carers could result in the child/young person having a problem in recognising what is abuse. The child/young person may have little privacy, a poor body image or low self-esteem;
• Carers and staff may lack the ability to communicate adequately with the child/young person, and may not be trained appropriately to meet the needs of the child/young person;
• A lack of continuity in care or multi-disciplinary working which leads to an increased risk that behavioural changes may go unnoticed;
• Lack of access to 'keep safe' strategies available to others; and overprotectiveness of carers/services so the child or young person cannot identify what abuse is;
  • Disabled children/young people living away from home and community are not seen daily by others outside of the organisation they live in which can lead to badly managed settings and poor care and abuse can occur such as issues around are particularly vulnerable to over-medication, poor feeding regimes, toileting arrangements, issues around control of challenging behaviour, lack of stimulations and emotional support (see Children Living Away from Home Procedure);
  • Parents'/carers' own needs and ways of coping may conflict with the needs of the child/young person; pressure on family carers with limited support can be a risk factor for the disabled child/young person;
  • Some adult abusers may target disabled children/young people in the belief that they are less likely to be detected; evidence indicates a disabled child or young person is less likely to be seen as a reliable witness when they do disclose;
• The child/young person's dependence on carers could result in the child/young person having a problem in recognising what is abuse. The child/young person may have little privacy, a poor body image or low self-esteem;
• Carers and staff may lack the ability to communicate adequately with the child/young person, and may not be trained appropriately to meet the needs of the child/young person;
• A lack of continuity in care or multi-disciplinary working which leads to an increased risk that behavioural changes may go unnoticed;
• Lack of access to 'keep safe' strategies available to others; and overprotectiveness of carers/services so the child or young person cannot identify what abuse is;
  • Disabled children/young people living away from home and community are not seen daily by others outside of the organisation they live in which can lead to badly managed settings and poor care and abuse can occur such as issues around are particularly vulnerable to over-medication, poor feeding regimes, toileting arrangements, issues around control of challenging behaviour, lack of stimulations and emotional support (see Children Living Away from Home Procedure);
• Parents'/carers' own needs and ways of coping may conflict with the needs of the child/young person; pressure on family carers with limited support can be a risk factor for the disabled child/young person;
• Some adult abusers may target disabled children/young people in the belief that they are less likely to be detected; evidence indicates a disabled child or young person is less likely to be seen as a reliable witness when they do disclose;
  • Signs and indicators can be inappropriately attributed to a disability, such as normalisation or overuse of restraint. Issues around abuse and mental health issues may be ignored or not seen due to the focus on disability;
  • Services do not have the expertise to support a child/young person with disabilities with other needs such as trauma, neglect etc.
  • Disabled children/young people are less likely to be consulted in matters affecting them and as a result may feel they have no choice about whether to accept or reject sexual advances.

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

In addition to the universal indicators of abuse/neglect, the following abusive behaviours must be considered:

• Force feeding;
• Unjustified or excessive physical restraint;
• Rough handling;
• Extreme behaviour modification including the deprivation of food medication, or clothing;
• Misuse of medication, sedation, heavy tranquillisation;
• Invasive procedures against the child/young person’s will;
• Neglect of personal care needs;
• Deliberate failure to follow medically recommended regimes;
• Non- compliance with programmes or regimes;
• Failure to address ill-fitting equipment e.g. callipers, sleep boards which may cause injury or pain, inappropriate splinting;
• Misappropriation/misuse of a child/young person's finances.

Throughout any Assessment or Section 47 Enquiry, all partner agencies must ensure that they communicate clearly with the disabled child/young person and the family and with one another as there is likely to be a greater number of services and staff involved than for a non disabled child/young person. All steps must be taken to avoid confusion so that the welfare and protection of the child/young person remains the focus.

Where there are communication impairments or learning difficulties, particular attention should be paid to the communications needs of the child/young person to ascertain the child/young person’s perception of events and his or her wishes and feelings. The practitioners should be aware of the additional vulnerability of disabled children/young people during the enquiries that are being undertaken. To facilitate communication with the child/young person, consideration should be given to seeking advice from those professionals who work with the child/young person and have an understanding of their communication needs. Workers should be sensitive to the child/young person's embarrassment where those who know well or see on a regular basis are present when they are asked about intimate details of abuse.

