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Adverse Childhood Experiences (ACEs) (Wales) 2017

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Extending position of trust provisions to capture those that lead activities in sporting and religious settings.

1. What are we going to do?

We are extending the "position of trust" offences within ss 16 - 19 of the Sexual Offences Act 2003 to include situations where certain activities take place in a sport or religion.

The "position of trust" offences are intended to target situations where the child has some dependency on the adult involved, often combined with an element of vulnerability of the child. Existing positions of trust are directed at those who are employed to look after children under the age of 18, for example those providing care for a child in a residential care home, hospital or educational institution.

Concerns had been voiced in Parliament and society more widely that the current positions of trust were too narrow, and that an extension to them was required to protect a wider range of relationships where adults held a position of influence or power over 16 and 17 year olds.

The further positions of trust were drafted following a Ministry of Justice (MoJ) review which engaged with stakeholders across the youth and criminal justice sectors, including the police, the Crown Prosecution Service (CPS), sports bodies, victims' groups, and religious organisations.

Together with the further positions of trust that have been drafted we are intending to include provisions in the Act to allow additional positions of trust to be added via secondary legislation should that prove necessary.

2. How are we going to do it?

We are creating a new s22A of the Sexual Offences Act 2003, rather than simply adding roles to the existing positions of trust contained in s21. This is because the current positions are defined either by reference to statutory settings or services so far as the adult's (A's) relationship to the young person (B) is concerned. Non-statutory settings represent a departure from the current legislation and require a different approach.

The new further positions of trust are defined by reference to the activity which A is carrying out in relation to B, namely, coaching, teaching, training, supervising or instructing in a sport or a religion, as defined. Both elements would need to be met.

Furthermore, it is a requirement that A carries out the activity "on a regular basis", to avoid an approach that is too broad and capture someone who only helps with a coaching session, say, on one occasion or infrequently.

Also, a knowledge requirement must also be met, so that A is aware that they carry out a certain activity on a regular basis in relation to B. This is to prevent the positions of trust being drawn too broadly and strengthen the requirement for a prior connection/contact between A and B. This is intended to ensure that if, for example, A preaches regularly to a congregation of 2000 people and has had never met B, so does not even know that B is a member of that congregation, A will not be considered to be in a position of trust over B.

Sport is defined using games in which physical skill is the predominant factor and those which are engaged in for the purpose of competition or display.

Religion is defined to capture those involved in a religion that holds a belief in one or more gods, and those involved in a religion that do not hold a belief in a god.

3. Background

Several examples of abuse in a sport and a religion have come to light in recent times, most prominently the widespread child sexual abuse in football that was revealed in 2016, including by former coach Barry Bennell.

Allegations of sexual abuse across a variety of religious and faith settings prompted an investigation by the Independent Inquiry into Child Sexual Abuse (IICSA).

There has been a call for change across Parliament and wider society, including the 'Close the Loophole campaign' run by the National Society for the Prevention of Cruelty to Children (NSPCC), and the All-Party Parliamentary Group on Safeguarding in Faith Settings report published in 2020, which called for a change in the existing legislation to protect young people.

In Spring 2019 the MoJ conducted a review of the law in this area, speaking to 45 stakeholders, including charities, sports bodies, religious organisations, victims' groups, the police, and the CPS. This review found strong evidence for extending the law to cover situations involving activities taking place in a sport or in a religion.

4. Frequently asked/useful questions

4.1 Q: Why were the existing positions of trust offences created?

The existing positions of trust offences were not intended to cover all scenarios or situations in which a person might have contact with, or a supervisory role over, those aged under 18. They were intended to target those where the young person has some element of dependency on the adult involved, often combined with an element of vulnerability of the young person: for example, those caring for a young person in a residential care home, hospital or educational institution.

4.2 Q: Did you consider simply expanding the "positions of trust" offences to cover any adult involved in caring for, training, supervising or being in sole charge of a child?

We looked at a range of options including such a broad reform. This is an incredibly complex area. Whilst tempting to expand the definitions in such a broad manner, it was important to note that as the definition widens so does the erosion of the legal right of those over the age of 16 to consent to sexual activity.

4.3 Q: Why only those individuals who coach, teach, train, supervise or instruct in a sport or a religion? Did you consider expanding the further "positions of trust" to cover other specific situations?

Those who carry out certain activities in a sport or religion are particularly influential over a child's development. For example, sports coaches have unique opportunities for physical contact, and can hold major influence over a young person's career and future development. Similarly, those who carry out certain activities in a religion often have significant influence over a young person's spiritual and religious development, often against a background of emotional vulnerability or immaturity. Both situations also have very high levels of trust, influence, power and authority and (particularly in the case of those involved in a religion) these figures are well established, trusted and respected in the community.

