Responding to child abuse and neglect - a view from NICE

Children who have experienced abuse or neglect could be offered therapy and their parents given the chance to take part in family support programmes.

A new guideline, from NICE, aimed at professionals who may come into contact with children, gives advice on what to do when faced with child neglect or abuse.

“It’s about being supportive and listening” – A, 16, London

For social workers and other specialist professionals supporting children to recover after abuse or neglect, the guideline sets out the most effective approaches. It details a range of talking therapies and parenting programmes that should be used depending on the child’s age and the type of abuse suffered. Children and their families should be given a choice of proposed therapies if possible.

One of these could be attachment-based interventions which focus on improving the relationships between young people and carers or parents. This often means helping the carer to respond more sensitively to the child. Alternatively, child-parent psychotherapy could also be considered when a child has been exposed to domestic violence.

The guideline also includes some recommendations for senior managers and service providers. It says they should plan services that will allow children and their families to work with the same people over time

Professor Gillian Leng, deputy chief executive at NICE: “This guideline gives clarity on what approaches work best to support children and their families. It brings together the body of research into best practice in child protection for the first time, and will help staff fulfil their statutory duties.”

Professionals such as teachers, police officers and others working with children outside hospitals, should act on their suspicions if they think a child is at risk or they suspect abuse or neglect has already taken place, the guidance says.

If the child is deemed to be at immediate risk of harm, then professionals should immediately contact police. But if not then the professionals should contact children's social care.

For parents who are identified as at risk of abusing or neglecting their child because of their lifestyle or drug addiction, the guideline suggests parenting programmes be considered. A range of other options (such as regular home visits) are listed according to the severity and extent of the abuse.

Hear from young people and experts on key principles when responding to child abuse

Early help can be provided by GPs, social workers or health visitors. It should include practical assistance, such as help to attend appointments and emotional support.

The guideline also calls on services to ensure they have processes in place to respond to newly recognised forms of abuse such as female genital mutilation (FGM), sexual exploitation, child trafficking and forced marriage.

The guideline is based on the best available evidence and draws on expert testimonies. It gives guiding principles for approaching and responding to each child, and their family or carers.

The committee talked to a group of children and young people who have personal experience of abuse or neglect.

Stephen Goulder, Director of the NICE Collaborating Centre for Social Care (NCCSC), a partnership led by the Social Care Institute for Excellence (SCIE): “Children and young people’s views have been critical to the development of this guideline – giving their unique insights as experts by experience. The NCCSC was delighted to have helped to develop the guideline –which we hope will be a useful resource for practitioners in their work with children, young people and families, helping them to make use of research evidence and learning from practice.”

NICE encourages staff to listen carefully to children and their families, and to act on their suspicions. They should tailor their language to the child's level of understanding and employ other methods that children may be more comfortable with. For example, it suggests using drawings with very young children or providing interpreters.

The guideline lists the signs professionals should be aware of, which may suggest abuse or neglect is happening.

These include recurring nightmares and children arriving at school injured and persistently unclean. It gives details of appropriate action to take to help those involved.

It says staff should make sure children know they have been listened to and that they understand and are comfortable with discussions. It encourages professionals to speak to colleagues in other organisations if they have concerns so that children, and their parents or carers, do not have to repeat difficult conversations.

The guidance calls on staff to use their judgement and to follow up to make sure action has been taken.

We held a Facebook Live with the charities NSPCC and AVA on responding to child abuse and neglect

Staff should take the time to explain about confidentiality and when they might need to pass on information. They should be sensitive, listen actively and use open questions. The child should be given a record of the conversations where appropriate.

Professor Corinne May-Chahal, a leading researcher in child protection at Lancaster University and chair of the committee developing the guideline said: "Our awareness of the different forms of child abuse and neglect is developing all the time and it is difficult for professionals to keep track of the best ways to assess abuse and respond effectively. This guideline provides up to date evidence about which methods work best to identify abuse and reduce the significant harms for children and families"

The guideline describes how to assess the level of risk and what help should be given early on. This includes seeing how a child behaves with and without their parents or carers around them.

It says staff should find out about all significant adults in a child’s life such as their parents, carers or siblings. These people should be involved in any plans, unless they are under investigation for inflicting the harm.

The guideline sits alongside existing legislation and statutory guidance on safeguarding children, produced by the Department for Education, and professional guidance, providing important context on what works to help vulnerable children and their families.

Read the NICE guideline on handling and responding to child abuse and neglect

Update: We're also developing a new quality standard on child abuse, highlighting priority areas for service improvement. It will be published in February 2019. Registered stakeholders can respond to the consultation until 8 October.