Children with Disabilities/Complex Needs

There are several pieces of legislation which support the rights and needs of children with disabilities and complex needs and promote their safeguarding. These are the  Children Act 1989 and 2004 (which specifically addresses the welfare of disabled children), the Equality Act 2010 (which protects children from discrimination) and the Children and Families Act 2014 (which provides support via the development of Education, Health and Care Plans (EHCP).

The Children Act 1989 s17(1) creates a general duty on children's services to safeguard and promote the welfare of children within their area who are 'in need'. So far as is consistent with this duty, children's services must promote the upbringing of such children by their families. The definition of 'children in need' is found at Children Act 1989 s17(10), which provides that a child is to be taken as 'in need' if they are disabled.

Therefore, children with a disability are children first and foremost, and deserve the same rights and protection as any other children. By definition, any child with a disability should also be considered as a child in need. A child can be considered to be disabled if they have significant problems with learning, communication, comprehension, vision, hearing or physical functioning. The child will usually have a diagnosis from a medical professional.

Disabled children are more likely to be abused by someone in their family or someone they know compared to other children. Children at a greater risk are those with behaviour or conduct disorders. Other high-risk groups are children with learning disabilities, speech and language disorders, health related conditions, children who are completely dependent on others for their care and deaf children.

The number of services, agencies and legislation involved with this group of children does not always help the needs of the child. It is important that systems are robust and any services commissioned are open, coordinated and supportive. Trusted relationships, skilled practitioners and continuity of professionals are key in building up a picture of the child and in providing good quality ongoing support.

All children should have a communication plan included as part of their Educational, Health and Care Plan (EHCP) so all professionals and services know how to interact with the child and what communication aids are needed for any interaction.

Early help and support can mitigate safeguarding issues for this vulnerable group.

Many factors can make a child with disabilities more vulnerable to abuse, both online and offline, than a child of the same age. Safeguarding children with disabilities demands a greater awareness of their vulnerability, individuality and particular needs. It is also important to see the child in the context of the whole family and community supports that are present. This is particularly the case if a child is living away from home and in a residential setting.

Children with disabilities may be especially vulnerable to abuse for a number of reasons due to the following:

• Disabled children are less likely to be consulted in matters affecting them;
• The family and child may be isolated and have limited contact with others due to the family’s circumstances and barriers in social interaction. For example, families with disabled children are more likely to be isolated due to difficulties with working, no appropriate school place for the child, poor finances, a fear of stigma, how difficult it can be to go out and interact with others and/or limited leisure services in the area. A child who is placed in residential care can be particularly isolated as they can be far away from family and not accessing the community;
• The child receives personal care from a number of carers, which may increase the risk of exposure to abusive behaviour and makes it more difficult to set and maintain physical boundaries;
• The child has communication difficulties that may make it difficult to tell others what is happening and no support is provided around their communication needs;
• The child or family may worry about complaining for fear of losing services and/or there will be nothing to replace them and/or not aware services are abusive due to over-dependency on them. Parents'/carers' own needs and ways of coping may conflict with the needs of the child. For example, the parent may also have needs such as mental health issues, learning disabilities, self-medication etc. Pressure on family carers with limited support can be a risk factor for the child. Remember: Good support within the home and outside can mitigate the need for a placement outside the family;
• Overprotectiveness of carers/services can increase abuse as the child is not aware of what abuse is;
• The child has not had any education or training on what safeguarding is and how to keep themselves safe;
• Children with disabilities can be especially vulnerable to bullying and intimidation (see Bullying Procedure) due to lack of recognition of those issues;
• Children can be more vulnerable than other children to abuse by their peers;
• Attitudes and discrimination can mean that the focus is on the child’s disability and everything is attributed to this rather than the full picture of abuse and neglect or their other needs such as mental health, trauma, family circumstances;
• A lack of continuity in care from professionals, providers or multi-disciplinary teams can lead to an increased risk that behavioural changes/abuse and neglect may go unnoticed or unchecked;
• Children living away from home and community are not seen daily by others outside of the service, which can lead to badly-managed and closed culture settings developing. Poor care and abuse can become normalised and accepted for example the child can be over-medicated, issues around control of behaviour that challenges, excessive restraint, few activities offered and no emotional support (see Children Living Away from Home Procedure);
• Some adult abusers may target children with disabilities in the belief that they are less likely to be detected due to the child’s communication issues.  Evidence indicates a child with a disability is less likely to be seen as a reliable witness when they do disclose;
• Services do not have the expertise to support a child with disabilities with other needs such as trauma, neglect etc. For example, a child with disability is more likely to have mental health issues such as stress, anxiety and depression due to the emotional and social impact of their disability.