4.4 Q. In moving away from existing defined statutory positions does it mean that the age of consent is effectively increased, thereby leading to the potential criminalisation of innocent relationships?

These further positions of trust have been drafted to strike the sensitive balance between the protection of young people and the need to ensure that we do not infringe upon the sexual rights and freedoms of those over the age of 16 granted to them by Parliament. We are very aware of the risk of inadvertently criminalising ordinary relationships. Achieving the right balance is therefore the key challenge in developing these additional measures.

4.5 Q: What are you doing to address wider concerns expressed during the review of the law?

Whilst we did not feel it was appropriate to extend positions of trust to capture all of those who come into contact with 16/17 years olds in every role, the provision will allow additional positions of trust to be added via secondary legislation should it prove necessary to do so. Some concerns expressed during our review, and in correspondence, relate to young people aged under 16.

It is important to remember that our laws on sexual activity with under-16s are robust and clear. It is a crime for anyone to engage in sexual activity with someone under the age of 16, whether or not they consent to that activity. Non-consensual sexual activity, whatever the age of the victim, is also illegal.

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Positions of trust: Police, Crime, Sentencing and Courts Act 2022 factsheet

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Extending position of trust provisions to capture those that lead activities in sporting and religious settings. We are extending the "position of trust" offences within ss 16 - 19 of the Sexual Offences Act 2003 to include situations where certain activities take place in a sport or religion.

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https://www.youtube.com/watch?v=xYBUY1kZpf8

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Childhood Trauma and the Brain | UK Trauma Council

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Responding to a Child's Disclosure of Abuse | NSPCC Learning

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Introduction

This is a 10 step guide on data protection considerations when sharing personal information for child safeguarding purposes. It aims to help you feel confident about sharing information when you need to safeguard a child or young person at risk of harm.

It does not tell you how to safeguard children and young people, but it does give you practical advice on data protection as part of the safeguarding process. The ICO's role is as the regulator of information rights, not of safeguarding practices.

Data protection law allows you to share information when required to identify children at risk of harm and to safeguard them from harm. Data protection law doesn't prevent you from doing this. It simply helps you to share information in a fair, proportionate and lawful way.

It can be more harmful not to share information that is needed to protect a child or young person.

Appropriate information sharing is central to effectively safeguarding children from harm and promoting their wellbeing. There have been many reviews of cases where children have died or been seriously harmed through abuse or neglect. The case reviews frequently identify gaps in information sharing as a factor contributing to failures to protect the children involved.

Data protection law has an enabling role, supporting you to share information.

Who is this guidance for?

This guide is aimed at people who are involved in safeguarding children: at all levels, and in all sectors in the UK.

Safeguarding children is everyone's responsibility - not just practitioners in child safeguarding.

The NSPCC emphasises:

"If you have any concerns at all about a child's safety or wellbeing, don't hesitate to contact [the NSPCC]".

There is no single definition of safeguarding. Sharing information to safeguard children includes:

preventing harm;

promoting the welfare of a child; and

identifying risk in order to prevent harm (especially helpful where the risk may not be obvious to a single person or organisation).

A number of organisations have their own definitions and advice on safeguarding (see the Annexe for definition examples).

In this guide, the 'safeguarding of children' and references to children include children and young people up to the age of 18.

The information in this guide is important for people in a wide range of roles and organisations, such as:

senior leaders in organisations (they might not work directly with children on a day-to-day basis, although some have a legally defined role, such as Directors of Children's Services in England, and the Chief Social Work Officer in Scotland);

managers who hold key responsibilities for ensuring their staff share information appropriately, and sit between senior leadership and people in front line practice;

people who are designated safeguarding leads and practitioners, as well as people who are less directly involved;

those who work or volunteer in smaller local organisations such as youth groups, arts groups, or sports teams, including the social sector;

those who work in the private sector, such as childminders, private schools, private day nurseries, and after school clubs; and

competent authorities, such as the police or certain other public bodies and specific officials, sharing personal information for law enforcement purposes, who are subject to Part 3 of the Data Protection Act 2018 (DPA 2018).

Senior leaders should make sure everyone in their organisation has the required level of understanding of what to do to safeguard children. See Step 3: Develop clear and secure policies and systems for sharing information for more on this.

Follow these 10 steps:

Step 1: Be clear about how data protection can help you share information to safeguard a child

Our clear message is that data protection is a framework to help you share information. It doesn't prevent you from sharing information to safeguard a child.

