What is Significant Harm? - a simple guide for social workers

What is Significant Harm?
a simple guide for social workers

The Children Act 1989 introduced the term 'significant harm' as the key to child protection work. This guide is based on my experience of doing child protection work in the 1990s in an authority which maintained an appropriate balance between child protection and child welfare.

The term 'significant harm' is so basic that staff at all levels, from front line workers to directors, need to have a sound understanding of its meaning in practice. They also need the capacity for recognising when the threshold of 'significant harm' has been crossed - as this is the point at which compulsory measures are justified. Correct interpretation of the law is the key to good practice.

Lynn Davis explains 'significant harm' in The Social Worker's Guide to Children and Families Law :

s31(9)CA89 defines 'harm'. It tells us that 'harm' includes 'ill-treatment' which itself includes 'sexual abuse and forms of ill-treatment which are not physical', such as emotional abuse. Physical abuse itself is not explicitly included, but this is taken as read. This part of the definition therefore covers all forms of abuse.

'Harm' also includes 'the impairment of health or development'. Just as in s17 CA89, 'health' includes both physical and mental health, and 'development' includes physical, intellectual, emotional, social and behavioural development, so this part of the definition covers neglect cases.

A later amendment to CA89 added a separate reference to harm caused by seeing or hearing someone else ill-treated (such as a sibling who is being abused or a parent subjected to domestic violence). This amendment was perhaps unnecessary as such cases were arguably already covered by the broader definition but it serves to clarify matters.

Formal Investigation

The justification for an initial child protection investigation, under section 47 of the Children Act 1989, requires 'reasonable cause to suspect' actual or likely significant harm. There must be 'reasonable cause' - the information only has to be enough to warrant suspicion. This is completely different from a 'safeguarding intervention' and should not be confused with one. To justify compulsory intervention in a family's life there must be something unusual - at least something more than the common-place human failure or inadequacy of parents.

All agencies share responsibility for the protection of children but social services is the lead agency. Social work managers are responsible for making initial enquiries about any child protection concerns, organising a strategy meeting and, if appropriate, taking the decision to commence a section 47. Social workers carry out the investigative visit, sometimes working in pairs.

Problems have arisen because an informal approach to safeguarding is always preferred and reluctance to use the formal route means the term 'significant harm' often gets forgotten. There is an assumption that social workers doing an initial assessment of need will incidentally pick up any child protection concerns in the course of their home visit. Sometimes there is even a mistaken assumption that, when concerns have been raised about a child, social workers can simply delegate responsibility for a formal investigation of 'significant harm' to the police.

The shift from informal safeguarding work to formal child protection work can be triggered in a number of different ways. There may be a specific allegation of abuse, or reasonable cause for suspicion of abuse or neglect, or serious concerns about a child's safety and well-being. Once formal procedures commence the basic social work principle of 'informed consent' may, if necessary, be over-ridden because the protection of children is regarded as more important. This means that professionals may decide to share information about children with each other without the knowledge of parents.

Quite often there is a single incident which raises concerns - such as something which may indicate physical or sexual abuse. A single incident of neglect or exposure to domestic violence can also be the reason for concerns. The seriousness of the harm the child may have suffered is an important factor. In the case of physical injury it is well known that all children tend to have accidents but some injuries are so serious they raise the suspicions of the medical profession and require further investigation. Sometimes the harm is less serious, e.g. a slight fracture, facial bruising, a burn, but it may be 'significant' because it may point to neglect or poor supervision. Suspicions might also be raised when parents do not seek medical treatment, or there is a delay in seeking medical treatment.

In some cases a well-founded allegation, or a single incident resulting in a serious injury, provides sufficient evidence for criminal proceedings to commence. In these situations 'suspicion' of significant harm may be replaced by a 'preliminary belief' that the child has suffered significant harm, which may provide the grounds for the commencement of care proceedings. However, it is more often the case that social workers are dealing with situations where the threshold for criminal proceedings has not been met.

The social work investigation involves more than the obvious task of gathering information about the child and family and recognising any signs of physical injury to a child or unsatisfactory conditions in the home enironment. A broader focus is also necessary so that sensitive enquiries can made to obtain full clarification of the circumstances around the alleged incident or injury, and to gather any other information that seems appropriate - such as the child's developmental needs, the household composition, the family dynamics, the physical conditions in the home and relevant factors in the wider social environment. Fine judgements need to be made about the quality of parenting and family relationships, the meaning of verbal and non-verbal communication from the child and the impact of any stressful circumstances on the family.

The conventional wisdom is that child protection work is complex and difficult but, in fact, the main risk factors that may give rise to safeguarding concerns are relatively easy to spot. These include the following: an adult in the home with a history of violence, incidents of domestic violence, parents who are immature, have addictions to drugs or alcohol, significant learning disabilities, serious mental health problems or a personality disorder and are socially isolated, a baby who is failing to thrive or frequently presented for medical attention or suffers a serious injury, children with special needs or challenging behaviour who seriously test out the resources of parents, teenagers who may be subject to sexual exploitation or who repeatedly go missing from home. Social workers should be trained to look for signs such as these which might indicate abuse or neglect.

