The life chances of children are determined, to some extent, before a child is born. Poor nutrition, smoking, substance misuse and mental health problems during pregnancy can have a major impact on birth weight and the health of the child. Parents who do not make use of antenatal care services are less likely to have problems identified and addressed and the welfare of the child may suffer.
Working Together to Safeguard Children (1)
highlights specific cohorts of children/young people who are more vulnerable and thus more likely to need safeguarding. These include children:
Living in family circumstances which presents challenges for the child such as substance misuse, adult mental health problems and/or domestic violence
With special educational needs and disabilities
Who are engaging in anti-social or criminal behaviour including substance misuse
Who go missing
Returned to their family from care
1.1 What makes children and young people more vulnerable; parental characteristics
There are a trilogy of risk factors, sometimes referred to as the toxic trio, which are often present where there are concerns about the safety or wellbeing of a child or young person. These are domestic violence, parental substance use and parental mental health problems. The presence of these factors creates an increased likelihood that children will be harmed in households where these factors are present.
Parental alcohol/substance misuse is strongly correlated with family conflict, and with domestic violence and abuse. This poses a risk to children of immediate significant harm and of longer-term negative consequences, which is magnified where both issues co-exist.
In a study of 338 social work files from six English local authorities, domestic violence featured in 60% of the referrals, parental substance misuse in just over half (52%) of cases, and both issues were present in a fifth (20%) of cases (2).
Evidence of parental substance misuse was noted in 57% of serious case reviews (3) and parental alcohol misuse noted in 22% of serious case reviews (4).
1.1.1 Parental alcohol/substance misuse
Substance misuse is often, but not always, associated with poor or inadequate parenting. In the majority of cases, substance misuse is associated with deprivation, poor physical and mental health, poor housing, domestic abuse, debt, offending and unemployment. Any or all of these factors are likely to have an impact on the family.
Substance misuse and withdrawal may affect a parent’s ability to care for their child; specifically, a parent’s ability to control their emotions. Severe mood swings and angry outbursts may confuse and frighten a child, hindering healthy development and control of their own emotions.
Nationally, parental substance misuse features prominently on the caseloads of social workers, although there is a need to understand why cases involving parental alcohol misuse seem to come to attention later, and often follow a different pathway, through social care (5).
In addition, children living with parental alcohol misuse come to the attention of services later than children living with parental drug misuse. Boys are less likely than girls to seek help and are more likely to come to the attention of services with regards to their presenting behaviour, for example through Youth Offending Services, than for the harm they are experiencing.
Nationally, it is estimated that 30% of children live with an adult binge drinker, 22% with a hazardous drinker and 2.5% with a harmful drinker (6). An estimated 79,291 babies under 1 year old in England live with a parent who is a problem drinker (7). Over three quarters (78%) of young offenders who also misused alcohol had a history of parental substance misuse (or domestic abuse) in their family (8)
Dual diagnosis describes the association between, substance misuse and mental illness. Research shows that substance use, intoxication, harmful use, withdrawal and dependence may lead to or exacerbate psychiatric or psychological symptoms. Conversely, psychological morbidity and psychiatric disorders can lead to substance use, harmful use and dependence. Children who have a parent with dual diagnosis are particularly likely to need safeguarding.
For more information please see http://nottinghamshirescb.proceduresonline.com/p_ch_par_misuse_subs.html
1.1.2 Parental Mental Health Problems
Parental mental health problems may be life-long, episodic or specifically related to parenthood; around one in eight mothers experiencing postnatal depression. Failure to promote the secure relationships that underlie emotional health in infancy can have a direct result on emotional, social and physical health, both in childhood and in the longer term.
It is estimated that more than 4.2 million parents in the UK experience mental health problems. Approximately half of all adult mental health service users have children under the age of 18 years, and one in 10 will have a child under the age of 5 years (9). Whilst many individuals with mental health problems function effectively with support from their family and community, some parents may need additional support to reduce the effect their mental health problem has on their capacity to parent.
