World view

The World Health Organization (WHO) has emphasised that investment in children’s health should include the prevention of abuse (WHO 2002). Child abuse does not discriminate against sex, age, social class, community or country, which is illustrated by the international interest in this area and the existence of organ-isations such as the International Society for the Prevention of Child Abuse and Neglect (ISPCAN). This international society was founded in 1977 with the aim of ‘prevent[ing] cruelty to children in every nation, in every form: physical abuse, sexual abuse, neglect, street children, child fatalities, child prostitution, children of war, emotional abuse and child labor. ISPCAN is committed to increasing public awareness of all forms of violence against children, developing activities to prevent such violence, and promoting the rights of children in all regions of the world’ (ISPCAN 2006, p. 1).

International organisations promoting children’s welfare and supported by world governments, such as UNICEF and the World Health Organization, accept that child protection issues can and do occur in all cultures and countries across the globe and across all social groups (WHO 2002). A number of initiatives emphasise children’s rights, such as the adoption in many countries of the United Nations Convention of the Rights of the Child (UN 1989), which was ratified by the UK government in December 1991. This policy document has led to the increasing development of child-friendly and child-focused policies at a national level in many countries. Progress towards implementing the UN Convention varies from some countries where children are viewed as an integral part of society to the other extreme, where children are left to live on the streets or are exploited in war, as slave labour and through child prostitution.

The Wave Trust (Worldwide Alternatives to ViolencE) is an international charity dedicated to raising ‘public awareness of the root causes of violence, and the means to prevent and reduce violence in our society’ (Hosking & Walsh 2005, p. 4). The organisation was established in 1996. WAVE is particularly concerned with ‘reducing child abuse and neglect because these are the major root sources of teenage and adult violence; they underlie much emotional suffering in adults who may never be violent; and violence and abuse are entirely preventable through implementing known, economically viable, and effective programmes to break the cycle of violence’ (Hosking & Walsh 2005, p. 4).

Childhood outcomes

Perhaps the most important reason for taking a public health approach to safeguarding children is the impact of unidentified or unresolved children in need or child abuse issues on the individual and society. There is a growing body of evidence which links the failure to address the needs of children to a negative outcome in terms of their social and emotional development and their ability to form positive social relationships (see for example Macdonald 2001). Furthermore, evidence from neurobiological studies is increasingly illustrating that brain development is associated with the quality of the emotional support and environment in which an infant is nurtured (Hosking & Walsh 2005, Lowenhoff 2004, Shonkoff & Phillips 2000). In particular, these studies are providing evidence of the deleterious effects on brain function due to maltreatment and an increase in stress hormones in childhood (Bremner et al 2003, Glaser 2000, Hosking & Walsh 2005, Teicher 2002).

The relationship between problems in child rearing, such as harsh family discipline and ‘consequent childhood behaviour problems, later delinquency and criminality’ is well recognised in the literature (Buchannan 1996, Farrington 1995, p. 100, Hosking & Walsh 2005). Farrington (1995) and Silverman et al (1996) highlight the possible long-term mental health and behavioural problems associated with childhood physical abuse or neglect.

Research evidence suggests that there may be a correlation between adult mental health problems, a history of past abuse, and subsequent ability to parent successfully and positively rear children (Gibbons et al 1995). Child abuse can result in poor self-esteem or an inability to make social relationships. As a worst-case scenario this may lead to childhood delinquency, offending behaviour, substance misuse and later delinquency, violence and imprisonment. Bifulco and Moran (1998) illustrated through in-depth interviews with over 800 women, that childhood abuse and neglect can increase the probability of women suffering depression in adulthood. Their research evidence also demonstrates how such negative childhood experiences can result in low self-esteem for women and abusive relationships in their adult life. This supports the findings of Mullen et al (1996), who studied the long-term impact of childhood physical, emotional and sexual abuse in a group of women and found that a history of any form of abuse was associated with increased risk of mental health problems, interpersonal problems and sexual difficulties. Lang et al (2006) also report an association between maternal childhood maltreatment and increased depression, anxiety and illicit drug use during pregnancy and the early postnatal period.

