Multi-Agency Practice Guidance and additional information
You can access a wide range of additional information and guidance developed by the Partnership based on children or adults in specific circumstances as well as signposting to National and Statutory guidance to support the Child and Adult Safeguarding Procedures.
A glossary of terms for safeguarding children and a glossary of terms for acronyms used in Child and Adult Safeguarding is available to support practitioners: Acronym Glossary of Terms [PDF document] Glossary of Terms for Safeguarding Children [PDF document].
What is Child Criminal Exploitation?
Child Criminal Exploitation (CCE) is abuse where children and young people are manipulated and coerced into committing crimes.
CCE often occurs without the victim being aware that they are being exploited and involves young people being encouraged, cajoled or threatened to carry out crime for the benefit of others. In return they are offered friendship or peer acceptance, drugs, alcohol, cigarettes or even food.
Criminal exploitation is not restricted to drugs; some children are transporters of cash as well as firearms and weapons, and are coerced into carrying out theft and burglaries. Many children and young people subject to CCE are exploited by criminal gangs.
Children and young people involved in criminal exploitation are often sent to differing locations within the United Kingdom to carry out tasks for gangs, such as supplying drugs to suburban areas, market and coastal towns. Gangs are usually based in cities. This criminal activity is known as 'County Lines'.
What is County Lines?
County Lines is a term used to describe gangs, groups or drug networks that supply drugs from an urban location to suburban areas across the country, using dedicated mobile phone lines. They exploit children and vulnerable adults to achieve storage and/or supply of drugs, movement of cash proceeds and to secure the use of houses for supply (referred to as 'cuckooing').
A mobile phone line is established, to which orders re placed by customers. The line will commonly (but not exclusively) be controlled by a 3rd party, who is remote from the market. The group will use intimidation, violence and weapons to gain control upon the child and vulnerable adults to establish a foothold in the marketplace.
Contextual Safeguarding Network - Practice Guides [external link]
GOV.UK - Criminal Exploitation of children and vulnerable adults - County Lines Guidance [external link]
NSPCC - Criminal Exploitation and gangs [external link]
National County Lines Coordination Centre - County Lines Awareness YouTube Video [external link]
National Crime Agency - County Lines [external link]
National Crime Agency - Intelligence Assessment - County Lines Drug Supply, Vulnerability and Harm (2018) [external link]
Home Office Child Exploitation disruption toolkit - disruption tactics [external link]
GOV.UK - Knife, gun and gang crime guidance [external link]
The Childrens Society - County Lines and Criminal Exploitation [external link]
Making Language Matter - Attending to Language when working with children subject to or at risk of Exploitation - A Practice & Knowledge Briefing [pdf document]
Fearless - access information and advice about crime and criminality [external link]
What is Child Sexual Exploitation?
Sexual exploitation is child abuse and, although they may not realise it, it puts the young victim at huge risk of damage to their physical, emotional and psychological health.
'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'.
Many young people who are being abused do not realise they are at risk and will not call for help. They may see themselves as willing participants when in fact their behaviour is anything but consenting.
Darlington Safeguarding Partnership - CSE Procedure and Practice Guidance
The practice guidance has been designed to assist practitioners in identifying Child Sexual Exploitation and outlines how they can support children and young people.
In order to identify children at risk of sexual exploitation or experiencing sexual exploitation, you should consider the risk factors outlined within the risk assessment form.
If you have a concern for child at risk of CSE then follow DSP child Protection Procedures
Information Sharing Form
It is important, if you have any information no matter how small in relation to: suspected offenders; suspected vehicles; or locations of interest you must provide details. You
should record any detail on the ‘CSE intelligence/Information Sharing Form’ and submit to Durham Constabulary as a matter of urgency.
Young victims can report anonymously online at www.fearless.org
Multi-agency delivery of CSE training
The DSP offers Child Exploitation training co-delivered by Barnardo's and provides an overview of the different forms of exploitation, including criminal and exploitation. Visit the DSP training page for more information.
Further help and support is available:
Barnardo's [external link]
NSPCC [external link]
CEOP [external link]
NWG [external link]
When does Obesity become a safeguarding issue?
Childhood obesity alone is a concern but not usually a child protection concern. A consultation with the family of an obese child should not raise safeguarding issues if obesity is the only cause for concern. The root causes of obesity are complex and in many instances it is not appropriate to institute child protection proceedings in relation to parental neglect as being the cause of the obesity.
However, practitioners working with obese children must be mindful of the possible role of abuse or neglect in contributing to the obesity. Older children and adolescents should be offered the chance to speak apart from their parents to explore their understanding of their weight issues.
Darlington Safeguarding Partnership has developed a policy and practice guidance document to support practitioners who may have concerns that a child is obese and that neglect is considered to be a factor. The guidance can be viewed below:
The guidance below has been developed to provide information to those who are working with families and children. When you visit a family that has a dog, you need to consider whether the dog poses any threat to a child's health, development or safety.
There are several factors that contribute to disabled children and young people being at greater risk of abuse. These include communication barriers, increased isolation, misunderstanding the signs of abuse and inadequate support. Disabled children with behaviour or conduct disorders are at the highest risk of abuse. Other high risk groups include children with learning disabilities, speech and language difficulties, deaf children and children with health related conditions.
If a child is disabled this does not necessarily account for why they are showing particular behaviours and practitioners should always look beyond the disability or diagnosis.
For further information and guidance see NSPCC.org.uk/safeguarding-child protection-deaf and disabled children [External Link]
Assessment of disabled children and their carers
Working Together to Safeguard Children (2018) [PDF Document] requires Statutory Safeguarding Partners and relevant partner agencies have a shared response to meet the needs of disabled children who have specific additional needs. When undertaking an assessment of a disabled child the local authority must also consider whether it is necessary to provide support under Section 2 of the Chronically Sick and Disabled Persons Act (CSDPA) 1970 [external link]. Where a local authority is satisfied that the identified services and assistance can be provided under S2 CSDPA and the support is necessary to meet the child’s needs, the local authority must arrange this support.
Where a local authority is assessing the needs of a disabled child, a carer of that child may also require the local authority to undertake an assessment of their ability to provide, or continue to provide, care for the child under Section 1 of the Carers (Recognition and Services) Act 1995 [external link]. The local authority must take account of the results of any such assessment when deciding whether to provide services to the disabled child.
If the local authority considers that a parent or carer of a disabled child may have support needs, it must carry out an assessment under 17ZD of the Children Act 1989 [external link]. The local authority must also carry out such an assessment if a parent carer requests one. Such an assessment must consider whether it is appropriate for the parent carer to provide, or continue to provide, care for the disabled child in light of the parent carer’s needs and wishes.
What is the Disclosure and Barring Service (DBS)?
The Disclosure and Barring Service (DBS) helps employers make safer recruitment decisions each year by processing and issuing DBS checks for England, Wales, the Channel Islands and the Isle of Man. DBS also maintains the Adults’ and Children’s Barred Lists, and makes considered decisions as to whether an individual should be included on one or both of these lists and barred from engaging in regulated activity.
Disclosure teams carry out DBS checks (previously known as CRB, or criminal record checks).
There are four types of DBS check, and each type results in a DBS certificate being issued to an individual. Employers can then ask to see the certificate to ensure that they are recruiting suitable people into their organisation.
The four levels of DBS check are:
- Basic DBS check
- Standard DBS check
- Enhanced DBS check
- Enhanced with Barred List(s) DBS check
The information contained on each type of check is different.
Further information on the DBS is available on the GOV.UK website [external link]
A guide to DBS checks [PDF Document]
Referral to the DBS
If you dismiss or remove a person from Regulated Activity (or you would have done so had they not left) because they have harmed or posed a risk of harm to a child, or to an adult receiving Regulated Activity, then you have a legal duty to refer the person to the DBS.