The proportion of parents who experience serious mental illness (SMI) is not well defined. A recent systematic review has reported that at any one time in the UK, 9‑10% of women and 5–6% of men with a mental health disorder are parents, less than 0.5% of whom will be experiencing a psychotic disorder (10). SMI is associated with increased risk of adverse outcomes in children. Short-term outcomes include poorer mental and physical health as well as increased risk of a range of behavioural, social and educational difficulties. Longer-term outcomes may extend into adulthood and include social or occupational dysfunction, lower self‑esteem, increased psychiatric morbidity and alcohol or substance misuse (11).
Children of parents with mental health problems are more likely to enter the care system. Childcare social workers estimate that 50–90% of parents on their caseload have mental health problems, alcohol or substance misuse issues (12).
There are instances where a child may be at risk of significant harm as a result of parental mental illness, which can include children who feature within parental delusions as these children can become a target for parental aggression or rejection. The National Confidential Inquiry into Suicide or Homicide by people with Mental Illness (2016) identified that 11% of all homicides were by mental health patients. The data source does not enable an assessment of how many of these people were parents or how many victims were children. The majority of mental health patients convicted of homicide had a history of alcohol and drug misuse.[i]
Other potential risks relate to an unborn child of a pregnant woman with any previous major mental illness.
Where it is believed that a child of a parent with mental health problems may be at risk of significant harm the process is the same as for similar concerns about any child or young person in that a Strategy Discussion/Meeting should be held and consideration given to undertaking a Section 47 Enquiry.
For more information please see http://nottinghamshirescb.proceduresonline.com/p_ch_par_mental_health.html
1.1.3 Domestic Violence
Domestic violence and abuse (DVA) is defined by the Home Office (2013) as
“Any incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse between those aged 16 or over who are or have been intimate partners or family members regardless of gender or sexuality. This can encompass, but is not limited to, the following types of abuse: psychological, physical, sexual, financial and emotional.”
This definition includes so called 'honour’ based violence, female genital mutilation (FGM) and forced marriage, and is clear that victims are not confined to one gender or ethnic group (Home Office 2013).
Nationally, the majority of domestic violence and abuse is perpetrated by men against women but it is important to acknowledge that men are also affected by domestic and sexual violence. Research suggests that approximately 50% of male victims were also perpetrators of abuse. According to the British Crime Survey (BCS) at least 10% of women and 2.5% of men will suffer from domestic violence and abuse in a given year and 1 in 3 women will be subject to repeat incidents, compared to 1 in 10 male victims.
In almost a third of cases, DVA begins or escalates during pregnancy. DVA in pregnancy is associated with increased rates of miscarriage, premature birth, foetal injury and foetal death. The mother may be prevented from seeking or receiving anti‑natal care and/or post-natal care.
Violence can pose a threat to an unborn child as assaults on pregnant women often involve punches or kicks to the abdomen, risking injury to the mother and baby. In addition if the mother is being abused this can affect her attachment to her child, more so if the pregnancy is a result of rape by her partner.
Children are considerably affected by DVA and witness about three‑quarters of the abusive incidents within a household (Domestic Violence JSNA chapter).
The abuser often uses his/her children in his/her controlling and coercive behaviour. Young people who live in households where there is DVA are more likely to experience DVA in their own relationships.
If a child lives in a home where there is DVA then they are likely to be at risk of abuse themselves including physical, sexual, or emotional abuse and/or neglect. 70% of children living in UK refuges have been abused by their father (14) Domestic abuse is a factor in more than 50% of serious case reviews
For more information please see Domestic Violence (2014) JSNA
1.2 What makes children and young people more vulnerable? Characteristics of the child/young person
1.2.1 Children with Disabilities
Research suggests that children with disabilities are more vulnerable to abuse than non‑disabled children. A large scale American study (16) that examined records of over 40,000 children found that disabled children were 3.4 times more likely to be abused or neglected than non‑disabled children. Overall, the study concluded that 31% of disabled children had been abused, compared to a prevalence rate of 9% among the non-disabled child population.23
Research in the UK is limited; systematic review undertaken Stalker, K. and McArthur, K. (2010) identified few studies into the prevalence of abuse among disabled children.
A meta-analysis of data from research studies into prevalence and risk of violence against disabled children estimated that disabled children were 3.68 times more likely to experience violence than non-disabled children (17).
