Presentation on theme: "Identifying, assessing and understanding neglect"— Presentation transcript:
1Identifying, assessing and understanding neglect Understanding and assessing neglectIdentifying, assessing and understanding neglectPatrick AyreDepartment of Applied Social StudiesUniversity of BedfordshirePark Square, Lutonweb:
2Understanding and assessing neglect Neglect is the persistent failure to meet a child’s basic physical and/or psychological needs, likely to result in the serious impairment of the child’s health or development. Neglect may occur during pregnancy as a result of maternal substance abuse. Once a child is born, neglect may involve a parent or carer failing to:provide adequate food, clothing and shelterprotect from physical and emotional harm or dangerensure adequate supervisionensure access to medical care or treatment.It may also include neglect of, or unresponsiveness to, a child’s basic emotional needs.
3Understanding and assessing neglect Neglect is the persistent failure to meet a child’s basic physical and/or psychological needs, likely to result in the serious impairment of the child’s health or development. Neglect may occur during pregnancy as a result of maternal substance abuse. Once a child is born, neglect may involve a parent or carer failing to:provide adequate food, clothing and shelterprotect from physical and emotional harm or dangerensure adequate supervisionensure access to medical care or treatment.It may also include neglect of, or unresponsiveness to, a child’s basic emotional needs.
4Understanding and assessing neglect Neglect is the persistent failure to meet a child’s basic physical and/or psychological needs, likely to result in the serious impairment of the child’s health or development. Neglect may occur during pregnancy as a result of maternal substance abuse. Once a child is born, neglect may involve a parent or carer failing to:provide adequate food, clothing and shelterprotect from physical and emotional harm or dangerensure adequate supervisionensure access to medical care or treatment.It may also include neglect of, or unresponsiveness to, a child’s basic emotional needs.
5Understanding and assessing neglect Neglect is the persistent failure to meet a child’s basic physical and/or psychological needs, likely to result in the serious impairment of the child’s health or development. Neglect may occur during pregnancy as a result of maternal substance abuse. Once a child is born, neglect may involve a parent or carer failing to:provide adequate food, clothing and shelterprotect from physical and emotional harm or dangerensure adequate supervisionensure access to medical care or treatment.It may also include neglect of, or unresponsiveness to, a child’s basic emotional needs.
6Understanding and assessing neglect Parents who neglect their children basically just don’t know any better because of their own poor upbringings. If we send them to a family centre for Parental Skills training, all will be well.
7Understanding and assessing neglect Parents who neglect their children basically just don’t know any better because of their own poor upbringings. If we send them to a family centre for Parental Skills training, all will be well.IF ONLY!!....
8Understanding and assessing neglect So neglected children who come into care may be a bit thin, a bit dirty, badly in need of seeing a doctor or dentist, maybe a bit wild.But we can place them with foster carers for a bit of looking after, a bit of TLC, a bit of structure and everything will be fine. The children will absolutely love it and will immediately start to thrive. Simple really!
9Understanding and assessing neglect So neglected children who come into care may be a bit thin, a bit dirty, badly in need of seeing a doctor or dentist, maybe a bit wild.But we can place them with foster carers for a bit of looking after, a bit of TLC, a bit of structure and everything will be fine. The children will absolutely love it and will immediately start to thrive. Simple really!IF ONLY!!....The damage is not on the surface, it often runs quite deep and we need to understand how it got there in order to put it right. Painful though it is, we need to understand what it does to you to be neglected.
10Understanding and assessing neglect Brain developmentAt birth our brains are only 25% developedBy age 3, a child’s brain has reached almost 90% of its adult size and has accpmplished 80% of its total development.The growth in each region of the brain largely depends on receiving stimulation.This stimulation provides the foundation for learning.
11Experience Affects the Structure of the Brain Understanding and assessing neglectExperience Affects the Structure of the BrainBrain development is “activity-dependent”Every experience excites some neural circuits and leaves others aloneNeural circuits used over and over strengthen, those that are not used are dropped resulting in “pruning”
15Understanding and assessing neglect Poor integration of hemispheres and underdevelopment of the orbitofrontal cortexDifficulty regulating emotion,Lack of cause-effect thinking,Inability to recognize emotions in others,Inability to articulate own emotions,Incoherent sense of self and autobiographical historyLack of conscience.
16Other physiological issues Understanding and assessing neglectSerotonin: emotional stability and feeling goodMalnutrition: cognitive and motor delays, anxiety, depression, social problems, and attention problemsMyelinationSensitive periods (infancy & attachment)
17Emotional development Understanding and assessing neglectSensitive period for emotional development: up to 18 monthsShaped primarily by the way in which the prime carer interacts with the childEmotional deficits harder to overcome once the sensitive window has passed.How often do we intervene assertively at this point?