It can be more harmful not to share information that is needed to protect a child or young person.
Example
In a hospital out-patients appointment, a doctor suspects that a carer has inflicted an injury on a child. The doctor follows procedures and does not hesitate to share information about the child and their injury with local safeguarding services.

But we know that there can be challenges when you want to share information:

practical challenges, such as technological ones, or relating to systems and processes that aren't effective or that aren't compatible with other organisations you need to share information with;

challenges due to organisational culture or long-established practices, that can be difficult to change; and

misconceptions that you cannot share information 'due to data protection'. Yes, you can!

Following these steps will help you to overcome these.

Get advice from your data protection officer (DPO), expert or team about your information sharing plans. For smaller organisations, ask your umbrella group or governing body for advice.

There are likely to be other laws and duties outside data protection that you also have to comply with in your safeguarding work. Some of those require you to share information in certain circumstances. Some sectors have particular requirements; for example, guidance for professionals laid down by UK regulators such as the General Medical Council, which cover things such as doctor-patient confidentiality. For those detailed requirements within your own organisation, make sure you adhere to agreed policies and obtain internal advice as needed.

Also, don't worry about receiving a fine or other penalty, when you share information in good faith to help identify and safeguard a child you believe is at risk of harm. You won't get into trouble with us. It will never breach UK data protection law to share all the information you need to with an appropriate person or authority in order to safeguard a child.

The Information Commissioner has made this clear in his video message:

The ICO upholds information rights in the public interest, and we always use our powers in a targeted and proportionate way. Our focus is to help you carry out information sharing in a compliant way, to support child safeguarding.

Step 2: Identify your objective for sharing information, and share the information you need to, in order to safeguard a child

Be clear about your purpose for sharing the information.

Safeguarding a child is a compelling reason for sharing information.

You can share all the information you need to, with an appropriate person or authority, in order to safeguard a child.
How this works in practice
You are working with a child and have identified concerns about their welfare. You are going to share this information with an organisation who can help, and you want to know how much to share.

You may be able to share a minimal amount of information to achieve your purpose, such as accessing direct support for a service to benefit the child. In this scenario, it's appropriate only to share this minimal information.

However, there will be times where multiple organisations are involved in an intervention, or where there are concerns about serious harm. In these cases, it may be necessary to share information more widely, or to share more information on a child's circumstances.

It is not always clear how the details of a child's history or circumstances are relevant to the concerns you've identified. But you will be sharing proportionately if you can link it back to a compelling reason to share. In these circumstances, that compelling reason is safeguarding the child.

Documenting this link will not only help you make your decision, but it helps you comply with the law.

Step 3: Develop clear and secure policies and systems for sharing information

Put strong governance, policies and systems in place and keep everything under regular review.

Follow a 'data protection by design and default' approach to handling and sharing information.

Build a culture of compliance and good practice throughout your organisation to help you to share information securely.

Train everyone in your organisation in safeguarding and data protection to the level they need. Ensure that staff, contractors and volunteers all understand what they need to do to share information to safeguard children.
Example
A nursery assistant notices a concerning pattern of behaviour by an adult towards a toddler in the adult's care. The nursery assistant understands that she needs to promptly tell her manager her concerns. To protect the child, the nursery shares the information with local safeguarding services.

If safeguarding is not their day-to-day responsibility, they will require additional support from their management team.

Arrange regular refresher sessions of this training.

Alongside your organisation's training, policies and procedures, highlight information on where people working within your organisation can get help on data protection, so they have support to make the right decisions.

Putting these policies and systems in place will help you to share information, whether you are sharing information on a routine basis or as a one-off.

Routine information sharing is sharing done on a regular basis in a pre-planned way. For example, a group of organisations might arrange to share information for specific purposes, on a frequent or regular basis, or both.

For this type of sharing, establish rules and agree procedures in advance, including assessing the risks by doing a DPIA and entering into a data sharing agreement.

For one-off information sharing, make a decision on what is needed to safeguard a child based on the circumstances at the time, bearing in mind what is fair and proportionate. Planning ahead within your organisation will make the process clear to everyone. However, in some instances you may decide, or be asked, to share information in one-off situations that are not covered by any routine arrangement or agreement. You may still share that information, assessing the risks at the time. We recommend that you make plans to cover such situations.

Sometimes you may have to decide quickly about sharing information in conditions of real urgency, or even in an emergency. In these situations, don't be put off from sharing information; assess the risk and do what is necessary and proportionate. (See Step: 9 Share information in an emergency).
Example
In a secondary school in north west England, a maths teacher was concerned about a young person, J, in her class as she had noticed that his mood had changed. This included J letting his head drop to the table instead of working and being unwilling to speak in front of others. This was out of character. The teacher expressed her concern via the school's online safeguarding system to the school's safeguarding lead.