The UK Social Work Practice in Safeguarding Disabled Children and Young People report details some of the reasons why disabled children and young people are at greater risk and the reasons why, including where gaps in provision exist.

In addition to the universal indicators of abuse/neglect, the following abusive behaviours must be considered:

• Is there a closed culture within the family home or with the provider. For example, all support provided in house, not encouraging others to visit (this however needs to be considered in the context of the child’s needs and if they would find visits difficult due to coping with change and autism);
• Behavioural changes (including different patterns of usual behaviour);
• Unexplained bruising;
• Fabricated or induced illness;
• Withdrawal;
• Fear;
• Self-harming behaviours;
• Unjustified or excessive physical restraint and limited record keeping around restraint;
• No deprivation of liberty assessment in place when continuous supervision and control is occurring;
• Unmet medical needs;
• Limited boundaries around sexual abuse and harm;
• Peer on peer violence that goes unchecked;
• Limited education and leisure options;
• The child is losing weight and there is no physical reason around this;
• Misuse/overuse of medication to manage behaviour;
• Neglect of personal care needs;
• Deliberate failure to follow professional advice, not following care and placement plans or omitting support from the necessary professionals such as psychology, physiotherapy, occupational therapy and/or speech and language support;
• Failure to address ill-fitting equipment e.g. callipers, sleep boards which may cause injury or pain, inappropriate splinting; and/or
• Misappropriation/misuse of a child’s finances.

It should be remembered that children with disabilities are children first and foremost, and have the same rights to protection as any other child. People caring for and working with disabled children need to be alert to the signs and symptoms of abuse. See Recognising Abuse and Neglect Procedure.

Where there are concerns about a child with disabilities a referral should be made in accordance with the Referrals Procedure.

Children with disabilities should not be left in situations where there is a high level of neglect or other forms of abuse, because a practitioner feels that the parent, carer or provider/ service “is doing their best”. Poor care is still a safeguarding issue. Carers will need to be challenged and supported in the same way as carers of other children.

Throughout any Assessment (see Assessment Procedure), including a Section 47 Enquiry, all service providers must ensure that they communicate clearly with the child with a disability, the family and the wider agencies involved. All steps must be taken to avoid confusion so that the welfare and protection of the child remains the focus. Where the child has communication difficulties, the child should have a communication plan so the child’s wishes and feelings could be ascertained. 

Safeguards for children with disabilities should follow the same route as any child who is referred but with further protection:

• Make it common practice to enable children with disabilities to make their wishes and feelings known in respect of their care and treatment. If this is not possible, everything should be done in their best interests including advocacy being offered;
• Ensure that children with disabilities receive appropriate personal, health and social education (including sex education) and work across the multi-agency team is coordinated and good communication is in place;
• Make sure that all children with disabilities know how to raise concerns by giving them the vocabulary to report abuse that is age- and ability-appropriate and give them access to a range of adults with whom they can communicate. This could mean using interpreters (e.g. signers, Makaton specialist) and speech and language support using the child’s preferred method of communication. It may also mean visiting a number of times to get to know the child; 
• Recognise and utilise key sources of support including staff in schools, friends and family members where appropriate;
• Develop the safe support services that families want, and a culture of openness and joint working with parents and carers;
• Ensure that guidance on good practice is in place and recorded and being followed in plans in relation to personal care, managing behaviour that challenges, issues around consent to treatment, anti-bullying and inclusion, sexuality and safe sexual behaviour among young people, as well as monitoring and challenging placement arrangements for children living away from home.

