Sometimes only one child is targeted by parents in a family; sometimes children feel like they are living in a war zone; sometimes a disclosure to social services is the only way of keeping the child safe.

This child experienced all these scenarios, though had the courage and the bravery to finally speak up, and bring safety to her life.

The government is not expecting a significant rise in social care referrals from introducing a duty on professionals to report child sexual abuse.

Its assessment came as it issued a consultative proposals to introduce mandatory reporting of CSA, which fall short of those put forward by the Independent Inquiry into Child Sexual Abuse (IICSA), in its final report, published last year.

The Home Office’s proposed duty would require those carrying out regulated activities with children to report CSA to the police or children’s social care, where they have personally witnessed it or it has been disclosed to them by the perpetrator or victim. Regulated activities include all unsupervised work or volunteering with children or work for specific establishments that gives the person the opportunity to have contact with children.

Failure to report would result in referral to the Disclosure and Barring Service, which could result in the person being barred from carrying out regulated activities. Professionally regulated staff, such as social workers, would also be subject to sanctions from their regulator body.

IICSA proposed the introduction of mandatory reporting to combat what it saw as systemic under-identification of CSA.

No requirement to report recognised indicators of CSA

The Home Office accepted the recommendation in April this year, subsequently carried out a “call for evidence” on the topic and last week followed this up with consultative proposals.

However, these differ in significant respects from those put forward by IICSA.

Firstly, while IICSA proposed that mandatory reporting should also apply in cases where the practitioner or volunteer observes “recognised indicators” of CSA, as well as when they witness it or it is disclosed to them, the Home Office has rejected this.

It said that this would have involved “subjective assessment of indicators”, and that it had received “strong feedback” that “recognising child sexual abuse is likely to be difficult for those without formal training or who see children infrequently”.

Criminal offence for failure to report rejected

Secondly, while IICSA said that a failure to report cases of witnessed or disclosed CSA should be a criminal offence, the Home Office has also rejected this, saying respondents to the call for evidence were split on the idea.

The government department said it was “not our intention for the duty to inappropriately criminalise those working with children, often in challenging circumstances”.

It added that “non-criminal sanctions might provide more proportionate penalties which take account of the different levels of responsibility and experience applicable to the wide range of people who undertake regulated activities in relation to children, including volunteers”.

However, it has proposed introducing an offence for anyone who deliberately obstructs an individual from carrying out the mandatory reporting duty, for example, through destroying or concealing evidence or coercion.

“More must be done to address the identification and underreporting of child sexual abuse, and we see the introduction of this duty as an important step in improving awareness and reporting cultures,” the Home Office said.

Mandatory reporting ‘will lead to significant rises in abuse cases’

In its final report, the inquiry said that evidence from other countries showed that the introduction of mandatory reporting led to a significant increase in the number of children identified as in need of protection, and that this figure was higher in jurisdictions with mandatory reporting than those without it.

While CSA referral rates to local authorities are not recorded in England and Wales, the inquiry said the evidence suggested they were small. In 2022-23, CSA perpetrated by an adult was identified as a risk factor following 18,810 children in need assessments (3.7% of the total), with CSA perpetrated by children found in 13,100 cases (2.6%) and child sexual exploitation in 15,020 (3%), latest Department for Education figures show.

IICSA accepted that the Working Together to Safeguard Children statutory guidance states that anyone with concerns about a child’s welfare “should make a referral to local authority children’s social care”, doing so immediately in cases of suspected significant harm, such as child sexual abuse.

But the inquiry stressed that this did “not impose a legislative requirement on those working with children to report child sexual abuse”, only setting an expectation that could be departed from in “exceptional circumstances”.

Government not expecting large referral rise

However, in an impact assessment on its proposals, the Home Office said that, while it expected there would be an increase in referrals to children’s social care due to the introduction of mandatory reporting, it did not expect this to be large, because of the existing requirement in Working Together.

The impact assessment modelled a 1%, 2% and 3% rise in the number of annual CSA referrals to children’s social care, with different estimates over the proportion of new referrals that were “precautionary”, where CSA was not then identified.

Based on this, its central estimate was that its proposal would result in an additional 575 children being assessed as having experienced CSA in the first year of its introduction, an average of just under four per local authority.

The Home Office consultation runs until 30 November 2023.

To respond, complete this online questionnaire.