The same day, J's form tutor also raised a concern via the school's online safeguarding system, saying he had noticed J seemed much more tired than usual. He had tried to get J to talk about it, but J was reluctant to engage - although J did say he was feeling sad.

Both concerns led to the pastoral manager speaking to J the same day. J became tearful and explained he was worried about how he was feeling, because he could not shake the sense of sadness and worry. J also disclosed that he had recently begun to self-harm, but it became clear that he had not experienced any suicidal thoughts.

The pastoral manager found out from J that he was feeling extremely anxious about his parents' divorce and his current housing situation. He was clear that there were no concerns about his parents.

The safeguarding officer phoned home to discuss the concerns with the family and agreed with the family that she would make a referral to CAMHS (Child and Adolescent Mental Health Service).

She drew up a safety plan with the young person and his family before the end of the day and, as the CAMHS referral was likely to take some time, arranged for the young person to begin to see the school's counsellor straight away.

She discussed the housing situation with the family and offered a referral to the local Families First support service. The family said they felt they did not need it at the present time; the officer arranged to check back in with them weekly.

Note that different devolved referral agencies and arrangements may be in place in Northern Ireland, Scotland and Wales.

Step 4: Be clear about transparency and individual rights

Be clear about what happens to personal information at every stage; about how you'll inform people about this, and how you'll handle requests by people to access their information rights.

Tell people about how and why their information is used, giving them privacy information.

In any sharing arrangement, ensure you have policies and procedures that allow people to exercise their individual rights under data protection law:

the right to access information held about them (the right of subject access);

the rights to have their information rectified, erased or restricted;

the right to object;

the right to portability of their information; and

the right not to be subject to a decision based solely on automated processing.

However, if you're sharing information for safeguarding purposes, you might not be obliged to allow people to exercise all these rights. For example, if giving access to a person to information you hold about them would be likely to cause serious harm to a child.

There are exemptions and restrictions that you may use in some circumstances to limit these rights. The DPA 2018 lists the exemptions relating to health, social work, education and child abuse, and the circumstances where they can be applied. This includes cases of information being processed by a court, requests made by someone with parental responsibility or in cases where compliance would be likely to cause someone serious harm.

Step 5: Assess the risks and share as needed

When you are making a decision about sharing information about a child, it is very important to assess the risks.

If you are an organisation that shares information on a regular or routine basis, a Data Protection Impact Assessment (DPIA) will help you to do that. A DPIA is a practical tool to help you plan for the information sharing and assess and mitigate the risks to children's rights and freedoms. It helps you to ensure your sharing is done safely, lawfully and with accountability. You may decide to carry out an overarching DPIA to cover situations that occur on a regular basis. It is worth noting that all organisations involved in the sharing need their own DPIA.

To do a DPIA, ask your data protection officer (DPO), expert or team, and for smaller organisations, your umbrella group or governing body.

However, there will be circumstances not covered by a DPIA, such as sharing information on a one-off basis (for example, if you are an individual employee or volunteer raising the alarm over something you have seen), or in an urgent situation or in an emergency. You can go ahead and share that information based on what is necessary and proportionate in the circumstances at the time to safeguard the child.

Step 6: Enter into a data sharing agreement

Although it isn't mandatory to enter into a data sharing agreement, we recommend it because it helps all parties.

As an organisation, draw up a data sharing agreement (DSA) between you and any others that you are intending to share information with. As with a DPIA this is more likely to be feasible in scenarios of regular and routine information sharing between organisations.

Benefits include helping you and the party or parties you are planning to share the information with to:

be clear about what information you are sharing;

be clear how it will happen; and

demonstrate that you are responsible for complying with data protection law (the accountability principle).

It may also be known as an information sharing agreement (ISA), or a data or information sharing protocol or contract.

Some organisations, including Government departments, may instead enter into a memorandum of understanding (MOU) with each other that includes information sharing provisions and fulfils the role of a data sharing agreement.

Consult your DPO, expert or team, or for smaller organisations, your umbrella group or governing body about drawing up a data sharing agreement.
Example
Some local organisations wanted to identify young people who already had been or were currently at high risk of disengaging from education, employment or training. They decided to routinely share personal information with each other. These partner organisations included two councils, local schools and colleges, housing providers, relevant community organisations, the local job centres and careers service. By sharing the information, they were able to co-ordinate their approach to providing the most appropriate support to the young person to encourage them back into education, work or training.

