Recommendations

Recommendations in sections 1.1 to 1.3 are for anyone whose work brings them into contact with children, young people, parents and carers including those who work in early years, social care, health (including staff in A&E and health drop‑in settings), education (including schools), the police, the voluntary and community sector, youth justice services and adult services.

1.1 Principles for working with children, young people, parents and carers

Working with children and young people

1.1.1 Take a child-centred approach to all work with children and young people. Involve them in decision-making to the fullest extent possible depending on their age and developmental stage.

1.1.2 Use a range of methods (for example, drawing, books or activities if appropriate) for communicating with children and young people. Tailor communication to:

  • their age and developmental stage

  • any disabilities, for example learning disabilities, neurodevelopmental disorders and hearing and visual impairments, seeking assistance from specialists if needed

  • communication needs, for example by using communication aids or providing an interpreter (ensure the interpreter is not a family member).

1.1.3 In all conversations with children and young people where there are concerns about child abuse and neglect:

  • explain confidentiality and when you might need to share specific information, and with whom

  • be sensitive and empathetic

  • listen actively and use open questions

  • find out their views and wishes

  • check your understanding of what the child has told you

  • be sensitive to any religious or cultural beliefs

  • use plain language and explain any technical terms

  • work at the child or young person's pace

  • give them opportunities to stop the conversation or leave the room, and follow up if this does happen

  • explain what will happen next and when.

1.1.4 Make sure that conversations take place somewhere private and where the child or young person feels comfortable. Take account of any sensory issues the child or young person may have.

1.1.5 If your interaction with a child or young person involves touching them (for example, a medical examination) explain what you are going to do and ask for consent:

  • from them if they are over 16 (follow the Mental Capacity Act 2005) or under 16 but Gillick competent or

  • from their parent or carer if they are under 16 and not Gillick competent.

    If the child, young person or parent does not agree, respect their wishes unless touching them is essential to their treatment (seek legal advice first unless the need for treatment is immediate).

    For more guidance on seeking consent for medical examination in children and young people see the General Medical Council's 0-18 years: guidance for all doctors.

1.1.6 Produce a record of conversations with children and young people about child abuse and neglect, and any subsequent interventions as appropriate to their age, developmental stage and language abilities. This could be in writing or another format suitable to meet the child or young person's communication needs. Ensure that you:

  • Accurately represent their words, using their actual words unless there is a good reason not to, for example if this would include information about another child or young person.

  • Check that they have understood and agree with what is recorded (this could include both of you signing a written record) and record any disagreements.

1.1.7 Share reports and plans with the child or young person in a way that is appropriate to their age and understanding.

1.1.8 Clearly explain how you will work together with children and young people and do what you have said you will do. If circumstances change and this is no longer possible, explain why as soon as possible, and offer alternative actions.

1.1.9 Agree with the child or young person (if age appropriate) how you will communicate with each other. Give them contact details, including for services available out of hours. When contacting them:

  • be aware of safety issues such as whether a perpetrator of abuse may have access to a young person's phone

  • agree what will happen if you contact them and they do not respond, for example following up with their nominated emergency contact.

Working with parents and carers

1.1.10 Aim to build good working relationships with parents and carers to encourage their engagement and continued participation. This should involve:

  • actively listening to them, and helping them to deal with any emotional impact of your involvement with their family

  • being open and honest

  • seeking to empower them and engaging them in finding solutions

  • avoiding blame, even if they may be responsible for the child abuse or neglect

  • inviting, recognising and discussing any worries they have about specific interventions they will be offered

  • identifying what they are currently doing well, and building on this

  • making adjustments for any factors which may make it harder for them to get support, such as refugee status, long-term illness, neurodevelopmental disorders, mental health problems, disability or learning disability

  • being sensitive to religious or cultural beliefs

  • working in a way that enables trust to develop while maintaining professional boundaries

  • maintaining professional curiosity and questioning while building good relationships.

1.1.11 When working with parents and carers:

  • be reliable and available as promised

  • provide clear information about who to contact, including in an emergency

  • keep them informed, including explaining what information has been shared, and with whom

  • support people's communication needs, for example by using communication aids or providing an interpreter

  • agree records of any conversations, and share relevant documents and plans

  • be clear about the issues and concerns that have led to your involvement, and inform parents and carers if those concerns are resolved

  • be clear about the legal context in which your involvement with them is taking place.

Working with other practitioners

1.1.12 Coordinate your work with practitioners in other agencies so that children, young people, parents and carers do not need to give the same information repeatedly, in line with the Department for Education's advice on Information sharing: advice for practitioners providing safeguarding services.

Critical thinking and analysis

1.1.13 Present information critically and analytically and do not rely solely on protocols, proformas and electronic recording systems to support your professional thinking and planning.

