No one, no issue is off the table when it comes to safeguarding

This is a post by Sarah Phillimore.

I was sent a copy of an article this evening. It appears in the October edition of ‘Professional Social Work Magazine’ which I am told is a publication for those who belong to the British Association of Social Workers (BASW) a powerful and influential organisation which claims over 20,000 members, ‘committed to the highest standards of practice and ethics’.

The article was written by someone who did not want to reveal their identify, in order to protect that of their child, which I can quite understand. The article is titled ‘Listen to children on gender – what being the parent of a trans child has taught me’.

It is the account of a teenager who struggled with a ‘gender identity’ that did not ‘match the sex they were assigned at birth’ and how the parents supported the child to transition from female to male after the child made his wishes known at 12 – having spent ‘months, if not years’, ‘thinking about his body as wrong’.

It is a sensitive account from a parent about how they responded to their child who, on this account clearly did appear to be expressing strong views that had been held over time. I have absolutely no difficulty with this. It is clear that ‘gender dysphoria’ does exist and a small percentage of people will benefit from surgery to bring their physical body more into alignment with what they believe their body should be.

However, there will, I am equally sure, be those who profess a wish to ‘change sex’ who have other issues and difficulties that medication or surgery will not alleviate. Such intervention may have permanent and life long consequences and should not be entered into lightly. Enormous caution should be taken around ‘supporting’ a child who is not Gillick competent into making any serious decision about their lives.

And this is where the article began to make me feel very uneasy. Far from restricting it to an account of one child’s journey, it is clear that the author wishes to offer far more general guidance and does so on the basis of assertions that are – in my view – profoundly misguided and actively dangerous.

The author raises as a ‘myth’ that hormone treatments are given to children under the age of 16 or surgery is considered only at 18. Possibly she or he is unaware of the activities of Dr Helen Webberley and what appears to be a growing number of activists who demand that ‘puberty blockers’ should be available to children as young as 12. Ironic also is the fact that the CEO of Mermaids Susie Green took her child abroad for surgery when the child was only 16.

Offering up these age limits of 16 and 18 as some kind of inviolate barrier beyond which people cannot pass is simply naive – particularly given the inevitable ‘drive’ for increased intervention at a younger age as that will make it easier for a child to ‘pass’ – particularly a boy who wants to become a girl.

But my real fears are raised by the ‘bullet points’ at the end of the article

  • Just because a child is telling you they are transgender, does not mean they are too young to know this
  • Its not possible to force a child or young person to be trans
  • parents supporting their child in their gender identify is not a safeguarding issue

I wonder if the author of this article has read the judgement in Re J?  I wrote about this in more detail in this post – In whose best interests? Transgender children: choices and consequences – and the issues around bear repeating here.

This is an important case – J (A Minor), Re [2016] EWHC 2430 (Fam) (21 October 2016).

The Transparency Project wrote about the case and the media response here and summarised the court’s approach in this way:

Mr Justice Hayden heard the case over a number of days in the summer and, based upon the experts and professionals whose evidence he heard (along with that of the mother herself), the judge concluded that J was a little boy whose mother’s perception of his gender difference was suffocating his ability to develop independently – and was causing him significant emotional harm. He was placed with his father, where he quickly began to explore toys and interests that were stereotypically “boys”. The judgement is very clear that the father had brought “no pressure on J to pursue masculine interests” and that his interests and energy were “entirely self motivated” (pa 47). So, not forced to live “like a boy” (whatever that means) – but choosing (there is more detail in the judgment).

Importantly, Hayden J acknowledged that there are genuinely children who are transgender or gender dysphoric, and who present in this way from an early stage, but – and here is the crux of it – this child was not one of them. This was all about the mother’s position.

