Health Organisations and Health Professionals

The roles and responsibilities of all health care and health related services in relation to safeguarding children are defined in Working Together to Safeguard Children as:

2.27 The National Service Framework for Children, Young People and
Maternity Services (NSF) highlights the serious impact child physical,
emotional or sexual abuse or neglect and domestic violence (and parental
mental ill health, substance misuse problems) can have on all aspects of a
childs health, development and well being. This impact can last throughout
adulthood. The high cost of this to both individuals and to society underpins
the statutory responsibility of all health organisations to make arrangements to
safeguard and promote the welfare of children8. This is defined9 as:
" Protecting children from maltreatment;
" Preventing impairment of childrens health or development;
" Ensuring that children are growing up in circumstances consistent with
the provision of safe and effective care;
and undertaking that role so as to enable those children to have optimum life
chances and to enter adulthood successfully.

8 Guidance on section 11 of the Children Act 2004
9 Statutory guidance on making arrangements to safeguard and promote the welfare of
children under Section 11 of the Children Act, HM Government. 2004

2.28 The NSF sets out a ten-year programme for improving the quality of
services for children, young people and pregnant women. Safeguarding
children is a theme running through the NSF and standard 5 deals specifically
with safeguarding and promoting the welfare of children. The NSF is an
integral part of the Every Child Matters: Change for Children Programme.
2.29 Health professionals and organisations have a key role to play in
actively promoting the health and well-being of children. Section 11 of the
Children Act 200410 places a duty on Strategic Health Authorities, designated
Special Hospitals, Primary Care Trusts, NHS Trusts and NHS Foundation
Trusts to make arrangements to ensure that in discharging their functions,
they have regard to the need to safeguard and promote the welfare of
children.
2.30 The Public Health White Paper and Delivery Plan sets out the issues of
safeguarding and promoting the welfare of children in a public health policy
and prevention context.
General principles

2.31 The aim is to ensure that all affected children receive appropriate and
timely therapeutic and preventative interventions. These principles apply to all
health services and health service providers in both the NHS and independent
healthcare settings.
2.32 The safety and the health of a child are intertwined aspects of their well
being. Many health interventions also equip a child to stay safe11.
2.33 All health professionals working directly with children should ensure
that safeguarding and promoting their welfare forms an integral part of all
stages of the care they offer. Other health professionals who come into
contact with children, parents and carers in the course of their work also need
to be aware of their responsibility to safeguard and promote the welfare of
children and young people. This is important even when the health
professionals do not work directly with a child, but may be seeing their parent,
carer or other significant adult.
2.34 All health professionals who work with children and families should be
able to:
" Understand the risk factors and recognise children in need of support
and/or safeguarding;
" Recognise the needs of parents who may need extra help in bringing
up their children, and know where to refer for help;
" Recognise the risks of abuse to an unborn child;
10 Section 11 of the Children Act 2004 came into force on 1 October 2004.
11 Staying Safe  is a key outcome of Every Child Matters

" Contribute to enquiries from other professionals about a child and their
family or carers;
" Liase closely with other agencies including other health professionals;
" Assess the needs of children and the capacity of parents/carers to
meet their childrens needs including the needs of children who display
sexually harmful behaviours;
" Plan and respond to the needs of children and their families,
particularly those who are vulnerable;
" Contribute to child protection conferences, family group conferences
and strategy discussions;
" Contribute to planning support for children at risk of significant harm
e.g. children living in households with domestic violence, parental
substance misuse;
" Help ensure that children who have been abused and parents under
stress (e.g. who have mental health problems) have access to services
to support them;
" Play an active part, through the child protection plan, in safeguarding
children from significant harm;
" As part of generally safeguarding children and young people, provide
ongoing promotional and preventative support through proactive work
with children, families and expectant parents; and
" Contribute to serious case reviews and their implementation.
2.35 The above should all be undertaken with reference to the core
processes set out in this document (summarised in What to do if youre
worried a child is being abused, DH 2003), Responding to domestic abuse: A
handbook for health professionals, DH 2005, and Local Safeguarding
Childrens Board (LSCB) procedures. It is essential that all health
professionals and their teams have access to advice and support from named
and designated child safeguarding professionals and undertake regular
safeguarding training and updating.