To make a referral:
DBS Regional Outreach Service – North East
The Disclosure and Barring Service (DBS) has launched a new Regional Outreach Service to focus on working collaboratively with safeguarding and recruiting organisations. The aim is to work closer with organisations and networks to build and develop relationships, acting as a single point of contact for all DBS related enquiries within their region.
Beth Dale is the DBS Regional Outreach Advisor for North East and is based in the region. She is available to discuss all matters in relation to DBS, as well as support you and your colleagues in safeguarding and safer recruitment.
Beth is able to work with you and your organisation in a number of ways, including:
- Answering phone calls or emails to clarify any DBS related queries/questions or advice
- Attending meetings, training, conferences or visiting organisations to have a face to face discussion (in line with pandemic restrictions)
- Developing and delivering presentations, workshops, webinars or discussions to provide an overview of DBS and safer recruitment
- Taking any feedback, suggestions or comments from DBS experiences and feeding this back into the business
- Review organisations policies and procedures in relation to DBS
- Helping to understand what level of check can be applied for and what information these checks will provide
- Informing organisations and employers of their duty or power to refer individuals who may pose a future risk of harm within regulated activity. Including an overview of:
- How to make barring referrals;
- When should a referral be made and
- How DBS assess whether a referred person should be included on the Children’s and/or Adults’ Barred List.
- If you have any questions regarding the DBS or would like any further information, please do contact Beth:
Tel: 0300 0716743
What is Domestic Abuse?
The definition of domestic violence and abuse is 'any incident or pattern of incidents of controlling, coercive, 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.
The information provided below will help you spot the signs of domestic abuse and provide useful tools to support you in your work.
Children and Adults with Care and Support Needs - Domestic Abuse - Co Durham and Darlington Multi-Agency Domestic Violence and Abuse Procedural Flow Chart [PDF document]
A good practice guide: Improving service provision for Gypsy, Roma and Traveller domestic abuse survivors (Feb 2022) [PDF Document]
Additional advice and guidance and information is available on
The finalised domestic abuse safe accommodation has now been published. Click here to view [pdf document]
What is Clare's Law?
The Domestic Abuse Offender Disclosure Scheme (DAODS) known as Clare's Law was introduced in 2014 and is named after Clare Wood who was murdered by her ex-partner who had a history of violence towards women. Clare would not have been in a relationship with her killer if she had known about his abusive past with previous partners. The scheme allows information to be shared with an individual regarding the criminal history of their partner in relation to domestic abuse and any other information deemed proportionate and necessary to enable the individual to keep themselves safe and to prevent further crime.
Further details are available, see Durham Constabulary: Clares Law [external link]
Operation Encompass (children)
Darlington Borough Council is working with police and schools to improve the support for children affected by domestic abuse. Young people who see or hear arguments and violence at home often arrive for classes the next day upset and unprepared. Darlington Borough Council and the police are set to work more closely to better share information so teachers can provide the help their pupils may need. Further information and sample templates on the initiative can be found below:
Protocol [PDF document]
Poster [PDF document]
School sign up form [Word document]
Further information is available on the Operation Encompass Website [external link]
Hourglass - Safer Ageing- stopping abuse
One in six older people are victims of abuse. The hourglass mission is simple: end the harm, abuse and exploitation of older people in the UK. Hourglass provide a helpline for older men, women and their families suffering form abuse whether it is physical, psychological, financial, sexual or neglect.
Helpline telephone number: 0808 808 8141
On Track: The Women's aid outcome measurement system
On Track is a comprehensive case management and outcomes monitoring programme created by Women's Aid for specialist support services including refuge providers which will provide vital insight into the domestic abuse sector and evidence of the value and impact of their services. Further information is available by clicking on the link below.
Understanding domestic abuse: findings from On Track [external link]
Domestic Violence and your workplace
A leaflet is available to support employers on raising awareness of domestic abuse within the workplace and how you can provide the best support for any of your employees suffering domestic violence.
Domestic Violence and Your workplace leaflet [PDF document]
Links between animal abuse, child abuse and domestic abuse
There is a growing research base in the UK to suggest that if a child is cruel to animals this may be an indicator that serious neglect and abuse has been inflicted on the child. Whilst research in the UK suggests that animal abuse by children is quite widespread, in a minority of more extreme cases it appears to be associated with abuse of the child or subsequent abusive behaviour by the child. For more information see www.nspcc.org.uk
Ask for ANI
The Government has launched a new initiative, Ask for ANI (Action Needed Immediately), which is a codeword scheme to enable victims of domestic abuse to access immediate help from the police or other support services, from the safety of their local pharmacy. The codeword will alert members of staff that a victim is seeking immediate, urgent help.
The pharmacy environment lends itself well to this scheme, as most pharmacies will have consultation rooms available and staff will have undergone safeguarding training. Boots stores are taking part and other participating local pharmacies will display posters to show they are also available to help. Staff can offer a safe space at the branch and a phone to call for help or information on what support is out there. Find out more here [external link].
Ask for ANI - visit Employers Initiative on Domestic Abuse website [external link]
Female Genital Mutilation (FGM) refers to procedures that intentionally alter, mutilate or cause injury to the female genital organs for non-medical reasons. FGM is medically unnecessary and can have serious health consequences, both at the time it is carried out and in later life.
FGM is prevalent in 30 African countries and areas of the Middle and Far East, but it is increasingly practiced in the U.K. in communities with larger populations of first-generation immigrants, refugees and asylum seekers.
FGM is deeply embedded in some communities and is performed for cultural and social reasons. It is usually carried out on girls before they reach puberty, but in some cases it is performed on new-born infants or on women before marriage or pregnancy. It is often justified by the belief that it is beneficial for the girl or woman, but FGM is an extremely harmful practice which violates basic human rights.
The most significant risk factor for girls and young women is coming from a community where FGM is known to be practised and/or where a mother, sister or other female family member has been subjected to FGM.
Practitioners should be aware of this and provide families with advice and information which makes it clear that FGM is illegal.
If practitioners are aware, or suspect that a child or young person as undergone, or maybe undergoing the procedure they should follow the DSP Child Protection Procedures.
DSP has developed a practice guidance document to support practitioners.
Female Genital Mutilation Multi-Agency Practice Guidance [PDF document]
FGM - Reporting Process Map [PDF document]
Mandatory Reporting of Female Genital Mutilation [external link]
HM Government - Multi-Agency Statutory Guidance on Female Genital Mutilation [external link]
World Health Organization - Care of girls and women living with Female Genital Mutilation- A clinical Handbook [PDF document]
As well as threats to the welfare of children from within their families, children may be vulnerable to abuse or exploitation outside of the family. Working Together to Safeguard Children 2018 highlights the importance of practitioners having awareness of the additional vulnerabilities for children and young people who may be affected by gang activity. See NSPCC guidance.
What is Contextual Safeguarding
Contextual Safeguarding is an approach to understanding, and responding to, young people’s experiences of significant harm beyond their families. Traditional approaches to protecting children/young people from harm have focussed on the risk of violence and abuse from inside the home, usually from a parent/carer or other trusted adult and don’t always address the time that children/young people spend outside the home and the influence of peers on young people’s development and safety.
Contextual safeguarding recognises the impact of the public/social context on young people’s lives, and consequently their safety. Contextual safeguarding seeks to identify and respond to harm and abuse posed to young people outside their home, either from adults or other young people. It’s an approach that looks at how interventions can change the processes and environments, to make them safer for all young people, as opposed to focussing on an individual.
Research illustrates that young people's experience is not only influenced by their family, but also by their peer network, wider community and society in general.
The model of contextual safeguarding was developed by Dr Carlene Firmin at the University of Bedfordshire.
For more information visit the Contextual Safeguarding website [external link]
To access policy and practice resources visit the virtual hub of the Contextual Safeguarding Practitioners Network [external link]
Internet Safety relating to children
Darlington Internet Safety Partnership
The Darlington Internet Safety Partnership, is a multi-agency partnership which aims to build digital literacy and resilience skills in children, young people, professionals and parents and carers.