The partners used a data sharing agreement to set out their purpose, lawful bases and the information they would share. The agreement included a section on how to handle people's rights and agreed shared security standards; the partners also updated their privacy notices. To quality-assure their agreement, they shared it with a regional group of data protection practitioners for feedback. They also set a timescale for the partners to regularly review the agreement to ensure it stayed up-to-date and fit for purpose.

Step 7: Follow the data protection principles

The seven data protection principles lie at the heart of data protection; follow them when handling or sharing personal information. They are all important.

Lawfulness, fairness and transparency

Purpose limitation (share only for your clear, specified, legitimate purposes)

Data minimisation (share information that is adequate, relevant and limited to what is necessary for your purposes)

Accuracy (and keep the information up to date)

Storage limitation (keep the information no longer than necessary for your purposes)

Integrity and confidentiality (ensure appropriate security)

Accountability (demonstrate your compliance with the principles)

Please note that the principles and some other provisions are slightly different for law enforcement processing under Part 3 of the DPA 2018.

Step 8: Share information using the right lawful basis

Sharing information is always lawful when you choose the right lawful basis for you and for the circumstances. The ICO has a tool to help you - see below.

A lawful basis is a valid reason in data protection law for processing personal information. Using the right lawful basis means you can share all the information you need to, with an appropriate authority or individual, in order to safeguard a child.

Identify at least one lawful basis for sharing information before you start the sharing. Ensure you can demonstrate that you considered which lawful basis to use, in order to satisfy the accountability principle. Keep a record of your decision and your reasons, even if you decide that you do not have a lawful basis and therefore can't share the information.

Consent is one lawful basis, but it is not required for sharing information in a safeguarding context. In fact, in most safeguarding scenarios you will be able to find a more appropriate lawful basis.

See more on this, below.
Example
A teacher notices a child in his class is demonstrating some concerning behaviour, including showing fear about being collected from school by a relative with whom they live. The teacher follows the school's procedures and speaks to the safeguarding lead. The school contacts the local safeguarding service to share the information about the child.

The school does not need to obtain the consent of the relative to share this information.

The most common lawful bases suitable for safeguarding purposes are public task, legitimate interests and legal obligation.

Public task: a lawful basis mainly for public sector organisations

This allows you to share information "in the exercise of official authority". It is most relevant to public authorities, but it can apply to any organisation that exercises official authority or carries out tasks in the public interest.

You do not need a specific statutory power to share information using public task, as long as you have a clear basis in law.

Legitimate interests: a lawful basis for organisations outside the public sector

For example, charities or other social sector organisations, or the private sector. This includes organisations in the private or social sector contracted by a public authority to deliver a service.

Legal obligation: where you're required by a different law to share information to safeguard a child

This might be a law outside data protection, and it might be either in statute or in common law, but not a contractual obligation.

Vital interests: sharing information to protect a life

Of course, you can always share information in an urgent situation where a child's life or immediate wellbeing might be at risk.

Consent

While it is always good to work with the knowledge and understanding of those involved, or even their agreement, it is important to remember that the lawful basis of consent is not required for sharing information in a safeguarding context. And the withholding of consent will not affect your ability to share for a legitimate safeguarding purpose.

For a number of reasons, including the fact that there is often an imbalance of power between people and organisations, there is likely to be a different, more appropriate lawful basis for the information sharing.
Note
Please bear in mind that in data protection the lawful basis of consent has a technical meaning that is completely different and separate from any other type of consent, agreement or permission that you might need to obtain from someone as part of service provision. For example, consent to medical treatment.

Don't conflate them with the data protection lawful basis of consent, although we acknowledge that in practice there may be, or may appear to be, a degree of overlap.

Additional rules for special category (sensitive) data

For special category data there are more rules to meet. Special category data is personal information that is sensitive and therefore needs more protection. It includes information about health, or revealing racial or ethnic origin.

When you are planning to share special category data, in addition to identifying a lawful basis, you also need to meet:

a condition for processing under Article 9 of the UK GDPR (including health and social care); and

for some of those provisions, a condition in the DPA 2018 (including substantial public interest conditions such as the safeguarding of children and individuals at risk).

When sharing information to safeguard a child, in the light of all the other factors you have considered, you are very likely to be able to meet one or more conditions.

Sharing sensitive data for law enforcement purposes under Part 3 of the DPA 2018 is slightly different.

Step 9: Share information in an emergency

In an emergency, don't hesitate to share information to safeguard a child. You might not have time to follow all the usual processes.

Make a record of what you shared, who with, and why, as soon as possible.

Some situations might be urgent, but not an emergency. Take a proportionate approach in the circumstances.

Plan ahead for emergency or urgent situations so that everyone knows what to do and the processes to follow when time is of the essence.