Standards and Healthcare

2.36 National Standards, Local Action, DH 200412 incorporates Standards
for Better Health, DH 2004, which describes the level of quality that health
care organisations, including NHS Foundation Trusts, and private and
voluntary providers of NHS care are expected to meet. It sets out core
standards, which are not optional, and developmental standards, such as
national service frameworks, which the Healthcare Commission will use to
assess continuous improvement. Core standard C2, within the safety
domain, states: Health care organisations protect children by following
national child protection guidance within their own activities and in their
dealings with other organisations.
2.37 The NSF, especially in Standard 5 Safeguarding and Promoting the
Welfare of Children and Young People, gives additional detail and markers of
good practice in achieving this. In discharging their roles and responsibilities,
NHS organisations will therefore need to meet core standard C2 and take
account of the NSF.
2.38 The Healthcare Commission is responsible for assessing and reporting
on the performance of the NHS and independent health organisations, to
ensure that they are providing a high standard of care. The Healthcare
Commission is required to pay particular attention to the rights and welfare
of the child and to safeguard the public by acting swiftly and appropriately on
concerns about healthcare. In addition, the Healthcare Commission is also
responsible for regulating the independent healthcare sector.
2.39 All health organisations whether in the NHS or independent health
sector should ensure safeguarding children is an integral part of their
governance systems.
Recruitment

2.40 All healthcare organisations must ensure they have in place safe
recruitment policies and practices, including enhanced Criminal Record
Bureau (CRB) checks, for all staff, including agency staff, students and
volunteers, working with children.
Training

2.41 All staff involved in working with children should attend training in
safeguarding and promoting the welfare of children and have regular updates
as part of any post registration educational programme.
12 The NHS is increasingly assessed through core and developmental standards. The Health
and Social Care (Community Health and Standards) Act 2003 includes a duty on each NHS
body to put and keep in place arrangements for the purpose of monitoring and improving the
quality of health care provided by and for that body (s45) and gives the Secretary of State the
power to set out standards to be taken into account by every English NHS body in
discharging that duty (s46).

2.42 Employers have a responsibility to ensure that all staff, including
administrative staff are given opportunities to attend local courses in
safeguarding and promoting the welfare of children or ensure that
safeguarding training is provided within the team. See chapter 4 for details of
inter-agency training.
HEALTH ORGANISATIONS

Strategic Health Authorities

2.43 The Strategic Health Authoritys (SHAs) role is to performance
manage and support the development of NHS and Primary Care Trusts
arrangements to safeguard and promote the welfare of children and young
people13. SHAs will need to manage performance against the core and
developmental standards and Trusts implementation of child protection
serious case review action plans. They will be able to draw on the findings of
a number of inspection processes- the Joint Area Review and Youth
Offending Teams Inspections undertaken by a number of inspectorates
working in partnership, including the Health Care Commission; and the annual
health checks, improvement reviews and investigations undertaken by the
Healthcare Commission. Their membership of the LSCBs will enable them to
oversee the health contribution to safeguarding children at local level. The
Department of Health holds SHAs to account for this role.
Primary Care Trusts

2.44 Primary Care Trusts (PCTs) are under a duty to make arrangements to
ensure that in discharging their functions, they have regard to the need to
safeguard and promote the welfare of children. PCTs should work with local
authorities to commission and provide co-ordinated and, wherever possible,
integrated services. PCTs should identify a senior lead for children and young
people14 to ensure that their needs are at the forefront of local planning and
service delivery. There should be a named public health professional who
addresses issues around children in need as well as those in need of
protection.
2.45 PCT Chief Executives have responsibility for ensuring that the health
contribution to safeguarding and promoting the welfare of children is
discharged effectively across the whole local health economy through the
PCTs commissioning arrangements. The PCTs role is not only about specific
clinical services, but also about exercising a public health responsibility for a
whole population and a key task is ensuring the health and well-being of
children in need in their area. Where practice-based commissioners
undertake commissioning of services, this should be done in partnership with
PCTs who will need to ensure their safeguarding duties are fulfilled.
13 Foundation Trusts are accountable to an independent corporate body called Monitor. It is
responsible for authorising, monitoring and regulating NHS Foundation Trusts.
14 NSF Core Standards 3  Markers of good practice