Social Work Recap is a weekly series where we present key news, events, conversations, tweets and campaigns around social work from the preceding week.

From the Finley Boden case to how Fatima Whitbread went from looked-after child to champion and the children’s services with a history of failure that were rated good, here’s what you might have missed this week in social work:

Finley Boden’s parents convicted of murder

Finley Boden (photo: Derbyshire Constabulary)

The parents of Finley Boden, who died at 10 months old, just 39 days after he was returned to their care, have been convicted of his murder.

A post-mortem found that Finley, who died in the early hours of Christmas Day, 2020, had 71 bruises, 57 fractures and two burns on his body, caused by multiple, separate assaults. A paediatrician concluded he would have been in “severe and protracted pain” before his death.

Despite his injuries, his parents, Stephen Boden and Shannon Marsden, told paramedics that he had been poorly with a cold and high temperature. According to Derbyshire Constabulary, they had also previously been evasive with health practitioners and social workers.

A child safeguarding review is currently underway to examine agencies’ involvement with Finley and his parents.

You can read a full rundown of the case in our article.

Fatima Whitbread’s journey from child in care to Olympian

Photo by WikiCommons/LailaSohila

Former javelin champion Fatima Whitbread has opened up about her childhood in care and the trauma she experienced before she was saved by sport.

Speaking to the Guardian, Whitbread shared her story of being sent to hospital as a baby, after neighbours discovered her malnourished and dehydrated in a London flat.

She spent the next several years in children’s homes, describing a life of deprivation – physical and emotional – to the publication. From the age of 14, she was looked after by her javelin coach, who later adopted her.

Whitbread did not let her past define her. She went on to become an Olympic medalist and break the world javelin record – the first British athlete to set a record in a throwing event.

Today, she is an advocate of children in care, expressing a particular concern about young people leaving the system at 16.

“At 16, these are vulnerable kids. For a lot of [them], history starts repeating itself: they start getting in trouble, or offending, and it costs the state a whole lot more. […] Because once they get out there they’re easily preyed upon.”

BBC: adults assaulted at care home years before abuse uncovered at same provider’s child services

Photo posed by model: (credit: Tinnakorn/ AdobeStock)

Adults were abused at a Doncaster care home run by a provider in whose services child abuse was uncovered years later, the BBC has revealed.

The incidents, according to the BBC, included physical assaults, residents being found in soiled clothing, peer-on-peer abuse, use of tasers, and neglect, and were detailed in a 2010 Doncaster council report.

Hesley, the care home provider, said improvements were made to address the failings. However, the company was also the subject of a national inquiry into the serious abuse of disabled children in three of its residential special schools in Doncaster from 2018-21.

In a report last year, the Child Safeguarding Practice Review Panel found a culture of abuse and harm in the settings. This included evidence of physical abuse and violence, neglect, emotional abuse and sexual harm.

It also found evidence that medication was misused and maladministered, an overuse of restraint, and unsafe and inappropriate use of temporary confinement.

The BBC further revealed staff members accused of assault finding work elsewhere after the homes closed, failures to report abusive staff and months-long delays in verifying criminal records checks.

Last week, the panel published a follow-up report with recommendations on improving the safeguarding of disabled children in care. You can read about them in our latest article on the case.

Children’s services with history of failing services rated good

Image: DOC RABE Media/Adobe Stock

Birmingham’s children’s services have been upgraded to ‘good’ by Ofsted, after being branded ‘inadequate’ from 2009-18.

The progress comes five years after government intervention resulted in Birmingham Children’s Trust taking charge of the then failing services from Birmingham council. When the council’s children’s services were last inspected in 2018, they were rated requires improvement.

Ofsted found further improvement in its latest inspection, with children now “safeguarded through effective ‘front door’ arrangements, thorough child protection assessments and a strong response to safeguarding children at risk of exploitation”.

Other improved areas included manageable caseloads, children and young people being listened to and their physical, emotional and mental health needs being well considered.

However, the inspectorate still found areas for the service to work on, including the effectiveness of the response to domestic abuse, the need for earlier pre-birth assessments and the consistency of written plans.

You can read more about Birmingham’s journey from ‘inadequate’ to ‘good’ here.

Scotland: national social care service bill pushed back

Scottish Parliament building (photo: Heartland Arts/Adobe Stock)

The first vote on Scotland’s proposed national care service has been pushed back until after the Holyrood summer recess by new social care minister Maree Todd.

