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3.22.Mentor Assessment Paperwork L3 RC - RCC 3.22 - Copy

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An example of permanency planning

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6.1.2 Permanency Planning for Children in Care - Guidance

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Appendix 1: Identifying Permanence Options

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Useful information relating to care plans for children and young people in residential care

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14.

1. The care planning standard is that children receive well-planned care from the home and have a positive experience of admission and transition processes;

2. In particular, the standard in paragraph (1) requires the registered person to ensure:

1. That children are admitted to the home only if their needs are within the range of needs of children for whom it is intended that the home is to provide care, as set out in the home's statement of purpose;

2. That arrangements are in place to:

1. Ensure the effective induction of children into the home;

2. Manage and review the placement of children in the home; and

3. Plan for, and support, each child to prepare to leave the home or to move into adult care, in a way that is consistent with arrangements agreed with his or her placing authority.

3. That each child's relevant plans are followed;

4. That, subject to regulation 22 (contact and access to communications), contact between each child and his or her parents, relatives and friends, is promoted in accordance with the child's relevant plans;

5. That the child's placing authority is contacted, and a review of that child's relevant plans is requested, when:

1. The registered person considers that the child is at risk of harm or has concerns that the care provided for the child is inadequate to meet his or her needs;

2. The child is, or has been, persistently absent from the home without permission; or

3. The child requests a review of his or her relevant plans; and

6. That staff help each child to access and contribute to the records kept by the registered person in relation to the child.

'Relevant Plans'

Relevant plans are defined in the interpretation section of the Regulations (regulation 2) as: any placement plan; any care plan; any statement of special educational needs; any education, health and care plan ("EHC plan")[1]; and where the child is a youth justice child any detention placement plan, or any other plan prepared by that child's placing authority in relation to the remand or sentencing of that child. 'Relevant' thus has a meaning here that is distinct from the normal meaning of that word. If a child has any of the above plans, they will fall within the meaning of 'relevant plans', but a child may not have all of the plans defined as 'relevant' (for example, there will be children living in children's homes who do not have an EHC plan). Similarly a child may have a plan that the Regulations define as 'relevant', but may have no impact on the issue the provider is considering at that point in time, and providers should not feel obliged to make a plan apply where it does not. The essential point is that a child's plans should form the basis of their care, and providers should use their judgement as to what is relevant in each case, taking the plans listed in the definition in the Regulations as a starting point rather than a complete list or a tick-box exercise.
[1] In some cases the child's special education needs statement (SEN) will be a relevant plan, until such time as it is reviewed (the latest date being 2018) and replaced with an EHC plan.

Effective care planning and strong working relationships between the staff of the home and the placing authority are essential to the success of placements. [13]
[13] Placing authority is defined in 2(1) of the Children's Homes Regulations 2015
For most looked-after children, many of these planning duties fall to the placing authority. The registered person should ensure that they and their staff engage proactively with the placing authority to contribute fully to the relevant plans for the child's care on an ongoing basis. Homes should consider during the course of this engagement, seeking appropriate permissions for the person conducting independent visits to access the relevant parts of the child's records, as agreed with the child.

The registered person should only accept placements for children where they are satisfied that the home can respond effectively to the child's assessed needs as recorded in the child's relevant plans and where they have fully considered the impact that the placement will have on the existing group of children. The Statement of Purpose is an important document in the process of care planning as it sets out the needs of children the home is set up and equipped to care for.

The registered person must challenge (under regulation 5(c)) any placing authority who asks them to accept a child in the absence of a complete and current relevant plan, as the expectation that a placement of a child without the necessary information would go ahead (in circumstances other than an emergency) is inadequate in relation to their role. It is essential that homes understand what will be required of them before they accept responsibility for a child's placement, to avoid disruption and instability for the child in future and for other children in the home. For non-looked-after children, the home should ensure they have sufficient information from the child's 'placing authority' (usually their parents/carers) and other relevant agencies to effectively assess whether they can meet the child's needs before agreeing to the placement.

Homes set up for emergency placements as indicated and detailed in their Statement of Purpose will require sufficient staff trained and skilled in in the admission and care of children, where their full background may not be known.

Registered persons must ensure there are procedures in place for welcoming and introducing each child to the home, and that they are sensitive to the needs of the child at the time of arrival. A warm welcome and introduction to the home is an entitlement for all children whether they are admitted in a planned way or in an emergency. Where possible other children and young people should be supported to contribute to the design of the welcome and introduction and where appropriate the welcome itself. The home has a key role in helping children to understand why they are living there and the plans for their future.

An effective introduction to a home will take into account the child's abilities and capacity to understand and retain information. Such an introduction may take place over a period of time and may be delivered in different formats according to the child's communication and cognitive abilities. The registered person should ensure staff establish the child's understanding of key information about living in the home and the expectations of their care in order to establish whether there are gaps in the child's understanding.

As well as longer-term support for children to move on from the home effectively (regulation 6(2)(b)(vi)), the home has an important role in supporting each child leaving the home in the period immediately before their departure. The registered person should work with the placing authority to ensure that each child's transition is planned and help each child to prepare for leaving both practically and emotionally.

Significant changes to a looked-after child's care, such as a change of placement, should only take place following a statutory review of their care plan chaired by their Independent Reviewing Officer (IRO). The child should be actively involved in these important meetings and supported to express their views, wishes and feelings.

For looked-after children, the registered person should seek to ensure that the local authority regularly consults the child and the home about the child's relevant plans. If the child raises concerns about the content of any of their plans, their implementation or the process of review, staff should advocate for the child and seek to ensure that their concerns are addressed.

Where the registered person considers that a child is at serious risk of harm, such as being persistently missing from their placement, they must contact the local authority to request a review of the child's care plan (regulation 14(2)(e)). Local authorities must give serious consideration to such requests.[14] Where a review does not take place, the Registered Person must escalate this concern under regulation 5 (engaging with the wider system to ensure children's needs are met).

If, in an emergency situation, the registered person has to move a child out of the home to other accommodation, the accommodation must should be suitable and meet the child's needs. The placing authority should be contacted immediately. If the child is looked-after, a statutory review should be convened as soon as possible after the emergency move has taken place.
[14] Regulation 33, Care Planning, Placement and Case Review (England) Regulations 2010.

Both the arrangements for contact and any contact details (telephone numbers etc.) must be included in the placement plan agreed between the registered person and the child's placing authority and updated regularly.

There may be circumstances where children's homes staff assess that restriction of contact is necessary in the interests of the child, to safeguard them or promote their welfare. This decision should not be taken lightly and must be agreed with the placing authority, where possible, except in an emergency situation, where the placing authority must be notified within 24 hours. (See regulation 22 (5) and (6)).

Children's homes have a duty to provide access to a telephone that children can use privately (regulation 22(3)(a)). This can include the provision of a mobile phone where appropriate and safe for the child, as long as an alternative is in place for the child to make telephone calls in private if their personal mobile phone is lost, out of credit or broken.

Appropriate forms of contact should be promoted and facilitated for each child, including where appropriate visits to the child in the home; visits by the child to relatives and/or friends; letters, emails and texts; use of social media and other forms of contact via the internet.

Children should be encouraged by staff to see the home's records as 'living documents' supporting them to view and contribute to the record in a way that reflects their voice on a regular basis.

The registered person must consider the contact needs of children living in secure accommodation, as set out in their relevant plan. By nature of their location, secure children's homes can be a significant distance away from the child's home, making agreed face to face contact with friends and relatives difficult. Wherever possible, staff should work with the child to help them understand why face to face contact with their friends and relatives may be less frequent than they would like.

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Supporting children living in residential child care to build relationships with their family

Find out more about how you can support the children you care for to build relationships with their family

An introduction to supporting children living in residential child care to build relationships with their family

For many young people, living close and staying connected to their birth family is something they take for granted. However, for children in the care system, relationships with their birth family are often restricted, dictated and controlled by other people.

How to support safe and appropriate family relationships

You should be clear with the young person about which family members they're allowed to see (including how they can see them) and help them to understand any restrictions.

Tell the local authority if:

a young person has had unauthorised time with family members

you have concerns around them spending time with family

the young person wants to establish a new relationship.

Young people who don't have meaningful relationships with their family have the right to access an Independent Visitor. Independent Visitors can give children an opportunity to have positive interactions with someone outside the network of professionals they usually meet. All local authorities should have access to this scheme.

Be positive and encouraging about family relationships

You must show an encouraging and positive attitude towards the relationships a young person has with their family. This can have a big impact on the quality of that relationship and the young person's ability to talk to you about it.

You should also try to form positive working relationships with the young person's family members and create a comfortable and welcoming environment when they visit the home.

Help the young person to remember important dates

You should help children to remember important days like family birthdays and religious and cultural occasions, for instance by supporting them to use diaries.

Take the time to talk with the young people about appropriate presents, cards and arrangements to attend celebrations. You could also help them make cards and gifts.

What does a positive family relationship look like?

Time spend between a young person and their family is positive when it is:

safe

beneficial

consistent

purposeful

meaningful

stimulating

appropriate

enjoyable.

Relationships and communicating between the young person and their family can take many forms:

speaking on the phone

texting

social media, for instance Facebook, Snapchat, Instagram, WhatsApp

letters

face-to-face time.

The relationships and communications may be supervised or unsupervised.

It's important to remember that supervised meetings involve a third person directly observing interactions between parent and child. Both parties will likely find this a strange and difficult experience.

Advice about support before, during and after family time

When a child communicates with their family you may see them behaving in an unusual way, as they process what's going on. You should identify the best person to provide the young person with emotional and practical support before, during and after family time.

Before family time:

never force the young person to see their family if they don't want to

never use family relationships as a bartering tool to manage difficult behaviour in a child; appreciate that difficult behaviour may be an expression of how they're feeling

have an encouraging and positive attitude towards the young person's family

identify the best person to take the child to spend time with their family.

During family time:

It it's you who's supervising the time:

make sure you know the young person's circumstances

know what's expected of the birth family and what's expected of you

know what the family have been told about what's expected of them

know what to do if things don't go to plan; this is essential to ensure the safety of everyone and promote positive meetings.

After family time:

identify which support strategies will help the young person after their time with family

identify who's the best person to support them

be aware that if the child is distressed it may not mean the visit was a negative experience; it could reflect that they miss and love their family. This is important, as your interpretations will influence what information is recorded about their relationship.

Useful resources

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Supporting children living in residential child care to build...

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Information for residential child care workers about supporting children to build relationships with their family

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Secure home advocacy

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Are you in care, leaving care, have a social worker or need one? If so then Coram Voice is the place for you.

Despite the Coranavirus outbreak we are still here to tell you about your rights, make sure you get the help you need and get your voice heard.

Find out how

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Are you in care, leaving care, have a social worker or need one? If so then Coram Voice is the place for you. Despite the Coranavirus outbreak we are still here to tell you about your rights, make sure you get the help you need and get your voice heard.

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The four types of discrimination, as outlined by the Equality Act of 2020, include:

Direct discrimination.

Indirect discrimination.

Harassment.

Victimisation.

Investigate the 4 above

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The practitioner and advocacy

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Rights are entitlements, freedoms and protections which are defined and protected by law. England's current legal framework does not guarantee access to independent advocacy to every child or young person who may need it. Entitlements to advocacy for different groups of children and young people in England are found across different sources, from primary to...

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advocates and the voice of the child

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If you are growing up in care, or have a social worker and feel like adults are not really listening to how you feel about things and people are making decisions about you, not with you, AdvoCat can help you find support.

AdvoCat helps put children and young people in touch with an 'Advocate', someone who is here to make sure your voice is heard loud and clear. This means anything you want to say or know about your time in care, AdvoCat can support you.

Download AdvoCat activity sheet

What is an advocate and what colour do you think AdvoCat should be?

Take part by downloading the free worksheets.

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"I'm AdvoCat and I'm here to help you get your voice heard." If you are ... Continue reading "AdvoCat"

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legislative frameworks

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Improving outcomes for children and young people with SEND

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Ofsted and the Care Quality Commission ( CQC) have today launched a new joint framework for inspecting provision for children and young people with special educational needs and/or disabilities ( SEND) within a local area. Beginning in January 2023, inspections will focus on whether local area partnerships are delivering improved outcomes and experiences for children and young people with SEND.

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Convention on the Rights of the Child (CRC)

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This international treaty sets out the civil, political, economic, social and cultural rights of all children. It protects the rights of children in all areas of their life including privacy, health and education.

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Introduction

Across the UK there are many laws which aim to keep children safe and protect their rights. These laws:

ensure children's voices are heard

set out when a child can take part in various activities

make sure children have access to education

provide for children having a safe home

provide support for children who need to leave home

make sure children are safe if they decide to get a job

make sure children's personal information is safe.

We've put together an overview of the key legislation in these areas, to help people who work with children.

Definitions of a child

Definitions of a child

The United Nations Convention on the Rights of the Child (UNCRC) defines a child as everyone under 18 unless, "under the law applicable to the child, majority is attained earlier".

England

In England, a child is defined as anyone who has not yet reached their 18th birthday. Child protection guidance points out that even if a child has reached 16 years of age and is:

living independently

in further education

a member of the armed forces

in hospital; or

in custody in the secure estate

they are still legally children and should be given the same protection and entitlements as any other child (Department for Education, 2023).

Northern Ireland

In Northern Ireland, The Children (Northern Ireland) Order 1995 defines a 'child' as a person under the age of 18.

Scotland

In Scotland, the definition of a child varies in different legal contexts, but statutory guidance which supports the Children and Young People (Scotland) Act 2014, includes all children and young people up to the age of 18.

Where a young person between the age of 16 and 18 requires support and protection, services will need to consider which legal framework best fits each persons' needs and circumstances. The National guidance for child protection in Scotland gives more detail about this and explains how professionals should act to protect young people from harm in different circumstances (Scottish Government, 2023).

Wales

Section 3 of the Social Services and Well-being (Wales) Act 2014 states that a child is a person who is aged under 18.

Children's rights and views

Children's rights

Children's rights are protected by law internationally and within the UK.

International laws

Some rights are recognised at international level through agreements between governments. The UK has signed up to the United Nations Convention on the Rights of the Child (UNCRC) and the European Convention on Human Rights (ECHR) (PDF), both of which set out a number of children's rights.

UN Convention on the Rights of the Child

The UN Convention on the Rights of the Child (UNCRC) sets out the rights of every child in the world to:

It sets standards for education, health care, social services and penal laws, and establishes the right of children to have a say in decisions that affect them.

(Office of the United Nations High Commissioner for Human Rights (OHCHR), 1989).

Children's rights must be respected and protected online as well as offline (OHCHR, 2021). The UK signed this convention in 1990. The Rights of Children and Young Persons (Wales) Measure 2011 ensures that children's rights are included in all legislation and policy making in Wales (Welsh Government, 2019).

The United Nations Convention on the Rights of the Child (Incorporation) (Scotland) Bill, which is moving through the Scottish Parliament, will incorporate the UNCRC into Scottish law. This means that public authorities across Scotland will have to comply with children's rights in all the work they do (Scottish Parliament, 2021).

European Convention on Human Rights (ECHR)

The 1950 European Convention on Human Rights (ECHR) (PDF) is an international treaty which gives a set of rights to both adults and children. The Human Rights Act 1998 made most of the ECHR UK law. This means that children can complain to a UK court if their rights have been broken, and if the claim is rejected, take their claim to the European Court of Human Rights.

Rights set out in the convention include:

the right to life

the right to be kept safe from torture and cruel treatment

freedom from slavery

the right to a fair trial

the right to respect for private and family life

the right to an education.

Children's rights in the UK

The Human Rights Act 1998

The Human Rights Act 1998 sets out the fundamental rights and freedoms that everyone in the UK is entitled to. It incorporates the rights set out in the European Convention on Human Rights (ECHR) (PDF) into domestic British law. The Human Rights Act came into force in the UK in October 2000.

The Equality Act 2010

The Equality Act 2010 protects children, young people and adults against discrimination, harassment and victimisation in relation to housing, education, clubs, the provision of services and work. The Act applies to England, Scotland and Wales.

Northern Ireland has a number of different anti-discrimination laws relating to the provision of services.
> Read our information about establishing anti-racist social work practice
> Find out more about safeguarding d/Deaf and disabled children
> Find out more about safeguarding LGBTQ+ children and young people
Children's views

Children's Commissioners

Each of the four nations in the UK has a Children's Commissioner who is responsible for promoting and protecting the rights and best interests of children and young people:

England: The Children's Commissioner for England (Children's Commissioner for England, 2021)

Northern Ireland: Commissioner for Children and Young People for Northern Ireland (Northern Ireland Commissioner for Children and Young People (NICCY), 2018)

Scotland: Children and Young People's Commissioner (Children and Young People's Commissioner Scotland, 2021)

Wales: Children's Commissioner for Wales (Children's Commissioner for Wales, 2018).

Gillick competency and Fraser guidelines

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 meet the 'Fraser guidelines'.

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 under-16-year-old girls without parental consent.

Since then, the Fraser guidelines still apply to advice and treatment about 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.

Gillick v West Norfolk and Wisbech Area Health Authority went to the House of Lords and is often used as a legal precedent across the UK. In Scotland, the Age of Legal Capacity (Scotland) Act 1991  sets out when a person under the age of 16 has the legal capacity to make decisions.
> Read more about Gillick competency and Fraser guidelines

Leaving school and home

Leaving school

School leaving age varies across the UK.

England

In England, pupils can leave school on the last Friday in June if they'll be 16 by the end of the summer holidays.

Young people must then do one of the following until they're 18:

stay in full-time education, for example at a college

start an apprenticeship or traineeship

spend 20 hours or more a week working or volunteering, while in part-time education or training

(Gov.uk, 2021a).

Northern Ireland

In Northern Ireland, if a pupil turns 16 during the school year (between 1 September and 1 July) they can leave school after 30 June of that year.

If a pupil turns 16 between 2 July and 31 August they can't leave school until 30 June the following year (Gov.uk, 2021a).

Scotland

In Scotland, if a pupil turns 16 between 1 March and 30 September they can leave school after 31 May of that year.

If a pupil turns 16 between 1 October and the end of February they can leave at the start of the Christmas holidays in that school year (Gov.uk, 2021a).

Wales

In Wales pupils can leave school on the last Friday in June, as long as they'll be 16 by the end of that school year's summer holidays (Gov.uk, 2021a).

Leaving home

As young people get older they may start to think about moving out and living independently, for various reasons. They may:

want to live with friends or partners

have their own child to care for

want to avoid family conflict

no longer feel safe at home.

In some cases parents may ask their children to leave the home, for example for financial reasons or a breakdown in relationships.

Parents of under-16-year-olds are legally responsible for making sure their child has somewhere safe to stay.

Once a young person reaches 16 they can leave home, or their parents can ask them to move out. However parents are still legally responsible for their child until they reach 18.

Support for children who need to leave home

If a child under 16 is made to leave or doesn't feel safe in their home, local children's services can help.

Children's services should provide a family with support so that the child doesn't have to leave home. But if it's in the child's best interests to live somewhere else, they can arrange for them to live with another family member or friend, or provide emergency accommodation, such as a foster placement.

A child or young person aged 16 or 17 should contact their local children's services team if they are considering leaving home. Children's services should discuss the matter with them to see what support they need. Children's services may be able to work with the family to enable the young person to stay at home, or arrange alternative accommodation such as with another family member or friend. But they should also respect the child's wishes about where they want to live.

Homelessness

A child or young person may be considered homeless when their home is not suitable or they do not have the right to stay where they live. For example they may be living somewhere that is dangerous or overcrowded.

A homeless child is entitled to accommodation from their local authority children's services, regardless of their nationality or immigration status.

England

In England, certain public authorities (including child protection services) have a duty to refer service users who are homeless or at risk of homelessness to a housing authority. They must get consent from the individual service user to do this, and allow the service user to choose which housing authority the referral is made to (DfE, 2023).

Statutory guidance for supporting homeless 16- and 17-year-olds is set out in Prevention of homelessness and provision of accommodation for 16 and 17 year old young people who may be homeless and/or require accommodation (PDF) (Ministry of Housing, Communities and Local Government, 2018).

Northern Ireland

In Northern Ireland, Health and Social Care Trusts have a duty under The Children (Northern Ireland) Order 1995 to provide services for persons under 18 who are children in need (Housing Executive, 2022).

Scotland

In Scotland, local authorities have a duty under The Children (Scotland) Act 1995 to provide accommodation for any child who is homeless because:

no-one has parental responsibility for them

they are lost or abandoned

the person who is caring from them is unable to provide them with suitable accommodation or care.

The local authority also has the power to provide accommodation for any child in their area to safeguard or promote their welfare.

16- to 17-year-olds can also apply to their local authority as a homeless adult. All non-intentionally homeless people are entitled to permanent accommodation. Scotland's Homelessness: code of guidance (Scottish Government, 2019) states that a young person who has left their parents' home due to a "clash of lifestyles" should not automatically be considered intentionally homeless. Equal weight should be given to both the young person's views and the views of the parents.

Wales

In Wales statutory guidance for homeless 16- and 17-year-olds is Provision of accommodation for 16 and 17 year old young people who may be homeless (PDF) (Welsh Government, 2010).

Financial support

If a child or young person wants to live independently it's important to consider their ability to support themselves financially. They may not be in a position to put down a deposit on a property, pay rent and bills, or buy food.

In England, Northern Ireland and Wales, young people are not legally entitled to have a tenancy agreement to rent a property in their own name until they are 18. In Scotland this is possible from 16.

Universal Credit is available for those aged 18 or over who are on a low income or are unemployed. In some circumstances 16- and 17-year-olds are also able to claim Universal Credit (Gov.uk, 2022).

The local Citizen's Advice Bureau can help work out what support a child is entitled to. More information is also available from Jobcentre Plus in England, Scotland and Wales or the Jobs & Benefits office in Northern Ireland.

If a child or young person needs confidential help and advice direct them to Childline. Calls to 0800 1111 are free and children can also contact Childline online or read about homelessness on the Childline website. You can also download Childline posters.

Leaving care

In all nations of the UK, children leaving care at 18 are entitled to support from their local authority until they are at least 21.
> Find more about children and young people leaving care
Young parents

Young people who have their own children are entitled to support. The local children's services or the Citizen's Advice Bureau can advise about what help is available.

Child employment

Child employment

Age limits

The youngest age a child can work part-time is 13, except for children involved in specific areas such as television, theatre or modelling (Gov.uk, 2021b). Children working in these areas will need a performance licence.

> Find out more about safeguarding in the performing arts

Children can only start working full-time once they've reached the minimum school leaving age - after this they can work up to 40 hours per week (Gov.uk, 2021b). In England, a young person must be in part-time education or training until they're 18 (Gov.uk, 2021a).

Young people can work as apprentices from the age of 16. Apprentices are paid a salary for their work and also pay tax and national insurance.

More information about apprenticeships is available from:

Some local areas also offer a junior apprenticeship scheme for 14- to 16-year-olds, which enables students to spend part of their week in school and/or college, and part of their week at work.

Rules about child employment

To help keep children safe and protect their rights, there are laws governing what kinds of work they can do, how they are paid, and when they can work. An employer can be prosecuted for breaking these laws.

In most cases, businesses intending to employ school-aged children need to apply to their local authority for a child employment permit before the child can start work.

Children are only allowed to work:

at certain hours of the day. For example they can't work during school hours, early in the morning or late at night. They also need to have regular breaks.

in places that are considered safe for children. For example children can't work in a factory or industrial site, or in most jobs in a pub or betting shop.

if it doesn't affect their health, wellbeing and education.

The local authority won't allow a child to do any job they think may be harmful to them.

Local bylaws may also restrict the kind of work children can do (Gov.uk, 2021b).

Keeping children safe at work

Employers have a responsibility to keep all the children they work with safe. This includes providing a safe environment and making sure they are doing a job which is suitable for their physical and psychological capabilities.

Employers must carry out a risk assessment before a child starts work, and take measures to reduce any risks identified. In most cases, if the child is below school leaving age, the employer must inform the child's parents about the results of the risk assessment.

The Health and Safety Executive (HSE) provides guidance on health and safety considerations for young people in the workplace (HSE, 2021a).

Young people who work with other children

Although there is no law in the UK saying how old a babysitter should be, we recommend they should be at least 16.

Child care establishments like nurseries, crèches, and out-of-school clubs are heavily regulated to ensure that children in their care are safe.

In general, only people aged 18 or over should be included as adults when calculating adult to child ratios.

If over-16-year-olds are doing work that is classed as "regulated activity" they need to have a criminal records check.
> Find out more about criminal records checks
Work experience placements

The Department for Education (DfE) has published non-statutory advice for everyone involved in the planning or delivery of 16 to 19 study programmes, which includes best practice information about work experience placements (DfE, 2021).

The HSE have published information on their website for employers who have young people doing work experience with them (HSE, 2021b).

Age of consent and marriage

Age of consent and marriage

In each UK nation, the age at which people can legally consent to sexual activity (also known as the age of consent) is 16-years-old. ( Sexual Offences Act 2003; Sexual Offences (Northern Ireland) Order 2008; Sexual Offences (Scotland) Act 2009; Protection of Children and Prevention of Sexual Offences (Scotland) Act 2005).

This is the same regardless of the person's gender identity, sexual identity and whether the sexual activity is between people of the same or different gender.

Responding to underage sexual activity

Sexual activity involving a child under the age of 16 should be considered a potential safeguarding concern. Professionals who are aware of sexual activity involving a child aged under 16, should follow their organisational, local, and national procedures when deciding whether to make a safeguarding referral. Sexual activity involving a child under the age of 13 should always result in a child protection referral.
> Read more about recognising and responding to abuse
It's important to have open, honest and age-appropriate conversations with children with about the law, consent and healthy relationships.
> Read more about promoting healthy relationships > Find out more about our Talk Relationships service for secondary services
The law is there to protect children from abuse or exploitation. It is not designed to unnecessarily criminalise children.

Legislation in all four nations makes a distinction between sexual activity involving 13- to 15-year-olds and sexual activity involving an under-13-year-old. It also treats sexual offences by children under the age of 18 in England, Wales and Northern Ireland, and children under the age of 16 in Scotland, differently to those perpetrated by older people ( Sexual Offences Act 2003; Sexual Offences (Northern Ireland) Order 2008; Sexual Offences (Scotland) Act 2009; Protection of Children and Prevention of Sexual Offences (Scotland) Act 2005).

Guidance across the UK makes it clear that sexual activity between children who are close in age and understanding should not automatically result in prosecution. Instead, a range of factors should be considered to determine whether it would be in the public interest (Crown Prosecution Service (CPS), 2021; Public Prosecution Service for Northern Ireland, 2021; Lord Advocate, 2022). These include:

whether the sexual activity was entered into willingly

any power imbalance, coercion or exploitation

the children's relative age, maturity and level of development.

Additional protection up to the age of 18

Although children over the age of 16 can legally consent to sexual activity, they may still be vulnerable to harm through an abusive sexual relationship. Practitioners should assess and address their safety and wellbeing in line with safeguarding procedures.

The law gives extra protection to all under-18-year-olds, regardless of whether or not they are over the age of consent. It is illegal:

to take, show or distribute indecent photographs of a child under the age of 18 (this includes images shared through sexting or sharing nudes)

to sexually exploit a child under the age of 18

for a person in a position of trust (for example teachers or care workers) to engage in sexual activity with anyone under the age of 18 who is in the care of their organisation.

