By Elise Walker, ABI Coordinator London South (Header picture source: Coolbeenart on Facebook)
Every person has a paramount duty to protect children and young people from “all forms of physical or mental violence, injury or abuse, neglect or negligent treatment, maltreatment or exploitation…” (United Nations Convention for the Rights of the Child) (henceforth referred to as abuse). Knowing how to identify signs of abuse is essential to protection and is at the centre of most safeguarding policies and procedures. However, as the National Society for the Prevention of Cruelty to Children (NSPCC, 2022) recognises, “…the signs of child abuse aren’t always obvious, and a child might not feel able to tell anyone what’s happening to them. Sometimes, children don’t even realise that what’s happening to them is abuse.” Considering this, identifying the signs of abuse in CYP (CYP) with learning, behavioural, physical and (particularly) communication needs, can be especially difficult – including many CYP living with an acquired brain injury (ABI). It is essential that individuals are all able to identify and follow correct procedures when abuse of a CYP(s) is suspected. However, in this blog I want to encourage you to reflect on how we can more equitably and effectively meet our duty to protect all CYP (including those with ABI in particular) by not only focusing on identification of abuse, but the prevention of abuse in the first instance.
Why are children and young people with an ABI vulnerable?
ABI refers to any injury to the brain which occurred as a result of an acute traumatic (e.g., head injury during sports, road traffic collision, fall or assault) or non-traumatic (e.g., illness like meningitis, stroke, lack of oxygen to the brain) event after birth and a period of development. Many CYP living with an ABI experience complex short and/or long-term physical, emotional, cognitive and communication difficulties. This, in turn, can significantly increase the vulnerability of CYP with ABI to abuse. For example, they might have difficulties with memory (e.g., remembering if they have had food/drink, or how they sustained an injury); understanding social cues (e.g., recognising the intentions of others); understanding language (e.g., understanding what someone is implying or asking of them); speaking and/or producing language (e.g., expressing wants, needs and wishes); or planning, organisation and processing information (e.g., managing money, understanding and signing documents). This list is non-exhaustive and each CYP with ABI is different.
Changing Perspectives: Thinking About Equity and The Prevention of Abuse
The key take-away word that I want to focus on is equity. The Cambridge Dictionary (2022) defines Equity as “the situation in which everyone is treated fairly according to their needs…”. To take an equitable and child-centred approach, adults around the CYP need to cultivate ways of working or caring which identify and aim to mitigate the risks for CYP with ABI as far as possible. This way of thinking about the prevention of abuse is not new, and has been used to attempt to identify and address inequalities in protection of CYP who are affected by societal and structural racism (see www.childwelfare.gov/topics/preventing/promoting/equity/). In fact, intersectionality between protected characteristics is an extra layer of consideration for CYP with ABI that needs to be considered. I won’t be able to cover this here, but it’s important to be mindful.
Reflections from an ABI Coordinator: How can we protect children and young people with ABI?
Reflecting on my case-by-case and wholistic experiences as an ABI coordinator, I have noticed a few core ways of working at the Child Brain Injury Trust (as a charity focused on family support at an intrinsic level) which I think play a role in reducing the risk of safeguarding concerns for the CYP with ABI that we support. Some of these seem self-explanatory because they cover basic support needs of families with disabled CYP, but these are not always in place for families, and it is the combination and interaction between the below that I feel has worked best.
Communication
Not only increased communication between professionals and directly discussing the specific risks for individuals, but also having open conversations with the CYP about their increased vulnerability using those safe spaces, where appropriate/possible. These conversations might be direct (For example, the London ABI Coordinators hosted a picnic with members of the Metropolitan Police, who talked through with the CYP about keeping themselves safe) or indirect (such as whilst watching a TV show or reading a book). Having conversations with the CYP about bullying and abuse, what it means and ways they might spot is a way of empowering CYP to protect themselves. Where a CYP has communication difficulties, using alternative methods to explore concepts with them is equally as important.
Safe spaces
It is well established that communication is most effective when a CYP with ABI has a safe medium to ask for help and to share their wants, needs, wishes, and worries. This might be more official counselling support, mentorship, social work sessions or a specific therapeutic/early intervention (like play therapy or social Prevent services). Or it might involve a more informal way of directing a CYP towards safe, healthy relationships and a space where they can explore concepts surrounding abuse. This might be an out-of-school club (sports, scouts clubs, youth groups), meeting other CYP with ABI in a structured way, day-to-day check-ins with parents/carers/professionals, during school activities or otherwise.
Increased education
It is really important that all individuals around the CYP with ABI, including professionals, family members and friendship groups, understand about the CYP’s ABI, how this specifically affects their cognition and behaviour, and how this impacts how they need to be safeguarded and protected. Each CYP with a brain injury is different, and so safeguarding each CYP will require different preventative approaches. Professionals and parents/carers need to be ready to adapt what they already know to fit the needs of a CYP with ABI and to best support them. Oftentimes, identifying the right support is trial and error. Through education, however, we can empower those around the CYP to advocate for them and ensure the CYP is receiving equitable support.
Multidisciplinary working
Making sure the family are being supported by multidisciplinary professionals (with a designated lead professional) who understand the CYP and their needs across all areas – including social, emotional and physical wellbeing. In doing this, the team can ensure that there is a safe setup at home, that the CYP has access to their basic needs and that the vulnerabilities for abuse are being assessed (and any abuse identified) by an appropriate person and properly safeguarded. The team can ask for specialist help if needed – this might be a specialist social worker, specialist nurse, mental health services, psychiatry or other. The multidisciplinary team can then work to develop specific strategies for the young person that focus on their specific needs.
Developing a clear support plan as a team
Once all these ways of working are in place, it follows naturally that the multidisciplinary team will work alongside the family to put preventative support structures in place. Some such strategies might be: a professional interventions and/or referral to social care; using social stories and scaffolds to empower the young person – including alternative ways of communicating that best suit the young person; getting the young person involved in a club or activity that they enjoy; monitoring the young person’s phone/computer use and talking to them about online safety; starting conversations about consent, sex, relationships, grooming and similar topics early on (including resources such as PANTS by the NSPCC); and make sure parents/carers have all the right information about who to contact with concerns, including a safety plan. There is so much more that you can put in place beyond these examples, too. Families and professionals can reach out to services like the NSPCC and ChildLine for further support, information and training.
What is the take-home message?
As a charity, we primarily aim to address the support needs of families after a CYP has had an ABI. Within this role, we have clear safeguarding policies for child protection and safeguarding. However, I believe the core preventative work is embedded in our day-to-day support of families, cultivating ways of working that empower and protect CYP with ABI. ABI is not as well-known as other conditions, however. This means that outside of the Child Brain Injury Trust, professionals around the CYP are not always as aware of the specific vulnerabilities of young people with ABI. A society, and as professionals, we need to ensure that we are doing what we can to best protect CYP with ABI with a preventative, child-centred and equitable approach. I would love to hear if you have any other thoughts on this, and if you feel I have missed any ways that we can protect CYP with ABI.