Adverse childhood experiences (ACEs)
There is no universally agreed definition of an adverse childhood experience. Most studies addressing the issue have agreed a similar set of experiences falling under this term – verbal abuse, physical abuse, sexual abuse, physical neglect, emotional neglect, parental separation, household mental illness, household domestic abuse, household alcohol abuse, household drug abuse and incarceration of a household member.
Experiencing childhood adversity is correlated to a higher risk of experiencing certain problems in later life, for example, the prevalence of some conditions, such as low mental wellbeing, rises significantly with the number of adverse childhood experiences that individuals have experienced.
However, those children and young people who live through adverse childhood experiences are not guaranteed to engage in health-harming behaviour or have worse health outcomes. Furthermore, all these health-harming behaviours were also exhibited by some of those who had experienced no adverse childhood experiences.
Although the correlation between suffering adverse childhood experiences and negative consequences in later life seems widely accepted, this does not necessarily demonstrate causation. The British Psychological Society outlined one possible mechanism by which adverse childhood experiences could lead to negative later outcomes:
Research indicates that experience of traumatic events in childhood can have a profound adverse impact on brain development leading to both physical and behavioural changes as the child tries to adapt to environmental stressors. If trauma occurs over a prolonged period, it can rupture the child’s internal stress system which then contributes to physical and mental health problems over the life course, making children more vulnerable to difficulties with emotional regulation from birth and is often linked to difficulties with cognition such as problems with attention and focus in early and later childhood.
Survivors of adverse childhood experiences can often be reluctant to disclose voluntarily, due in part to feelings of shame, guilt and anxiety about their experiences and the act or consequences of disclosure. However, survivors have suggested that these issues can either be exacerbated or alleviated by the responses of the person listening to their disclosure. Furthermore, health and social care practitioners have described an unwillingness or discomfort with the idea of having to ask people about childhood adversity and trauma.
Advocate
The advocate’s role is widely described as ‘protecting the rights of children and young people’, ‘speaking up’ on behalf of children and young people or enabling them to ‘have a voice’ or ‘put their views across’ or gain access to much needed services.
Care leavers
Children and young people formerly in care before the age of 18 years of age. Such care could be in foster care, residential care (mainly children’s homes), or other arrangements outside the immediate or extended family. There is a legal definition of care leavers, and we should acknowledge the term care experienced to describe any child or young person of any age who has experienced being in the care of the local authority/council/health and social care trust.
Child maltreatment
Child maltreatment is the abuse and neglect that occurs to children under 18 years of age, including the unborn child. It includes all types of physical and/or emotional ill-treatment, sexual abuse, neglect, negligence and commercial or other exploitation, which results in actual or potential harm to the child’s health, survival, development, or dignity in the context of a relationship of responsibility, trust or power.
Child protection
Child protection is a part of safeguarding and promoting welfare for children and young people. This refers to the activity that is undertaken to protect specific children who are suffering or are likely to suffer significant harm as a result of maltreatment or neglect.
Children and young people
People under 18 years old, (babies, children, young people), in some circumstances including the unborn child. The changing scope of service provision increasingly however encompasses care leavers and young people in education, as well as young adults up to the age of 25 years.
Clinical care
Direct patient interaction to support or provide health care management
Competence
The ability to perform a specific task, action, or function successfully.
Consent
Consent means agreeing to what’s happening by choice and having the freedom and ability to make or change that choice. Consent requires clear affirmative action; silence is not consent.
Contextual safeguarding
Contextual safeguarding is an approach to understanding, and responding to, children and young people’s experiences of significant harm beyond their families.
Corporate parenting
The term in England set out in the Children Act 2004 refers to the collective responsibility of the local authority/council/health and social care trust, partner agencies and services including health, to provide the best possible care and protection for looked after children and young people, and to act in the same way as a good parent/ birth parent would.
County lines
County Lines is where illegal drugs are transported from one area to another, often across police and local authority/council/health and social care trust boundaries (although not exclusively), usually by children or vulnerable people who are coerced into it by gangs. The ‘County Line’ is the mobile phone line used to take the orders of drugs. Importing areas (areas where the drugs are taken to) are reporting increased levels of violence and weapons-related crimes as a result of this trend.
