The 1987 Cleveland child abuse scandal saw 121 children
removed from their families. Natalie Valios finds out what has
changed for professionals when they take on abuse cases
today.
Many will remember 1987 as the year the great storm hit the south
of England. In Cleveland, it will go down in history as the year
that child protection professionals were battered by a storm of
quite another nature.
Over the course of a few months, two paediatricians diagnosed
sexual abuse in 121 children from 57 families in the area. Most of
the children were removed from their homes under place of safety
orders. This unprecedented situation came at a time when
professionals were waking up to the existence of child sexual
abuse. One factor in this was the launch of ChildLine in 1986. High
profile inquiries into the deaths of Jasmine Beckford and Tyra
Henry in their family homes combined to form a climate where social
workers were wary of leaving children in potentially abusive
situations.
Norfolk paediatrician Rosalyn Proops was working in Edinburgh
and then East Anglia during the Cleveland months. "It was a time
when UK paediatricians were hearing about concerns of sexually
abused children from the USA. We were realising that a number of
children we were seeing may well have been sexually abused."
When the Cleveland story broke, Proops' boss said he supposed
that a child he had seen years ago who had gonorrhoea "probably
didn't catch it from the toilet seat".
"For paediatricians, Cleveland was a defining moment in
realising that the unthinkable did happen to children," Proops
says.
In June 1986 Sue Richardson was appointed to the new post of
child abuse consultant by Cleveland social services department.
Faced with the paediatricians' diagnoses, she thought the only way
forward was to remove the affected children from their
families.
The 1988 inquiry into child abuse in Cleveland, chaired by
Baroness Butler-Sloss, blamed the crisis on lack of proper
understanding by agencies of each others' functions lack of
communication between agencies and a difference of opinion by
middle managers which weren't recognised by senior staff and then
affected those on the ground.
Twenty years on, Richardson says she is still waiting for the
real lessons from Cleveland to be learned. "The majority of
children can't speak about the abuse and they need adults to
diagnose it. The ones who couldn't tell anyone what had happened
were our controversial cases. Nobody has yet addressed how those
children can be protected."
Many in the field argue that it is still no easier to get child
sexual abuse out in the open today than it was then. Tink Palmer,
director of Stop it Now! UK and Ireland, a public education
campaign to prevent child sexual abuse and a project of child
protection charity the Lucy Faithfull Foundation, says: "There have
been new laws and procedures, practice and policies and that's all
very good, but they're applicable to the children we know about.
But research shows us that we are dealing with about 10 per
cent.
"Eighty per cent of children are sexually abused by someone
known to them. This means they aren't going to be able to report
what is happening easily."
Palmer says that we as a society have failed to get to grips
with the embedded issues of child sexual abuse in our communities
and how we get that into the open. "Since the 1997 publication of
Sir William Utting's report People Like Us there has been
no or little progress in bringing abusers to justice and securing
convictions or providing adequate help and treatment for abused
children," she complains.
Lord Laming, whose name has become synonymous with child
protection since heading the Victoria Climbie Inquiry, agrees "the
position is rather patchy" when it comes to diagnosis of, and
response to, cases of child abuse.
"In many places there is much better interagency,
multi-professional working and there's more sensitivity to
listening to children and taking their concerns seriously," Laming
says. "My concern is that this isn't assured everywhere and there
are still times where children feel they aren't heard and too much
attention is focused on the adults in their lives and not
them."
For Laming, who was social services director at Hertfordshire in
1987, the biggest thing that has happened since Cleveland is the
passing of the
Children Act 1989, which he regards as an
ambitious piece of legislation that includes, but goes beyond,
child protection.
"The saddest thing is that we are still some way off from
implementing it so that children can benefit from the different
ways of providing assistance to them and their families," he
says.
Laming is now pinning his hopes on the new local safeguarding
boards, bought in to replace Area Child Protection Committees under
the Children Act 2004. "I hope they will usher in a
new era of effective interagency working," he says.
For professionals, raising the issue of child abuse remains as
difficult as it was 20 years ago. Earlier this month, 50 UK
paediatricians accused the General Medical Council of deterring
doctors from raising child protection concerns through its
treatment of paediatricians David Southall and Sir Roy Meadow.
Proops, who is also the child protection officer for the
Royal College of
Paediatrics and Child Health, says: "There are few times when a
doctor can say with any degree of confidence that a child has been
abused. Most of the things we find when we examine children can
have occurred through a number of different ways. It's about
probabilities."
However, while everything during Cleveland hinged on the medical
diagnosis - in particular anal dilatation - now looking at the anus
is just part of the clinical examination of a child and is not as
significant as it used to be, says Proops. And multi-agency
working, supervision and peer review ensure that doctors are
properly supported and not left to work alone on difficult
cases.
"If we are concerned, we will want to find out more and talk to
health visitors, social workers, GPs and that's how you build up a
jigsaw of finding out what has happened so you can decide whether
they have been abused," Proops says. "All forms of child protection
must be managed in a multi-agency way."
Proops thinks there have also been important changes in the
intervening years when it comes to identifying abuse.
"Paediatricians have more experience of examining children so we
know that minor abnormalities are just that and not something to be
worried about. They are not as definitive as we thought they were
20 years ago, for example the size of a hymen opening in a
pre-pubertal child."
There is also more research, and in November the RCPCH is due to
publish evidence- based guidance on the physical signs of child
sexual abuse.
The majority of the Cleveland children were eventually returned
home with all proceedings dismissed. Nowadays the approach to child
abuse allegations is more measured, with the onus being on removing
the perpetrator from the home rather than the child.
Viv Hogg, team manager for one of two access and assessment
teams at Gateshead learning and children's services, started
working in child protection 12 years ago. Then the emphasis was on
preventing danger rather than building safety, often resulting in
removing children from their parents. "Now we look at how we can
ensure the child is safe within the setting they live in," she
explains.
Despite this, Richardson believes that the legacy of Cleveland
is "fear of controversy, and fear of getting it wrong". As one who
was caught up in the eye of this storm, it is hard not to take her
concerns seriously.
The
Lessons
Improvements in diagnosing and
responding to child abuse since 1987:
• Greater interagency working, supported by new Local Safeguarding
Children's Boards
• Clinical examinations backed up with multi-agency working,
supervision and peer review
• More experience and research around the physical signs of child
sexual abuse versus natural minor physical abnormalities
• Greater focus on ensuring the child is safe within the setting
they live in, including removing the perpetrator from the home
rather than the child
Further
information
Working Together guidance, 1999 and
2006
Achieving Best Evidence in Criminal Proceedings:
guidance for vulnerable or intimidated witnesses, including
children, 2002
Signs of Safety: A Solution and Safety Oriented
Approach to Child Protection Casework
The Resolutions approach was developed in
Bristol in 1992 to work with families who were in denial or in
dispute with authorities
Contact the author
Natalie Valios
This article appeared in the 26 April issue under the headline
"Twenty years of progress?"
This weeks other feature article:
Commissioning and children's centres. How Hertfordshire broke the
mould