Safeguarding Children in High-Risk Environments

Safeguarding is everyone's job but is of heightened responsibility when one is working with children and families (DFE,2018). Everyone working with children and families should understand child protection and the complexities of protecting children. Child Protection essentially implies the safety and welfare of a child from all abuse types (NSPCC,2020). According to NSPCC (2020), child protection refers to the prevention and response to domestic violence, sexual exploitation, female genital mutilation (FGM) and Fabricated illness. For those studying healthcare dissertation help, understanding these aspects is crucial for addressing healthcare challenges effectively.

In this safeguarding scenario Lucy, who is two and a half years old, shows clear signs of neglect and emotional abuse. She is living in an environment where she is at significant risk of harm. Lucy's mum Joanne is a single mother, and research suggests that single mothers are more likely to experience poor mental health than partnered mothers. The primary factors associated with this are financial hardship and lack of social support (Crosier et al,2007). A recent study confirms the above finding (Pollman-Schult,2017). Toxic stress in society (Financial pressures, poverty, no support, education limited literacy issues, living in deprived area discrimination) are all stresses that affect parents and children (McCrae et al,2021).

Another factor that can lead to harm for Lucy and Liam is that the family is currently living in social housing, and it can be inferred that their home will become overcrowded once the baby arrives. Research suggests that families living in deprived areas are more likely to live in overcrowded homes than those in affluent areas. Over two-thirds of overcrowded households in England are in the 10 per cent most deprived areas (dddd). Overcrowded homes are identified as one of the factors for child abuse or neglect (Cantt et al, 2019).

Joanne is a single parent. The harsh reality lone parents must face is evident in reviewing the available statistics on single parents. Twelve million dependent children living in England and Wales in 2011, 8.8 million lived in either married, civil partnership or cohabiting families, while 3.3 million lived with lone parents. At the same time, most children whose parents are separated remain with their mothers (Miah and Jackson,2015), yet fathers play a significant role in helping children to learn and grow. Fathers have become increasingly involved in childcare in the past several decades and play an essential role in developing a child (Luker et al,2012). Greater father involvement is linked with children's greater cognitive competence, fewer behavioral problems, and better mental health (Bi et al,2018).

Joanne's mental health is another complication in Lucy’s life, and it is a significant barrier in the attachment. Mental health in the prenatal and postnatal period is a growing issue in the UK. Depression and anxiety are the most common mental health problems during pregnancy, with around 12% of women experiencing depression and 13% experiencing anxiety; at some point, many women will experience both (NICE, 2020).

Parental mental health problems can vary in impact and severity depending on the victim’s daily life. Davenport et al (2020) observed that this depends on the parent’s circumstances and the support they receive. Nonetheless, as per Wickham et al (2017), parental mental health can occur alongside other stressful life experiences such as financial problems (such as one experienced by Lucy’s mother), and this can significantly affect the mother’s ability to work – exacerbating their financial problems.

Reviews of serious case reviews have noted an association between parental mental health problems and the risk of serious harm for children (Brandon et al, 2008; Falkov, 1996; Reder and Duncan, 1999). For instance, parental mental health can inhibit parents' ability to respond to their children's emotional cues and offer consistent care (Falkov, Mayes and Diggins, 1998; Gorin, 2004). Harris et al (2018) observed that parents (such as Lucy’s mother) with mental health problems may not be able to cope with their activities of daily living such as mealtimes, housework, taking children to school, and taking children to medical appointment. This explains why in the case study, Joanne did not attend the GP’s appointment, was not able to ensure that Lucy finishes subsequent hospital appointments and is not able to take care of Lucy’s sporadic nursery appointments.

Other mental health-related problems that might be affecting Joanne’s ability to deliver effective parental care to her children include her inability to control her emotions and moods around her children, her inability to respond to her children’s emotional and physical needs, her inability to socially engage with her children and ability to maintain an appropriate and safe boundary for managing the children’s behavior (Phua et al, 2017). Failure to get the support she needs might lead to an escalation of these challenges into more severe challenge such as maternal insensitivity.

