Living on a railway line Turning the tide of child abuse and exploitation in the UK and overseas: international lessons and evidence-based recommendations Professor Andrew Graeme Rowland B MedSci (Hons) BMBS (Hons) MFMLM MAcadMEd FCEM FRCPCH FRSA Honorary Professor, University of Salford Churchill Fellow 2014, Winston Churchill Memorial Trust Travel Bursary Award 2014, Association of Paediatric Emergency Medicine Consultant in Paediatric Emergency Medicine, The Pennine Acute Hospitals NHS Trust Living on a Railway Line Some children in the world are physically living on a railway line; others are metaphorically living on that same railway line at significant risk of harm from many different sources. Figure 1: Living on a Railway Line, Sihanoukville, Cambodia drandrewrowland.wordpress.com Page 2 of 338 1.0 Contents LIVING ON A RAILWAY LINE 2 1.0 CONTENTS 3 2.0 FOREWORD 13 2.1 FOREWORD BY PROFESSOR DESMOND K. RUNYAN AND PROFESSOR DONALD C. BROSS 13 EXECUTIVE SUMMARY 17 3.0 EXECUTIVE SUMMARY 18 RECOMMENDATIONS 23 4.0 RECOMMENDATIONS 24 4.1 KEY RECOMMENDATIONS FOR THE UK 24 4.1.1 MANDATORY REPORTING OF CHILD ABUSE AND NEGLECT 24 4.1.2 KEY RECOMMENDATION ONE 24 4.1.3 PHYSICAL PUNISHMENT OF CHILDREN 24 4.1.4 KEY RECOMMENDATION TWO 24 4.1.5 LEGISLATIVE CHANGE REQUIRED IN THE UK 24 4.1.6 KEY RECOMMENDATION THREE 24 4.1.7 KEY RECOMMENDATION FOUR 25 4.1.8 KEY RECOMMENDATION FIVE 25 4.1.9 PAEDIATRIC EMERGENCY MEDICINE SOCIAL WORKER PILOT 25 4.1.10 KEY RECOMMENDATION SIX 25 4.1.11 CHILD ABUSE AND NEGLECT EDUCATION AND TRAINING 25 4.1.12 KEY RECOMMENDATION SEVEN 25 4.1.14 SOCIETY’S VIEWS ON CHILD ABUSE 26 4.1.15 KEY RECOMMENDATION EIGHT 26 4.1.16 CHILD ABUSE AWARENESS EVENT 26 4.1.17 KEY RECOMMENDATION NINE 26 4.1.18 CHILDREN’S ADVOCACY 26 4.1.19 KEY RECOMMENDATION TEN 26 drandrewrowland.wordpress.com Page 3 of 338 4.2 ASSOCIATED AND ENABLING RECOMMENDATIONS FOR THE UK 27 4.2.1 MANDATORY REPORTING OF CHILD ABUSE IN THE UK 27 4.2.2 RECOMMENDATION ONE 27 4.2.3 RECOMMENDATION TWO 27 4.2.4 RECOMMENDATION THREE 28 4.2.5 UK LEGISLATIVE PROCESS 29 4.2.6 RECOMMENDATION FOUR 29 4.2.7 CHILD MALTREATMENT SCREENING TOOL 29 4.2.8 RECOMMENDATION FIVE 29 4.2.9 SAFEGUARDING VULNERABLE CHILDREN PROFESSIONAL EDUCATIONAL PROGRAMMES 29 4.2.10 RECOMMENDATION SIX 29 4.2.11 RECOMMENDATION SEVEN 29 4.2.12 MEDICAL INVESTIGATIONS IN CASES OF SUSPECTED CHILD MALTREATMENT 30 4.2.13 RECOMMENDATION EIGHT 30 4.2.14 RECOMMENDATION NINE 30 4.2.15 CHILD PROTECTION PEER REVIEW AND MULTI-PROFESSIONAL INVOLVEMENT 30 4.2.16 