The partnership uses local and national intelligence and data as an evidence base. It's aim is to increase knowledge and skills to safely use the internet and social media, with a strong understanding of social media apps, cyberbullying, CSE, identity fraud, radicalisation, gaming, digital footprints and much more.
A number of resources are available which include:
- Cyber Squad – Internet safety peer group for primary schools
- support for parents and carers around internet safety
- Cyber Champions - lead person for internet safety within organisations
Further details are available on the Internet Safety Partnership website.
Guidance for staff using technology with young people
The internet is great place for finding information and communicating, but we all need to know how to use it safely. It is recognised that Internet Safety (e-safety) Risks are posed more by behaviours and values than the technology itself. Children are likely to have internet access in many places and in many ways, so it's important to equip them with the skills to use technology safely and appropriately, alongside which adults working with children and young people must also ensure they establish safe and responsible online behaviours.
There are a number of resources and websites available to support your work on internet safety, click links below for further information.
Internet Watch Foundation (IWF) - New tool to empower children and young people to stop spread of nude images online [external link]
Childline - Remove a nude image shared online [external link]
Erase Exploitation - eraseabuse.org [external link]
The Marie Collins Foundation and NWG - Online Sexual Harm Reduction Guide [PDF Document]
Cyber Safety [PDF Document]
Cyber Support Leaflet [PDF Document]
Parents Guide to Cyber Safety Book [PDF Document]
UK Council for Child Internet Safety Sexting in Schools and Colleges [external link]
NSPCC - Share Aware [external link]
Childnet works in partnership with others around the world to help make the internet a great and safe place for children to access the resources visit the Childnet website. [external link]
UK Safer Internet Council [external link]
Internet Matters [external link]
Think U Know [external link]
Kayleigh Heywood - Love Story [You Tube Video]
Lighthouse [external link]
SIMFIN - online safety and digital citizenship specialist [external link]
Multi-Agency Public Protection Arrangements (MAPPA)
Multi-Agency Public Protection Arrangements (MAPPA) are to address and manage violent and sexual offenders living in the community who pose a serious risk of harm.
MAPPA are designed to protect the public, including previous victims of crime, from serious harm by sexual and violent offenders.
MAPPA arrangements were introduced by the Criminal Justice Act 2003. Statutory safeguarding agencies have a duty to work together in partnership in dealing with these offenders, see further details below:
MAPPA National Guidance [external link]
MAPPA Information Sharing Briefing [PDF document]
Information for agencies working with people at risk from Domestic Abuse
A Multi-Agency Risk Assessment Conference (MARAC) is a regular local confidential meeting to plan how to help people at high risk of murder or serious harm in domestic abuse situations and address their ongoing safety.
MARAC provides a consistent approach to support victims of domestic abuse who are identified as at risk of serious harm. It puts in place various plans and actions in relation to the safety and well being of the identified person, and if appropriate, their children.
An Independent Domestic Violence Advisor (IDVA), the Police, Children's Social Care, Health Agencies and other relevant agencies come together to talk about the victim, the family and the perpetrator and share information.
The MARAC Process does not override pre-existing procedures within organisations where issues of Child Protection are concerned.
Additional information is provided below:
MARAC Procedure [PDF Document]
MARAC Guidance [PDF Document]
MARAC Referral Form [PDF Document]
National Mental Capacity Forum - Mental Capacity Act Competency Framework [external link]
It is known that children who go missing are at risk of suffering significant harm and there are specific risks around children running away and the risk or criminal or sexual exploitation.
Police define 'missing' and 'absent' in relation to children and adults as:
anyone whose whereabouts cannot be established will be considered as missing until located, and their well-being or otherwise confirmed. All reports of missing people sit within a continuum of risk from 'no apparent risk (absent)' through to high-risk cases that require immediate, intensive action.
The below DSP guidance provides details of what you need to do if you have concerns.
Additional Statutory Guidance.
The protocol is a Durham Constabulary initiative to help locate and safely
return a young person who is missing from a residential home/foster care as
quickly as possible when they are missing. The basis of the scheme is for vital information about the young person to be recorded on a form which can be used to locate them quickly. The form should then be stored safely either in electronic format or a printed version. The Police will then ask for the form, or the information recorded on the form, in the event of a child going missing.
See flyer for more information.
As well as threats to welfare of children from within their families, children may be vulnerable to abuse or exploitation outside of the family. Working Together to Safeguard Children 2018 highlights the importance of practitioners having awareness of additional vulnerabilities for children and young people who may be at risk of modern slavery.
Modern Slavery at a glance [PDF document]
Modern Slavery Referral Pathway [PDF document]
Modern Slavery: A Council Guide (Local Government Association) [External Link]
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 abuse. Once a child is born, neglect may involve a parent or carer 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 needs (WT 2018).
Additional definitions can be found on NSPCC website [External Link].
Neglect is the most common reason for Child Protection Plans in the United Kingdom. Analysis of Child safeguarding Practice Reviews has made the link between neglect and childhood fatalities. Neglect causes great distress to children and leads to poor outcomes in the short and long term. Consequences can include an array of health and mental health problems, difficulties in forming attachment and relationships, lower educational achievements, and increased risk of substance misuse, higher risk of experiencing abuse as well as difficulties in assuming parenting responsibilities later on in life.
For further information and guidance see Darlington Safeguarding Partnership Neglect Practice Guidance [PDF document] and Darlington Safeguarding Partnership Neglect Strategy 2017-2020 [PDF document]
Home Environment Assessment Tool (Health) [Word Document]
Was Not Brought Policy (Health) [PDF Document]
NHS England Was Not Brought Guidance [PDF Document]
NHS England - Pocket Guide to Safeguarding Children [external link]
NHS England - Pocket Guide to Safeguarding Adults [external link]
Complex (organised or multiple) abuse may be defined as abuse involving one or more abusers and a number of related or non-related abused children. The adults involved may be acting in concert to abuse children, acting in isolation or may be using an institutional framework or position of authority to recruit children for abuse.
Such abuse can occur both as part of a network of abuse across a family or community and within institutions such as residential settings, boarding schools, day care and in other provisions such as youth services, sports clubs, faith groups and voluntary groups. There will also be cases of children being abused via the use of electronic devices, such as mobile phones, computers, games consoles etc. which all access the internet.
Organised and multiple abuse is profoundly traumatic for children who are involved. Each investigation of complex and organised abuse will be different, according to the characteristics of each situation and the scale of complexity of the investigation. But all will require thorough planning, collaborative inter-agency working and attention to the needs of the child victims involved.
Information on Darlington's procedure can be found in the guidance below:
Organised and Multiple Abuse Procedure and Practice Guidance [PDF Document]
PREVENT is part of the Government's counter terrorism strategy CONTEST, its aim is to stop people becoming terrorists or supporting terrorism. It places protection around people vulnerable to radicalisation, stopping them from being drawn into terrorism - regardless of the ideology.
The Counter Terrorism and Security Act 2015 contains a duty on specified authorities in England, Wales and Scotland. The Government has produced a Prevent Duty Guidance for providers.
See also Prevent Strategy [pdf document]
The Government's CONTEST strategy [pdf document]
PREVENT has a strong link to safeguarding because vulnerable people can be susceptible to radicalisation and recruitment into terrorist organisations.
For more information about Prevent see the Lets talk about it website [external link]
Channel is part of the Prevent Programme. It's a voluntary, confidential, early intervention programme that supports people who may be at risk of being drawn into terrorism. See Channel Duty Guidance [PDF document]
Channel Panels were established under the Counter Terrorism and Security Act 2015 to assess the extent to which identified individuals are vulnerable to being drawn into terrorism and where appropriate to arrange for support to be provided. When assessing Channel referrals the Statutory Safeguarding Partners and the relevant partner agencies should consider how best to align these with assessments undertaken in accordance with the Children Act 1989.