In the formal investigative role the social worker adopts a very different style of working from that of social workers working with voluntary clients using a 'safeguarding' approach. Social workers who are frank and open about what they are doing have a greater chance of achieving an effective working relationship with parents. The parents’ perspective must be understood but not necessarily accepted. The social worker should seek their permission to see the child alone. On occasions it will be necessary to obtain parental consent for a medical examination of the child.

It is good practice to make a home visit within 48 hours if the level of concerns at referral indicate the need for an urgent investigation. All information gathered during a section 47 interview must be carefully recorded in case it is subsequently required as evidence in court proceedings. Managerial decisions, including the reasons for, or against, the use of specific child protection procedures, must also be recorded. Finally, the parents should always be notified of the outcome of any enquiries commenced under section 47 immediately and provided with information about the nature of the support that might be offered to them.

Child Protection Conference

Where concerns are substantiated and the child is judged to be at continuing risk of significant harm a child protection conference should be held. One consideration at the conference is whether it will be possible to work collaboratively with the parents or whether an element of coercion will be required. The major part of the conference is taken up with the assessment of risk by the multi-agency group which uses various factors to determine the level of risk. One is to treat the concerns about the child as cumulative. Another is to focus is on the likelihood of the incident of abuse being repeated. Another focuses on specific parental behaviour resulting in abuse or neglect. Consideration is sometimes given to the existence of family dysfunction and patterns of relating that are harmful to children - but this may be very resistant to change.

The main factors leading to the decision to register are: the perceived severity of the abuse or neglect, the existence of secondary concerns and information about the previous involvement of the family with agencies providing supportive services.

Registration

Although the child protection register was abolished in England other parts of the UK have retained it. Nevertheless, the formal approach involving the child protection plan is the same everywhere. This will probably be necessary if there are clear indications that a criminal conviction of someone in the family is a real possibility. Immediate protective action may need to be triggered at this stage and the local authority should be granted the necessary powers by the family court. Where there is evidence of abuse or neglect but insufficient to prove it 'beyond reasonable doubt' in a criminal court the benefits of registration and ongoing surveillance of the family are obvious. In other situations, where evidence is weak but abuse or neglect remains a serious possibility, a risk-averse approach may indicate the need for registration. Finally, where there are generalised concerns about low standards of care, or the parents are not intentionally harmful, the family may be offered support services - either informally or within the structure provided by registration.

Post-registration work

Registration is an important social work tool which combines measures to keep the family under surveillance with a package of support services, often including help of an educational or therapeutic nature. The child protection plan provides a structured, inter-agency approach with a clear focus on child protection. A more detailed assessment is then carried out by the social worker - the use of core groups for sharing information, planning and review is an essential part of this. On occasions, the use of a written agreement may help parents understand what changes they must make to avoid care proceedings and how this may be achieved.

Social workers aim to reduce the risk of 'significant harm' and prevent the need for care. However, if risks are not reduced consideration may have to be given to whether there are grounds for removing the child - although this is not a decision that is taken lightly. For an application for a Care or Supervision Order to be successful the court must be satisfied on the evidence presented that the 'threshold criteria' (where the child is suffering, or likely to suffer, significant harm) are proven 'on the balance of probabilities'.

Summary

Current problems in the more dysfunctional authorities are being caused by confusion about their legal powers. The system in which social workers are working surrounds everything they do in layers of law, guidance and procedures which can trip up even the most able social workers.

The Children Act 2004 is poorly written and imprecise and gives influential groups scope for obfuscation of the law to suit their own agendas. It has diverted attention away from the path set by the 1989 Act and this has resulted in too many subjective concerns being used to justify compulsory social work intervention and even the removal of the child from its family.

The Children Act 1989 treats section 17 (children in need) and section 47 (investigation of abuse or neglect) as separate and distinct activities. However, current policies and practices tend to combine these activities and families can find this confusing. Many parents are now less inclined to trust social workers and may be fearful of what the real purpose of a home visit may actually be.

In the worst performing authorities there has been a loss of practice knowledge in carrying out formal investigations. It is essential that this work is carried out by experienced social workers but this is not always the case. Worse still, long delays in carrying out the core assessment/section 47 often occur, possibly due to staffing difficulties. It can only be concluded that some authorities are failing in their duties under section 47.

The social work profession believes that child protection work has moved too far towards the control end of the spectrum since the baby Peter case and that a culture of risk aversion has taken hold. However, recent Serious Case Reviews have shown the opposite. They show a child protection system that is very unreliable in dealing with cases of cruelty and extreme neglect. At the root of these problems is the failure of the profession to get to grips with the term 'significant harm' and the failure of managers in children's services to ensure that all staff understand their legal duties and take proportionate and timely protective action.

Hilary Searing