1.2 Factors that increase vulnerability to child abuse and neglect

Vulnerability factors are factors that are known to increase the risk of child abuse and neglect. The presence of these factors does not mean that child abuse or neglect will occur, but practitioners should use their professional judgement to assess their significance in a particular child, young person or family. They should be considered in conjunction with the alerting features in section 1.3.

These recommendations add further detail to the Department for Education's What to do if you're worried a child is being abused about factors that increase vulnerability to child abuse and neglect.

1.2.1 Recognise that vulnerability factors can be interrelated, and that separate factors can combine to increase the risk of harm to a child or young person.

1.2.2 Take into account socioeconomic vulnerability factors for child abuse and neglect, such as poverty and poor housing.

Family factors

1.2.3 Recognise that the following parental factors increase vulnerability to child abuse and neglect, and that these may be compounded if the parent or carer lacks support from family or friends:

  • Substance misuse problems.

  • A history of domestic abuse, including sexual violence or exploitation.

  • Emotional volatility or having problems managing anger.

  • Mental health problems which have a significant impact on the tasks of parenting.

1.2.4 Recognise the following as vulnerability factors for recurring or persistent child abuse and neglect:

  • The parent or carer does not engage with services.

  • There have been 1 or more previous episodes of child abuse or neglect.

  • The parent or carer has a mental health or substance misuse problem which has a significant impact on the tasks of parenting.

  • There is chronic parental stress.

  • The parent or carer experienced abuse or neglect as a child.

1.2.5 Recognise that neglect and emotional abuse may be more likely to recur or persist than other forms of abuse.

Child factors

1.2.6 Be aware of the impact of a child or young person's age or gender on their vulnerability to child abuse and neglect, and the likelihood of recognition. For example, boys and young men may be less likely to disclose sexual exploitation (see also the Department for Education's guidance on Child sexual exploitation).

1.2.7 Recognise that disabled children and young people are more vulnerable to child abuse or neglect.

1.3 Recognising child abuse and neglect

These recommendations add further detail to What to do if you're worried a child is being abused on alerting features for child abuse and neglect.

Children and young people telling others about child abuse or neglect

1.3.1 Recognise that children and young people who are being abused or neglected may find it difficult to tell someone for the first time because:

  • they may have feelings of confusion, shame, guilt and of being stigmatised

  • they may not recognise their own experiences as abusive or neglectful

  • they may be being coerced by (or may be attached to) the person or people abusing or neglecting them

  • they may fear the consequences of telling someone, for example that no one will believe them, the abuse or neglect might get worse, their family will be split up or excluded by their community, or they will go into care

  • they may have communication difficulties or may not speak English fluently.

1.3.2 Recognise that children and young people who are being abused or neglected may not acknowledge this when asked, or may not want others to know.

1.3.3 Recognise that children and young people may communicate their abuse or neglect indirectly through their behaviour and appearance (see recommendations 1.3.12 to 1.3.47 and NICE's guideline on child maltreatment).

1.3.4 Take into account that when children and young people communicate their abuse or neglect (either directly or indirectly), it may refer to non-recent abuse or neglect.

1.3.5 Explore your concerns with children and young people in a non-leading way, for example by using open questions, if you are worried that they may be being abused or neglected.

1.3.6 Avoid causing possible prejudice to any formal investigation during early conversations about child abuse and neglect with children and young people by following guidance in the Ministry of Justice's Achieving best evidence in criminal proceedings.

1.3.7 If a child or young person tells you they have been abused or neglected, make a referral to children's social care using your local procedures. Explain to the child or young person who you will need to tell, and discuss what will happen next and when.

1.3.8 For people working in regulated professions (healthcare professionals and teachers), if a girl or young woman tells you they have experienced female genital mutilation (FGM), or you observe physical signs of FGM, you must report this to the police, in line with Home Office guidance on Mandatory reporting of female genital mutilation.

Supporting staff to recognise child abuse and neglect

1.3.9 Senior managers should ensure staff working in community settings, including education, can recognise and respond to child abuse and neglect and are aware of child safeguarding guidance relevant to their profession, for example the Department for Education's Keeping children safe in education.

1.3.10 Commissioners should ensure all practitioners working in primary care can recognise and respond to child abuse and neglect. Ways to achieve this include:

  • ensuring that newly qualified practitioners receive training in line with an approved training programme, for example levels 1 to 3 in the Royal College of Paediatrics and Child Health's intercollegiate training document. This should include an understanding of vulnerability factors for child abuse and neglect, such as parental mental health problems, alcohol and substance misuse

  • giving information to newly qualified practitioners, for example about local resources such as children's centres and parenting groups

  • giving practitioners advice on how to make a referral to social care.

1.3.11 For guidance on training health and social care practitioners to respond to domestic violence and abuse, follow recommendations 15 and 16 in NICE's guideline on domestic violence and abuse.

Alerting features for child abuse and neglect

This section describes indicators that should alert practitioners to the possibility of child abuse or neglect. It may be child abuse or neglect occurring now or that has occurred in the past. Note that physical injuries and other clinical indicators are covered in the NICE guideline on child maltreatment.