Kennedy reported that those working with disabled children were more likely to accept abusive practices, such as locking a child in a room, than they would be of their non-disabled peers. Marchant identified myths regarding the sexual abuse of disabled children including that disabled children are less likely to be sexual abused and more likely than other children to make false allegations of abuse.
Research suggests that the likelihood of abuse varies by type of disability. Sullivan and Knutson (2000) (18) found that children with behaviour disorders were approximately seven times more likely to experience neglect, physical and emotional abuse and 5.5 times more likely to experience sexual abuse. Children with speech and language difficulties were found to be nearly five times more at risk of neglect and physical abuse, almost three times more at risk of sexual abuse and almost seven times more at risk of emotional abuse.
Spencer et al.
(2005) (19) found that children with conduct disorders were seven times more likely to be subject to a protection plan in any category, children with learning difficulties almost five times as likely, children with non-conduct psychological problems four times as likely and those with moderate/ severe speech and language disorders almost three times as likely. Studies in the US have also reported significant levels of abuse of children with Autism and Asperger’s Syndrome (20).
As there are inconsistencies in the way disabled children are defined and counted, reported statistics are likely to be underestimates given that it may be difficult to prove neglect and the barriers disabled children and young people face in reporting.
Whilst the mechanism behind the increased risk of abuse disabled children face is not fully understood research by the NSPCC highlighted that children with special educational needs and disabilities were more likely to report lower knowledge, understanding and self-efficacy to keep safe in relation to bullying, domestic abuse, and appropriate and inappropriate touch when compared to their peers (21).
There is very limited data regarding the characteristics of children who have been the subject of serious case reviews (SCR) so it is not possible to assess whether they are over/under represented at SCR.
1.2.2 Young people who have substance misuse problems
The likelihood of using illicit drugs increases with the vulnerability of children and young people. The Home Office (22) identified five vulnerable groups of young people, namely those having that have been in care, have been homeless, truants and those excluded from school and ‘serious’ or frequent offenders. The report estimates that 24% of young people having one or more of these vulnerabilities will have used illicit drugs frequently during the last year compared to 5% of those without vulnerabilities.
Young people who misuse substances are more likely to need safeguarding. For example:
If a parent/carer is not addressing a young person’s drug misuse then they may not be adequately protecting them from harm.
A young person may be misusing substances because he has or is suffering physical or mental harm as a result of neglect or abuse from their parents/carers or others such as in cases of CSE.
Actual physical harm due to accidents is more likely in a young person misusing drugs or alcohol.
Substance misuse is nearly always likely to be linked to an underlying cause. Identifying and addressing the cause can help support the young person.
1.2.3 Children and young people involved in anti‑social or criminal behaviour
It is often the most vulnerable and victimised young people that become involved in persistent offending and
There is a strong correlation between areas with high levels of crime and high levels of poverty. The work on identifying risk factors for offending is based on an understanding that offending is part of a larger pattern of anti-social activity which begins in childhood and often persists into adulthood. Only a limited understanding exists however, about the relationship between risk and protective factors and later offending and anti-social behaviour.
The existence of one or more risk factors in a child’s life is not a good predictor of outcomes and children vary in terms of how they respond to risk. Risk factors are context-dependent and vary over time and with different circumstances. Where multiple risk factors exist, there is increased likelihood of poor outcomes for children. The best predictors of offending differ according by age group. For children aged between 6 and 11, committing an offence appears to be the best predictor of future delinquent behaviour; the strongest predictors for children aged 12 to 14 are a lack of social ties and association with anti-social peers (23).
Young people who offend are a risk to themselves and others. Siblings of young offenders are more likely to become offenders themselves.
Research suggests that young people who perpetrate group-based offending and violent behaviour will often have been the victims of abuse or neglect (24).
For example, where violence is a common occurrence in the home or wider community, such behaviour becomes normalised and this will have an impact on the likelihood that young people will perpetrate this behaviour (25).
Young people who perpetrate crime and acquire weapons may also have been subject to other risk factors such as poverty, inconsistent parenting and reduced educational and life chances (26) (27) (28).
1.2.4 Children who go missing from home or care
Children who go missing from home any be fleeing problems such as abuse or neglect, to stay somewhere they’d rather be or because they have been coerced to run away by someone else. It is estimated that approximately 25 per cent of children and young people that go missing are at risk of serious harm (29). There are particular concerns about the links between children running away and the risk of sexual exploitation.