This is the second time the National Care Service (Scotland) Bill, which has been criticised for its lack of detail, has been pushed back. The first debate on the bill had been due to take place in March but, last month, was pushed back to June.

“We wish to use the time ahead of the stage one debate to find compromise and reach consensus with those who have raised concerns during the stage one scrutiny undertaken so far,” wrote Todd, in a letter to the Scottish Parliament committee studying the bill.

One of the changes under the bill would see adult social care and, potentially, children’s services transferred from local authorities to regional care boards, which would be responsible to ministers.

It is not yet clear when the Scottish Government now intends to hold the first vote.

Must watch: what does social work mean to practitioners?

To mark our tenth anniversary year as a charity, we spoke to our social workers about what social work means to them, and their experiences of making a difference in the lives of the children and families they work with. Their stories are authentic and inspiring. pic.twitter.com/NaTb6sUemk

— Frontline | Social work charity (@FrontlineSW) April 19, 2023

For its tenth anniversary, Frontline has put together an inspiring video of social workers describing what the profession and helping children and families have meant to them.

“The reason I’m still here is because I love my job,” said one social worker.

“There’s nothing I can imagine myself doing that is not social work based or social work related.”

Tweet of the week: Eid Mubarak!

#EidMubarak to my friends and colleagues celebrating #EidAlFitr today and tomorrow
These beautiful cards were made with love by @RaisingExp and have gone to people with learning disabilities and their families who celebrate with you, bringing colour and happiness to their lives pic.twitter.com/4bWB9VrZHV

— Elaine James (@ElaineLJames) April 21, 2023

Government safeguarding advisers set out a series of recommendations for improving care, social work practice, commissioning and regulation in residential services for disabled children and those with complex needs, in a report last week.

The study, from the Child Safeguarding Practice Review Panel, came in response to “very serious abuse and neglect” of children – mainly autistic or with learning disabilities – at three residential special schools registered as children’s homes in Doncaster, from 2018-21.

In a predecessor report published in October, the panel, while heavily critical of provider the Hesley Group for allowing a “culture of abuse and harm” to prevail at the schools, also found significant failings among the institutions responsible for oversight.

Failures of oversight

These included Ofsted, who had rated the settings as good as of 2021, despite receiving complaints dating back to at least 2015. But the panel also applied this critique to the 55 councils that placed 108 children at Fullerton House, Wilsic Hall and Wheatley House during the time studied, and Doncaster, as the ‘host’ authority.

In relation to the latter, the panel found major failings by Doncaster’s local authority designated officer (LADO) service, which received 232 referrals in relation to staff at the schools from January 2018 to March 2021.

The panel found that the Doncaster LADO function did not effectively collate information from different sources to analyse patterns of concerns about staff, and there was a lack of communication about staff conduct between it and LADOs at placing authorities.

In relation to those authorities, the panel found that quality assurance was inconsistent, with insufficient challenge of reports provided by Hesley or collation of evidence from different sources. This meant that practitioners did not have “a full picture of the children’s progress, welfare and safety”.

Some children ‘known only through written records’

The children were placed, on average, 95 miles from home, and, the review found, some were “known only through written records”, with limited capacity for practitioners to visit children placed so far away.

This was exacerbated by Covid and, potentially, high turnover of social workers, team managers and commissioning staff, though the panel highlighted good practice from some practitioners who travelled up to 200 miles so they could visit children regularly.

The panel’s work for the first report triggered a number of actions designed to address these issues.

Education secretary Gillian Keegan announced a review of the LADO role, with a view to consulting on “developing a LADO handbook that includes improving handling whistleblowing concerns and complaints in circumstances such as these”.

And, before the phase one report’s publication, the panel wrote to directors of children’s services, calling on them to ensure:

• LADOs urgently reviewed all referrals, complaints or concerns regarding residential special schools registered as children’s homes over the previous three years to ensure they had been appropriately dealt with.
• Reviews were carried out by placing authorities of children in these settings to ensure they were in safe placements, with any concerns being shared with the local LADO if the threshold for referral were met.

Several requirements were set for the latter, known as quality and safety reviews. These included ensuring the child was seen at home and school, talking directly to their families and checking if any safeguarding issues had been raised and that these had been followed up appropriately.