In this section we use 'consider' and 'suspect' (as defined in the NICE guideline on child maltreatment) to indicate the extent to which an alerting feature suggests child abuse and neglect, with 'suspect' indicating stronger evidence of child abuse and neglect.

How to use these recommendations

If a child is in immediate danger, refer to children's social care and/or the police. Otherwise, in response to any of the alerting features in this section, please follow the steps below in line with the Department for Education's Working together to safeguard children.

For all alerting features:

  • Seek advice from named or designated colleagues or your organisation's safeguarding lead.

  • Speak to the child or young person as detailed in recommendations 1.3.5 and 1.3.6, if this is age and developmentally appropriate and it is safe to do so.

For recommendations starting with 'suspect':

  • Discuss the need for a referral with children's social care using local multi-agency safeguarding procedures.

For recommendations starting with 'consider':

  • Look for other alerting features in the child or young person's history, presentation or interactions with their parents or carers, now or in the past.

  • Gather information from other agencies and explain to the family that this information is needed to make an overall assessment of the child or young person. If this is likely to place the child or young person at risk, seek advice from children's social care.

  • Make sure a review of the child or young person takes place, with the timing depending on your level of concern. Continue to look out for the alerting feature being repeated, or for any other alerting features.

After taking these steps, if your level of concern increases to 'suspect', discuss the need for a referral with children's social care. If you conclude that a referral to children's social care is not required, you may wish to undertake or make a referral for early help assessment in line with local procedures.

As highlighted in the recommendations below, alerting features for child abuse and neglect can be similar to behaviours arising from other causes, such as other stressful life experiences or neurodevelopmental disorders such as autism. However, practitioners should continue to consider the possibility of child abuse or neglect as a cause for behavioural and emotional alerting features, even if they are seemingly explained by another cause.

Practitioners should also recognise that alerting features may be due to non-recent child abuse or neglect. If the alerting features relate to past child abuse or neglect, but the child or young person is now in a place of safety (for example, in an adoptive family), assess the child or young person to see what support they and their parent, carer, foster carer or adoptive parent need to cope with the consequences of the child abuse or neglect.

Behavioural and emotional alerting features

1.3.12 Consider child abuse and neglect if a child or young person displays or is reported to display a marked change in behaviour or emotional state (see examples below) that is a departure from what would be expected for their age and developmental stage and is not fully explained by a known stressful situation that is not part of child abuse and neglect (for example, bereavement or parental separation) or medical cause. Examples include:

  • recurrent nightmares containing similar themes

  • extreme distress

  • markedly oppositional behaviour

  • withdrawal of communication

  • becoming withdrawn.

1.3.13 Consider child abuse and neglect if a child's behaviour or emotional state is not consistent with their age and developmental stage or cannot be fully explained by medical causes, neurodevelopmental disorders (for example, attention deficit hyperactivity disorder [ADHD], autism spectrum disorders) or other stressful situation that is not part of child abuse or neglect (for example, bereavement or parental separation). Examples of behaviour or emotional states that may fit this description include:

  • Emotional states:

    • fearful, withdrawn, low self-esteem

  • Behaviour:

    • aggressive, oppositional

    • habitual body rocking

  • Interpersonal behaviours:

    • indiscriminate contact or affection seeking

    • over-friendliness to strangers including healthcare professionals

    • excessive clinginess

    • persistently resorting to gaining attention

    • demonstrating excessively 'good' behaviour to prevent parental or carer disapproval

    • failing to seek or accept appropriate comfort or affection from an appropriate person when significantly distressed

    • coercive controlling behaviour towards parents or carers

    • lack of ability to understand and recognise emotions

  • very young children showing excessive comforting behaviours when witnessing parental or carer distress.

1.3.14 Consider child abuse and neglect if a child shows repeated, extreme or sustained emotional responses that are out of proportion to a situation and are not expected for the child's age or developmental stage or fully explained by a medical cause, neurodevelopmental disorder (for example, ADHD, autism spectrum disorders) or bipolar disorder and the effects of any known past abuse or neglect have been explored. Examples of these emotional responses include:

  • anger or frustration expressed as a temper tantrum in a school-aged child

  • frequent rages at minor provocation

  • distress expressed as inconsolable crying.

1.3.15 Consider child abuse and neglect if a child shows dissociation (transient episodes of detachment that are outside the child's control and that are distinguished from daydreaming, seizures or deliberate avoidance of interaction) that is not fully explained by a known traumatic event unrelated to maltreatment.

1.3.16 Consider current or past child abuse or neglect if children or young people are showing any of the following behaviours:

  • substance or alcohol misuse

  • self-harm

  • eating disorders

  • suicidal behaviours

  • bullying or being bullied.

