The safety and welfare of all children and young people is central to the Teenage Mental Health counselling service in Suffolk.

We are all responsible for the protection of children and all concerns about a child’s safety or well-being will be followed up and dealt with as quickly and as sensitively as possible.
We seek to ensure the safest possible environment for all children using the Teenage Mental Health service. Staff accept and recognise their responsibilities to develop awareness of any issues which cause children harm.

Principles
 
1: Teenage Mental Health is fully committed to providing high-quality therapeutic services to children and families.
 
2: The needs of a child are our first concern and we will always act to ensure their safety and protection. Our code of practice is outlined in Appendix 1.
 
3: The best results for children are achieved in partnership with their parents/carers and we will work in this way at all times, unless we feel that this could cause a child further harm.
 
4: All Teenage Mental health staff within the area of Child Protection Committee’s procedures and guidance; if we are concerned that a child is being abused or harmed in any way we will report this to the Social Services department.
 
5: Any help offered should be the best for that child or family and we will work openly and flexibly with parents/carers, children and other agencies to ensure that this happens.

6: We recognise some groups of children may be most vulnerable to abuse, for example disabled children, and the policy and procedure applies to all children irrespective of gender, ethnicity, disability, sexual orientation, or religion as set out in Teenage Mental Health’s equal opportunities statement.
 
7: Safeguarding will be put in place to maximise a child’s right to protection and children will know that they have the right to:

• Be safe – Teach children that everyone has equal rights. Tell children that no one should take away their right to be safe.

• Protect their own bodies – Children need to know that their body belongs to them.

• Say NO – Tell children that it is all right to say no to anyone if that person tries to do something to them that they feel is wrong. Most children are taught to listen to and obey adults and older people without question. Disabled children in particular are taught to be compliant.

• Get help against bullies – Bullies usually pick on younger children. Tell children to enlist the help of friends or say no without fighting and to tell an adult. Bullies are cowards and a firm, loud ‘no’ from a gang of children with the threat of adult intervention often puts them off.

• To tell – You must assure children that no matter what happens you will not be angry with them and that you want them to tell you of any incident that frightens or confuses them or makes them unhappy.

• To be believed – When children are told to go to an adult for help they need to know that they will be believed and supported. This is especially true in the case of sexual abuse which children very rarely lie about. If the child is not believed when he or she tells, the abuse may continue for years and result in suffering and guilt for the child.

• Not to keep secrets – Teach children that some secrets should never be kept, no matter if they promised not to tell. Child abusers known to the child often say that a kiss or touch is ‘our secret’. This confuses the child who has been taught to keep secrets.

Teenage Mental Health Child Protection Policy
 
Introduction

The purpose of this child protection policy is:
 
To ensure that all children using the Teenage Mental Health therapeutic services are kept safe and that concerns about a child are followed up in the correct way and to ensure everyone including parents/carers, the Teenage Mental Health staff, and children know what should happen and what is expected of them.

Keeping children safe and safe staffing 
 
Recruitment of Teenage Mental Health staff will follow the policy and procedures of Teenage Mental Health. This includes undertaking checks with the Criminal Records Bureau, health checks, and taking up two references. All appointments are subject to this vetting procedure and a probationary period.

Staff will be made aware of child protection procedures, health and safety and safe practice issues of part of their induction. All staff will be required to undertake basic child protection training. All staff will receive regular supervision from their identified line manager.

A risk assessment will be undertaken to ensure safe procedures for all staff. Please see appendix 2, this outlines appropriate behaviour when in contact and supervision of children.
 
If anyone has a concern about a member of staff or volunteer and their behaviour towards a child or children, the Director or Executive Director should be informed immediately. Appropriate action will then be taken to ensure the safety of children.
 
Safe environment

All premises and equipment used will be assessed to ensure safety and suitability. When children are attending the Teenage Mental Health therapeutic services the level and quality of staffing will confirm to the BACP Ethical Framework for Good Practice in Counselling and Psychotherapy and to the Code of Ethics and Practice for Counsellors. Our therapy takes into account the age, ability, and needs of the children attending and Teenage Mental Health ensures safety and supervision at all times.

