Disabled & SEN children – advice for practitioners

Disabled children are up to three times more vulnerable to significant harm through physical, sexual, emotional abuse and / or neglect than their peers, because of factors relating to the child’s disability – such as their increased need for different carers and the intimate nature of the care that is needed.

Some ways in which vulnerability to abuse is increased:

• some children with disabilities will find it more difficult to communicate what they are feeling. Professionals are not always good at hearing / understanding what they are trying to say. This can also mean that they are less involved in decision making about their lives
• sometimes behaviour can be misinterpreted as being a consequence of a disability when in fact it is a sign of abuse
• a need for practical assistance in daily living
• intimate care from multiple carers
• a lack of continuity in care between different carers
• physical dependency of child for longer periods
• an increased likelihood that the child is socially isolated
• spending lots of time away from their families, in respite and short break services, residential schools etc.
• negative social attitudes towards children with disabilities can affect people’s willingness to believe that abuse has taken place
• sometimes the fact that a child is treated abusively can go unrecognised; for example, some methods of feeding, restraint, control or discipline may be permitted when in fact they are causing harm
• many disabled children from black and minority ethnic groups face double discrimination
• higher levels of bullying of disabled children can be classified as assault or abuse. Disabled children can be particularly vulnerable to cyber-bullying
• some cultures or faiths are unwilling to accept the disability as a medical problem but see the disability instead as a spiritual problem, curse or possession. This can lead to families to access spiritual care only, refusing to access medical and other recommended care, and in extreme cases may lead to practices such as witchcraft.

Children with disabilities may struggle to let people know they are being harmed. This can be due to difficulties they may have with communication. Other barriers to protecting disabled children include confusion of abuse indicators with symptoms of their disability.

Consideration should be given to how non-verbal communication is interpreted, and by whom.

Each child should be assessed carefully and supported where relevant to participate in the criminal justice system, particularly in relation to how they can be assisted to communicate, using appropriate communication facilitation techniques.

Other practitioners may be of help, there are:

• social workers who co-ordinate the transition to adults
• named child doctors / nurses who provide advice to staff about safeguarding issues
• Designated Officers who investigates any allegations about professionals and child abuse.

Signs of abusive or neglectful behaviours in carers
In addition to the usual indicators of abuse / neglect, the following abusive behaviours must be considered:

• restraining a child without knowing how to do so safely
• rough handling
• using inappropriate kinds of discipline, such as withholding medication or food, restricting movement or removing essential equipment
• using medication in a way that has not been medically advised, including sedation, heavy tranquillisation
• deliberate failure to follow medically recommended regimes
• misapplication of programmes or regimes
• invasive procedures against the child’s will
• invasive procedures that are carried out by people without the right skills or against a child’s will
• using badly fitting or inappropriate equipment (e.g. callipers, sleep board, inappropriate splinting) which may cause pain or injury
• force feeding
• undignified age or culturally inappropriate intimate care practices.

The NSPCC has published a report which identifies key issues about safeguarding disabled children. It looks at why disabled children are particularly vulnerable; examines the policy context and the current state of safeguarding services in the UK; and sets out recommendations for improving the protection of disabled children. The full report can be found on the NSPCC website at learning.nspcc.org.uk/safeguarding-disabled-children-england

The SEND (Special Educational Needs & Disability) Local Offer (or ‘Local Offer’) provides information for parents and carers in a single place. The Local Offer helps children, young people and their parents to understand what services and support they can expect from a range of local agencies – including their statutory entitlements.

Find out more in our SEND Local offer resource.

Families of children with a disability need a break now and then.

Parents may want to spend time with their other children or each other. They need to know their child is happy and well cared for.

MCC Children’s Services offer specialist advice to families and assess what the essential need is for children and families around short breaks. Their role is also to bring professionals together in meetings with the family to try and support children in their homes, encouraging everyone to be doing what the child needs and be a lead professional. Find out more on their website at manchester.gov.uk/short_breaks_for_carers_of_disabled_children

Sibs is the only UK charity representing the needs of siblings of disabled people. Siblings of disabled children and adults have a lifelong need for information; they often experience social and emotional isolation, and have to cope with difficult situations. Find out more on their website at www.sibs.org.uk

The site is designed to support parents in explaining a child’s disability to their siblings. It offers tips and advice for parents around what information should be shared (based on age and understanding), as well as looking at the impact disability can have on other children within the home.

The time of change from 13 or 14, up to 18 or 19 years of age (up to 24 years for some young people with very complex needs) is called transition.

Often a great many people need to be involved, so organising a transition plan which meets a young person’s needs can be a difficult business.

From age 14
Planning for transition should start in school at the beginning of Year 9 (the year in which the young person is 14). From this first meeting, the school Special Educational Needs Coordinator (SENCO) should hold meetings at least every year to discuss and plan future school, college, work experience or placement, or employment opportunities.

The first transition planning meeting can involve:

• the young person
• parents or other carers
• doctors, nurses and therapists
• social worker
• respite carer
• brothers, sisters or other family members, friends
• housing or welfare benefits advisor
• volunteers or workers from support groups
• and anyone else who can contribute.

They will try to work together so that full information is available to the young person about their options for the future.

Those people working directly with the young person will seek their views and aspirations and those of their parents. They aim to develop a transition plan that meets individual circumstances and needs as the young person gets closer to adulthood.

The young person will be given a copy of the transition plan and should be encouraged to look at it from time to time and think about changes they want at a later stage.

From age 16

• staff from all the agencies involved will meet to review the transition plans if the young person has complex disabilities
• this is especially important if the young person has been away at school or college, and plans to move back to the borough – the transition plans need to link back into local networks and checks made that service and support needs for them and their carer have been assessed
• although parents may not be invited to these meetings, they will be told if any changes to the transition plan need to be made.

Other changes at 16

• the young person will be responsible for consent and have the right to confidentiality over health matters
• the young person will need to apply for some benefits, such as Disability Living Allowance, in their own right and it will be paid directly to them
• parents should speak to a benefits advisor to see how their family income could be affected or call the benefit enquiry line on 0800 88 22 00.

Mental Capacity Act

• people of 16 and over have their right to make their own decisions and are protected by the Mental Capacity Act.

Changes at 17–18 years of age

• if parents are already receiving direct payments for the young person, they will be able to receive these in their own right and be able direct their own care
• if the young person is unable to undertake the responsibility of managing the payment, their parent could become their ‘third party’ and manage the fund on their behalft
  • the hourly rate will change at 18, the figure for adult services being lower than the children’s rate)
• if the young person is in receipt of a care package their parent’s needs as carer can now be assessed.

Changes at 18 years of age

• parents may need to discuss these issues with a social worker: their personal advisor or other key worker can refer them to the social work team or contact them directly
• if a young person has social care needs beyond age 18, their social care needs will be assessed as an adult. This is through a community care assessment, a copy of which is given to the young person and their carer
• only adults who are thought to have a critical or substantial risk to their independence receive care services
  • information about fairer access to care services will explain how this works.
• if a young adult is not eligible for support services, their social workers or care managers may explore what other options are available from local voluntary sector agencies.