1.3.17 Consider child abuse and neglect if a child or young person has run away from home or care, or is living in alternative accommodation without the full agreement of their parents or carers.

1.3.18 Consider child abuse and neglect if a child or young person regularly has responsibilities that interfere with the child's essential normal daily activities (for example, school attendance).

1.3.19 Consider child abuse and neglect if a child responds to a health examination or assessment in an unusual, unexpected or developmentally inappropriate way (for example, extreme passivity, resistance or refusal).

Sexual behavioural alerting features

For more guidance about responding to potentially harmful sexual behaviours, see NICE's guideline on harmful sexual behaviour among children and young people.

1.3.20 Suspect current or past child abuse and neglect if a child or young person's sexual behaviour is indiscriminate, precocious or coercive.

1.3.21 Suspect child abuse and neglect, and in particular sexual abuse, if a pre‑pubertal child displays or is reported to display repeated or coercive sexualised behaviours or preoccupation (for example, sexual talk associated with knowledge, emulating sexual activity with another child).

1.3.22 Suspect sexual abuse if a pre-pubertal child displays or is reported to display unusual sexualised behaviours. Examples include:

  • oral–genital contact with another child or a doll

  • requesting to be touched in the genital area

  • inserting or attempting to insert an object, finger or penis into another child's vagina or anus.

Alerting features for child physical neglect

1.3.23 Suspect child abuse and neglect if a child repeatedly scavenges, steals, hoards or hides food with no medical explanation (for example Prader–Willi syndrome).

1.3.24 Suspect neglect if you repeatedly observe or hear reports of any of the following in the home that is in the parents' or carers' control:

  • a poor standard of hygiene that affects a child's health

  • inadequate provision of food

  • a living environment that is unsafe for the child's developmental stage.

    Be aware that it may be difficult to distinguish between neglect and material poverty. However, care should be taken to balance recognition of the constraints on the parents' or carers' ability to meet their children's needs for food, clothing and shelter with an appreciation of how people in similar circumstances have been able to meet those needs.

1.3.25 Suspect neglect if a child is persistently smelly and dirty. Take into account that children often become dirty and smelly during the course of the day. Use judgement to determine if persistent lack of provision or care is a possibility. Examples include:

  • child seen at times of the day when it is unlikely that they would have had an opportunity to become dirty or smelly (for example, an early morning visit)

  • if the dirtiness is ingrained.

1.3.26 Consider neglect if a child has severe and persistent infestations, such as scabies or head lice.

1.3.27 Consider neglect if a child's clothing or footwear is consistently inappropriate (for example, for the weather or the child's size). Take into account that instances of inadequate clothing that have a suitable explanation (for example, a sudden change in the weather, slippers worn because they were closest to hand when leaving the house in a rush) or resulting from behaviour associated with neurodevelopmental disorders such as autism would not be alerting features for possible neglect.

Alerting features relating to child development

1.3.28 Consider neglect if a child displays faltering growth because of lack of provision of an adequate or appropriate diet. NICE has produced a guideline on faltering growth.

1.3.29 Consider current or past physical or emotional child abuse or neglect if a child under 12 shows poorer than expected language abilities for their overall development (particularly in their ability to express their thoughts, wants and needs) that is not explained by other factors, for example neurodevelopmental difficulties or speaking English as a second language.

Alerting features relating to interactions between children and young people and parents or carers

These recommendations assume that practitioners are seeing a parent or carer and child interacting.

1.3.30 Consider neglect or physical abuse if a child's behaviour towards their parent or carer shows any of the following, particularly if they are not observed in the child's other interactions:

  • dislike or lack of cooperation

  • lack of interest or low responsiveness

  • high levels of anger or annoyance

  • seeming passive or withdrawn.

1.3.31 Consider emotional abuse if there is concern that parent– or carer–child interactions may be harmful. Examples include:

  • Negativity or hostility towards a child or young person.

  • Rejection or scapegoating of a child or young person.

  • Developmentally inappropriate expectations of or interactions with a child, including inappropriate threats or methods of disciplining.

  • Exposure to frightening or traumatic experiences.

  • Using the child for the fulfilment of the adult's needs (for example, in marital disputes).

  • Failure to promote the child's appropriate socialisation (for example, involving children in unlawful activities, isolation, not providing stimulation or education).

1.3.32 Suspect emotional abuse if the interactions observed in recommendation 1.3.31 are persistent.

1.3.33 Consider emotional neglect if there is emotional unavailability and unresponsiveness from the parent or carer towards a child or young person and in particular towards an infant.

1.3.34 Suspect emotional neglect if the interaction observed in recommendation 1.3.33 is persistent.

1.3.35 Consider child abuse and neglect if parents or carers are seen or reported to punish a child for wetting or soiling despite practitioner advice that the symptom is involuntary.

1.3.36 Consider child abuse and neglect if a parent or carer refuses to allow a child or young person to speak to a practitioner on their own when it is necessary for the assessment of the child or young person.