Before a child enters therapy we will ensure that we have necessary information about the child including contact number for emergencies and parents/carers will also be given information about the service. When children are collected, we will only hand them over to the named adult, unless alternative arrangements have been arranged beforehand.
 
Children often need and enjoy close contact with those caring for them, staff will be aware of boundaries and will ensure when giving hugs or cuddles children are comfortable with this and that it is carried out in the open and with the presence of other adults. All workers will undertake first aid training and there will always be a trained first aider on the premises, all accidents will be recorded in line with Health & Safety regulations.

3: Dealing with and identifying concerns

Many concerns about children arise on a day to day basis, a child may have an accident at home or at Teenage Mental Health they may be tired, ill, or behaving differently. In most cases these can be dealt with quickly and easily by discussions between staff and parents/carers, further advice or help may be offered if needed. Where appropriate these may be recorded in the accidents and incidents log book and accident forms completed.

Sometimes concerns can be more worrying because it is clear that the child may be affected by what is happening to them. The child may be being harmed or hurt in some way.

There are many ways in which a child can be harmed;
 
Physical abuse

Physical abuse can include hitting, shaking, throwing, poisoning, burning or scalding, drowning, suffocating, or other wise causing physical harm to a child. Physical harm may also be caused when a parent/carers feigns symptoms or deliberately causes ill health to a child.
 
Neglect

Neglect is the persistent failure to meet a child’s basic physical or psychological needs, likely to result in the serious impairment of the child’s health or development. It may involve a parent/carer failing to provide adequate food, clothing and shelter, failing to protect a child from physical harm or danger, or the failure to ensure access to appropriate medical care or treatment. It may also include neglect of, or unresponsiveness to a child’s basic emotional needs.
 
Sexual abuse

Sexual abuse involves forcing or enticing a child or young person to take part in sexual activities, whether or not the child is aware of what is happening. The activities may involve physical contact, including penetration for example, rape or buggery, or none penetrative acts. They may include non-contact activities, such as involving children in looking at, or in the production of pornographic material or watching sexual activities or encouraging children to act in sexually inappropriate ways.

Emotional abuse

Emotional abuse is the persistent ill treatment of a child such as to cause severe and persistent adverse effects on a child’s emotional behaviour. It may involve conveying to the child that they are worthless or unloved, inadequate, or valued only in so far as they meet the needs of another person. It may feature age or development inappropriate expectations being imposed on the child. It may involve causing the child to frequently feel frightened or in danger, or the exploitation or corruption of the child. Some level of emotional abuse is involved in all types of ill treatment of a child, though it may occur alone. Please see Appendix 3 for full definitions of abuse.

Concerns about a child may come to the attention of Teenage Mental Health staff in a number of ways:
 
1: Through observation of the child. A child’s behaviour may indicate that it is likely that he/she is being abused.
 
2: The child may disclose abuse.
 
3: Information may be given by parents, other people, or agencies.
 
4: A child may show some signs of physical injury of which there seems to be satisfactory explanation.
 
5: Something in the behaviour of one of the workers or young person, or in the way the worker or young person relates to a child, alerts them or makes them feel uncomfortable in some way.
 
6: Observing one child abuse another.

There may be barriers to children telling, the power of relationships between adults and children should not be underestimated nor should the deliberate and skilled way that abusers target their victims. Children may not tell because:

1: Are scared because they have been threatened.
 
2: Believe they will be taken away from home.
 
3: Believe they are to blame.
 
4: Think that it happens to all children.
 
5: Feel embarrassed.
 
6: Feel guilty.
 
7: Don’t want to get the abuser in trouble.
 
8: Have communication or learning difficulties.
 
9: May not have the vocabulary for what happened.
 
10: Are afraid they won’t be believed.

11: Believe they have told maybe by dropping hints but haven’t been believed so don’t bother again.