Fortunately, these reviews found that the vast majority of children were having their needs met, none was living in an unsafe setting and councils were taking appropriate assurance action when concerns had been raised about a placement, said the panel in its report last week.

Need for greater professional curiosity

However, the panel did find areas for improvement, including “the need for greater curiosity and challenge from social workers and independent reviewing officers in visit and review processes” to recognise the “inherent safeguarding risks” children faced in these settings.

“Practitioners in these roles also need the requisite skills to communicate with children with disabilities, complex needs and behaviour that challenges,” the panel added.

The panel also found the reviews had revealed an “urgent training requirement to ensure that practitioners understand the requirements for legally compliant practice” in cases where children were being deprived of their liberty.

Council and children’s home practitioners had not sought authorisation to deprive children of their liberty in cases where children were being subject to restrictive interventions, due to a lack of understanding.

Children in residential special schools registered as children’s homes are generally subject to multiple statutory review processes, being both looked after and having education health and care plans (EHCPs) for their special educational needs.

A positive outcome of the reviews, said the panel was that councils, along with health commissioners, were using them as a model for assuring themselves of placement quality, with come bringing together looked-after children and EHCP reviews for the children concerned.

The panel’s first report exposed the failure of monitoring bodies – Ofsted, placing authorities, to piece together the bits of the picture they each held about what was going on at the Hesley Group’s homes.

Proposed oversight role for host authorities

Consequently, a key priority set out in the second report was improving “systems for triangulation of intelligence, information sharing and
identification of risk in residential settings”.

The panel said that it saw host authorities and ICBs as key to bringing this intelligence together, and that they should have an enhanced role in doing so. One reason for this was that children at residential special schools, whether on term-time, 38-week placements or 52-week arrangements, were registered local ICB population.

It suggested a possible model for this role. This included:

• Having named officers in the local authority and ICB with responsibility, oversight and accountability for ensuring high quality care and health provision for children placed in the area.
• For those named officers to receive and review reports on settings by regulation 44 visitors – appointed by children’s homes to inspect them monthly – and six-monthly regulation 45 reviews of the quality of care by the provider.
• Ofsted and DfE regional improvement and support leads notifying host authorities and ICBs about whistleblowing reports and parental complaints.
• Having a maintained register of children living away from home in children’s homes, residential special schools, residential special schools registered as children’s homes, and children’s homes registered with both Ofsted and the Care Quality Commission.
• LADOs to monitor and analyse allegations and share information with placing authorities.

Ongoing LADO review

Meanwhile, the government’s review of the LADO role is ongoing.

In a statement on the panel’s phase 2 report last week, children’s minister Claire Coutinho said the DfE had been working on it with the LADO Network, which represents officers, Association of Directors of Children’s Services (ADCS), Home Office and Ofsted, among others.

The panel, in its second report, said it welcomed the DfE’s plan to develop a handbook on the key requirements of the role. It said these should include:

• an understanding of the inherent safeguarding risk factors associated with residential settings;
• a grasp of risks associated with ‘closed cultures’;
• the importance of multi-agency advice to the LADO to support decision making about whether thresholds for intervention have been met.

Though the panel concluded that most of its recommendations could be delivered by more effective use of existing resources, its plans to strengthen the oversight role of host authorities was one that needed additional resource.

Whether this will materialise will have to await the DfE’s full response to the report, due within the next six months.

In a statement last week, the lead reviewer for the report, Christine Lenehan, director of the Council for Disabled Children, spelt out her view of the consequences of the panel’s recommendations not being implemented.

“These recommendations set out a roadmap to more humane treatment of these children,” she said. “But without the wholehearted commitment to implement these measures fully, these failings will come back to haunt us when the next group of disabled children fall foul of services that cost the taxpayer dearly but rob vulnerable children of their basic humanity.”

Councils should have a bigger role monitoring local residential settings in their areas to better protect disabled children, an inquiry into the abuse of children in three services has concluded.

The measure is among nine recommendations designed to overhaul the safeguarding of disabled children and those with complex health needs in residential care, made by the Child Safeguarding Practice Review Panel today.

The panel also called for disabled children and those with complex needs to have access to advocacy, for services for them to be jointly commissioned by councils and integrated care boards, for joint inspections of services by Ofsted and the Care Quality Commission and for investment in the workforce.