> Find out more about the legislation relating to child sexual abuse > Find out more about the legislation relating to child sexual exploitation
Marriage and civil partnerships

In England and Wales the minimum age of marriage is 18 under the Marriage and Civil Partnership (Minimum Age) Act 2022. Under no circumstances can anyone under the age of 18 in England or Wales marry, including if they travel to another UK country where the minimum age is 16 (Ministry of Justice, 2022a).

The law in Northern Ireland (Age of Marriage Act 1951) states a person must be at least 16 years of age on the day of their marriage. If they are under 18 then permission is needed from their parent or guardian, or they need a court order (NIdirect, n.d.).

In Scotland, under the Marriage (Scotland) Act 1977 the legal age of marriage is 16 and no parental or guardian consent is required.

Forced marriage

Child marriage is a form of forced marriage, and is recognised across the UK as a form of child abuse (Ministry of Justice, 2022b; NIdirect, n.d.; Scottish Government, 2014).

In all four UK nations any marriage arranged through use of violence, threat or coercion is illegal; regardless of the age of the people involved.

England, Scotland and Wales recognise forced marriage as a criminal offence under the Anti-social Behaviour, Crime and Policing Act 2014. For Northern Ireland it is the Human Trafficking and Exploitation (Criminal Justice and Support for Victims) Act 2015.

The age of criminal responsibility

Age of criminal responsibility

The age of criminal responsibility in England, Wales and Northern Ireland is 10-years-old ( Crime and Disorder Act 1998, Criminal Justice (Northern Ireland) Order 1998). The age of criminal responsibility in Scotland is 12-years-old ( Age of Criminal Responsibility (Scotland) Act 2019).

England and Wales

In England and Wales children between 10 and 17 can be arrested and taken to court if they commit a crime. They are treated differently from adults:

the case is dealt with by youth courts

they are given different sentences

if given a custodial sentence, they will be sent to special secure centres for young people, not adult prisons (Crime and Disorder Act 1998).

In England and Wales, children under 10 cannot be charged with committing a criminal offence. However, they can be given a:

local child curfew

child safety order.

Children under 10 who break the law regularly can sometimes be taken into care, or their parents could be held responsible ( Crime and Disorder Act 1998).

Young people aged 18-25 are treated as an adult by the law in England and Wales. However, if they're sent to prison, they'll be sent to a special centre for 18- to 25-year-olds, not an adult prison ( Crime and Disorder Act 1998).

Northern Ireland

In Northern Ireland, the age of criminal responsibility is 10-years-old (Criminal Justice (Northern Ireland) Order 1998).

Children between the ages of 10 and 17 can be arrested if they commit a crime but are treated differently from adults.

First- or second-time minor offences or anti-social behaviour by young people can be dealt with outside the court system. Alternatives include being given a formal reprimand by the police, or attending a restorative justice scheme.

For repeat or more serious offences, young people can be sent to court. Cases are usually heard in a youth court, although for the most serious cases young people may have to appear in a Crown Court. If a custodial sentence is given they will be sent to a secure facility for young people, rather than an adult prison (Criminal Justice (Northern Ireland) Order 1998).

Scotland

In Scotland, the age of criminal responsibility is 12 ( Age of Criminal Responsibility (Scotland) Act 2019).

Children aged 12 to 16 can be taken to court but only for serious crimes. Most offences committed by children of this age will be dealt with by early intervention (like a warning or help from a support organisation) or the children's hearings system ( Criminal Procedure (Scotland) Act 1995).

Data protection

The General Data Protection Regulation (GDPR)

The General Data Protection Regulation (GDPR) came in to force on 25 May 2018. It is an EU law that sets out guidelines for the collection and processing of personal information and aims to give individuals more rights over how their data is used. GDPR is incorporated into the UK's Data Protection Act 2018.

Why is GDPR important and what impact does it have on children?

The GDPR explicitly states that children's personal data merits specific protection. It also introduces new requirements for the online processing of a child's personal data.

Children have the same rights as adults over their personal data. These include the right to:

be provided with a transparent and clear privacy notice which explains how their data will be processed

be given a copy of their personal data

have inaccurate personal data rectified and incomplete data completed

exercise the right to have personal data erased if they wish.

A child may exercise these rights on their own behalf as long as they are competent to do so. In Scotland, a person aged 12 or over is presumed to be of sufficient age and maturity to be able to exercise their data protection rights. In England and Wales and Northern Ireland, competence is assessed depending upon the level of understanding of the child.

Even if a child is too young to understand the implications of their rights, they are still their rights, rather than anyone else's such as a parent or guardian (Information Commissioners Office, 2021a).

GDPR and online data

The provisions of GDPR help children to keep themselves safe online by giving them more control over the information they share.

GDPR gives children the 'right to erasure'. This means they can request online platforms to remove their personal data, including pictures, text or status updates.

If a child has shared any material online that they no longer wish anyone to see, they have a legal right to get this material removed, even if the content was posted by someone else.

Apps, sites and games must make it clear to users how and why they are using data.

Under this law, children must be at least 13-years-old to provide consent for an information society service (ISS) to process their personal data. Parents must provide consent if the child is under 13 (Information Commissioner's Office, 2021b). An ISS is an online service that is typically commercial and provided on request, for example social media platforms, apps, connected toys and devices, and search engines (Information Commissioner's Office, 2021c).

GDPR and child protection

GDPR emphasises the importance of asking children for consent before sharing personal information.

If a child is mature enough you should give them the opportunity to decide whether they agree to their confidential information being shared. If a child doesn't have the capacity to make their own decisions, you should ask their parent or carer (unless this would put the child at risk).

However, if you have a child protection concern, you must share information with the relevant agencies, even if you haven't been given consent. GDPR does not affect this principle.

The Information Commissioner's Office (ICO) have a 10-step guide to sharing information to safeguard children with advice on data protection as part of the child protection and safeguarding process (ICO, 2023).

References

References

Children and Young People's Commissioner Scotland (2021) About the Commissioner. [Accessed 13/11/2023].

Children's Commissioner for England (2021) The Children's Commissioner for England. [Accessed 13/11/2023].

Children's Commissioner for Wales (2021) About us. [Accessed 13/11/2023].

Council of Europe (2018) European Convention on Human Rights (PDF). Strasbourg: Council of Europe.

Department for Education (2023) 16 to 19 study programmes: guidance. [Accessed 13/11/2023].

Department for Education (DfE) (2023) Working together to safeguard children 2023: a guide to multi-agency working to help, protect and promote the welfare of children. [Accessed 15/12/2023].

Department of Health (2017) Co-operating to safeguard children and young people in Northern Ireland. [Accessed 13/11/2023].

Gov.uk (2021a) School leaving age. [Accessed 13/11/2023].

Gov.uk (2021b) Child employment. [Accessed 13/11/2023].

Gov.uk (2022) Universal credit. [Accessed 15/11/2023].

Health and Safety Executive (HSE) (n.d.) Young people at work - the law. [Accessed 13/11/2023].

Health and Safety Executive (HSE) (2021b) Young people at work - work experience. [Accessed 13/11/2023].

Housing Executive (2022) Ending homelessness together - homelessness strategy 2022-27 (PDF). Belfast: Northern Ireland Assembly

Information Commissioners Office (2021a) What rights do children have? [Accessed 13/11/2023].

Information Commissioner's Office (2021b) Children and the GDPR [Accessed 13/11/2023].

Information Commissioner's Office (2021c) Age appropriate design code [Accessed 13/11/2023].

Information Commissioner's Office (ICO) (2023) A 10 step guide to sharing information to safeguard children. [Accessed: 13/11/2023].

Lord Advocate (2022) Lord Advocate's guidelines on offences committed by children [Accessed: 13/11/2023].

Ministry of Housing, Communities and Local Government (2018) Prevention of homelessness and provision of accommodation for 16 and 17 year old young people who may be homeless and/or require accommodation (PDF). London: Ministry of Housing, Communities and Local Government.

Ministry of Justice (2022a) Boost for public safety as four justice bills receive Royal Assent. [Accessed: 13/11/2023].

Ministry of Justice (2022b) Implementation of the Marriage and Civil Partnership (Minimum Age) Act 2022. [Accessed: 13/11/2023].

Northern Ireland Commissioner for Children and Young People (NICCY) (2018) The Commissioner. [Accessed: 13/11/2023].

Nidirect (n.d.) Guidance on marriage procedures in Northern Ireland. [Accessed: 13/11/2023].

Office of the United Nations High Commissioner for Human Rights (OHCHR) (1989) Convention on the Rights of the Child. Geneva: OHCHR.

Office of the United Nations High Commissioner for Human Rights (OHCHR) (2021) General comment No. 25 (2021) on children's rights in relation to the digital environment. Geneva: OHCHR.

Public Prosecution Service for Northern Ireland (2021) Guidelines for the prosecution of young people. [Accessed: 13/11/2023].

Scottish Government (2019) Homelessness: code of guidance. [Accessed 13/11/2023].

Scottish Government (2023) National guidance for child protection in Scotland 2021 - updated 2023. Edinburgh: Scottish Government.

Scottish Parliament (2021) United Nations Convention on the Rights of the Child (Incorporation) (Scotland) Bill. [Accessed: 13/11/2023].

Welsh Government (2010) Provision of accommodation for 16 and 17 year old young people who may be homeless (PDF). [Cardiff]: Welsh Government.

Welsh Government (2019) Children's rights in Wales. [Accessed: 13/11/2023].

Further reading

For further reading about children's rights, search the NSPCC Library catalogue using the keyword "children's rights".
> Find out more about the Library and Information Service

Introduction

Across the UK there are many laws which aim to keep children safe and protect their rights. These laws:

ensure children's voices are heard

set out when a child can take part in various activities

make sure children have access to education

provide for children having a safe home

provide support for children who need to leave home

make sure children are safe if they decide to get a job

make sure children's personal information is safe.

We've put together an overview of the key legislation in these areas, to help people who work with children.

Definitions of a child

Definitions of a child

The United Nations Convention on the Rights of the Child (UNCRC) defines a child as everyone under 18 unless, "under the law applicable to the child, majority is attained earlier".

England

In England, a child is defined as anyone who has not yet reached their 18th birthday. Child protection guidance points out that even if a child has reached 16 years of age and is:

living independently

in further education

a member of the armed forces

in hospital; or

in custody in the secure estate

they are still legally children and should be given the same protection and entitlements as any other child (Department for Education, 2023).

Northern Ireland

In Northern Ireland, The Children (Northern Ireland) Order 1995 defines a 'child' as a person under the age of 18.

Scotland

In Scotland, the definition of a child varies in different legal contexts, but statutory guidance which supports the Children and Young People (Scotland) Act 2014, includes all children and young people up to the age of 18.

Where a young person between the age of 16 and 18 requires support and protection, services will need to consider which legal framework best fits each persons' needs and circumstances. The National guidance for child protection in Scotland gives more detail about this and explains how professionals should act to protect young people from harm in different circumstances (Scottish Government, 2023).

Wales

Section 3 of the Social Services and Well-being (Wales) Act 2014 states that a child is a person who is aged under 18.

Children's rights and views

Children's rights

Children's rights are protected by law internationally and within the UK.

International laws

Some rights are recognised at international level through agreements between governments. The UK has signed up to the United Nations Convention on the Rights of the Child (UNCRC) and the European Convention on Human Rights (ECHR) (PDF), both of which set out a number of children's rights.

UN Convention on the Rights of the Child

The UN Convention on the Rights of the Child (UNCRC) sets out the rights of every child in the world to:

It sets standards for education, health care, social services and penal laws, and establishes the right of children to have a say in decisions that affect them.

(Office of the United Nations High Commissioner for Human Rights (OHCHR), 1989).

Children's rights must be respected and protected online as well as offline (OHCHR, 2021). The UK signed this convention in 1990. The Rights of Children and Young Persons (Wales) Measure 2011 ensures that children's rights are included in all legislation and policy making in Wales (Welsh Government, 2019).

The United Nations Convention on the Rights of the Child (Incorporation) (Scotland) Bill, which is moving through the Scottish Parliament, will incorporate the UNCRC into Scottish law. This means that public authorities across Scotland will have to comply with children's rights in all the work they do (Scottish Parliament, 2021).

European Convention on Human Rights (ECHR)

The 1950 European Convention on Human Rights (ECHR) (PDF) is an international treaty which gives a set of rights to both adults and children. The Human Rights Act 1998 made most of the ECHR UK law. This means that children can complain to a UK court if their rights have been broken, and if the claim is rejected, take their claim to the European Court of Human Rights.

Rights set out in the convention include:

the right to life

the right to be kept safe from torture and cruel treatment

freedom from slavery

the right to a fair trial

the right to respect for private and family life

the right to an education.

Children's rights in the UK

The Human Rights Act 1998

The Human Rights Act 1998 sets out the fundamental rights and freedoms that everyone in the UK is entitled to. It incorporates the rights set out in the European Convention on Human Rights (ECHR) (PDF) into domestic British law. The Human Rights Act came into force in the UK in October 2000.

The Equality Act 2010

The Equality Act 2010 protects children, young people and adults against discrimination, harassment and victimisation in relation to housing, education, clubs, the provision of services and work. The Act applies to England, Scotland and Wales.

Northern Ireland has a number of different anti-discrimination laws relating to the provision of services.
> Read our information about establishing anti-racist social work practice
> Find out more about safeguarding d/Deaf and disabled children
> Find out more about safeguarding LGBTQ+ children and young people
Children's views

Children's Commissioners

Each of the four nations in the UK has a Children's Commissioner who is responsible for promoting and protecting the rights and best interests of children and young people:

England: The Children's Commissioner for England (Children's Commissioner for England, 2021)

Northern Ireland: Commissioner for Children and Young People for Northern Ireland (Northern Ireland Commissioner for Children and Young People (NICCY), 2018)

Scotland: Children and Young People's Commissioner (Children and Young People's Commissioner Scotland, 2021)

Wales: Children's Commissioner for Wales (Children's Commissioner for Wales, 2018).

Gillick competency and Fraser guidelines

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 meet the 'Fraser guidelines'.

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 under-16-year-old girls without parental consent.

Since then, the Fraser guidelines still apply to advice and treatment about 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.

Gillick v West Norfolk and Wisbech Area Health Authority went to the House of Lords and is often used as a legal precedent across the UK. In Scotland, the Age of Legal Capacity (Scotland) Act 1991  sets out when a person under the age of 16 has the legal capacity to make decisions.
> Read more about Gillick competency and Fraser guidelines

Leaving school and home

Leaving school

School leaving age varies across the UK.

England

In England, pupils can leave school on the last Friday in June if they'll be 16 by the end of the summer holidays.

Young people must then do one of the following until they're 18:

stay in full-time education, for example at a college

start an apprenticeship or traineeship

spend 20 hours or more a week working or volunteering, while in part-time education or training

(Gov.uk, 2021a).

Northern Ireland

In Northern Ireland, if a pupil turns 16 during the school year (between 1 September and 1 July) they can leave school after 30 June of that year.

If a pupil turns 16 between 2 July and 31 August they can't leave school until 30 June the following year (Gov.uk, 2021a).

Scotland

In Scotland, if a pupil turns 16 between 1 March and 30 September they can leave school after 31 May of that year.

If a pupil turns 16 between 1 October and the end of February they can leave at the start of the Christmas holidays in that school year (Gov.uk, 2021a).

Wales

In Wales pupils can leave school on the last Friday in June, as long as they'll be 16 by the end of that school year's summer holidays (Gov.uk, 2021a).

Leaving home

As young people get older they may start to think about moving out and living independently, for various reasons. They may:

want to live with friends or partners

have their own child to care for

want to avoid family conflict

no longer feel safe at home.

In some cases parents may ask their children to leave the home, for example for financial reasons or a breakdown in relationships.

Parents of under-16-year-olds are legally responsible for making sure their child has somewhere safe to stay.

Once a young person reaches 16 they can leave home, or their parents can ask them to move out. However parents are still legally responsible for their child until they reach 18.

Support for children who need to leave home

If a child under 16 is made to leave or doesn't feel safe in their home, local children's services can help.

Children's services should provide a family with support so that the child doesn't have to leave home. But if it's in the child's best interests to live somewhere else, they can arrange for them to live with another family member or friend, or provide emergency accommodation, such as a foster placement.

A child or young person aged 16 or 17 should contact their local children's services team if they are considering leaving home. Children's services should discuss the matter with them to see what support they need. Children's services may be able to work with the family to enable the young person to stay at home, or arrange alternative accommodation such as with another family member or friend. But they should also respect the child's wishes about where they want to live.

Homelessness

A child or young person may be considered homeless when their home is not suitable or they do not have the right to stay where they live. For example they may be living somewhere that is dangerous or overcrowded.

A homeless child is entitled to accommodation from their local authority children's services, regardless of their nationality or immigration status.

England

In England, certain public authorities (including child protection services) have a duty to refer service users who are homeless or at risk of homelessness to a housing authority. They must get consent from the individual service user to do this, and allow the service user to choose which housing authority the referral is made to (DfE, 2023).

Statutory guidance for supporting homeless 16- and 17-year-olds is set out in Prevention of homelessness and provision of accommodation for 16 and 17 year old young people who may be homeless and/or require accommodation (PDF) (Ministry of Housing, Communities and Local Government, 2018).

Northern Ireland

In Northern Ireland, Health and Social Care Trusts have a duty under The Children (Northern Ireland) Order 1995 to provide services for persons under 18 who are children in need (Housing Executive, 2022).

Scotland

In Scotland, local authorities have a duty under The Children (Scotland) Act 1995 to provide accommodation for any child who is homeless because:

no-one has parental responsibility for them

they are lost or abandoned

the person who is caring from them is unable to provide them with suitable accommodation or care.

The local authority also has the power to provide accommodation for any child in their area to safeguard or promote their welfare.

16- to 17-year-olds can also apply to their local authority as a homeless adult. All non-intentionally homeless people are entitled to permanent accommodation. Scotland's Homelessness: code of guidance (Scottish Government, 2019) states that a young person who has left their parents' home due to a "clash of lifestyles" should not automatically be considered intentionally homeless. Equal weight should be given to both the young person's views and the views of the parents.

Wales

In Wales statutory guidance for homeless 16- and 17-year-olds is Provision of accommodation for 16 and 17 year old young people who may be homeless (PDF) (Welsh Government, 2010).

Financial support

If a child or young person wants to live independently it's important to consider their ability to support themselves financially. They may not be in a position to put down a deposit on a property, pay rent and bills, or buy food.

In England, Northern Ireland and Wales, young people are not legally entitled to have a tenancy agreement to rent a property in their own name until they are 18. In Scotland this is possible from 16.

Universal Credit is available for those aged 18 or over who are on a low income or are unemployed. In some circumstances 16- and 17-year-olds are also able to claim Universal Credit (Gov.uk, 2022).

The local Citizen's Advice Bureau can help work out what support a child is entitled to. More information is also available from Jobcentre Plus in England, Scotland and Wales or the Jobs & Benefits office in Northern Ireland.

If a child or young person needs confidential help and advice direct them to Childline. Calls to 0800 1111 are free and children can also contact Childline online or read about homelessness on the Childline website. You can also download Childline posters.

Leaving care

In all nations of the UK, children leaving care at 18 are entitled to support from their local authority until they are at least 21.
> Find more about children and young people leaving care
Young parents

Young people who have their own children are entitled to support. The local children's services or the Citizen's Advice Bureau can advise about what help is available.

Child employment

Child employment

Age limits

The youngest age a child can work part-time is 13, except for children involved in specific areas such as television, theatre or modelling (Gov.uk, 2021b). Children working in these areas will need a performance licence.

> Find out more about safeguarding in the performing arts

Children can only start working full-time once they've reached the minimum school leaving age - after this they can work up to 40 hours per week (Gov.uk, 2021b). In England, a young person must be in part-time education or training until they're 18 (Gov.uk, 2021a).

Young people can work as apprentices from the age of 16. Apprentices are paid a salary for their work and also pay tax and national insurance.

More information about apprenticeships is available from:

Some local areas also offer a junior apprenticeship scheme for 14- to 16-year-olds, which enables students to spend part of their week in school and/or college, and part of their week at work.

Rules about child employment

To help keep children safe and protect their rights, there are laws governing what kinds of work they can do, how they are paid, and when they can work. An employer can be prosecuted for breaking these laws.

In most cases, businesses intending to employ school-aged children need to apply to their local authority for a child employment permit before the child can start work.

Children are only allowed to work:

at certain hours of the day. For example they can't work during school hours, early in the morning or late at night. They also need to have regular breaks.

in places that are considered safe for children. For example children can't work in a factory or industrial site, or in most jobs in a pub or betting shop.

if it doesn't affect their health, wellbeing and education.

The local authority won't allow a child to do any job they think may be harmful to them.

Local bylaws may also restrict the kind of work children can do (Gov.uk, 2021b).

Keeping children safe at work

Employers have a responsibility to keep all the children they work with safe. This includes providing a safe environment and making sure they are doing a job which is suitable for their physical and psychological capabilities.

Employers must carry out a risk assessment before a child starts work, and take measures to reduce any risks identified. In most cases, if the child is below school leaving age, the employer must inform the child's parents about the results of the risk assessment.

The Health and Safety Executive (HSE) provides guidance on health and safety considerations for young people in the workplace (HSE, 2021a).

Young people who work with other children

Although there is no law in the UK saying how old a babysitter should be, we recommend they should be at least 16.

Child care establishments like nurseries, crèches, and out-of-school clubs are heavily regulated to ensure that children in their care are safe.

In general, only people aged 18 or over should be included as adults when calculating adult to child ratios.

If over-16-year-olds are doing work that is classed as "regulated activity" they need to have a criminal records check.
> Find out more about criminal records checks
Work experience placements

The Department for Education (DfE) has published non-statutory advice for everyone involved in the planning or delivery of 16 to 19 study programmes, which includes best practice information about work experience placements (DfE, 2021).

The HSE have published information on their website for employers who have young people doing work experience with them (HSE, 2021b).

Age of consent and marriage

Age of consent and marriage

In each UK nation, the age at which people can legally consent to sexual activity (also known as the age of consent) is 16-years-old. ( Sexual Offences Act 2003; Sexual Offences (Northern Ireland) Order 2008; Sexual Offences (Scotland) Act 2009; Protection of Children and Prevention of Sexual Offences (Scotland) Act 2005).

This is the same regardless of the person's gender identity, sexual identity and whether the sexual activity is between people of the same or different gender.

Responding to underage sexual activity

Sexual activity involving a child under the age of 16 should be considered a potential safeguarding concern. Professionals who are aware of sexual activity involving a child aged under 16, should follow their organisational, local, and national procedures when deciding whether to make a safeguarding referral. Sexual activity involving a child under the age of 13 should always result in a child protection referral.
> Read more about recognising and responding to abuse
It's important to have open, honest and age-appropriate conversations with children with about the law, consent and healthy relationships.
> Read more about promoting healthy relationships > Find out more about our Talk Relationships service for secondary services
The law is there to protect children from abuse or exploitation. It is not designed to unnecessarily criminalise children.

Legislation in all four nations makes a distinction between sexual activity involving 13- to 15-year-olds and sexual activity involving an under-13-year-old. It also treats sexual offences by children under the age of 18 in England, Wales and Northern Ireland, and children under the age of 16 in Scotland, differently to those perpetrated by older people ( Sexual Offences Act 2003; Sexual Offences (Northern Ireland) Order 2008; Sexual Offences (Scotland) Act 2009; Protection of Children and Prevention of Sexual Offences (Scotland) Act 2005).

Guidance across the UK makes it clear that sexual activity between children who are close in age and understanding should not automatically result in prosecution. Instead, a range of factors should be considered to determine whether it would be in the public interest (Crown Prosecution Service (CPS), 2021; Public Prosecution Service for Northern Ireland, 2021; Lord Advocate, 2022). These include:

whether the sexual activity was entered into willingly

any power imbalance, coercion or exploitation

the children's relative age, maturity and level of development.

Additional protection up to the age of 18

Although children over the age of 16 can legally consent to sexual activity, they may still be vulnerable to harm through an abusive sexual relationship. Practitioners should assess and address their safety and wellbeing in line with safeguarding procedures.

The law gives extra protection to all under-18-year-olds, regardless of whether or not they are over the age of consent. It is illegal:

to take, show or distribute indecent photographs of a child under the age of 18 (this includes images shared through sexting or sharing nudes)

to sexually exploit a child under the age of 18

for a person in a position of trust (for example teachers or care workers) to engage in sexual activity with anyone under the age of 18 who is in the care of their organisation.

> Find out more about the legislation relating to child sexual abuse > Find out more about the legislation relating to child sexual exploitation
Marriage and civil partnerships

In England and Wales the minimum age of marriage is 18 under the Marriage and Civil Partnership (Minimum Age) Act 2022. Under no circumstances can anyone under the age of 18 in England or Wales marry, including if they travel to another UK country where the minimum age is 16 (Ministry of Justice, 2022a).

The law in Northern Ireland (Age of Marriage Act 1951) states a person must be at least 16 years of age on the day of their marriage. If they are under 18 then permission is needed from their parent or guardian, or they need a court order (NIdirect, n.d.).

In Scotland, under the Marriage (Scotland) Act 1977 the legal age of marriage is 16 and no parental or guardian consent is required.

Forced marriage

Child marriage is a form of forced marriage, and is recognised across the UK as a form of child abuse (Ministry of Justice, 2022b; NIdirect, n.d.; Scottish Government, 2014).

In all four UK nations any marriage arranged through use of violence, threat or coercion is illegal; regardless of the age of the people involved.

England, Scotland and Wales recognise forced marriage as a criminal offence under the Anti-social Behaviour, Crime and Policing Act 2014. For Northern Ireland it is the Human Trafficking and Exploitation (Criminal Justice and Support for Victims) Act 2015.

The age of criminal responsibility

Age of criminal responsibility

The age of criminal responsibility in England, Wales and Northern Ireland is 10-years-old ( Crime and Disorder Act 1998, Criminal Justice (Northern Ireland) Order 1998). The age of criminal responsibility in Scotland is 12-years-old ( Age of Criminal Responsibility (Scotland) Act 2019).

England and Wales

In England and Wales children between 10 and 17 can be arrested and taken to court if they commit a crime. They are treated differently from adults:

the case is dealt with by youth courts

they are given different sentences

if given a custodial sentence, they will be sent to special secure centres for young people, not adult prisons (Crime and Disorder Act 1998).

In England and Wales, children under 10 cannot be charged with committing a criminal offence. However, they can be given a:

local child curfew

child safety order.

Children under 10 who break the law regularly can sometimes be taken into care, or their parents could be held responsible ( Crime and Disorder Act 1998).

Young people aged 18-25 are treated as an adult by the law in England and Wales. However, if they're sent to prison, they'll be sent to a special centre for 18- to 25-year-olds, not an adult prison ( Crime and Disorder Act 1998).

Northern Ireland

In Northern Ireland, the age of criminal responsibility is 10-years-old (Criminal Justice (Northern Ireland) Order 1998).

Children between the ages of 10 and 17 can be arrested if they commit a crime but are treated differently from adults.

First- or second-time minor offences or anti-social behaviour by young people can be dealt with outside the court system. Alternatives include being given a formal reprimand by the police, or attending a restorative justice scheme.