The Children Act 1989 promotes the view that all children and their parents should be considered as individuals and that family structures, culture, religion, ethnic origins and other characteristics should be respected. Local authorities should ensure they support and promote fundamental British values of democracy, the rule of law, individual liberty, mutual respect and tolerance of those with different faiths and beliefs.
For further information and guidance and details of how to report a concern see Darlington Safeguarding Partnership PREVENT Practice Guidance and the Channel Process [PDF Document].
ACT Early (Counter-Terrorism Policing safeguarding website) is a dedicated safeguarding website and advice line from the specialists in Counter Terrorism policing. It provides advice, guidance and support for anyone who is concerned that someone they may know ay be at risk from being radicalised by terrorist or extremist content online.
ACT Early website [external link]
- Professional Challenge
- How should a practitioner make a challenge
- Threshold for reporting the use of professional challenge to DSP
The purpose professional challenge process is to establish processes to ensure a culture which promotes professional challenge is embedded across all agencies.
When working in the arena of safeguarding and child protection, it is inevitable that from time to time, there will be practitioner disagreement. Whilst this is understandable and generally acceptable, it is vital that such differences do not affect the outcomes for children and young people. This procedure provides a process for resolving practitioner disagreements and ensuring there is effective challenge in the system. It also provides practitioners with advice and support to enable them to escalate concerns where disagreements are not resolved at a practitioner level.
Professional challenge is a positive activity and a sign of good practice and effective multi-agency working. Being professionally challenged should not be seen as a criticism of the person’s professional capabilities.
Both national and local Child Safeguarding Practice Reviews (CSPRs) continue to draw attention to the importance of interagency communication and have identified an apparent reluctance to challenge interagency decision making with concerns that were not followed up with robust professional challenge which may have altered the professional response and the outcome for the child.
Disagreements can arise in a number of areas of multi-agency working such as:
- thresholds applications
- outcomes of assessments
- decision making; roles and responsibilities of workers
- service provision
- information sharing and communication in relation to practice or actions which may not effectively ensure the safety or well-being of a child or young person or his/her family
Professional challenge and critical reflection about the focus and intended outcome of intervention should include questioning and being open to professional challenge from colleagues, as well as being confident to challenge others.
Many professional challenges will be resolved on an informal basis by contact between the practitioner raising the challenge (or their manager) and the agency receiving the challenge and will end there.
Professional challenge is about challenging decisions, practice or actions which may not effectively ensure the safety or well-being of a child or young person or his/her family.
At no time must professional disagreement detract from ensuring that the child or young person is safeguarded. Any unresolved issues should be escalated with due consideration that might exist for the child. Every effort should be made to resolve the disagreement as quickly and openly as possible, within a time frame which clearly protects the child, determined on a case by case basis. Effective working together depends on resolving disagreements to the satisfaction of practitioners and agencies and a belief in a genuine partnership.
How should a practitioner make a challenge?
Concerned practitioner to speak to person who made original decision to express their view and discuss the basis of the decision. Record reason why to you do not agree and record reason for disagreement on case management file.
If the issue cannot be resolved at Stage 1 it should be raised with respective managers/named practitioner /designated safeguarding lead.
If manager deems appropriate, arrange an interagency meeting to discuss differing views. Agreement should be reached on who should attend. A clear record of the agreed outcome and any outstanding issues should be made.
If the issue cannot be resolved in Stage 3 the professional raising the concern should escalate to their Head of Service who will contact the relevant agency's Head of Service to attempt to resolve. With a decision to be reached as soon as possible ensuring the interest of the child taking precedent over professional stalemate.
If resolution cannot be found at Stage 4 the relevant Head of Service for the agency raising concern should raise the issue with the Chair of Darlington Safeguarding Partnership who will make the ultimate decision on the next course of action.
Threshold for reporting
The threshold for reporting professional challenge to DSP is when it becomes necessary to move to stage 5 above, because the issue cannot be resolved at stages 1 - 4.
To monitor the use of this procedure the following information should be provided to DSP Business Unit by the Named Person for the agency which raised the challenge:
- what was the challenge?
- what was done to address the challenge?
- what was the outcome of these actions?
- how was the issue resolved?
- are practitioners involved satisfied with the outcome?
- if resolution could not be achieved was the issue referred to the Darlington Safeguarding Partnership?
The areas of challenge, the use of this procedure and the outcomes will be reported to the Darlington Safeguarding Partnership and subsequently reported to the Statutory Safeguarding Partners (with equal and joint responsibility for safeguarding children) on a six monthly basis. Statistical information about professional challenge and the use of this procedure to address professional challenges will be reported in the Safeguarding Partnership Annual Report. The procedure will be reviewed in light of any feedback provided to the Darlington Safeguarding Partnership.
Further information is available in the Professional Challenge Procedure [PDF document]
Children have the right to be protected from abuse and harm so it is important that any organisation or group that works with them has a clear set of guidelines about how they will keep children safe and to respond to child safeguarding concerns.
DSP has developed a Safeguarding Policy check list which highlights key areas you should consider including.
DSP Model Child Safeguarding Policy check list [PDF document]
Additional information relating to those that work with children is outlined in the NSPCC policy guidance document below.
NSPCC Model Safeguarding Policy Guidance [external link]
Self-harm and suicide pathway and guidance [PDF Document] - children
NSPCC - find out how to spot the signs of self harm and what you can do to help [external link]
Darlington Mind can also offer further advice and guidance [external link]
Information for children is available on Young Minds website [external link]
Information for adults and children is available on Mind [external link]
Darlington Samaritans for further advice and support [external link]
Self Neglect and Hoarding Practice Guidance October 2021
This guidance had been developed to support those practitioners who are supporting adults with care and support needs who are at risk of harm as a result of self-neglect.
Self-neglect features in a significant number of national Safeguarding Adult Reviews (SARs), highlighting the fact that self-neglect is a complex area for intervention as issues of capacity, lifestyle and choice are often involved which requires the judgement of individual practitioners about what is an acceptable way of living and the degree of risk some lifestyle choices pose to the individual. The decisions often centre on whether the adult at risk has the capacity to make an informed choice about their lifestyle and the risks to which they are exposed.
This guidance sets out indicators of self-neglect and the role of Adult Social Care and multi-agency practitioners in assessing the needs of individuals and providing support in accordance with the requirements of the Care Act 2014. The practice guidance emphasises the importance of a robust capacity assessment; robust assessment of the degree of risk and proportionate intervention is the key to effective safeguarding. Often people who self-neglect present as making a capacitated choice when refusing to engage with services or accept help, but a more detailed assessment may indicate that the person’s decision making or executive capacity is impaired.
What is Self-Neglect?
Self-neglect is defined as covering a wide range of behaviours. A person may not be keeping themselves clean, neglecting to care for their own health or their surroundings, may refuse care or treatment for health and care needs, or could be hoarding various types of possessions to the point of being a risk. Someone may be unable to manage their personal affairs, for instance debt and bill.
Self-neglect is a continuum of behaviours ranging from moderate to severe. It may be unintentional, such as not eating due to memory issues. Where self-neglect gets out of control, including an inability to avoid or control self-harm, it can lead to a high risk of death or serious harm to the adult involved and to others’ health and safety.
There is no standard definition of self-neglect, but the Care Act 2014 Statutory Guidance provides the following definition: “Self-neglect covers a wide range of behaviour neglecting to care for one’s personal hygiene, health or surroundings and includes behaviour such as hoarding”
Social Care Institute for Excellence (SCIE) provides additional guidance on self-neglect – see Self-Neglect at a glance [external link].
The Care Act
The Care Act 2014 [external link]and Statutory Guidance introduced self-neglect as a category of abuse which now falls under the definition of causes to make safeguarding enquiries. Care and Support Statutory Guidance (2021) [external link] clarified that self-neglect may not always prompt a S42 enquiry and an assessment should be made on a case by case basis.