Alerting features relating to supervision by parents or carers

1.3.37 Consider neglect if parents or carers persistently fail to anticipate dangers and to take precautions to protect their child from harm. However, take into account that achieving a balance between an awareness of risk and allowing children freedom to learn by experience can be difficult.

1.3.38 Consider neglect if the explanation for an injury (for example, a burn, sunburn or an ingestion of a harmful substance) suggests a lack of appropriate supervision.

Alerting features relating to providing access to medical care or treatment

1.3.39 Consider neglect if parents or carers fail to administer essential prescribed treatment for their child.

1.3.40 Suspect neglect if parents or carers fail to seek medical advice for their child to the extent that the child's health and wellbeing is compromised, including if the child is in ongoing pain.

1.3.41 Consider neglect if parents or carers repeatedly fail to bring their child to follow-up appointments that are essential for their child's health and wellbeing.

1.3.42 Consider neglect if parents or carers persistently fail to engage with relevant child health promotion programmes, which include:

  • immunisation

  • health and development reviews

  • screening.

1.3.43 Consider neglect if parents or carers have access to but persistently fail to obtain treatment for their child's dental caries (tooth decay).

1.3.44 Follow recommendations 1.2.11 and 1.2.12 in child maltreatment if you have concerns about fabricated or induced illness.

Recognising child trafficking

1.3.45 Recognise that children and young people may be trafficked for sexual exploitation and other reasons including:

  • forced marriage

  • domestic servitude

  • working for low or no pay, or in illegal industries

  • being used for benefit fraud.

1.3.46 Recognise that both girls and boys can be trafficked and that children and young people can be trafficked within and from the UK, as well from other countries.

1.3.47 If you suspect a child or young person may have been trafficked:

  • make a referral to children's social care and the police

  • a designated first responder should make a referral to the government's National Referral Mechanism

  • ensure that concerns about their age and immigration status do not override child protection considerations

  • recognise that choosing an interpreter from the child's community may represent to them the community that has exploited them

  • aim to ensure continuity with the same independent interpreter, keyworker or independent advocate.

1.4 Assessing risk and need in relation to child abuse and neglect

These recommendations are for practitioners undertaking:

Refer to guidance on early help and statutory assessment in Working together to safeguard children as well as local protocols for assessment. The following recommendations highlight areas or practice which have been shown by evidence as being of particular importance, or as not always working well in practice.

Carrying out assessments

1.4.1 During assessment:

  • observe the child or young person, including their relationships with parents or carers

  • communicate directly with the child or young person without their parent or carer being present, with the parent or carer's consent

  • explore in a non-leading way any presenting signs or possible history of child abuse and neglect.

    Do not rely solely on information from the parent or carer in an assessment. See also recommendations 1.1.1 to 1.1.11 about working with children, young people, parents and carers.

1.4.2 When assessing a child or young person follow the principles in recommendations 1.1.2 and 1.1.3.

1.4.3 During assessment, focus primarily on the child or young person's needs but also remember to:

  • address both the strengths and weaknesses of parents, carers and the wider family network

  • acknowledge that parenting can change over time, meaning that strengths and weaknesses are not fixed and should be reviewed

  • focus attention equally on male and female parents and carers.

1.4.4 As part of assessment or enquiry into child abuse and neglect under the Children Act 1989, collect and analyse information about all significant people (including siblings) in the child or young person's care environment, unless it is not safe to do so (for example in cases of domestic abuse or forced marriage) or it could affect the nature of a criminal investigation. Use professional judgement to determine the risks and benefits of including people in assessment in these instances. Gather the following information about each person:

  • Their personal, social and health history.

  • Their family history, including experiences of being parented.

  • Any adverse childhood experiences.

  • The quality of their relationship with the child or young person.

1.4.5 As part of assessment or enquiry into child abuse and neglect under the Children Act 1989, communicate your concerns honestly to families about child abuse and neglect. Take into account what information should be shared, and with whom, to avoid increasing the risk of harm to the child or young person (and adult victims in cases of domestic abuse).

1.4.6 Organisations should ensure that practitioners conducting assessment in relation to abuse or neglect of disabled children or young people, or those with neurodevelopmental disorders, can access a specialist with knowledge about those children and young people's specific needs and impairments.

1.4.7 Analyse the information collected during assessment and use it to develop a plan describing what services and support will be provided. Make sure the plan is agreed with the child or young person and their family (also see recommendations 1.1.7 and 1.1.11). Analysis should include evaluating the impact of any vulnerability factors and considering their implications for the child or young person.

1.4.8 Review assessments and plans regularly.

1.5 Early help for families showing possible signs of child abuse or neglect

These recommendations are for:

  • Practitioners involved in early help for families showing possible signs of child abuse and neglect. This could include those undertaking the lead professional role (including a GP, family support worker, teacher, health visitor or special educational needs coordinator) or those providing early help interventions, such as family support workers.

