2.4 Children with disabilities

Children with a disability are children first and foremost and are deserving of the same rights and protection as other children.  A child can be considered as having a disability if he/she has significant problems with communication, comprehension, vision, hearing or physical functioning.  By definition, any child with a disability may be eligible for assistance as a ‘child in need’. 

The Children Act 1989 s17(1) creates a general duty on children’s services authorities 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 authorities must promote the upbringing of such children by their families.

The definition of ‘children in need’ is to be found at CA 1989 s17(10), which provides that a child is to be taken as ‘in need’ if:

“(c) he is disabled.”

At subsection (11) the definition of ‘disabled’ for the purposes of CA 1989 Part III is given as follows:

‘For the purposes of this Part, a child is disabled if he is blind, deaf or dumb or suffers from mental disorder of any kind or is substantially and permanently handicapped by illness, injury or congenital deformity or such other disability as may be prescribed’.

Practitioners should also be aware of the definition of disability used in the Equality Act 2010 -

“A person has a disability if the person has a physical or mental impairment and the impairment has a substantial and long-term adverse effect on the person’s ability to carry out normal day to day activities.”

This definition is also used in the Children and Families Act 2014, which sets out duties of Education, Health and Social Care in respect of children with Special Educational Needs or Disabilities. It should be noted that children and young people with Special Educational Needs, may not be regarded as having a disability, but may be at additional vulnerability. Educational setting will have details of a child’s Special Educational Needs.

Safeguarding children with disabilities demands a greater awareness of their vulnerability, individuality and particular needs. A child with a disability can be more vulnerable to abuse than other children of the same age.

Children with disabilities are more vulnerable to abuse than children without a disability due to a number of reasons, including:

• They may have fewer outside contacts than other children.
• They may receive intimate care from a considerable number of carers, which may increase the risk of exposure to abusive behaviour and make it more difficult to set and maintain physical boundaries.
• They may have an impaired capacity to identify, resist or avoid abuse.
• They may have communication difficulties that make it difficult to tell others what is happening.
• Not all disabilities are visible, children may also face discrimination.
• They may be inhibited about complaining for fear of losing services.
• They are especially vulnerable to bullying and intimidation (see Bullying procedure).
• They are more vulnerable than other children to abuse by other children, particularly when out in public places due to being filmed due to behaviours or difference..

Additional factors may be:

• The child’s dependence on carers could result in the child having a problem in recognising what abuse is. The child may have little privacy, a poor body image or low self-esteem.
• Carers and staff may lack the ability to communicate adequately with the child.
• A lack of continuity in care leading to an increased risk that behavioural changes may go unnoticed.
• Lack of access to ‘keep safe’ strategies available to others.
• Children with disabilities living away from home (see Children Living Away from Home procedure) in poorly managed settings are particularly vulnerable to over-medication, poor feeding and toileting arrangements, issues around control of challenging behaviour, lack of stimulation and emotional support.
• Parents’/carers’ own needs and ways of coping may conflict with the needs of the child.
• Some adult abusers may target children with disabilities in the belief that they are less likely to be detected.
• Signs and indicators can be inappropriately attributed to disability.
• Children with disabilities are less likely to be consulted in matters affecting them and as a result may feel they have no choice about whether to accept or reject sexual advances.

Children with a disability should not be afforded a different standard of care as children without a disability.. In addition to the universal indicators of abuse/neglect, the following behaviours should be considered as abusive:

• Force feeding;
• Unjustified or excessive physical restraint;
• Restraint which may be more than the minimum required which may indicate a potential deprivation of liberty;
• Rough handling;
• Persistent carrying or handling children when alternative safe methods have been identified (i.e. carrying a child upstairs when an alternative has been provided);
• Extreme behaviour modification including the deprivation of food, medication, or clothing;
• Misuse of medication, sedation, heavy tranquillisation;
• Inappropriate use of invasive procedures;
• Deliberate failure to follow medically recommended regimes.
• Non-compliance with programmes or regimes;
• Failure to address ill-fitting equipment, e.g. callipers, sleep boards which may cause injury or pain, inappropriate splinting;
• Misappropriation/misuse of a child’s finances.
• Depriving the child of their liberty without due regard to their wishes and feelings (i.e. Including using reins, harness or lap belt or being locked in a room)

It should be remembered that children with disabilities are children first and foremost, they have the same rights to protection as any other child. People caring for and working with children with disabilities need to be alert to the signs and symptoms of abuse. See responding to abuse and neglect procedure.

Where there are concerns about a child with disabilities a referral should be made in accordance with the Referrals procedure. If there is a child without a disability in the family as well, all children should be assessed, not just the child with the disability.

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 service ‘is doing their best’. Carers will need to be challenged in the same way as carers of children without a disability.

When a local authority is assessing the needs of a disabled child, if they consider that a parent/ carer of the child may have support needs they must carry out an assessment of those needs.  In addition, any carer of a disabled child may require the local authority to assess their ability to continue to provide care for the child, this can be ascertained from a Child and Young Person assessment and a Carers Assessment. The wishes and feelings of the child must be ascertained as reasonably practicable and the process must take into consideration their communication needs.