All partner agencies should be aware of non-verbal communication systems and should know how to contact suitable interpreters and facilitators. If a disabled child/young person has communication impairments or learning disabilities, special attention should be paid to those needs (see Interpreters, Signers and Others with Special Communication Skills Procedure). When a child/young person is unable to tell someone of her/his abuse (s)he may convey anxiety or distress in some other way, e.g. behaviour or symptoms and carers and staff must be alert to this. Partner agencies must not make assumptions about the inability of a disabled child/young person to give credible evidence, or to withstand the rigours of the court process.

Each child/young person should be assessed carefully and supported where relevant to participate in court proceedings, whether criminal or otherwise, when this is in their interests as set out in Achieving Best Evidence which includes comprehensive guidance on planning and conducting interviews with children/young people and a specific section about interviewing disabled children/young people. Intermediary support can be provided if a disabled child/young person needs support with communication in court or in a tribunal hearing. Please see the Government website around how to access an intermediary service - HMCTS intermediary services (GOV.UK).

Participation in all forms of meetings such as Child Protection Conferences and Core Groups must be encouraged and facilitated. The use of specialist advocates should be considered.

The full range of service providers and carers must be represented at all meetings.

Each child/young person should be assessed carefully and supported where relevant to participate in the child protection and criminal justice system, when this is in her/his interests and the interests of justice. Consideration should be given to the factors highlighted above in paragraph 2 above.

It should be remembered that children/young people with disabilities are children/young people first and foremost and have the same rights to protection as any other child. People caring for and working with disabled children/young people need to be alert to the signs and symptoms of abuse. See Definitions and Recognitions of Abuse and Neglect

Where there are safeguarding concerns about a disabled child/young person, there is a need for greater awareness of the possible indicators of abuse and/or neglect as the situation is often more complex. It is crucial that the disability is not allowed to mask or deter the need for an appropriate investigation of child protection concerns and a referral should be made in accordance with the Referrals procedure (see Contacts and Referrals Procedure).

Children/young people with disabilities should not be left in situations where there is a high level of neglect or other forms of abuse, because a practitioner feels that the parent, carer or service "is doing their best". Carers will need to be challenged in the same way as carers of non-disabled children/ young people.

Throughout any Assessment (see Assessment Procedure), including a Section 47 Enquiry, all service providers must ensure that they communicate clearly with the child/young person with the disability and the family and with one another as there is likely to be a greater number of services and practitioners involved than for a non-disabled child/young person. All steps must be taken to avoid confusion so that the welfare and protection of the child/young person remains the focus. Where there are communication impairments or learning difficulties, particular attention should be paid to the communications needs of the child/young person to ascertain the child/young person's perception of events and his or her wishes and feelings.

Safeguards for disabled children/young people are essentially the same as all other children/young people:

• Make it common practice to enable disabled children/young people to make their wishes and feelings known in respect of their care and treatment;
• Ensure that disabled children/young people receive appropriate personal, health and social education (including sex education);
• Make sure that all disabled children/young people know how to raise concerns and give them access to a range of adults with whom they can communicate. This could mean using interpreters and Speech and Language support using the child/young person’s preferred method of communication; it may mean visiting a number of times;
• Recognise and utilise key sources of support including staff in schools, friends and family members where appropriate;
• Develop the safe support services that families want, and a culture of openness and joint working with parents and carers on the part of services;

Ensure that guidance on good practice is in place and being followed in relation to: intimate care; working with children/young people of the opposite sex; managing behaviour that challenges families and services; issues around consent to treatment; anti-bullying and inclusion strategies; sexuality and safe sexual behaviour among young people; monitoring and challenging.

The Children Act 1989 s17(1) creates a general duty on Children's Services authorities to safeguard and promote the welfare of children/young people within their area who are 'in need'. So far as is consistent with this duty, Children's Services authorities must promote the upbringing of such children/young people by their families.

The definition of 'children in need' is to be found at CA 1989 s17(10), which provides that a child is to be taken as 'in need' if:….

(c) he is disabled.

At subsection (11) the definition of 'disabled' for the purposes of CA 1989 Part III is given as follows:

'For the purposes of this Part, a child is disabled if he is blind, deaf or dumb or suffers from mental disorder of any kind or is substantially and permanently handicapped by illness, injury or congenital deformity or such other disability as may be prescribed'.

Ofsted thematic inspection: Protecting Disabled Children

Safeguarding Disabled Children: Practice Guidance