Today’s report is the panel’s second into the abuse of children at three residential special schools registered as children’s homes run by the Hesley Group in Doncaster, between 2018 and 2021, and is designed to draw systemic lessons from the failures of care, safeguarding, regulation and oversight exposed in its first report, published in October 2022.

Lead reviewer Christine Lenehan, director of the Council for Disabled Children, said the report echoed findings from previous abuse inquiries and warned that, this time, its conclusions needed to be heeded.

‘Child protection failings will recur without government action’

“Earlier reports have catalogued how disabled children with a complex mix of autism and health needs can be locked away behind closed doors, often in placements far from their families, with little concern for their quality of life or futures.

“These recommendations set out a roadmap to more humane treatment of these children. But without the wholehearted commitment to implement these measures fully, these failings will come back to haunt us when the next group of disabled children fall foul of services that cost the taxpayer dearly but rob vulnerable children of their basic humanity.”

Claire Coutinho (photo: HM Government)

The government is due to respond to the report within six months but, in a written statement to Parliament, children’s minister Claire Coutinho said that the DfE’s separate reforms to children’s social care and special educational needs and disability “[laid] the foundation for improving outcomes for this group of vulnerable children”.

She added: “There is more that can be done to support and protect these children and we intend to focus our existing reform programme to ensure that they consistently receive the care and support that they need and deserve, enabling them to thrive and fulfil their potential.”

‘Safeguarding systems are not working’ 

For the Association of Directors of Children’s Services, president John Pearce said: “The National Panel’s review is a stark reminder that the systems currently in place to safeguard and support some of our most complex children and young people are not working, and of how far we need to travel to ensure that they do.

The panel has assumed that its recommendations can largely be financed through more effective use of existing resources across social care, health and education, with some additional resource required to fund improved quality assurance by councils and integrated care boards (ICBs).

However, Pearce warned that many of the nine recommendations would require “a significant multi-agency resource requirement to implement effectively and take time to achieve”.

“The impact that 13 years of austerity has had on our ability to offer the kind of local solutions that allow all children to remain in provision close to home and connected to their communities, wherever possible, cannot be understated,” he added.

“Demand for placements of all types far outstrips supply and profiteering takes money out of the system when it’s needed most,” said Pearce. “We face longstanding challenges around placement quality, sufficiency and cost.

Commissioner: ‘children must be consistently seen and heard’

Children’s Commissioner for England Rachel de Souza said: “At the heart of this report is the necessity of keeping the voices of children and families at the heart of their support, and of providing safe, suitable care where required. Where a child’s behaviour is seen as ‘challenging’, this is often evidence that their needs are not being properly met, which is why having trusted professionals, positive engagement from parents and independent advocates is essential to prevent crises.

“I am particularly pleased that this report recognises that children with disabilities have specific needs and risks which should be set out in statutory guidance. However, ultimately, children will only be kept safe if they are consistently seen and heard, through positive contact with their families, face-to-face visits from social workers, independent reviewing officers and health commissioners, and a greater level of professional curiosity from all those responsible for their care.”

By Andy Bilson

In a recent report, the Child Safeguarding Practice Review Panel (“the panel”) asked safeguarding partners to review their policies on bruising in non-mobile infants “to check for consistency with the evidence base and national guidelines.”

The panel acknowledges that there are a small number of children who are seriously harmed or die, where bruises have been seen by staff with a responsibility to protect children before more serious injuries have taken place. So why does the panel require these policies to change and what should they say?

Is a bruise ‘reasonable cause to suspect significant harm’?

My research with a colleague, published this week, reviewed policies covering 148 of England’s 152 local authorities and found most risked misleading staff by exaggerating the risk that a bruise was non-accidental. Almost a quarter treated any bruise in a pre-mobile baby as “reasonable cause to suspect significant harm” without any assessment of the case. Seven of these required all bruised babies to be investigated under section 47 of the 1989 Children Act and 28 required a strategy discussion.

The harm to children and families by this investigative orientation is discussed below.

Most standalone procedures had the rationale that bruising in pre-mobile babies was very rare and likely to be “highly predictive” of non-accidental injury. This view was used to justify removing discretion from frontline staff. It also orients staff towards thinking that such bruises are highly likely to be non-accidental. The evidence does not support this.

What the evidence on bruising says

Photo: Fotolia/aquarious83men

According to the panel, research shows that between 0.6% and 5.3% of children not yet crawling had an accidental bruise on any single observation. My article shows that the lowest finding would mean there would be almost 2,000 accidental bruises for every infant placed on a child protection plan for physical abuse. Further, a UK study found that 27% of pre-mobile babies had an accidental bruise over an average of eight weekly observations.