2.46 PCTs must co-operate with the Local Authority in the establishment
and operation of the LSCB and as partners share responsibility for the
effective discharge of its functions in safeguarding and promoting the welfare
of children. Representation on the Board should be at an appropriate level of
seniority. PCTs are also responsible for providing and / or ensuring the
availability of appropriate expertise and advice and support to the LSCB in
respect of a range of specialist health functions e.g. primary care, mental
health (adult and child and adolescent) and sexual health, and for coordinating
the health component of serious case reviews (see Chapter 8).
They should notify the SHA of all serious case reviews. The PCT must also
ensure that all health organisations including the independent healthcare
sector with whom they have commissioning arrangements have links with a
specific LSCB and that health agencies work in partnership in accordance
with their agreed LSCB plan. This is particularly important where Trusts
boundaries/catchment areas are different to those of LSCBs. This includes
ambulance trusts and NHS Direct services.
2.47 PCTs should ensure all health providers from whom they commission
services - both public and independent sector - have comprehensive single
and multi-agency policies and procedures to safeguard and promote the
welfare of children which are in line with and informed by LSCB procedures,
and are easily accessible for staff at all levels within each organisation.
2.48 Each PCT is responsible for identifying a senior paediatrician and
senior nurse to undertake the role of designated professionals for
safeguarding children across the health economy and for identifying a named
doctor and a named nurse (or midwife) who will take a professional lead
within the PCT on safeguarding children matters. (For more detail see
paragraphs 2.60 to 2.65). Designated professionals should be performance
managed in relation to their designated functions, at the level of Board Level
Director who has executive responsibility for safeguarding children as part
of their portfolio of responsibilities. If this person is not the Board
level lead for clinical governance and clinical professional leadership,
the designated professional will also need to work closely with this lead
person. PCTs should ensure that all their staff are alert to the need to
safeguard and promote the welfare of children, have knowledge of local
procedures and know how to contact the named and designated
professionals.
2.49 PCTs are expected to ensure that safeguarding and promoting the
welfare of children are integral to clinical governance and audit arrangements.
Service specifications drawn up by PCT commissioners should include clear
service standards for safeguarding and promoting the welfare of children,
consistent with LSCB procedures. By monitoring the service standards of
NHS Foundation Trusts and contracted service providers PCTs will assure
themselves that service providers are meeting the required safeguarding
standards.

2.50 PCTs should ensure that all primary care teams have easy access to
paediatricians trained in examining, identifying and assessing children and
young people who may be experiencing abuse or neglect, and that local
arrangements include having all the necessary equipment and staff expertise
for undertaking forensic medical examinations. These arrangements should
avoid repeated examinations.
2.51 PCTs jointly commission services of Sexual Assault Referral Centres
(SARCs) with the police and voluntary sector organisations for victims of rape
and sexual assault, including services for children and young people. SARCs
provide forensic, medical and counselling services involving specialist sexual
health input. This is a target in the Public Health White Paper Delivery Plan,
and joint Department of Health, National Institute for Mental Health in England
and Home Office national service guidelines have been published on
Developing Sexual Assault Referral Centres (2005).
NHS Trusts and NHS Foundation Trusts