Throughout any assessment (see Assessment procedure), including Section 47 enquiries, all professionals must ensure that they communicate clearly with the child with the disability and the family, and with one another. For children with Special Educational Needs or Disability there is likely to be a greater number of services and practitioners involved, a child’s education setting is the main point of contact for Education, Health and Care Plans. Every effort must be taken to avoid confusion so that the welfare and protection of the child remains the focus. Where there are communication impairments or learning difficulties, particular attention should be paid to the communication needs of the child to ascertain the child’s perception of events and his or her wishes and feelings. If the child has an Education, Health and Care Plan this should provide a helpful view of the child’s functioning, including how the child communicates and their cognitive skills and needs.

When multiple assessments are carried out under different legislation it is important to coordinate the assessments so that the child does not become lost between different agencies and different procedures. A Carers Assessment should be considered. If a child has an Education, Health and Care Plan (EHCP) or is going through an Education, Health and Care Needs Assessment (EHCNA) all agencies involved must contribute to the EHCP or EHCNA to ensure a full picture of the child’s SEND and detail the provision required to meet their needs, (this includes provision required from social care)

Safeguards for children with disabilities are essentially the same as for other children:

• Make it common practice to enable children with disabilities to make their wishes and feelings known in respect of their care and treatment.
• Ensure that children with disabilities receive appropriate personal, health and social education (including Personal, Social, Health Education [PSHE]).
• Make sure that all children with disabilities know how to raise concerns and give them access to a range of adults with whom they can communicate. This could mean using interpreters, advocates and facilitators who are skilled in using the child’s preferred method of communication.
• Ensure all professionals are aware of the child's communication passport and EHCP.
• 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 on the part of services.
• Ensure that guidance on good practice is in place and being followed in relation to: intimate care and ensure training for this is updated every 6 to 12 months and according to the changing needs of the child; working with children of the opposite sex; managing behaviour that challenges families and services; issues around consent to treatment; anti-bullying and inclusion strategies; sexuality and safe sexual behaviour among young people; monitoring and challenging placement arrangements for young people living away from home.

Carers are relied upon (whether family or paid carers) as a source of information about children with disabilities and to interpret and explain behaviour or symptoms. Professional staff can potentially feel out of their depth in terms of knowledge of a child’s impairment, where the familiar developmental milestones may not apply.

Children with disabilities should not be left in situations where there is a high level of neglect or other forms of abuse, because a professional feels the parent, carer or service is ‘doing their best’.

Carers will need to be challenged in the same way as carers of children without disabilities.

Any assessment of the needs of a  child with disabilities should consider the support needs of the carer(s). This may require a separate Carers Assessment.

Children’s social care and the police should be aware of the child’s preferred communication system, which may include Alternative and Augmentative Communication including talking boards, speech output software, Picture Exchange Communication System etc.  and should contact suitable interpreters and facilitators to tailor questions to the child’s level of understanding.

Agencies must not make assumptions about the inability of a child with a disability to give credible evidence, or to withstand the rigours of the Court process. Communication should be undertaken within the child using their preferred style or method of communication to gain their wishes, feelings and experience of abuse, instead of stating that a child is ‘non-verbal’

Each child should be assessed carefully and supported where relevant to participate in the criminal justice system when this is in their interests as set out in Achieving Best Evidence in Criminal Proceedings: Guidance on Vulnerable and Intimidated Witnesses (Home Office 2011), which includes comprehensive guidance on planning and conducting interviews with children and a specific section about interviewing children with disabilities.

Participation in all forms of meetings such as Child Protection Conferences and Core Groups must be encouraged and facilitated. The use of specialist advocates should be considered.

In a pregnancy where a disability has been identified such as Down’s Syndrome or Spina Bifida, for example, and there are concerns around the unborn baby, the local Pre-birth Assessment process should be followed.

Care Act 2014 c. 23

Transition for children to adult care and support

Consent to an assessment must be taken into consideration. The Mental Capacity Act 2005 states that a young person must be assumed to have capacity to consent, unless there is evidence which suggests otherwise. Therefore the practitioner must consider whether  the child has capacity or is competent to consent to a child’s needs assessment being carried out and whether the child does so consent; or whether the child lacks capacity or is not competent so to consent but the authority is satisfied that carrying out a child’s needs assessment would be in the child’s best interests. This could be determined via formal Mental Capacity Assessment (at the age of 16yrs onwards).

Children and young people with disabilities should be supported to have good quality adult lives which encourages their independence where possible and provides ongoing provision for this to happen. Local community resources should be explored so they are able to enjoy the same opportunities as their non-disabled peers. Good planning along with an inclusive approach towards their needs will assist in their transition and preparedness for adult life.

Practitioners should refer to their local guidance on how children and young people can be supported. There is also a useful online resource. If the young person has an Education, Health and Care Plan, this should specifically include provision to enable Preparation for Adulthood.

Advocacy

Advocacy is about representing the views, wishes and needs of children and young people to decision-makers, and helping them to navigate the system.’

For children and young people with disabilities it is important that a range of advocacy services are available to ensure that the child’s wishes, and feelings are heard and that they are helped to navigate systems that make decisions for and about them.

More information.

Deprivation of Liberty Safeguards

Consideration should be given as to whether a young person has been deprived of their liberty by the actions of the state, in certain circumstances legal action might be necessary to ensure that the deprivation of liberty is authorised. The law and caselaw around this is complex and help and advice can be obtained as per the local policies and procedures.

More information.

• Safeguarding Disabled Children: Practice Guidance
• Protecting Disabled Children: thematic inspection report (Ofsted)
• Reducing the need for restraint and restrictive intervention
• Working with disabled children knowledge and practice hub
• Children with speech, language and communication needs: quick guide