At para 63 of the July judgment, the judge commented on the expert opinion of the mother and how she presented:

When stressed and distressed, [M] becomes controlling, forceful and antagonistic. This reflects her underlying anxiety. She is actually very frightened and upset. She tries to sooth herself by taking control of situations but her interpersonal style is counter-productive. She does not negotiate well. She finds it difficult to compromise and situations become inflamed rather than de-escalated. In situations of interpersonal conflict, she protects herself from loss of confidence or face by unambiguously perceiving herself as correct which means that from her perspective, the other party is wrong. To acknowledge her flaws, even to herself, feels crushing and devastates her self-esteem so she avoids this possibility by locating responsibility and blame elsewhere. When she is unable to achieve the outcome that she wants, she resorts to formal processes and/or higher authorities: complaint procedures, The Protection of Human Rights in Public Law, the European Court of Human Rights, Stonewall and so on.”

It is clear that the mother was insistent with all agencies that J ‘disdained his penis’ and was being subjected to bullying at school etc. She could not provide any proof of this and the school denied it was happening. She was supported throughout by Mermaids who played a significant role in the development of a ‘prevailing orthodoxy’ that J – at 4 years old – wished to be a ‘girl’. That view was found by the court to have no bearing in reality and was a product of both ‘naivety and professional arrogance’

Mr Justice Hayden was highly critical of the local authority for getting swept up in this prevailing and false orthodoxy, commenting at paragraph 20 of the July judgment

This local authority has consistently failed to take appropriate intervention where there were strong grounds for believing that a child was at risk of serious emotional harm. I propose to invite the Director of Children’s Services to undertake a thorough review of the social work response to this case. Professional deficiencies to this extent cannot go unchecked, if confidence in this Local Authority’s safeguarding structures is to be maintained.

No one and no thing is exempt from safeguarding

I am profoundly worried by that last bullet point in the article – “parents supporting their child in their gender identify is not a safeguarding issue”.

The mother in re J was supported throughout by Mermaids, who issued an angry press release after the judgment and said there would be an appeal. There was not. The author of this article refers its readers to Mermaids as a useful resource.

It is surely the antithesis of any responsible social work or safeguarding policy to set up groups of people or particular issues that are immune from examination or critical regard. While the author’s 12 year old child may have thought long and hard about the issue and demonstrated his Gillick competence beyond doubt – I suggest the same certainly cannot be offered with regard to a 4 year old. But is the issue of ‘trans’ now off the table for social workers? Whatever the child’s age or level of understanding – if he or she declares they are trans, then that is that? No further investigation or assessment is required? How can this be right? How is this good social work?

I am really worried about this. I would be interested to hear from other social workers about what they think, and how they would approach a case involving a very young child who wished to embark upon a path of ‘changing sex.’

 

 

12 thoughts on “No one, no issue is off the table when it comes to safeguarding

  1. Angelo Granda

    If gender transition is to be regarded as a ‘ safe-guarding’ issue then i suggest a child should be protected by parents and medicals not by Local Authorities . Transition is not against the law thus rationally it does not put a child in moral or spiritual danger; according to the majority, it is not objectively wrong.
    In Re .v. J, the argument was between parents and both made their feelings known to school. It is possible it was Father made anonymous referrals to the L.A. although not certain and impossible to prove either way.
    What is the law around medical treatment for minors? I suggest the consent of both those with parental responsibility should be required to sign informed consent until a child becomes eighteen.Would that work?

    Reply
    1. Sarah Phillimore Post author

      How can a child be ‘protected’ by a parent who is doing him harm? As the mother was in Re J.
      Your continued championing of the mother in this case is really disturbing to me.

      Reply
  2. Angelo Granda

    I”m not championing either of the parties ( Mum or Dad). I am completely unable to pass judgment and I am suggesting that the Family Courts are also unable thus they shouldn’t be involved.
    The Local Authority should not be getting involved with these cases either except when the Education Committee lays down school dress and personal privacy policies ( in toilets and changing rooms,swimming baths etc.).
    My reasoning is that whilst we may think Mum in ReJ was doing the child harm and many think likewise that she was wrong objectively , she will have seen herself as right objectively.
    In law, she was not acting unlawfully ; there is no law against gender transition or encouraging it although some may think there should be.If she had been breaking some law,i would say charge her immediately.
    Don’t be disturbed by my comments.All i am trying to do is put a neutral point of view.I have no axes to grind on this issue.Also we must try and discuss things openly and come to compromises.
    I merely suggested that medics ( including psychologists) alongside both parents should protect the child and that where parents disagree, the child would be protected from the actual final transition ( the op.) physical if both parents were required to sign consent forms.