Step 10: Read our data sharing code

We recommend you use this 10 step guide in conjunction with our:

Annexe

Here are some examples of definitions of safeguarding:

"What is safeguarding?

Safeguarding is the action that is taken to promote the welfare of children and protect them from harm.

Safeguarding means:

protecting children from abuse and maltreatment

preventing harm to children's health or development

ensuring children grow up with the provision of safe and effective care

taking action to enable all children and young people to have the best outcomes.

Child protection is part of the safeguarding process. It focuses on protecting individual children identified as suffering or likely to suffer significant harm. This includes child protection procedures which detail how to respond to concerns about a child."

Department for Education - England

The Department for Education's statutory 'Working Together' guidance for safeguarding and promoting the welfare of children defines safeguarding as:

"protecting children from maltreatment;

preventing impairment of children's mental and physical health or development;

ensuring that children grow up in circumstances consistent with the provision of safe and effective care;

taking action to enable all children to have the best outcomes."

Education Scotland

The Education Scotland child protection and safeguarding policy says about safeguarding:

"This is a much wider concept than child protection and refers to promoting the welfare of children, young people and protected adults. It encompasses protecting from maltreatment, preventing impairment of their health or development, ensuring that they are growing up in circumstances consistent with the provision of safe and effective care, and taking action to enable all children, young people and protected adults to have the best outcomes. Child protection is part of this definition and refers to activities undertaken to prevent children suffering, or likely to suffer, significant harm.

We have a distinctive approach to safeguarding in Scotland linked to Getting It Right for Every Child (GIRFEC) which promotes action to improve the wellbeing of every child and young person."

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A 10 step guide to sharing information to safeguard children

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This is a 10 step guide on data protection considerations when sharing personal information for child safeguarding purposes. It aims to help you feel confident about sharing information when you need to safeguard a child or young person at risk of harm.

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This document provides an overview of safeguarding to dental teams and reinforces its importance.

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How a child's brain develops through early experiences

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There are considerable advantages to establishing the lived experience of the child and their parent: as this example demonstrates:

Duty to report from GP

Concerns that Marc 11 years old suffers from poor dental hygiene he has tooth decay and has constant infections because of a failure on the part of his mother to take him to a dentist or complete courses of medication

Whilst identifying a concern this report does not provide a clear picture of the impact of the dental neglect on Marc and the degree of urgency in getting him dental care. Consequently, the report may result in no further action or a care and support plan. However, by considering a day in the life of a child and using professional expertise to identify the impact, one gains a much clearer account, with evidence of the specific ways the abuse or neglect is affecting the child. This makes assessment much more precise and child-focused.

In Marc's case, for example, as practitioners ask Marc about his day, as part of the assessment, they learn about his experience of toothache.

He describes sleepless nights because he is in pain. He rarely eats as it hurts so he tends to live on fizzy drinks at home and if he's at school he cannot eat his school dinner. He often does not go to school as he frequently gets infections and feels ill or his tooth ache means he finally falls asleep in the early hours and therefore does not wake up in time for school. If he stays at home, he tries to sleep on the sofa. As he is irritable he annoys his mum and they end up arguing. When that happens, he will go and sit in the park for a bit. If he does go to school, he is usually late, really tired due to lack of sleep and therefore lacks ability to concentrate, feels miserable, is irritable and gets into fights easily. Also, his breath smells and other children tease or bully him. He finds the pain is worse in the evenings and is increasingly helping himself to mum's vodka as he's learnt this numbs the pain for a bit and helps him sleep.

Drawing on the above it becomes apparent that most aspects of Marc's health and development are affected by dental neglect.

His general health is clearly affected.

His educational needs are as his school attendance is poor and his ability to learn when at school means he is falling behind.

His social presentation is affected as his teeth look unpleasant and he smells.

His self-esteem is low particularly as others tease or bully him.

His behaviour is erratic; he is aggressive because of the pain he is in. Drinking vodka is also likely to impact on his behaviour.

His relationships are also affected because of his irritability.

However, to begin to identify why the needs of the child are not being met it is also necessary to understand a day in the life of the parent/s as the two are inextricably linked. Practitioners can only begin to appreciate how daily parenting is impacting on a child if they know about both the parent/s day and their approach to meeting the needs of the child during the day.

