PG13. Disabilities

1.1

Children with a disability are children first and foremost, and deserving of the same rights and protection as other children. Any child with a disability is by definition a 'child in need' under s17 of the Children Act 1989. Since the Disability Discrimination Act 1995 was repealed in 2011 by the Equality Act 2010 it remains unlawful to discriminate against a disabled person in relation to the provision of services.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. The Disability Discrimination Act 2005 (DDA) and the Equality Act 2010 define a disabled person as someone who has:

"a physical or mental impairment which has a substantial and long term adverse effect on his or her ability to carry out normal day to day activities"

This means that the needs of children and young people with long term illnesses such as leukaemia, diabetes, cystic fibrosis, or sickle cell are addressed. They may not usually be thought of as disabled, but their vulnerabilities may be similar. A child can also be considered to be disabled if he or she has significant problems with learning, communication, comprehension, vision, hearing or physical functioning. The key issue is the impact of abuse or neglect on a child or young person's health and development and how best to support them and safeguard their welfare.

1.2

Research suggests that children with a disability may be generally more vulnerable to significant harm through physical, sexual, emotional abuse and / or neglect than children who do not have a disability.

Safeguarding disabled children demands a greater awareness of their vulnerability, individuality and particular needs. It is also important to see the child in the context of the whole family and community supports that are present. See Recognising Abuse and Neglect Procedure.

Significant harm is defined in Responding to Concerns of Abuse and Neglect Procedure, Concept of significant harm as a situation where a child is suffering, or is likely to suffer, a degree of physical, sexual and / or emotional harm (through abuse or neglect) which is so harmful that there needs to be compulsory intervention by child protection agencies into the life of the child and their family.

1.3

The national guidance Safeguarding Disabled Children - Practice Guidance (DCSF 2009) provides a framework collaborative multi-agency responses to safeguard disabled children.

1.4

The available UK evidence on the extent of abuse among disabled children suggests that disabled children are at increased risk of abuse, and that the presence of multiple disabilities appears to increase the risk of both abuse and neglect. See Disabled children and young people and those with complex health needs. Disabled children may be especially vulnerable to abuse for a number of reasons:

• Many disabled children are at an increased likelihood of being socially isolated with fewer outside contacts than non-disabled children;
• Their dependency on parents and carers for practical assistance in daily living, including intimate personal care, increases their risk of exposure to abusive behaviour;
• They have an impaired capacity to resist or avoid abuse;
• They may have speech, language and communication needs which may make it difficult to tell others what is happening and lack support around their Speech and Language difficulties;
• They often do not have access to someone they can trust to disclose that they have been abused; and/or
• They are especially vulnerable to bullying and intimidation and more willing to accept bullying due to lack of recognition of those issues;
• Attitudes and discrimination can mean that only their disability is seen rather than the full picture.

1.5

Additional factors may be:

• The child's dependence on carers could result in the child having a problem in recognising what is abuse. The child 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, and may not be trained appropriately to meet the needs of the child;
• 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 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);
• Parents'/carers' own needs and ways of coping may conflict with the needs of the child; pressure on family carers with limited support can be a risk factor for the disabled child;
• Some adult abusers may target disabled children 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 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 with disabilities with other needs such as trauma, neglect etc.
• Disabled children 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.

1.6

Looked after disabled children are not only vulnerable to the same factors that exist for all children living away from home, but are particularly susceptible to possible abuse because of their additional dependency on residential and hospital staff for day to day physical care needs.

• Force feeding;
• Unjustified or excessive physical restraint;
• Rough handling;
• Extreme behaviour modification, including the deprivation of liquid, medication, food or clothing;
• Misuse of medication, sedation, heavy tranquillisation;
• Invasive procedures against the child's will;
• Deliberate failure to follow medically recommended regimes;
• Misapplication of programmes or regimes;
• Ill fitting equipment (e.g. callipers, sleep board that may cause injury or pain, inappropriate splinting);
• Undignified age or culturally inappropriate intimate care practices.

1.7

Safeguards for disabled children are essentially the same as for non-disabled children. Particular attention should be paid to promoting a high level of awareness of the risks of harm and high standards of practice, and strengthening the capacity of children and families to help themselves. Measures should include:

• Making it common practice to help disabled children make their wishes and feelings known in respect of their care and treatment;
• Ensuring that disabled children receive appropriate personal, health, and social education (including sex education);
• Making sure that all disabled children know how to raise concerns, and giving them access to a range of adults with whom they can communicate. Those disabled children with communication impairments should have available to them at all times a means of being heard;
• An explicit commitment to, and understanding of disabled children's safety; and
• Welfare among providers of services used by disabled children;
• Close contact with families, and a culture of openness on the part of services;
• Guidelines and training for staff on good practice in intimate care; working with children of the opposite sex; handling difficult behaviour; consent to treatment;
• Anti-bullying strategies; and sexuality and sexual behaviour among young people, especially those living away from home; and
• Guidelines and training for staff working with disabled children aged 16 and over to ensure that decisions about disabled children who lack capacity will be governed by the Mental Health Capacity Act once they reach the age of 16.

1.8

Where there are concerns about the welfare of a disabled child, they should be acted upon in accordance with the guidance in Chapter 5, in the same way as with any other child. Expertise in both safeguarding and promoting the welfare of child and disability has to be brought together to ensure that disabled children receive the same levels of protection from harm as other children (see Safeguarding Disabled Children - Practice Guidance (2009)).

1.9

Where a disabled child has communication impairments or learning disabilities, special attention should be paid to communication needs, and to ascertain the child's perception of events, and his or her wishes and feelings. In every area, children's social care and the police should be aware of non-verbal communication systems, when they might be useful and how to access them, and should know how to contact suitable interpreters or facilitators. Agencies should not make assumptions about the inability of a disabled child to give credible evidence, or to withstand the rigours of the court process. Each child should be assessed carefully, and helped and supported to participate in the criminal justice process when this is in the child's best interest and the interests of justice.

1.10

In criminal proceedings under the Youth Justice and Criminal Evidence Act 1999112 witnesses aged under 17 (to be raised to under 18 by the end of 2010) may be eligible for special measures assistance when giving evidence in court. There is a presumption that child witnesses should give their evidence by video recorded statement (if taken) and live link, which allows a witness to give evidence during a trial from outside the courtroom through a televised link to the courtroom. The other special measures available to vulnerable witnesses include clearing the public gallery in sexual offence cases and those involving intimidation, screens to shield the witness from seeing the defendant, and assistance with communication through an intermediary or communication aid.

1.11

Achieving Best Evidence in Criminal Proceedings: Guidance on vulnerable and intimidated witnesses including children gives detailed guidance on planning and conducting interviews with children and vulnerable adults and includes a section on interviewing disabled children and also those that are very young or psychologically disturbed.

See Interpreters / Communication Facilitators Procedure.