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Different cultures but equal needs

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Janet Riddell-Heaney, MA, RN, RHV, DipChild Protection, Cert Ed.

Designated Nurse for Child Protection, Harrow Primary Care Trust, Harrow

Professional Nurse 2003 Jan;18(5):248-9.

All health professionals who come into contact with children can contribute to identifying those in need of safeguarding or support. However, to enable them to fulfil this part of their role, they need policies to support their actions.

 

All health professionals who come into contact with children can contribute to identifying those in need of safeguarding or support. However, to enable them to fulfil this part of their role, they need policies to support their actions.

 

 

Harrow Primary Care Trust (PCT) has been instrumental in providing not only training for staff in the front line, but also for putting in place a strategic policy framework on child protection.

 

 

Awareness
This commitment has included developing a training pack that focuses on multicultural issues in child protection with the aim of developing a multidisciplinary understanding of roles and responsibilities and local and national standards of care.

 

 

The pack is intended for use alongside staff training provided by the area child protection committee (ACPC) within Harrow PCT, to disseminate knowledge about the complex and sensitive nature of multicultural issues in child-protection work.

 

 

It was also designed to improve interdisciplinary communication through common understanding of key terms, definitions and thresholds for action and to promote staff reflection on working practices.

 

 

The roles
Health visitors, school nurses and practice nurses, in particular, provide universal services to all members of the community and have knowledge about and access to families on a daily basis.

 

 

Nurses may need to contribute to the assessment process of a maltreated child, to the child’s treatment and subsequently to case conferences or reviews. But to do so effectively the nurse must have a clear understanding of the issues surrounding child abuse, and the legislation and agencies involved in preventing and dealing with the problem.

 

 

The costs
A report by the Institute of Public Finance, commissioned by the National Commission of Inquiry into the Prevention of Child Abuse (Childhood Matters), estimated that the annual cost of child abuse to statutory and voluntary agencies was £1 billion (NCIPCA, 1996a). ‘Most of this,’ said the report, ‘is spent (on) dealing with the aftermath of abuse rather than its prevention’ (Box 1).

 

 

The commission reported an estimate of an increase of £348 million, if patients and clients using adult mental health and/or prison services as a result of childhood abuse and maltreatment were included. Neither figure incorporates the costs of universal health visiting and community-based health services, so it is not unreasonable to assume that the total cost of dealing with child-protection issues far exceeds these estimates.

 

 

The policies
It would be unreasonable to think that the basis of any child-protection policy is cost-efficiency. The purpose of effective child protection is to safeguard those at risk of injury or harm. National standardised procedures, supported by adequate training and understanding for staff, could be one way to reduce costs in the long term.

 

 

The law
Guidance for safeguarding children is neither clearly identified in one piece of UK-wide legislation, nor are there any specific laws in each of the four countries of the UK.

 

 

Child-protection structures have evolved from a series of public inquiries undertaken in direct response to fatal child abuse and government circulars and directives. Lord Laming’s report on the Victoria Climbie inquiry is expected to have an impact on future developments both nationally and locally.

 

 

The Children Act (1989) for England and Wales brought about a change of emphasis in children’s services. Where the law had previously concentrated on protection, its remit broadened to the promotion of children’s welfare, including all spheres of health service delivery.

 

 

In Scotland, the Children (Scotland) Act 1995 came into force in 1996. Although the principles it contained are similar to the England and Wales Act, the legal process differs, as Scottish law deals with all aspects of both criminal and civil law relating to child protection.

 

 

In 1996 the Children (Northern Ireland) Order 1995 came into force. This gives statutory responsibilities for child protection to the health and social services boards, unlike in England, Wales and Scotland, where they lie with local authority social services.

 

 

The agencies
Social services departments have wide-ranging duties that include safeguarding and promoting the welfare of children. This includes providing appropriate support for families, for example through housing and education, to ensure their needs are met.

 

 

The role of the ACPC in each local authority is multifunctional (Box 2). It is a multi-agency forum for professional organisations and services facilitating co-operation in safeguarding the interests of children. The work of these agencies is also guided by the responsibilities outlined in the Government’s Working Together to Safeguard Children (1999).

 

 

Charities such as the National Society for the Prevention of Cruelty to Children attempt to bring together policies and procedures to set national standards. They are also instrumental in pressing for changes in legislation and raising public awareness about child abuse and child safety.