2.52 NHS Trusts, Mental Health Trusts and NHS Foundation Trusts are
responsible for providing health services in hospital and community settings.
They must co-operate with the Local Authority in the establishment and
operation of the LSCB and as statutory partners share responsibility for the
effective discharge of its functions in safeguarding and promoting the welfare
of children. Representation on the board should be at an appropriate level of
seniority. A wide range of their staff will come into contact with children and
parents in the course of their normal duties. All these staff should be trained in
how to safeguard and promote the welfare of children, be alert to potential
indicators of abuse or neglect in children, and know how to act upon their
concerns in line with LSCB procedures.
2.53 All NHS Trusts and NHS Foundation Trusts should identify a named
doctor and a named nurse/midwife for child protection (see paragraphs 2.60
to 2.65 for more detail).
2.54 Staff working in Accident and Emergency (A&E) departments,
ambulatory care units, walk in centres and minor injury units should be able to
recognise abuse and be familiar with local procedures for making enquiries to
find out whether a child is subject to a child protection plan. Staff in A&E
departments should also be alert to the need to safeguard the welfare of
children when treating parents or carers of children. They should also be alert
to parents and carers who seek medical care from a number of sources in
order to conceal the repeated nature of a childs injuries. Specialist paediatric
advice should be available at all times to A&E Departments, and all units
where children receive care. If a child  or children from the same household
 presents repeatedly, even with slight injuries, in a way which doctors,
nurses or other staff find worrying, they should act upon their concerns in
accordance with Chapter 5 of this guidance (the key processes are
summarised in What To Do If Youre Worried A Child Is Being Abused).
Children and families should be actively and appropriately involved in these
processes unless this would result in harm to the child.

2.55 The relevant childs GP should be notified of visits by children to an
A&E department, ambulatory care unit, walk in centre or minor injury. Where
the child is not registered, the appropriate contact in the Primary Care Trust is
to be notified for arranging registration. Consent should be sought from a
competent child or young person for the PCT, health visitor and school nurse
or other health professional to be notified where such professionals have a
role in relation to the child. This will require careful discussion and
explanation, but overriding a refusal to provide consent should only take place
when there is a public interest of sufficient force. Where there is a clear risk
of significant harm to a child, or serious harm to an adult, the public interest
test will almost certainly be satisfied.15 In such circumstances the reasons for
taking such action should be carefully documented and an explanation given
to the child or young person.
Ambulance trusts and NHS Direct sites

2.56 The staff working in these health services will have access (by phone
or in person) to family homes and be involved with individuals in a time of
crisis and may therefore be in a position to identify initial concerns regarding a
childs welfare. Each of these organisations should have a named
professional for child safeguarding. (See paragraph 2.60 to 2.65 for more
detail) All staff should be aware of local procedures in line with LSCB policies.
Independent sector

2.57 PCTs should ensure that through their contracting arrangements,
independent sector providers deliver services that are in line with PCTs
obligations with respect to safeguarding and promoting the welfare of children
and their duty to notify the local authority of children who are, or are likely to
be accommodated for at least three months.16 Should the Healthcare
Commission be obliged at any time to consider deregistration of the
independent healthcare provider there is a need to ensure measures are in
place to make arrangements to re-provide relevant services for children as
quickly and safely as possible. PCTs should ensure that they apply the same
standards and requirements as for NHS providers (as set out at in paragraphs
2.36-2.39) when contracting with the independent sector. PCTs will need to
ensure that appropriate links are established between independent providers
and LSCBs and that the provider is aware of LSCB policies and procedures.
Employers should have access to regular safeguarding training and
supervision. Where PCTs have commissioning arrangements with
independent providers then the provider should have a named professional on
site, and access to designated professionals for complex issues or where
concerns may have to be escalated and involve social services. Clinical
networks17 can provide a further opportunity for sharing highly specialised
resources across teams and geographical areas.
15 Information Sharing: Practitioners Guide provides advice on these issues - see

www.everychildmatters.gov.uk

16 Section 85, Children Act 1989
17 A guide to promote a shared understanding of the benefits of managed local networks, DH