For repeat or more serious offences, young people can be sent to court. Cases are usually heard in a youth court, although for the most serious cases young people may have to appear in a Crown Court. If a custodial sentence is given they will be sent to a secure facility for young people, rather than an adult prison (Criminal Justice (Northern Ireland) Order 1998).

Scotland

In Scotland, the age of criminal responsibility is 12 ( Age of Criminal Responsibility (Scotland) Act 2019).

Children aged 12 to 16 can be taken to court but only for serious crimes. Most offences committed by children of this age will be dealt with by early intervention (like a warning or help from a support organisation) or the children's hearings system ( Criminal Procedure (Scotland) Act 1995).

Data protection

The General Data Protection Regulation (GDPR)

The General Data Protection Regulation (GDPR) came in to force on 25 May 2018. It is an EU law that sets out guidelines for the collection and processing of personal information and aims to give individuals more rights over how their data is used. GDPR is incorporated into the UK's Data Protection Act 2018.

Why is GDPR important and what impact does it have on children?

The GDPR explicitly states that children's personal data merits specific protection. It also introduces new requirements for the online processing of a child's personal data.

Children have the same rights as adults over their personal data. These include the right to:

be provided with a transparent and clear privacy notice which explains how their data will be processed

be given a copy of their personal data

have inaccurate personal data rectified and incomplete data completed

exercise the right to have personal data erased if they wish.

A child may exercise these rights on their own behalf as long as they are competent to do so. In Scotland, a person aged 12 or over is presumed to be of sufficient age and maturity to be able to exercise their data protection rights. In England and Wales and Northern Ireland, competence is assessed depending upon the level of understanding of the child.

Even if a child is too young to understand the implications of their rights, they are still their rights, rather than anyone else's such as a parent or guardian (Information Commissioners Office, 2021a).

GDPR and online data

The provisions of GDPR help children to keep themselves safe online by giving them more control over the information they share.

GDPR gives children the 'right to erasure'. This means they can request online platforms to remove their personal data, including pictures, text or status updates.

If a child has shared any material online that they no longer wish anyone to see, they have a legal right to get this material removed, even if the content was posted by someone else.

Apps, sites and games must make it clear to users how and why they are using data.

Under this law, children must be at least 13-years-old to provide consent for an information society service (ISS) to process their personal data. Parents must provide consent if the child is under 13 (Information Commissioner's Office, 2021b). An ISS is an online service that is typically commercial and provided on request, for example social media platforms, apps, connected toys and devices, and search engines (Information Commissioner's Office, 2021c).

GDPR and child protection

GDPR emphasises the importance of asking children for consent before sharing personal information.

If a child is mature enough you should give them the opportunity to decide whether they agree to their confidential information being shared. If a child doesn't have the capacity to make their own decisions, you should ask their parent or carer (unless this would put the child at risk).

However, if you have a child protection concern, you must share information with the relevant agencies, even if you haven't been given consent. GDPR does not affect this principle.

The Information Commissioner's Office (ICO) have a 10-step guide to sharing information to safeguard children with advice on data protection as part of the child protection and safeguarding process (ICO, 2023).

References

References

Children and Young People's Commissioner Scotland (2021) About the Commissioner. [Accessed 13/11/2023].

Children's Commissioner for England (2021) The Children's Commissioner for England. [Accessed 13/11/2023].

Children's Commissioner for Wales (2021) About us. [Accessed 13/11/2023].

Council of Europe (2018) European Convention on Human Rights (PDF). Strasbourg: Council of Europe.

Department for Education (2023) 16 to 19 study programmes: guidance. [Accessed 13/11/2023].

Department for Education (DfE) (2023) Working together to safeguard children 2023: a guide to multi-agency working to help, protect and promote the welfare of children. [Accessed 15/12/2023].

Department of Health (2017) Co-operating to safeguard children and young people in Northern Ireland. [Accessed 13/11/2023].

Gov.uk (2021a) School leaving age. [Accessed 13/11/2023].

Gov.uk (2021b) Child employment. [Accessed 13/11/2023].

Gov.uk (2022) Universal credit. [Accessed 15/11/2023].

Health and Safety Executive (HSE) (n.d.) Young people at work - the law. [Accessed 13/11/2023].

Health and Safety Executive (HSE) (2021b) Young people at work - work experience. [Accessed 13/11/2023].

Housing Executive (2022) Ending homelessness together - homelessness strategy 2022-27 (PDF). Belfast: Northern Ireland Assembly

Information Commissioners Office (2021a) What rights do children have? [Accessed 13/11/2023].

Information Commissioner's Office (2021b) Children and the GDPR [Accessed 13/11/2023].

Information Commissioner's Office (2021c) Age appropriate design code [Accessed 13/11/2023].

Information Commissioner's Office (ICO) (2023) A 10 step guide to sharing information to safeguard children. [Accessed: 13/11/2023].

Lord Advocate (2022) Lord Advocate's guidelines on offences committed by children [Accessed: 13/11/2023].

Ministry of Housing, Communities and Local Government (2018) Prevention of homelessness and provision of accommodation for 16 and 17 year old young people who may be homeless and/or require accommodation (PDF). London: Ministry of Housing, Communities and Local Government.

Ministry of Justice (2022a) Boost for public safety as four justice bills receive Royal Assent. [Accessed: 13/11/2023].

Ministry of Justice (2022b) Implementation of the Marriage and Civil Partnership (Minimum Age) Act 2022. [Accessed: 13/11/2023].

Northern Ireland Commissioner for Children and Young People (NICCY) (2018) The Commissioner. [Accessed: 13/11/2023].

Nidirect (n.d.) Guidance on marriage procedures in Northern Ireland. [Accessed: 13/11/2023].

Office of the United Nations High Commissioner for Human Rights (OHCHR) (1989) Convention on the Rights of the Child. Geneva: OHCHR.

Office of the United Nations High Commissioner for Human Rights (OHCHR) (2021) General comment No. 25 (2021) on children's rights in relation to the digital environment. Geneva: OHCHR.

Public Prosecution Service for Northern Ireland (2021) Guidelines for the prosecution of young people. [Accessed: 13/11/2023].

Scottish Government (2019) Homelessness: code of guidance. [Accessed 13/11/2023].

Scottish Government (2023) National guidance for child protection in Scotland 2021 - updated 2023. Edinburgh: Scottish Government.

Scottish Parliament (2021) United Nations Convention on the Rights of the Child (Incorporation) (Scotland) Bill. [Accessed: 13/11/2023].

Welsh Government (2010) Provision of accommodation for 16 and 17 year old young people who may be homeless (PDF). [Cardiff]: Welsh Government.

Welsh Government (2019) Children's rights in Wales. [Accessed: 13/11/2023].

Further reading

For further reading about children's rights, search the NSPCC Library catalogue using the keyword "children's rights".
> Find out more about the Library and Information Service

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Covers legislation and definitions about children's rights, ages of consent and criminal responsibility, school leaving age, child employment and GDPR.

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Laws protecting children’s rights | CRAE

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There are many international human rights treaties and domestic laws which protect children's rights. International human rights treaties are agreements between different governments around the world. When a country ratifies (signs up to) a treaty, it takes on legal obligations under international law . Domestic laws are laws decided by the UK Government and Parliament.

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Schon's reflective model

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Overview

Schon reflective model was given by Donald Schon in 1991 to provide a base for reflection. The model provides an additional element in reflection by differentiating reflection during and after the occurrence of an event. The use of this model helps in the quality enhancement work of practitioners by considering individual actions at the time of occurrence of an event and considering actions that could have been implemented to effectively deal with a particular situation. This model is different from all other reflection models as the use of this model is not a multi-stage or circular model, rather it is a type of reflection model that involves reflection during and after an event.

This model of reflection mainly focuses on three concepts which include knowing in action, reflection in action, and reflection on action. Knowledge in action is less commonly used in this reflective model as it relates to the intuitive ability of an individual to perform certain tasks. For instance, knowledge in the action phase of a health practitioner may include visiting patients. Indeed, the two other commonly cited concepts are a reflection in and on the action which are mostly used during and after an event (Hébert, 2015). Reflection in action helps practitioners to become more responsive while dealing with some complicated situations and reflection on action allows an individual to spend more time considering the complexity of a situation and practices that could have been adopted to effectively deal with a situation.

Students often confuses Schön's model with johns model of reflection cycle but the major difference between the both is that Schön's model majorly focuses on action and learning from experiences, while Johns model encourages a broader range of reflection while giving suitable question from various aspects.

Considering the use of Schon reflective model, this model is mainly used in nursing care as this model helps practitioners properly plan immediate responses to some situations and to learn from such experiences. The use of this model of reflection also helps to promote the continuous professional development (CPD) of nursing professionals by considering implicit knowledge. Schon reflective model also helps to nurture professional knowledge via reflection to further enhance the quality of care.

Three stages of Schon reflective model

Now, you must be thinking about how we can apply this model of reflection. Schon reflective model can be applied by following three steps which are discussed as follows:

Stage 1: Knowledge in action

The first step involved in this model is thinking about knowledge in action where a nurse can consider actions that are implemented in day-to-day operations beforehand. This can help to boost the confidence and strength of nursing staff. In this section, you will highlight what you already know and why that information is important. Some of the questions that can help you in answering this section of the reflection are

Stage 2: Reflection IN action

The second stage includes reflection in action where nursing staff can reflect on actions that can be undertaken to deal with this situation. This includes reflection during the doing stage where nurses reflect on their practice while the incident is occurring. Some assisting questions for the same are

Stage 3: Reflection ON action

The last stage of schon's reflective model is 'reflection on action' where practitioners can provide complete detail on the event after the event has happened. Questions that can help you in answering this section are listed below.

After critically understanding the model, for a better comprehension of the model, let's take an example of the implementation of the model.

Example of reflection in nursing using Schon's model

Case assessment: schon's reflective model example is of the nurse working in Addenbrooke's Hospital, Cambridge. This example of reflection will focus on her experience while working in the child placement unit with a patient suffering from heavy bleeding due to a cut on her knee.

Stage 1: Knowledge in action

Stage 2: Reflection IN action

Stage 3: Reflection ON action

FAQs

Can Schön's reflection model be used in fields other than nursing?

What distinguishes reflection-on-action from reflection-in-action?

How can I get around the limitations of applying the Schön reflective model?

References

Hébert, C. (2015). Knowing and/or experiencing: a critical examination of the reflective models of John Dewey and Donald Schön. Reflective Practice, 16(3), 361-371. https://doi.org/10.1080/14623943.2015.1023281

Kano, M. (2005) First-aid training and capabilities of the lay public: A potential alternative source of emergency medical assistance following a natural disaster, Disasters. U.S. National Library of Medicine. Available at: https://pubmed.ncbi.nlm.nih.gov/15720381/ (Accessed: December 2, 2022).

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Understanding Schön's Reflective Model with an easy guide

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Schön Model of Reflection was developed by Donald Schön in 1991. This column accurately describes the model along with an example in nursing practice.

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11.

1. The positive relationships standard is that children are helped to develop, and to benefit from, relationships based on:

1. Mutual respect and trust;

2. An understanding about acceptable behaviour; and

3. Positive responses to other children and adults.

2. In particular, the standard in paragraph (1) requires the registered person to ensure:

1. That staff:

1. Meet each child's behavioural and emotional needs, as set out in the child's relevant plans;

2. Help each child to develop socially aware behaviour;

3. Encourage each child to take responsibility for the child's behaviour, in accordance with the child's age and understanding;

4. Help each child to develop and practise skills to resolve conflicts positively and without harm to anyone;

5. Communicate to each child expectations about the child's behaviour and ensure that the child understands those expectations in accordance with the child's age and understanding;

6. Help each child to understand, in a way that is appropriate according to the child's age and understanding, personal, sexual and social relationships, and how those relationships can be supportive or harmful;

7. Help each child to develop the understanding and skills to recognise or withdraw from a damaging, exploitative or harmful relationship;

8. Strive to gain each child's respect and trust;

9. Understand how children's previous experiences and present emotions can be communicated through behaviour and have the competence and skills to interpret these and develop positive relationships with children;

10. Are provided with supervision and support to enable them to understand and manage their own feelings and responses to the behaviour and emotions of children, and to help children to do the same;

11. De-escalate confrontations with or between children, or potentially violent behaviour by children;

12. Understand and communicate to children that bullying is unacceptable; and

13. Have the skills to recognise incidents or indications of bullying and how to deal with them; and

2. That each child is encouraged to build and maintain positive relationships with others.

'Bullying'

Bullying is behaviour by an individual or group, repeated over time, that intentionally hurts another individual or group either physically or emotionally. Bullying can be in many forms and this standard's references to bullying cover bullying of any kind or description.

'Restraint'

Restraint is defined in regulation 2 and means using force or restricting liberty of movement. Also see regulation 20 and The Protection of Children Standard of the Guide in relation to restraint.

Children's homes should work closely with the placing authority to understand the child's relationship history and the impact that the child's arrival may have on the group living in the home. Staff should understand, for each child, what the placing authority has recorded in the relevant plan as an appropriate level of contact with family and friends.

Homes should work closely with health and education professionals to ensure that outcomes identified and progress made by children in building relationships and achieving socially acceptable behaviours can be recorded and measured.

Homes should develop and maintain effective working relationships with local youth justice and police services where children in their care have targets to achieve in reducing offending or socially unacceptable behaviour.

Regulation 11(2) sets out the expectations on staff in building a positive relationship with each child and helping the child develop skills to have positive relationships with others. 'Others' includes individuals both inside and outside the home such as other children in the home, staff, family members, siblings, previous carers and friends (in accordance with their relevant plans). The care planning standard (see The Care Planning Standard) provides further detail in respect of contact with parents, relatives and friends.

Children should be supported to understand how to build friendships with other children. They should be able to spend time with their friends in the local community, in their home area, and by having friends visit them at the home, in line with the child's plans, age and understanding.

Staff should be skilled in understanding the range of influences that friendships can have and should encourage those with a positive impact and discourage those with a negative impact. Homes that care for children who have, or are likely, to sexually offend should establish the extent to which friendships can be supported, in line with the child's relevant plans and subject to the safety of all concerned.

Decisions about overnight stays with friends should be delegated to children's homes staff by the placing authority for looked-after children. The level of delegated authority should be recorded in the placement plan. Where children wish to stay overnight with friends, staff should carry out the same kind of checks that responsible parents might make in similar circumstances to seek reassurance that the child will be well cared for and safe.

Staff should understand and help children to understand what makes a healthy, nurturing relationship. Staff should be skilled to recognise the signs and provide support to children in danger of or involved in exploitative or damaging relationships with others and where possible prevent these types of relationships.

Expectations of standards of behaviour should be high for all staff and children in the home. These standards should be clear and unambiguous. Children should be supported to develop understanding and empathy towards each other. Positive behaviour and relationships should be reinforced, praised and encouraged; poor behaviour should be challenged and discussed. The development of safe, stable and secure relationships with staff in the home should be central to the ethos of the home and support the development of secure attachments that, where appropriate, persist over time.

Where positive relationships exist between children and staff this should be respected and maintained as far as possible when making any decisions to alter staffing arrangements. The registered person should respond to children's views about changes to staff and be aware of the potential impact this may have for the child's stability and emotional well-being.

Staff should understand factors that affect children's motivation to behave in a socially acceptable way. Staff should encourage an enthusiasm for positive behaviour through the use of positive behaviour strategies in line with the child's relevant plans.

The capacity and competence of staff to build constructive, warm relationships with children that actively promote positive behaviour, provides the foundations for managing any negative behaviour. Staff should have the skills to respond to each child's individual behaviour. Where necessary they should manage conflict, maintain constructive dialogues and react appropriately if challenged by a child in their care.

Staff supervision must enable staff to reflect and act upon how their own feelings and behaviour may be affected by the behaviour of the children they care for.

Staff should understand what they must do to prevent bullying of children by other children or adults. Staff should be able to recognise and address different types of abuse such as peer abuse, cyberbullying and bullying in day-to-day relationships in the home. Registered persons must ensure that procedures for dealing with allegations of bullying are in place and staff have the skills required to intervene, protect and address bullying behaviours effectively (see regulation 34(3) on the policy for the prevention of bullying).

Where homes are also registered as schools, the home's policies and procedures around bullying should not unnecessarily duplicate or contradict any requirements of other relevant legislation.

Secure children's homes are subject to the requirements of the positive relationship standard. However, with regard to regulation 11(2)(a), secure children's homes may consider managing certain relationships by limiting the interactions between those children.

Secure children's homes should also consider how they can support children to sustain the friendships they already have outside of the home, for example encouraging friends to remain in contact or visit if it would meet an expressed need of the child in secure care.

Children with disabilities can be disadvantaged and socially isolated from friends, especially if they attend a school which is not in their local community such as a residential special school. The registered person in a short break setting should ensure that the short break service offers the chance for children to develop friendships, by carefully matching groups and, where possible, by arranging for children to frequently stay with the same group.

Short break settings have an important role to play in extending and increasing the opportunities available to children to share, socialise with others and choose activities alongside their peers.

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Skip to content 11. The positive relationships standard is that children are helped to develop, and to benefit from, relationships based on: Mutual respect and trust; An understanding about acceptable behaviour; and Positive responses to other children and adults.

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The importance of building relationships in SC

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The importance of building relationships in SC

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Good resource used in Wales but relevant to this unit

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You must have a good understanding of the importance of relationships to support young people. These relationships could be with young people's families, peers or practitioners.

Children and young people who live in children's homes are among the most vulnerable in society, often with complex and diverse needs. This makes having a support network around them particularly important.

Be aware that the care system itself can make it difficult for young people to form relationships due to frequent changes of social worker, home, school, and often geographical location. The children you're supporting may also be limited in who they can see, or how often they can see them.

However, despite negative experiences in the past, with your help and support young people can learn to develop healthy relationships.

Positive and meaningful relationships are important because they can:

contribute to children's resilience

promote physical, mental and emotional well-being

support positive outcomes

may help to minimise the risk of forming inappropriate and risky relationships that could lead to exploitation or abuse

help with therapeutic work.

Positive and meaningful relationships can also support young people's transition through the care system and when leaving care by:

enhancing the stability of placements

influencing permanency planning.

Not forming positive relationships with the children you care for can lead to:

challenging behaviour

placement instability

a continuing cycle of rejection and instability for that child.

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The importance of relationships to children living in residential...

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You must have a good understanding of the importance of relationships to support young people. These relationships could be with young people's families, peers or practitioners. Children and young people who live in children's homes are among the most vulnerable in society, often with complex and diverse needs.

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Nice resource to facilitate this unit

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REGULATIONS AND STANDARDS

The Positive Relationships Standard

Regulation 19 - Behaviour Management and Discipline

SCOPE OF THIS CHAPTER

This chapter provides guidance for staff on helping children to establish positive relationships and on managing behaviour, which includes supporting positive behaviour, de-escalation of conflicts and discipline. This procedure is made clear to the responsible authority/placing authority, child and parent(s) before the placement begins or, in an emergency placement, at the time of the placement.

This procedure must be understood and applied at all times by staff, and will be kept under review and revised where appropriate.

RELATED CHAPTERS
Use of Restraint and Physical Intervention Procedure Bullying Procedure
AMENDMENT

This chapter was updated in May 2023 to incorporate Ofsted feedback. Information was added into Section 2, Positive Behaviour Support, Section 6, Risk Assessment and Section 9, Recording and Reporting.

1. Positive Relationships

2. Positive Behaviour Support

3. Minimum House Rules

4. General Principles for Behaviour Management

5. Placement Planning

6. Risk Assessment

7. Managing Challenging Behaviour and De-escalation of Conflicts

8. Discipline and Sanctions

9. Recording and Reporting

10. Follow Up After an Incident

Further Information

1. Positive Relationships

Children in the Home are helped to develop, and to benefit from, relationships based on:

Mutual respect and trust;

An understanding about acceptable behaviour; and

Positive responses to other children and adults.

In particular, the registered person will ensure that staff:

Meet each child's behavioural and emotional needs, as set out in the child's relevant plans;

Help each child to develop socially aware behaviour;

Encourage each child to take responsibility for the child's behaviour, in accordance with the child's age and understanding;

Help each child to develop and practise skills to resolve conflicts positively and without harm to anyone;

Communicate to each child expectations about the child's behaviour and ensure that the child understands those expectations in accordance with the child's age and understanding;

Help each child to understand, in a way that is appropriate according to the child's age and understanding, personal, sexual and social relationships, and how those relationships can be supportive or harmful;

Help each child to develop the understanding and skills to recognise or withdraw from a damaging, exploitative or harmful relationship;

Strive to gain each child's respect and trust;

Understand how children's previous experiences and present emotions can be communicated through behaviour and have the competence and skills to interpret these and develop positive relationships with children;

Are provided with supervision and support to enable them to understand and manage their own feelings and responses to the behaviour and emotions of children, and to help children to do the same;

De-escalate confrontations with or between children, or potentially violent behaviour by children;

Understand and communicate to children that bullying is unacceptable; and

Have the skills to recognise incidents or indications of bullying and how to deal with them; and

That each child is encouraged to build and maintain positive relationships with others.

Children should be supported to understand how to build friendships with other children. They should be able to spend time with their friends in the local community, in their home area, and by having friends visit them at the Home, in line with the child's plans, age and understanding.

Staff should understand and help children to understand what makes a healthy, nurturing relationship. Staff should be skilled in understanding the range of influences that friendships can have and should encourage those with a positive impact and discourage those with a negative impact. Staff should be skilled to recognise the signs and provide support to children in danger of or involved in exploitative or damaging relationships with others and where possible prevent these types of relationships.

In the case of children who have, or are likely to, sexually offend, the Home should establish the extent to which friendships can be supported, in line with the child's relevant plans and subject to the safety of all concerned.

2. Positive Behaviour Support

The Home is committed to an holistic approach that draws on established theoretical bases, research, best practice and guidance in order to promote and develop positive behaviour.

The Home's approach to behaviour support:

Aims to create a safe, caring environment where children are supported to develop understanding and empathy towards each other;

Ensures that all children have opportunities to become confident and achieve their full potential;

Encourages the child's consultation and participation in setting rules and consequences;

Ensures that all children and young people have clear expectations in relation to their behaviour, are supported to understand and to develop alternative positive approaches to challenges within their lives;

Ensues that all children and young people understand how positive behaviour is recognised and rewarded;

Ensures that all children and young people are supported to understand the consequences of negative behaviour;

Ensures that all staff understand and share the principles of positive approaches to behaviour;

Accepts the individuality of children and young people and celebrates the diversity of their backgrounds.

The quality of relationships between professionals, staff caring for the children, the children and their parents (as appropriate) is crucial to this approach.

Staff play an important part in the day-to-day life of a child, and will be trained and supported in establishing positive relationships with children and in managing behaviour, including behaviour which may be challenging at times.

Staff training on behaviour management techniques and strategies will enable them to achieve and develop a more positive relationship with the child and a more harmonious life and will enable the child to feel good about themselves. The development of safe, stable and secure relationships with staff in the Home is central to the ethos of the Home and supports the development of secure attachments that, where appropriate, persist over time.

The capacity and competence of staff to build constructive, warm relationships with children that actively promote positive behaviour, provides the foundations for managing any negative behaviour. Where positive relationships exist between children and staff this should be respected and maintained as far as possible when making any decisions to alter staffing arrangements. The registered person should respond to children's views about changes to staff and be aware of the potential impact this may have for the child's stability and emotional well-being.

Positive behaviour and relationships should be reinforced, praised and encouraged; poor behaviour should be challenged and discussed.

Staff should at all times endeavour to:

Understand factors that affect children's motivation to behave in a socially acceptable way to enable them to respond to each child's individual behaviour;

Encourage an enthusiasm for positive behaviour through the use of positive behaviour strategies in line with the child's relevant plans;

Listen to and empathise with children, respect their thoughts and feelings and take their wishes into consideration;

Look for things that are going well, or any step in the right direction, and appropriately reward it;

Use rewards in a creative and diverse way, specific to children's needs, capabilities and interests. This may mean that children are rewarded with activities or rewards that they enjoy. But all 'tangible' rewards should be accompanied by use of 'non tangible' encouragement and support - by staff demonstrating to children that they have done well. Such 'non tangible' rewards include smiling and praising children;

Make sure that children and young people are aware of the things that they have done well. This should involve prompt verbal feedback, along with clear recording in the child or young person's file. All 'tangible' rewards should be clearly identified;

Where necessary, manage conflict, maintain constructive dialogues and react appropriately if challenged by a child in their care.

The PACE model can help staff work successfully with a child.

PACE stands for:

Playfulness

Using a light-hearted, reassuring tone - similar to parent-infant interactions - to creating an atmosphere of safety and reassurance where no one feels judged and your child feels able to cope with positive feelings.

Acceptance

Acceptance is about actively communicating that you accept the feelings, thoughts and internal struggles that are underneath the child's outward behaviour. It is not about accepting the behaviour itself but helping to teach the child to not feel ashamed by their inner turmoil.

Curiosity, without judgement, is how we help children become aware of their inner life. It's about wondering out loud without necessarily expecting an answer in return. Phrases like "I wonder if"..." will help the child to put a name to their emotions and thoughts.

Feeling a child's sadness of distress with them, being emotionally available to them during times of difficulty shows the child that they are not alone and that the adult are strong enough to support them both through it.

(Sometimes 'L' for Love is included, making PLACE).

3. Minimum House Rules

The Home has house rules, setting out the expectations for how things are managed within the Home. This should be explained to children, with the reasons for the rules and they should also know that that there are rules for everyone. They should not feel that they are being treated with less regard than other children in the Home. Ideally children should know these expectations before they are placed.

These house rules should be recorded on the Placement Plan and in the safe caring document.

House rules will be posted in the staff office, in the Children's' Guide and on children's notice boards. House rules will be revised regularly in consultation with the children and staff team.

4. General Principles for Behaviour Management

Treating each child with understanding, dignity, kindness and respect; building, protecting and preserving positive relationships between each child and the adults caring for them;

Understanding each child's behaviour to allow their needs, aspirations, experiences and strengths to be recognised and their quality of life to be enhanced;

Involving children and relevant others wherever practical in behaviour management;

Supporting each child to balance safety from injury (harm) with making appropriate choices;

Making sure the child's rights are upheld.

5. Placement Planning

Before a child is admitted to the Home, the placing authority will provide information on the following as part of the placement planning process:

Any previous challenging behaviour (including violence and aggression);

A description of the behaviour, including any triggers so staff can identify whether there are any patterns of behaviour.

Staff in the Home should also ascertain the following:

What intervention strategies have been used to manage the behaviour?

What interventions had positive outcomes?

What interventions triggered further acts of aggression or violence?

Whether additional specialist support (e.g. from CYPMHS) is required.

The Home will work closely with the placing authority to understand the child's relationship history and the impact that the child's arrival may have on the group living in the Home.

The Home will maintain effective working relationships with local youth justice and police services where children living in the Home have targets to achieve in reducing offending or socially unacceptable behaviour.

The Home will work closely with health and education professionals to ensure that outcomes identified and progress made by children in building relationships and achieving socially acceptable behaviours can be recorded and measured.

6. Risk Assessment

The Home's manager should:

Ensure all staff are provided with training on how to de-escalate conflict and confrontation and manage aggression and potentially violent behaviour (see Use of Restraint and Physical Intervention Procedure);

Undertake written risk assessments and develop strategies for managing any challenging behaviour in individual cases.