 

 

Cultural issues
It is important to recognise that professionals working within child protection are faced with ethical situations where child rearing and parenting practices within various cultures might be mistaken for abuse or neglect. Racial and cultural stereotyping of black and ethnic minority families can lead to inappropriate interventions in families as well as a failure to protect black and ethnic minority children from abuse. Equal opportunities for service users and staff are key issues in child-protection service provision. Other issues in safeguarding children that are evident surround competent interpreter availability for service users; there can be gender issues mainly for female family members involved in child-protection investigations where the interpreter is often male.

 

 

Child-protection processes highlight the structural problems that can impede and hinder anti-racist practice within the social care and NHS systems.

 

 

In summary, Childhood Matters states: ‘Despite the apparent acceptance of institutional racism in child-care services and apparent acknowledgement of the evidence provided around practice with black children, there has been no co-ordinated institutional response to counteract some of the effects that racism continues to have’ (NCIPCA, 1996b).

 

 

The 1976 Race Relations Act highlighted the need for organisations to undertake a review of their equal opportunity policies and although the responsibility of this was placed on the shoulders of local authorities, Phillips (2002) reports that it was largely ignored. However, to tackling racism requires recognition of and respect for cultural differences as this allows cultural diversity to be seen positively.

 

 

In order to identify and clarify what is meant by culture and ethnicity, it is important that common language and definitions are used.

 

 

Culture is a broad term that encompasses lifestyle, belief systems, language, roots and origins as well as behaviour and attitudes such as dress codes and gender identity.

 

 

The Framework for the Assessment of Children in Need and their Families (DoH et al, 2000) states:

 

 

- Cultural identities belong to everyone

 

 

- Culture is dynamic not monolithic

 

 

- Culture is acquired through life experiences

 

 

- There are differences between families who have the same cultural backgrounds.

 

 

Ethnicity is a difficult concept but is often used to provide a description about a person. A child is born in Wales and may consider his ethnicity to be Welsh. However, his parents, who are African-Caribbean, may ascribe an ethnic identity of British African-Caribbean to him.

 

 

Training
Professionals working in the field of child protection should be culturally sensitive and have a sound understanding of how to serve ethnically diverse clients.

 

 

How professionals achieve this is difficult to ascertain. Phillips (2002) reports that the ‘matching of ethnicity of workers to families’ may or may not have positive outcomes for the family. It may be difficult for professionals from the same ethnic background as a family to be non-judgemental and objective in assisting the family, or it may assume common ground.

 

 

To date, there is no comprehensive national standard for the level to which health-care professionals and professions allied to medicine should be trained. The Government leaves this decision to individual trusts and regions. As safeguarding children is such an important issue, there is a case for saying that basic child-protection training should be mandatory for all health workers.

 

 

An issue in focus
This month Professional Nurse begins a four-part series on child protection processes. We will also explore racism both from a staff and service user viewpoint. We shall also look at culture and ethnicity, specifically in relation to refugees and asylum seekers.

 

 

As stated above, Lord Laming’s conclusions on the Victoria Climbie case are expected to have extensive repercussions for child-protection services.

 

 

It would be refreshing to think that maybe, for once, the health service was ahead of the report and beginning to act in a proactive and considered way in relation to safeguarding all children of all cultures, ethnic groups and abilities.

 

 

- A four-part Study series on this subject begins in this issue. See page 280.

 

 

 

 

Department of Health, Home Office, Department for Education and Employment. (1999)Working Together to Safeguard Children. London: The Stationery Office.

 

 

Department of Health, Home Office, Department for Education and Employment. (2000)Framework for the Assessment of Children in Need and their Families. London: The Stationery Office.

 

 

National Commission of Inquiry into the Prevention of Child Abuse. (1996a)Childhood Matters: Report of the National Commission of Inquiry into the Prevention of Child Abuse: Vol. 1: The report. London: The Stationery Office.

 

 

National Commission of Inquiry into the Prevention of Child Abuse. (1996b)Childhood Matters: Report of the National Commission of Inquiry into the Prevention of Child Abuse: Vol. 2: Background papers. London: The Stationery Office.

 

 

Phillips, M. (2002)Issues of ethnicity and culture. In: Wilson, K., James, A. (eds). (2002) The Child Protection Handbook. Edinburgh: Balliere Tindell

 

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