This challenges the idea that bruises alone are a reliable sign that physical abuse is ongoing or is likely and shows bruising is far from rare.

Research into parents’ explanations of non-accidental bruises in pre-mobile children found causes:

“… included bumping into mother’s tooth, falling asleep on a dummy, banging themselves with a fist or rattle and a toy that was dropped on one baby …[and] 12 children who had fallen or toppled over, 7 rolled into something, 4 banged into an object and 6 hit themselves with an object.”

Twenty three local authority procedures directly contradicted this, as in the following two examples:

“Infants do not bruise themselves by lying on a dummy or banging themselves with rattles and other infant toys or by flopping forwards and banging their heads against their parents’ faces.”

“Any explanation that any injury, barring a small scratch, is self-inflicted should not be accepted.”

These contradictions and exaggerations orient staff to believe that there is no valid explanation for bruises or that valid reasons cannot be accepted, reducing curiosity and exploration of alternative explanations. They lead to interventions, including child protection investigations and taking children into care, which can themselves harm children and families.

Harming children and families

For my latest article, we consulted four sets of parents who had been investigated because of bruises in pre-mobile children and found not to have harmed their child.

One family took their five-month-old to a hospital with what they thought was a rash on his knee, and were told that it was an unexplained bruise. The mother had to remain with her child for further examinations under threat that the police would be called and legal action taken. The examinations took four days, with the mother staying with her baby whilst the father cared for their 20-month-old child. The hospital carried out a full skeletal survey, involving multiple x-rays, along with a CT scan of the child’s head, which found no injuries. A social work investigation quickly found no reason for further action, but the local policy mandated repeating these tests two weeks later. This process was only halted when the parents employed a lawyer at considerable expense to challenge this because of their concern at the risk to their child of unnecessary exposure to the high levels of radiation.

Another parent, who lived in a local authority that mandated a child protection investigation for all bruises in pre-mobile babies, had her child removed for four months based on a small bruise on his arm, which she had pointed out to a health visitor. The child was breastfed and the mother continued to pump milk and deliver it to the child’s carer. She was given limited, supervised access, not even daily. Almost three years later, she still had flashbacks to her experiences and needed treatment for post-traumatic stress disorder.

Parents stressed that investigations caused significant harm to their children and them. In a case where a child was placed in care, her four-year-old sibling:

“…has gone from a confident little girl to a nervous wreck asking for [her sibling] all the time; hysterical if she can’t see a family member by her at all times (in the house or outdoors); saying don’t leave me, or don’t let anyone take me; waking up throughout the night.”

Related articles

• Pre-mobile infant bruising should not automatically prompt section 47s, say government advisers
• ‘Why the evidence does not support multi-agency child protection units’
• From parental blame to partnership with families: how to transform children’s social care

Image: Syda Productions

Parents and grandparents reported frequent bouts of crying, not sleeping, having nightmares and flashbacks. They worried that their child might be subject to further investigations or removed, long after their involvement with children’s services was over, and even experienced physical illnesses due to anxiety.

Parents were concerned at the effect of a record of an investigation remaining on file, including one couple who were considering adopting a child in the future. One parent worked in social care and was concerned that the investigation might affect their future career. These experiences fit with a range of research into children and their families’ harmful experiences of involvement in child protection.

All the bruises in these cases were initially unexplained and parents had voluntarily raised them with a medical professional because of concern about their child’s health. One child had a small bruise on their arm and was taken to hospital for tests and a section 47 investigation commenced. During the initial stages they continued to say that they did not know the cause of the bruise, a statement that the social worker said in their report was implausible. However,

“a day or so after our hospital stay we observed our son vigorously suckling his forearm … which we came to realise through our own online research could well be the cause of the mark.”

The hospital paediatrician accepted this as a reasonable explanation, validated by articles in medical journals. Despite this, it took two months to complete the investigation, a time during which the parents were extremely upset, unsettled and frightened. Thus, the lack of an explanation is not evidence that a bruise is likely to be non-accidental and more research is needed in this area.