Designated professional (Lead child protection professionals in Scotland)
In England, the term designated doctor or nurse denotes professionals with specific roles and responsibilities for safeguarding children and looked after children, including the provision of strategic advice and guidance to service planners, commissioning organisations, and organisational boards across healthcare services, which includes private healthcare and independent providers. Designated professionals should be part of local multi-agency safeguarding children organisations and looked after children organisations. In England, designated professionals (doctors and nurses) are statutory roles, and all integrated care boards are required to have a designated doctor and designated nurse for safeguarding children and for Looked after Children, which should be separate roles. Designated professionals should have regular, direct access to the CCG accountable officer or chief nurse to provide expert advice and support for child safeguarding matters, and they should also be invited to all key safeguarding partnership meetings.
In Wales, designated professionals for safeguarding (including looked after children) are employed by Public Health Wales and have national roles. The strategic overview of health services for looked after children within each health board is fulfilled by the named doctors for looked after children with additional responsibility (named doctor for looked after children, strategic role). The National Safeguarding Team (NHS Wales) is part of Public Health Wales comprising of designated nurses, doctors and a GP lead. They support the seven health boards (HBs) and three NHS trusts in Wales. Public Health Wales has an internal safeguarding team, as do all the other health boards and trusts, which include lead safeguarding professionals. The health boards and Velindre NHS Trust also have named doctors. In Wales there are now six regional safeguarding children boards. (There are also currently six regional adult safeguarding boards, and, in some areas, there are plans to merge to become adult and children boards).
In Scotland, specialist paediatricians, GPs and nurses deliver services for looked after and accommodated children/young people, including health assessments and provide medical advice to fostering and adoption panels. The lead paediatricians and consultant/lead nurses who provide clinical leadership, advice, strategic planning and are members of the child protection committee. In larger health boards there are child protection nurse advisers who support the lead nurses. In addition, NHS health boards have a nominated board director with corporate responsibility for looked after children, young people, and care leavers.
In Northern Ireland, each health and social services trust has designated professionals for child protection. The designated professionals provide strategic advice about safeguarding children and looked after children to key regional bodies including public health agency and Safeguarding Board Northern Ireland.
Disability
A disability may be visible disabilities, e.g. physical impairments, or hidden, such as intellectual disability or a neurodevelopmental condition.
Health care staff
Health care staff includes health professionals, health care professional, or health care worker, who provide health care treatment and advice, based on training and experience.
In good standing
Refers to regulated healthcare professionals who are on their respective regulatory body registers without conditions and who are up to date with their professional CPD, annual appraisal and revalidation requirements – i.e., https://www.gmc-uk.org/ and https://www.nmc.org.uk/revalidation/
Initial and review health assessments
Assessments that are a statutory duty for looked after children and young people. N.B There is no statutory requirement for review health assessments in Scotland, only for initial.
Looked after child/children (and young people) (children and young people in care/children and young people looked after)
The term ‘Looked after Child’ is defined in the Children Act 1989 (c.41) and in the Statutory guidance, Promoting the health and wellbeing of looked-after children, 2022. Many local authorities/councils/health and social care trusts have consulted with children in care and use other terms such as Children in Care/Children Looked After/care experienced/child or young person leaving care. These terms are used to describe any child or young person who is in the care of the local authority/council/health and social care trust or who is provided with accommodation by the local authority/council/health and social care trust for a continuous period of more than 24 hours. This includes children in respect of whom a compulsory care order or other court order has been made, including those on an adoption pathway. It also refers to children that are accommodated voluntarily, including under an agreed series of short-term placements which may be called short breaks, family link placements or respite care, as well as those who are on remand. The term Looked After Children is used throughout the document for consistency, recognising that varying terms maybe used. For example, in Scotland the term ‘looked after and accommodated children’ is used and for care leavers, the term care experienced is also used. Whilst the term, ‘child or young person leaving care’, is used in Northern Ireland.
Missing children
Anyone whose whereabouts cannot be established will be considered missing until located, and their well-being or otherwise confirmed. Children and young people can be missing for several reasons, usually a combination of ‘push’ and ‘pull’ factors.