Maternal insensitivity commonly caused by depression, can either be 'intrusive and hostile' or 'withdrawn and disengaged.’ This can cause children distress and damage their social and emotional development (Murray et al, 2010). Daily, mothers routinely interact with their children. However, when the mother is experiencing a maternal depression, their capacity to regulate their interaction with the children is compromised through two main interactive patterns: withdrawal and intrusiveness (Thapa et al, 2020). Intrusive mothers exemplify a hostile effect, disrupting the infant’s activity. Consequently, the infant experience anger and turns away from her mother to avoid her intrusiveness and internalise a protective and hangry way of coping. On the other hand, according to Kendig et al (2017), withdrawn mothers are unresponsive, disengaged and do little about their children’s activity. Children with withdrawn mothers cannot self-regulate or cope with this negative state, causing them to develop withdrawal, passivity and self-regulatory behaviours such as sucking their thumb or looking away – explaining why when Lucy is frustrated, she bites her hand. Nonetheless, other things that may make neglect more likely include living in poverty, unsuitable housing or a deprived area (Thoburn et al, 2000). Similarly, poor housing and multiple moves are common features in serious child abuse cases.

Lucy has some frustration expressing herself as not speaking any words yet, and a referral will be required to a speech and language therapist. More than 1.4 million children and young people in the UK have speech, language, and communication needs (SLCN). Language disorder alone is one of the most common disorders of childhood, affecting nearly 10% of children and young people everywhere throughout their lives (ddd). In areas of a social disadvantage, this number can rise to 50% of all children and young people, including those with delayed language and children with identified SLCN (dddd). Research by Bercow (2018) also indicate that children with poor vocabulary skills are twice as likely to be unemployed when they reach adulthood. On the same note, 60% of young offenders have low language skills (Bercow, 2018).

Advanced communication skills required when discussing with Joanne about her mental health and risk to significant harm children. The principle of advanced communication is active listening, motivational interviewing, and effective communication (Luker et al, 2012). It entails, for example, the use of open-ended questions to explore feelings, and sometimes direct questions help to clarify things. That said, the author would use effective communication to empower the client and gain more trust. Building rapport and a therapeutic relationship is the key to get the right help and support for Joanne (Luker et al,2012; Common knowledge and skills for the workforce,2010).

Complexities of child protection can be identifying all the above issues for the purpose of establishing that neglect is taking place and identifying how to protect these children (Munro,2011). Whereas no significantly harming event has occurred within the family, Laming (2009) suggested that professionals should not wait until something wrong happens to act. Furthermore, professionals can almost see beyond the obvious with an excellent solid knowledge base to underpin their practice of child protection. As such, it is important to understand and put in practice, child development, the needs are attachment theory, and other factors that create a better understanding of child maltreatment in this scenario (Boyed and Bee,2014).

The impact of maltreatment has a massive effect on brain development; for example, the attachment theory helps to understand that a child’s experience of attachment will impact how they relate to others and how to interact in relationships (Rosemlan,2016). As such, elements of maltreatment such as child neglect affect brain development while fear and stress can significantly impact on the child’s immune system (First 1000 days of life report 2019; and Allen's 2011).

A growing body of research reveals that adverse childhood experience has long-term effects on children. For instance, the California Adverse Childhood Experiences Study was one of the most extensive investigations ever to link childhood maltreatment and poor later-life health and well-being (Andra et al, 2006). The study found that adults who had adverse childhoods showed higher levels of violence and antisocial behavior (Hosking, 2005), adult mental health problems, school underperformance and lower IQs (Perry 1995), economic underperformance (Sinclair, 2007) and poor physical health. These led to high expenditure on health support, social welfare, justice and prisons; and lower wealth creation (Matlin et al,2019).

Children who have been removed from adverse environments thrive, live a normal life and build resilience. The concept of resilience dates to the second World War when it was observed that evacuated children appeared to suffer more than children who stayed home to face the bombing. Resilience can be promoted in children by building their self-esteem and providing a secure and loving environment for them (Luker,2012). It is the ability to 'bounce back and involves doing well against the odds, coping, and recovering (Rutter, 1985; Stein, 2005).

In Lucy’s scenario, there is a lack of intrinsic and extrinsic factors to help build her resilience. However, changing Lucy’s environment for the better will help her develop resilience and self-esteem, and consequently suffer less adverse effects in later life. Ideally, those who face the most adversity is least likely to have the resources necessary to build resilience (Marmout,2010). This 'double burden' means that inequalities in resilience are likely to contribute to health inequalities (Public Health England, 2014). Health Inequalities is one of the challenges for some areas, creating a need for health promotion.