18Understanding and assessing neglect Building a childBuilding a child is like building a house, each new level built on the one below. If the lower levels are unsound, no amount of tinkering with the upper floors will make it stable.
19Checkpoint 1: timing intervention Understanding and assessing neglectCheckpoint 1: timing interventionIf we wait until we can see the evidence of neglect in a child’s behaviour, it may be too late to put it right completely.
20Understanding and assessing neglect BehaviouralConstant hungerConstant tirednessFrequent lateness or non-attendance at schoolDestructive tendencies
21Understanding and assessing neglect Low self-esteemNeurotic behaviourNo social relationshipsRunning awayCompulsive stealing or scavenging
22Understanding and assessing neglect PhysicalPoor personal hygienePoor state of clothingEmaciation, pot belly, short staturePoor skin and hair toneUntreated medical problems
23Understanding and assessing neglect Significant harmHarm is defined by Children Act 1989:ill-treatment (including sexual abuse and, by implication, physical abuse)impairment of health (physical or mental) or development (physical, intellectual, emotional, social or behavioural)
24Understanding and assessing neglect The child's basic needsbasic physical careaffectionsecuritystimulation of innate potentialguidance and controlresponsibilityindependence
25Understanding and assessing neglect Why do parents neglect?We need to understand the interaction between:3 Ns: Nurture, Nature, NowCircumstantial factors and fundamental factors
26Understanding and assessing neglect Why do parents neglect?CircumstantialPovertyParticular relationshipsLack of skill/knowledgeTemporary illnessLack of supportEnvironmental factorsFundamentalLack of parenting capacityDeep seated attitudinal/behavioural/ psychological problemsLong term health issuesEntrenched problematical drug /alcohol use
27Understanding and assessing neglect Forms of neglectUnderstanding and assessing neglectHowe identifies 4 types of neglectEmotional neglectDisorganised neglectDepressed or passive neglectSevere deprivationEach is associated with different effects and implications for intervention(Howe, D (2005) Child Abuse and Neglect, Basingstoke: Palgrave Macmillan)
28Understanding and assessing neglect Emotional neglectSins of commission and omission‘Closure’ and ‘flight’: avoid contact, ignore advice, miss appointments, deride professionals, children unavailableHowever, may seek help with a child who needs to be ‘cured’Intervention often delayedAssociated with avoidant/defended patterns of attachment
29Emotional neglect: parents Understanding and assessing neglectEmotional neglect: parentsCan’t cope with children’s demands: avoid/disengage from child in need; dismissive or punitive responseChildren provided for materially but there is a failure to connect emotionallyMore rules; everyone has a role and knows what to do.Parents may feel awkward & tense when alone with their children.
30Emotional neglect: children Understanding and assessing neglectEmotional neglect: childrenWhen attachment behaviour rejected:Learns that caregiver’s physical and emotional availability is reduced when emotional demands are made;Caregiver most available when child is showing positive affect, being self-sufficient, undemanding and compliant;Reverse roles, “false brightness” to care for/ reassure parent.
