ABUSE AND DISABLED CHILDREN

In response to a dearth of information on the protection of children with disabilities in the UK, Pamela Cook, Consultant, Ann Craft Trust, Centre for Social Work, University of Nottingham carried out a research study, summarised here. Her recommendations may offer healthy food for thought to Irish social services and health boards.

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There is very little statistical information about the abuse of disabled children in Great Britain; we do not know how many have been abused, nor do we know what happens to them— what they receive in terms of service or interventions, and whether or how many of their abusers are identified and prosecuted. Existing research is sparse and government figures on child protection do not contain data on whether or not an abused child has a disability.

In these circumstances, how can local authorities be prepared to meet the needs of disabled children if they have no reliable information on the number of children with disabilities who are being abused, the degree or type of disability, or the kind of abuse they have suffered?

The aims of this research, which was funded by Children-in-Need, were:

  • to study current practices in recording the abuse of disabled children
  • to attempt to estimate the incidence of abuse of disabled children
  • to identify the outcomes for those disabled children who have been conferenced for abuse and compare the outcomes for children with disabilities with those of a small group of children without disabilities
  • to make recommendations to increase the competence of authorities to protect disabled children from abuse.
The research study

A questionnaire was sent to all Social Services Departments, through the Chairs of the 121 Area Child Protection Committees in England, Scotland, Wales and Northern Ireland. There were 73 returns (60-3%). Below is a summary of the questions and responses received.

  1. Do you have specific guidelines for the protection of children with disabilities? Twenty-four authorities (32.9%) had specific guidelines.
  2. When recording abuse do you record whether a child has a disability? Thirty-seven authorities (just over 50%) kept a record of disability.
  3. If you do, does this record give details on the type of disability? Of the 37 authorities above, only 33 (45.2%) recorded the type of disability.
  4. Do you record whether a sibling who may be at risk has a disability? Only 26 (35.6%) recorded whether a sibling who might also be at risk had a disability. It seems, from personal conversations I have had with social workers, that when children are registered for abuse, there is often no information about their disabled siblings.
  5. Are your records on computer? 61 authorities (83.5%) had computer records; 2 said ‘no’; one respondent did not know!
  6. Who maintains the record if the abused child is disabled? There was a real lack of consistency here. Thirty-seven authorities (50-6%) said they kept this record (see question 2), but only 35 (47.9%) replied to this question. Almost 50% of ‘these’ authorities, that is 23% of the whole, said that the Child Protection Team kept the record, but there was considerable variety in the rest. These included learning disability teams, and joint teams comprising child protection and learning disability, specialist disability teams, child and family teams, planning and administration teams.
  7. With regard to actual figures—although 50% of authorities said they kept a record, only 10 authorities (13.6%) could actually give a figure, and 44% made no return.
  8. What was the total number of reported cases of child abuse of all children for the previous year?

Only 45 authorities (61.6%) gave a figure (This is required by the Department of Health).

A more detailed consideration of the responses showed that having ‘specific guidelines’ on the abuse of children with disabilities’ made some difference with regard to the authority’s ‘recording of abuse’. Of the 24 authorities who had specific guidelines—i.e. beyond the usual guidelines for all children following the Children Act—64.5% recorded the abuse of children with disabilities, as compared with 42% of those authorities who did not have specific guidelines.

Recording abuse, however, does not necessarily mean that authorities can produce an actual figure, although again there was a slightly higher rate for authorities that had guidelines—17%, compared with 13% for authorities without guidelines.

The high percentage of returned questionnaires, however, seems to indicate that Social Services are concerned with this area of work. A number of authorities commented that they were in the process of improving their procedures—but at that time many did not identify whether an abused child had a disability or, when they did, were not able to abstract this information from the child protection record system—and many of the questions posed received incomplete or inconsistent answers.

Of the 45 authorities that said they did not have specific guidelines: 5 made further comment that they did not have guidelines separate from the child Protection Procedures already in place. Four of these could not give any figures with regard to disabled children, and one authority said that ‘our view is that there should not be separate procedures with reference to particular needs’, implying that to identify children as having disabilities was discriminating. This authority did not keep a central record on abused disabled children and gave no abuse figures.