The adult at risk does not need to be eligible for social care services for a safeguarding enquiry to commence and the threshold of significant harm has been removed.
The statutory guidance identifies that it can be difficult to assess self-neglect. In particular, it may be difficult to determine if the person is making a capacitated choice to live in a particular way (which may be described as an unwise decision) or whether they lack the mental capacity to make the decision.
What causes Self-Neglect?
It is not always possible to establish a root cause for self-neglecting behaviours. Self-neglect can be a result of:
- a person’s brain injury, dementia or other mental disorder
- obsessive compulsive disorder or hoarding disorder
- physical illness which has an effect on abilities, energy levels, attention span, organisational skills or motivation
- reduced motivation as a side effect of medication
- traumatic life change.
Sometimes self-neglect is related to deteriorating health and ability in older age. People with mental health problems may display self-neglecting behaviours. There is often an assumption that self-neglecting behaviours indicate a mental health problem but there is no direct correlation.
There is no standard definition of self-neglect. Self-neglect is often defined across three domains:
- neglect of self and lack of self-care
- neglect of the environment
- refusal to accept help and support
Neglect of self may include:
- poor personal hygiene
- dirty or inappropriate clothing
- poor hair care
- poor diet leading to malnutrition or dehydration
- medical or health needs disregarded (for example refusing medication or treatment)
- refusing to allow access to health/and or social care staff in relation to personal hygiene and care
- alcohol or substance misuse
- eccentric behaviour or a lifestyle leading to harm
- social isolation
- situations where a child is at risk of suffering significant harm because of self-neglect by an adult
Neglect of Environment may include:
- unsanitary or dirty conditions which could result in serious harm to the individual or others
- situations which create a fire risk (for example hoarding)
- poor maintenance of property
- keeping lots of animals which are neglected
- lack of heating
- no running water or sanitation
- poor management of finances (leading to utilities being cut off)
All the above are often accompanied by a refusal to accept help or support. A key element is that risks to safety are high and many of the most significant challenges in self-neglect cases arise when individuals are reluctant to engage with services which might provide relevant support. This may be the result of an inability on the part of the individual to recognise the risks or take action to reduce risks. Sometimes there is an overlap between these factors and the issues become indistinguishable.
It is important to recognise that assessments of self-neglect and hoarding are influenced by personal, social and cultural values and practitioners should always reflect on how their own values may affect their judgement. Self-neglect concerns an individual’s lack of ability to manage their surroundings, personal care, finances or daily living skills to the extent that their health and safety or that of other people around them is compromised.
Types of Self Neglect: Hoarding
Hoarding is the persistent inability to discard possessions regardless of their actual value. This behaviour can have adverse consequences for the hoarder, family members or neighbours and fire risk is a particular hazard.
Hoarding is now widely considered as a mental health disorder and appears in the US ‘Diagnostic and statistical manual of mental disorders’ (5th Edition). Hoarding can sometimes relate to obsessive compulsive disorder but hoarding and self-neglect do not always appear together and one does not necessarily cause the other. Hoarding Disorder is distinct from the act of collecting and is also different from people whose property is generally cluttered or messy. It is not simply a lifestyle choice. The main difference between a hoarder and a collector is that hoarders have strong emotional attachments to their objects which are well in excess of their real value
The Diagnostic and Statistical Manual (DSM) uses the following criteria for diagnosing hoarding disorder:
- persistent difficulty with discarding objects or possessions, regardless of their actual value
- difficulties with discarding items are due to a perceived need to save the possessions and the distress it would cause
- accumulation of clutter that congests living areas and compromises the functioning of the living area
- presence of clinically significant psychological or emotional distress or impairment to social or work functioning (or any other area)
- the hoarding is not attributable to any other medical condition
- the hoarding is not better accounted by the symptoms of another mental health problem
Hoarding can lead to a reduced quality of life. The collection can lead to reduced living space and often limits private and family life for example by making it impossible to invite friends and family to the house because of fear and shame of the hoard.
Extreme hoarding can lead to serious risk to life through the possibility of the hoard collapsing and the risk of fire and a lack of means of escape. The hoard may prevent routine cleaning and may lead to infestation. Sometimes the hoard is so extreme that rooms become unusable and this may include the kitchen or bathroom. Fire risks increase when an individual tries to cook surrounded by inflammable materials. Neighbours can be placed at risk of fire or infestation. When the individual with a hoarding disorder is part of a family, normal family life is disrupted, and children can suffer harm by becoming socially isolated or having nowhere to store possessions or do homework.
Hoarding may become a reason to make safeguarding enquires when:
- the level of hoarding poses a serious health risk to the individual, other people within the household (including children) or to neighbours
- there is a high risk of fire
- there is a high risk of infestation
- hoarding is accompanied by other concerns of self-neglect such as inadequate nutrition
- hoarding may be linked to serious cognitive decline and lack of capacity to care for the home environment
- hoarding is threatening the individual’s tenancy and they are at risk of being made homeless through closure orders or possession orders
Responses to Hoarding
Many people who hoard have capacity in terms of making a decision about the issue and will often be torn between wanting a better quality of life and their psychological inability to let go of the hoarded items. In order to support a person with this disorder patient encouragement is required combined with therapeutic interventions such as counselling. The National Institute for Health Care and Excellence (NICE) recommends a course of Cognitive Behavioural Therapy (CBT) for adults who have significant problems with hoarding.
In some cases, support from a house clearance service may be useful but this is rarely successful in the long term, unless it is carried out sensitively with the cooperation of the individual. Otherwise house clearance can simply add to the trauma and intensify the need to start the collection again.
Some people who hoard may do so because they are experiencing cognitive decline because of dementia or another disorder which prevents them from being able to manage or discard possessions. It is important to obtain a history to establish whether the hoarding is long established and linked to a psychological disorder or whether it is linked to loss of cognitive capacity or learning disability. Establishing the reason for the behaviour will inform the best way to intervene.
The following responses to hoarding should be considered:
- a careful assessment of capacity and a needs assessment is essential to establish how best and on what basis to intervene
- when an individual has capacity, it is important to work with them and understand their wishes and feelings. If the individual lacks capacity to make relevant decisions a best interest decision may be necessary but should still take into account the wishes of the adult at risk as far as these can be ascertained
- if an individual has the capacity to make decisions about seeking help a referral to therapeutic or psychological services (with their consent) may be appropriate
- if the individual has the capacity to make decisions about seeking help a referral to psychological services (with their consent) may be appropriate
- working with the individual over a period of time to support them in clearing the hoard. This may involve targeted work with the individual on a plan to gradually clear the hoard and to support them in doing this
- if hoarding is present then please place a referral into County Durham and Darlington Fire and Rescue Service. The fire service will check smoke alarms are present and working in the property and provide alarms, free of charge, if required. The fire service will deliver advice to the occupant about home fire safety and discuss key challenges relating to hoarding behaviour. Further information available from Free Safe and Wellbeing Visit County Durham and Darlington Fire and Rescue Service (ddfire.gov.uk)
- if the individual lives in rented accommodation they may need support in liaising with the landlord if threatened with eviction
- the individual may need support to liaise with environmental services or pest control services
- if the individual lacks capacity with regard to managing their domestic environment they may need ongoing support with self-care and managing their domestic routine
- in cases of animal collecting, the practitioner will need to consider the impact of this behaviour carefully. Where there is a serious impact on the adult's health and wellbeing, the animals' welfare, or the health and safety of others the practitioner should collaborate with the RSPCA and public health officials. Although the reason for animal collecting may be attributable to many reasons including compensation for a lack of human companionship and the company the animals may provide, considerations have to be given to the welfare of the animals and potential public health hazards.
The National Institute for Health and Care Excellence (NICE) recommends that a period of Cognitive Behavioural Therapy (CBT) be considered for adults who have a significant problem with hoarding, for further details see NHS Guidance - Hoarding Disorder [external link].