Missing children may be vulnerable to other forms of exploitation, violent crime and/or to drug and alcohol misuse; Children in Care missing from their placements are particularly vulnerable. In 2012, two national reports highlighted that many children missing from home were not being effectively safeguarded: the Joint All Party Parliamentary Group (APPG) Inquiry on Children Who Go Missing from Care (30) and the accelerated report of the Office of the Children’s Commissioner’s on-going inquiry into Child Sexual Exploitation in Gangs and Groups (31).
Children in residential care are at particular risk of going missing and vulnerable to sexual and other exploitation. Local Safeguarding Children Boards have an important role to play in monitoring and interrogating data on children who go missing.
It is difficult to establish the number of children who are missing from home or care but national estimates suggest the figure is in the region of 100,000 per year. One in six young runaways end up sleeping rough, one in eight resort to begging or stealing to survive and one in 12 are hurt or harmed as a direct result of running away (32)
Although Children in Care are particularly vulnerable when they go missing the majority of children who go missing are not looked after rather they go missing from their family home.
1.2.5 Children and Young People who return to their family following a period in local authority care
Nationally, 21% of children who entered care because their mother had a problem of addiction, left care an average 22 months after entry, if addiction was the only major difficulty. In contrast, where there were other serious problems in addition to addiction, only 12 per cent of children returned home. Children who enter care because of domestic abuse are less likely to return home unless the known abuser has left the home (33). Parents with disabilities or physical health problems are more likely to have their children returned home to them than those with mental health problems (34).
Evidence suggests that the likelihood of children being returned to their parents within a fairly short space of time is lower for those who enter care as infants (especially for reasons of maltreatment) (35) (36) and for teenagers who enter care because of challenging behaviour. In the case of teenagers it may not be because they no longer need additional care and support but because at the age of 18 years they are no longer classified as Children in Care.
Children whose entry into care is precipitated by concerns about physical or sexual abuse are more likely to be returned home than those for whom neglect is the primary reason for entry into care (37) (38). This is usually as in cases of physical and sexual abuse the abuser has the left the family home including parents/carers who are in prison because of the abuse they committed. For children whose families have complex problems including drug and/or alcohol addiction, the proportion of children who are returned home after being in care is lower. Evidence suggests the longer the time children spend longer in care, the smaller the chance those children will return (36) (33).
Research carried out by Farmer and et al found that 82% of children went home to parents with a history of domestic violence, alcohol or drugs misuse or exposure to inappropriate sexual activity; whilst three-fifths (60%) went to a parent with mental health problems. Poor parenting was found to be the greatest predictor of child maltreatment after return (39). In addition, the study found that whilst almost half (46%) of the mothers and a fifth (17%) of the fathers to whom children returned were known to have alcohol or drug problems, only 5% received treatment to help them address their substance misuse (40).
Children and Young People who return to their family after being in care are particularly vulnerable and are three times more likely to return into care after 5 years (41), Nationally, 32% (3,180 of the 9,970) of the children who returned home in 2009-10 had re-entered care by 31 March 2013 (41). It is also important to recognise that a significant number of children oscillate between home and care. In a study by Farmer et al in 2011, a third of the children experienced two or more failed returns. This is strongly associated with poor outcomes for the child (42).
1.2.6 Children and young people who are carers
Children and young people who are carers will need additional support and may need safeguarding. Young carers carry out, often on a regular basis, significant or substantial caring tasks and assume a level of responsibility that would usually be associated with an adult (43). (Becker, 2000: 378). Being a carer at a young age can have a tremendous impact on a young person that can last into adulthood. If a child has to care for his parents or younger siblings it is very possible that his own needs are not being met.
Under The Children Act 1989, Local Authorities are required to provide services for children in need and young carers come under this responsibility. According to the Act if a local authority considers that young carers must have support needs they must also carry out an assessment. The Young Carers (Needs Assessment) Regulations 2015 require local authorities to look at the needs of the whole family when carrying out a young carers’ needs assessment. Young carers’ assessments can be combined with assessments of adults in the household, with the agreement of the young carer and adults concerned.