RECOMMENDATION TEN 30 4.2.17 RECOMMENDATION ELEVEN 30 4.2.18 ADVERSE CHILDHOOD EXPERIENCES (ACES) 31 4.2.19 RECOMMENDATION TWELVE 31 4.2.20 RECOMMENDATION THIRTEEN 31 4.2.21 WORLD HEALTH ORGANISATION (WHO) HEALTH NEEDS ASSESSMENT (HNA) 31 4.2.22 RECOMMENDATION FOURTEEN 31 4.2.23 CHILDREN’S ADVOCACY 31 4.2.24 RECOMMENDATION FIFTEEN 31 4.2.25 ADVOCATING FOR ADOLESCENTS 32 4.2.26 RECOMMENDATION SIXTEEN 32 4.2.27 PAEDIATRIC EMERGENCY MEDICINE RESEARCH 32 4.2.28 RECOMMENDATION SEVENTEEN 32 4.2.29 CHILD PROTECTION PRO-BONO WORK 32 4.2.30 RECOMMENDATION EIGHTEEN 32 4.2.31 RECOMMENDATION NINETEEN 32 4.2.32 COMMONWEALTH SCHOLARSHIP COMMISSION AWARDS AND FELLOWSHIPS 33 4.2.33 RECOMMENDATION TWENTY 33 4.2.34 CHILD SEXUAL EXPLOITATION 33 4.2.35 RECOMMENDATION TWENTY-ONE 33 drandrewrowland.wordpress.com Page 4 of 338 4.2.35 CHILDREN GIVING EVIDENCE IN COURT IN THE UK 33 4.2.36 RECOMMENDATION TWENTY-TWO 33 4.2.37 LOCALLY PROVIDED HEALTH SERVICES 33 4.2.38 RECOMMENDATION TWENTY-THREE 33 4.2.39 DOMESTIC AND INTER-PARTNER VIOLENCE 34 4.2.40 RECOMMENDATION TWENTY-FOUR 34 4.2.41 INTERNATIONAL NETWORK DEVELOPMENT 34 4.2.42 RECOMMENDATION TWENTY-FIVE 34 4.3 INTERNATIONAL RECOMMENDATIONS 35 4.3.3 RATIFICATION OF THE UN CONVENTION ON THE RIGHTS OF THE CHILD IN THE USA AND SOMALIA 35 4.3.4 INTERNATIONAL RECOMMENDATION ONE 35 4.3.5 INTERNATIONAL PROHIBITION OF PHYSICAL PUNISHMENT OF CHILDREN AGED UNDER 18 YEARS OF AGE 35 4.3.6 INTERNATIONAL RECOMMENDATION TWO 35 4.3.7 CHILDREN GIVING EVIDENCE IN COURT IN THE USA 36 4.3.8 INTERNATIONAL RECOMMENDATION THREE 36 4.3.9 CHILD PROTECTION STRATEGY FOR MALAYSIA 36 4.3.10 INTERNATIONAL RECOMMENDATION FOUR 36 4.3.11 INTERNATIONAL RECOMMENDATION FIVE 36 4.3.12 INTERNATIONAL RECOMMENDATION SIX 36 4.3.13 INTERNATIONAL RECOMMENDATION SEVEN 36 IMPLEMENTATION STRATEGY 37 5.0 IMPLEMENTATION STRATEGY 38 5.1 IMPORTANT RECOMMENDATIONS THAT CAN BE IMPLEMENTED OR GENERALISED 38 5.2 RECOMMENDATIONS THAT ARE MOST IMPORTANT AND URGENT 39 5.3 RECOMMENDATIONS THAT ARE MOST IMPLEMENTABLE 40 5.4 RECOMMENDATIONS THAT CAN BE MOST GENERALISED 41 PURPOSE OF THIS REPORT 43 6.0 BASIS OF LIVING ON A RAILWAY LINE 44 6.1 PURPOSE OF THIS REPORT 44 6.2 DISCLAIMER 45 drandrewrowland.wordpress.com Page 5 of 338 INTRODUCTION 47 7.0 INTRODUCTION 48 7.1 AIMS 48 7.2 OBJECTIVES 49 7.3 BACKGROUND 50 PUBLIC POLICY TRANSFER 55 8.0 TRANSFER OF PUBLIC POLICY FROM ONE JURISDICTION TO ANOTHER 56 8.1 WHO LEARNS WHAT FROM WHOM? 56 8.2 THE EXAMPLE OF THE INTRODUCTION OF THE UK CHILD SUPPORT AGENCY 58 8.3 