31Emotional neglect: children Understanding and assessing neglectEmotional neglect: childrenFrightened, unhappy, anxious, low self- esteemWithdrawn, isolated, fear intimacy and dependencePrecocious, ‘streetwise’, self-reliant
32Emotional neglect: children Understanding and assessing neglectEmotional neglect: childrenMay show compliance to dominant caregivers but anger and aggression in situations where they feel more dominant.May learn that power and aggression are how relationships work and you get your needs metBehaviour increasingly anti-social and oppositionalBrain development affected: difficulties in processing and regulating emotional arousal
33Understanding and assessing neglect Disorganised neglectClassic ‘problem families’Thick case filesCan annoy and frustrate but endear and amuseChaos and disruptionReasoning minimised, affect is dominantFeelings drive behaviour and social interactionWorker may feel agenda co-opted by family’s immediate needs
34Disorganised neglect: carers Understanding and assessing neglectDisorganised neglect: carersFeelings of being undervalued or emotionally deprived in childhood so need to be centre of attention/affectionDemanding and dependant with respect to professionalsMay be regarded as overwhelmed but amenable to servicesCrisis is a necessary not a contingent stateAssociated with ambivalent/coercive patterns of attachment
35Disorganised neglect: carers Understanding and assessing neglectDisorganised neglect: carersCope with babies (babies need them) but then…Parental responses to childrenunpredictable and insensitive (though not necessarily hostile or rejecting).driven by how the parent is feeling, not the needs of the childLack of ‘attunement’ and ‘synchronicity’
36Disorganised neglect: children Understanding and assessing neglectDisorganised neglect: childrenAnxious and demandingInfants: fractious, fretful, clinging, hard to sootheYoung children: attention seeking; exaggerated affect; poor confidence and concentration; jealous; show off; go to farTeens: immature, impulsive; need to be noticed leads to trouble at school and in communityNeglectful parents feel angry and helpless: reject the child; to grandparents, care or gangs
37Understanding and assessing neglect Depressed neglectClassic neglectMaterial and emotional povertyHomes and children dirty and smellyUrine soaked matresses, dog faeces, filthy plates, rags at the windowsA sense of hopelessness and despair (can be reflected in workers)
38Depressed neglect: carers Understanding and assessing neglectDepressed neglect: carersOften severely abused/neglected: own parents depressed or sexually or physically abusiveMay seem unmotivated, mild learning disabilityLearned helplessness in response to demands of family life;Stubborn negativism; passive-aggressiveHave given up both thinking and feelingIt is a personality trait marked by a pervasive pattern of negative attitudes and passive, usually disavowed resistance in interpersonal or occupational situations. It can manifest itself as learned helplessness, procrastination, stubbornness, resentment, sullenness, or deliberate/repeated failure to accomplish requested tasks for which one is (often explicitly) responsible. It is a defense mechanism, and usually only partly conscious.
39Depressed neglect: carers Understanding and assessing neglectDepressed neglect: carersListless and unresponsive to children’s needs and demands, limited interactionLack of pleasure or anger in dealings with children and professionalsNo smacks, no shouting, no deliberate harm but no hugs, no warmth, no emotional involvementNo structure; poor supervision, care and food
40Depressed neglect: children Understanding and assessing neglectDepressed neglect: childrenYounger the child, more debilitating the effectsLack interaction with parents required for mental and emotional developmentInfant: Incurious and unresponsive; moan and whimper but don’t cry or laughAt school: isolated, aimless, lacking in concentration, drive, confidence and self-esteem but do not show anti-social behaviour
41Depressed neglect: case management Understanding and assessing neglectDepressed neglect: case managementThese families need:Long term involvementSupportive approachResponsiveness to family’s signals and needsBUT these need to be balanced with a recognition of the children’s needs. (How long is too long? How much is too much?)
42Depressed neglect: infants and children Understanding and assessing neglectDepressed neglect: infants and childrenMust experience responsive and stimulating environments that also provide human comfort for a few hours each day.The longer the child is exposed to helplessness, the more intense and longer the intervention needed to remedy the situation.
43Depressed neglect: parents Understanding and assessing neglectDepressed neglect: parentsMust learn appropriate ways to show their feelingsPractice smiling, laughing, soothingMay be mechanical at firstGenuine feelings will emerge with repetitionAs parents learn to show their feelings, the child’s responsiveness will increase; virtuous spiral
44Understanding and assessing neglect Severe deprivationEastern European orphanages, parents with serious issues of depression, learning disabilities, drug addiction, care system at its worstChildren left in cot or ‘serial caregiving’Combination of severe neglect and absence of selective attachment: child is essentially alone
45Severe deprivation: children Understanding and assessing neglectSevere deprivation: childrenInfants: lack pre-attachment behaviours of smiling, crying, eye contactChildren: impulsivity, hyperactivity, attention deficits, cognitive impairment and developmental delay, aggressive and coercive behaviour, eating problems, poor relationshipsInhibited: withdrawn passive, rarely smile, autistic-type behaviour and self-soothingDisinhibited: attention-seeking, clingy, over-friendly; relationships shallow, lack reciprocity
46Checkpoint 2: case management Understanding and assessing neglectCheckpoint 2: case managementHow should we manage cases of:Emotional NeglectDisorganised neglectDepressed neglectSevere deprivation
47Emotional neglect: case management Understanding and assessing neglectEmotional neglect: case managementHelp parents to learn to use others for support.Teach parents to engage emotionally with their children.Must be highly structured as neither parent or child know how to interact normally & spontaneously.Fear of affect – need clear rules & roles
48Disorganised neglect: case management Understanding and assessing neglectDisorganised neglect: case managementLogic would argue for warding off crises for a while so that families can be taught to organise their lives, but…Family may want to have needs met, but cannot delay gratification or trust logic and planning;Without intense demands associated with crises, have no way of being important to others;Will CREATE new crises.