HEALTH PROFESSIONALS

Designated and Named Professional

2.58 The terms designated and named professionals denote professionals
with specific roles and responsibilities for safeguarding children. All PCTs
should have a designated doctor and nurse to take a strategic, professional
lead on all aspects of the health service contribution to safeguarding children
across the PCT area, which includes all providers. PCTs should ensure
establishment levels of designated and named professionals are
proportionate to the local resident populations following any mergers, and to
complexity of provider arrangements. For large PCTs, NHS Trusts and
Foundation Trusts which may have a number of sites, a team approach can
enhance the ability to provide 24 hour advice and provide mutual support for
those carrying out the designated and named professional role. If this
approach is taken it is important to ensure that the leadership and
accountability arrangements are clear.
2.59 Designated and named professional roles should always be explicitly
defined in job descriptions and sufficient time and funding should be allowed
to fulfil their child safeguarding responsibilities effectively. Intercollegiate
Safeguarding competencies and job description work will be published.
Designated Professional

2.60 Appointment as a designated professional does not, in itself, signify
responsibility personally for providing a full clinical service for child protection.
This will usually be done by a team of professionals. Designated professionals
provide advice and support to the named professionals in each provider trust.
Designated professionals are a vital source of professional advice on
safeguarding children matters to other professionals, the PCT, Local Authority
childrens services departments and the LSCB.
2.61 Designated professionals play an important role in promoting,
influencing and developing relevant training, on both a single and inter-agency
basis to ensure the training needs of health staff are addressed. They also
provide skilled professional involvement in child safeguarding processes in
line with LSCB procedures, and in serious case reviews. As part of serious
case reviews they should review and evaluate the practice and learning from
all involved health professionals and providers who are involved within the
PCT area. For more detail see paragraph 8.18.
Named Professional

2.62 All NHS Trusts, NHS Foundation Trusts, and PCTs providing services
for children should identify a named doctor and a named nurse/midwife for
2005

safeguarding. In the case of NHS Direct and ambulance trusts, and
independent providers this should be a named professional. The focus for the
named professional role is safeguarding children within their own
organisation.

2.63 Named professionals have a key role in promoting good professional
practice within the trust and provide advice and expertise for fellow
professionals. They should have specific expertise in childrens health and
development, child maltreatment and local arrangements for safeguarding
and promoting the welfare of children.
2.64 Named professionals should support the Trust in its clinical governance
role by ensuring audits on safeguarding are undertaken and that safeguarding
issues are part of the Trusts clinical governance system.
2.65 The named professional will usually be responsible for conducting the
Trusts internal case reviews except when they have had personal
involvement in the case, when it will be more appropriate for the designated
professional to conduct the review. The named professional will also be able
to ensure the resulting action plan is followed up. They also have a key role in
ensuring a safeguarding training strategy is in place and delivered within their
organisation.
Paediatricians

2.66 Paediatricians, wherever they work, will come into contact with child
abuse in the course of their work. All paediatricians need to maintain their
skills in the recognition of abuse, and be familiar with the procedures to be
followed if abuse and neglect is suspected. Consultant paediatricians in
particular may be involved in difficult diagnostic situations, differentiating
those where abnormalities may have been caused by abuse from those which
have a medical cause. In their contacts with children and families they should
be sensitive to clues suggesting the need for additional support or inquiries.
2.67 Where paediatricians undertake forensic medical examination, they
must ensure they are competent to do so, or work together with a colleague
such as a forensic medical examiner who has the necessary complementary
skills18.
2.68 Paediatricians will sometimes be required to provide reports for child
protection investigations, civil and criminal proceedings and to appear as
witnesses to give oral evidence. They must always act in accordance with
guidance from the General Medical Council and professional bodies, ensuring
their evidence is accurate.
18 The core and case dependent skills required are outlined in detail in Guidance on
Paediatric Forensic Examinations in Relation to Possible Child Sexual Abuse (2004),
produced by the Royal College of Paediatrics and Child Health and the Association of
Forensic Physicians.