For more information and guidance about hoarding see:
Self Neglect and Hoarding toolkit A guide for Practitioners [PDF document]
Hoarding (chart): clutter image rating [PDF document]
Effective Multi-Agency working
Self-neglect and hoarding can be a complex and challenging area for practitioners and it has become increasingly evident that a short-term case management approach is unlikely to be successful. Case studies of successful intervention with people who self-neglect demonstrate the need to employ traditional social work values of relationship building, gaining trust, listening to people assessing capacity at a decision making and executive functioning level, taking into account the history of the individual in understanding the self-neglect.
An adult who self-neglects may not always be at a level of risk which warrants adult safeguarding arrangements to be initiated. However, there are often many agencies and professions already involved with them before safeguarding concerns become significant.
It is imperative that all agencies work with the adult and each other to try and prevent individuals who self-neglect from getting to a point where it is deemed that safeguarding processes or a type of enforcement action is needing to be implemented to protect them. Even when safeguarding processes are initiated to protect the adult; the aim of these are to reduce the risk to the adult to the extent that safeguarding measures are no longer required.
Research in Practice for Adults (RiPFA) has developed a Practice Tool (2020) [external link] for working with people who self-neglect. (note: there is a charge to access these tools)
Research indicates that early intervention is more effective than waiting until the concerns become more severe and behaviour more entrenched. Rigid adherence to eligibility criteria may be counter-productive and lead to more intensive and intrusive support being required at a later stage.
Practitioners should be prepared to challenge individuals to consider the implications of self-neglect and to challenge them to demonstrate how they carry out the actions required (for example to go shopping and prepare a meal) rather than simply accept a verbal assurance that they will do what is required.
Intervention – raising a safeguarding concern
The starting point for all intervention should be to encourage the individual to do things for themselves. Where this fails in the first instance this approach should be revisited regularly throughout the period of the intervention. The response of the individual to this approach should be recorded. There must be a clear interface with adult safeguarding procedures and all action taken in respect of cases of self-neglect and must be in accordance with Darlington Safeguarding Partnership Multi-Agency Safeguarding Adult Procedures.
In making referrals to Adult Social Care or when following up concerns practitioners should gather sufficient information to inform an assessment of need. This should include:
- name, address and date of birth of individual
- details of GP, District Nurse/health Visitor
- information about social or family contacts
- whether the adult at risk lives alone
- whether the individual knows a referral is being made and have they given consent
- the nature of the concern and the individual’s views on this as far as this can be ascertained
- establish the adult’s views and wishes and their desired outcome
- relevant history of the adult at risk and previous safeguarding referrals
- whether this is an ongoing issue or whether there has been a sudden deterioration in the wellbeing of the individual
- whether children are at risk as a consequence of the adult’s self-neglect
- whether neighbours are at risk as a result of the self-neglect
Adult Social Care will screen all safeguarding concerns using the risk threshold practice tool to determine if it is appropriate to escalate to an initial Enquiry. More complex issues would require further coordination through a strategy meeting (S42)
Listed below are examples of questions to ask where there is concern about someone’s safety in their own home, where it is believed that there is a risk of self-neglect and hoarding. The questions should be adapted to suit the individuals and practitioners should be prepared to challenge the individual to demonstrate how they can carry out the action and not simply accept verbal reassurance.
- How do you get in and out of your property, do you feel safe living here?
- Have you ever had an accident, slipped, tripped up or fallen? How did it happen?
- How have you made your home safer to prevent this from happening again?
- How do you move safely around your home? (where the floor is uneven or covered, or there are exposed wires, damp, rot or other hazards)
- Has a fire ever started by accident?
- How do you get hot water, lighting, heating in here? Do these services work properly? Have they ever been tested?
- Do you ever use candles or an open flame to heat and light here or cook with camping gas?
- How do you manage to keep yourself warm especially in winter?
- When did you last go out in your garden? Do you feel safe to go out there?
- Are you worried about other people getting in to your garden to try and break in? Has this ever happened?
- Are you worried about mice, rats or foxes or other pests? Do you leave food out for them?
- Have you ever seen mice or rats in your home? Have they eaten any of your food or are they nesting anywhere?
- Can you prepare food, cook and wash up in your kitchen?
- Do you use your fridge? Can I have a look in your fridge? How do you keep things cold in the hot weather?
- How do you keep yourself clean? Can I see your bathroom? Are you able to use your bathroom and use the toilet and wash, bathe or shower?
- Can you show me where you sleep? Are you able to change your bed linen regularly? When did you last change them?
- How do you keep yourself warm at night? Have you got extra coverings to put on your bed if you are cold?
- Are there any broken windows in your house? Are repairs required?
- Because of the number of posessions you have, do you find it difficult to use some of your rooms? If so which ones?
- Do you struggle with discarding things or to what extent do you have difficulty discarding (or recycling, selling or giving away) ordinary things?
Assessment of Risk
It is the responsibility of all practitioners involved with the adult to conduct and record a risk assessment. A robust risk assessment of the degree of risk is vital and should include:
- whether the individual is refusing medical treatment or medication and whether this is life threatening
- whether there is adequate heating, lighting, sanitation and water in the home
- whether there are signs of malnourishment
- the condition of the home environment, whether it is in a poor state of repair and the presence of vermin or flies or a large number of pets
- whether there is evidence of hoarding or obsessive compulsive disorder
- whether there are concerns over the level of personal or environmental hygiene
- whether the adult is suffering from an untreated illness (including depression) or injury meaning that they are unable to self-care
- whether the adult has serious problems with memory or decision making, signs of confusion or dementia meaning that they are unable to self-care
- whether there are associated risks to children
- whether there are associated risks to others living in the vicinity
- whether there is a fire risk – consider items which may pose a fire risk, i.e. state of household appliances, candles, overloaded sockets or worn electrical wires, greatest risk factor is smoking when combined with alcohol or lack of mobility greatly exacerbates the risk – the fire risk significantly increases if these factors are associated with hoarding
- seek to establish a history of the life of the individual including trauma or losses to understand their situation
- Think Family: establish if the individual has dependent children and consider what the children are experiencing, and evidence shows that parental self-neglect impacts on children and other people in the household particularly if the adult at risk is the sole carer of the child.
Best Practice Guidelines
There is the need to balance and determine what is someone’s right and choice with what becomes a serious risk to the person and others. It is therefore, essential that agencies work collaboratively to support individuals at risk of self-neglect.
Effective and timely sharing of information including previous referrals and non–recent intelligence is essential. In respect of complex cases it may be necessary to hold a multi-disciplinary and multi-agency planning meeting to share information and formulate a safeguarding plan. It should be noted that self-neglect may not always prompt a section 42 enquiry, an assessment of risk should be made on a case by case basis. A decision on whether a response is required under safeguarding will depend on the adult’s ability to protect themselves by controlling their own behaviour and there may come a point when they are no longer able to do this without external support.
Take a creative and flexible approach and think about different ways to engage the adult for example, establish who might the best person be to try and engage. Ensure the adult has the necessary information in a format that they can understand and check they do understand their options and consequences of their choice. Consider who may help in these conversations such as a friend, family member or advocate.
Professionals must be prepared to not only challenge each other when disagreements arise about decision making but to challenge individuals in respect of their actions and refusal to engage in circumstances where self-neglect presents a high risk to themselves or others. Professional challenge is a positive activity and a sign of good professional practice and effective multi-agency working. For further information see Darlington Safeguarding Partnership Professional Challenge Procedure (Feb 2021)
When an agency makes a decision to withdraw services from an individual at risk of self-neglect at any stage this information must be shared with partner agencies as this will afford the opportunity for services still involved with the individual to monitor the situation and report any deterioration in living conditions or welfare as the result of a service being withdrawn and take appropriate action. It is essential that the local authority is informed of the decision whether the local authority is involved in the case or not.
