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This chapter
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Working Together to Protect Children
Everyone who works with children and families should be alert to signs that a family is under stress or in need of help with bringing up their children. Early support may help the child or family to tackle problems, improve coping and prevent the risk of significant harm. Guidance on supporting vulnerable children and families is contained in Scotland's Children: Children (Scotland) Act 1995 Regulations and Guidance, Volume 1 - Support and Protection for Children and their Families. Where professionals suspect child abuse or neglect they should consult with senior staff or designated child protection officers, or contact the social work service, the police or the Children's Reporter directly for advice. Any person who believes or suspects that a child is being abused or is at risk should tell the social work service, the police or the Children's Reporter about their concerns. A National Commission of Inquiry into the Prevention of Child Abuse (1996) identified components of child health services required to prevent child abuse or neglect. The aims included specified health checks to take account of child protection concerns, health promotion and prevention and family support and to follow up all children who miss appointments. The strategy suggested to achieve these were:
Child health services need to be accessible and supportive with greater emphasis on prevention (pages 89, 92-94).
Promoting Children's Welfare
Health professionals are responsible for the physical and psychological well-being of their patients. They may be the first to see symptoms of abuse or neglect, and should share information about concerns arising from suspicions with other agencies. The future emotional well-being of children is based on the early quality of their relationship with their carers. All professionals working with children and their families need basic information to develop awareness of child abuse and neglect and, where necessary, training to enhance their skills in recognising and identifying signs of physical injury or neglect, or sexual or emotional abuse. For example, midwives and health visitors should be alert to risk factors concerning abuse of drugs and alcohol, and/or mental health in pregnant women including a risk of post-natal depression. Domestic violence can be an important indicator for the risk of child abuse (Scottish Office 1998). The report on Confidential Enquiries into Maternal Deaths in the United Kingdom 1994-1996 Why Mothers Die (1998), estimate about 30% of domestic violence starts in pregnancy. Recommendations from the report include the use of simple screening in pregnancy, by sensitive questioning. Nurses and midwives caring for babies in neonatal units need to be aware that infants separated from their mothers may be at risk of developing problems with bonding and attachment which give rise to a higher incidence of child abuse. They should encourage bonding by promoting parent and child contact that forms the foundation of a parent/child relationship, for example through encouraging breastfeeding and assisting the development of good parenting skills. Early recognition and referral of families in difficulty will help promote children's welfare, the provision of support and ensure a prompt response to cases of suspected abuse or neglect. For example, health visitors, school nurses and other professionals can offer considerable advice and support to families under stress. Because of their daily contact with children and families and their specialist training and expertise in preventive health care, health visitors have a key role in supporting vulnerable families and children, helping parents care adequately for their child and ensuring that everything possible is done to avert situations where a child might come to harm. Joint training for professionals from different agencies is one important way to help them understand differing agency responsibilities and perspectives in order to work together more effectively.
So far as is consistent with safeguarding and promoting a child's welfare, public authorities should promote the upbringing of children by their families. Where parents care of their children is 'good enough' to facilitate their safe development, health and other professionals should provide support and help in order to promote families staying together in the best interests of children.
The Children (Scotland) Act 1995 (Section 19) requires local authorities to prepare and publish Children's Services Plans in consultation with all relevant local interests including social work, health, housing, education, the Reporter, voluntary agencies and service users. Plans should set out the range and level of services available for children in the local authority's area, including local services for children and families in which there are concerns about child abuse and neglect. Child Protection Committees also produce annual reports outlining local inter-agency activity and developments in child protection.
Schools are taking steps within the curriculum to enable children to protect themselves through programmes of education in health and personal safety. Such programmes should deal with the risk to children of abuse or exploitation, not only by strangers but also by people they may know. The school health team should be actively involved with child protection initiatives within their schools and with stafftraining in the implementation of local child protection procedures.
The Scottish Office Social Work Inspectorate issued a report, A Commitment to Protect (1997); one of its seven recommendations was that all Education Authorities should have in place a Personal Safety Programme for pupils. A useful guide, Promoting Personal Safety and Child Protection in the Curriculum, was published in 1998, with funding from The Scottish Office.
The school nurse activities should contribute to prevention and early detection of child abuse by:
- involvement with teachers in curricular health and social skills education
- enabling assertiveness and pupil confidence through group work on specific issues.