When asked about her day Marc's mother, Megan, a single parent describes:

Megan knows the flat is a mess and she never gets around to cleaning-up or washing etc. She struggles to get up in the morning as she is on anti-depressants and has often been up in the night to look after her 4-month-old baby. By the time she does get up it is mid-morning, so she never knows if Marc has gone to school or not, what he is wearing and whether he has washed or eaten something. If he hasn't gone to school, she has not got the energy to argue with him and just lets him be. By the time she's got herself up and sorted out the baby it's usually one-ish and she is exhausted. She rarely bothers to get dressed and has no appetite. If she has money she gives Marc some to get her vodka and himself food, but she has little idea what he buys. She spends the afternoon in-front of the TV and has usually had a couple of vodkas so she's able to have a snooze. She finds Marc is always moaning and irritable and gets really cross if she asks him to mind the baby. She knows he has toothache and that she should sort it out, but the days just seem to fly past and she never gets around to making an appointment for him at the dentist.

It is only by understanding the lives of both parent/s and each individual child in a family that one can begin to understand why the needs of the child are not being met and what would need to change for those needs to be met. For example, in the case of Marc there would be little point in just saying to Megan she needs to take Marc to the dentist and ensure he brushes his teeth.

To gather information about the daily lived experience of family members consider the following:

1. Create a positive environment for the conversation by considering the location, time of day, length of the session and who needs to be there.

2. Family members may be guarded so, it is important to explain to the child or carer what is happening, why you are there and what your role is.

3. Try to create an open, honest and respectful relationship from the beginning.

4. Think about the individual characteristics of the family member: their age, capacity, ethnicity and current stress levels.

5. Be mindful of other important influences on family life as well as support networks.

6. Try to record the actual words used.

7. Use age appropriate tools: clocks, strip cartoons.

8. Do not let children become bored: you might need to have breaks and do this over a couple of sessions.

9. Some family lives are so chaotic there is no typical day. Asking about the previous day can work.

10. Find out how life varies at week-ends, school holidays, with different carers and people in the house.

11. Ask open questions: don't take anything for granted.

12. Don't jump to conclusions, for example, presuming children have breakfast.

13. Elicit information about the lives of young children through observation and finding out about their day from carers.

It is crucial that practitioners do not pressurise children and young people into discussing their daily lived experience. It is important to bear in mind:

Whether the child is keeping 'safe' by not telling professionals things

Whether the child has learned to minimise the situation and it's impact

The child is blaming themselves for the problems and/or do not want to get their parent/s into trouble.

(Horwath 2019)
Further information:
Horwath, J. (2016) Making a Difference to the Neglected Child's Experience in Gardiner, R. Working with Child Neglect. London: Jessica Kingsley. pp.70-93.

Horwath, J. and Platt D (2019) The Child's World. The Essential Guide to Assessing Vulnerable Children, Young People and their Families London: Jessica Kingsley

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There are considerable advantages to establishing the lived experience of the child and their parent: as this example demonstrates: Concerns that Marc 11 years old suffers from poor dental hygiene he has tooth decay and has constant infections because of a failure on the part of his mother to take him to a dentist or complete courses of medication Whilst identifying a concern this report does not provide a clear picture of the impact of the dental neglect on Marc and the degree of urgency in getting him dental care.

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Marchant and Triangle Consultancy have developed guidance for managing disclosures from children about possible abuse and/or neglect. This guidance is based on years of taking children's and young adults' testimony about abuse, including testimony from young children and those with complex needs. These testimonies have been used successfully in court. The Guidance is referred to as 'Opening Doors' because practitioners need to know how to 'open doors' so that the child feels safe and able to tell.

The following 10 key principles should inform the approach.

1. If a child tells, plays, draws or shows abuse, listen and attend carefully, with 100% of your attention, even if you look like you are doing something else. This demonstrates that you are taking what they are saying seriously. Many children find it easier if eye contact isn't demanded of them.

2. Let the child tell you what they want to tell you, or show you, without interruption, what they want to show you, as long as they and others are safe. If the time or place is tricky, you might be able to adjust the environment rather than interrupt or stop them (e.g. move others, reduce sound in the room, and always try and have a pen and notebook nearby).

3. If you aren't sure what the child said or did, or if you aren't sure what they meant, offer an open invitation, e.g. reflect back what they have just said, or 'tell me more about that' or 'show me that again'. Avoid leading questions that could impact on further investigations by police.

4. Say things like 'uhuh' or 'mmhmm' or 'go on' to show you are listening. These are safe things to say because they encourage the child to continue, without directing their account in anyway. Saying 'OK' or 'right' or 'yes' is riskier because these can suggest approval of what is being said, and some things that they need to tell are really not OK.

5. Make clear through your behaviour and body language that you are calm, alright and not shocked and that you have time. Give the child as much physical space as they need.

6. Adapt your language and communication style in line with the child's needs. Be clear about what you need to know. Let the child use his or her own words.

7. Try to get just enough information to work out what action is required. Make a careful record of what they said and did, and any questions you asked as soon as you can.