  • Commissioners of early help services for children, young people and families.

These recommendations support Working together to safeguard children by highlighting evidence-based programmes that could be offered as part of early help support based on the evidence.

Supporting families at the early help stage

1.5.1 Provide early help in line with local protocols and Working together to safeguard children, and based on an assessment of the needs of children, young people and families.

1.5.2 Discuss early help support and interventions with children, young people and families as part of building close working relationships with them and gaining their consent (see section 1.1 for principles for working with children, young people, parents and carers). Explain what the support will involve and how you think it may help.

1.5.3 Give children, young people and their families a choice of proposed interventions if possible. Recognise that some interventions may not suit that person or family.

1.5.4 Early help should include:

  • practical support, for example help to attend appointments and details of other agencies that can provide food, clothes and toys

  • emotional support, including empathy and active listening, and help to develop strategies for coping.

1.5.5 Give families information about local services and resources, including advocacy, that they may find useful.

Knowledge and skills of practitioners who provide early help

1.5.6 Commissioners and managers should ensure that all practitioners working at the early help stage:

  • have an understanding of typical and atypical child development

  • are able to tailor interventions to the needs of the child or young person, parents and carers including any disability or learning disability

  • understand the parental vulnerability factors for child abuse and neglect (see recommendations 1.2.3 to 1.2.5)

  • are aware of the possibility of escalation of risk, particularly if family circumstances change

  • understand how to work with families as a whole in order to better support children and young people.

Parenting programmes

1.5.7 Consider a parenting programme lasting at least 12 weeks for parents or carers at risk of abusing or neglecting their child or children. Tailor parenting programmes to the specific needs of parents or carers and children (see recommendations 1.5.9 to 1.5.12).

1.5.8 When selecting parenting programmes think about whether parents or carers would benefit from help to:

  • develop skills in positive behaviour management

  • address negative beliefs about the child and their own parenting

  • manage difficult emotions, including anger.

1.5.9 Consider the Enhanced Triple P (attributional retraining and anger management) programme for mothers of young children (up to age 7), who are experiencing anger management difficulties.

1.5.10 Consider a parenting programme for vulnerable mothers (for example, those with a low level of education or income or aged under 18) of preschool children. It should be based on a planned activities training model and focus on equipping parents or carers to prevent challenging behaviour by:

  • planning and explaining activities

  • establishing rules and consequences

  • ignoring minor misbehaviour and using positive interaction skills.

    This can be provided with or without support provided by text message between training sessions.

1.5.11 Consider the Parents Under Pressure programme for mothers taking part in methadone maintenance programmes.

1.5.12 For parents or carers who have substance misuse problems, include content in the parenting programme to help them address their substance misuse in the context of parenting. For example, help them to address parenting stress which may be a trigger for substance misuse.

Home visiting programmes

1.5.13 For parents or carers at risk of abusing or neglecting their child or children, consider a weekly home visiting programme lasting at least 6 months, for example the Healthy Families model. This should be in addition to universal health visiting services available through the Department of Health's Healthy child programme.

1.5.14 Identify parents and carers who could be supported by a home visiting programme during pregnancy or shortly after birth, wherever possible.

1.5.15 Ensure that the home visiting programme is agreed with families and includes:

  • support to develop positive parent–child relationships, including:

    • helping parents to understand children's behaviour more positively

    • modelling positive parenting behaviours

    • observing and giving feedback on parent–child interactions

  • helping parents to develop problem-solving skills

  • support for parents to address the impact of any substance use, previous domestic abuse and mental health problems on their parenting

  • support to access other relevant services, including health and mental health services, substance misuse services, early years, educational services and other community services

  • referral to children's social care where necessary, for example if current domestic abuse is discovered.

1.5.16 Ensure that the programme of home visits is delivered by a practitioner who has been trained in delivering that particular home visiting programme.

1.6 Multi-agency response to child abuse and neglect

These recommendations are for practitioners working with children, young people and parents or carers where a child or young person has been abused or neglected, including those assessed as 'in need', likely to suffer significant harm or suffering significant harm.

Practitioners must follow the 'Processes for managing individual cases' in Working together to safeguard children. These recommendations complement the statutory guidance by adding or emphasising detail which has been shown by evidence to be of particular importance, or not currently happening in practice.

Multi-agency working

1.6.1 Practitioners supporting children and young people who have been assessed as being 'in need', or suffering (or likely to suffer) significant harm in relation to child abuse or neglect should:

  • build relationships with other practitioners working with that family

  • organise handovers if new staff members from their agency become involved

  • ensure actions set out in the 'child in need' or child protection plan are completed.