2. 69 Some paediatricians will act as independent expert witnesses in legal
proceedings. The Academy of Royal Colleges issued guidance for those
undertaking expert witness work in 200519.
Dental Practitioners and Dental Care Professionals (DCPs)

2.70 Dental practitioners and the dental care professionals (dental
therapists, dental hygienists, dental nurses etc) work in a variety of settings as
salaried staff of PCTs, as providers of PCT commissioned services and as
independent practitioners. They may see vulnerable children both within
health care settings and when undertaking domiciliary visits. They are likely to
identify injuries to the head, neck, face, mouth and teeth, as well as potentially
identifying other child welfare concerns.
2.71 The dental team, irrespective of the healthcare setting in which they
work, should therefore be included within the child protection systems and
training within the local trust. Child protection and the Dental Team  an
introduction to safeguarding children in dental practice will shortly be
published as guidance for all dental practice staff. Dentists should have
access to a copy of the LSCBs procedures.
2.72 The dental team should have knowledge and skills to identify concerns
regarding a childs welfare, know how to refer to childrens social care, and
who to contact for further advice, including the named professionals in the
local health trust.
Other Health Professionals

2.73 All other health professionals and staff who provide help and support to
promote childrens health and development should have knowledge of the
local LSCB procedures and how to contact named professionals for advice
and support. They should receive the training and supervision needed to
recognise and act upon child welfare concerns, and to respond to the needs
of children. This includes those covered in the preceding sections and those
such as:
" clinical psychologists;
" staff in genito-urinary medicine services;
" obstetric and gynaecological staff;

" occupational therapists, physiotherapists;

" staff in sexual health services;
" speech and language therapists;
19 Medical Expert Witness: Guidance from the Academy of Medical Royal Colleges. (2005)
www.aomrc.org.uk

" optometrists;

" pharmacists; and
" other professions allied to medicine;

This list is not exhaustive.

HEALTH SERVICES

Universal services - General Practitioner, the Primary Health Care Team,
practice employed staff and school nurses

2.74 General practitioners (GPs), other members of the primary health care
team (PHCT) and practice employed staff have key roles to play both in the
identification of children who may have been abused and those who are at
risk of abuse; and in subsequent intervention and protection. Surgery
consultations, home visits, treatment room sessions, child health clinic
attendance, drop-in centres and information from staff such as health visitors,
midwives, school nurses and practice nurses may all help to build up a picture
of the childs situation and can alert the team if there is some concern.
2.75 All PHCT members and practice employed staff should know when it is
appropriate to refer a child to childrens social care for help as a child in
need, and how to act on concerns that a child may be at risk of significant
harm through abuse or neglect. In addition, where the GP is not making the
referral, they should be informed at the earliest opportunity.
2.76 The GP, practice employed staff and the PHCT are also well placed to
recognise when a parent or other adult has problems which may affect their
capacity as a parent or carer, or which may mean that they pose a risk of
harm to a child. While GPs have responsibilities to all their patients, children
may be particularly vulnerable and their welfare is paramount. If the PHCT
has concerns that an adults illness or behaviour may be causing, or putting a
child at risk of, significant harm, they should follow the procedures set out in
Chapter 5 of this guidance (summarised in What to Do If Youre Worried a
Child is Being Abused).
2.77 Because of their knowledge of children and families, GPs, together with
other practice staff and PHCT members, have an important role in all stages
of child protection processes, from appropriate information sharing (subject to
normal confidentiality requirements) with childrens social care when enquiries
are being made about a child, and contributing to assessments, to
involvement in a child protection plan to protect a child from harm, as
appropriate. GPs, practice staff and other PHCT practitioners should make
available to child protection conferences relevant information about a child
and family, whether or not they  or a member of the PHCT  are able to
attend.