APPLYING PUBLIC POLICY RESEARCH TO LIVING ON A RAILWAY LINE 61 MANDATORY REPORTING OF CHILD ABUSE 63 9.0 REPORTING OF SUSPECTED CHILD ABUSE 64 9.1 OVERVIEW 64 9.2 JURISDICTIONS WITH MANDATORY REPORTING 66 9.3 ARGUMENTS SURROUNDING MANDATORY REPORTING LEGISLATION 73 9.3.10 RECOMMENDATION ONE 75 9.4 REPORTING OF CASES 81 9.5 PUBLIC OPINION 85 9.6 SOCIAL JUSTICE 88 9.7 IMPLICATIONS FOR THE UK 90 9.7.12 KEY RECOMMENDATION ONE 93 9.7.30 RECOMMENDATION TWO 96 9.7.34 RECOMMENDATION THREE 98 PHYSICAL PUNISHMENT OF CHILDREN 99 10.0 PHYSICAL PUNISHMENT OF CHILDREN 100 10.1 OVERVIEW 100 10.2 PADDLING IN THE USA 103 10.3 SUPPORT FOR PHYSICAL PUNISHMENT OF CHILDREN 104 10.4 RESEARCH INTO PHYSICAL PUNISHMENT OF CHILDREN 107 drandrewrowland.wordpress.com Page 6 of 338 10.5 WORLDWIDE PERSPECTIVE 110 10.5.14 INTERNATIONAL RECOMMENDATION ONE 112 10.5.15 INTERNATIONAL RECOMMENDATION TWO 112 10.6 IMPLICATIONS FOR THE UK 113 10.6.8 KEY RECOMMENDATION TWO 114 LEGISLATIVE CONSIDERATIONS 115 11.0 LEGISLATIVE CONSIDERATIONS 116 11.1 OVERVIEW 116 11.2 SEXUAL OFFENCES ACT 2003 117 11.2.5 KEY RECOMMENDATION THREE 117 11.2.7 KEY RECOMMENDATION FOUR 118 11.3 THE CHILDREN ACT 2004 119 11.3.11 KEY RECOMMENDATION FIVE 121 11.4 MODERN SLAVERY LEGISLATION 122 11.4.10 RECOMMENDATION FOUR 124 SAFEGUARDING IN THE EMERGENCY DEPARTMENT 125 12.0 SAFEGUARDING CHILDREN IN THE EMERGENCY DEPARTMENT 126 12.1 OVERVIEW 126 12.2 THE USE OF CHILD ABUSE SCREENING TOOLS IN THE EMERGENCY DEPARTMENT 127 12.2.20 RECOMMENDATION FIVE 134 12.3 SOCIAL WORKER PRESENCE IN THE EMERGENCY DEPARTMENT 135 12.6.12 KEY RECOMMENDATION SIX 139 PROFESSIONAL EDUCATION IN CHILD ABUSE AND NEGLECT 141 13.0 PROFESSIONAL EDUCATION IN CHILD ABUSE AND NEGLECT 142 13.0.6 RECOMMENDATION SIX 143 13.0.9 RECOMMENDATION SEVEN 144 13.0.10 KEY RECOMMENDATION SEVEN 144 13.1 RADIOLOGICAL INVESTIGATIONS OF SUSPECTED CHILD ABUSE 145 13.1.9 RECOMMENDATION EIGHT 146 13.2 HAEMATOLOGICAL INVESTIGATIONS OF SUSPECTED CHILD ABUSE 147 13.2.11 RECOMMENDATION NINE 150 drandrewrowland.wordpress.com Page 7 of 338 13.3 CASE MANAGEMENT AND PEER REVIEW OF CHILD PROTECTION CASES 151 13.3.10 RECOMMENDATION TEN 154 13.4 THE ROLE OF ADVANCED (NURSE) PRACTITIONERS IN CHILD PROTECTION TEAMS 156 13.4.12 RECOMMENDATION ELEVEN 158 THE ROLE OF SOCIETY IN PROTECTING CHILDREN 159 14.0 THE ROLE OF SOCIETY IN PROTECTING CHILDREN 160 14.1 OVERVIEW 160 14.2 PROTECTING CHILDREN IS EVERYONE’S BUSINESS – EVEN YOURS! 