There was a serious case review of children with disabilities involving a significant number of children from many local authorities from 2018 to 2021 involving three residential settings in Doncaster which highlighted the wider picture for children with disabilities who are placed in residential care. This has led to a national review and recommendations being made around the systems in place for this vulnerable group.

It is clear that children with disabilities need a range of services from all groups such as health, social care and education and there needs to be the following in place to protect this group of children such as oversight, more support in place, roles to be strengthened and joined up working.

Recommendations

The Panel has made recommendations for government departments, inspectorates and NHS England that aim to ensure children with learning disabilities, autism and complex health needs have the support they need to thrive.

National Recommendations

1. All children with disabilities and complex health needs should have access to independently commissioned, non-instructed advocacy from advocates with specialist training to actively safeguard children and respond to their communication and other needs;
2. Where an admission to a residential placement for 38 weeks or more is being considered, children, young people and their parents should have access to advice and support through their jointly-commissioned and suitably-resourced local Special Educational Needs and Disability Information Advice and Support Service, with allocation of a ‘navigator’ to work with the family where this is identified as being necessary;
3. Local authorities and ICBs should be required in statutory guidance developed by the Department for Education and NHS England to jointly commission safe, sufficient and appropriate provision for children with disabilities and complex health needs aligned with local inclusion plans and planning for care through Regional Care Cooperatives;
4. The Department of Education, Department of Health and Social Care and NHS England should co-ordinate a support programme for commissioners in local authorities and ICBs, focusing on improvements in forecasting, procurement and market shaping;
5. Local and sub-regional initiatives to improve the quality and range of provision in the community and in schools for children with disabilities and complex health needs should be priorities for inclusion in the government’s pathfinder programmes in children’s social care and SEND;
6. The government should commission the development of an integrated strategy for the children’s workforce in residential settings, to include: leadership development, workforce standards and training;
7. National leadership and investment by providers is urgently required to address the longstanding challenges in recruiting, retaining and developing a skilled workforce in residential settings;
8. Systems for the early identification of safeguarding risks in residential settings should be strengthened through an enhanced role for host local authorities and ICBs in the oversight of residential settings in their area;
9. The Department for Education and Department of Health and Social Care should (a) review and revise the regulatory framework for residential settings to reduce complexity and improve the impact of the current arrangements for monitoring, quality assurance and oversight; (b) take immediate steps to establish arrangements for joint inspection by Ofsted and CQC of residential settings for children with disabilities and complex health needs.

Supplementary Recommendations

These are recommendations to be taken forward through national implementation plans or local partnerships:

1. To ensure that practitioners understand the requirements for legally compliant practice in relation to Deprivation of Liberty and for those over the age of 16, the Mental Capacity Act. Local authorities, health services and residential settings should review their current systems, procedures and practice to determine their readiness for meeting the requirements under this framework;
2. The specification for the Regional Care Cooperative pathfinders should include measures to improve commissioning for children with disabilities and complex health needs;
3. The Families First for Children pathfinders should include programmes focused specifically on the development of integrated provision in the community and in schools for children with disabilities and complex health needs;
4. All children with disabilities and complex health needs who are on a pathway for admission to residential placement longer than 38 weeks per year should be part of a Care, Education and Treatment Review process. No decision should be made without multi-agency agreement and commitment;
5. To assist the understanding of all staff, statutory guidance about the inherent risks from ‘closed cultures’ should be included in ‘Working Together to Safeguard Children’ and ‘Keeping Children Safe in Education’;
6. Practice leadership should form the basis for a national programme of leadership development for leaders and senior managers in residential settings for children and young people;
7. A SEND practice guide for practitioners working with children with disabilities and complex health needs should be one of the first three SEND practice guides produced under the SEND/Alternative Provision (AP) Improvement Plan;
8. The process for developing national SEND standards should be aligned with the work already underway relating to standards in children’s social care so that they are completed in a timely way for residential special schools as well as children’s homes.

Research and analysis: Safeguarding children with disabilities in residential settings (GOV.UK) - National safeguarding practice review into safeguarding children with disabilities and complex needs in residential settings.

Closed cultures in social care: Guidance and questions to ask (Local Government Association) - Information on what a closed culture is.

Safeguarding children with disabilities in residential settings: progress report (GOV.UK)