It is also important to explore medical conditions that make a child susceptible to bruising. A video, made in response to my earlier research, graphically demonstrates the impact on a mother and her family when an infant’s susceptibility to bruises due to Ehlers Danlos Syndrome was not diagnosed speedily. Her son, Theo, was removed into care and remained there for more than a year. She says:

“Me, Theo and my mum are now in a hostel because we were made homeless … I had to leave my job in the end because of the stress. Me and Theo’s dad broke up because we became distant because of it all. We couldn’t stop arguing. We just lost everything!”

What policies should say

Photo: sepy/Fotolia

Staff will need to unlearn some of the messages of earlier policies and training, particularly that bruises in pre-mobile babies are not “highly predictive” of abuse and are not “extremely rare”. The Royal College of Paediatrics and Child Health should also change its statement that “accidental bruising is rare (0-1.3%)” to fit with the research quoted above.

I agree with the panel that no policies should mandate a child protection investigation or strategy meeting in every case, and a standard definition of pre-mobile should be agreed, based on developmental stage, not age. What Kemp et al’s research shows is that some children start to be mobile (crawling, bottom shuffling, cruising etc) from the age of four months and some babies start to roll before that age. They show that rolling is an important stage as babies who are not mobile but can roll had a bruise in almost 10% of observations, whilst before being able to roll, bruises were found in 2.2% of observations.

There are some key messages for policy which can be summarised as follows:

• Where a pre-mobile baby is bruised, staff should be curious and explore with parents the cause in a fair and balanced manner, considering whether the child has been abused.
• Whilst bruising is less common in babies who cannot roll or crawl than in mobile infants, accidental bruising is still many times more common than non-accidental injuries.
• Once a baby can roll the chances of an accidental bruise increase.
• A bruise alone is not sufficient cause to suggest a baby has been or is at risk of significant harm and does not reach the threshold for a child protection investigation, strategy discussion or interim care order without other indicators of risk of significant harm.
• Parents who have not harmed their child may not have a plausible explanation for bruising. This does not mean that there isn’t one, or that they are hiding abuse.

Panel recommendations 

The panel recommends:

• A review by a health professional who has the appropriate expertise to assess the nature and presentation of the bruise and any associated injuries, and to appraise the circumstances of the presentation including the developmental stage of the child, whether there is any evidence of a medical condition that could have caused or contributed to the bruising, or a plausible explanation for the bruising.
• A multi-agency discussion to consider any other information on the child and family and any known risks, and to jointly decide whether any further assessment, investigation or action is needed to support the family or protect the child. This multi-agency discussion should always include the health professional who reviewed the child.

It is prudent to check with other agencies if there is any cause to suspect abuse, but these multi-agency discussions will only help accurate decision-making if their members are aware of the mistakes and misleading content of earlier policies and training.

This request to review policies is an opportunity to improve the use of research and encourage an approach to families based on relationship building and curiosity. This change is particularly needed in the current climate of high stress and limited resources in children’s social care and health services.

Andy Bilson is emeritus professor of social work at the University of Central Lancashire 

Professionals need to engage better with male carers, backed by increased investment in children’s services, to reduce the risk of them harming their babies, government advisers have said.

Systemic weaknesses in how services operated often left fathers of babies “hidden, unassessed and unengaged”, found a report by the Child Safeguarding Practice Review Panel on cases of children under one seriously harmed or killed by male carers.

Poor engagement by universal services, such as midwives and health visitors, set a pattern for how targeted services, such as children’s social care, worked with male carers, found the panel. Too often professionals made “simplistic judgments” casting men as either ‘good’ – and able to be entrusted with their children’s care’ – or ‘bad’, to be kept at arms-length or, if possible, excluded from family life.

By contrast, mothers were generally seen in a more rounded way, with their strengths identified and a focus on enabling them to be the best parents they could be – with a failure to take this approach with fathers having a “catastrophic” effect, said the panel.

Experience of abusive parenting

While there was no “single identifier”, the review found a number of factors that heightened the risk of abuse, including men who had experienced abusive or neglectful parenting themselves, leading to poor mental health. This was often exacerbated by poverty, unemployment, racism, substance misuse, problematic relationships with mothers and domestic abuse, coupled with a rapid resort to violence when men experienced difficulties with others.

“It is in the combination of factors described here that risk occurs and secondly, the fact that too many men are not well engaged by services means that those risks go unidentified,” the review concluded.