Child abuse thrives on secrecy and needs to be handled in a sensitive, accepting way. In order to achieve this adults may have to overcome certain barriers also as:
 
1: Sometimes it may be hard to believe what the child is saying.
 
2: It may be difficult that the suspicion may be about some that is known.
 
3: ‘The fear of getting it wrong’.
 
4: The fear of what consequences there may be for ‘getting it wrong’ for the child, for the family, and for themselves.
 
5: Worry that it may make it worse for the child.
 
6: Believe that the services are stigmatising.
 
7: Simply do not want to be involved.
 
8: Do not have the necessary information on what to do or who to contact.

Responding to a concern

It is not the responsibility of Teenage Mental Health staff to investigate allegations or concerns but to identify concerns and pass them on to the Social Services or the Police. Teenage Mental Health staff do have a duty to follow TOTB CP procedures.

If a staff member has a concern about a child, they should:

1: Take appropriate action if the child is in need of urgent attention.

2: Collect as much information as possible about the situation – this may be from the child, parent, carer, or other workers and should include date and time of the incident or disclosure, parties who were involved, what was said or done by whom and any further actions. It may also be helpful to record perception of emotional and physical presentation.

3: Be open about the concern and make it clear they will have to tell others.

4: Take their concern to their line manager as soon as possible and within the same working day or session or go to another Teenage Mental Health manager if their manager is not available.

5: Complete the appropriate Teenage Mental Health form after discussion with the manager.

It is the responsibility of the Teenage Mental Health manager to consider the information and to decide what action needs to be taken. This should be clearly recorded on the form and if the manager needs help in making a decision, they should speak with a senior manager or with the child protection co-ordinator / duty officer at the Social Services. If no further action is considered necessary the reasons why should be documented and the form should be placed on file and recorded by administrative staff. Wherever possible parents/carers should be made aware of this record.

If the concern is to be managed within the Teenage Mental Health, either monitoring the situation or by working with the child and parents/carers on specific issues, it should be made clear to all relevant staff and to parents what is being done and what is expected of them. The manager should review what has been happening within an agreed period of time.

Referral to Social Services

An INOC form should be completed as far as possible; this will ensure that all the information is to hand when making the referral. The worker should not delay if all information is not available.
 
A referral should be made to the Social Worker involved with the family or to the Duty Officer, if the family’s Social Worker is not available or if no Social Worker is involved. The Teenage Mental Health worker and the Social Worker should agree what will happen next. The INOC form should be completed and signed and sent to Social Services within 24 hours of the telephone referral. A copy should be placed in the family file and a further copy given to the Programme Manager.

If a Teenage Mental Health worker is not already working with the family, the manager should identify a worker to follow up the referral and ensure any agreed action is taken.
 
The parents/carers of the child should be involved as far as possible, unless it has been decided that this would put the child at further harm. It should be clear about any decisions made and what will happen next. The manager should support the worker in making the decision and be available to give advice and guidance, as necessary.  

4: Working with Social Services and other agencies.

Teenage Mental Health provides universal, non-stigmatising therapeutic services to families with children over the age of 4. Families decide to use our services and attending any activities. If Social Services or any other agency have concerns about a child, the family can be encouraged or supported to use our services, but they do always have a choice to refuse.

We will always work within the principle stated ay the beginning of this policy; we will work with parents/carers in an open and honest manner and, as far as possible offer support which is flexible to meet the needs and wishes of the family. Parents/carers will be involved in making decisions and with any work or contact involving other agencies, unless this would put the child at risk. (See also our policy on sharing information).

Although Social Services may be the accountable body for the Teenage Mental Health therapeutic services, the therapeutic services is not part of the core Social Services Activities. Teenage Mental Health staff do not have statutory responsibilities, nor do they have access to information held by Social Services on their databases.
Teenage Mental Health does not carry out risk assessments on behalf of the Social Services, it may be possible to support families while they are going through an assessment, if they would like this to happen. If individual work to help a family is taken, the roles of each agency involved will be agreed and set out with the family, including what information will be recorded and shared. If a family attend community or group activity, they will be treated in the same way as any other family attending.

