protecting disabled children: systems maltreatment and neglect

Ofsted’s assumptions in their report Protecting disabled children: thematic inspection that “risks to disabled children are not well identified or that support effectively reduces risks and helps to keep them safe” appear to be based on some rather unreliable data. That doesn’t mean Ofsted wasted its time doing an inspection. But what concerned me about the report – in addition to the statistical analysis that triggered it – wasn’t so much what was said, as what wasn’t said about the risks to disabled children and support for them.

If we had robust data I’d be surprised if they didn’t show disabled children to be at an increased risk of maltreatment or neglect. That’s because of the risk factors involved. Many disabilities have a genetic component, meaning that other family members are more likely to have health or disability issues. Add to that the challenge of looking after a disabled child, the impact on siblings, the likelihood of a reduced income with increased expenditure and you have a situation where all those directly involved are likely to be vulnerable. But some protection from those risks can be offered by the community. Appropriate support from relatives, friends, neighbours and the local authority can make a big difference to families’ quality of life and thus reduce the risk of maltreatment or neglect.

Ofsted’s inspection focused on safeguarding and looked after children services in relation to disabled children. Nothing wrong with that focus, per se. But Ofsted also refers to more general support services that could have an impact on the safety and wellbeing of disabled children. In this post I want to examine some of the wider issues relating to child protection and support services for disabled children.

What does child protection mean?

‘Child protection’ is a term commonly used to refer to the protection of children from maltreatment and neglect by people they know well, like family members. There’s no doubt that children are most at risk from people they know well. That’s not because people who know children well are inherently more evil than people who don’t; it’s partly because not everyone who brings up a child is good at doing so, but also because children spend a great deal more time with people they know well, as distinct from with people they don’t. When that situation is reversed, historical evidence from children’s institutions suggests that the main source of risk to children changes accordingly.

‘Child protection’ can also refer to protection from people who work with children (hence Criminal Record Bureau checks), from strangers (hence ‘stranger danger’ warnings), and sometimes from other children (hence anti-bullying policies in schools). But ‘child protection’ is rarely used in the context of what the Australian government calls ‘systems abuse’, defined as:

preventable harm [that] is done to children in the context of policies or programs which are designed to provide care or protection. The child’s welfare, development or security are undermined by the actions of individuals or by the lack of suitable policies, practices or procedures within systems or institutions.

I’d broaden this definition by omitting the words ‘which are designed to provide care or protection’, since children can experience collateral damage from policies of any sort.

An example of what I mean was featured in a recent documentary shown on BBC 4 (unfortunately not currently viewable) entitled ‘Growing children: autism’. The last part of the programme shows footage of two young brothers, Jake and Zaine, both on the autistic spectrum. Their behaviour results in their mother spending much of her time protecting her shins. Zaine explains very clearly and persuasively why he doesn’t want to attend school (the people, the noise) but it’s no use, he has to go to school. (I’m not blaming his mother, incidentally, because her options might have been limited.) If a child had behaved like that at the end of the school day, rather than at the beginning, and said those things about going home, my guess is that social services would have been contacted. But despite much rhetoric about listening to the voice of the child (and s.17. 4(A) of the Children Act 1989 requiring the wishes and feelings of children in need to be ascertained in respect of service provision), the impact of some policies and programmes on children is simply ignored regardless of the distress and harm it causes, as many parents of children with disabilities and those children themselves can testify.

This is what Bronfenbrenner’s ecological systems theory highlighted; that children are most strongly influenced by people they come into direct contact with (for obvious reasons), but that the actions of people they never meet, such as decision-makers in organizations and national and international governments, can have a significant influence too – for good or ill. This brings me to the point about support services.

Support services

The Ofsted inspection involved 12 local authorities – that’s fewer than 10% of the total in England. Of the 12, seven had been judged ‘good’ and five ‘satisfactory’ in previous inspections of safeguarding and looked after children services (p.9). Ofsted wanted to look in detail at the ‘child’s journey through the system’, so it made sense to investigate authorities that were following procedures fairly closely, in order to identify shortcomings resulting from the design of the system rather than because of failures in implementation. Inspectors also met with “18 parents, 10 of whom had disabled children with child in need plans and eight of whom had children subject to child protection plans” (p.9). I couldn’t discover how many families were represented, but at best it was obviously a very small sample, an average of 1.5 per local authority inspected.