The child's Placement Plan should outline strategies for managing and promoting positive behaviour. If necessary, there should be a separate detailed Behaviour Management Plan/Risk Management Plan.

See also: Risk Assessment and Planning Procedure.

7. Managing Challenging Behaviour and De-escalation of Conflicts

The Home's approach to positive behaviour support ensures that:

The Home provides an environment and culture that promotes, models and supports positive behaviour. Expectations of standards of behaviour are high for all staff and children in the Home.

Children are enabled to build trusted and secure relationships with adults who are looking after them. Staff, who know the children well, listen to them, invest time in them, protect them and promote their welfare. Children are enabled to develop an appropriate sense of permanence and belonging.

The care and help from staff assists children and young people to develop a positive self-view and to increase their ability to form and sustain attachments and build emotional resilience and a sense of their own identity. This care and help also help them to overcome any previous experiences of neglect and trauma.

All staff receive training in positive care and support of children, including training in de-escalating problems and disputes.

Conflict management is used effectively by staff and includes the appropriate use of restorative practices that improve relationships, increase children's sense of personal responsibility and reduce the need for formal police intervention. Proactive and effective working relationships with the police help to support and protect children. Staff work with the police to protect children from any unnecessary involvement in the criminal justice system.

Children are encouraged and helped to develop skills and strategies to manage their own conflicts and difficult feelings through developing positive relationships with staff. There are clear, consistent and appropriate boundaries for children.

Children receive help and support to manage their behaviour and feelings safely. Staff respond with clear boundaries about what is safe and acceptable and seek to understand the triggers for behaviour.

Positive behaviour is promoted consistently. Staff use effective de-escalation techniques and creative alternative strategies that are specific to the needs of each child and planned in consultation with them where possible.

Staff receive support on how to manage their responses and feelings arising from caring for children, particularly where children display very challenging behaviour, and understand how children's previous experiences can manifest in challenging behaviour.

8. Discipline and Sanctions

Any sanctions used to address poor behaviour should be restorative in nature, to help children recognise the impact of their behaviour on themselves, other children, the staff caring for them and the wider community. In some cases it will be important for children to make reparation in some form to anyone hurt by their behaviour and the staff in the Home should be skilled to support the child to understand this and carry it out.

Equally, staff should understand the system for rewarding and celebrating positive behaviour and recognising where children have managed situations well.

8.1 Guidance on use of Sanctions

Sometimes children present behaviours that are difficult. Because of their experiences some behaviours can be worrying, confusing, upsetting and challenging.

Any action that constitutes a sanction should be proportionate, measured, not harsh and logical. Sanctions should be the last resort. They must work for the child or young person and be child-focused.

Staff should work from a therapeutic or PACE framework to support the child or young person.

Repetition of the rules, humour and clear messages can avoid sanctions being needed.

For a child or young person of an appropriate age, it is important to discuss what they think is an appropriate and fair restriction such as not using their games console for a night, not going out with a friend etc.

8.2 Non Approved Sanctions

The following sanctions are non-approved, which means they may never be imposed upon children:

Any form of corporal punishment; i.e. any intentional application of force as punishment, including slapping, punching, rough handling and throwing missiles;

Any measure of control, restraint or discipline which is excessive or unreasonable. Restraint is used on a child only where it is necessary to prevent injury to the child or other persons, or serious damage to property. See also: Use of Restraint and Physical Intervention Procedure;

Any sanction relating to the consumption or deprivation of food or drink;

Any restriction on a child's contact with their parents, relatives or friends; visits to the child by their parents, relatives or friends; a child's communications with any of the persons listed below; or their access to any telephone helpline providing counselling or advice for children. This does not prevent contact or communication being restricted in exceptional circumstances, where it is necessary to do so to protect the child or others:

Any officer of the Children and Family Court Advisory and Support Service appointed for the child;

Any social worker for the time being assigned to the child by their placing authority;

Any Independent Visitor;

Any person authorised by the Regulatory Authority;

A solicitor or other adviser or advocate acting for the child;

An Independent Visitor appointed for the child;

A person appointed to investigate a complaint under the Children Act 1989 Representations Procedure (England) Regulations 2006;

An independent person conducting a Regulation 44 visit.

Any requirement that a child wear distinctive or inappropriate clothes;

The use or withholding of medication or medical or dental treatment;

The intentional deprivation of sleep;

The modification of a child's behaviour through bribery or the use of threats;

Any sanction which may humiliate a child or could cause them to be ridiculed;

The imposition of any fine or financial penalty, other than a requirement for the payment of a reasonable sum by way of reparation. (The court may impose fines upon children which staff should encourage and support them to repay);

Any intimate physical examination of a child;

The withholding of aids/equipment needed by a disabled child;

Any measure which involves a child in the imposition of any measure against any other child; or the sanction of a group of children for the behaviour of an individual child;

Swearing at the child or the use of foul, demeaning or humiliating language or measures.

(Note that this does not prohibit the taking of any action by, or in accordance with the instructions of, a registered medical practitioner or a registered dental practitioner which is necessary to protect the health of the child; or taking any action that is necessary to prevent injury to any person or serious damage to property).

8.3 Approved Sanctions

Sanctions should be proportionate and work with the child or young person.

These should be recorded and agreed with other professionals. Acceptable sanctions may include:

Confiscation or withdrawal of a telephone or mobile phone in order to protect a child or another person from harm, injury or to protect property from being damaged;

Restriction on sending or receiving letters or other correspondence (including the use of electronic or internet correspondence) in order to protect a child or another person from harm, injury or to protect property from being damaged;

Reparation, involving the child doing something to put right the wrong they have done; e.g. repairing damage or returning stolen property;

Restitution, involving the child paying for all or part of damage caused or the replacement of misappropriated monies or goods. No more than two thirds of a child's pocket money may be taken in these circumstances if the payment is small and withdrawn in a single weekly amount. Larger amounts may be paid in restitution but must be of a fixed amount with a clear start and end period. If the damage is serious or the size of payment particularly large then the child's social worker should be informed of the matter;

Curtailment of leisure activities, involving a child being prevented from participating in such activities;

Early bedtimes, by up to half an hour or as agreed with the child's social worker;

Removal of equipment, for example the use of a TV or DVD player;

Loss of privileges, for example the withdrawal of the privilege of staying up late;

Suspension of pocket money for short periods.

9. Recording and Reporting

The Home Manager must monitor, evaluate and review the use of sanctions and that the sanction used has been appropriate.

The effectiveness of sanctions should be reviewed to ensure sanctions are an effective tool and to help identify any patterns in behaviour. If the sanctions are not working alternative methods should be applied.

The review of the appropriateness, and effectiveness, of any additional measure should include the opinion of the child or young person that the measure relates to.

Sanctions to be recorded in the Sanctions Record and child's record.

The record should contain the opinions of the child or young person. If they are not willing to give an opinion then the record should evidence the time and date that their opinion was sought.

Where relevant, a decision should be made between the staff member, the manager and young person about whether to report matters to the police, see Offending and Anti-Social Behaviour - guidance on when to involve the Police Procedure.

10. Follow Up After an Incident

Whenever an act of violence or aggression has occurred, the Home's manager should ensure that both staff and the child concerned are allowed to discuss the incident and its impact on themselves and others in the group.

Managers should:

Undertake a review and make necessary changes to internal policies, routines and children's Placement Plans to help with reducing or preventing incidents from occurring in the future;

Discuss with staff how they dealt with the situation and, if required, how they could deal with the situation differently in the future.

The Home's manager should collate data emanating from incidents and periodically undertake a review. The Home's policies, training strategies, routines and methods for promoting positive behaviour amongst children should be revised as required.

If the level of risk is such that the continuing placement of the child is threatened, or may be at risk of coming to an end, the Home's manager must draw this to the attention of the child's social worker and Independent Reviewing Officer (IRO), who may decide to convene a Looked After Review.

Further Information

Legislation, Statutory Guidance and Government Non-Statutory Guidance
Positive and Proactive Care: Reducing the Need for Restrictive Interventions - Department of Health and Social Care Guidance: Positive Environments Where Children Can Flourish (Ofsted)

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Positive Relationships and Behaviour Management

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The Positive Relationships Standard Regulation 19 - Behaviour Management and Discipline This chapter provides guidance for staff on helping children to establish positive relationships and on managing behaviour, which includes supporting positive behaviour, de-escalation of conflicts and discipline.

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Overcoming barriers to accessing health provisions

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More than 120,000 babies and small children in England are not registered with a doctor - raising fears that they could be missing life-saving health checks.

Leading doctors have warned children are at risk of missing out on key vaccinations and check-ups because their parents have not signed them up with a surgery.

Official NHS figures show there are about 3,262,000 newborns and children under five registered with GP practices in England.

However, separates figures from the Office for National Statistics (ONS) put the total number of children aged four and under at 3,385,000.

The difference between GP list and population figures suggest that around 123,000 children - four per cent of the population in England - are not on a GP' practice register.

Professor Russell Viner, President of the Royal College of Paediatrics and Child Health, has urged parents to ensure their children are registered.

She said: "I find it deeply concerning that so many children appear to be unregistered with a GP at a time where we are seeing an emergence of preventable and deadly diseases such as the measles, record levels of childhood obesity and its associated conditions, and with 34 per cent of all child deaths in the UK considered avoidable - the vast majority of which are in infancy."

The figures show that more than 4,000 children in outer areas of Bradford are not on the GP register.

Some 21,605 newborns and children under five are registered in the NHS Bradford Districts Clinical Commissioning Group (CCG) area. ONS figures show a population aged four and under of 25,670.

The figures also suggest around 650 children in the Doncaster CCG area and 580 youngsters in Sheffield are not on the GP register. The NHS offers regular health checks for babies until they are two-years old to monitor their development.

Youngsters are also given a personal child health record, known as a red book, in which parents and health professionals keep a log of their vaccinations and measurements.

In 2017-18, just 87 per cent of children in England had received both the recommended MMR jabs - which protects against measles, mumps and rubella - by the time they turned five.

At least 95 per cent coverage is needed to lower the risk of an outbreak, according to the World Health Organisation.

A monthly snapshot of GP patients was taken on January 1, while the most recent population estimates are for mid-2017. This means the number of children not on a GP register is an estimate.

However, the number of GP patients is generally higher than the actual population because many patients are on multiple GP registers as a result of moving house, or are not being removed after they die.

Prof Viner added: "Registering a child with a doctor can be life-saving or, at the very least, life-changing. It will mean parents get important vaccination and health check reminders, their child's weight and development monitored and concerns acted upon quickly.

"If required, access to specialist NHS healthcare can be arranged. I urge all parents to register their child with their local GP and, if unsure, visit nhs.uk to find out more."

NHS England pledged to increase the number of doctors in general practice by 5,ooo as part of the GP Forward View.

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Fears for health of thousands of children not registered with a doctor

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More than 120,000 babies and small children in England are not registered with a doctor - raising fears that they could be missing life-saving health checks. Leading doctors have warned children are at risk of missing out on key vaccinations and check-ups because their parents have not signed them up with a surgery.

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Article relating to outcomes related to inability to access primary care

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Abstract

Background

Universal health coverage (UHC) aims to improve child health through preventive primary care and vaccine coverage. Yet, in many developed countries with UHC, unplanned and ambulatory care sensitive (ACS) hospital admissions in childhood continue to rise. We investigated the relation between preventive primary care and risk of unplanned and ACS admission in children in a high-income country with UHC.

Methods

We followed 319,780 children registered from birth with 363 English practices in Clinical Practice Research Datalink linked to Hospital Episodes Statistics, born between January 2000 and March 2013. We used Cox regression estimating adjusted hazard ratios (HR) to examine subsequent risk of unplanned and ACS hospital admissions in children who received preventive primary care (development checks and vaccinations), compared with those who did not.

Results

Overall, 98% of children had complete vaccinations and 87% had development checks. Unplanned admission rates were 259, 105 and 42 per 1000 child-years in infants (aged < 1 year), preschool (1-4 years) and primary school (5-9 years) children, respectively.

Lack of preventive care was associated with more unplanned admissions. Infants with incomplete vaccination had increased risk for all unplanned admissions (HR 1.89, 1.79-2.00) and vaccine-preventable admissions (HR 4.41, 2.59-7.49). Infants lacking development checks had higher risk for unplanned admission (HR 4.63, 4.55-4.71). These associations persisted across childhood. Children who had higher consulting rates with primary care providers also had higher risk of unplanned admission (preschool children: HR 1.17, 1.17-1.17). One third of all unplanned admissions (62,154/183,530) were for ACS infectious illness. Children with chronic ACS conditions, asthma, diabetes or epilepsy had increased risk of unplanned admission (HR 1.90, 1.77-2.04, HR 11.43, 8.48-15.39, and HR 4.82, 3.93-5.91, respectively). These associations were modified in children who consulted more in primary care.

Conclusions

A high uptake of preventive primary care from birth is associated with fewer unplanned and ACS admissions in children. However, the clustering of poor health, a lack of preventive care uptake, and social deprivation puts some children with comorbid conditions at very high risk of admission. Strengthening immunisation coverage and preventive primary care in countries with poor UHC could potentially significantly reduce the health burden from hospital admission in children.

Electronic supplementary material

The online version of this article (10.1186/s12916-018-1142-3) contains supplementary material, which is available to authorized users.

Keywords: Universal health coverage, Child health, Unplanned hospital admissions, Ambulatory care sensitive conditions, Preventive primary care

Background

Achieving universal health care (UHC) coverage is a Sustainable Development Goal (SDG3.8.1) [ 1] to improve global health without exposing individuals to financial hardship. Indicators of UHC, such as child immunisation, access to preventive primary care and service capacity [ 2], are particularly relevant for improving children's health [ 3, 4], contributing to substantial progress in reducing under five mortality in children [ 5].

Yet, even in high-income countries such as the United Kingdom (UK), which has high UHC coverage and where 98% of children are registered with a general practitioner (GP) from birth, children's health lags behind other Western European nations and unplanned hospital admissions have steadily increased [ 6, 7]. Rising admissions have been ascribed partly to health system failures to adapt to a growing chronic disease burden in children [ 6] and primary care policies that have impeded children's access to high quality primary care [ 8].

Cross sectional and ecological trend studies using aggregate data have reported correlations between access to primary care and lower hospitalisation rates for ambulatory care sensitive (ACS) conditions in children [ 7, 8]. ACS conditions in children include common infectious conditions but also chronic conditions commonly seen in primary care (asthma, diabetes and epilepsy) [ 9, 10].

However, previous studies have been unable to demonstrate how specific UHC interventions such as child immunisation and preventive care around the time of birth may mitigate a child's risk of admission to hospital, partly due to a previous lack of linked data records between primary care and hospital.

We hypothesised that preventive primary care use, including timely vaccination and development checks, is associated with fewer childhood illness consultations and unplanned and ACS admissions to hospital in a high-income country with a high UHC index.

Methods

Study design and data sources

We undertook a birth cohort study using prospectively collected data from the UK Clinical Practice Research Datalink (CPRD), the largest and best validated primary care research database within the UK [ 11]. It contains longitudinal, patient-level, anonymised computerised health records from 674 general practices and is broadly representative of approximately 7% of the UK population. Clinicians use codes to record diagnoses, prescriptions and procedures, including vaccination. Three quarters (75%) of all English CPRD practices are now linked with Hospital Episode Statistics (HES) [ 11], which contains International Classification of Diseases version 10 (ICD-10) coded records for the main reason for admission for all National Health Service (NHS) hospitals in England.

Cohort construction

Our target population was children born between January 1, 2000, and March 31, 2013. A delivery date is provided in the CPRD mother-baby link but also in HES. HES records a child's birth as an admission method as '82' for a birth of a baby within the hospital or '83' for a baby born outside the hospital [ 12]. Babies born at home 'as intended' will not have a HES birth record. Therefore, to establish a birth cohort we took the child's date of birth from hospital record and when missing (potentially due to home birth) from the primary care records.

To ensure our cohort included children's full consulting history in primary care from the time of a child's birth, we included children born to mothers who were registered at an 'up to standard' CPRD-participating practice at the time of their birth (Fig. 1 ). This is because many children are not registered with a GP until their first visit for vaccination and development checks. We assumed that a child would not visit another practice prior to their registration at their mother's practice.

Children were followed up from birth to the end of the study period (December 31, 2013), the date a child left a practice (deregistered) or the last practice data collection date (whichever came first). During follow-up, children were assigned to one of four developmental age groups, defined as infants (when aged < 1 year), preschool (1-4 years) and primary school (5-9 years). We restricted our cohort to children aged less than 10 years because older children (10-15 years) in CPRD would have had insufficient follow-up time (Fig. 1 ). We created three sub-cohorts of children aged 5-9 years with ACS conditions as those who had a diagnosis code for asthma, diabetes or epilepsy in their consulting history (Additional file 1: Table S1); this age group was chosen as asthma and epilepsy cannot be reliably diagnosed in young children.

Exposure to preventive care and illness consultations

In the UK, all children are invited for a development check at 6-8 weeks old (recommended by Healthy Child Programme) and to receive vaccinations at 8, 12 and 16 weeks, and again at 1 and 3 years of age as an integral part of a child's health and immunisation programme during their early years [ 13]. At each visit, vaccinations are given both orally and by injection. We determined the dates of vaccinations and also identified children who had incomplete infant vaccinations defined as those with fewer than three consultations for vaccination in their first year and identified children with delayed vaccination if their first vaccine was given after 5 months of age [ 2].

We defined an infant development check or vaccination as 'preventive' consultations (Additional file 1: Table S1) and an illness consultation as any face-to-face clinical contact with a GP excluding those for preventive care [ 14]. Details of this process are provided in Additional file 2. We explored illness consultations primarily as an explanatory variable for unplanned and ACS admissions.

Outcomes

The primary outcome was the first record of an unplanned (rather than elective) or ACS admission [ 7]. We defined admissions for ACS conditions using ICD-10 codes (Additional file 1: Table S2) [ 9, 10, 15]. ACS infectious illnesses were defined as vaccine-preventable conditions, gastroenteritis, lower and upper respiratory tract infection, and urinary tract infection in all children. We calculated risk for admission with chronic ACS conditions in sub-cohorts of children aged 5-9 years.

Secondary outcomes were illness consultation and unplanned admission rates.

Covariates: social factors, parenting experience and co-morbid conditions

We examined the relation between several covariates identified from previous studies known to increase admission risk, including social factors and the presence of co-morbid conditions diagnosed in the child's HES records [ 16- 18].

We identified children who had preterm birth recorded in any diagnosis field of their HES birth record [ 12] (Additional file 1: Table S3). We also identified children with congenital conditions such as immunodeficiency, cystic fibrosis, chronic lung disease, congenital heart disease, nervous system congenital anomalies, other congenital anomalies (including Down's syndrome), other perinatal conditions and cerebral palsy (Additional file 1: Table S4) [ 19].

We assigned each child to one of five population weighted deprivation groups using English Indices of Multiple Deprivation quintiles [ 20] based on the child's post code; < 1% of children were missing these data. We identified children of first time mothers to indicate a relative lack of parenting experience compared with mothers who had a previous child, and used maternal age at birth of the child to identify teenage mothers aged < 20 years, who are known to have high consulting rates in primary care, comparing them with mothers aged 20-39 years and older mothers aged 40+ years.

Statistical analysis

We calculated illness consultation rates by summing consultations for each child divided by their follow-up time in each of the three developmental age bands. We calculated unplanned admission rates as the total number of admissions divided by total follow-up time within each developmental age band. Since unplanned admission rates change with the age of a child, we used Cox proportional hazard model to estimate hazard ratios (HR) for admission. One strength of this methodology is that it does not assume a baseline rate allowing admission rates to change over time. We carried out bivariate and multivariable analyses adjusting (where relevant) for sex, deprivation level, whether the child was a firstborn, maternal age band at birth, child's prior illness consultation rate (an age band-specific measure: GP consultations prior to admission or, if no admission, within an age band divided by follow-up time), the presence of comorbid health conditions (prematurity and congenital disease), vaccination status and development checks (as preventive care in infants is at 8 weeks old vaccinations and development checks were included as time updating variables when modelling in infants). Covariates were added sequentially to the models based on bivariate association and we considered an association of p  < 0.05 as statistically significant (model Wald test).

We assessed for interactions between illness consultation and ACS chronic condition status on admission risk. We calculated population attributable risks and, using previously published admission numbers [ 7], estimated how many preschool children in 2011 could have avoided an admission if fully vaccinated.

We checked Cox proportional hazard assumptions of proportionality, using Nelson-Aalen cumulative hazard plots and non-informative censoring as a sensitivity analysis stratifying by censored versus non-censored children. As sensitivity analyses, we investigated multilevel (random intercept) Cox models, clustering by GP practice. This method models within practice variability allowing GP practice factors such as access to be ignored. We used Stata version 14 (StataCorp, College Station, Texas, USA) for the analyses.

Results

Our birth cohort consisted of 319,780 children born and registered with 363 English practices between January 2000 and March 2013. One in three of these children (97,836) left their practices during the study period. There were a total of 4,801,171 illness consultations and 183,530 unplanned admissions, with 1,540,977 child-years of follow-up. The median follow-up time (interquartile range) in infants, preschool and primary school children was 1.0 (1.0-1.0), 3.0 (1.1-4.0) and 3.4 (1.5-5.0) years, respectively.

Twenty-three percent (74,233/319,780) of children lived in the most affluent areas compared with 18% (57,440/319,780) of children living in the most deprived areas. Four percent (12,814/319,780) of children were born to teenage mothers (Table 1 ). One in five infants in the cohort had a record of a congenital condition (18.2%) or were born prematurely (6.0%). Nine percent of primary school children (13,484/141,519) had a diagnosis of an ACS chronic condition (asthma, diabetes mellitus or epilepsy).

Table 1

Number of children

N = 319,780

Characteristics

Number (%)

Boys

163,713 (51.2)

Deprivation b

Least deprived fifth

74,233 (23.2)

Most deprived fifth

57,440 (18.0)

Maternal age at birth of child (years)

< 20

12,814 (4.0)

20-39

291,846 (91.3)

40+

15,120 (4.7)

Mother's first child

234,781 (73.6)

Prematurity for constisency

19,275 (6.0)

Congenital condition

57,937 (18.2)

Diagnosed with ACS c chronic condition in children aged 5-9 years ( N  = 141,519)

Asthma

12,654 (8.9)

Diabetes

268 (0.2)

Epilepsy

670 (0.5)

More than one ACS chronic condition

123 (0.1)

Uptake of preventive care was high; 98% (5417/289,989) of preschool children had complete vaccinations, of whom 1% (1736/289,989) had delayed vaccination, and 87% (253,408/289,989) of preschool children had development checks.

Infants had, on average, four illness consultations in their first year; while preschool had 2.9 and primary school aged children had 1.3 illness consultations per year, respectively (Table 2 ). Primary school children with ACS chronic conditions consulted GPs more frequently than children without, on average, twice per year (Table 2 ).

Table 2

Number of children in cohort

Infant (age < 1 year)

Preschool (age 1-4 years)

Primary school (age 5-9 years)

Asthma diagnosis
(age 5-9 years)

Diabetes diagnosis
(age 5-9 years)

Epilepsy diagnosis
(age 5-9 years)

N = 319,780

N = 289,989

N = 141,572

N = 12,654

N = 268

N = 670

Rate per child/year (95% confidence interval)

Illness consultation b

4.01 (4.00-4.03)

2.91 (2.90-2.92)

1.33 (1.32-1.34)

2.18 (2.15-2.22)

2.02 (1.81-2.23)

2.22 (2.06-2.39)

Rate per 1000 child-years (95% confidence interval)

Infectious ACS admissions

Chronic ACS admissions c

N/A

N/A

N/A

26.0 (23.5-28.8)

193 (168-223)

178 (147-216)

Risk of unplanned hospital admissions

Unplanned admission rates were 259 per 1000 child-years among infants, 105/1000 among preschool children and 42/1000 among primary school children (Table 2 ). The subset of primary school-aged children diagnosed with an ACS chronic condition (asthma, diabetes and epilepsy) had higher unplanned admission rates compared to all primary school children (84/1000, 342/1000 and 461/1000 child-years for children with ACS chronic conditions).

Lack of preventive care was associated with a higher risk for unplanned admission, after adjusting for deprivation, maternal age and firstborn indicators (Table 3 ). In preschool children, the adjusted HR for incomplete vaccination was 1.89 (1.79-2.00) and the population attributable risk was 0.0115 (95% CI 0.0101-0.0130). We estimated that, annually, approximately 2000 (0.0115 × 207,573) unplanned admissions in England could be avoided if all preschool children had the same admission rate as those who were fully immunised. In preschool children, those who had delayed vaccinations had an increased risk of unplanned admissions compared to those who had timely vaccinations (HR 1.15, 1.04-1.27). Infants who had no development checks had over four times the risk for unplanned admission than those who had development checks (HR 4.63, 4.55-4.71); this was observed to a lesser extent for preschool and primary school children (HR 1.19 and 1.09, respectively). Illness consultations were associated with a higher risk for unplanned admission, with the risk increasing across childhood; an additional consultation per year increased the average admission rate by 0.5% (HR 1.005, 1.005-1.005) in infants and by 23% (HR 1.23, 1.23-1.24) in primary school children.

Table 3

Adjusted hazard ratiob (95% confidence interval)

Infant

Preschool

Primary school

(age < 1 year)

(age 1-4 years)

(age 5-9 years)

Deprivation f

5 vs. 1

1.22 (1.20-1.25)

1.38 (1.34-1.41)

1.44 (1.37-1.51)

Maternal age

< 20 vs. 20-39 years

1.33 (1.28-1.38)

1.35 (1.30-1.40)

1.28 (1.18-1.39)

The presence of comorbid conditions and social factors, such as material deprivation, were also strongly associated with unplanned admission. Children born prematurely or with a congenital condition had a greater risk of unplanned admission across all age groups (HR 1.21, 1.18-1.25 in preterm infants; HR 2.40, 2.36-2.45 in infants with congenital conditions). Children living in the most deprived quintile had a 22% higher risk of an unplanned admission from infancy. This increased risk of admission doubled to 44% in primary school years (HR 1.22, 1.20-1.25) and in infants (HR 1.44, 1.37-1.51) (Table 3 ). Infants of teenage mothers had a 33% increased risk of an unplanned admission compared with older mothers aged 20-39 years HR 1.33 (1.28-1.38).

Risk factors for ACS infectious admissions (Table 4 )

Table 4

Infant

Preschool

Primary school

(aged < 1 year)

(aged 1-4 years)

(aged 5-9 years)

HRb (95% CI)

HRb (95% CI)

HRb (95% CI)

Vaccine preventable admissions

Upper respiratory tract infection

Lower respiratory tract infection

Gastroenteritis admissions

Urinary tract infection

One-third of all unplanned admissions (62,154/183,530) in the birth cohort were for ACS infectious illness, of which only 271 were for vaccine-preventable conditions. Overall, the risk factors for ACS infectious admissions were similar to the risks for all unplanned admissions (Table 4 ); however, the magnitude of the association between deprivation and ACS infectious illness tended to be greater than for all admissions. Infants with incomplete vaccination were over four times more likely to be admitted for a vaccine-preventable condition (HR 4.41, 2.59-7.49), with the risk persisting, and increasing in magnitude, across childhood.