    Reply
    1. Sarah Phillimore Post author

      She was however acting unlawfully. She was causing significant emotional harm to her child. That was an objective fact. That is contrary to law.

      Reply
      1. Angelo Granda

        I agree entirely the Family Court found on all the evidence presented that Mum was the cause of significant harm to the child. That decision was taken at the discretion of one judge , of course., From what I have gleaned from High Court Judgments summarised on the CPR, the law says that it is inevitable in life that children are often placed at risk of significant harm and it is inevitable it will, in many cases,be due to a child’s parents. Most parents are flawed and this often leads to concern. I believe the High Courts decreed that, in such cases, children should nevertheless remain with the parent unless there is a danger of ‘moral or physical’ harm.
        We have seen the judgment in Re J and it laid emphasis on an opinion that Mum disagreed with and contested professional evidence ( she thought she was right and they were wrong). He also thought she was unreasonable to exercise her human rights and make official complaints under official procedures. That is why the Judge thought the child was in moral and physical danger .Because she denied concerns in Court. That is why he withdrew her human rights and took the child from her. All at his own discretion.Was she given the chance to accept the court’s findings and change?

        There is no law against gender transition in itself,however,is there? It is acceptable in this day and age as it was in ancient times.The decision depended on the value-judgments of the Court.The case was brought because of the value-judgments of the L.A. professionals.
        What about fundamental human rights? We can’t persecute citizens for unorthodox beliefs and their various ‘isms’.
        How would a parent bringing up a child in Athe-ISM or in Judah-ISM like it if they were persecuted and told they were causing significant emotional harm by not teaching orthodox moral doctrines to their child. How would they feel if when they disagreed and complained , they were castigated and deprived of their human rights to a family life for doing so?
        It’s all about fundamental freedoms in my eyes. Personally , i thing atheism teaches children wrong lessons but I would never enforce my beliefs on others or persecute atheists for it.

        Reply
  3. Charlie Noack

    You are quite right in raising this as an issue. I met one social worker who was “managed out” after raising concerns in regard to children who identify as trans and a youth worker who won’t be returning after a medical leave of absence because they know they cannot adequately protect vulnerable children after their LA adopted new transgender guidelines in the meantime.

    The answer to your question is that neither would feel capable of protecting this child because any concerns would be ignored, questioned or penalised. (I have also heard this raised as an issue from a number of other social workers at meetings I attended, but did not speak to them myself.)

    You are also right about questioning the claim that hormones are not available to under 16s and surgery not to the under 18s. The author may not have heard about the Tavistock study that involved under 16s being given puberty blockers. Clear proof that this age group is receiving medical treatment that can have irreversible side effects as well as longterm negative consequences for a child’s normal development. Puberty blockers are of course a form of hormone treatment – as is anything that effects the body’s endocrine system. Presumably the author does not understand this and therefore only considers cross-sex hormones to be relevant?

    Furthermore, children continue to be removed from this country in order to undergo surgeries before they reach their majority – indeed, the ITV drama Butterflies showed the parents planning on taking their child to the States to circumvent UK restrictions. This drama was of course warmly welcomed by various trans advocacy groups who are currently lobbying policy makers to allow surgeries in children under 18. We know that in the US mastectomies have been performed on trans-identifying female children as young as 13.

    Nothing and no one should ever go unquestioned or unexamined when it comes to children. The demand, repeated by this parent, that children who identify as trans should be excluded from standard safeguarding principles, should be seen as the red flag it is. One wonders why these children in particular should be considered undeserving of the protection that our safeguarding frameworks seek to provide to all other children. However imperfect these frameworks may be, they cannot work at all for children deemed to be outwith their remit.

