Safeguarding

Safeguarding:

·        Protecting the rights of adults to live in safety, free from abuse and neglect.

·        People and organisations working together to prevent and stop both the risks and experience of abuse or neglect.

·        People and organisations making sure that the adult's well-being is promoted, including, where appropriate, taking fully into account their views, wishes, feelings and beliefs in deciding on any actions.

·        Recognising the adults sometimes have complex interpersonal relationships and may be ambivalent, unclear or unrealistic about their personal circumstances and therefore potential risks to their safety or well-being.

Who needs it?

·        Everyone

·        Especially the vulnerable (adults and children)

o   These people may be at risk of abuse or neglect due to the actions (or lack of actions) of another person.

Vulnerable person

Certain individuals or groups of children may be more vulnerable to abuse or neglect because of risk factors in their family or environment, or because of the way they are perceived by their carers.

Most child abuse occurs within a child's own family by persons known to the child.

Children may be abused in institutional/community settings by those known to them or, more rarely, by a stranger.

·        Parental, social and child factors

Factors of vulnerability

·        Child indications

·        Parental indications

·        Housing indications

·        Education, skills and training indications

·        Income indications

Under 1s

·        Two out of three of all child deaths (all causes) aged under one year

·        Research shows that under one’s experience, particularly high levels of abuse and early intervention can make a big difference.

·        On average, under one’s are 8 times more likely to be killed than older children.

·        Nearly half of all serious case reviews are in relation to babies under one

Children with disabilities

·        Children with disabilities face an increased risk of abuse and neglect

·        Communication  difficulties, isolation, dependency on a carer, can affect a disabled child’s ability to recognise and understand that they are being abused as well as their ability to access help and support

·        Sometimes indicators of abuse are mistakenly attributed to the child’s disability

Looked after children

·        91,000 children in care at any one time in UK

·        Majority enter because of abuse and neglect and 45% have a diagnosable mental health condition

·        Generally children in care continue to have poorer outcomes than the wider population – particularly in relation to educational achievement, homelessness and mental health

·        Minority are at continued risk of abuse or neglect, including from their carers, other young people and those in the wider community who target them.

Vulnerable Adults

·        May not always have been classified as ‘vulnerable’

·        Do not always live in supported/nursing accommodation

·        Do not always lack capacity

·        May not be easily identifiable

·        Do not always disclose their concerns/issues

·        Vulnerable adult status may change

Neglect

·        Most common form of child abuse

·        Persistent failure to meet a child’s physical and/or psychological needs, likely to result in serious impairment of the child’s health or development

·        Adversely affects a child physically, educationally, psychologically, socially and medically

·        Can be life threatening

·        Includes the failure to access appropriate health case

o   Parents have responsibility to look after their children

When are we concerned?

·        Irregular attendance

·        Multiple WNB/UTA/FTA

·        Delayed presentation despite symptoms

·        Lack of support with oral hygiene measures

·        Non-compliance with advice

·        Non-completion of treatment

·        New disease

·        Patient reports concerns

Recognising neglect in adults

·        Patient disclosure

·        Patient has an unkempt appearance

·        Medication not administered

·        Inappropriate clothing

·        Personal care not being carried out

·        Not taken to healthcare appointments (regular occurrence)

·        Soiled clothing

·        Malnourished

·        Dehydrated

·        Persistent infection

Dental health

·        Diet

·        Oral health/hygiene

·        Fluoride

·        Check-ups

Dental Neglect

Wilful failure of a parent or guardian to seek and follow through with treatment necessary to ensure a level of oral health essential for adequate function and freedom from pain and infection

·        Dental neglect may occur on its own or as an indicator of general neglect

Abuse

An individual is considered to be abused if they are treated in a way that is unacceptable in a given culture at a given time

Recognising Abuse

Not always clear, examples include:

·        Difficult relationships

·        Nonaccidental injury

·        Change in behaviour (clingy, withdrawn, anxious)

·        Not attending appointments

·        Inappropriate behaviours with others

·        Dirty clothing/equipment

Types of abuse:

·        Physical abuse

·        Modern slavery

·        Domestic violence

·        Psychological abuse

·        Financial abuse

·        Organisational abuse

·        Sexual abuse

·        Neglect/acts of omission

·        Discriminatory abuse

·        Self-neglect

It is not your responsibility to diagnose or investigate.

It is your responsibility to report concerns.

The pyramid of severity of child abuse

·        Severe, deliberate and persistent abuse

·        Inflicted physical or emotional abuse

·        Neglect, poor physical care, emotional unavailability

·        Casual attitudes, carelessness, poor parenting

Physical Abuse

·        Hitting, shaking, kicking, punching, poisoning, scalding, suffocating and inflicting pain or harm to a child

·        Giving a child harmful substances (drugs/alcohol)

·        Reporting non-existent symptoms of illness in a child/deliberately causing illness in a child

·        Cigarette burns, human bites, scalds and burns

·        Remember a child with one injury may have further injuries that are not visible to you

Accidental areas of injury

·        Forehead

·        Nose

·        Chin

·        Knees

·        Shin

·        Palm of hands

·        Elbows

Signs of physical abuse

·        Any common orofacial injury

·        Bruising

·        Scalds/burns

·        Bite marks

·        Eye injuries

·        Bony fracture

·        Abrasions and lacerations

·        Intraoral injury

Recognising physical abuse

Just because a patient has an injury, doesn’t mean physical abuse has occurred

·        Why

·        Take a history (behaviour)

·        Site

·        Colour

·        Size

·        Photographs

Recognising emotional abuse

Frequently seen alongside other types of abuse

·        Difficult relationships

·        Inappropriate behaviour

·        Inappropriate language

·        Responds only when prompted

·        Challenging behaviour

·        Clingy

·        Withdrawn

Recognising sexual abuse

·        Disclosure from patient

·        Inappropriate behaviour (by patient, by supporters)

·        Behavioural signs

·        Sexually transmitted infections

·        Pregnancy

GDC Principles

Raise concerns if a patient is at risk

“Members of the dental team are in a position where they may identify the signs of child abuse or neglect or hear something that causes them concern about a child. The dental team has an ethical responsibility to find out about local procedures for child protection and to follow them if a child or might be at risk of abuse or neglect”

Legislation

·        Care Act 2014

·        Mental Capacity Act 2005

·        Lord Laming Report

·        Deprivation of Liberty Safeguards 2009

·        Office of the Public Guardian

·        Children’s Act

·        Every Child Matters

·        Working together to safeguard

è NHS safeguarding app

Your role

·        GDC standards

·        Raise concerns

·        Escalate concerns

·        Sharing information (MD approach)

·        Oral health promotion

·        Every contact counts

In your practice

·        Safeguarding policy

·        Named safeguarding lead

·        Regular safeguarding training