However, limited resources and the area's population's low education level pose as the significant challenges that might hinder health promotion activities (Marmout,2010). Universal action is needed to reduce the steepness of the social gradient of health inequalities, but with a scale and intensity that is proportionate to the level of disadvantage (Marmout,2010). However, to reduce health inequalities, the commissioning of parenting programmes should be part of a more comprehensive local system of measures to support parents. Good financial and emotional resources make it easier for parents to take good parenting actions (PHE,2014).

Multi-agency working is the key in protecting children. The child protection legislation underpins the role of health visitor in child protection (Luker et al, 2012). Moreover, many international laws are in place to protect children, while the UN Convention (UNC) 1989 is the base for protecting children worldwide. For instance, article 3 of UNC stipulates that best interests of children must be the primary concern in making decisions that may affect them. All adults should do what is best for children i.e. when adults make decisions, they should consider how such decisions will affect children. This particularly applies to budget, policy and law makers.

Through Article 4 of the Human Rights Act, governments have a responsibility to take all available measures to make sure children’s rights are respected, protected and fulfilled. When countries ratify the Convention, they agree to review their laws relating to children. This involves assessing their social services, legal, health and educational systems, as well as levels of funding for these services (Appleton & Peckover, 2015). Governments are then obliged to take all necessary steps to ensure that the minimum standards set by the Convention in these areas are being met. As per Department of Children and Families (2006), they must help families protect children’s rights and create an environment where they can grow and reach their potential. In some instances, this may involve changing existing laws or creating new ones. Such legislative changes are not imposed but come about through the same process by which any law is created or reformed within a country. Furthermore, Article 41 of the Convention points out the when a country already has higher legal standards than those seen in the Convention, the higher standards always prevail.

In this context, the UK’s Local Authorities and fostering agencies play a significant role in safeguarding children like Lucy. Whereas the local authorities’ responsibility is to take care of ‘looked after’ children, the independent fostering agencies work closely with local authorities to identify the most suitable foster care for children when the authorities are not able to place a child within any of their approved foster parents (Department for Eductaion, 2012). Therefore, independent fostering agencies step in to help the local authorities in case there is a shortage of registered foster parents or when the child has some specific complex needs that make sit challenging for the local authorities to place the child with one of the approved foster parents.

The UK Child protection history of legislation began in 1880. However, it has taken a series of high-profile child protection cases to establish the child protection system we have today in England and Wales (NSPCC,2020). In 1945 first child death Inquiry in England was regarding Dennis O Neill. Her foster father killed her at the age of 12, the 1973 death of 7 years old Maria Colwell, and then in 1984, the 4 years old Jasmine Beckford. The Children Act 1989 formed the statutory law framework for the existing child protection system in England and Wales (NSPCC,2020). The Children Acts of 1989 set out special duties: section 17 of the Children Act 1989 puts a duty on the local authority to offer services to children in need in their area, regardless of where they are found; section 47 of the same Act involves local authorities to undertake enquiries if they believe a child has suffered or is likely to suffer significant harm. (DFE,2018).

In 2000, Victoria Columbie child abuse and death high profile safeguarding case took place, and the Laming 2003 report came out. This inquiry (Laming,2003) made numerous recommendations and improvements relating to child protection in England, including the Children's Act 2004, Sexual offences Act 2003, the Children and Families Act 2014. This Act introduced several reforms regarding fostering and adoption, which are in place in today child protection law. EHC plan presented in this Act 2014. EHC Plans will provide statutory protection comparable to that in Statements of SEN for young people in education or training up to the age of 25 instead of ending at 16 and working together to safeguard children in 2015 introduced information sharing and integrated working, which is updated in 2018. Some concerns were raised with GDPR and data protection Act 2018, although GDPR and Data protection act 2018 do not prevent or limit information sharing to keep children and young people safe (HM Government,2018). We knew who maria was and who her parents were; we did not know about Victoria or her carers; the complexity of racial backgrounds and identities is recognised as another issue that needs to be resolved with multi-agency working.

Dig deeper into Understanding organisation and the role of human resource management with our selection of articles.

Regardless of the above changes and recommendations, there continue to be

children who are abused by their parents and carer. All serious case review displays

similar kind of flaws, including lack of communication between professionals, lack of confidence, lack of training in safeguarding in frontline practitioners, and overworked staff with more enormous caseloads (Luker,2012). In June 2010, the Munro Report proposed to modernise the system to remove unnecessary or unhelpful recommendation and focus only on the essential rule for effective multi-agency working and on the principles that underpin good practice.