8. If a child tries to demonstrate violent or sexual acts using your body, say calmly 'I can't let you do that' and if necessary, move away.

9. If appropriate, reflect back using the child's own words. Say exactly what they said, without expanding or amending or asking questions. If appropriate, comment to show that you have noticed what they are doing (e.g. 'you're showing me').

10. Let the person know what you will do next including who you will have to tell. This can be very simple: 'I am going to have a think and then I will come back' then perhaps 'Someone from the police is going to come. They need your help. I will stay with you when they are here'.

Further information:

Marchant, R. (2013). How Young Is Too Young? The Evidence of Children under Five in the English Criminal Justice System. Child Abuse Review, Volume 22, 6: 432-44.

Marchant, R. (2016). 'Age is not determinative: The Evidence of Very Young Children in the English Justice System. Criminal Law and Justice Weekly 180: 12-13.

Marchant R (2019) Opening Doors: Best practice when a child might be showing or telling that they are at risk of harm in Horwath, J. and Platt, D The Child's World The Essential Guide to Assessing Vulnerable Children and their Families; London, JKP.

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Marchant and Triangle Consultancy have developed guidance for managing disclosures from children about possible abuse and/or neglect. This guidance is based on years of taking children's and young adults' testimony about abuse, including testimony from young children and those with complex needs. These testimonies have been used successfully in court.

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Resources and background information on the law giving children the same protection as adults from assault.

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Standards for Dental Teams

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https://www.csacentre.org.uk/documents/signs-and-indicators-a-template-for-identifying-and-recording-concerns-of-child-sexual-abuse1/

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Some really useful information however it is based on the English safeguarding guidance and some of the language may be different. For instance 'on a safeguarding plan' = on the child protection register and 'children in need' category is similar to what we call in Wales 'care and support needs'

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https://www.csacentre.org.uk/documents/communicating-with-children-education/

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Head and spinal injuries in children: Core info leaflet

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Head and spinal injuries in children: Core info leaflet

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How to identify fractures that may be the result of child abuse

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How to identify fractures that may be the result of child abuse

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Useful information to support for specific safeguarding issues

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Useful information to support for specific safeguarding issues

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Resources to support judgement about indicators of abuse

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Resources to support judgement about indicators of abuse

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https://learning.nspcc.org.uk/Search?term=core+info

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Safeguarding and child protection training and resources for anyone working or volunteering with children.

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Easy Read

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Guidance on Child Protection and Vulnerable Adults

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The dental team has an ethical responsibility to find out about local protection procedures for adults, children and young people and to follow them if they are or might be at risk of abuse or neglect (Standards for the Dental Team. GDC, 2013).

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Reporting FGM

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A new mandatory duty to report female genital mutilation (FGM) cases to the police came into effect in England and Wales on 31 October 2015. It applies to all registered healthcare professionals, including dentists and dental care professionals.

The new duty applies where a dental professional, in the course of their work, either:

​is informed directly by a girl that an act of FGM has been carried out on her

observes physical signs which appear to show an act of FGM has been carried out and has no reason to believe that the act was necessary for the girl's physical or mental health or for purposes connected with labour or birth.

The duty applies only to girls who are under 18 at the time that FGM is observed or disclosed. It does not apply if the health professional only suspects that FGM may have been carried out.

Dental professionals should familiarise themselves with the government's guidance on the new duty which includes FAQs and a process map on how the new duty fits with existing safeguarding arrangements.

A range of resources to help health professionals comply with the new duty is available from the Government website.

Under the legislation, failure to comply with the new duty may result in an investigation of a dental professional's fitness to practise.

The new duty is limited to the specific circumstances described above. However, in complying with the Standards, dental professionals, including those who employ, manage or lead a team should continue to take into account their wider safeguarding responsibilities, whether in relation to FGM or any other forms of abuse.

Who does the duty apply to?

All registered healthcare professionals and social workers in England and Wales. This includes all dental professionals registered with the GDC.

Who does the duty relate to?

Any girl under the age of 18 who you observe to have had FGM (this will apply mostly to doctors, nurses and midwives) or who tells you that she has been subject to FGM.

How do I make a report?

By calling the non-emergency number for the Police (101). The government's guidance tells you what information you will need to give

When should I report it?

As soon as possible and by the end of the next working day. For information on exceptions to this, please see the guidance.

What about dental professionals practising in Scotland and Northern Ireland?

Although the mandatory duty does not apply, you should still follow your local safeguarding procedures.

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A new mandatory duty to report female genital mutilation (FGM) cases to the police came into effect in England and Wales on 31 October 2015. It applies to all registered healthcare professionals, including dentists and dental care professionals.