The study drew on interviews with eight men serving prison sentences who had been found guilty of killing or causing serious harm to a baby; analysis of 92 cases involving death or serious harm to babies referred to the panel; an in-depth review of 23 of these; discussions with key stakeholders, and a review of relevant literature, carried out by the Fatherhood Institute.

Of the 92 children considered, 45 were known only to universal services at the time of the abuse, 24 were known to early help, 12 were open to social care as children in need and 11 were subject to child protection plans.

“This indicates that a significant proportion of these families and these men do not become visible to more specialist services until the abusive incident occurs,” the report said.

Factors behind dangerous behaviour

Interviews with the men serving prison sentences revealed many had difficulties in their childhoods, poor attachment histories, limited coping skills and problems with anger management. Six turned to substance misuse to self-medicate for mental health problems or to try to diminish the impact of traumatic thoughts and feelings.

“These factors and experiences coalesced to create behaviour that was very dangerous to the safety and wellbeing of the babies for whom they were caring,” the report says.

The report found children’s services often did not know who the fathers were nor the risks they presented to the child.

It quoted background research that fathers were invited to child protection conferences only 55% of the time; known violent fathers were not contacted by social workers prior to meetings 38% of the time and only 68% of completed assessments included contact with the father.

The report said ‘recurrent fathers’ – those who attended multiple care proceedings – were a particularly vulnerable group who had experienced disadvantages in their childhoods and more recently.

“Whilst they may pose a risk, they are themselves also at risk and need to be seen and treated as such,” it found.

Care leaver vulnerability

The report also raised particular concerns about care leavers, whose histories often exacerbated the challenges posed by being a young parent, poverty and social isolation.

It found there was not enough focus in children’s services on preparing care leavers for parenthood, and said it should be routine to carry out pre-birth assessments for all those about to become parents. This was not “to stigmatise them,” but to “ensure that the system responds as good corporate parents and enables them to become the best parents they can be,” it added.

The report found children’s services must be “much more alert” to the risks to children of parents that were angry, frustrated or had poor impulse control, especially when they were drug users.

It said children’s services frequently reported that they were aware of cannabis use in a family’s household but that it was “taken for granted and not seen as a major risk factor demanding assessment”.

“Behaviour patterns associated with addiction seem poorly understood and indicate that much more needs to be done to support children’s practitioners to understand and respond better to patterns of drug misuse, its impact on parenting and on the health and safety of babies,” it said.

Exclusion from adults’ services

The panel also found that adult mental health and substance misuse services often excluded these men from services through tight eligibility criteria, meaning issues around personality disorder, anger management or depression were not addressed.

“However, those are often the very factors that can present serious risks to children and often warrant statutory intervention” in children’s services.

“These adults can therefore represent an enormous financial and service demand on the system as a whole, let alone create the havoc, harm and sometimes tragedy that affects some children,” it added.

 ‘More investment in children’s social care needed’

The panel recommended that the government funds a mixture of local areas with different socio-economic, ethnic and cultural characteristics to develop models of good practice in working with fathers and then disseminate the learning.

This should include applying the family safeguarding model – in which specialists in domestic abuse, mental health and substance misuse work alongside children’s social workers to tackle the root causes of families’ problems – to practice with fathers. Pioneered in Hertfordshire and now being adopted by local authorities across the country, an evaluation last year found the model was “replicable and effective” in preventing children coming into care and reducing child protection plan numbers.

The panel also urged the government to pilot several areas to provide an “end-to-end, multi-agency integrated” service to tackle the issues identified in the review.

It said these schemes would need to:

• Integrate children’s services more with adults’ services, particularly mental health and substance misuse.
• Ensure that children’s social care services developed practice that improved their engagement and assessment of men involved in children in need, child protection and children in care services.
• Develop their leaving care services to ensure they addressed the need for preparation and support for parenthood.
• Develop their ante- and post-natal health provision to include fathers fully, provide extra support to those who need it and identify risk factors earlier.
• Integrate their response to the Domestic Abuse Act 2021, and identify how they would ensure a focus on the risks to babies and children and how they would work with perpetrators.

The report also called for the government to commission further research to improve understanding of the psychology and behaviour patterns of men who had physically injured babies, particularly around fathers’ backgrounds, characteristics and trigger factors for the abuse.

“Part of this research should be to explore the gender issues raised in this report, including why some of the experiences and factors described and which are experienced by men and women alike, can result in more men harming babies than women,” it added.