In the second part of the research, schedules were completed for the total number of disabled children and young people conferenced by four Social Services Departments, in two city and two county areas, regarding allegations of abuse over one year from 1 October 1997 to 30 September 1998. Thirty-five schedules were completed for the disabled children and 17 for the non-disabled children, under the following headings: personal details (age, gender, parents, siblings, etc.), the type of disability, the type of abuse, what actions were taken, what interventions were offered, and those interventions wanted but not available. In addition, there was space for the social workers to make comment about the cases, the service and their training. Each young person was identified by a code number so that confidentiality was maintained.

The non-disabled children were matched for the type of abuse first and thereafter as closely as possible with regard to gender, age and home background.

There were more young males with disabilities abused (66%) than in the non-disabled group (53%), but the difference was not significant. The mean age for children with disabilities was 10 and it was 9 for the non-disabled group. Most of the young people in both groups lived at home, but in the disabled group 17% lived elsewhere, 1 lived in an adoptive home, 3 lived in foster homes, 1 lived with a maternal grandmother and 1 at a residential school. In the non-disabled group, all lived at home except 1 who lived with his mother in a mother-and-baby home. Also, while it did not register as significant, 57% of the disabled group had no father at home, as compared with 35% of the non-disabled group.

TYPE OF ABUSE RELATED TO DISABILITY + NON-DISABILITY

 DISABLED (number) NON-DISABLED   
ABUSESEVERE/PROFOUND

LEARNING DISAB.
MILD/MODERATE

LEARNING DISAB.
PHYSICAL

DISABILITY
 

%
 

(number)
 

%
SEXUAL311***143%741%
PHYSICAL4*6234%635%
NEGLECT2**3220%318%
EMOTIONAL--13%16%
TOTAL:9206100%17100%

* 2 also neglect
* 1 also emotional
* incl. 6 abusers with learning disabilities

Information with regard to the type of abuse and its relationship to disability and to the non-disabled group was identified (Table 1). The matching with regard to the percentage of type of abuse was very close between the disabled and non-disabled groups. Sexual abuse showed the highest rate of abuse, followed by physical abuse and then neglect. Emotional abuse was not reported at all for children with learning disabilities, except for one young person who was found to be both neglected and emotionally abused.

The response also showed that far more young people with learning disabilities were reported as being abused than those with physical disabilities (83%, compared to 17%). The numbers for mild to moderate learning disabilities, however, included six young abusers.

A possible connection appeared in the 7 cases of neglect of disabled children: 5 mothers were coping on their own; in the sixth case, both parents had moderate learning disabilities; in the seventh case, the mother was unsupported by her husband in the care of four children (he was only the father of the new baby). The Manager in one area felt quite strongly that earlier support should have been offered to the single mothers and to mothers/fathers who also had a disability, particularly a learning disability. She hoped that the continuum of care now being offered, would ensure more preventative work. In the non-disabled group also, the three cases of neglect included a mother coping on her own with four children, a mother with learning disabilities, and in only one case were there two parents at home without disabilities.

The research also showed that those most likely to be indicating concern for disabled children were their parents (26%) and teachers (26%), rather than social workers (3%) or health workers (11%). For non-disabled children, concern was raised/reported by 18% of their parents, 6% of teachers, but 18% by social workers and 24% by health workers.

Apart from their parents, the teacher may well be the person who spends most time with the child with a disability. This underlines the need to ensure that teachers, both in special and mainstream schools, obtain awareness training on the abuse of disabled children.

INTERVENTIONS

 DISABLED GROUPNON-DISABLED GROUP
Child Protection Register

(Child Protection Plan)
54%82%
Medical Investigation43%29%
Police Investigation54%53%
Legal Proceedings17%*18%
Therapy/Counselling23%35%
Medical Treatment20%12%
Change of Residence20%35%
Family Support Package46%59%

*6% re. adolescent abusers with learning disabilities

An analysis of the interventions (Table 2) indicated that there was a significant (p<0-0509) difference in relation to the Child Protection Register. 82% of non-disabled children were registered compared with 54% of disabled children—the latter were therefore less likely to be receiving a Child Protection Package. In other areas—such as receiving a family support package, or therapy, or a change in residence—there was a trend towards fewer interventions for disabled children. In police investigations and legal proceedings, the results were almost identical, although 6% of the legal proceedings concerned cases against adolescent abusers with learning disabilities. Only in the area of medical investigation/treatment were children with disabilities receiving more interventions. This did not, as expected, relate to the type of abuse, such as physical injury or sexual abuse. Questions might be posed whether this was because there were more serious signs of abuse, or because a child was unable to tell, or perhaps because these children were generally submitted to more medical interventions?