For more information see Carers JSNA
1.3 Children who are, or may be, experiencing abuse and/or neglect
Children and young people may enter the care of the local authority voluntarily, such as when parents are struggling to cope, or Children's Services may intervene because a child is at significant risk of harm. Children who are suspected of being subject to abuse and/or neglect are referred to children’s social care services and may become subject to a child protection conference and a child protection plan.
In 2014 there were approximately 68,840 children in England and Wales under the care of Local Authorities (44) an estimated 46,155 (62%) of whom were looked after due to abuse or neglect.
Approximately 60 per cent of children enter care because of abuse or neglect (45). The vast majority of children live safely in foster care and residential care, but a minority of children across the UK experience harm each year from those responsible for their care. Biehal estimated there are 450–550 cases of abuse or neglect in foster care per year, and 250–300 cases of abuse or neglect in residential care per year (46).
1.3.1 Children and young people experiencing neglect
Neglect is the persistent failure to meet a child's basic physical and/or psychological needs, likely to result in the serious impairment of the child's health or development.
Neglect may occur during pregnancy as a result of maternal substance misuse, maternal mental ill health or learning difficulties or a cluster of such issues. W
Where there is domestic abuse and violence towards a carer, the needs of the child may be neglected.
Once a child is born, neglect may involve a parent failing to:
Provide adequate food, clothing and shelter (including exclusion from home or abandonment);
Protect a child from physical and emotional harm or danger;
Ensure adequate supervision (including the use of inadequate care-givers);
Ensure access to appropriate medical care or treatment.
It may also include neglect of, or unresponsiveness to, a child's basic emotional, social and educational needs.
These definitions are used when determining significant harm and children can be affected by combinations of maltreatment and abuse, which can be impacted on by, for example, domestic violence and abuse in the household or a cluster of problems faced by the adults. Parental alcohol/substance misuse is strongly correlated with neglect.
Neglect has an impact on attachment as well as brain development for children less than 3 years of age. If a baby is neglected and/or malnourished neural cells can become weak or damaged which lowers brain function. If a child has a poor relationship, attachment or little interaction with a parent then it can change how their brain develops emotional and verbal pathways. Neglect can severely alter the way a child's brain works. Changes to the brain caused by neglect have been linked to panic disorder, post-traumatic stress disorder (PTSD) and attention deficit and hyperactivity disorder (ADHD) (47).
Some children who have been neglected may experience short and long term effects that last throughout their life. Whilst the consequences of neglect are varied they often include:
Difficulties in maintaining healthy relationships later in life, including with their own children.
Experiencing mental health problems including depression, dissociative disorders, memory impairments and post-traumatic stress disorder.
Taking risks, such as running away from home, breaking the law, abusing drugs or alcohol, or getting involved in ‘dangerous which can led to sexual exploitation.
1.3.2 Children and young people experiencing other types of abuse
Child abuse is any action by another person, adult or child, that causes significant harm to a child. Abuse can be physical, sexual or emotional with many children experiencing more than one type of abuse, often alongside neglect. Working Together to Safeguard Children identifies four categories of abuse, Physical, Sexual, emotional and neglect. In order to fully understand the nature of child abuse it can be helpful to look at a wider set of types of abuse.
is deliberately, not accidentally, hurting a child by hitting, kicking, burning and/or poisoning. Injuries due to physical abuse can include bruises, broken bones, burns and cuts. Shaking or hitting babies can cause non-accidental head injuries (NAHI) which are associated with brain damage and death.
Some parents or carers will make up or cause the symptoms of illness in their child to gain medical attention. For example, by giving the child medicine they don’t need to make them unwell. This is known as fabricated or induced illness.
Adults who physically abuse children may have:
Experienced child abuse themselves.
Emotional or behavioural problems such as difficulty controlling their anger.
Parenting difficulties including unrealistic expectations of children and/or not knowing how to respond to a child.
Family or relationship problems.
Health issues which impacts their capabilities to parent (48)
involves forcing or enticing a child or young person to take part in sexual activities, not necessarily involving a high level of violence, whether or not the child is aware of what is happening. The activities may involve physical contact, including assault by penetration (for example, rape or oral sex) or non-penetrative acts such as masturbation, kissing, rubbing and touching outside of clothing. They may also include non-contact activities, such as involving children in looking at, or in the production of, sexual images, watching sexual activities, encouraging children to behave in sexually inappropriate ways, or grooming a child in preparation for abuse (including via the internet).