Risk factors for ACS chronic admissions

Primary school-aged children diagnosed with an ACS chronic condition, compared with children without an ACS chronic condition, had an increased risk of unplanned admission (for any admission diagnosis) of 1.90 (1.77-2.04), 11.43 (8.48-15.39) and 4.82 (3.93-5.91) for asthma, diabetes and epilepsy. There was no evidence that deprivation was a stronger risk factor for children with an ACS chronic condition (Table 5 ).

Table 5

Primary school

(aged 5-9 years)

HRa (95% CI)

Asthma

Prematurity

No association

Congenital conditions

No association

Diabetes

No Associations

Epilepsy

Prematurity

No association

Congenital conditions

No association

Illness consultation rates modified the association of unplanned admissions for ACS chronic conditions, with interaction factors of 0.92 (0.91-0.93), 0.88 (0.82-0.95) and 0.95 (0.92-0.98) in asthma, diabetes or epilepsy, respectively. For example, a child with asthma has, on average, 90% greater risk of an unplanned admission compared with children without an ACS chronic condition (holding consultation rate constant); this reduced to 74% with a single additional illness consultation per year.

Of the primary school children diagnosed with an ACS chronic condition, 19% (2597/13,484) had an unplanned admission (any diagnoses), while only 5% (729/13,484) had an unplanned admission for an ACS chronic condition.

Sensitivity analyses

Sensitivity analyses showed that our findings were robust to age and duration of registration. Unplanned admission HRs for variables of interest were similar when children were followed up from 8 weeks of age compared with follow-up from birth. HRs were similar but more extreme in those who were censored due to leaving their registered practice compared with those who remained until the end of the study period (December 2013) or the practice's last data collection date (if earlier) (Additional file 1: Tables S5 and S6).

Unplanned admission HRs for variables of interest were higher in infants when we applied a multilevel model (Additional file 1: Table S7), but were similar in older age groups.

Discussion

Main findings

To our knowledge, this is the largest study of its kind to assess the impact of preventive primary care on the risk of unplanned and ACS hospital admissions across childhood. In our birth cohort of 319,780 children registered with UK primary care and followed over 1,540,977 child-years, there was a high uptake of preventive care, with 98% of children having complete vaccinations and 87% having development checks in infancy and high contact rates with GP (four times in infancy for illness). A lack of preventive primary care, including vaccination and development checks, was strongly associated with a higher risk of unplanned and ACS admission in children. For example, there was a four-fold increased risk of vaccine-preventable hospital admissions that increased across childhood. We estimate that, in the UK, 2000 preschool children are admitted annually to hospital for problems that are potentially attributable to a lack of basic vaccinations. One-third of all unplanned admissions, in our cohort, were for ACS infectious illness. One in five primary school age children who had a chronic ACS condition (asthma, diabetes or epilepsy) were admitted to hospital. We also found comorbidity and social deprivation to be associated with unplanned admission.

Comparison with past research

We found no previous studies specifically investigating the impact of preventive primary care on children's admission risk over time. However, our findings are consistent with systematic reviews and numerous other studies that have demonstrated a relation between various features of primary care in adults and avoidable admission [ 3, 21].

We, and others, have previously reported that emergency department visits and admissions for ACS chronic conditions are associated with poor access to primary care, highlighting the importance of primary care in preventing adverse outcomes for children with chronic conditions [ 7, 8]. Our study further supports this evidence, which is especially important since the number of children with chronic conditions is increasing. In recent years, adult admission rates for ACS chronic diseases, including asthma, diabetes and epilepsy, are reported to have fallen following major financial incentives in primary care to improve chronic disease management [ 22], suggesting scope for a similar policy intervention for children.

The age, sex and sociodemographic profile of our sample was representative of the national population [ 23] and other variable characteristics, such as the proportion of children born to teenage mothers, were comparable over the study period. A similar proportion of our birth cohort was born prematurely compared with national and international estimates [ 24]. We could not find comparable studies giving estimates of congenital anomalies. One study investigating child mortality found that only 3% of children who died had a congenital anomaly [ 25]. However, our study purposefully took a much broader definition of congenital conditions, which included comorbid conditions diagnosed within infancy as well as suspected conditions affected by birth.

In England, since 2007/2008, the combined vaccine coverage in infants for diphtheria, tetanus, polio, pertussis and haemophilus influenza B and for pneumonia vaccine has reached 93-95%. Our cohort may have achieved a higher uptake rate firstly because the national picture is likely to include some children who do not engage with primary care, but also because CPRD participating practices may perform better. We found illness consultation rates in the community and rates of unplanned admission in children were comparable to recent studies [ 7, 14, 26].

Implications for research and policy

Our findings support a body of evidence in favour of UHC of primary care to add to efforts to reduce the burden of disease in the population and alleviate strain on hospital services from unplanned admissions [ 3, 8, 27]. The high level of infant immunisation coverage across all four nations in the UK in recent years is a success story that other nations have yet to achieve [ 28]. UHC is an important means of improving health equity, especially essential in lower-income settings. However, even in high-income countries, we found a significantly higher risk for hospital admission for children living below the poorest quintile, demonstrating additional room for improvement in countries with UCH and that service provision alone is not enough. Our findings suggest preventive primary care may help to reduce unplanned admissions, particularly in infants who have the highest contact rates with primary care. Nevertheless, health services beyond infancy tend to be responsive rather than anticipatory, which may disadvantage children with chronic illness.

The UK health system currently lacks a clear framework for the health and wellbeing of children beyond infant immunisation. The healthcare needs of children differ in important ways from those of adults; with greater dependency on parents, education remains an important component of families' ability to care. In the United States, potentially preventable admissions among children have been decreasing [ 29]. Future work could explore cost effectiveness of new models of care such as GP-led urgent care centres and impact of certain core features of primary care such as access, structured preventive care, continuity of care and case management of children with chronic conditions [ 30]. We need to better understand how primary care can serve the needs of children with long-term or complex conditions.

Limitations

Data quality and extensive coverage of the CPRD database [ 11] reduces the possibility that our findings are due to chance but, as with any observational cohort study, there are several important biases relating to coding accuracy, completeness and losses to follow-up [ 31]. A main source of bias in our findings likely arises due to losses to follow-up across the period; however, these were minimised by the way our cohort was constructed such that children contributed time in the cohort according to their age band. We excluded children registered at practices without HES and mother and baby linkage. We found children living in deprived areas were more likely to deregister than children from affluent groups; therefore, our findings are not likely to be generalisable to these children, who may represent a more mobile population and may require a different policy response [ 32]. However, our sensitivity analysis suggests findings are similar for these families although effect sizes of associations are diluted by their loss to follow-up over the period. We did not obtain health records for the mother, restricting our ability to investigate further health maternal factors or those arising from birth.

Our analysis was highly powered and all reported associations in the full cohort had a significance level greater than 99%. However, in the ACS cohorts, numbers were much smaller, for example, only 268 (0.2%) children aged 5-9 years had a diagnosis of diabetes. As a result, we lacked power to identify association between preventive care and unplanned admissions in children with diabetes.

Our measure of incomplete vaccination may be an underestimate. Determining whether children in birth cohorts, born over several birth years, have received all their primary immunisations is complex given the relatively frequent changes to the detail of the nationally recommended immunisation schedule. In some years, catch up immunisations took place, increasing the basic number [ 33, 34].

There is residual confounding in our study comparing children with delayed or incomplete vaccination with those who engage with the immunisation programme. These groups are likely to differ in important ways relating to their underlying health, health seeking behaviour and health beliefs, which could also impact on their risk for admission to hospital.

Although most routine preventive care occurs in the community, our data sources would not capture preventive care such as developmental check-ups and vaccinations received in specialist settings. This may be the case in a small minority of children, for example, those with preterm birth or congenital conditions.

Our methodologies, calculating within practice variation and marginal means, reduce the impact of practice level confounding and our sensitivity analyses suggest that practice level confounding may exist in infants but has little effect in older children. Differentiating between health status and illness severity is challenging given a lack of reliable indicators in routine data. In a UHC system, consultations with GPs are not a good proxy for poor health status since preventive advice or disease management for ACS chronic conditions can be given during a consultation; this is highlighted by the fact that illness consultations modify the effect of having an ACS chronic condition on unplanned hospital admissions [ 35]. Hence, this is among a number of sources of residual confounding that we were unable to account for.

Conclusions

A high uptake of preventive primary care, including vaccination and development checks, is associated with fewer unplanned and ACS admissions from birth and through childhood. However, the clustering of poor health, a lack of preventive care uptake, and social deprivation puts some children with comorbid conditions at very high risk of admission. Countries with poor immunisation coverage and preventive primary care could significantly reduce the health burden from hospital admission in children, especially those with ACS conditions, through strengthening UHC and primary care.

Funding

Elizabeth Cecil and Sonia Saxena were funded by a National Institute for Health Research (NIHR) Career Development Fellowship (CDF-2011-04-048). Richard Ma was funded by NIHR for In-Practice Fellowship (NIHR-IPF-2014-08-11). This article presents independent research commissioned by the NIHR. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

Availability of data and materials

The datasets analysed during the current study are not publicly available as access is subject to approval. We will consider (via the corresponding author) requests for data sharing on an individual basis; however, we will be governed in respect of data sharing by the data owners (CPRD) and any requests to share will be subject to their permission and to the approval of ethics committees overseeing the use of these data sources.

Abbreviations

ACS

ambulatory care sensitive

CPRD

Clinical Practice Research Datalink

GP

general practitioner

HES

Hospital Episode Statistics

ICD-10

International Classification of Diseases version 10

NHS

National Health Service

UHC

universal health care

UK

United Kingdom

Authors' contributions

EC contributed to the conception and design of the study, carried out the analysis, took part in interpreting the data, drafted the initial manuscript and wrote the final manuscript as submitted. AB contributed to the conception and design of the study, provided statistical advice, took part in interpreting the data and helped to revise drafts of the manuscript. SS and RM contributed to the conception and design of this study, took part in interpreting the data and helped to revise drafts of the manuscript. DSH, IW and AGM took part in interpreting the data and helped to revise drafts of the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Notes

Ethics approval and consent to participate

We obtained ethical and scientific approval for the use of CPRD for our study from the Independent Scientific Advisory Committee Protocol number: 15_008R.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Contributor Information

References

1. United Nations . Report of the Secretary-General: Progress Towards the Sustainable Development Goals. New York, NY: UN; 2017. [ Google Scholar]

5. Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100):1084-150. [ PMC free article] [ PubMed]

14. Hippisley-Cox J, Fenty J, Heaps M. Trends in consultation rates in general practice 1995 to 2006: analysis of the QRESEARCH database. QRESEARCH research highlights. Leeds: The Information Centre; 2007. p. 29. [ Google Scholar]

29. Torio CM, Elixhauser A, Andrews RM. Trends in Potentially Preventable Hospital Admissions among Adults and Children, 2005-2010: Statistical Brief #151. Rockville: Agency for Health Care Policy and Research (US); 2013. [ Google Scholar]

Articles from BMC Medicine are provided here courtesy of BioMed Central

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Impact of preventive primary care on children's unplanned hospital admissions: a population-based birth cohort study of UK children 2000-2013

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Universal health coverage (UHC) aims to improve child health through preventive primary care and vaccine coverage. Yet, in many developed countries with UHC, unplanned and ambulatory care sensitive (ACS) hospital admissions in childhood continue to rise. We investigated the relation between preventive primary care and risk of unplanned and ACS admission in children in a high-income country with UHC.

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Standards of residential child care have never been higher, but a shortage of provision and rising demand due to more traumatised children coming into the system is stretching local authority budgets to the limit

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Local health services are provided by Northumbria Healthcare NHS Trust, Northumberland, Tyne and Wear NHS Trust and Newcastle Hospitals who provide care in your home, from your GP practice, in a primary care centre, and for children in schools.

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Local health services are provided by Northumbria Healthcare NHS Trust, Northumberland, Tyne and Wear NHS Trust and Newcastle Hospitals who provide care in your home, from your GP practice, in a primary care centre, and for children in schools.

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services in Northumberland

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All parents and carers know something about health services. Nearly everyone has a family doctor (GP) and has visited a local hospital at some time. The health service (NHS) provides services that everyone in the population can access. These are called universal services. It also provides other services that you are more likely to come across because your child needs extra help and support. These services are called specialist services. Due to the varying and often complex needs of children, it is possible that a range of health professionals will be involved in helping and supporting you, your child, and your family.

Below is an introduction to some of the job roles and specialist services you may come across. Some of these services are provided in hospitals or clinics and you may have to attend appointments at a distance to access them.

General practitioner (GP)
Health visitors
School nurses
Child and Adolescent Mental Health Services
Clinical psychologists
Paediatrician
Paediatric neurologist

General practitioner (GP)

A GP is a family doctor who works in a surgery, either on their own or with other GPs. Your doctor deals with your child's general health and can refer you to clinics, hospitals and specialists when needed. They may also support applications for benefits or other types of help. Any concerns about your child's health, wellbeing and development can be raised with your local GP. They can request the involvement of other health services, social care and community related support to promote the wellbeing of your child and family.

You can find GP services on the NHS website.

Health visitors

Health visitors provide a service for all families with children under the age of five years old. They assess your child's development and can work with a range of professionals to provide ongoing support and request the involvement of other services if necessary. Family health issues, for example postnatal depression, weaning or parenting concerns, can also be addressed by the health visitor and support offered where necessary. All families with children under five years will have a nominated health visitor who can be contacted via your GP.

Health visiting services in Lancashire are provided by Lancashire Healthy Young People and Families Service (external link).

School Nurses

School nurses provide a service to school age children, their parents/carers and teachers to help promote the health and wellbeing of children. They offer advice and support on health related issues and topics such as obesity, substance misuse, sexual health, emotional health and wellbeing. They can be contacted through your child's school or relevant health centres.

School nursing services in Lancashire are provided by Lancashire Healthy Young People and Families Service (external link).

Child and Adolescent Mental Health Services (CAMHS)

CAMHS are specialist NHS services. They offer assessment and treatment when children and young people have complex and persistent emotional, behavioural or mental health difficulties

Clinical psychologists

A Clinical Psychologist is a health professional who helps children and young people with specific problems with learning or behaviour difficulties.

Paediatrician

A Paediatrician is a doctor who specialises in working with babies and children. They are often the first point of contact for families who find out that their child has an impairment or medical condition. Paediatricians may give you a diagnosis about your child's condition, answer any questions you may have and refer you to more specialist services.

Paediatric neurologist

A Paediatric Neurologist is a doctor who specialises in how the brain works in very young children.

Health and wellbeing services
Search for health and wellbeing services
Find NHS services and local or national organisations that provide health and/or wellbeing services to children and young people. Some of these services are called universal services and can be accessed by everyone, and some of these services are available only to children and young people with special educational needs and disabilities (SEND).

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Key roles within children's health services

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All parents and carers know something about health services. Nearly everyone has a family doctor (GP) and has visited a local hospital at some time. The health service (NHS) provides services that everyone in the population can access. These are called universal services.

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If you're worried about your child's development or wellbeing and you think they need extra support, speak to their GP, health visitor, teacher or nursery worker first.
Ask for advice about what to do next to help your child. If you or your child needs more significant support, contact the children's services team at your local council for a needs assessment.
Find your local council on GOV.UK
Needs assessments

A needs assessment is carried out by the children's services team at your local council and determines if your child needs more specialised support.

Children's services must work with you when making decisions about your child, so discuss with them the type of help that would best meet the needs of your family.

Family support

Family support can include help looking after your child, such as:

day care for children under 5

help with parenting - such as parenting classes

courses or family support workers

practical home help

access to a Children's Centre

Support services may also be provided by education or health authorities, or by voluntary organisations.

Many of these services are available to all families. Check your local council's website to see what's available in your area.

You may also find support from these charities:

Children with special educational needs and disabilities

Additional help is available for parents and children with special educational needs and disabilities.

Looked-after children

Local authority children's services have responsibilities for the children they look after who live with foster carers or in residential care on either a short- or long-term basis.

These organisations also offer information and advice:

The Family Rights Group offers independent specialist information and advice for families about children who are looked after in care.

For more information, read the Family Rights Group's advice sheets about looked-after children.

Child protection

Child protection is available to children and young people who are at risk of significant harm and need protecting. This includes harm from physical, emotional or sexual abuse, and neglect.

If children's services suspect that a child may be at risk of harm, they must look into the child's situation and take any action necessary to keep them safe and promote their welfare.

If child protection enquiries have been made about your child, it does not necessarily mean your child will be taken away from you. But your child will be interviewed or medically examined without you being present.

The Family Rights Group offers independent specialist information and advice for families about child protection procedures.

For more information, read the Family Rights Group's advice sheets about child protection.

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Children and young people's care and support services - Social care and support guide

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Read about care and support options for children and young people.

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Overall standards to be included in your work

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Use this if someone witness's your practice
Don't forget to sign and date all your paperwork

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Use this template for your reflections of practice

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Your portfolio of evidence

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Employer observation sheet.
Dont forget to get your work signed and dated please

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In a nut shell your standards

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Vygotsky's Theory of Cognitive Development in Social Relationships

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Spotting the signs of emotional distress in children

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Spotting emotional distress in children and young people is not easy. In this resource from The Spark discover the most common signs of anxiety and stress.

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All behaviour has meaning. Children and young people communicate through their behaviour, especially those who have not acquired language and vocabulary skills to tell the adult what the problem is. The behaviour used to communicate can be made stronger and more likely by how it is responded to. For example, if a child becomes aggressive because of a demand placed on them, often the demand is taken away.

Everybody, whether young or old has times when they are upset, angry, worried, confused or hurt. Strong emotions can be tough to understand, express and manage, particularly for children and young people who may not have the language or ability to communicate verbally what they are experiencing. When a young person's behaviour becomes concerning, it may be that they are experiencing a strong, overwhelming emotion that is hard for them to manage. Behaviour serves a purpose and is useful in some way even if there are unintended or negative consequences. For example, if a young person is feeling angry they may become verbally or physically aggressive. Whilst verbal and physical aggression is not a helpful or appropriate response, it is a way of communicating and expressing how the young person is feeling.

Many young people respond to strong and overwhelming emotions impulsively and reactively in the moment and without much thought or consideration of the consequences. This is why sometimes children and young people (and even adults) can behave in extreme or concerning ways from time to time.

Experiencing different emotions at a time that are strong and overwhelming is very confusing for a young person and may lead to unpredictable or changeable behaviour. The factors that influence how a child or young person may behave include:

Pressure and expectations (both real or perceived) or demands (especially being asked to do something they don't want or feel able to do)

Hormone fluctuations and developmental changes (going from a baby to infant to child to teenager)

Pain or feeling unwell (physically or emotionally)

Unpredictability, uncertainty or change

Strong emotional states (especially fear, anger or sadness)

Interactions with others (such as friends, family, teachers or even strangers)

Significant life events (such as bereavement/ loss, bullying, illness/ accident/ injury, trauma)

If a child or young person is behaving in a way that is concerning or that places themselves or others at risk, it can be worrying and difficult to know how best to support them. We have put together a download of top tips that you might find helpful as well as video of a workshop on how to manage concerning behaviour.

There are a number of resources that may also be helpful to you and your child in better understanding the function of the concerning behaviour and how to find other ways of achieving the same function without needing to use concerning behaviour.

CAMHS Behaviour of Concern Referral Guidance
What we do, what we don't do and what you can do if you are worried about your child
All behaviour has meaning. Children and young people communicate through their behaviour, especially those who have not acquired language and vocabulary skills to tell the adult what the problem is. A young person's behaviour can be made stronger and more likely by how it is responded to. Here's a guide to help you know how best to support your young person if they are behaving in a way that is concerning. This is not an exhaustive list; there may be other behaviour and responses to this which have not been included.

Green
Useful Resources
Books:

Apps:

Amber

08088025544
Useful Resources
Books:

Red

08088025544

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All behaviour has meaning. Children and young people communicate through their behaviour, especially those who have not acquired language and vocabulary skills to tell the adult what the problem is. The behaviour used to communicate can be made stronger and more likely by how it is responded to.

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strategies for challenging behaviour

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Below is an extract from the above information sheet, which we featured in our latest Challenge newsletter Winter/Spring 2021: Consistency in uncertain times.
For many family members their role as carer is not just around providing support for their loved one. Family carers often become informal care managers who coordinate care and support across multiple settings and providers. As the demands of this role increase so does the risk of stress, burnout, decline in own health and the ability to fulfil other roles.

The term resilience has often been used to describe people's behaviour in response to a situation, for example: "Jake is coping well, he is very resilient." However, 'resilient' is not something you are, or not, rather resilience is a much more of a dynamic ever-evolving process. Resilience is highly situation-related, meaning that a person who seems to cope in one situation may not function as well in another case.

Why is resilience important?

You are the heartbeat of your family and can only look after others who depend on you if you look after yourself. You spend so much time looking after other people that you may forget yourself - but you are important too and deserve to be cared for as much as anyone else.

Looking after yourself is not being selfish; being aware of your own feelings and needs means that you will have greater resilience to carry on - the better you feel, the better you can help others to feel.

Positive pathway to resilience

Remember resilience is a process.

Here are some steps which may be helpful.

Keep a focus on:

Sense of purpose (having goals and something to aim for makes you better equipped to deal with difficult times)

Positive mental attitude (having a positive but realistic approach to what you can achieve/ manage)

Connection with others (asking for help, sharing, and talking)

Determination (being proactive and not giving up)

Taking control (recognising what we can do something about and what that action might be)

Looking after yourself (having a healthy lifestyle, taking time to relax)

Adapted from Cranfield Trust's webinar: Managing Resilience in Difficult Times: www.cranfieldtrust.org
You do not have to struggle alone

Do not be afraid to ask for help; many family carers will be feeling the same way as you and asking for help, and looking after your own needs is a strength, not a weakness. Reaching out and taking the help that is there for you is the best way to look after the people who matter to you. Notice who is reliably there for you to listen and offer practical support

Soldiering on alone can lead to longer term stress, which, if ignored, can result in burnout.

Resources

The CBF is offering free online support for family carers via video call during the COVID-19 pandemic, including Carers' Catch Ups and Behaviour Chats. Consult our website for more information.

If you don't have internet access, find out more about our new peer-to-peer telephone listening ear service by calling 0300 666 0126.

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Below is an extract from the above information sheet, which we featured in our latest Challenge newsletter Winter/Spring 2021: Consistency in uncertain times. For many family members their role as carer is not just around providing support for their loved one. Family carers often become informal care managers who coordinate care and support across multiple settings and providers.

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Wellbeing and resilience are important in preventing the onset of mental health problems as well as potentially lessening the severity of existing mental health problems. Wellbeing and resilience are vital to developing efficient problem-solving skills, building and maintaining interpersonal relationships and realistic goal setting, all of which greatly enhance an individual's ability to perform and contribute meaningfully in daily life.

What is wellbeing and resilience?

Good health is about more than just the absence of sickness. Focusing on wellbeing and building resiliency is important in establishing a holistic approach to health, addressing both physical and psychological states.

The World Health Organisation defines wellbeing as "the state in which an individual realises his or her own abilities, can cope with normal stresses of life, can work productively, and is able to make a contribution to his or her own community". Wellbeing involves having positive self image and esteem.

Resilience, which is directly related to wellbeing, is about having the ability to cope with and adapt to new situations. Having a sense of resilience and positive wellbeing enables a person to approach other people and situations with confidence and optimism, which is especially important for young people given the enormous changes that occur with the transition into adolescence and adulthood.
Signs of resilience and wellbeing:

confidence to approach new situations and approach new people

realistic optimism

avoiding constant self-blame

ability to set goals

positive self image and self esteem.

How can students focus on wellbeing and resilience?

In a practical sense developing and improving on setting realistic and achievable goals, problem solving and social skills all contribute to wellbeing and resiliency. Other important skills include identifying and becoming aware of one's own strengths and weaknesses.

1. Setting realistic, achievable and measurable goals is a great way to promote self-efficacy. Setting goals should be motivating. One way to increase motivation (and minimise feeling pressure or 'failure') is to set sub-goals, smaller and achievable related targets.

2. Understanding and avoiding negative self-talk as well as actively practicing positive self-talk, is an important tool for building self-esteem. Self-talk, which is essentially internal reflections on personal ability and/or image, can greatly influence self esteem and perceptions about personal ability.

3. Developing and focusing on interpersonal skills, especially learning how to engage with people from different backgrounds, is a valuable tool for young people that will enhance self esteem and ability to maintain personal and fulfilling relationships.

What can teachers do?

create safe and supportive learning environments

provide consistent guidelines for behaviour

model appropriate responses and behaviours

provide opportunities for goal setting, success, failure and reflection.

ReachOut.com resources on wellbeing and resilience

How to help

Talk to young people about their mental health in terms of building strength and resilience.

Suggest self-awareness and resilience strategies, such as mindfulness meditation. Try the Smiling Mind app.

Recommend ReachOut.com content on resilience and wellbeing.

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Wellbeing and resilience are important in potentially preventing the onset of and lessening the severity of existing mental health problems.

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Links for Equality and diversity webpages

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* The Resilience Framework summarises a set of ideas and practices that promote resilience. It is based on a body of research and practice development called Resilient Therapy (RT).
* This was originally developed by Angie Hart and Derek Blincow, with help from Helen Thomas and a group of parents and practitioners.
* Adapted versions have been created to adapt the Framework to different groups.
How the Resilience Framework was developed
We took the resilience research evidence base and padded other sets of ideas from our practice with very disadvantaged children and families in an NHS Child and Adolescent Mental Health Clinic, working closely with schools and other agencies. Alongside this, Professor Angie Hart's adoptive parenting knowledge went into the mix and, more recently, we've collected experiences from a much wider group of collaborators.

We distilled all these different sets of ideas into a handy table that summarises our approach and acts as a reminder to people of what's included. We've called this table various things over the years, and have represented it in different ways - firstly, as a Resilient Therapy Magic Box of potions and remedies, a toolkit of ideas, then a more detailed summary table.

The current doesn't use the language of 'therapy', so that it is more accessible to a wider range of people. It is available as a black and white Resilience Framework in case you, or the young people you support, prefer to colour code the Framework yourselves, or don't have access to a colour printer. There is also a blank Resilience Framework so that you can write your own items if you wish.

The Resilience Framework has been translated into Greek, Spanish, Turkish, French, Swedish, Portuguese, Danish and Polish with more languages on the way. We've also been developing a version of the table for use with adults, the Resilience Framework for Adults, also available in German, and a Family Resilience Framework to support members of the wider family (parents, siblings, carers etc.).

All our tables and frameworks are available as PDFs and can be downloaded from the Boingboing website. But the Interactive Framework we've designed especially for schools is probably what you want at the moment. Marton Primary School, Blackpool, have also co-produced a Resilience Framework for Primary School children.
The Summary Table & how it works
The Summary Table visually shows you how we have split our ideas under five headings or compartments - Basics, Belonging, Learning, Coping and Core Self - to help us think strategically and practically about doing things resiliently.

Within each of these compartments is a selection of evidenced based ideas or remedies, to draw on when trying to make a resilient move with a child or young person. Navigate through the table to find out more about each term.

The Resilience Framework Summary Table does look pretty simple, but there's quite a lot of work behind it. And if you're thinking you are still unsure about how to give it a go, take a look at the Resilient Therapy background page and see if it can help.