The sudden ending of services may also necessitate notifying local authority social services or similar agencies, such as educational institutions, about the unexpected termination of mental health supportive care. This is because, while Teenage Mental Health is not part of local authority frameworks for social or educational services, these agencies may assume we are providing support in their place when we are not. They may also wrongly believe we are seeing a patient when they are not, and would be able to report any concerns of the patients general care and wellbeing when not able. We cannot allow risk of patients falling through the gaps of safeguarding and care services. We have a duty of care to ensure all those in a position of care are aware of unplanned, sudden endings so they can adjust their supportive roles as required with this knowledge, if necessary.

Appendix 1
 
Code of Practice

Teenage Mental Health will:

• Treat all children and young people with respect

• Provide an example of good conduct you wish others to follow

• Respect a young person’s right to personal privacy / encourage young people and adults to feel comfortable and caring enough to point out attitudes or behaviours they do not like.

• Remember that someone else might misinterpret your actions., no matter how well intentioned.

• Recognise that special caution is required when you are discussing sensitive issues with children or young people.

• Challenge unacceptable behaviour and report all allegations/suspicions of abuse.

 
You must not:

• Have inappropriate physical or verbal contact with children or young people

• Allow yourself to be drawn into inappropriate attention seeking behaviour/make suggestive or derogatory remarks or gestures in front of children and young people.

• Jump to conclusions about others without checking facts

• Either exaggerate or trivialise child abuse issues

• Show favouritism to any individual

• Believe ‘it could never happen to me’

• Take a chance when common sense, policy, or practice suggests another more prudent approach

Appendix 2
 
Protecting Children and Staff
 
A: Contact with children
 
You can reduce likely situations for abuse of children and help protect your staff from false accusations by ensuring that everyone is that, as a general rule, it doesn’t make sense to:

• Spend excessive amounts of time alone with children, away from other.

• Take children alone in a car on journeys, however short.

• Take your children to your home.

When it is unavoidable that these things happen, they should only occur with the full knowledge and consent of someone in charge of the organisation and/or the child’s parent.
 
B: Relationships with children

You should make it clear to all your staff in your organisation that they should never:

• Engage in rough physical games including horse-play.

• Engage in sexually provocative games.

• Allow or engage in inappropriate language unchallenged.

• Make sexually suggestive comments about or to a child, even in fun.

• Let allegations a child makes be ignored or unrecorded.

• Do things of a personal nature for children that they can do themselves.

C: Restraint

Restraint is where a child is being held, moved or prevented from moving, against their will, because not to do so would result in injury to themselves or others or would cause significant damage to property.
Restraint must always be used as a last resort, when all other methods of controlling a situation have been tried and failed. Restraint should never be used as a punishment or to bring out compliance (except where there is a risk to injury).

Only staff who are properly trained in restraint techniques should carry it out. A young person should be restrained for the shortest period necessary to bring the situation under control.
All such incidents should be entered into the ‘Restraint Log Book’, detailing the facts of the behaviours, witnesses, who restrained the young person and how, what other methods had been tried and what follow up action took place.
 
A restraint policy applies to all young people equally, regardless of age or sex. It is acceptable for a member of the opposite sex to restrain a child because it is being used to prevent a serious injury. There should be a programme of training in place on restraint procedures.
 
D: Intimate care

It may sometimes be necessary for Teenage Mental Health staff to do things of a personal nature for children, particularly if they are very young or disabled. These tasks should only be carried out with the full understanding and consent of parents/carers. In an emergency situation that requires this type of help, parents/carers should be fully informed, as soon as reasonably possible.

In such situations, it is important that you ensure that all staff are sensitive to the child and undertake personal care tasks with the utmost discretion.