    Reply
  4. Angelo Granda

    Charlie, Thanks to a Social Worker for giving us such a useful insight.
    Please would you consider these two questions carefully and answer if you are able.
    a) the parent refers to standard safeguarding principles,what are they?
    b) you refer to safeguarding frameworks, what are they?

    I do think these questions are important because i think protection as meant by the Children Act is not strictly the same as safeguarding but the term has entered into this discussion. The only reference to safeguards i have seen before are to those to be put in place in order to protect children’s human rights especially procedural safeguards.
    I am uncertain exactly what some social workers think is the danger when it comes to the transgender issue. The statute appears to say there must be a ‘risk of significant harm’ before c.p. services interfere and that human rights should not be contravened unless the child is thought to be in moral or physical danger. So , a third question,if i may, how do you think these transgender communities and groups put children in such danger and where is the significant harm ( i presume we are talking mainly of emotional harm)? One wonders if the potential for paedophile activity in these communities drives concerns. It SW’s differ and this suggests it can depend on the individual’s value judgments and morals rather than general ones.

    I quite understand your concerns ,by the way, but these questions are to clarify the issues for CPR readers and help discussion along.

    Reply
    1. Charlie

      An example: LGBT Youth Guidance in Scotland recommends that parents should as a matter of general principle never be informed if a child identifies as trans at school and does not wish the parents to know this. However, one of Scotland’s safeguarding frameworks, called “Getting It Right For Every Child” or GIRFEC for short, stipulates that no information should ever be withheld from those with legal parenthood/parental responsibility unless there are very serious concerns about the parents/carers. This cannot be a mere vague concern, it requires an actual case conference, with all the usual documentation of incidents that give rise to these concerns and so on.

      However, in the case of a child who identifies as trans, information is to be withheld even from parents/carers who are not considered to be a concern at all – perfectly fit, loving, capable parents are to have such a vital piece of information withheld for no other reason than it serves a narrative of “being trans is not a safeguarding concern”. Actually it is. The reasons are as follows:

      Children who identify as trans because they suffer from gender dysphoria urgently need support. LGBT Youth’s very own guidance outlines that these children actually fare much better if they are supported by their parents.

      Also, when the school withholds this information, it violates the human rights of the child. Specifically:

      Article 3, which stipulates that the child’s best interests must be paramount in any decisions made about that child. It is not in the child’s best interests to prevent parents from having important information that has an effect on the mental and emotional wellbeing of their child which in turn prevents them from taking action to protect and/or support the child.

      Article 5, which stipulates that children have the right to have parental support to aid them in
      exercising their rights, and to have their evolving capacities taken into account –

      LGBT Youth Guidance (as is typical for all other types of guidance on how to accommodate and deal with children who identify as trans) does not differentiate between a 4-year-old in Primary 1 and a 17-year-old in Secondary 6 in Scotland, despite the fact that each child would have vastly different capacity of understanding and maturity. The latter may be able to access needed support independently, the former most certainly is not.

      But even in the case of a teen, take this scenario:

      If a school is fine with not sharing information with the parents of a teen who identifies as trans, but not so good with making alternative arrangements for changing rooms (such as offering a staff changing room instead of insisting on the child sharing a changing room with other children of its biological sex), the teen may feel very uncomfortable or even distressed at undressing in front of the other children. The teen would in most cases be far better off if the parents were informed and could then navigate school procedures to ensure their child’s needs are met.

      Article 6, which stipulates that States have to “ensure to the maximum extent possible the survival and development of the child” which refers to ALL matters of development and health.

      Many female children who have gender dysphoria bind their breasts. The vast majority have no knowledge of the serious risks to their health (for instance a study by a pro-binding organisation showed that amongst females who bind their breasts, 97% reported at least one negative health outcome). They recommend that doctors treating such females should counsel and educate them carefully to help them manage either without breast binding or by doing so in the least harmful way possible.