If you really want to get stuck into understanding how we put it together, and get more information about how to use it, you might want to get hold of one of our books.

We've also used it in other places on this website to give you more of an idea of how to put some of the ideas into practice so don't bother buying a book before you have had a good look around the website for ideas such as

* The Resilient Classroom - a Tutor resource
* And check out ' One Step Forward' - a Looked After Children's resilience resource
* Have a look at the film below which was features Hove Park School (secondary) in Brighton where the Resilient Classroom resource was developed as part of a whole school approach to promoting resilience.

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CRSJ / Boingboing / ResilienceRevolution

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How to use the Resilience Framework - Boingboing

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The Resilience Framework summarises a set of ideas and practices that promote resilience. It is based on a body of research and practice development called Resilient Therapy (RT). * This was originally developed by Angie Hart and Derek Blincow, with help from Helen Thomas and a group of parents and practitioners.

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Wellbeing For Children: Identity And Values

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Harlow's Studies on Dependency in Monkeys

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Introduction

It is widely agreed among psychoanalysts that a bond between an infant and an adult who is special to them is central to a child's well-being. This is known as Attachment Theory. The concept was explored in depth by John Bowlby in his 'Maternal Deprivation Hypothesis' from the 1940s to the 1970s, in which he claimed that an early attachment to the mother was vital for a child's emotional stability. This was expanded by Mary Ainsworth and her observations of toddlers left in an unfamiliar room with a stranger, known as the 'Strange Situation' study. Faults in both studies have been highlighted and unravelled by subsequent psychoanalysts, and Attachment Theory has been buffeted by changing social expectations. In spite of this, Bowlby's research is recognised as the foundation for our understanding of the centrality of making secure attachments in infancy.

More recently, Elinor Goldschmied and others have pioneered the Key Person Approach, which advocates the forming of special relationships between adults and children in the nursery setting. As the rising numbers of working parents continue to demand good quality childcare, the Key Person Approach is designed to bring the building of individual relationships into group care.

A Closer Look at Attachment Theory

John Bowlby described attachment as 'the bond which ties' (Svanberg, p.6). He saw it as the basis of our evolutionary survival. Babies are completely dependent on the attentions of a close adult, usually the mother, for all their needs. Bowlby understood that infants had to make a clear attachment in order to ensure this protection. Other researchers have observed that there is a psychological, as well as a physical need to form early attachments: 'Attachment is central to our very survival, and what we are beginning to realise is that it is also central to our wellbeing' (Svanberg, p.6).

The Phases of Attachment

Attachment is a process rather than something that happens overnight. There are three clear phases of attachment: Pre-attachment, Attachment in the Making, and Clear Cut Attachment. These describe the majority of relationships between infant and main carer and generally lead to a securely attached child. Pre-attachment refers to the first few weeks of life, when a newborn baby shows no definite preference for a particular person, but instinctively begins to hold their carer close by crying, gripping with their hands and making firm eye contact.

Attachment in the Making is the phase from six weeks to six months, during which a baby smiles, imitates, tells the difference between familiar and unfamiliar faces and shows a preference for their main carer. In turn, the main carer, usually the mother, often responds instinctively and with sensitivity to signals from her baby. Svanberg explains that this is known as 'mind-mindedness or mindfulness...the ability to put yourself into the baby's head and work out what he is thinking' (p.7).

Clear Cut Attachment is displayed from six months onwards. Now the baby shows distress when their main carer leaves the room and experiences what is known as 'separation anxiety' when left with another adult. Another feature of this phase is that the baby begins to learn that an object or a person continues to exist even if they cannot see them. This is Piaget's theory of 'object permanence' (1896-1980). Equally, it is believed that it is important to the baby to know that they are kept in mind by their carer. Lindon explains that 'their emotional security depends upon feeling that they are held in mind by an important person in their life' (p.90). There is a fourth phase of attachment that spans the pre-school years. During this period, a child begins to understand that their main carer has needs of their own. A relationship based on negotiation is established and the child can settle into longer patterns of separation from their carer.

The 'Strange Situation' Study

This research by Ainsworth centred on the observations of a number of 12 to 18 month old toddlers placed in what was called the 'strange situation'. This involved a mother and child entering an unfamiliar room together; a stranger comes in; the mother leaves; after a short time the mother returns. The toddler's reactions were recorded at each stage of the situation. Ainsworth found that there were three main types of responses: secure attachment referred to those toddlers who were distressed when their mothers left the room, but were happy to see her when she returned; insecure/avoidant attachment was displayed by children who showed little reaction on the departure or return of their mother: and ambivalent attachment toddlers showed distress when the mother left, but continued to be upset when she returned.

The children in these categories showed obvious strategies to deal with the separation from their mother. Ainsworth created a fourth category, disorganised attachment, for those toddlers who did not demonstrate a consistent coping mechanism. She linked her research to her observations of mothers at home with their babies, concluding that the development of attachment was greatly influenced by the responses of the main carer to the child.

The Benefits of a Secure Attachment

Bowlby believed that patterns of making relationships are formed in the very early stages of a child's life, through their very first relationship with their main attachment figure. 'The primary attachment, the first relationship, will make a sort of blueprint or internal model in the brain for...relationships in the future' (Siren Film 1, p.8). It is therefore vital that children experience positive and loving early attachments, from which they can grow in confidence and independence: 'Securely attached children have positive self-beliefs. They understand themselves through the reactions and responses of those close to them. Positive messages from their attachment figures help to build self-esteem and trust' (Siren Film 1, p.19). As children learn to understand themselves through their relationships, so they begin to develop empathy which is a key characteristic of a responsible and caring individual. Elfer explains that 'empathy is no more than the ability to understand the feelings of another person....the roots of that are in having your own feelings understood and that only happens through attachment relationships' (Siren Film 2, p.20).

Criticisms of Attachment Theory Research

The main accusation aimed at both Bowlby's and Ainsworth's studies are that they are based on a narrow section of society and focus only on the mother as the main care giver. Western society has changed dramatically since these studies were carried out, and some argue that they are outdated. As Goldberg writes 'an increasing number of children are reared in households with one parent, two partners of the same gender, multigenerational families, or households that include a non-familiar resident' (p.97). Our society is now built from many cultures, each having their own traditions and familial organisation. What is clear from all studies of attachment is that it is not who is doing the caring, but the 'amount, quality and consistency of care' that is important (Goldberg, p.106).

A Closer Look at the Key Person Approach

The Key Person Approach is described as 'a way of working in nurseries in which the whole focus and organisation is aimed at enabling and supporting close attachments between individual children and individual nursery staff' (Elfer, Goldschmeid and Selleck, p.18). Care by large, ever changing groups of adults, rather than by someone especially present for a child, has been called 'multiple indiscriminate care' (Bain and Barnett in E, G, S, p.13). The Key Person approach recognises that an infant is distressed by differences and comforted by the familiar. A Key Worker, whose task is generally administrative and organisational, is not the same as a Key Person, who's role embodies 'an emotional relationship as well as an organisational strategy' (E, G, S, p.19).

The Key Person's Role As a Key Person, a nursery practitioner will be responsible for a small group of children. In a professional way, the Key Person needs to demonstrate three characteristics: availability, sensitivity and warmth (Siren Film 2). Settling in Before a child is due to start at the early years setting, the Key Person meets with the child and their parent, either at home or in the nursery, to plan a suitable settling in programme. They learn little facts about the child, such as who is in their family, what they like to do, how they like to be held. It is the Key Person who greets the child at the start of a session, and supports the parent and the child as they say goodbye. By sensitively handling this moment, which is naturally distressing for the securely attached child and parent 'the Key Person can help to make the parting a dignified and carefully thought out time, even if it is quite a brief affair' (E, G, S, p.24). The practitioner is also present at the reunion between parent and child at the end of the session so that they can talk about the child's day and provide a link between the setting and home.

Building an Attachment

The Key Person meets any physical needs, such as changing nappies, feeding or cuddling at nap time, and in this way they begin to build a secure attachment with the young child. Lindon emphasises the importance of physical contact when comforting and playing with a child: 'Touch is a powerful non-verbal message, reassuring children that they are liked and welcome' (p.93). The practitioner reminds the child that they are 'kept in mind' by their parents and siblings by talking about these significant people and what they did with them yesterday, or will do later. The Key Person shares life's wonders and celebrates achievements as the child develops in confidence and independence. They need to be aware that they are the secure base from which the child can explore the setting, other children and other adults. Elfer explains that 'the role is not about limiting the child's activities with other children and other adults. The key person approach is about facilitating other relationships through allowing a close relationship' (Siren Film 2, p.24).

Relationships with Parents

The Key Person must also consider the needs of the parent. They may require reassurance that the benefits of a special relationship with a Key Person in the nursery will not replace attachments at home. Pound points out that 'attachment is not a fixed quantity in children's lives. More at nursery does not mean less at home' (p.45). The practitioner must recognise boundaries, remaining professional while expressing warmth and understanding. Any problems between the adults must be resolved without disruption to the child's attachments (Lindon). Goldschmeid advises the early years practitioner to think of 'the importance of a triangle of relationships between the child, the parents and the key person' (E, G, S p.19).

Nursery Organisation

Implementing a Key Person Approach in an early years setting is not just a case of devising an organisational strategy: 'It needs to be motivated and driven by a spirit of advocacy for the rights of children to be listened to, even before they can speak' (E, G, S, p.31). Every setting is unique and there is no single, right way to introduce this approach. However, plans need to be in place to cover for sickness, holiday, meetings or a job change. In these unavoidable situations, children's attachments are necessarily disrupted, but the change needs to be kept to a minimum by having a back up key person. As Elfer explains, 'It is much better that they have that experience of attachment even if they have to lose it at some later time than not to have any attachment experience at all' (E, G, S, p.23). The Key Person's role needs to be recognised within the setting as being rewarding but intellectually and emotionally demanding. Time needs to be given to each member of staff to talk about concerns and to share experiences; 'Managers have a vital role, not just in their ingenuity for creating time for talking, but in creating a climate of attitudes that sees talking about heartfelt worries or concerns as a positive part of the developing professional life of the nursery' (E, G, S, p.33). Working as a team becomes even more important as the Key Person Approach is introduced. Conclusion The current understanding of early attachment relationships has evolved a great deal from Bowlby and Ainsworth's original theories, but the general principle remains the same. Infants and children need to form secure attachments with a few adults who are special to them. Using this to inform their practice, with some guidance from the Key Person Approach, early years settings can build positive and rewarding attachments with the children in their care.

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Attachment Theory and the Key Person Approach

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Introduction It is widely agreed among psychoanalysts that a bond between an infant and an adult who is special to them is central to a child's well-being. This is known as Attachment Theory. The concept was explored in depth by John Bowlby in his 'Maternal Deprivation Hypothesis' from the 1940s ...

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NICE guidelines

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I was delighted to be invited to a Parliamentary reception at the House of Commons recently on social pedagogy. If you're wondering what that is - read on! There were quite a few social workers there and I was inspired by how well the methodology chimes with strengths based social work practice and the exemplification of practice leadership when working directly with people we are privileged to serve. I am delighted that Ali Gardner, a senior lecturer at the University of Central Lancashire, has agreed to post the first of a series of occasional blogs exploring social pedagogy and social work practice leadership.
Ali: The title of this blog post is also the most common reaction I receive when I tell people I work in the field of social pedagogy, so here's a helpful definition right at the start:

"Social pedagogy describes a holistic and relationship-centred way of working in care and educational settings with people across the course of their lives...it has a long-standing tradition as a field of practice and academic discipline concerned with addressing social inequality and facilitating social change by nurturing learning, well-being and connection both at an individual and community level."

Social pedagogy is based on humanistic values. It is primarily concerned with well-being, learning and growth and seeks to recognise and promote individual potential. It is underpinned by the concept of 'Haltung', a German phrase roughly translating as 'mindset' or 'attitude'.

At a time when social work is struggling to assert its unique contribution in the face of increasing pressures and austerity, it has never been more important to strengthen the meaning and purpose of working alongside individuals, families and their communities.

In my work with students and practitioners, I am frequently told they share the principles of social pedagogy and try to embed them in their practice. This is a good starting point and it is encouraging that many practitioners still hold fire in their bellies to promote, protect and deliver social justice.
It's all about relationships
Social workers often describe the importance of relationships and supporting individuals to effect change in their own lives. However, they also reference the lack of agency in making professional judgements about the focus and nature of their work.

This leads to a form of practice where power remains firmly in the hands of the professional determining the format and sequence of each intervention. This reinforces notions of fixing problems and working from a deficit model in which the professional 'knows best'.

Social pedagogy, on the other hand, promotes educational solutions to social problems. Education in this sense does not refer to the professional, teaching an individual how to change, but instead focuses on supporting them in finding ways to enhance their wellbeing.
The wellbeing narrative
Wellbeing as a concept has taken central stage in adult social care narratives. The Care Act (2014) and subsequent policies have cemented this notion, promoting a strength based approach to social care. Within this approach, there is an expectation that individuals are supported to identify and design support that enhances their wellbeing.

Practitioners recognise that nothing is fixed when we enter the lives of others but we draw upon what we feel is required to engage with others in a given context. In social pedagogy there is a commonly used phrase 'It depends'. Instead of viewing this phrase as flaky and lacking conviction, it calls for practitioners to show courage, integrity, confidence and leadership in aligning their practice to values rather than instrumental processes. The graphic below captures this notion.
Wellbeing teams and social pedagogy
Having a shared professional timeline in learning disability, person centred practice, self-directed support and personalisation with wellbeing teams founder Helen Sanderson, we have discussed our philosophies, theories, approaches, frustrations and hopes in relation to adult social care.

It was during one such discussion that the synergy between social pedagogy and the development of Wellbeing Teams became apparent. For both of us, social pedagogy provided a language to understand, articulate and apply many of the values and beliefs that have shaped our professional careers

Wellbeing Teams were established in 2016 by Helen and are currently operating in several areas across the country. The model aims to provide person centred care and support to people and to connect them with their communities. The teams are small and neighbourhood based and provide a flexible and responsive approach to meeting individual needs.

Social pedagogy has provided an important language in which words such as happiness, friendship, belonging and love can be used when describing a professional approach to one's work.

I hope I never get bored of being asked the 'social what?' question and I dream of a day when social pedagogy slips off the tip of the tongue for all of us working in health and social care.

More about Ali
Ali Gardner is a Senior Lecturer at the University of Central Lancashire. She teaches on the Social Work programme and the newly developed Social Pedagogy programme.

Ali has worked as a social worker, policy development officer and lecturer throughout her career as well as a Director of an Advocacy Project and a Social Work Advisor to Well Being Teams.

Ali has written academic texts relating to Personalisation and is awaiting the release of her new Sage publication Social Pedagogy and Social Work with her colleague Lowis Charfe. Together, Ali and Lowis have also been part of the development of a MOOC supporting the international development of Social Pedagogy.
For more information about any of the new social pedagogy programmes click the links below: MA social pedagogy leadership BA Hons social pedagogy advocacy participation

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I was delighted to be invited to a Parliamentary reception at the House of Commons recently on social pedagogy. If you're wondering what that is - read on! There were quite a few social workers there and I was inspired by how well the methodology chimes with strengths based social work practice and the exemplification of practice leadership when working directly with people we are privileged to serve.

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What social pedagogy means

Social Pedagogy offers a values-led approach to relationship-centred practice that aims to holistically support people's well-being, learning and social inclusion. At the heart of Social Pedagogy lies a belief that each person deserves to be treated with human dignity and possesses unique inner resources and potential, which we can help them unfold. To do so requires meaningful and authentic relationships that enable us to recognise a person's potential, their qualities, strengths and interests, and to create learning situations in which people can experience their resourcefulness and develop new abilities. This is why Social Pedagogy is often translated as education in the broadest sense of the term, with a focus on learning in the 'everyday'.

In much of continental Europe, and across Latin America, there is a strong tradition of Social Pedagogy as an academic discipline and field of practice across a variety of educational and care settings: from the early years, through to schools, residential child care, play and youth work, community and family support, social work, employment support, addiction work, prisons, support for people with disabilities, and care for the elderly. At first sight, some of these settings may not seem to have much in common. Yet, there is a shared ethical underpinning, an understanding that in any of those settings we can make a positive difference not just for the individuals, but indeed for society as a whole if we create an environment that enhances well-being, supports learning, human growth and social inclusion through empowering relationships. In this sense, Social Pedagogy seeks to find educational solutions to social issues by connecting individuals to society and promoting social justice.

The value of Social Pedagogy lies in the fact that it is more than just an approach to social care and social work practice; it offers a coherent conceptual framework and ethical orientation that strengthens existing practice and enables professionals to navigate challenging and complex situations with a clear sense of purpose and direction. Whilst it can provide professionals with a broad range of methods to use, it ensures that their focus is on the deeper purpose of supporting well-being, learning and social inclusion - and selecting or developing methods that contribute to these aims and seem meaningful within a given practice situation. This is why Social Pedagogy can enhance other current approaches frequently used in UK practice, such as systemic practice, strengths-based, person-centred and risk-sensible models. It is the guiding principle and foundation on which 'everyday' practice is built on and influences how professionals then understand and use the approaches mentioned above.

Origins

The term 'pedagogy' stems from the Greek terms país (child) and ágõ (to lead, to guide). 'Social' pedagogy has grown organically out of a longstanding tradition of educational philosophers, social thinkers and practitioners who were concerned with creating a more just society through educational means. Social pedagogy therefore aims to connect each person to society, with society supporting its most disadvantaged members and each individual taking responsibility for wider society. It aims to create the conditions in which each person can grow and become both more independence and integrated. As this is a lifelong process, social pedagogues work within a range of different settings, from early years through adolescence to working with disadvantaged adult groups as well as older people. Consequently, what exactly social pedagogy means depends very much on the context or setting. Social pedagogues who are working with marginalised adults will draw on other specialisms and theories than social pedagogues working with very young children, but they will be connected through a shared ethos and principles underpinning their social pedagogical orientation.

Social pedagogy is very closely related to society and reflects cultural attitudes and traditions in many ways. It provides clues about how a given society thinks about children's upbringing, the relationship between the individual and society, and how society supports its disadvantaged or marginalised members. This is why social pedagogy has developed in somewhat different ways across different countries over time - and why a Spanish social pedagogue might explain it in slightly different ways than a Swedish social pedagogue.

Irrespective of the cultural contexts and the different settings in which social pedagogues can work, there are shared underpinning principles: What connects all social pedagogies is the way of thinking, the philosophy and (congruence between values and actions) with which different methods are used. What characterizes social pedagogy in practice depends not so much on what is done but on how it is done and with what rationale. This means that social pedagogy is both a science and an art form - it's not just a skill to learn but needs to be brought to life through the social pedagogue's Haltung.

This perspective of social pedagogy means that it is dynamic, creative, and process-orientated rather than mechanical, procedural, and automated. It demands from social pedagogues to be a whole person, not just a pair of hands. It also offers an insight into how we can develop social pedagogy in the UK: following the same principles, we need to put people at the heart and connect to their Haltung. And we can only construct a social pedagogy for the UK together, in dialogue with each other. Only then can it offer a holistic overarching conceptual framework that can guide professional practice in a meaningful way. And only then can we capture the spirit of social pedagogy which makes it an art, not a method.

Social Pedagogy Standards

Over the last decade, much effort has gone into developing a clearer understanding of what the principles and practices of social pedagogues and social pedagogy practitioners in the UK are. In 2016, as part of a UCL Institute of Education-led project called Scaling Up Social Pedagogy, we consulted widely with professionals engaged in social pedagogy as practitioners, students, managers, academics or policy-makers to compile social pedagogy standards. These standards are held by the Social Pedagogy Professional Association.

Standards - Philosophy and Haltung

These threshold standards address the philosophy underpinning of Social Pedagogy and the Haltung we expect Social Pedagogy Practitioners and Social Pedagogues to develop and maintain in their practice. These standards should be held in a person's heart and guide their way of living and working.

As a Social Pedagogy Practitioner / Social Pedagogue, I agree to:

1. Develop and nurture an attitude of empathy and regard for people and cultures and the world of which we are a part

2. Foster relationships that respect human dignity and promote human rights, mutuality and well-being

3. Recognise the inherent resourcefulness and potential of human beings to bring about change

4. Appreciate that human relationships, in all their complexity, are intrinsically valuable and therefore central to Social Pedagogy

5. Enable people to use their voices and effect change within their own lives and wider society

6. Understand and work with the tensions inherent in valuing individual autonomy and social interdependence

7. Engage with social and political aspects of human development, childhood and community

8. Educate for community through community

9. Develop an attitude of professional curiosity and critical self-reflection

10. Be open to and informed of new theory, research and good practice relevant to social pedagogical practice

11. Use situated professional judgment and maintain appropriate confidentiality

12. Understand issues relating to the protection of vulnerable individuals, groups and communities and address social inequalities

13. Recognise the value of creativity, playfulness and adventure

14. Be accountable for my practice, engage in meaning-making and know when to seek advice

Standards - Practice

These standards represent the threshold level of practice for Social Pedagogy Practitioners and Social Pedagogues. We expect their employing organisations to provide a working culture and support that enables Social Pedagogy Practitioners and Social Pedagogues to apply these standards within their practice.

As a Social Pedagogy Practitioner / Social Pedagogue, I agree to:

1. Engage with others in ways that respect their equal value and human dignity, understanding the part played by personal communication in supporting this

2. Make decisions with a high degree of situation awareness, recognising the complex factors involved in different circumstances

3. Recognise and respect that personal histories, characteristics and social and political contexts have brought each person and group to their current understanding of the world

4. Invite, consider and integrate multiple perspectives in decision making as a means of deepening social justice, community and well-being

5. Create opportunities and contexts for people to actively participate in society, express their own views and listen to those of others

6. Hold my relationship with the people I work with and support in the foreground in all my practice

7. Value the opportunities that everyday activities provide for developing relationships

8. Facilitate learning processes that enhance well-being and enable individuals to find meaning and purpose in their everyday lives

9. Work collaboratively and be willing to both support and challenge colleagues

10. Use theory and research in my everyday practice

11. Support the individuals, groups and communities I work with to realise their hopes and aspirations by identifying, with them, the steps required to meet their goals

12. Adapt my practice to take account of the physical, intellectual, emotional, spiritual, social and cultural needs and strengths of individuals, groups and communities, in keeping with the principles of social pedagogy

13. Practice safely and competently within the legal and ethical boundaries of my profession

14. Take into account relevant social policy and at the same time bring critical awareness to any tensions existing between our values and such policies.

15. Support community development by encouraging networking and connections through participatory processes that draw on the community's resourcefulness.

16. Promote inter-professional dialogue and co-operation across settings and agencies.

You can find these as a downloadable document here.

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Social Pedagogy - ThemPra Social Pedagogy

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Social pedagogy is based on principles around holistic learning and well-being. Here we provide more details.

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One of the major challenges facing professionals involved in the education and care of children in the UK concerns how best to meet the needs of troubled, vulnerable and disadvantaged children who are struggling at school and who have, for...

One of the major challenges facing professionals involved in the education and care of children in the UK concerns how best to meet the needs of troubled, vulnerable and disadvantaged children who are struggling at school and who have, for whatever reason, become disengaged from what schools have to offer.

In recent years it is evident that the educational policy climate within which schools are judged has become overwhelmingly focused on their pupils' academic qualifications. This pupil attainment target-driven climate, together with an aggressive style of Ofsted inspection coupled with the threat of school closure based on low pupil attainment, has made it increasingly difficult for schools to devote time, effort and resources to meet the needs of troubled pupils.

It says much for the sheer professionalism of many teachers that they are doing as much as they can within such a climate to provide support, care and encouragement to troubled pupils.

It's hard to believe how much the climate has changed in recent years, when just ten years ago the Labour government was exploring ways in which all those professionals who work with children, including teachers and support staff, social workers, health care practitioners, the police and youth justice personnel, educational psychologists, and mental health workers (referred to collectively as the children's workforce) could work together across professional boundaries to look at how best to support troubled pupils. The phrase used very much at the time was that the educational, health, welfare and social care services should be "wrapped around the needs of the child".

Prompted by the introduction in schools of the Every Child Matters agenda in 2004, the Labour government explored the use of 'social pedagogy' - an approach widely practised in mainland Europe where a trusted adult seeks to help and support a troubled child. Such an approach is focused on the needs of each child in a way that looks at the bigger picture - it considers their educational, health and welfare needs as a whole; their family and care setting; their personal and social development as well as their academic progress; whether the child feels included within the mainstream of society; the child's long term prospects, including their opportunities for employment and access to post-16 education and training; how the child relates to others - their parents or carers, their teachers, and their peers; and finally, and perhaps most importantly of all, it considers whether the child has regular contact with a trusted and caring adult.

Social pedagogy has a long history of theory and practice in mainland Europe, and has its roots in social, political and philosophical writings concerning how best to create a healthy community within with all individuals feel empowered, respected, included, and can take their place in contributing to the health of the society within which they live. Typical activities with troubled children include mentoring; offering advice and direct help; liaising with others and offering advocacy on behalf of the pupil; and shared creative and social activities designed to enhance the pupil's personal development, social engagement, and wellbeing.

The practice of social pedagogy in the UK has continued to grow steadily amongst education and welfare professionals. Some excellent examples of social pedagogy in practice can be found in educational and social care settings for children, particularly in residential care for looked after children, pupil referral units, youth and community work, mentoring schemes operated by a range of charities, and in alternative educational provision.

The Labour party is currently reviewing how best to meet the needs of all pupils, and has recognised the particular challenges involved in meeting the needs of troubled pupils. Implicit in much of the policy making is the need to do more to ensure that what is offered is better tailored to meet the specific needs and circumstances of each pupil.

However, what has not been well articulated so far iss the importance played in a child's development by having a relationship with a caring and trusted adult. It would now be timely for the Labour party to include social pedagogy practice as part of its policy strategy for supporting troubled, vulnerable and disadvantaged pupils in schools.
Chris Kyriacou is professor of educational psychology at the University of York Department of Education and vice-chair of the York Fabian Society.

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Education: Helping troubled pupils through social pedagogy | Fabian Society

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One of the major challenges facing professionals involved in the education and care of children in the UK concerns how best to meet the needs of troubled, vulnerable and disadvantaged children who are struggling at school and who have, for...

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Gertrude Wilson and social group work. Gertrude Wilson was a pivotal figure in the development of the theory and practice of group work during the 1940s and 1950s. Here we briefly assess her contribution.

Contents: Gertrude Wilson · on group work · conclusion · bibliography · how to cite this article.

Gertrude Wilson (1895-1984) was born in Dana, Illinois. In 1914 she entered Illinois (Women's) College, a small denominational institution in Jacksonville, Illinois, earning an A.B. in 1918. She then joined the University of Chicago and earned a Ph.D. in 1920. At Chicago she was influenced by philosopher John Dewey and sociologist Robert E. Park. She taught in high school for a couple of years, and then joined the YWCA in 1922. (All biographical details are taken from Greenwood 1985 et al).

Within the Young Women's Christian Association Gertrude Wilson started as a secretary (in Allentown, Pennsylvania) and later became a program director (Buffalo, New York) and then administrator of the Chicago YWCA's program for young women in industry. She studied part-time and gained an MA in 1938 from the University of Chicago's School of Social Service Administration. Janice Andrews (2001) has reported that Gertrude Wilson was attracted to the role of the group in promoting democratic ideals while a student at the University of Chicago. However, Sophinisba Breckenridge, one of her social work teachers there, argued that Wilson was "wasting" herself by being a person who worked with groups'. Gertrude Wilson retained her interest in the possibilities of the group as a milieu for problem solving. She became active in the American Association for the Study of Group Work.