An additional issue appeared in the number of adolescents with learning disabilities presenting with sexually abusive behaviour. One young man faced legal proceedings in the civil court, one in the criminal court. There was also information which showed that they had clearly suffered severe sexual abuse in the past and, by comparison, their alleged offenders had not been apprehended, charged or suffered any penalties.

The third part of the study consisted of semi-structured discussions with eight of the key social workers for the abused disabled children, in order to add depth to the information given on the schedules. One of the eight social workers interviewed who had considerable knowledge and expertise in relation to learning disabilities, one was a member of the Deaf Team, one was part of a Children with Disabilities Team, and the other five were members of Child Protection Teams. All but one of them felt that children with disabilities were likely to be at a disadvantage in relation to abuse issues. As one worker put it: ‘the fact that they have a disability is seen first…’ and this seems to be crucial in the recognition, or possibly lack of recognition, of abuse. The disability may be identified rather than the abuse—bruising may be seen as a result of clumsiness; sexualised behaviour may be seen as being associated with a learning disability (they ‘tend to do that, don’t they’), rather than considering what might lie behind such behaviour or the age and understanding of the child concerned. It is extremely important to have awareness training on abuse indicators.

There may also be occasions where greater empathy is shown to parents or carers who are felt to be under particular stress. In one case, where it was eventually decided, though without the type of proof required for a legal investigation, that the foster parents had been physically abusing a disabled child who was unable to ‘tell’, the decision by the child protection manager to have the case reviewed by a social worker from another area was crucial. The social worker had not worked with the foster parents and had formed no relationship with them, so feelings of ‘it could not have been them’ were left out of the equation.

Although only two of the results in the schedules reached significance, most lent support to the comments made by the social workers who were interviewed: that they did not believe children with disabilities had the same opportunities as non-disabled children with regard to services, where abuse issues were concerned. All the social workers emphasised the need for training in relation to the abuse of children with disabilities, and most said they had received little training in this respect. Overall there was a feeling by the social workers that there is a tendency ‘not to see’ the abuse of disabled children. There are obviously a number of reasons for this, both conscious and subconscious, relating to lack of knowledge and support, but also because of the complications which may arise in such cases, including the cost in terms of time and resources.

These responses indicate the possibility that the abuse of children with disabilities may not be ‘recognised’ until the symptoms are gross. In addition, even when the cases are recognised and dealt with, poor recording often means that examples of good practice are lost and the times when work is less than satisfactory are not noted..

Recommendations
  1. The collection of national statistics on the abuse of disabled children as a subset of the child protection national statistics required by the Department of Health.
  2. Clear definitions of disability, agreed nationally, which will ensure that the collection of national statistics has reliability.
Recording
  1. Recording both on forms and on computer which identify whether a child being investigated for abuse has a disability and what that disability is.
  2. All staff to receive information and relevant training with regard to definitions of disability and forms of recording.
  3. A computer programme which can effectively extract statistical information on abused disabled children as a subset of all abused children.
Training
  1. Training on recognition, recording and responding to the abuse of disabled children needs to be included in qualifying social work programmes, with relevant updating during in-service training.
  2. A training programme on abuse awareness regarding disabled children which is included in pre-qualification for social workers, health workers, teachers and the police. This might be linked to national vocational qualifications.
  3. To integrate training on the abuse of disabled children into the new post-qualifying childcare award for social workers. To ensure that health workers, teachers and the police receive appropriate post-qualifying training on the abuse of disabled children which takes into account research information and their level of professional experience.
  4. Training for all social services staff on the interface between disability and abuse, so that child protection workers will be able to recognise the abuse of disabled children and disability workers will be able to work with child protection allegations. Workers will then also become more aware of the strengths each brings towards the protection of disabled children.
Communication
  1. The need to ensure that social workers are given training in appropriate methods of communication to enable protection work with disabled children.
  2. A clearly defined protocol to ensure better communication between child-protection teams and child-disability teams.
  3. Information on the resources available for disabled children in each area (collected nationally, this could provide material for ideas for all authorities).

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