A study by Glaser and Prior (1997) indicated links between parental attributes and outcomes for children’s emotional health. These parental attributes were mental illness, domestic violence and alcohol or drug misuse, which appeared to impair parenting and affect children’s emotional and social development. These researchers raised questions about the appropriateness of professionals’ early responses to concerns about children’s emotional health. Rather than immediately using formal child protection procedures in the investigation and assessment of suspected emotional abuse, they suggest using alternative strategies, where a multi-disciplinary approach is taken and preventative work with the child and family in the form of planned interventions undertaken over a time-limited period.

Messages from research (Department of Health (DH)/Dartington Social Research Unit 1995) described the long-term ill-effect for children of living in a low-warmth/high-criticism environment as far more damaging than a single incident of over-chastisement. Roberts (1996) and Hagell (1998) have also reported the negative impact of children growing up in such low-warmth/high-criticism environments. Roberts (1996) describes how absence of family support interventions during childhood may result in high levels of aggression and risk-taking behaviour in adulthood. Reder and Duncan (1999) suggest that a further effect of childhood distress can be seen in family life-cycles, particularly at times of transition, such as birth, death or loss of a job. Unresolved child in need or child protection issues can affect adults, so their ability to adjust to changes may be prolonged, or result in psychological symptoms or relationship struggles.

Domestic violence is increasingly recognised as having a damaging effect on childhood outcomes (Department of Health 2006, Osofsky 2003, Smith Stover 2005) and, in particular, children’s emotional and behavioural development (Edleson 1999). The Department of Health (2002a, p. 16) estimated that ‘nearly three-quarters of children [on the child protection register] live in households where domestic violence occurs’. The risks to children are increased when domestic violence occurs alongside parental mental illness, or drug and alcohol abuse (Cleaver et al 1999). Violent childhood experiences have also been linked with intimate partner violence in later adulthood relationships (Coid et al 2001, Whitfield et al 2003).

While the Wave Trust has highlighted the significant economic costs of rising violence in the UK (Hosking & Walsh 2005), it is important to highlight that, in spite of adversity or adverse backgrounds, people can and do rise above past abuse, poverty, loss and relationship difficulties to become mature and balanced individuals (Bifulco & Moran 1998, Heller et al 1999). As yet, though, there is little understanding of the factors that make some children more resilient to maltreatment than others (Macdonald 2001).

Key definitions

‘Safeguarding children’ is a relatively new term; at its simplest, safeguarding is about ‘keeping children safe from harm, such as illness, abuse or injury’ (Children’s Rights Director 2004, p. 3). The term was initially referred to in The Children Act (1989) introduced on 14th October 1991, when a duty was placed on local authorities ‘to safeguard and promote the welfare’ of children in need (Section 17). This focus was further examined by Sir William Utting in his report People like us – a review of the care system for children living away from home, where he described the terms ‘safeguard’ and ‘promote’ as ‘equal partners in an overall concept of welfare. Safeguards are an indispensable component to the child’s security, and should be the first consideration for any body providing or arranging accommodation for children. Safeguards form the basis for ensuring physical and emotional health, good education and sound social development’ (Utting 1997, p. 15).

This broadening of focus was reiterated in the Framework for the assessment of children in need and their families consultation draft (DH 1999, p. 3), which identified that safeguarding has two dimensions: ‘a duty to safeguard children from maltreatment’ and ‘a duty to prevent impairment’. This assessment framework supported the shift in policy focus from the identification of abuse and significant harm to one that adopted a broader view of children’s needs and wellbeing and identified impairment in the context of a child’s developmental needs and his/her current and long-term health and wellbeing (Cleaver et al 2004, DH et al 2000b, Gray 2002, Parton 2006).

Despite the Children Act (2004) placing a new duty, in Section 11, on all the key agencies who work with children ‘to safeguard and promote the[ir] welfare’ (p. 9), and the term ‘safeguarding’ being used in the titles of several influential child welfare policy documents, such as Working together to safeguard children (DH/Home Office/Department of Education and Employment 1999), Safeguarding children involved in prostitution (DH et al 2000a), and Core Standard 5 in the National Service Framework for Children, Young People and Maternity Services (DH & DfES 2004), the term was not defined in government guidance until 2005. Instead, the definition commonly in use in the literature was that offered in the first joint Chief Inspectors’ Report on arrangements to safeguard children (DH 2002b) and retained in the second Safeguarding Children report published in July 2005 (CSCI 2005).