In 1935 Gertrude Wilson became an Assistant Professor at Western Reserve University's School of Applied Social Sciences. There she joined, among others, Grace Coyle, to teach social group work. In 1938 she became a Professor and later an Associate Dean. While there she wrote two of her seminal publications: Case Work and Group Work (1942) and in 1949 Social Group Work Practice, co-authored with Gladys Ryland (Ryland was a colleague at Pittsburgh and went on to work for the YWCA).

Gertrude Wilson joined School of Social Welfare at Berkeley in 1951 as Professor and Director of Social Welfare Extension. She had the task of developing a professional education program for the professionally untrained social worker. She set up the "Certificate Program in the Social Services" which consisted of four sequential courses extending over two years and culminated in a two-week seminar in residence on the Berkeley campus. She also taught a course in social group work theory and practice. While at Berkeley she conducted several nationwide surveys of social work practice. Among the latter were the survey of recreational and group work services for the 1950 White House Conference on Children and Youth (Wilson 1951), and the mid-1950's survey of group work practice for the National Association of Social Workers (Wilson 1956). She retired in 1963 but continued to be involved in community activities. Gertrude Wilson died in 1984 after a five year battle with cancer.

On group work

Gertrude Wilson's first major publication Case Work and Group Work (1942) gained her an enthusiastic audience among certain sectors of US social work. As Greenwood et al (1985) have noted, when she began writing, social-work practice was dominated by casework (focusing on the intra-psychic problems of individuals and was rooted in psychoanalytic theory). Wilson 'was among the first to oppose this view, arguing that personal problems originate not only in internal, but also in external, sources. Hence, no single ameliorative method suffices'. Case Work and Group Work argued for an integrated approach. Case work and group work were presented as being aspects of the helping process. She demonstrated that they draw upon many of the same basic concepts from the behavioural sciences as well as from dynamic psychology; and that there were key common skills. As Reid (1963: 148) has commented, the book:

... led caseworkers to experiment with groups, and it resulted in the introduction of group services into agencies that had formerly provided help on a one-to-one basis. It also served as a reminder to group workers that a significant amount of time was spent working with individuals and that similarities far outweighed differences.

At the National Conference on Social Work in 1942 Gertrude Wilson looked to the use of group work in bring about changes in the values of individuals and society as a whole. She argued that group work was a process through which group life was influenced by a worker who directed the process toward the accomplishment of a social goal conceived in a democratic philosophy (Reid 1981: 143). She defined group work as:

[1] developmental, as it provided for normal social growth;

[2] protective or corrective, in that it could be offered to people without groups; and

[3] instrumental in achieving of socially desirable ends. By understanding the personality of each member, the worker influenced the process within the group, and participation in the process helped members use the group for their own growth and development. ( op cit)

She viewed group work as a social work method rather than a movement and argued for continued research into practice.

In 1949, after a number of years work, Gertrude Wilson and Gladys Ryland published Social Group Work Practice. This book was to have a formidable effect. Dubbed the 'Green Bible' (after the colour of its cover) it was arguably the most influential book on group work within social work. It was also one of the most substantial. Within its 700 pages there was a detailed discussion of the social group work method; analysis of different programme media (including play and leisure activities, games, dance and music, story telling and dramatics, and arts and crafts, trips and the out-of-doors); a series of detailed case studies; and an exploration of supervisory and administrative processes. As such it provided a rich resource for social work training programmes and for social workers wanting to deepen and expand their working processes. Significantly, much of the case study material was drawn from work in 'recreational and informal educational agencies' as, 'quantitatively speaking', more social group work was practiced in these areas (Wilson and Ryland 1949: ix).

Many of the notions that are familiar today as established nostrums of practice are set out in the book including a discussion of the conscious use of self and the helping process as a generic element. Social group work is portrayed as:

... a method through which the creative use of the social process is achieved. It is a process and a method through which group life is affected by a worker who consciously directs the interaction towards the accomplishment of desirable goals, which in our country are conceived in a democratic frame of reference. And the goals for which the social group work method is used are both individual and social, in that the process of social group work is directed, first, toward helping individuals participate in a qualitative group relationship which enables them to become more effective social beings, and second toward helping the group-as-a-whole to achieve ends significant to the growth and development of a more democratic society. (Wilson and Ryland 1949: 622)

This conceptualization is interesting both in the emphasis upon intervention and direction on the part of the worker, and the extent to which individual outcomes are valued. To a significant degree these emphases derive from what might be called a social work frame of reference and contrast with more facilitative, dialogical and group-oriented perspectives of informal educators such as youth workers and community development workers. Grace Coyle had similarly looked to the impact of the group on the individual, but had retained a stronger focus on the associational power of groups. However, many subsequent writers and much practice was stubbornly individualistic in nature and continue to ignore the social (as they had done for many years as C. Wright Mills memorably pointed out in his essay on 'The professional ideology of social pathologists').

Conclusion

Gertrude Wilson's contribution to the establishment of social group work within social work in the United States was pivotal. She was able to articulate the relationship between group work and case work, and she provided the practice text for workers (with Gladys Ryland). Her conceptualization of group work as a method of social work was influential in shifting the overarching frame of reference away from recreational and informal educational activity.

Bibliography

Andrews, J. (2001) 'Group work's place in social work: a historical analysis', Journal of Sociology and Social Welfare, http://www.findarticles.com/cf_0/m0CYZ/4_28/83530630/p1/article.jhtml.

Greenwood, E., Chernin, M. and Stewart, K. (1985) 'Gertrude Wilson, Social Welfare, Berkeley', University of California In Memoriam, Accessed January 2, 2004.

Mills, C. W. (1943) 'The professional ideology of social pathologists', American Journal of Sociology 49(2).

Reid, K. E. (1981) From Character Building to Social Treatment. The history of the use of groups in social work, Westport, Connecticut: Greenwood Press.

Wilson, Gertrude (1941) Group work and case work, their relationship and practice, New York, Family Welfare Association of America.

Wilson, Gertrude (1945) A bibliography on group work, New York: Association Press.

Wilson, Gertrude and Ryland, Gladys (1949) Social group work practice; the creative use of the social process, Boston, Houghton Mifflin Co.

Wilson, G. (1951) Recreational and informal educational service. Prepared for the Midcentury White House Conference on Children and Youth, New York: American Association of Group Workers.

Wilson, Gertrude (1956) The Practice of Social Group Work. New York: National Association of Social Workers.

Acknowledgements: The picture 'Ari is facilitating' was taken by Shira Golding and is reproduced under a Creative Commons Attribution-Noncommercial 2.0 Generic licence. It can be found on Flickr.com: http://www.flickr.com/photos/boojee/2668136741/.
Links
Gertrude Wilson Group Work papers, Social Welfare History Archives, University of Minnesota Libraries.

How to cite this article: Smith, M. K. (2004). 'Gertrude Wilson and social group work', The encyclopedia of pedagogy and informal education. [ https://infed.org/mobi/gertrude-wilson-and-social-group-work/. Retrieved: insert date].

© Mark K. Smith 2004

Last Updated on

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Contents: Gertrude Wilson · on group work · conclusion · bibliography · how to cite this article. Gertrude Wilson (1895-1984) was born in Dana, Illinois. In 1914 she entered Illinois (Women's) College, a small denominational institution in Jacksonville, Illinois, earning an A.B. in 1918. She then joined the University of Chicago and earned a Ph.D.

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Framework for the Assessment of Children in Need and their Families

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Framework for the Assessment of Children in Need and their Families

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Dimensions of Child's Developmental Needs

Health

Includes growth and development as well as physical and mental wellbeing. The impact of genetic factors and of any impairment needs to be considered. Involves receiving appropriate health care when ill, an adequate and nutritious diet, exercise, immunisations (where appropriate) and developmental checks, dental and optical care and, for older children, appropriate advice and information on issues that have an impact on health, including sex education and substance misuse.

Education

Covers all areas of a child's cognitive development which begins from birth. Includes opportunities:

For play and interaction with other children;

To have access to books;

To acquire a range of skills and interests;

To experience success and achievement.

Involves an adult interested in educational activities, progress and achievements, who takes account of the child's starting point and any special educational needs.

Emotional and Behavioural Development

Concerns the appropriateness of response demonstrated in feelings and actions by a child, initially to parents and care givers and, as the child grows older, to others beyond the family. Includes nature and quality of early attachments, characteristics of temperament, adaptation to change, response to stress and degree of appropriate self-control

Identity

Concerns the child's growing sense of self as a separate and valued person. Includes the child's view of self and abilities, self-image and self-esteem, and having a positive sense of individuality. Race religion, age, gender, sexuality and disability may all contribute to this. Feelings of belonging and acceptance by family, peer group and wider society, including other cultural groups.

Family and Social Relationships

Development of empathy and the capacity to place self in someone else's shoes. Includes a stable and affectionate relationship with parents or care givers, good relationships with siblings, increasing importance of age appropriate friendships with peers and other significant persons in the child's life and response of family to these relationships.

Social Presentation

Concerns child's growing understanding of the way in which appearance, behaviour, and any impairment are perceived by the outside world and the impression being created. Includes appropriateness of dress for age, gender, culture and religion; cleanliness and personal hygiene; and availability of advice from parents or care givers about presentation in different settings.

Self Care Skills

Concerns the acquisition by a child of practical, emotional and communication competencies required for increasing independence. Includes early practical skills of dressing and feeding, opportunities to gain confidence and practical skills to undertake activities away from the family and independent living skills as older children. Includes encouragement to acquire social problem solving approaches. Special attention should be given to the impact of a child's impairment and other vulnerabilities, and on social circumstances affecting these in the development of self care skills.

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1.9 Framework for the Assessment of Children in Need and their Families

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Assessment framework

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xxxRCC 3.4 effctive communication [Autosaved] [Autosaved]

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Medicines policy updated

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The purpose of reflective practice

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Essential reading regarding theories of reflective practice

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Understanding challenging behaviour in children for residential child care workers | Social Care Wales

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Information for residential child care workers about understanding and responding to challenging behaviour in children

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ERA is a Licensed Residential Treatment Center for Troubled Teens

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All troubled youth programs know that dealing with a troubled teen can often feel like a never-ending battle. Communication can be virtually non-existent or reduced to elevated arguments. Not all troubled teens are destined for an intervention from the authorities or psychiatrists. Delinquency varies from minor rule braking, being withdrawn to violent aggressive behavior, and law breaking. Learning how and when to communicate effectively can make all the difference.

When emotions are high, rationality is limited or not present at all. When an angry parent approaches the upset teen, the teen will automatically be defensive or closed off. Neither party will accept the other's explanation of reasoning.

Instead of fighting fire with fire, allow a cool off period. Some matters do not have to be addressed immediately, and it will not deduce the importance of the matter when brought up later. At this junction, it will go against the parent's natural judgment to forestall the conversation; however, it will be extremely unproductive and can make matters worse.

Nonetheless, when the offense is committed, tell the teen that the conversation will take place, just not at that time.

Instead, address the issue when the emotional state both parties are level. This approach will ensure the parent and teen to be receptive. Teens might be prone to a certain extent of openness; however, the parent's words will sink through, even if the teen does not verbally express the understanding.

Troubled Youth Programs Recommend taking a Positive Conversational Approach

Utilizing a positive approach is a highly effective technique as well. When beginning a conversation with accusations and pointing out only the negative, the teen will tune out the parent. No one likes to be demoralized, even when he or she is wrong. Start the conversation with explaining that the parent will not get upset at what the teen has to say, they only want to hear what they were thinking at the time of transgression. This encourages the teen to believe that he or she is heard. What they have to say is the truth, as they know it. Keep in mind teens have not yet experienced many situations and have not learned many truths as adults have. To this end, it makes parents protective of their children's hearts and emotions. However, certain things teenagers will have to come to terms with, as well as realizations they must have for themselves at some point or another. When a parent feels as though they have failed at protecting, and a teen is disobedient, it automatically upsets the parent. As hard as it may be, hold back the bark, and empathize with the teen.

Share some level of understanding for their untrained mind and immature ways of thinking. Place oneself in that age as the teen. Share a story of the past and relay the lesson learned. Explain the reason of protectiveness. Explain the level of consequences, not as a mere punishment but as a learning lesson. Be sure to talk with the teen and not at the teen. The key is receptiveness; otherwise, there is no point in having the conversation.

Enter discussion forums with other parents struggling with teen communication, or take a look at some of the resources provided to teens and parents in some of the leading troubled youth programs.

Communicating with a teen has to be constructive, consistent, and careful. It is like walking on ice, once one falls through it takes a while for the ice to reform.

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How to Communicate with a Troubled Teen: Troubled Youth Programs Discussion - ERA is a Licensed Residential Treatment Center for Troubled Teens

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How to Communicate with a Troubled Teen: Troubled Youth Programs Discussion All troubled youth programs know that dealing with a troubled teen can often feel like a never-ending battle. Communication can be virtually non-existent or reduced to elevated arguments. Not all troubled teens are destined for an intervention from the authorities or psychiatrists.

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RCC Programme of study 2022 - 2024
RCC Standards

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true.Residential Childcare APP Prog of Study 22-24

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When you down load and print out make sure its in landscape mode

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Good introductory resource for communication use it to investigate further

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Dartmouth Trauma Interventions Research Center

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Lets you know what's going on - and may even help you  course

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LibGuides: Reflective Practice Toolkit: Models of reflection

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LibGuides: Reflective Practice Toolkit: Models of reflection

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Safeguarding supervision training

This series of six two-hour online sessions explores models of supervision and working with staff, thinking about the dynamics in safeguarding discussions in a practical but developmental way. The course aims to equip supervisors with the skills and confidence to support and challenge staff to better understand risk and the quality of work being undertaken with children and families.

"This is the best CPD I've had in ages, I'm learning so much", DSL

Ruby Parry has nearly 40 years of experience in child protection roles to Director of Children's Services & Communities level, has been an Independent Chair of Local Safeguarding Children Boards, authored numerous serious case reviews including a joint domestic homicide review, and designed and led the delivery of safeguarding training for Ofsted from 2012 to 2014. Hugely experienced, her engaging and personable approach enables leaders to develop their supervision skills in a meaningful way.
Supervisors will:

understand the principles behind supervision models

recognise and apply reflective supervision

undertake dynamic risk assessment during supervision

Create clear, focused and reviewable plans and actions

Where necessary sessions are recorded to allow you to 'catch up'. The full programme is £249+VAT (£199+VAT for Safeguarding Network members).

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This series of six two-hour online sessions explores models of supervision and working with staff, thinking about the dynamics in safeguarding discussions in a practical but developmental way. The course aims to equip supervisors with the skills and confidence to support and challenge staff to better understand risk and the quality of work being undertaken with children and families.

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There's no denying that although teaching can be an incredibly rewarding career, there are aspects of the role that can bring emotional stress.

Working as a designated safeguarding lead (DSL) can be especially testing.

We need to protect the children in our care by being vigilant about potential signs of abuse as well as managing allegations, disclosures and concerns, and taking action to advocate for children.
Quick read: Quick listen: Want to know more? How to 'poverty proof' your school Why we need more support for mental health in primary Do no harm: ethical guidelines for teacher-researchers
The pressure of the role can be overwhelming, with concerns about time constraints, (especially in relation to keeping accurate, secure records), ensuring all staff are aware of (and understand) safeguarding policies and procedures, keeping up to date with legislation, managing reprisals when discussing concerns with families, and providing adequate support to staff involved with children for whom there are safeguarding concerns.

All of these worries occupy headspace. However much you tell yourself to keep your worries at school, sleepless nights can be a common occurrence.

Sometimes it's a gut feeling that a child may be at risk - there's no disclosure or evidence of abuse but a nagging sense of unease that you've missed something.

I find the "what-if"s come thick and fast in the small hours. What if they've gone to bed hungry? Were those tears at home time because they were scared to go home?

Was that bruise on the head really from falling out of bed, or was there was more to it? They've not been in all week - what if they're staying away because they're covered in bruises?

All these scenarios lead to overthinking and overanalysing. But I'd rather consider and reflect on concerns than be blinkered and miss something.

Breaking down

When concerns around a child's welfare are raised, this will inevitably lead to difficult conversations with parents and carers. These relationships can break down, placing more stress on the DSL.

Being shouted at, called a liar and facing threats and abuse are all unfortunate repercussions from acting on concerns about a child's welfare.

But the fear of damaging relationships with parents and carers must never impact on judgement when it comes to a child's welfare. The child must come first.

DSLs face a wide variety of scenarios every day, from referrals resulting from disclosures to liaising with other professionals in order to investigate concerns. But whatever the circumstances, it is the DSL who feels the burden of responsibility.

Open discussion

So how can we manage our own wellbeing? Who safeguards us?

With an ever-increasing focus on teacher wellbeing, it's time for open, honest discussion about the impact of the emotional stress associated with this important role.

Having procedures to offload our concerns is vitally important; without a means of talking things through, the burden stays with the DSL, impacting on their mental health.

But confidentiality means that offloading at home with family or friends is not an option. This process of reflection and supervision must take place within the school or setting. But in busy schools with tight budgets, where is the time to talk?

We need to make time. A debrief procedure for all DSLs must be available after any referrals, conferences or meetings. Whether this is a quick exchange of information or a chance to unburden will depend on the seriousness of the case.

Providing this time to talk highlights that their role is recognised as being stressful and a cause of worry and that systems are in place to protect them.

If we simply accept that stress and worry are unfortunate by-products of the job, we negate its value. Let's protect those who protect our children.

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Wellbeing: who safeguards the safeguarding leads?

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There's no denying that although teaching can be an incredibly rewarding career, there are aspects of the role that can bring emotional stress. Working as a designated safeguarding lead (DSL) can be especially testing. We need to protect the children in our care by being vigilant about potential signs of abuse as well as managing allegations, disclosures and concerns, and taking action to advocate for children.

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Outcomes focused supervision and reflective practice

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Outcomes focused supervision and reflective practice

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Skip to main content

Embedding the outcomes approach

Find information and resources on how culture, systems and processes need to change to support the embedding of an outcomes approach across our organisations.

Balancing rights and responsibilities can be difficult, as professionals often see risk as something to avoid and control, instead of being part of a shared decision-making process.

In reality, taking some risks is an important part of everyday life that supports people to do what matters to them.

We commissioned some work to co-produce practice principles for balancing risks, rights and responsibilities in adult services. The principles set out how social care practitioners can take a positive and shared approach to making decisions about risk.

We'd like to know how we can help you use these principles in your practice, take a moment to answer our survey.

The work builds on a study we produced to help understand how professionals who support people can move towards shared decision making, which found that decision-making should be:

balanced - recognising the potential for benefit as well as the risk of harm, and considering the possible emotional, psychological, social and physical impact of each option

defensible - well-founded, justifiable and recorded proportionately, and not defensive or driven by the need to protect ourselves and our agencies

collaborative - with people who use services, their families and other professionals, using all available resources to achieve the outcomes that matter most to people.

You can read the full report below:

Children's services currently use several models which might be described as 'outcome focused', 'strengths based' or 'relational'. All of these models are based on similar principles:

a collaborative relationship between the practitioner and individual/family, developed through active and reflective listening, and based on empathy and a recognition of differences of power

a belief that change is possible and that ambivalence is natural

affirming strengths and building on exceptions, balanced with assessing risks

honest and open conversations with families and others about risks

working with individuals and families to identify solutions and set goals

identifying and mobilising wider networks and resources

taking a whole systems approach to families, communities and services.

Effective and regular supervision is key and should:

Other factors that were supportive of practitioners working in this way are:

developing skills and training, backed up by opportunities to shadow and co-work

maximising opportunities for earlier intervention

involving families in safety planning to build their capacity to prevent and respond effectively to crisis in the future

recognising the impact that poverty can have on families, with practitioners being sensitive to power and structural inequalities.

Watch this video to see how social worker Dawn works with a parent to develop a safety plan:

a performance system which focuses on processes, tasks and outputs, rather than on the quality of engagement and tangible outcomes for children and young people

pressure from inflexible timescales

increasing demand within a context of reduced resources

a blame culture in services, the wider system and the media which can increase defensive practice

assumption that a quantifiable threshold is possible in a complex situation

taking an over-simplistic view of risk factors

court processes increasing defensive and adversarial practice.

the legislative framework is clear that children should be involved in decision-making when they are subject to statutory processes

where children are unseen, and their voices are unheard, there is more likelihood of unsafe practices

effective involvement of children and young people allows practitioners to develop a better understanding of their needs are as early as possible

when they are involved in their plans children and young people are more likely to be empowered, they can feel they are a part of the positive changes happening in their families effectively involved children and young people report more positive experiences in child protection processes.

the opportunity to build a trusting relationship with their worker

receiving clear, accessible and timely information about processes, meetings and plans

being able to decide whether to attend meetings and supported to contribute if they do; or being involved in decision-making in other age-appropriate ways

Watch social worker Ian use the 'drama triangle' to describe how children can view formal interventions from services:

better engagement with families improves the ability of workers to get a fuller picture of the well-being of children

when parents' strengths are recognised by professionals, this can improve their morale and their motivation to change

increased likelihood of improved outcomes when parents are actively involved in developing child protection plans

a lack of effective engagement with and support for parents whose children are removed may increase the chances of them being unable to cope as a parent in the future, and having further children removed - particularly for younger parents

families' experiences and views must be seen as a resource to help improves systems and processes; we can learn from existing practice about what works well to engage parents who may have been initially hostile.

There is a relatively small body of research evidence regarding the views and experiences of parents and carers within child protection processes. When asked however, there is a consistent message of wanting to be more involved when their children are subject to statutory child protection services. Specifically, parents and carers say they value or would like:

clear, jargon-free information about the processes and time and support to digest the information at their own pace

the opportunity to build a relationship with a (ideally one) social worker, who gets to know the family, spends time with their children and acts 'like a human'

hands-on support, not just monitoring

a balanced approach with workers and their reports acknowledging parents' strengths and positive intentions, but also being frank and specific about concerns and risks

conferences which don't involve too many people or too many surprises, and which are as informal and inclusive as possible

workers who ask parents for their ideas about solutions within their own families, and also seek their feedback about how the wider system and processes might be improved

plans which set out clearly what is expected of them, focusing on outcomes and not just outputs, and are followed without 'moving the goalposts'

workers who are non-judgemental, reliable and trustworthy

workers who really listen and recognise how stressful and traumatic these processes can be for families.

Listen to a parent talk about how being worked with in an outcome focused, strength-based way supported her to make changes for herself and her children:

Listen to Keri talk about how she encouraged culture change in children's services by collaborating with families and front-line staff:

These ways of working need to be part of whole systems change if they are to be embedded. Leaders have a key role to play and should:

Listen to Maria explain how changing paperwork and processes to become outcome focused made a positive difference to families:

Practice:

what is the quality of your relationships with families?

what are the benefits and challenges of building a relationship with families?

what are the risks to you and our organisation of working more collaboratively with families?

what are you already doing that works to manage risks collaboratively with families?

do families understand our concerns, what they need to do about it and what the consequences might be? How do you know?

what role do you play in supporting collaborative work with families?

what might a successful outcome look like for families? Can you give an example and what the components were that brought this about?

what would the families you work with say has been the most useful to them to help them manage risks better?

how do you know the children you work with are safer?

Strategy:

how do you create a culture where you're able to manage risks collaboratively with families?

how does your organisation support creativity, curiosity and hold ambivalence and uncertainty in practice?

what do you notice about your organisation when things go wrong?

which of the processes are helping families most; which could be counter-productive?

do you articulate and measure 'risks' and 'outcomes' in terms of concrete differences for children and families, or in terms of 'your' processes?

how can different parts of the system, and partner agencies, best support each other to manage risks collaboratively?

what is the role of elected members in this?

what would be the trigger/motivation to change the system in your organisation?

Taking an outcomes approach requires a culture of co-production, practitioners need to build their skills, confidence and capabilities in strengths-based working. To support this cultural shift, we a whole system change to ensure all processes and policies support this was of working

This means building personal outcomes into:

support for staff

workforce planning

performance management

continuing professional development.

Supervision is a two-way process, which supports, motivates and enables professionals to develop good practice. Supervision provides regular contact between a supervisor and a worker, where space is given for reflection and learning.

Good two-way discussion is at the heart of the supervision experience, modelling the outcomes approach which is strengths based and outcomes focused. The supervisor's practice framework will influence the nature of the discussion which, in turn, shapes the process of review, reflection, evaluation and outcome setting.

In the same way that we should be building relationships with families where power 'with' rather than power 'over' is established, an environment where both supervisor and supervisee can contribute their expertise to the relationship should be developed.

This way of working supports supervisees to find solutions within themselves based on their existing strengths and prior positive experiences.

Outcomes focused supervision can be structured using the following discussion framework:

Watch these videos to see how using outcomes focused supervision supports the worker to reflect on her work.

You'll see in the first video about the 'traditional' supervision session that it's not outcome focused. It gives less space for reflection.

Now watch the video below about using an outcomes approach in a supervision session. Compare the two videos and see how the second focuses on personal outcomes, priority risks and good enough outcomes.

The following resource can be used to support supervision:

Group reflection should also be used to support an outcomes approach, this is different to supervision. Group reflection brings teams together to discuss case work, share practice and support decision making.

Group reflection can be done as part of a regular team meeting or can be structured to support regular team development and provides an excellent learning opportunity to develop confidence and capabilities in outcomes focused practice.

During reflection a member of the team will talk about one of their cases for 10-15 minutes and the rest of the team will listen without interruption. When talking through the details they will share details following details about the person and/or the family they're been working with:

The team can then ask clarification questions and constructively challenge to ensure that an individual's network, community services and lastly commissioned options have been fully explored. The discussion can support decision making and should be recorded in a way that shows the reflective and decision-making stages. When group reflection is strengths based it can increase motivation, creativity and confidence of practitioners and their managers.

This resource shows how to facilitate an outcome focused reflective group session:

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Skip to main content Embedding the outcomes approach Find information and resources on how culture, systems and processes need to change to support the embedding of an outcomes approach across our organisations. Balancing rights and responsibilities can be difficult, as professionals often see risk as something to avoid and control, instead of being part of a shared decision-making process.

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LibGuides: Reflective Practice Toolkit: Models of reflection

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LibGuides: Reflective Practice Toolkit: Models of reflection

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Skip to main content

An introduction to safeguarding children living in residential care

Find out more about safeguarding the children you're caring for

Safeguarding children is about recognising the possible dangers they may face and protecting them from abuse and neglect. It's also about helping them to recognise the dangers around them.

Safeguarding is everyone's responsibility at any time. However, as a professional in social care you have a duty to do everything you can to ensure children are protected from abuse and are safe. You also have a duty to report any safeguarding issues (about children or adults).

Your organisation is required to have a safeguarding policy to address any concerns you have about a child's welfare. It's important that you understand the safeguarding policy and this should be an important part of your induction and ongoing training to ensure you understand the process of safeguarding and to how to report any concerns you have.

For example, a young person may say they will tell you something if you promise not to tell. You can never agree to this, and the children that you look after need to know and understand this.