2.78 All GPs have a duty to maintain their skills in the recognition of abuse,
and to be familiar with the procedures to be followed if abuse is suspected.
GPs should take part in training about safeguarding and promoting the
welfare of children and have regular updates as part of their postgraduate
educational programme and as employers should ensure that practice nurses,
practice managers, receptionists and any other staff whom they employ, are
given the opportunities to attend local courses in safeguarding and promoting
the welfare of children or ensure that safeguarding training is provided within
the team.
2.79 PHCTs should have a clear means of identifying in records those
children (together with their parents and siblings) who are the subject of a
child protection plan. This will enable them to be recognised by the partners of
the practice and any other doctor, practice nurse or health visitor who may be
involved in the care of those children. There should be good communication
between GPs, health visitors, school nurses, practice nurses and midwives in
respect of all children about whom there are concerns.
2.80 Standard 1 of the NSF outlines the new universal child health
promotion programme. This provides a framework to ensure the promotion of
the health and well-being of individual children and young people. The child
health promotion programme is being delivered by multi-agency support
services involved with children and young people including GPs, midwives,
health visitors, dentists, early years workers, school nurses and teachers
working together. The programme addresses the needs of children from preconception
to adulthood and integrates pre-school and school aged health
promotion and assessment. All professionals need to be alert to concerns and
the requirements to safeguard children. More support should be targeted to
children and families who are vulnerable or those with complex needs.
2.81 The NSF recognises that many children will have contact with a variety
of professionals beyond those described in the child health promotion
programme. If concerns arise during an assessment that may require support
from another agency it will be important for the professionals involved to work
in partnership and share relevant information as required in accordance with
confidentiality obligations.
2.82 PCTs are responsible for planning integrated GP out-of-hours services
in their local area and staff working within these services should know how to
access advice from designated and named professionals within the PCT, and
local LSCBs. Each GP and member of the PHCT should have access to a
copy of the local LSCBs procedures.
2.83 School nurses have regular contact with school age children who
spend a significant proportion of their time in school. Their skills and
knowledge of child health and development mean that, in their work with
children in promoting, assessing and monitoring health and development, they
have an important role in all stages of safeguarding children and child
safeguarding processes.

Maternity services

2.84 Midwives are the primary health professionals likely to be working with
and supporting women and their families throughout pregnancy. However,
other health professionals including maternity support workers, health visitors
and, where applicable, specialist key workers may also be directly engaged in
providing support. The close relationship they foster with their clients provides
an opportunity to observe attitudes towards the developing baby and identify
potential problems during pregnancy, birth and the childs early care.
2.85 It is estimated that a third of domestic violence starts or escalates
during pregnancy (see paragraphs 11.45 to 11.50). All health professionals
working with pregnant women should understand that vulnerable women are
more likely to delay seeking care, to fail to attend antenatal clinics regularly
and will tend to deny and minimise abuse. Recognising the prevalence of
abuse across all socio economic groups, it is important to provide a
supportive and enabling environment, where the issue of abuse is raised with
every pregnant woman, with the provision of information about specialist
agencies, thus enabling disclosure should a woman choose. (Maternity
Section Childrens NSF 2004). The Department of Health issued revised
guidance Responding to Domestic Violence: A Handbook for Health
Professionals in January 2006.
2.86 Women and their families are increasingly choosing to access
midwifery led maternity services. These are provided primarily outside
hospitals in community based settings, including in Childrens Centres. Where
midwives and other maternity support staff are employed directly by NHS
Primary Care or Hospital Trusts they are integrated in that Trusts
safeguarding arrangements. In the future new commissioning arrangements
may provide more flexible employment options. Contracting processes must
explicitly specify and monitor that health professionals working in this way are
fully integrated into the local safeguarding arrangements applicable to all
other relevant health care providers.
2.87 Nurses and other health professionals working with children and
families in a variety of environments need to be alert to the strong links
between adult domestic abuse and child abuse and are well placed to
recognise when a child is in need of help, services or at potential risk of
significant harm.
Child and Adolescent Mental Health Services

2.88 Standard 9 of the NSF is devoted to the Mental Health and
Psychological Wellbeing of Children and Young People. The importance of
effective partnership working is emphasised and this is especially applicable
to children and young people who have mental health problems as a result of
abuse and/or neglect.
2.89 In the course of their work, child and adolescent mental health
professionals will therefore want to identify as part of assessment and care

planning whether child abuse or neglect, or domestic violence are factors in a
childs mental health problems and to ensure this is addressed appropriately
in their treatment and care. If they think a child is currently affected they
should follow the child protection procedures laid down for their services
within their area. Consultation, supervision and training resources should be
available and accessible in each service.