Supporting children and young people

1.6.2 Practitioners supporting children and young people who have been assessed as being 'in need' or suffering (or likely to suffer) significant harm in relation to child abuse or neglect should, with leadership and coordination by the social worker, do the following as a minimum:

  • protect them from further abuse or neglect

  • support them to explore aspects of their experience and express their feelings

  • provide early emotional support, including building emotional resilience and strategies for coping with symptoms such as nightmares, flashbacks and self-harm

  • assess their physical health needs

  • assess the need for further mental health support

  • support them to reduce the risk of future abuse if appropriate, for example if a young person is at risk of sexual exploitation.

Children and young people affected by domestic abuse

1.6.3 For guidance on domestic abuse, see recommendations 10 and 11 of NICE's guideline on domestic violence and abuse.

Child trafficking

1.6.4 When working with children and young people who have been trafficked, follow the guidance in the government's Safeguarding children who may have been trafficked.

1.7 Therapeutic interventions for children, young people and families after child abuse and neglect

These recommendations are for:

  • Social workers and others coordinating support for children and young people, to help them decide what services to refer children and young people to.

  • Child and adolescent mental health practitioners (psychologists, psychotherapists, psychiatrists), practitioners in specialist family intervention teams (for example social workers) and voluntary sector agencies.

  • Strategic commissioners of services for children and young people who have been abused or neglected.

Where interventions are recommended for particular groups, this reflects the evidence base for this intervention.

1.7.1 Discuss in detail with children, young people, parents and carers any interventions you offer them, explaining what the intervention will involve and how you think it may help (see section 1.1 for principles for working with children, young people, parents and carers).

1.7.2 Give children, young people, parents and carers a choice of proposed interventions if possible. Recognise that some interventions, although effective, may not suit that person or family.

1.7.3 The choice of intervention should be based on a detailed assessment of the child or young person.

Therapeutic interventions following child physical abuse, emotional abuse or neglect

This section provides a range of options for therapeutic interventions for children and young people who have experienced physical abuse, emotional abuse or neglect. Some interventions involve the parent or carer who abused or neglected the child, and others involve alternative carers such as foster carers or adoptive parents. An overview of interventions is shown below.

Figure 1 Interventions following physical abuse, emotional abuse or neglect

Figure 1

For more recommendations about looked-after children, including children in residential care, see NICE's guideline on looked-after children and young people.

Children under 5

1.7.4 Offer an attachment-based intervention, for example Attachment and Biobehavioural Catch-up, to parents or carers who have neglected or physically abused a child under 5.

1.7.5 Deliver the attachment-based intervention in the parent or carer's home, if possible, and provide at least 10 sessions. Aim to:

  • improve how they nurture their child, including when the child is distressed

  • improve their understanding of what their child's behaviour means

  • help them respond positively to cues and expressions of the child's feelings

  • improve how they manage their feelings when caring for their child.

    [This recommendation is adapted from NICE's guideline on children's attachment.]

1.7.6 Consider child–parent psychotherapy for parents or carers and their children under 5 if the parent or carer has physically or emotionally abused or neglected the child, or the child has been exposed to domestic violence.

1.7.7 Ensure that child–parent psychotherapy:

  • is based on the Cicchetti and Toth model[1]

  • consists of weekly sessions (lasting 45–60 minutes) over 1 year

  • is delivered in the parents' home, if possible, by a therapist trained in the intervention

  • involves directly observing the child and the parent–child interaction

  • explores the parents' understanding of the child's behaviour

  • explores the relationship between the emotional reactions of the parents and their perceptions of the child on the one hand, and the parents' own childhood experiences on the other hand.

    [This recommendation is adapted from NICE's guideline on children's attachment.]

1.7.8 Offer an attachment-based intervention in the home to foster carers looking after children under 5 who have been abused or neglected. Aim to help foster carers to:

  • improve how they nurture their foster child, including when the child is distressed

  • improve their understanding of what the child's behaviour means

  • respond positively to cues and expressions of the child's feelings

  • behave in ways that are not frightening to the child

  • improve how they manage their feelings when caring for their child.

    [This recommendation is adapted from NICE's guideline on children's attachment.]

1.7.9 Consider the attachment-based intervention in recommendation 1.7.8 for adoptive parents and those providing permanence (including special guardians, foster carers or kinship carers) for children under 5 who have been abused or neglected.

[This recommendation is adapted from NICE's guideline on children's attachment.]

Children aged 12 and under

1.7.10 Consider a comprehensive parenting intervention, for example SafeCare, for parents and children under 12 if the parent or carer has physically or emotionally abused or neglected the child. This should be delivered by a professional trained in the intervention and comprise weekly home visits for at least 6 months that address:

  • parent–child interactions

  • caregiving structures and parenting routines

  • parental stress

  • home safety

  • any other issues that caused the family to come to the attention of services.

    As part of the intervention, help the family to access other services they might find useful.

1.7.11 Consider parent–child interaction therapy for parents or carers and children under 12 if the parent or carer has physically abused or neglected the child. Combine group sessions for these parents with individual child–parent sessions focusing on developing child-centred interaction and effective discipline skills.

