Safeguarding and Disability: The national picture

Anne Patmore

Why a separate day?Relationship between child abuse and disability is complex:

Child abuse can cause or contribute to disability

Disability can increase a child's vulnerability

A disabled child may have:

A different method of communication Differences in physical experiences Different life experience Differences in learning and knowledge

The Social Model of Disability

‘redefines disability as the disadvantage or

restriction of activity caused by society which

takes little or no account of people who have

impairments and thus excludes them from

mainstream activity’

A Jigsaw of Services DoH 2000

Why is the social model important in protecting disabled children? Emphasises their right to be protected

from harm Ensures the child is not seen as the cause

of their own abuse Challenges the ‘feel sorry for factor’-

disability is not a tragedy

Medical(individual)

model

Welfaremodel

Social Model

Rights Model

“For children and young people who are both

black and disabled, the experience of

discrimination on the basis of their disability

is compounded by the effects of racism.

Despite this, many black and disabled

children find that only one aspect of their

experience is addressed at any one time.”

Framework for the Assessment of Children in Need and Their Families – Practice Guidance (DoH, 2000)

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Kennedy & Wonnacott, 2000

DISABLING BARRIERS

Disabling barriers create barriers … to a fulfilling and positive life

Euthanasia / termination of pregnancy life itself

Denial of sufficient resources leading to poverty / hardship

health and development

Discriminatory and prejudicial practice leading to oppression

self-esteem, confidence, emotional and psychological well- being

Degrading and humiliating treatment human rights

Lack of research on disabled children’s experiences of abuse

safety and protection

Language of ‘care’ gives image of ‘burden’

empowerment / independence

Likelihood of maltreatment of disabled children compared to non-disabled children, by type of

maltreatment

Type of Maltreatment Sullivan & Knutson Maltreatment and Disabilities: A School-based

Epidemiological Study 1999

Neglect 3.8 times as likely

Sexual Abuse 3.1 times as likely

Physical Abuse 3.8 times as likely

Emotional Maltreatment 3.9 times as likely

Maltreatment of Disabled Children

THE DEPENDENCY – STRESS MODEL OF ABUSE

Caregiver stress

Dependency

Impairment

Family Stress

ReductionAbuse

This model assumes that abuse occurs as an outlet for increased family stress associated with the

abused individual’s disability and the family’s limited resources

Sobsey, D Violence & Abuse in the Lives of People with Disability – The End of Silent Acceptance? Paul Brookes Publishing 1994

Caregiver

Stress

Poor / negligent care given to disabled child

‘Good relationship of care’

Poor child care as a result of inadequate service provision

Poor / inadequate

services and support

AdequateService

provisionCaregiver Feels stress

Disabled child seen as cause of stressand scapegoated, leading to abuse

and neglect

Adverse conditionsin families• parental mental ill health• substance misuse• domestic violence• problematic relationships

The professional network

Abuse and Neglect as the Result of Adverse Family Conditions Despite Adequate services

Do we understand the way in which abuse for disabled

children may involve practices which would not affect non-

disabled children?

Practices which harm disabled children:

Parents who will not allow equipment the child might need, rejection of household adaptations, ‘rejection of markers’

Body integrity compromised

Denial of treatments / alternative regimes

Verbal abuse / degrading comments

Threats of abandonment / exclusion

Is there a different threshold for

intervention where disabled children are

concerned?

The Integrated Ecological Model of

AbuseCulture

Environment

RelationshipPotential

VictimPotential Offender

Provides support and rationale for power

inequities and abuse

Sobsey, D Violence & Abuse in the Lives of People with Disability – The End of Silent Acceptance?

Paul Brookes Publishing 1994

Relationships: Likely to be in contact with a larger number of

service providers and are likely to receive intimate care from a larger number of people

More likely to be away from their familiesThree times as many disabled children as non-disabled children

attend residential educational establishments (Utting 1997)

Disabled children are 8 times more likely to be living away from their families (Utting 1997)

The more complex or severe the impairment, the more likely the child is to be cared for outside the family home …

Relationships:

Low self worth may lead to a desire to please Disabled children often do not have access to

someone they can trust to disclose that they have been abused

There is a common failure to consult with and listen to disabled children about their experiences – children may not tell about abuse if they are not used to being listened to

Service provision: Poor service provision may lead to social

isolation, disabled children have fewer outside contacts than non-disabled children

When the organisation of service systems fails to take account of the additional needs of disabled childrene.g.

lack of independent visitors/advocates for disabled children environments that lack stimulation or access to the ‘real’ world long waiting lists for essential equipment ..

Service provision: Focus on disability masking child

protection issues e.g.

- services to address disability needs but not assessing wider needs of the child and family and missing child protection concerns

- workers not sufficiently experienced and knowledgeable about child protection issues

- failure to recognise the increased vulnerability of disabled children, for example to child sexual abuse

Culture: Offenders will think it is safer to victimise a

disabled child

Society gives permission to abuse

May be overt, e.g. difference in law with regard to termination of pregnancy

Or covert, e.g. limitation of services, including those which impact on quality and length of life

Failure to acknowledge and promote disabled children’s human rights means that abusive practices are seen as acceptable

Bullying: 82% of children and young people with a learning

disability have experienced bullying

They are twice as likely to be bullied as other children8 out of 10 children and young people with a learning disability

who have been bullied had experienced bullying at school 5 out of 10 children with a learning disability had been bullied

in more than one place

Children with a learning disability already face barriers in accessing education and leisure opportunities – bullying compounds this, preventing them from living full and happy lives.