If you don't report a concern you have about a child, this can lead to:

a child being caused harm or in being danger of abuse that you could possibly have prevented

disciplinary action from your employer

a fitness to practice investigation by Social Care Wales for breaking the Code of Professional Practice.

All the people (children and adults) you work with should understand this limit to confidentiality. You should discuss this with your senior on duty, the child's social worker or the police depending on the nature of your concern. You should never ignore it.

Before the children you look after came into care, they will have usually experienced some form of trauma or abuse.

When working with children, abuse is commonly broken up into four types (under definitions of The Children Act 1989)

Physical abuse is deliberately hurting a child causing injuries such as bruises, broken bones, burns or cuts. It isn't accidental - children who are physically abused are subjected to violence such as being hit, kicked, poisoned, burned, slapped or having objects thrown at them.

Sometimes parents or carers will deliberately cause illness in a child or lie about its symptoms. This is called fabricated or induced illness by proxy (previously known as 'Munchausen's by proxy'). You should be aware of this as something to consider if a young person is ill after coming home from a family visit.

Female Genital Mutilation (FGM) is a type of physical abuse where girls have their genitals cut. This abuse can lead to girls and women having gynecological problems as they develop. You may see the following signs of FGM in children and young people that you care for:

difficulties urinating or incontinence

frequent or chronic vaginal, pelvic or urinary infections

menstrual problems

kidney damage and possible failure

cysts and abscesses

pain when having sex

infertility

complications during pregnancy and childbirth

emotional and mental health problems.

Female genital mutilation: signs, indicators and effects The All Wales Protocol on Female Genital Mutilation

Emotional abuse is the ongoing emotional maltreatment of a child. It's sometimes called psychological abuse and can seriously damage a child's emotional health and development. Children who are emotionally abused are often suffering another type of abuse.

Emotional abuse includes deliberate behaviour to a child, such as:

scaring them

humiliating them

isolating them

ignoring them

witnessing domestic abuse.

Sexual abuse is when a child is forced or persuaded to take part in sexual activities. This doesn't have to be physical contact and it can happen online. Sometimes the child won't understand that what's happening to them is abuse or even understand that it's wrong. They may be afraid to speak out. The NSPCC estimates that 1 in 20 children in the UK have been a victim of sexual abuse.

Contact abuse involves touching, where an abuser makes physical contact with a child, including penetration. This includes:

sexual touching of any part of the body, whether the child is wearing clothes or not

rape or penetration by putting an object or body part inside a child's mouth, vagina or anus

forcing or encouraging a child to take part in sexual activity

making a child take their clothes off, touch someone else's genitals or masturbate.

Non-contact abuse involves non-touching, such as grooming, exploitation, persuading children to perform sexual acts over the internet and flashing. It includes:

encouraging a child to watch or hear sexual acts

not taking proper measures to prevent a child being exposed to sexual activities by others

meeting a child following sexual grooming with the intent of abusing them

online abuse including making, viewing or distributing child abuse images

allowing someone else to make, view or distribute child abuse images

showing pornography to a child

sexually exploiting a child for money, power or status (child sexual exploitation).

Neglect: when a caregiver does not meet the child's basic needs. Neglect can mean:

physical neglect: Failing to provide for a child's basic needs such as food, clothing or shelter. Failing to adequately supervise a child or provide for their safety

educational neglect: Failing to ensure a child receives an education

emotional neglect: Failing to meet a child's needs for nurture and stimulation, perhaps by ignoring, humiliating, intimidating or isolating them. This is often the most difficult form of neglect to prove

medical neglect: Failing to provide appropriate health care, including dental care and refusal of care or ignoring medical recommendations.

If the children you're working with have experienced abuse, and their abuser has been found guilty of a crime, they may be entitled to Criminal Injuries Compensation. If you think that one of the children you look after may be eligible, speak to your manager or the child's social worker.

In addition to the abuse discussed above, children can sometimes experience other types of abuse you should be aware of, including:

Teenagers can be at risk of domestic abuse, particularly where they have witnessed it as children and do not recognise healthy relationships.
Violence in young people's relationships - Reflections on two serious case reviews
People of any gender and sexuality can be victims of domestic abuse. The young people you work with may not realise that they're being abused and may confuse some of the signs of abuse with love. For example, a young person may experience:

control

coercion

be isolated from their friends and family

not able to wear make-up

be forced to wear certain clothes.

But they may think these behaviours mean their boyfriend or girlfriend is showing them love.

This may also be the case if they're being stalked or being stopped from going out alone: the intensity of the relationship may feel nice for a while.

If they're experiencing physical abuse, they may have bruises that they can't explain, They may not realise that violence in relationships is wrong, for example saying, "it was just a slap." Teenagers in abusive relationships face the same risks as adults, so you need to manage these risks carefully.

SafeLives has produced a useful resource Working with young people who experiencing relationship abuse

STIRitAPP is a web-based tool about abusive relationships which has been developed by young people themselves.

You may also encounter honour-based violence: a form of domestic abuse where people are at risk of harm, as they are seen to have damaged their family's 'honour' by behaving in ways that don't fit with the family's culture or beliefs. It may be that a young person has been in a relationship with someone their family doesn't approve of, or they've behaved in a way the family considers inappropriate. To keep the family's 'honour', that person may then be subject to abuse or harm.

The Welsh Government's website Live Fear Free has advice about honour based violence and forced marriage

Children can be trafficked in many different ways. Some children may have been brought into the UK specifically to be exploited. However, children can be trafficked from one town or street to the next, or across county borders as well, and this type of trafficking is often linked to other types of abuse, usually CSE or criminal exploitation.

Signs to look out for in children include:

going missing for days, and not saying where they are going or have been

not answering their phone when they are missing

asking to be picked up from places where they have no connection (for example, if their family and friends are in one place in the county or town but they are asking to be picked up from the other side of the county or town)

wearing inappropriate clothing or no shoes when they're collected. This may mean they've escaped from somewhere

unusual behaviour or substance misuse

becoming withdrawn

losing weight

neglecting their personal hygiene or appearance.

There is a difference in the way that children who run away are reported to the Police:

'Missing' - means that nobody knows where they child or young person is and they are thought to be at risk. This can involve children being gone overnight.

'Absent without authority' - means that you know where they are and they won't come home. This can involve children staying out past curfew.

When you report their absence to the police it is helpful to be clear about the difference, and follow the child's care plan and what that says about how to deal with this.

Some children are abused online. This may take the form of non-contact sexual abuse as discussed above but may also be online bullying or grooming with the aim of involving children in some of the other types of abuse discussed here ( CSE, radicalisation and others).

Signs to look out for include children:

becoming withdrawn

being reluctant to go to school

not wanting to go out

avoiding familiar places and people

self-harm or suicide attempts

meeting people they are not normally with

unusual use of substances

having more than one or different phones

being secretive about their online activities.

The NSPCC has a useful resource called Online abuse - what is online abuse

Some children are targeted by groups that hold extreme views. In the same way that the children you look after are vulnerable to being groomed for CSE or criminal exploitation, they may also seek a feeling of 'belonging' and these groups will take advantage of this.

Radicalisation may be extreme religious views, far right views (for instance, racism) or far left (for instance, promoting violent social unrest) and is not restricted to particular religions or ethnicities. If you suspect anyone is being radicalised for the purpose of terrorism you have to report it.

Signs to look out for are similar to the online/cyber abuse above but also include:

spending increasing time online and not telling you what they are doing

change in behaviour and/or appearance

expressing racist or extreme views.

Financial abuse can take many forms, and again may cross over into the types of abuse described above. This can include the child's benefits or allowances that the home is being paid not being used properly, or wages or pocket money being taken from them. Children can also be used to falsely claim benefits or be forced to beg or commit crime for money. As example of this is where children are being forced to steal to order from shops to make money.

Signs to look out for include:

a child not having basic essentials such as sanitary products and appropriate clothing, or being asked to pay for them out of their own money

children not having the right amount of money that you know they should have (for instance pocket money)

children stealing items that don't seem to be for them.

Read more about financial abuse

If you have any concerns about the children you look after experiencing abuse, you must speak to someone. If somebody tells you about abuse, you cannot keep it a secret. Remember that a child may experience a range of abuse and will not always fit into the neat categories above.

Keep your eyes and ears open for any signs or changes in their behaviour and always discuss any worries you have with your manager, the child's social worker or police, according to your organisation's safeguarding policy. Some incidents are 'notifiable incidents' and you must report them to Care Inspectorate Wales. There is more information about this duty in Part 15 of the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017.

Sadly, there are occasions where the children who are looked after, are not kept safe in their children's homes. This is where children are not cared for properly and poor or unsafe practice is systematic in the home and/or organisation.

This may happen because staff don't understand the responsibilities of how to provide care or it may be that workers set out deliberately to cause harm to children. It may be one worker, or a group of workers, and a culture of poor care and/or abuse can develop in homes. For example, you may see 'restraint' being used incorrectly or too often to exercise power over children.

There are many known occasions where children have been systematically abused by a number of individuals in children's homes. This is always about the misuse of power and it can be very hard to speak out if you see or hear anything worrying, particularly if you feel you're the only person with concerns. If you can, speak to your manager or a senior colleague or someone you're not worried about. No matter how hard it is to speak up, you must not do nothing. Your organisation has a 'whistle blowing' policy and as you're registered with Social Care Wales, you have a responsibility to report any concerns you have.

Help us to improve the Residential child care worker resource by telling us what you think about it in our short four question survey.

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An introduction to safeguarding children living in residential care

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Skip to main content An introduction to safeguarding children living in residential care Find out more about safeguarding the children you're caring for Safeguarding children is about recognising the possible dangers they may face and protecting them from abuse and neglect. It's also about helping them to recognise the dangers around them.

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Skip to main content

An introduction to safeguarding children living in residential care

Find out more about safeguarding the children you're caring for

Safeguarding children is about recognising the possible dangers they may face and protecting them from abuse and neglect. It's also about helping them to recognise the dangers around them.

Safeguarding is everyone's responsibility at any time. However, as a professional in social care you have a duty to do everything you can to ensure children are protected from abuse and are safe. You also have a duty to report any safeguarding issues (about children or adults).

Your organisation is required to have a safeguarding policy to address any concerns you have about a child's welfare. It's important that you understand the safeguarding policy and this should be an important part of your induction and ongoing training to ensure you understand the process of safeguarding and to how to report any concerns you have.

For example, a young person may say they will tell you something if you promise not to tell. You can never agree to this, and the children that you look after need to know and understand this.

If you don't report a concern you have about a child, this can lead to:

a child being caused harm or in being danger of abuse that you could possibly have prevented

disciplinary action from your employer

a fitness to practice investigation by Social Care Wales for breaking the Code of Professional Practice.

All the people (children and adults) you work with should understand this limit to confidentiality. You should discuss this with your senior on duty, the child's social worker or the police depending on the nature of your concern. You should never ignore it.

Before the children you look after came into care, they will have usually experienced some form of trauma or abuse.

When working with children, abuse is commonly broken up into four types (under definitions of The Children Act 1989)

Physical abuse is deliberately hurting a child causing injuries such as bruises, broken bones, burns or cuts. It isn't accidental - children who are physically abused are subjected to violence such as being hit, kicked, poisoned, burned, slapped or having objects thrown at them.

Sometimes parents or carers will deliberately cause illness in a child or lie about its symptoms. This is called fabricated or induced illness by proxy (previously known as 'Munchausen's by proxy'). You should be aware of this as something to consider if a young person is ill after coming home from a family visit.

Female Genital Mutilation (FGM) is a type of physical abuse where girls have their genitals cut. This abuse can lead to girls and women having gynecological problems as they develop. You may see the following signs of FGM in children and young people that you care for:

difficulties urinating or incontinence

frequent or chronic vaginal, pelvic or urinary infections

menstrual problems

kidney damage and possible failure

cysts and abscesses

pain when having sex

infertility

complications during pregnancy and childbirth

emotional and mental health problems.

Female genital mutilation: signs, indicators and effects The All Wales Protocol on Female Genital Mutilation

Emotional abuse is the ongoing emotional maltreatment of a child. It's sometimes called psychological abuse and can seriously damage a child's emotional health and development. Children who are emotionally abused are often suffering another type of abuse.

Emotional abuse includes deliberate behaviour to a child, such as:

scaring them

humiliating them

isolating them

ignoring them

witnessing domestic abuse.

Sexual abuse is when a child is forced or persuaded to take part in sexual activities. This doesn't have to be physical contact and it can happen online. Sometimes the child won't understand that what's happening to them is abuse or even understand that it's wrong. They may be afraid to speak out. The NSPCC estimates that 1 in 20 children in the UK have been a victim of sexual abuse.

Contact abuse involves touching, where an abuser makes physical contact with a child, including penetration. This includes:

sexual touching of any part of the body, whether the child is wearing clothes or not

rape or penetration by putting an object or body part inside a child's mouth, vagina or anus

forcing or encouraging a child to take part in sexual activity

making a child take their clothes off, touch someone else's genitals or masturbate.

Non-contact abuse involves non-touching, such as grooming, exploitation, persuading children to perform sexual acts over the internet and flashing. It includes:

encouraging a child to watch or hear sexual acts

not taking proper measures to prevent a child being exposed to sexual activities by others

meeting a child following sexual grooming with the intent of abusing them

online abuse including making, viewing or distributing child abuse images

allowing someone else to make, view or distribute child abuse images

showing pornography to a child

sexually exploiting a child for money, power or status (child sexual exploitation).

Neglect: when a caregiver does not meet the child's basic needs. Neglect can mean:

physical neglect: Failing to provide for a child's basic needs such as food, clothing or shelter. Failing to adequately supervise a child or provide for their safety

educational neglect: Failing to ensure a child receives an education

emotional neglect: Failing to meet a child's needs for nurture and stimulation, perhaps by ignoring, humiliating, intimidating or isolating them. This is often the most difficult form of neglect to prove

medical neglect: Failing to provide appropriate health care, including dental care and refusal of care or ignoring medical recommendations.

If the children you're working with have experienced abuse, and their abuser has been found guilty of a crime, they may be entitled to Criminal Injuries Compensation. If you think that one of the children you look after may be eligible, speak to your manager or the child's social worker.

In addition to the abuse discussed above, children can sometimes experience other types of abuse you should be aware of, including:

Teenagers can be at risk of domestic abuse, particularly where they have witnessed it as children and do not recognise healthy relationships.
Violence in young people's relationships - Reflections on two serious case reviews
People of any gender and sexuality can be victims of domestic abuse. The young people you work with may not realise that they're being abused and may confuse some of the signs of abuse with love. For example, a young person may experience:

control

coercion

be isolated from their friends and family

not able to wear make-up

be forced to wear certain clothes.

But they may think these behaviours mean their boyfriend or girlfriend is showing them love.

This may also be the case if they're being stalked or being stopped from going out alone: the intensity of the relationship may feel nice for a while.

If they're experiencing physical abuse, they may have bruises that they can't explain, They may not realise that violence in relationships is wrong, for example saying, "it was just a slap." Teenagers in abusive relationships face the same risks as adults, so you need to manage these risks carefully.

SafeLives has produced a useful resource Working with young people who experiencing relationship abuse

STIRitAPP is a web-based tool about abusive relationships which has been developed by young people themselves.

You may also encounter honour-based violence: a form of domestic abuse where people are at risk of harm, as they are seen to have damaged their family's 'honour' by behaving in ways that don't fit with the family's culture or beliefs. It may be that a young person has been in a relationship with someone their family doesn't approve of, or they've behaved in a way the family considers inappropriate. To keep the family's 'honour', that person may then be subject to abuse or harm.

The Welsh Government's website Live Fear Free has advice about honour based violence and forced marriage

Children can be trafficked in many different ways. Some children may have been brought into the UK specifically to be exploited. However, children can be trafficked from one town or street to the next, or across county borders as well, and this type of trafficking is often linked to other types of abuse, usually CSE or criminal exploitation.

Signs to look out for in children include:

going missing for days, and not saying where they are going or have been

not answering their phone when they are missing

asking to be picked up from places where they have no connection (for example, if their family and friends are in one place in the county or town but they are asking to be picked up from the other side of the county or town)

wearing inappropriate clothing or no shoes when they're collected. This may mean they've escaped from somewhere

unusual behaviour or substance misuse

becoming withdrawn

losing weight

neglecting their personal hygiene or appearance.

There is a difference in the way that children who run away are reported to the Police:

'Missing' - means that nobody knows where they child or young person is and they are thought to be at risk. This can involve children being gone overnight.

'Absent without authority' - means that you know where they are and they won't come home. This can involve children staying out past curfew.

When you report their absence to the police it is helpful to be clear about the difference, and follow the child's care plan and what that says about how to deal with this.

Some children are abused online. This may take the form of non-contact sexual abuse as discussed above but may also be online bullying or grooming with the aim of involving children in some of the other types of abuse discussed here ( CSE, radicalisation and others).

Signs to look out for include children:

becoming withdrawn

being reluctant to go to school

not wanting to go out

avoiding familiar places and people

self-harm or suicide attempts

meeting people they are not normally with

unusual use of substances

having more than one or different phones

being secretive about their online activities.

The NSPCC has a useful resource called Online abuse - what is online abuse

Some children are targeted by groups that hold extreme views. In the same way that the children you look after are vulnerable to being groomed for CSE or criminal exploitation, they may also seek a feeling of 'belonging' and these groups will take advantage of this.

Radicalisation may be extreme religious views, far right views (for instance, racism) or far left (for instance, promoting violent social unrest) and is not restricted to particular religions or ethnicities. If you suspect anyone is being radicalised for the purpose of terrorism you have to report it.

Signs to look out for are similar to the online/cyber abuse above but also include:

spending increasing time online and not telling you what they are doing

change in behaviour and/or appearance

expressing racist or extreme views.

Financial abuse can take many forms, and again may cross over into the types of abuse described above. This can include the child's benefits or allowances that the home is being paid not being used properly, or wages or pocket money being taken from them. Children can also be used to falsely claim benefits or be forced to beg or commit crime for money. As example of this is where children are being forced to steal to order from shops to make money.

Signs to look out for include:

a child not having basic essentials such as sanitary products and appropriate clothing, or being asked to pay for them out of their own money

children not having the right amount of money that you know they should have (for instance pocket money)

children stealing items that don't seem to be for them.

Read more about financial abuse

If you have any concerns about the children you look after experiencing abuse, you must speak to someone. If somebody tells you about abuse, you cannot keep it a secret. Remember that a child may experience a range of abuse and will not always fit into the neat categories above.

Keep your eyes and ears open for any signs or changes in their behaviour and always discuss any worries you have with your manager, the child's social worker or police, according to your organisation's safeguarding policy. Some incidents are 'notifiable incidents' and you must report them to Care Inspectorate Wales. There is more information about this duty in Part 15 of the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017.

Sadly, there are occasions where the children who are looked after, are not kept safe in their children's homes. This is where children are not cared for properly and poor or unsafe practice is systematic in the home and/or organisation.

This may happen because staff don't understand the responsibilities of how to provide care or it may be that workers set out deliberately to cause harm to children. It may be one worker, or a group of workers, and a culture of poor care and/or abuse can develop in homes. For example, you may see 'restraint' being used incorrectly or too often to exercise power over children.

There are many known occasions where children have been systematically abused by a number of individuals in children's homes. This is always about the misuse of power and it can be very hard to speak out if you see or hear anything worrying, particularly if you feel you're the only person with concerns. If you can, speak to your manager or a senior colleague or someone you're not worried about. No matter how hard it is to speak up, you must not do nothing. Your organisation has a 'whistle blowing' policy and as you're registered with Social Care Wales, you have a responsibility to report any concerns you have.

Help us to improve the Residential child care worker resource by telling us what you think about it in our short four question survey.

# data[].attributes.attachment_link.title
An introduction to safeguarding children living in residential care

# data[].attributes.attachment_link.description
Skip to main content An introduction to safeguarding children living in residential care Find out more about safeguarding the children you're caring for Safeguarding children is about recognising the possible dangers they may face and protecting them from abuse and neglect. It's also about helping them to recognise the dangers around them.

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What is child abuse and neglect?

Child abuse

Anything that someone does to cause harm to a child or young person.

It can include:

Physical abuse

Sexual abuse

forcing you to have sex

touching you or making you touch them.

This type of abuse can also happen online and includes making you watch pornography or forcing you to send intimate pictures.

Emotional abuse

making you feel scared, worthless or unloved

ignoring you

controlling who you spend time with or where you go

constantly checking where you are or who you are with.

Neglect

The ongoing failure to care properly for a child, for example not providing enough food, clothes or a safe place to live, or not getting medical care for you when you need it.

It is also about a lack of love, care or attention.

What does the guideline say?

The guideline helps people who work with young people understand how best to support you if you have been abused or neglected. This could be talking about what has happened or taking action to help you feel safe.

People working with children and young people should:

Involve you in decisions about your life - your opinion should be
taken into account.

Tell you how to contact them, including out of hours, and check how you want them to contact you.

Find the right way to communicate - it's ok to ask if you don't understand something.

Work with other organisations to make sure you don't need to keep re-telling your story to different professionals.

Explain about confidentiality - when they may have to share information, what they will share and who with.

Write down, in your words, what you have talked about and get you to sign it - if you disagree with what they say, this should be written down too.

Ask permission if they need to touch you (for example, to examine you) and explain what they are going to do.

Help your parents and carers.

Give you a choice of different therapies and support.

Share any reports and plans with you.

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Anything that someone does to cause harm to a child or young person. It can include: Physical abuse Sexual abuse forcing you to have sex touching you or making you touch them. This type of abuse can also happen online and includes making you watch pornography or forcing you to send intimate pictures.

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Social Care Institute for Excellence (SCIE)

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By Corinne May-Chahal and Hannah Roscoe

A new quick guide for practitioners and managers who work with children, young people and families

It is hard to imagine a more traumatic experience than being abused or neglected, possibly by someone you know and trust. But this is the experience of 58,000 children substantiated as victims by UK authorities each year, with potentially many more who are not known to the authorities.

Once a child or young person is out of immediate danger of harm, for example on a child protection plan or care order, there is a tendency to think that they are 'safe now'. But that is not the end of the story. In order to prevent further harm, such as mental distress, children must get help and support to recover from their experience. The emphasis in our child protections system is too often on 'rescue' and much less on the medium and longer-term interventions that children need.

'Therapeutic interventions after abuse and neglect', the new quick guide from NICE (National Institute for Health and Care Excellence) and SCIE, is based on the recommendations of the NICE guideline on child abuse and neglect. The guide reflects the long-lasting impact that maltreatment can have on the health and wellbeing of children. The guide, which is for practitioners and managers working with children, young people and families, looks at what works when supporting abused and neglected children and young people.

This is important. One young person from our guideline reference group told us: 'Things were hard at home for a long time. I remember being scared all the time, and then I just kind of started to feel numb to everything. I skipped school, hung around with mates who were a bit older than me, anything to avoid being at home'.

Others talked about how abuse and neglect had affected them - 'being afraid', 'hurting yourself', 'feeling very angry' or 'crying a lot'. For some, abuse and neglect can lead to further abuse, for example, through exploitation; difficulties at school, or even involvement in the criminal justice system.

A key message is the importance of choice and involving children and families in discussions about what interventions you think will help, and why. Young people told us that not all types of help worked for them - so it is important to have different options and choices if possible.

The guide sets out the interventions which our review of the evidence found to be effective. For young children, interventions that help to rebuild attachments with caregivers have been shown to be helpful. For older children effective interventions involved addressing trauma, managing behaviour and crisis support. The guide also recommends specific interventions for addressing difficulties following sexual abuse.

A separate quick guide for children and young people highlights some key principles, such as keeping children involved in decision making and being clear about information sharing, as well as giving young people advice about where to find help and support.

As one young person said: 'Abuse can make you feel helpless and as though you are totally under the control of another person. It's really important that any help or support doesn't take even more control away from you, but empowers you and helps you to make choices as well as helping other people to understand what you have been through'.

We hope that managers and practitioners will use these guides to continue to support and empower children and young people affected by abuse and neglect.

Corinne May-Chahal is Professor of Applied Social Science at Lancaster University and chaired NICE's guideline committee on Child abuse and neglect. Hannah Roscoe is Senior Research Analyst at SCIE.

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Supporting children and young people after abuse and neglect

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By Corinne May-Chahal and Hannah Roscoe It is hard to imagine a more traumatic experience than being abused or neglected, possibly by someone you know and trust. But this is the experience of 58,000 children substantiated as victims by UK authorities each year, with potentially many more who are not known to the authorities.

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3.3/3.4 why they need support and strategies for supporting children after abuse

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3.3/3.4 why they need support and strategies for supporting children after abuse

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ANIMATION SHARES HOPE ON WORLD SUICIDE PREVENTION DAY

This World Suicide Prevention Day, PAPYRUS has launched Sinking Feeling - our brand new animation created in collaboration with the BAFTA Award-winning animation studio, Blue Zoo.

Sinking Feeling tackles the heart-breaking reality that many children and young people are suffering in silence without the vital help and support they need, according to PAPYRUS Prevention of Young Suicide.

We hope this animation will encourage more people to spot the signs and reach-in to guide young people away from thoughts of suicide.

The animation signposts to PAPYRUS and its HOPELINEUK service which offers confidential help and support to young people and anyone who is concerned for a young person who may be thinking of taking their own life.

Ged Flynn, Chief Executive of PAPYRUS, said: "This remarkable animation captures the overwhelming struggle of a young person who is literally sinking below the surface, weighed down, unable to function normally, incapable of keeping up and close to giving up on life.

"Sadly, in real life that's exactly what many young people are experiencing right now. They feel sad, isolated, worthless, bewildered, in emotional turmoil with seemingly no way out.

"The film challenges me to reach-in when a young person might be distressed, ask how they are, to really hear them, to offer help and to assist life itself."

The collaboration between PAPYRUS and Blue Zoo Animation Studio is timely as this year's theme for World Suicide Prevention Day is 'Creating Hope Through Action.'

With the challenges that 2020 brought, now more than ever Blue Zoo have worked to use their talent and platform to help others so they reached out to PAPYRUS to lend their support.

More than 60 artists volunteered to help on the animation project which took four months to complete. The Blue Zoo choir remotely recorded an emotive rendition of 'True Colours' to accompany the film.

Director, Mark Spokes, said, "Working with PAPYRUS and Blue Zoo on Sinking Feeling was an uplifting and enriching experience, especially in the midst of lockdown. The film's message is one that is close to my heart and I'm proud to be part of something that could save lives."

Tom Box, Co-founder of Blue Zoo said, "As a studio it is our ambition to use animation to make a positive impact on the world. We couldn't be prouder of how the team came together to produce a film that does that so beautifully."

For practical, confidential suicide prevention help and advice please contact PAPYRUS HOPELINEUK on 0800 068 4141, text 07860 039967 or email pat@papyrus-uk.org

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Sinking Feeling Animation Launch - Papyrus UK | Suicide Prevention Charity

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ANIMATION SHARES HOPE ON WORLD SUICIDE PREVENTION DAY This World Suicide Prevention Day, PAPYRUS has launched Sinking Feeling - our brand new animation created in collaboration with the BAFTA Award-winning animation studio, Blue Zoo. Sinking Feeling tackles the heart-breaking reality that many children and young people are suffering in silence without the vital help and support they need, according to PAPYRUS Prevention of Young Suicide.