Named general practitioner
The GP employed by the local healthcare organisation to support them in performing their statutory duties and responsibilities for safeguarding. Activities are likely to include providing teaching and training to primary care, supporting practice safeguarding leads, working alongside other children and young people’s safeguarding professionals locally e.g., designated professionals, working closely with adult safeguarding professionals including named GPs for adult safeguarding, working strategically within their local healthcare organisation to provide child safeguarding resources for primary care.
Named professional
In England, all providers of NHS, or otherwise, funded health services including NHS trusts, NHS foundation trusts and public, voluntary sector, independent sector and social enterprises including local authorities providing health services i.e., 0-19 years’ services which are CQC registered, private providers, online providers and organisations who only provide adult services should identify a named doctor and a named nurse (and a named midwife if the organisation provides maternity services) for safeguarding children and young people and named professionals for looked after children and young people (nurse and doctor) or a lead clinician where appropriate. In the case of NHS 111, ambulance trusts and independent providers/ contractors such as dentists for example, this should be a named practitioner i.e., dentist or paramedic. Each registered primary care dental setting should have access to a named dentist/ professional across a larger geographical area rather than one named dentist/professional in each setting. For optical practices this may be a lay person with responsibility for arranging the training.
Named professionals have a key role in promoting good professional practice within their organisation, providing advice and expertise for fellow professionals, and ensuring safeguarding training is in place. For those organisations that have multiple sites then a team of specialists should support the named professional proportionate to child population/attendees/case-mix/number of sites covered. For independent provider organisations there should be a named nurse and doctor at national level and a named nurse and doctor at each provider location. The named midwife has knowledge and expertise of all issues associated with safeguarding children, particularly with regard to specific concerns during the antenatal and early postnatal periods.
In Wales and Northern Ireland, the roles of named professionals exist with similar responsibilities. In Wales, Public Health Wales, as a provider organisation, has a structure of designated and named professionals for the three regions. In Northern Ireland, each health and social services trust has named professionals for child protection.
In Scotland, the title equivalent to the named doctor is ‘paediatrician with a special interest in child protection’. Along with lead paediatricians and consultant/lead nurses they provide clinical leadership, advice, strategic planning and are members of the child protection committee. In larger health boards there are child protection nurse advisers who support the lead nurses.
Not in employment, education, or training (NEET)
The term NEET is used to describe young people who are not engaged in any form of employment, education, or training.
Parental responsibility
This is a set of legal rights and responsibilities, including making sure a child is kept safe. Parental responsibility gives the right to make important decisions about a child’s life.
Perplexing Presentations (PP)/Fabricated or Induced Illness (FII) in Children
The term Perplexing Presentations (PP) has been introduced to describe the commonly encountered situation when there are alerting signs of possible FII (not yet amounting to likely or actual significant harm), when the actual state of the child’s physical, mental health and neurodevelopment is not yet clear, but there is no perceived risk of immediate serious harm to the child’s physical health or life. The essence of alerting signs is the presence of discrepancies between reports, presentations of the child and independent observations of the child, implausible descriptions and unexplained findings or parental behaviour.
FII is a clinical situation in which a child is, or is very likely to be, harmed due to parent(s) behaviour and action, carried out in order to convince doctors that the child’s state of physical and/or mental health and neurodevelopment is impaired (or more impaired than is actually the case). FII results in physical and emotional abuse and neglect, as a result of parental actions, behaviours or beliefs and from doctors’ responses to these. The parent does not necessarily intend to deceive, and their motivations may not be initially evident.
Position of Trust
Position of trust is a legal term that refers to certain roles and settings where an adult has regular and direct contact with children. Examples of positions of trust include teachers, care workers, youth justice workers, social workers, doctors. In England, Wales and Northern Ireland changes to the law made in 2022 extend the definition to include faith group leaders and sports coaches.
It’s against the law for someone in a position of trust to engage in sexual activity with a child in their care, even if that child is over the age of consent (16 or over). Protections are designed to prevent exploitation.