It is essential that practitioners ‘Think Family’ and consider the needs and welfare of children who may be affected by issues of self-neglect by an adult, for example where the adult at risk is the parent or carer of a child. In all such cases a referral must be made to Children’s Social Care. Adult Social Care practitioners must work closely with Children’s Social Care in the assessment process, attend multi-agency meetings and consider how the self-neglect and home environment of the individual impacts on the welfare of the child and consider what life must be like for a child living with an adult who neglects to self- care or fails to care for the home environment.
Self-neglect is a complex area for intervention and practitioners have a duty to inform managers of cases involving self-neglect and to involve managers in the decision-making process. Managers have a duty to support practitioners in the assessment of risk, challenge of individuals who refuse to engage with services and to have management oversight of the decision making in cases involving self-neglect and the recording of the decision making.
Learning from Safeguarding Adult Reviews
Self-neglect has featured in a significant number of national Safeguarding Adult Reviews (SARs), highlighting the fact that self-neglect is a complex area for intervention as issues of capacity, lifestyle and choice are often involved which requires the judgement of individual practitioners about what is an acceptable way of living and the degree of risk lifestyle choices pose to the individual.
Learning from Local Review – Adult 2
Darlington undertook a Local Lessons Review in respect of an adult who was disabled and lived in their own home with their young child and was supported by a commissioned care package involving twice daily visits by a domiciliary care service which provided personal care and domestic support. Adult 2 was admitted to hospital with a life-threatening condition as a result of severe self-neglect caused by refusal to engage with the personal care element of the care package.
What did we learn:
- There was limited involvement from professionals with Adult 2 in the eight months prior to the hospital admission. The only agency regularly attending the home and seeing Adult 2 were a home care agency, commissioned by the council to provide daily personal and home care to Adult 2. It appears the domiciliary carers had no understanding of self-neglect and the safeguarding procedures which needed to be followed.
- This review acknowledged that the degree of Adult 2’s self-neglect was serious and life threatening. The risks to Adult 2’s health and well-being were not identified, capacity was assumed, and no information was shared at the time about the state of either the client or the home by those attending regularly. Support and advice should always be sought as to whether a service users self-neglect is a safeguarding issue.
- When providing a service to an adult or a child, professionals should be aware of who else is involved and what their roles and responsibilities are. When the agreed care is not being provided this must be communicated to home care agency managers and those who commission and pay for the service.
- All professionals working with an adult with care and support needs should systematically consider others living within the household in terms of ‘what is life like for them’ and understand the safeguarding risk to others. There was a child in this family home who appeared to be invisible to services and it was concluded he had not been adequately safeguarded by those providing care to his mother. Professionals did not ‘think family’, assumptions were made about involvement of children’s services and there was little evidence of professional curiosity about the child’s lived experience. Practitioners need to systematically consider the impact of any assessment, intervention and concern of a child living in the household, especially if the adult is the sole carer of the child.
- Once the safeguarding alert was made, Adult 2 was safeguarded and received good care and support to recover and to return home.
- This review has identified that both the adult safeguarding responses were not undertaken in a way that follows procedures and they did not consider the need to fully investigate the role of the agency which was seeing Adult 2 daily, or the impact on others within the household.
There are times when the impact of self-neglect on an individual’s health and wellbeing or their home conditions or the impact on the neighbouring environment are of such concern that practitioners are required to consider legal intervention when engagement and attempts at persuasion have failed. There are several key pieces of legislation that practitioners working with adults who self-neglect should be aware of and apply in their everyday practice.
In all circumstances work with people with care and support needs should be carried out in a way which is the least intrusive and restrictive and maintains choice, control and dignity. However, failure to take action to support or protect people at risk of harm can amount to negligence and a failure to preserve their dignity and wellbeing.
It is necessary for practitioners to have a primary level of understanding of these key pieces of legislation to ensure they are able make the appropriate interventions and to ensure that they act within the law at all times. Legal literacy is required to make effective decisions about safeguarding interventions and to evidence in recording that the decisions are defensible.
Practitioners need a good understanding of the relevant legislation which provides legal options for intervention when necessary, hyperlinks to each of them are shown below:
- Mental Capacity Act 2005
- Mental Health Act 1983
- Mental Health Act 2007 (Deprivation of Liberty Safeguards)
- Housing Act 1985
- Housing Act 1996
- Housing Act 2004
- Public Health Act 1936 (S 83-85)
- Environmental Protection Act 1990
- The Prevention of Damage by Pests Act 1949
- Crime and Disorder Act 1998
- Police and Criminal Evidence Act 1984 (S17)
- Anti-social Behaviour, Crime and Policing Act 2014
- Animal Welfare Act 2006
- Working Together to Safeguard Children 2018
Practitioners should also understand the following:
- Court of Protection
- Office of Public Guardian
- Inherent Jurisdiction of the High Court
- Human Rights Act 1998
Mental Capacity and Best Interests
When an adult at risk refuses to engage and appears to be at risk of serious harm and legal intervention is deemed necessary a detailed and specific capacity assessment of both decision making and executive functioning skills is crucial in establishing how best to intervene. A capacity assessment in these circumstances is not a one-off event but a series of repeated assessments to understand an individual’s ability to make informed decisions and to implement these decisions.
Mental capacity is a key consideration in determining what action may or may not be taken. Mental capacity is a complex attribute and when assessing mental capacity, it is important to recognise the difference between decisional and executive capacity. The former refers to the ability to understand and reason through the elements of a decision and is captured by the standard form of the capacity test under the Mental Capacity Act 2005. The latter refers to the ability to realise when that decision needs to be put into practice and successfully execute it at the appropriate moment and this is sometimes overlooked in capacity assessments. Mental capacity assessments must be time and decision specific.
When an individual has been assessed as not having the mental capacity to make specific decisions the Mental Capacity Act 2005 allows for agency intervention in the person’s best interests. In particularly challenging and complex cases or where someone disagrees with the best interest decision then it may be necessary for a referral to the Court of Protection. The Court of Protection [external link] has the power to make a decision on behalf of the individual to allow access to the adult lacking capacity. The Court of Protection can also appoint a deputy to make welfare decisions on behalf of the individual.
If an individual is assessed as having mental capacity this does not negate the need for action, particularly where the risk of harm is deemed to be serious or critical. In this situation the duty of care for professionals extends to gathering all the necessary information to inform a thorough risk assessment and subsequent actions. It may be determined that there are no legal powers to intervene, however, it must be demonstrated that risks and possible actions have been fully considered on a multi-agency basis
The Mental Capacity Act 2005 provides a checklist of factors that decision-makers must work through in deciding what is in a person’s best interests. A person can put his/her wishes and feelings into a written statement if they so wish, which the person determining capacity must consider. In addition, people involved in caring for the person lacking capacity have to be consulted concerning a person’s best interests.
You must always seek manager or legal advice if not sure about whether the individual has capacity to support any decisions around interventions.
Mental Capacity Act - 11 things to think about briefing [pdf document]
Additional Resources and Guidance
It is acknowledged this is a complex area and there is a raft of resources and advice and guidance on self-neglect which may support professionals working with people who self-neglect, details of some of those are shown below.
SCIE Guidance – Self neglect [external link]
Care Act 2014 – Care and support statutory guidance [external link]
Community Care Inform – Self-neglect knowledge and practice hub (please note subscription required) [external link]
DSP has developed a briefing document [pdf document] to highlight key areas of self-neglect.
Support for people who self-neglect - services that can provide help or support in Darlington
People who seriously neglect themselves of their home in a way that is dangerous may be reluctant to engage with some services, however they may accept help or advice from other services. There are services which can offer help and advice which are shown below:
Darlington Borough Council - Adult Social Care
Adult social care can help address some needs that are linked to or caused by self-neglect.
At point of contact, depending on information presented Adult Social Care will determine if this can be met through advice/guidance/signposting, initial assessment or a safeguarding enquiry.