2.90 Child and adolescent mental health professionals have a role in the
initial assessment process in circumstances where their specific skills and
knowledge are helpful. Examples include: children and young people with
severe behavioural and emotional disturbance, eating disorders or self-
harming behaviour; families where there is a perceived high risk of danger;
very young children, or where the abused child or abuser has severe
communication problems; where the parent or carer fabricate or induce
illness; and where multiple victims are involved. In addition, assessment and
treatment services may need to be provided to young people with mental
health problems who offend. The assessment of children with significant
learning difficulties, a disability, or sensory and communication difficulties,
may require the expertise of a specialist learning disability or child and
adolescent mental health service.
2.91 Child and adolescent mental health services also have a role in the
provision of a range of psychiatric and psychological assessment and
treatment services for children and families. Services that may be provided, in
liaison with social services, include the provision of reports for Court, and
direct work with children, parents and families. Services may be provided
either within general or specialist multidisciplinary teams, depending upon the
severity and complexity of the problem. In addition, consultation and training
may be offered to services in the community including, for example social
services, schools, primary health care teams, and nurseries.
Adult Mental Health Services

2.92 Adult mental health services, including those providing general adult
and community, forensic, psychotherapy, alcohol and substance misuse and
learning disability services, have a responsibility in safeguarding children
when they become aware of or identify a child at risk of harm. This may be as
a result of services direct work with those who may be mentally ill, a parent, a
parent-to-be, or a non-related abuser, or in response to a request for the
assessment of an adult perceived to represent a potential or actual risk to a
child or young person. These staff need to be especially aware of the risk of
neglect, emotional abuse and domestic abuse. They should follow the child
protection procedures laid down for their services within their area.
Consultation, supervision and training resources should be available and
accessible in each service.
2.93 In order to safeguard children of patients, mental health practitioners
should routinely record details of patients responsibilities in relation to
children and consider the support needs of patients who are parents and their
children in all aspects of their work using the Care Programme Approach.

Mental health practitioners should refer to Royal College of Psychiatrists
policy documents including Patients as Parents and Child Abuse and Neglect:
the role of Mental Health Services.

2.94 Close collaboration and liaison between the adult mental health
services and childrens social services are essential in the interests of
children. This may require the sharing of information to safeguard and
promote the welfare of children or protect a child from significant harm. The
expertise of substance misuse and learning disability services may also be
required. The assessment of parents with significant learning difficulties, a
disability, or sensory and communication difficulties, may require the expertise
of a specialist psychiatrist or clinical psychologist from a learning disability or
adult mental health service.
Visiting of Psychiatric Patients by Children

2.95 All inpatient mental health services must have policies and procedures
relating to children visiting inpatients as set out in the Guidance on the Visiting
of Psychiatric Patients by Children (HSC 1999/222: LAC (99)32), to NHS
Trusts. Additional guidance has been provided for high security hospitals.
Mental health practitioners must consider the needs of children whose parent
or relative is an inpatient, whether formal or informal, in a mental health unit
and make appropriate arrangements for them to visit if this is in the childs
best interests.
Alcohol and Drug Services

2.96 A range of services are provided, in particular by health and voluntary
organisations, to respond to the needs of both adults (with parental
responsibilities) and children who misuse drugs. These services are linked to
the relevant agencies at local level through Drug Action Teams, which
comprise, as a minimum, health, social services, education and police
representatives. It is important that arrangements are in place, which enables
child protection, substance misuse (include alcohol) services referrals to be
made in relevant cases. Where children may be suffering significant harm
because of their own substance misuse, or where parental substance misuse
may be causing such harm, referrals will need to be made by drug action
teams or alcohol services in accordance with LSCB procedures. Where
children are not suffering significant harm, referral arrangements also need to
be in place to enable childrens broader needs to be assessed and responded
to.

Contact:  safeguardingchildrenboard@barnsley.gov.uk

This page was last updated on the 2nd of November 2011 and is scheduled for review on or before the 16th of March 2012