Radicalisation
Radicalisation is the process through which a person comes to support or be involved in extremist ideologies. It is in itself a form of harm.
Safeguarding (The term child protection is used in Scotland)
The terms safeguarding and promoting the welfare of children is defined in UK Government, Department for Education, Working Together to Safeguard Children, 2024 as:
- providing help and support to meet the needs of children as soon as problems emerge
- protecting children from maltreatment, whether that is within or outside the home, including online
- preventing impairment of children’s mental and physical health or development
- ensuring that children grow up in circumstances consistent with the provision of safe and effective care.
- promoting the upbringing of children with their birth parents, or otherwise their family network through a kinship care arrangement, whenever possible and where this is in the best interests of the children.
- taking action to enable all children to have the best outcomes in line with the outcomes set out in the Children’s Social Care National Framework.
Safeguarding is a term used in the UK and Ireland to denote measures to protect the health, wellbeing, and human rights of individuals, which allow people – especially children, young people, and vulnerable adults – to live free from abuse, harm and neglect.
Any child can be considered to be at risk of harm or abuse, regardless of age, ethnicity, gender, or religion. The UK government has enacted legislation and published guidance to protect children from maltreatment, prevent the impairment of children’s health or development, ensure children grow up in circumstances consistent with the provision of safe and effective care, and enable children and young people to have the best outcomes. Responsibility for these aims is deemed to lie with everyone who comes into contact with children and families.
Specialist medical, nursing and health professionals for looked after children, including named nurse/doctor and nurse specialists
These terms refer to registered nurses with additional knowledge, skills and experience, GPs or paediatricians that have a particular role with looked after children and are the health specialist for these children.
In England, the term named doctor/nurse denotes an identified doctor or nurse with additional knowledge, skill and experience in working with looked after children who is responsible for promoting good professional practice within their organisation, providing supervision, advice and expertise for fellow professionals, and ensuring that looked after children awareness training is in place.
Supervision
Clinical – a formal process of support, reflection, learning and development that aims to enhance professional development, improve practice, and ensure quality of care (Clinical supervision models | NHS Employers ); safeguarding supervision is regular meetings, in individual or group settings, to discuss cases, reflect on practice, and develop strategies for ensuring the safety and well-being of vulnerable individuals.
Restorative supervision is a model of clinical supervision focused on supporting professionals’ well-being and resilience, particularly in emotionally demanding roles.
Transitional safeguarding
Transitional Safeguarding is an “approach to safeguarding adolescents and young adults fluidly across developmental stages which builds on the best available evidence, learns from both children’s and adult safeguarding practice and which prepares young people for their adult lives”. It focuses on safeguarding young people from adolescence into adulthood, recognising transition is a journey not an event, and every young person will experience this journey differently (refer to Bridging the gap: Transitional Safeguarding and the role of social work with adults (publishing.service.gov.uk) and Transitional Safeguarding: A Knowledge Briefing for Health Professionals
Trauma informed care
Trauma informed care is an organisational structure and treatment framework that involves understanding, recognising, and responding to the effects of all types of trauma. Trauma informed care also emphasises physical, psychological, and emotional safety for both consumers and providers, and helps survivors rebuild a sense of control and empowerment.
Unaccompanied asylum-seeking child (UASC)
Unaccompanied children and young people who are seeking asylum in the UK are treated as looked after young people. The definition is an individual who is under 18 years old, has arrived in the UK without a responsible adult, is not being cared for by an adult who by law or custom has responsibility to do so, is separated from both parents and has applied for asylum in the United Kingdom in his/her own right.
Vulnerable person
In general, a vulnerable person is either a minor or someone who, for physical or mental reasons, is unable to look after themselves or their finances. The UK government define being vulnerable as in need of special care, support, or protection because of age, disability, risk of abuse or neglect. Vulnerability factors can be economic, social, cultural, institutional, political and psychological.
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Abbreviations
This page explains commonly used acronyms and abbreviations related to safeguarding children and children in care
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References & Resources
This page lists the references and resources that support the safeguarding children and children in care competencies
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Competencies
This section contains competencies for each of the five levels of health care staff who support children and young people and for senior managers and executives
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