Ofsted’s focus is on safeguarding and looked after children services but several references are made to universal services. The introduction (p.7) begins:

When the national Aiming High for Disabled Children programme was being developed in 2007 by the previous government it was estimated that there were 570,000 disabled children in England. This programme put in place a range of support for disabled children and their families.”

Aiming high for disabled children

Let’s take a closer look at the Aiming High programme, as described in Aiming high for disabled children: better support for families, published jointly by HM Treasury and the Department of Education and Skills in May 2007 and signed off by Ed Balls, then Economic Secretary to HM Treasury and Andrew Adonis, then Parliamentary Under-Secretary of State for Schools. The Aiming High programme was the outcome of the Disabled Children Review, one strand of a Review of Children and Young People, in turn part of a Comprehensive Spending Review (CSR), undertaken by the previous Labour government. The CSR set government departmental spending plans and priorities for 2008-2011. (Aiming High p.10)

So what is the ‘range of support for disabled children and their families’ that the Aiming High programme put in place? The Aiming High report identifies three core areas, which I’ve summarized for brevity. You can read them in full on pp. 6-8 of the document.

Empowering disabled children, young people and their families

• a “core offer“ to make it clear what entitlements and services disabled children, young people and their families can expect

• piloting individual budgets

• spreading good practice on engagement such as parents’ forums

Promoting more responsive services and timely support

• a national disabled children indicator

• evaluation and benchmarking good practice on early intervention

• Local Authorities and PCTs will improve their data collection

• continuing the Early Support Programme

• a Transition Support Programme

Boosting provision of vital public services

• provision of short breaks for disabled children

• a childcare accessibility project

• a radical reform of community equipment and wheelchair provision and

• research the skills and behaviours required by the workforce and to identify gaps.

Funding was allocated to some of these areas and funding for short breaks and parent forums, for example, has been maintained by the coalition government. But how much of this actually constitutes ‘support’? And how much support is on offer? Feedback from parent groups and voluntary sector organisations suggests that parents who can access short breaks, specialist childcare and individual budgets value these services, but that provision varies and access is often limited. And although the Aiming High document repeatedly refers to improvements in educational provision, the Education and Skills Select Committee report on Special Educational Needs, published less than a year earlier, had described the SEN system as ‘not fit for purpose’. Little mention is made in the Aiming High document of medical provision except in the context of improving workforce skills and behaviours. More recent reports on the state of healthcare (Kennedy), social care (Munro) and education (Lamb) suggest that there is still considerable scope for improvement in terms of universal services for children with disabilities. This is somewhat at odds with the overall impression I got from the Ofsted report that despite some weaknesses in the system around prevention of maltreatment and neglect by parents and carers (paras. 104-8), most local authorities had good information about disabled children, a high level of commitment to supporting them, and offered a wide range of early support services (para. 15).

Clearly the quality of healthcare, social care and education services has a disproportionate effect on the development of children with disabilities and the functioning of their families. But the home is not the only source of child maltreatment and neglect. It could be argued that disabled children in England have always been subject to systems maltreatment and neglect because they have never had access to consistently high quality support that’s timely, appropriate and effective. Ofsted’s focus was on safeguarding and looked after children services. But a narrow view of what constitutes child protection, overlooking concerns about universal services raised in recent high-profile reports, and basing statistical analyses on assumptions and unreliable data doesn’t help to paint an accurate picture of the real level of risk to disabled children.

A fundamental principle of democracy is that everyone matters. A key indicator of the health of a democratic society is how it treats its most vulnerable members, and disabled children constitute one of the most vulnerable groups in our society. Disability can strike anyone at any time, which is why it’s so important to have timely, appropriate and effective interventions available. Such interventions can optimise the quality of life of disabled people and their families as well as increasing the likelihood that the disabled person and their carers will be able to work and reducing the cost of support and the interventions that are too little too late – outcomes dear to the heart of the current government.

Despite its obvious concerns about the wellbeing of disabled children, I felt the Ofsted report perpetuated their marginalisation by failing to consider the wider failings of systems that are supposed to offer support.