These reports stated that safeguarding involves:

In 2005, ‘safeguarding and promoting the welfare of children’ was defined for the first time in statutory guidance on making arrangements to safeguard and promote the welfare of children under section 11 of the Children Act 2004 (HM Government 2005a) and the draft consultation document of Working together to safeguard children (HM Government 2005b) guidance as:

This definition was maintained when the final document was published in April 2006.

Working together to safeguard children (HM Government 2006a) stresses that these aspects of safeguarding a child’s welfare are cumulative, reinforcing their important contribution to the five outcomes identified in Every child matters (DfES 2003). These are legally recognised as the components of wellbeing in the Children Act (2004, Section 10(2), pp. 7–8) and the purpose for co-operation between agencies:

Defining child abuse and neglect

Defining child abuse is difficult (DH/Dartington Social Research Unit 1995) and there are many alternatives. The relative nature of the concept is accentuated in Gil’s (1975, p. 346) definition:

This broad yet complex definition also emphasises society’s responsibilities and children’s rights, which are central features of the current safeguarding agenda. In 1999, the World Health Organization’s Consultation on child abuse prevention drafted the following definition of child abuse:

The Working together to safeguard children (HM Government 2006a, p. xxvii) guidance describes abuse and neglect as ‘forms of maltreatment of a child’ and outlines the four main categories as: physical abuse, emotional abuse, sexual abuse and neglect.

The WHO has recently illustrated in a typology of violence that child abuse occurs within the broad category of interpersonal violence, which is divided into two subcategories (WHO 2002). Family and intimate partner violence includes child abuse, elderly abuse and intimate partner violence; ‘it occurs largely between family members and intimate partners, usually, though not exclusively, taking place in the home.’ Community violence occurs ‘between individuals who are unrelated, and who may or may not know each other’ (WHO 2002, p. 6). This includes youth violence, rape or sexual assault by strangers, and whilst it generally takes place outside the home, it may arise in institutional settings, such as schools, workplaces, nursing homes and prisons. Although family violence is both more prevalent and potentially more damaging than community interpersonal violence, the latter is more frequently the focus of media attention.

Categories of need

The new Working together to safeguard children (HM Government 2006a, p. 73) guidance talks about ‘working with children about whom there are child welfare concerns’ and stresses the need for interagency working as soon as concerns arise about a child’s welfare. During an initial assessment of a child referred to the local authority, the local authority children’s social care team should determine:

Over the last 10 years, children in need have been frequently described within the wider population of vulnerable children. ‘Vulnerable children are those disadvantaged children who would benefit from extra help from public agencies in order to make the best of their life chances’ (DH 1999, p. 4). Terminology is often used interchangeably and in some policy guidance, such as the Lead professional good practice guidance (DfES 2005a) and Common assessment framework (CAF) documentation (HM Government 2006b, 2006c) vulnerable children and children in need are referred to as ‘children with additional needs’ or ‘complex needs’. However, the Children Act (1989) defined child protection in terms of ‘children in need’ and ‘significant harm’.

A child will be in need (Part III, Section 17(10)) if his/her vulnerability is such that:

or

When an initial child protection conference is convened:

Is the child at continuing risk of significant harm?

The test should be that either:

(HM Government 2006a, Section 5(102–103), p. 101)

Over the last two decades, various theories and models have been debated in an attempt to understand the causal factors involved in child abuse; the ‘integrated’ model is now widely accepted. This theoretical model takes an eclectic viewpoint by combining the individual, social, environmental and interactive models and supports the view that child abuse and neglect is multi-factorial; it also recognises the potential complexity of family life. This model has been described by Browne (2002) and encompasses four elements that mitigate for or against the child’s present situation. These include:

‘Significant harm’ is the threshold beyond which ‘children in need’ are also regarded as ‘children in need of protection’ and child protection procedures are instigated. A child is in need of protection where there is likely or actual ‘significant harm’ to him/her or he/she is at risk. However, the Children Act 1989 does not give a definitive interpretation of the concept of ‘significant harm’. Furthermore Working together to safeguard children recognises that ‘there are no absolute criteria on which to rely when judging what constitutes significant harm.’ It states:

It also draws attention to existing research on sources of stress for children and families that may have an adverse effect on a child’s health, development, and wellbeing, which should be taken into account when assessing children and families needs. These sources of stress include social exclusion, domestic violence, mental illness of a parent or carer, parental learning disability and drug and alcohol misuse (HM Government 2006a, Section 9(11–25), pp. 158–162).