Don’t Stick It, Stop It -- Bullying Wrecks Lives, Mencap

Targeted violence and hostility has wide-ranging impacts on the lives of disabled people

It can:

lead to a deterioration of disabled people’s physical and mental well-being

cause disabled victims to restructure the way their lives are lived on a day-to-day basis so as to minimise the risk of repeated experiences

These impacts infringe on disabled people’s ability to exert full control over their lives and minimise the lifestyle choices available to them.

‘I tend to stick to myself – I’m worried about people taking advantage of me. People used to talk past me and try to hit me and call me an idiot at school and outside of school – it’s hard to trust people.’

Disabled people’s experiences of targeted violence and hostility (2009)

Equality and Human Rights Commission. Research Report 21

Housing: Families with a disabled child have a different tenure

profile to families with non-disabled children: More likely to be renting their home than families with non-

disabled children Less likely to be living in a decent home compared to families

with non-disabled children, on all measures of house condition, they emerge as more disadvantaged than families with non-disabled children

50% more likely to live in overcrowded accommodation

Disabled children appear to be disadvantaged compared to other groups of disabled people. Among those needing specially adapted housing, they are least likely to be living in suitable housing compared to all other age groups of disabled people

Disabled children experience a multiplicity of difficulties within their home, with a key and universal difficulty of lack of space

The research evidence is that living in unsuitable housing has an adverse impact on the physical and emotional well-being on all family members

“Within 24 hours of being in this house, it was like

WOW! She was a different child. Her confidence

increased overnight. I can’t describe to you the

difference in Debbie.”

23% going without heating 73% going without leisure and

days out14% going without food34% have fallen behind with

repayments, mostly for credit cards or loans

51% have borrowed from family or friends to keep financially afloat or pay for essentials

42% have applied for a charity grant

Almost 90% said that financial worries had a detrimental impact on their family life.

“I do not know how to describe the hell that is imposed on us as a family due to financial worries.

It impacts on every single aspect of our lives.”

“When the children have gone to bed, I turn off all the lights to

save electric.”

“Our debt frightens me, it is a constant source of stress and

anxiety, it makes me feel ill, and of course the creditors are not willing to listen, they just want

money, whether you can afford the repayments or not”.

Complex inter-relationship between poverty and disability:

Contact a Family Counting the Cost 2010

National Service Framework for children, young people and Maternity services - Standard 8:

‘Children and young people who are disabled or who have complex health needs receive coordinated, high-quality and family-centred services which are based on assessed needs, which promote social inclusion, and, where possible, which enable them and their families to live ordinary lives’

Access to information and services: Parents experiences of having to take a pro-

active role and in some cases ‘fight’ to access services were felt to be time-consuming and ‘stressful’ for parents, which in certain cases was said to have led to health problems.

This was particularly emphasised during the early stages of the process when parents were often struggling to come to terms with their child’s disability. ..

Parental experiences of services for disabled children (2009) DCSF

Information was often criticised for being too general and confusing in terms of the complexity of the language used and the format in which it was presented

Professionals were not always as forthcoming as they could be

parents’ experiences of ‘gaps in information’ and uncertainty in relation to specific issues such as the range of services and support available, expectations for service delivery, and the allocation of services

Parental involvement in decision-making about treatment, care and support varies considerably across the different sectors

Awareness of specific complaints procedures was generally limited across all service areas

Parental experiences of services for disabled children (2009) DCSF

“They can’t offer you what you need, and they know that, so they offer you something you don’t want and in the end you take it because they’re desperate to help you. You take it even though it’s not what you need. You feel you’ve been awkward if you don’t take it. You’re frightened they’ll put down that you’ve been offered such and such and turned it down.”

“I can remember being mortified that I’d become the sort of person who

needed a social worker. I felt abandoned.”

“That I must be a bad mother to need a social worker.”

“One half term when I had no support for the week, I felt I had to force the issue by ‘doing a bunk’ while my son was out with care workers. I rang the social workers to say I would not be at home when they returned him. The messages left for me were threatening, horrible – you must come back. It was awful. My son went to a children’s home some distance away. No one came to see me while my son was away to talk about why I had taken such action.”

(All parents of a disabled child)

Family perspectives on safeguarding and on relationships with children’s services

The Children’s Commissioner for England. June 2010

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

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.

Working Together to Safeguard Children (2010), para 6.45

Promoting resilience:

Secure base and a sense of belonging Promoting self esteem and self efficacy Positive school experience Importance of spare time activities

…. for disabled children this means …

Secure base and a sense of belonging:

Avoiding excessive respite care/hospital admissions Increasing family-based care and placement Addressing family dynamics rather than removing the

disabled child Promoting disability awareness and a positive self

identity

Promoting self esteem and self efficacy: Being disabled is not a

negative concept Positive expectation about

what the disabled child can achieve - focus on what child can do rather than what they can’t do

Promoting independence, choice and decision making in all areas of the disabled child’s life

Positive school experience: Sensitivity to individual

disabled children’s education needs

Tackling bullying of disabled children within school ..

Accessible school facilities

Participation encouraged in all activities, with support to facilitate participation if required

Importance of spare time activities: Offering the means to

enable disabled children to associate freely with their disabled and non-disabled peers

e.g. accessible transport

Facilitating the inclusion of disabled children in clubs and leisure activities that children enjoy

Empowering disabled children: Give choice wherever possible -

gives children the message they have rights

Encourage them to ‘speak’ for themselves and make decisions about their care

Learn to interpret their clues and gestures and messages they may give through play

Give lots of praise and encouragement - praise effort, not just achievement

Would this be acceptable for a non-disabled child?