Child Disability Payment decision making guide
Substantial danger
What amounts to substantial danger is a question of fact in each case. ‘Substantial’ should be given its ordinary, everyday meaning. Substantial danger could result from a fall, exposure, or neglect. Case managers should consider the circumstances of each individual in deciding whether the danger is substantial.
Emira is 12 and has epilepsy. She loses consciousness during frequent seizures and can fall if her parents are not there to prevent it. If she falls and loses consciousness, she is unlikely to be able to do anything to prevent injury or harm to herself. This is more likely to be a ‘substantial danger’ compared to another child who falls but instead experiences mild bruising.
People without certain disabilities can generally recognise everyday dangers like those from traffic. Individuals with mental health conditions may:
- be unaware of these dangers
- put themselves at risk of serious injury.
For example, a child with a learning disability may have substantially less road safety awareness than their peers.
Alex is 9 months old. He has moderate hearing loss in both ears and was provided with two over the ear hearing aids at 6 months old. Alex has started to grab at the hearing aids and has managed to remove one of them and attempt to chew on it. The aids contain a button battery which is toxic if ingested. Alex’s parents have been told he should wear the hearing aids as often as possible to increase his access to speech and sounds. They do not leave him in his playpen or on a playmat unattended, as he may try to put an aid in his mouth.
During the night or when he is napping, Alex’s hearing aids are removed and stored securely by his parents.
The risk of Alex swallowing the hearing aid is one that it is reasonable for his parents to guard against. The case manager determines Alex is entitled to the middle rate care component as, while all children of 9 months require supervision, parents of other children would mitigate risk by removing small or toxic items to manage brief periods of indirect supervision. For Alex, continual supervision is required during all times the aids are worn.
The case manager sets the review period for 2 years, to make sure Alex’s award continues to be right for him and as his needs may change or worsen through key development stages in his life. Children and young people’s ability to recognise and safely manage potential dangers generally increases with age. When considering this, the case manager should compare what is reasonably expected of someone of the same age without a disability.
Further information can be found here:
- Child Medical Guidance
- NHS Ages and Stages
Individuals with certain mental conditions may create danger for others without being aware of the consequences of their actions., For example, they may:
- lash out at others potentially causing injury
- turn on a gas appliance without lighting it.
Individuals may be a substantial danger to themselves if there is a risk of suicide. Continual supervision may be required to reduce the risk of self-harm although this may not eliminate all the substantial danger.
If a case manager has any concerns regarding an individual's safety they should speak to their line manager.
Jessica is 15 years old and is diagnosed with depression and anxiety. She is self-harming and having suicidal ideations. Jessica is getting support from CAMHS, is prescribed antidepressant medication and has a safety plan in place.
Jessica needs constant supervision during the day to ensure her safety, as per her safety plan. At school, staff are aware of this safety plan and Jessica has a “safe” card that means she can leave class without explanation to speak to a member of staff when feeling this way. At night, her parents lock away all sharp objects and they have also removed all internal locks on doors because Jessica regularly tries to self-harm at night when she thinks everyone is asleep. They get out of bed at regular intervals throughout the night to check on Jessica’s safety.
The Case Manager determines that Jessica is entitled to the highest rate of the care component because she requires continual supervision during the day and for another person to be awake for a prolonged period at night, to avoid Jessica causing substantial danger to herself.
Sarah is 14 years old and is diagnosed with depression and anxiety. Sarah is receiving input from CAMHS and has a safety plan in place as she is presenting with self-harming behaviours at home and having suicidal ideations.
Sarah’s parents have ensured that all sharp objects are locked away and that there are no locks on internal doors. They also maintain regular and consistent supervision to ensure her safety, as per the safety plan. Since starting new medication, Sarah’s parent’s have noted that the additional supervision is required more regularly during the day and that, at night, Sarah becomes very tired and sleeps well throughout. Sarah’s parents therefore don’t need to provide additional supervision at night.
The Case Manager determines that Sarah is entitled to the middle rate of the care component as she requires continual supervision during the day to avoid substantial danger to herself.
Martin is 13 and is entitled to the lowest rate of the care component. His parents have recently reported a change of circumstances that Martin’s social habits, mood and behaviour have recently changed since the onset of puberty.
As a result, the Case Manager conducts an unscheduled review of Martin’s entitlement to CDP and calls Martin’s Mum to discuss these reported changes. Martin’s parents disclose that he has no formal diagnosis however he reported to his Mum a few weeks ago that he had suicidal thoughts. Martin’s parents took him to the GP however, after the GP chatted with Martin, it became apparent that his thoughts were felt in the moment, after a fight with a friend at school, and that Martin no longer has these thoughts. The GP has asked to see Martin again in a month’s time to check-in, however no referrals to CAMHS have been made as yet. There is no mention of a risk assessment or safety plan being developed.
As Martin doesn’t require any specialist support or to have a safety plan in place and it is likely that the previously identified risk has been assessed with no further action made. Therefore the requirement for continual supervision to reduce the risk of self-harm is unlikely, and the Case Manager makes a determination that Martin remains entitled to the lowest rate of the care component.
Falls
An individual may be at risk of substantial danger because of a physical condition. For example, certain disabilities may put a person at risk of falling. These falls should be distinguished from accidental falls which could happen to anyone. Further guidance is available in the Medical Guidance.
Where an individual is at risk of falling as a result of a condition or illness.
The case manager should consider if the falling:
- is predictable, whether the individual can reasonably be expected to avoid the risk unless supervised
- is unpredictable, whether the falling may result in substantial danger to the individual
- is unpredictable, whether the risk of substantial danger is too remote.
Leon is 14 and has tonic epilepsy. During seizures, Leon would briefly lose consciousness. If he was standing, this means he would fall with a danger of injuring himself.
Leon was prescribed lamotrigine to help manage his seizures and it has been very successful. Leon has not had a seizure now for 12 months. As long as Leon continues to take his medication, his seizures are manageable. This means that the risk of substantial danger is remote.
Kristof is 11 and has muscular dystrophy. Kristof is no longer able to walk on his own and requires the use of aids to stand and walk very short distances. He is not able to climb stairs using the aids and needs help to stand and sit down.
Kristof needs to be supervised because there is a risk that he could fall and injure himself, even with the aids. Kristof has not fallen yet but, without supervision and attention from another person, it is likely that he would. It is also likely that he would injure himself when this happens.
It is important to appreciate that the key issue is the likelihood of serious injury, and not the frequency of falls. The individual does not need to have experienced a serious injury in order to be at risk of substantial danger from falls.