Policy focus: understanding the definitions

From the definitions outlined above, a broad picture of safeguarding emerges, which encompasses not only protection but a broader, more positive emphasis on prevention and ensuring children’s safety. Furthermore, the new Working together to safeguard children (HM Government 2006a) guidance describes child protection as ‘a part of safeguarding and promoting welfare’ (HM Government 2006a, p. 5) and states that it refers specifically to the activity undertaken to protect any child who is at risk of, or is suffering, significant harm. The document maintains that ‘effective child protection is essential as part of wider work to safeguard and promote the welfare of children’ (HM Government 2006a, p. 5).

The term ‘safeguarding children’ is, therefore, an umbrella term (or spectrum) incorporating all aspects of work with vulnerable children, children in need and children who are suffering, or at risk of significant harm.

Since the mid-1990s there has been a change of focus for much of the work that in the late 1980s and early 1990s would have been considered to be child protection work. Since the publication of Messages from research (DH/Dartington Social Research Unit 1995) and the subsequent ‘re-focusing debate’ it has been widely accepted that child protection must be viewed as a broad concept, which includes all elements of ‘children in need’ and ‘significant harm’. This is further substantiated by the recent policy move to focus on safeguarding children. Safeguarding also includes the need for early interventions to proactively identify children and their families who need professional input and support.

Local Safeguarding Children Boards are largely in agreement that initial responses to referrals should be seen as being about child welfare concerns. Following an initial assessment, this may indicate that a child is a ‘child in need’ as defined by Section 17 of the Children Act 1989, while the child protection focus (where it is suspected that a child is suffering or is likely to suffer significant harm) is retained for the more serious or chronic cases (DH/Dartington Social Research Unit 1995, HM Government 2006a, Thorpe & Bilson 1998).

This reframing of the issues in current policy to safeguarding and promoting children’s welfare (DH et al 1999) was further supported by the introduction of a new approach to assessment (Parton 2006). In recognition of the fact that there was no standardised approach to the assessment of children in need, the Department of Health produced a consultation document in 1999 aimed at clarifying such processes (DH 1999). The framework for the assessment of children in need and their families (DH et al 2000b) was developed as part of the Quality Protects Programme and introduced as a structured model for assessing children in need. It was produced primarily for social work practitioners; however, the assessment framework has been widely adopted as a framework for assessing all children and their families, across not only social care but health and education agencies. The assessment framework offers a core foundation and interagency model for a systematic approach to assessing children and families’ needs, emphasising the importance of safeguarding and promoting children’s welfare. It acknowledges the importance of combining evidence-based practice and professional judgement and incorporates three key areas:

The assessment framework supported the shift in policy focus from one that centred on the identification of abuse to an assessment that focuses on the whole child and impairment in terms of his/her developmental needs, current and long-term health and wellbeing. Most recently the Common Assessment Framework for Children and Young People (CAF) developed from the under-lying model of The framework for the assessment of children in need and their families (DH et al 2000b) has been launched by the Department for Education and Skills (DfES) to assist practitioners in all agencies in making assessments of children with additional needs. The DfES website states that the CAF ‘has been developed for practitioners in all agencies so that they can communicate and work together more effectively. It is particularly suitable for use in universal services, to tackle problems before they become serious. It helps practitioners identify the issues facing a child or young person who may have additional needs, in order to take appropriate action to provide them with the right kind of support.’ A number of local authorities piloted the CAF and the lead professional role in 2005–6. The CAF is discussed further in Chapter 1. It was rolled out across the UK in 2006, with social care taking the lead; however, it remains to be seen how agencies who have already integrated the assessment framework in their local procedures and assessment documentation take forward the CAF in practice.