      However, if a child discloses a practice of breast binding to a teacher in a school which follows LGBT Youth Guidance, this teacher is advised to respond in a manner which also violates established safeguarding practices around self-harm (which breast binding falls under because of its serious risks of irreversible damage to the developing child). Paramount of these practices is to ensure that the child receives help and support in minimising risk to themselves. This necessitates working closely with the parents/carers of the child. Which would mean informing the parents, which these schools don’t do. Moreover, because trans guidance talks down, glosses over or completely fails to mention known risks, these schools often don’t even understand the risks properly. (Teachers could of course seek to educate themselves, but they have many other children with many other issues to worry about. Unlike parents/carers who typically look after far fewer children.)

      Furthermore, children with gender dysphoria benefit from seeing a specialist. They cannot access a specialist without a parent arranging this. But the parent wouldn’t know. As trans advocates keep stressing, the increasing delays in accessing specialist support are putting children with gender dysphoria at risk. This hasn’t stopped these organisations from also recommending cutting off the children’s best chance to be supported to access help. There is no other wellbeing issue where creating such unnecessary delays would be deemed acceptable.

      Article 18 stipulates that children have the right for their parents to take responsibility for ensuring their needs are met in a way that is in their best interests. As I have outlined above, abandoning existing safeguarding frameworks means that this isn’t happening.

      There are any number of other issues we could look at. For instance, that every single child I know who is trans has underlying issues like trauma, bereavement or abuse and/or pre-existing conditions like anorexia, depression or neuro diversity which may be and often are the root cause for the child identifying as trans.

      In any other context, these underlying causes would be explored to their fullest and if at all possible we would help the child to work through them in order to limit the impact of these issues, and in the case of gender dysphoria to help the child to reconcile with its body. So that the child can thrive. However, the Memorandum of Understanding as signed by health professionals and counsellors actually classifies all such attempts as conversion therapy. This seriously interferes with how effectively such a child can be helped if it is in distress.

      Or take the fact that the Dutch clinic which pioneered the use of puberty blockers in such children used these only in connection with an extensive and thorough counselling program. That’s because desistance rates among children continue to be high but the previous best practice of watchful waiting did not lead to the most ideal outcomes for children who persisted into adulthood. So the Dutch doctors came up with a program they believed would harm neither desisters nor persisters, because it would temporarily halt their physical development while underlying causes would be explored and if possible resolved or at the very least managed and for those who desisted, puberty could then be allowed to proceed.

      There is as of yet no longitudinal study providing any evidence that this approach is any more beneficial to these children than the previous best practice of watchful waiting. However, what we do know from many other medical areas is that if you remove a vital and intrinsic part of a treatment regimen, of any kind of medical therapy it leads to worse outcomes (cf anorexic children for instance, where merely keeping them fed does not increase survival rates while feeding plus therapy using a number of different approaches does).

      Nonetheless, the current treatment model puts children with gender dysphoria on a medical pathway that no longer includes counselling as a major part of the treatment approach. On the contrary, many patients and their parents report that not even obvious issues are explored.

      And the medical pathway itself presents another deviation from established safeguarding principles. When health care professionals treat children, the child’s right to an open future is a consideration that is first and foremost in the minds of those deciding which treatment options to pursue. This “right to an open future” refers to the fact that children are in the unique position that they have rights that all human beings have (by dint of being human) but that they cannot yet exercise. Many of those rights they can only exercise when they reach maturity – legal, physiological or mental.

      The ethical approach, applied in paediatrics, is that neither parents nor doctors nor anyone else has the right to decide for the child to forego any of the rights it can only exercise in the future. Not unless the child is in mortal danger. And for much of its childhood the child itself is not deemed to be mature enough to understand the gravity and longterm consequences of foregoing these future rights either. Which is why parents don’t just have the right but also the responsibility to act in the best interests of their child, considering for the child the impact of the loss of future rights that they themselves have been able to exercise as adults.

      So, to come back to children with gender dysphoria and the medical pathway. Any other medical approach adheres to the principle of the right of the child to an open future. Treatment options that will irreversibly alter the child, but most importantly treatment options that will prevent the child from ever exercising its future rights, ie options that close its future are avoided until they are the very last option.