Sexual abuse is not solely perpetrated by adult males. Women can also commit acts of sexual abuse, as can other children.
Sexual abuse can be further defined as contact abuse and non-contact sexual abuse. Contact abuse is where an abuser makes physical contact with a child, which may include penetration. Non-contact abuse includes non-touching activities such as persuading children to perform sexual acts over the internet.
is when someone builds an emotional connection with a child to gain their trust for the purposes of sexual abuse, sexual exploitation or child trafficking. Whilst many children and young people are groomed online, grooming also takes place face‑to-face, by strangers or someone the child/young person know.
Groomers can be male or female and of any age. Many children and young people don't understand that they have been groomed or that what is happing is abuse
is the ongoing emotional maltreatment or emotional neglect of a child. It is seriously damaging to a child’s emotional health and development. Emotional abuse can involve deliberately trying to scare or humiliate a child and/or isolating or ignoring them. Many children who are emotionally abused are also suffering other types of abuse or neglect; however, this isn’t always the case.
As features of emotional abuse are present in all other types of child abuse and neglect, it can be challenging to spot the signs of emotional abuse and separate emotional abuse from other types of abuse. The NSPCC state that emotional abuse is the second most common reason for children needing protection from abuse (49)
1.3.2 Online abuse
Online abuse is any type of abuse that via the internet including through social networks, online games and mobile phones. Children and young people may experience cyberbullying, grooming, sexual abuse, sexual exploitation or emotional abuse through being online. Children can experience online abuse from people they know, as well as from strangers.
Some children/young people will experience online abuse as part of abuse that is taking place in the ‘real world’ such as bullying or grooming. For others, abuse only happens online for example abusers persuading children to take part in sexual activity online.
Children can feel like there is no escape from online abuse because abusers can contact them at any time of the day or night. The abuse enters safe places like their bedrooms with images and videos that can be stored and shared with other people.
1.3.3 Trafficked Children
Child trafficking was defined by the Council of Europe UK government in 2008 as:
“The recruitment, transportation, transfer, harbouring or receipt of a child for the purpose of exploitation shall be considered 'trafficking in human beings.”
Child trafficking is a form of child abuse in which children are recruited, moved or transported and then exploited, forced to work or sold. Children are trafficked for:
Child sexual exploitation
Domestic servitude such as cleaning, childcare, cooking
Forced labour including to work in factories or agriculture
Criminal activity including pickpocketing, begging, transporting drugs, working on cannabis farms, selling pirated DVDs and bag theft.
Whilst many children are trafficked into the UK from abroad, children are also trafficked within the UK.
Trafficked children experience multiple forms of abuse and neglect and can experience physical, sexual and emotional violence; this abuse is often used to control victims of trafficking.
Nationally it is estimated that 1 in 4 victims of trafficking are children. These figures don’t include prosecutions for crime related to trafficking such as assisting unlawful immigration, false imprisonment, and causing, inciting or controlling prostitution for gain. Children were most commonly trafficked from Vietnam, Nigeria, Slovakia, Romania and from within the UK. The most common reasons for children to be trafficked are sexual exploitation and criminal exploitation. Since 2007 the NSPCC have been involved with 1,100 cases of child trafficking.
1.3.4 Child Sexual Exploitation
Child sexual exploitation (CSE) is a type of sexual abuse in which children are sexually exploited for money, power or status. The new (2015), nationally agreed definition of CSE is:
Child sexual exploitation is a form of child sexual abuse. It occurs where an individual or group takes advantage of an imbalance of power to coerce, manipulate or deceive a child or young person under the age of 18 into sexual activity (a) in exchange for something the victim needs or wants, and/or (b) for the financial advantage or increased status of the perpetrator or facilitator. The victim may have been sexually exploited even if the sexual activity appears consensual. Child sexual exploitation does not always involve physical contact; it can also occur through the use of technology.
Sexual exploitation of children and young people under 18 years of age involves exploitative situations, contexts and relationships where young people, or a third person/s, receive 'something', including food, accommodation, drugs, alcohol, cigarettes, affection, gifts and/or money as a result of them performing, and/or others performing on them, sexual activities.