E: Relationships of trust

‘The inequality at the heart of a relationship of trust should be ended before any sexual relationship begins’ Caring for Young People and the Vulnerable? Guidance preventing abuse of trust (Home Office 1999).
This statement recognises that genuine relationships do occur between the different levels of staff and participants in a group but that no intimate relationship should begin whilst the member of staff is in a ‘position of trust’ over them.
 
The power and influence that an older member of staff has over someone attending a group or activity cannot be under-estimated. If there is an additional competitive aspect to the activity and the older person is responsible for the younger person’s success or failure to some extent, then the dependency of the younger member upon the older will be increased. It is therefore vital for staff to recognise the responsibility they must exercise in ensuring that they do not abuse their position of trust. Young people aged 16-18 can legally consent to some types of sexual activity; however, in some provisions of legislation they are classified as children.
 
In certain circumstances the ‘abuse of trust’ is a criminal offence (Sexual Offences (Amendment) Act) 2000 (UK wide).

Supervision of Children

Making arrangements for the proper supervision of children is one of the most effective ways of minimising opportunities for children to suffer harm of any kind whilst in your care.
 
Planned activities

• Organisers are responsible for the welfare and safety of the children for the whole time they are away from their home.

• All children should be adequately supervised and engaged in suitable activities at all times.

• In circumstances when planned activities are disrupter, e.g. due to adverse weather conditions, then organisers should have a number of alternative activities planned.

• Parents should be given full information about a trap, including details of the programme of events, the activities in which the children will be engaged and the supervision ratios. 

Supervision of children

• Leaders in charge must be satisfied that those working and adults who accompany group parties are full competent to do so.

• Children must be supervised at all times, preferably by one or more adults.

• Children must not be left unsupervised at any venue whether it be indoors or out.

• Staff should know at all times where children are and what they are doing.

• Any activity using potentially dangerous equipment should have constant adult supervision.

• Dangerous behaviour by children should not be allowed.

Appendix 3

Definition of Abuse

Recognising Child Abuse

Recognising child abuse is not easy, and it is not your responsibility to decide whether or not child abuse has taken place or is a child is significantly at risk, You do, however, have a responsibility to act if you have a concern. The following information is not designed to you into an expert, but it will help you to be more alert to the signs of possible abuse.

Physical abuse

Most children will collect cuts and bruises in their daily life. These are likely to be in places where there are bony parts of their body like elbows, knees, and shins.
Some children, however, will have bruising which can almost only have been caused non-accidentally. An important indicator of physical abuse is where bruises or injuries are unexplained or the exploration does not fit the injury, or when it appears on parts of the body where accidental injuries are unlikely, e.g. cheeks or thighs. A delay in seeking medical treatment when it is obviously necessary is also a cause for concern.
Bruising may be more or less noticeable on children with different skin tones or from different racial groups and specialist advise may need to be taken.
 
The physical signs of abuse may include:

• Unexplained bruising, marks, or injuries on any part of the body.

• Bruising which reflects hand marks or fingers (from slapping or pinching).

• Cigarette burns.

• Bite marks.

• Broken bones.

• Scolds.

Changes in behaviour which can also indicate physical abuse:

• Fear of parents being approached for an explanation.

• Aggressive behaviour or severe temper outbursts.

• Flinching when approached or touched.

• Reluctance to get changed, for example wearing long sleeves in hot weather.

• Depression.

• Withdrawn behaviour.

• Running away from home.

Recognising Sexual Abuse
 
Adults who use children to meet their own sexual needs abuse both boys and girls of all ages, including infants and toddlers.

Usually, in cases of sexual abuse it is the child’s behaviour which may cause you to become concerned, although physical signs can also be present. In all cases, children who talk about sexual abuse do so because they want it to stop. It is important, therefore, that they are listened to and taken seriously.
 
The physical signs of sexual abuse may include:

• Pain or itching in the genital/anal areas.

• Bruising or bleeding near genitals/anal areas.

• Sexually transmitted diseases.

• Vaginal discharge or infection.

• Stomach pains.

• Discomfort when walking or sitting down.

• Pregnancy.