1.7.12 Offer a group-based parent training intervention, for example KEEP, to foster carers of children aged 5 to 12 who have been abused or neglected and are showing problematic behaviours. Include strategies to manage behaviour and discipline positively. Provide group sessions over at least 16 weeks with groups of 8 to 10 foster carers, including video, role play and homework practice.

1.7.13 Consider the intervention in recommendation 1.7.12 for foster carers of children aged 5 to 12 who have been abused or neglected and are not currently showing problematic behaviours.

Children and young people aged 17 and under

1.7.14 Consider multi-systemic therapy for child abuse and neglect (MST‑CAN) for parents or carers of children and young people aged 10 to 17 if the parent or carer has abused or neglected their child. This should last 4 to 6 months and:

  • involve the whole family

  • address multiple factors contributing to the problem

  • be delivered in the home or in another convenient location

  • include a round-the-clock on-call service to support families to manage crises.

1.7.15 For foster carers of children and young people aged 5 to 17 who have been abused or neglected, consider a trauma-informed group parenting intervention, using a trust-based relational intervention as an example. It should last for at least 4 day‑long sessions and help foster carers to:

  • develop the child or young person's capacity for self-regulation

  • build trusting relationships

  • develop proactive and reactive strategies for managing behaviour.

1.7.16 Consider the trauma-informed group parenting intervention in recommendation 1.7.15 for adoptive parents and those providing permanence (including special guardians, foster carers or kinship carers) for children aged 5 to 17 who have been abused or neglected.

Therapeutic interventions for children, young people and families after sexual abuse

This section provides a range of options for therapeutic interventions for children and young people who have experienced sexual abuse. An overview of interventions is shown below.

Figure 2. Interventions following sexual abuse

Figure 2

1.7.17 Offer group or individual trauma-focused cognitive behavioural therapy over 12 to 16 sessions (more if needed) to children and young people (boys or girls) who have been sexually abused and show symptoms of anxiety, sexualised behaviour or post-traumatic stress disorder. When offering this therapy:

  • discuss it fully with the child or young person before providing it and make clear that there are other options available if they would prefer

  • provide separate trauma-focused cognitive behavioural therapy sessions for the non-abusing parent or carer.

1.7.18 For children and young people (boys or girls) aged 8 to 17 who have been sexually abused, consider an intervention, for example 'Letting the future in', that:

  • emphasises the importance of the therapeutic relationship between the child or young person and therapist

  • offers support tailored to the child or young person's needs, drawing on a range of approaches including counselling, socio-educative and creative (such as drama or art)

  • includes individual work with the child or young person (up to 20 sessions, extending to 30 as needed) and parallel work with non-abusing parents or carers (up to 8 sessions).

1.7.19 For girls aged 6 to 14 who have been sexually abused and who are showing symptoms of emotional or behavioural disturbance, consider one of the following, after assessing carefully and discussing which option would suit her best:

  • individual focused psychoanalytic therapy (up to 30 sessions) or

  • group psychotherapeutic and psychoeducational sessions (up to 18 sessions).

    Provide separate supportive sessions for the non-abusing parent or carer, helping them to support the child's attendance at therapy, as well as addressing issues within the family.

1.8 Planning and delivering services

These recommendations are for senior managers in agencies responsible for planning and delivering services to children and young people. They provide additional detail to guidance in Working together to safeguard children on strategic arrangements for multi-agency working.

1.8.1 Plan services in a way that enables children, young people, parents and carers to work with the same practitioners over time where possible.

1.8.2 Agencies responsible for planning and delivering services for children and young people should agree terminology across agencies relating to child protection roles and processes, and ensure these are well publicised.

1.8.3 Ensure that local threshold documents set out responses to other forms of abuse including child sexual exploitation, female genital mutilation, honour-based abuse (including forced marriage), child trafficking, serious youth violence and gang-related abuse. Ensure that these are communicated to local agencies, including those providing universal services, so that they are aware of these forms of abuse.

1.8.4 To address the risks posed by sexual exploitation and gang-related abuse, agencies responsible for planning and delivering services for children and young people should put in place:

  • effective leadership within agencies

  • a local lead who will coordinate planning and information sharing between agencies.

Supervision and support for staff

1.8.5 Organisations should support staff working with children and families at risk of or experiencing child abuse and neglect, and provide good quality supervision, tailored to their level of involvement in safeguarding work. This should include:

  • case management

  • reflective practice

  • emotional support

  • continuing professional development.



[1] Cicchetti D, Rogosch FA, Toth SL (2006) Fostering secure attachment in infants in maltreating families through preventive interventions. Development and Psychopathology 18: 623–49 and Toth SL, Maughan A, Manly JT et al. (2002) The relative efficacy of two interventions in altering maltreated preschool children's representational models: implications for attachment theory. Development and Psychopathology 14: 877–908.

  • National Institute for Health and Care Excellence (NICE)