But we do have highly resistant families. Families who do not engage or cooperate with services families, and therefore they do not demonstrate positive change

despite intervention and support from child protection services (C4Eo,2010). High profile child protection cases have raised concerns about baby peter, Kyra Ishaq and

Shannon Matthew. There is a need to understand better resistance and how these families can be helped.

Working together to safeguard children is vital. Professionals must have the skills to analyse and work through their own emotions, experiences, values and beliefs regarding children, child abuse and safeguarding (TheRoyal College of Nursing (RCN),2007). Safeguarding supervision is the system that allows this process to thrive (Luker et al,2012). To improve safeguarding knowledge, the practitioners require to develop the above-mentioned skills as well as the competence to reflect truthfully, critically, and logically (Thornbury,2009).

Supervision aims to help Health Visitors to develop the necessary skills, confidence and judgement, and it should be regular and proactive. Staff supervision and good practice assurance must become elementary requirements in each service (Laming,2009). Quality of supervision is dependent on several factors, e.g. supportive environment, knowledge and skills of the supervisor and adequate Time (Harlow and smith,2012). Supervision was recommended following the Victoria Columbie incident upon the discovery that adequate safeguarding supervision reduces risks to children and young people while identifying their needs (Munro,2011). Safeguarding supervision also helps frontline workers to provide high-quality care, risk analysis and individual action plans (Warren,2018).

Therefore, safeguarding supervision in practice is valuable and beneficial to manage the caseload. In Lucy's scenario, supervision will support identifying gaps in the author's knowledge. If there is a lack of resources the author is struggling with, the author's supervisor might signpost alternative services. In a severe case reviews analysis, Brandon et al (2009) stated that there is a need to have more regular and frequent supervision for Health Visitors in the NHS. The supervision should also monitor the continuity of care, missed appointments in the family, and extra support for the less experienced practitioner.

Various factors such as staff shortages, time pressure and poor communication may reduce the effectiveness of child and family interactions and the assessments (Laming,2009). Communication and information sharing is a key factor identified in all the serious case review – that poor communication and information sharing has resulted in missed opportunities to take action that keep children and young people safe (Laming,2009) (DFE 2018). While some claim otherwise, General Data Protection Act 2018 and human rights law are not barriers to share information. Instead, Health visitors should keep four key steps in mind: be alert, question behaviour, seek help and make referral (DFE,2010).

Thapa, S. B., Mainali, A., Schwank, S. E., & Acharya, G. (2020). Maternal mental health in the time of the COVID‐19 pandemic.

Kendig, S., Keats, J.P., Hoffman, M.C., Kay, L.B., Miller, E.S., Simas, T.A.M., Frieder, A., Hackley, B., Indman, P., Raines, C. and Semenuk, K., 2017. Consensus bundle on maternal mental health: perinatal depression and anxiety. Journal of Obstetric, Gynecologic & Neonatal Nursing, 46(2), pp.272-281.

Davenport, M. H., Meyer, S., Meah, V. L., Strynadka, M. C., & Khurana, R. (2020). Moms are not ok: COVID-19 and maternal mental health. Frontiers in Global Women's Health, 1, 1.

Wickham, S., Whitehead, M., Taylor-Robinson, D., & Barr, B. (2017). The effect of a transition into poverty on child and maternal mental health: a longitudinal analysis of the UK Millennium Cohort Study. The Lancet Public Health, 2(3), e141-e148.

Harris, R., Gibbs, D., Mangin-Heimos, K., & Pineda, R. (2018). Maternal mental health during the neonatal period: Relationships to the occupation of parenting. Early human development, 120, 31-39.

Phua, D. Y., Kee, M. K., Koh, D. X., Rifkin-Graboi, A., Daniels, M., Chen, H., ... & Meaney, M. J. (2017). Positive maternal mental health during pregnancy associated with specific forms of adaptive development in early childhood: Evidence from a longitudinal study. Development and Psychopathology, 29(5), 1573-1587.

Phua, D. Y., Kee, M. K., Koh, D. X., Rifkin-Graboi, A., Daniels, M., Chen, H., ... & Meaney, M. J. (2017). Positive maternal mental health during pregnancy associated with specific forms of adaptive development in early childhood: Evidence from a longitudinal study. Development and Psychopathology, 29(5), 1573-1587.