Changes in behaviour which can also indicate sexual abuse include:

• Sudden or unexplained changes in behaviour, e.g. becoming aggressive or withdrawn.

• Fear of being left with a specific person or group of people.

• Having nightmares.

• Running away from home.

• Sexual knowledge which is beyond their age or development level.

• Sexual drawings or language.

• Bedwetting.

• Eating problems such as overeating or anorexia.

• Self-harm or mutilation, sometimes leading to suicide attempts.

• Saying they have secrets that they can’t tell anyone about.

• Substance or drug abuse.

• Suddenly having unexplained sources of money.

• Not allowed to have friends (particularly in adolescence).

• Acting in a sexually explicit way towards adults.

Recognising Neglect
 
Neglect can be a difficult form of abuse to recognise, yet have some of the most lasting and damaging effects on children.

The physical signs of abuse may be:

• Constant hunger, sometimes stealing food from other children.

• Constantly dirty or ‘smelly’.

• Loss of weight, or being constantly underweight.

• Inappropriate dress for the conditions.

Changes in behaviour which can also indicate neglect may include:

• Complaining of being tired all the time.

• Not requesting medical assistance and /or failing to attend appointments.

• Having few friends.

• Mentioning their being left along or unsupervised.

The above list is not meant to be definite but as a guide to assist you. It is important to remember that many children and young people will exhibit some of these indicators at some time, and the presence of one or more should not be taken as proof that abuse is occurring.

There may well be other reasons for changes in behaviour, such as death or the birth of a new baby in the family, relationship problems between their parents/carers etc.

Facts about abuse:

• Most children are abused by adults they know and trust.

• The reported cases of child abuse are just the tip of the iceberg of the cruelty, exploitation, and neglect to which children in our society are subjected.

• Disabled children are more vulnerable to abuse. They are more dependent on intimate care and sometimes less able to tell anyone or escape from abusive situations.

• Children very rarely make false accusations that they have been abused and in fact frequently deny the abuse or take back an accusation after they have made it.

• Children who talk about the abuse fear the consequences of telling – if things are bad, perhaps they may get worse.

• Abuse has serious long-term harm effects on children and young people. If untreated, the effects of abuse on children can be devastating and continue into adulthood.

• Social Services will only remove children where there is actual, or a risk of, significant harm and if the child is in real danger of further abuse.

• Child sexual abuse is equally as common among all social classes, professions, cultures, and ethnic groups.

• Child sex abuse is an abuse of power – it is an abuse of power adults have over children.

• In most reported incidents of sexual abuse the abuser is someone known to the child.

• It is not only men who sexually abuse children – women also abuse but the most commonly quoted figure is that around 90% of all child sex abuse is by men, most of whom are heterosexual.

• A child is never to blame for sexual abuse.

• There are rarely any obvious signs that a child has been sexually abused. Child abuse is very hard to ‘diagnose’, even for professionals.

• The majority of calls to help-lines from children relate to bullying.

• If unchecked, bullying can profoundly damaging to the victim in both the short and longer-term, emotionally, physically or both.

• Bullying can leave children with feelings of worthlessness and self-hatred; of isolation and loneliness.

• At its worst, bullying can result in a child attempting suicide.

• Violence between parents (domestic violence) can have a profoundly diverse affect on children, causing intense anxiety, fear, and occasionally physical injury.

• Recent research has shown that children’s development can be adversely affected by serious parental mental illness without appropriate or effective treatment, and by problem alcohol or drug abuse.

Appendix 4

Teenage Mental Health Ltd are a weekly talking therapy service for children and adults in mental distress. Whilst at all times we comply with our confidentiality policy in full we reserve the right to inform statutory authorities (such as social services or a child's school) if any of the following occurs:

• A child is suddenly removed from our care without prior notice. 

• A child has multiple unexplained absences or absences which are not congruent with the presentation of the child

• A child is removed from our care without full consideration of the needs of the child ie the child wishes to attend but it interferes with the parents timetable