161 14.2.14 RECOMMENDATION TWELVE 164 14.2.17 RECOMMENDATION THIRTEEN 165 14.3 CHILD ABUSE PREVENTION IN THE COMMUNITY 166 14.3.15 KEY RECOMMENDATION EIGHT 171 14.4 WORLD HEALTH ORGANISATION (WHO) HEALTH NEEDS ASSESSMENT 172 14.4.6 RECOMMENDATION FOURTEEN 173 CHILD ABUSE AWARENESS EVENT 175 15.0 CHILD ABUSE AWARENESS EVENT 176 15.0.11 KEY RECOMMENDATION NINE 179 CHILDREN’S ADVOCACY 181 16.0 CHILDREN’S ADVOCACY 182 16.1 OVERVIEW 182 16.2 INVOLVING CHILDREN IN HEALTHCARE 185 16.2.19 RECOMMENDATION FIFTEEN 190 16.3 LAUNCH OF A CHILDREN’S ADVOCACY CENTRE 191 16.3.19 KEY RECOMMENDATION TEN 194 ADOLESCENT HEALTH 195 17.0 ADOLESCENT HEALTH 196 17.0.9 RECOMMENDATION SIXTEEN 203 drandrewrowland.wordpress.com Page 8 of 338 PAEDIATRIC EMERGENCY MEDICINE RESEARCH UNIT 205 18.0 PAEDIATRIC EMERGENCY MEDICINE RESEARCH UNIT (PEMRU) 206 18.0.10 RECOMMENDATION SEVENTEEN 208 INTERNATIONAL NETWORKS 209 19.0 INTERNATIONAL NETWORKS 210 19.0.11 RECOMMENDATION EIGHTEEN 213 19.0.16 RECOMMENDATION NINETEEN 214 19.0.31 RECOMMENDATION TWENTY 216 19.1 THE TRAVEL INDUSTRY AND CREATING A CHILDSAFE PILOT IN THE UK 217 19.1.12 RECOMMENDATION TWENTY-ONE 220 TRAVEL ITINERARY 221 20.0 ITINERARY 222 20.1 MAP 222 20.2 DETAILED DIARY 222 THE USA, SINGAPORE, MALAYSIA AND CAMBODIA 225 21.0 UNITED STATES OF AMERICA 226 21.1 AUSTIN, TEXAS 226 21.1.17 INTERNATIONAL RECOMMENDATION THREE 232 21.1.22 RECOMMENDATION TWENTY-TWO 233 21.2 PHOENIX, ARIZONA 234 21.2.19 RECOMMENDATION TWENTY-THREE 239 21.3 PHILADELPHIA, PENNSYLVANIA 240 21.3.13 RECOMMENDATION TWENTY-FOUR 244 21.4 AURORA, DENVER, COLORADO 245 22.0 SINGAPORE 251 22.1 SINGAPORE 251 23.0 MALAYSIA 254 23.1 KUALA LUMPUR, SELANGOR 254 drandrewrowland.wordpress.com Page 9 of 338 23.2 IPOH, PERAK 264 23.2.6 INTERNATIONAL RECOMMENDATION FOUR 265 23.2.7 INTERNATIONAL RECOMMENDATION FIVE 265 23.2.8 INTERNATIONAL RECOMMENDATION SIX 265 23.2.9 INTERNATIONAL RECOMMENDATION SEVEN 266 24.0 KINGDOM OF CAMBODIA 272 24.1 SIHANOUKVILLE 272 24.2 M’LOP TAPANG 273 24.2.25 RECOMMENDATION TWENTY-FIVE 279 APPENDICES 281 25.0 APPENDIX ONE 283 25.1 AUTHOR’S BIOGRAPHY 283 26.0 APPENDIX TWO 287 26.1 THE WINSTON CHURCHILL MEMORIAL TRUST (WCMT) 287 27.0 APPENDIX THREE 289 27.1 THE ASSOCIATION OF PAEDIATRIC EMERGENCY MEDICINE (APEM) 289 28.0 APPENDIX FOUR 291 28.1 PARTICIPANT CONSENT FORM: SINGAPORE AND MALAYSIA SURVEY 291 29.0 APPENDIX FIVE 293 29.1 SINGAPORE AND MALAYSIA SURVEY 293 30.0 APPENDIX SIX 305 30.1 ACKNOWLEDGEMENTS 305 31.0 APPENDIX SEVEN 309 31.1 TABLE OF FIGURES 309 32.0 APPENDIX EIGHT 311 32.1 ABBREVIATIONS AND GLOSSARY 311 drandrewrowland.wordpress.com Page 10 of 338