First Point of Contact – telephone 01325 406111
Darlington Borough Council - Housing support and homeless prevention
Landlord Services, Housing Associations and Registered Social Landlords play an important role in supporting people who self-neglect. Tenancy Support Officers can help build relationships with tenants in an effort to support people who are in need to help them avoid losing their tenancy and becoming homeless.
Sometimes a combination of offers of support and clear messages about the consequences of non-cooperation, for example court applications to repossess a property or the use of a temporary premises closure order to manage a property back to a state of repair can help secure the engagement of the adult at risk.
Housing can provide support and advice for people who are homeless or sleeping rough. Help and advice on: finding a home; housing advice; social housing; sheltered housing; lodgings; supported living
Telephone: 01325 405333
Website: Darlington Borough Council find a home [external link]
Darlington Borough Council - Environmental Health
Provide environmental advice.
Website: Darlington Borough Council Environmental Health [external link]
Darlington Borough Council - Trading Standards
Provide consumer advice including information for victims of scams
Website: Darlington Borough Council Trading Standards [external link]
County Durham and Darlington Fire and Rescue Service
The Fire and Rescue service can assess fire risks and provide information on fire prevention. They carry out home safety visits, including joint visits with partner agencies.
Telephone: 0345 305 8383
Website: Durham and Darlington Fire and Rescue Service [external link]
Police – Durham Constabulary
If someone is the victim of crime or at risk of being the victim of crime the Police can investigate and advise on crime prevention
Contact details – non-emergency call 101 – emergency call 999
NHS Services, accessed via GP
Online or telephone advice on a wide range of health issues, including:
- Alcohol and substance misuse
- Emotional and mental health
- Health risks
- Staying healthy and living well
- Counselling Services
Local and Voluntary help and support
Dependent on issues associated with the individual, signposting and referrals could be made to the following:
- PHD Wellbeing Service
- 700 Club
- Substance Misuse - We Are With You (Drug and Alcohol Service)
- Darlington Citizens Advice
Darlington Living Well Directory [external link] provides information and signposting to a wide range of services.
The Care Act 2014 requires that the Local Authority must arrange where appropriate for an independent advocate to represent and support an adult who is the subject of safeguarding enquiry or community care assessment where the adult has ‘substantial difficulty’ in being involved in the process and where there is no other appropriate individual to support them. There is a difference between people who do not lack capacity and have substantial difficulty and people who lack capacity whereby the nature of their cognitive impairment means that they have substantial difficulty.
People who self-neglect and hoard may not agree to engage with an advocate any more than with any other professional. However, the need for advocacy should be considered and may be particularly relevant in circumstances where the situation may lead to sanctions, for example a landlord seeking a repossession order because the property is unsafe or poses a health hazard.
Telephone: 020 3239 1600
Website: Hoarding UK [external link]
Telephone: 0300 1234 999
Website: RSPCA [external link]
What is sexual abuse?
When a child or young person is sexually abused, they're forced or tricked into sexual activities. They might not understand that what's happening is abuse or that it's wrong and they might be afraid to tell someone. Sexual abuse can happen anywhere, it can happen in person or online. It is never a child's fault they were sexually abused and is important to make sure children know this.
Links to additional guidance on sexual abuse can be found below.
NSPCC guidance - sexual abuse [external link]
Lucy Faithful Foundation Resources [external Link]
Barnardo's [external link]
Stop it Now - Helping to prevent child sexual abuse [external link]
Centre for Expertise on child sexual abuse [external link]
Child Welfare Information gateway - Perpetrators of Sexual Abuse [external link]
Medical examinations for Child Sexual Abuse Concerns
The Centre for Expertise has developed a short film on medical examinations for child sexual abuse concerns to help practitioners better understand and explain the paediatric medical examination to support children and carers through referral processes.
The Child Sex Offenders Disclosure Scheme (CSODS) known as Sarah's Law was established following the abduction and murder of 8 year old Sarah Payne. Sarah's mother campaigned and worked with the home office to develop this disclosure scheme. The aim of the scheme is to allow anyone who has concerns about a child being at risk from a child sex offender, making an application to the police for further information to protect the child. Further details are available on the Durham Constabulary website [external link]
A guidance document has been developed to help raise awareness of sexual exploitation and a referral pathway which provides information on how to report it if you suspect someone is being exploited.
Sexual Exploitation Referral Pathway [PDF document]
A guidance document has been developed to provide information on what to do if you are concerned that presenting skin damage is due to neglect/self-neglect and/or poor practice. The guidance will support you to decide wither to refer through the Safeguarding Adult Procedure.
Skin Damage Protocol and Safeguarding [PDF document]
HM Government Guidance - Safeguarding Children from Abuse linked to a Belief in Spirit Possession [pdf document]
Babies are particularly vulnerable to abuse and any work carried out in the antenatal period can help minimise any potential harm if there is early assessment, intervention and support. All practitioners should understand how respond to concerns for an unborn baby and how to be involved in safe planning with multi-agency practitioners working together, with families, to safeguard the unborn through to birth.
Where practitioners become aware a woman is pregnant, at whatever stage of the pregnancy, and they have concerns for the mother or unborn baby’s welfare, or that of a sibling, it must not be assumed that Midwifery or other health services are aware of the pregnancy or the concerns held. All practitioners should follow their own agency’s child protection procedures and discuss concerns with the agency’s safeguarding lead in the first instance.
An assessment by Children’s Social Care must commence as early as possible where:
- concerns exist regarding the mother’s or father’s ability to self-care or protect
- alcohol and/or substance abuse is present and is likely to impact on both the parent(s) and the child
- there are professional safeguarding concerns regarding parenting capacity, particularly where the parents have either mental health problems, learning disabilities and difficulties or mental capacity issues
- the child is believed to be at risk of significant harm due to domestic abuse
- the expectant parent(s) are very young and a dual assessment of their own needs as well as an assessment of their ability to meet the baby’s needs is required; this includes young people under 16 for who there is a risk of Child Sexual Exploitation, trafficked or as a result of non-consensual sex
- a previous child in the family has been removed either permanently or on a temporary basis because they have suffered harm or been at risk of suffering significant harm
- a person who has been convicted of an offence against a child or adult, or is believed by child protection professionals to have abused a child, intends to join or has contact with the family
- an unborn baby has siblings subject to a Child Protection Plan or previously subject to a Child Protection Plan a person is subject to Multi-agency Public Protection Arrangements (MAPPA) need to be considered
- the parent is a Looked After child or has been previously looked after by a local authority
- any other concerns that the professional beliefs may place the unborn at risk of harm
Any such concerns should be addressed as early as possible before the birth so that a full assessment can be undertaken and support offered to enable the parent/s (wherever possible) to provide safe care (including before the pregnancy is confirmed).
Referral into Children’s Services - Where agencies or individuals anticipate that prospective parents may pose a significant risk for their unborn these should be referred to social care at the earliest opportunity.
For those unborn babies about which practitioners are concerned but which do not meet the criteria for Social Care Assessment, consideration should be given at the earliest opportunity to signposting to other agencies which are able to provide support. Practitioners should also consider the completion of an Early Help Assessment which will identify support requirements and ensure that the wellbeing of the unborn is at the centre of the assessment, allowing early support to be provided to reduce the risks to the unborn. An Early Help assessment is a holistic assessment that considers the child’s developmental needs, parenting capacity, environmental needs and level of risk. Practitioners will be able to gather new information and with the information they already know provide a multi- agency package of support for the baby and family via the Team around the Family process. The information gathered through this process is shared appropriately and can be used to help determine if an unborn single assessment through social care is required.
Where an unborn baby is likely to be in need of services from children’s social care when born, you should contact the Children's Initial Advice Team to discuss. Telephone 01325 406252
For further detailed guidance and a flow chart of the referral process see Safeguarding the Unborn Procedure and Practice Guidance [PDF Document].