Child sexual exploitation (CSE) can occur through the use of technology without the child immediately recognizing their being exploited; for example, when a child is persuaded to post sexual images on the internet without immediate payment or gain. In all cases, those exploiting the child/young person have power over them by virtue of their age, gender, intellect, physical strength and/or economic or other resources.
Violence, coercion and intimidation are common in CSE through exploitative relationships that take advantage of the child or young person's limited availability of choice resulting from their social/economic and/or emotional vulnerability. Children or young people may be tricked into believing they're in a loving, consensual relationship.
The Casey Report (2015) sets out some key issues for local authorities and police forces when dealing with child sexual exploitation. A brief summary can be found in appendix 1.
1.3.5 Female Genital Mutilation
FGM is a form of child abuse and is illegal in the UK. Female Genital Mutilation (FGM) is described by the World Health Organisation as:
‘all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non‑medical reasons’. (51)
FGM is sometimes referred to as ‘female genital cutting’ or female circumcision’. However, it is preferred not to associate FGM with circumcision due to the severity of the procedure in comparison to male circumcision. FGM has no health benefits for women and girls, can cause severe short and long term health problems and is recognised internationally as being a violation of the human rights of women and girls.
FGM is a worldwide issue with an estimated 200 million women living with FGM in the world (52)
. However, women and girls from some communities are at increased risk. In some African countries, such as Somalia, the estimated prevalence of FGM is as high as 98%.
There are health implications for all women and girls undergo FGM. Health impacts caused by FGM can include, in the short term, severe pain, haemorrhage, shock and death. In the longer term women who have undergone FGM can experience psychological problems including post-traumatic stress disorder, anxiety and mood disorders and low self-esteem and problems with childbirth which can put both mother and baby at risk including difficult deliveries.
In Britain, FGM is seen in ethnic groups that have migrated from Egypt, Mali, Northern Sudan and Somalia. Dispersal of asylum seekers across the UK means increasing numbers of professionals will come into contact with women who have undergone FGM and girls who might be at greater risk
FGM is usually carried out sometime between infancy and adolescence; however, FGM can happen at any age. In the UK girls are at most risk of FGM between the ages of 7 and 10 years of age. Risk factors for FGM include:
A history of FGM in the family; especially if the mother has undergone FGM
Being a woman/girl are from a community or ethnic group where FGM is highly prevalent and a part of the culture of that community (although this does not always mean FGM will take place).
Girls are also at higher risk of FGM in the run up to and during the school summer holidays, as they are able to have a longer time off to recover from FGM before returning to school.
For more information please see FGM JSNA chapter
1.3.6 Honour Based Violence
Honour-based violence (HBV) is the term used to refer to a collection of practices used predominantly to control the behaviour of women and girls within families or other social groups in order to protect supposed cultural and religious beliefs, values and social norms in the name of ‘honour’. HBV crimes include forced marriage (FM), female genital mutilation (FGM), assault, rape and murder. The term HBV encompasses the full range of incidents and crimes which perpetrators carry out under the guise of maintaining or protecting perceived ‘honour’.
HBV occurs in communities where the concepts of honour and shame are fundamentally bound up with the expected behaviour of families and individuals, particularly that of women and girls. There have been a number of high-profile ‘honour killings’, the most extreme form of so-called “honour”-based violence, in the UK in recent years. In other circumstances, the victim can be subjected to long term physical abuse and bullying as ‘punishment’ for ‘bringing dishonour on the family.
1.4 Children in Care
In UK law, Children in the care of a local authority are referred to as ‘Children in Care’. Children in Care can be accommodated as a result of a court order or with the voluntary agreement of their parents (S20). Legally, this could be when they are:
The subject of an interim or full care order
The subject of an emergency legal order to remove them from immediate danger
Living in a secure children’s home, secure training centre or young offender institution or
Unaccompanied asylum seeking children.
Accommodation provided by the local authority includes foster parent placements and residential children's homes.
From School Summer Letter 2016
Appleby et al, 2016 The National Confidential Inquiry into Suicide or Homicide by people with Mental Illness, University of Manchester