      The child who identifies as trans on the current medical pathway however has one open future treatment option all but denied from the outset (counselling aiming to explore reasons for dysphoria and any attempt to reconcile the child with its body – which represents the most open future), and instead faces a long road of treatments leading to irreversible changes to its body.

      Puberty blockers – serious adverse side effects and unfortunately irreversible damage to health and mental capacity.

      Puberty blockers plus cross-sex hormones – adds high risk of never reaching sexual maturity, loss of fertility, arrested brain development, permanently altered voice and hair growth, vaginal atrophy, menopause (and that has life-limiting effects for one in three menopausal women).

      PB+CSH+surgery – adds the irreversible loss of healthy organs and tissue (breast amputation, castration, hysterectomy, penectomy).

      So, definitely not an open future when it may leave a child infertile without sexual function and any number of irreversible body modifications.

      Under normal circumstances then this medical pathway would not be entered upon unless as a last resort. The right of the child to an open future is not a principle that’s been abandoned. It still applies to all other children. Just not to the child with gender dysphoria.

      This isn’t an exhaustive list, but I hope I have managed to give you some idea of the issues involved. And thank you Sarah for letting me comment. I did not mean to write such an epic but thought this might be informative.

      Reply
      1. Sarah Phillimore Post author

        Never apologise for a lengthy comment that informs (and terrifies)
        Can I turn this into a guest post?

        Reply
  5. Angelo Granda

    Charlie, Thanks very much for the comment and I agree entirely that gender dysphoria is a safeguarding issue.
    After reading the lengthy comment, i think i was wrong to guess you were a social worker. You seem to have much more insight ,perhaps you are a child psychologist or come from some other medical profession.

    QUOTE: Furthermore, children with gender dysphoria benefit from seeing a specialist. They cannot access a specialist without a parent arranging this : UNQUOTE.

    I could not agree with you more . I think gender dysphoria should be included in the list of ‘ S PECIAL NEEDS’ just as autism or other difficulties. They are not disorders as such but do require special advice and safeguards in place.Do you suggest a parent should see a special needs consultant child psychologist or consultant educational psychologist for advice? He or she would make the parents aware of all the safeguards . Also they would be able to spot whether the parent him or herself ( see Re: J ) was responsible for causing the problem and advise with all the professional skill necessary to solve the problem.
    Would home visits by a special nursing along team be available such as cognitive therapists and even a special home tutor where a child isn’t coping with mainstream education?

    Readers, unfortunately many SW’s often misunderstand their duties and especially the law which limits interference with family life .They tend to choose oppression and to impose their own judgments which they make without qualifications.

    See these interesting posts:-
    http://childprotectionresource.online/the-children-act-1989-deeply-flawed-legislation/

    http://childprotectionresource.online/?s=can+i+photograph+my+child

    The difference between safeguarding and ‘protection’ as meant by the Children Act has to be understood to preserve our rights and freedoms. When a child goes to the park and walks round the lake, there will be a sign saying DANGEROUS,DEEP WATER or possibly a fence acting as a barrier. There may well be a park-keeper on duty to safeguard them and probably he will have training in life-saving and first-aid, resuscitation etc. Half-way round the lake there will be a life-buoy attached to a rope . There may be a sign saying NO SWIMMING if swimming is against bye-laws but if not, children are free to fish, paddle or swim to their hearts content.
    The same goes for a river ,swimming in a river is a right we all have, there may be a bridge available for us to dive off. On the bridge will be a sign: DANGER, SHALLOW WATER. but no-one can prevent you from diving in.
    We have fundamental liberties . These should not and cannot be taken away on the altar of ‘risk of harm’ and potential.

    Nevertheless safeguards and advice of danger plus safety nets ,life belts , first-aid kits are absolutely needed.

    I would think every one involved should be willing to put safeguards in place. As far as Mermaids is concerned, they should be the first to put them on their web-site and hand -out warnings in their literature. Transgender issues are complex as Charlie Noack has described.
    If there are no warnings such as SEE A SPECIALIST IF YOU THINK YOUR CHILD IS DYSPHORIC included in their advice , this will incur suspicion.

    Reply

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