49Disorganised neglect: case management Understanding and assessing neglectDisorganised neglect: case managementFeelings must be addressedNeed a structured, predictable environment with no surprises where:There are rewards for clear, direct, and undistorted communication of feelings and accurate cognitive information about future outcomesFamily can learn the value of compromiseTeach parents how to use cognitive information to regulate feelings (without denying them)
50Depressed neglect: case management Understanding and assessing neglectDepressed neglect: case managementInvolves much more than teaching appropriate parentingAll family members must learn that their behaviour has predictable and meaningful consequencesTeach that it helps to share feelings with empathetic others.
51Depressed neglect: case management Understanding and assessing neglectDepressed neglect: case managementOur standard approaches don’t workThreats / punitive approaches particularly ineffective:Parents don’t believe they can change so don’t even try.Even most reasonable pressure results in “shutting down” / blocking out all info.Parent education – may be ineffective because judgment impaired and gains not transferable.
52Severe deprivation: case management Understanding and assessing neglectSevere deprivation: case managementHighly unlikely to be in the child’s best interests to remain in the environment which caused the harm;It is probable that the child and new carers will require substantial therapeutic and emotional support;Significant challenges often persist despite a move to a caring and predictable environment.
53Capturing chronic abuse Understanding and assessing neglectCapturing chronic abuseJudging the quality of care is an essential component of any assessment but how well do we do it?Judgements subjective and prone to biasIntangible: Difficult to capture and compareHigh threshold for recognitionNeglect is a pattern not an event
54Capturing chronic abuse Understanding and assessing neglectCapturing chronic abuseJudging the quality of care is an essential component of any assessment but how well do we do it?Judgements subjective and prone to biasIntangible: Difficult to capture and compareHigh threshold for recognitionNeglect is a pattern not an event
55Our image of assessment Understanding and assessing neglectOur image of assessment
56The reality of assessment? Understanding and assessing neglectThe reality of assessment?
57Capturing chronic abuse Understanding and assessing neglectCapturing chronic abuseJudging the quality of care is an essential component of any assessment but how well do we do it?Judgements subjective and prone to biasIntangible: Difficult to capture and compareHigh threshold for recognitionNeglect is a pattern not an event
59Understanding and assessing neglect The pattern of neglect
60Understanding and assessing neglect The pattern of neglect
61Understanding and assessing neglect The pattern of neglect
62Understanding and assessing neglect The pattern of neglect
63Understanding and assessing neglect CumulativenessChild protection system is triggered when threshold of likely significant harm has been crossed.Physical and sexual abuse, where a serious precipitating incident comes to light which clearly crosses the threshold at once.Many chronic cases may be characterised by a lengthy pattern of actions or incidents, none of which is in itself sufficient to trigger intervention. They have to get added together like this
64Failure of cumulativeness Understanding and assessing neglectFailure of cumulativeness
65Understanding and assessing neglect What’s the problem?Chronic abuse and the principle of cumulativenessFiles very long and badly structuredPatterns missed and ‘chronic abuse’ overlookedThe problem of proportionalityAcclimatisation (case, agency and geographical)Three principle reasons for this failure of cumulativeness.The first is that the incidents giving rise to concern may lie scattered through the relevant files, recorded and responded to separately with no one making cumulative connections between them. They may lie unshared on the files of a variety of different interested agencies or unremarked within the files of a single agency. Picked up and put down Many 'duty worker' and 'team responsibility' systems may be prone to this failing.The notion of proportionality: uncomfortable about invoking the full might of the system over a 'minor' incident, even where this incident is just one of a very worrying series.Acclimatised to unacceptably low standards, typified by remarks such as 'What can you expect from this family?' or 'That's the way they are; they've always been the same'. Conditions likely to cause significant harm come to be regarded as the norm and all future incidents come to be judged against this depressed standard with the result that incidents have to be increasingly bad to be identified as causing concern at all and the cumulative effect on the child is overlooked.
66Checkpoint 3: Acclimatisation Understanding and assessing neglectCheckpoint 3: AcclimatisationDo you ever encounter acclimatisation?What do you do about it?Three principle reasons for this failure of cumulativeness.The first is that the incidents giving rise to concern may lie scattered through the relevant files, recorded and responded to separately with no one making cumulative connections between them. They may lie unshared on the files of a variety of different interested agencies or unremarked within the files of a single agency. Picked up and put down Many 'duty worker' and 'team responsibility' systems may be prone to this failing.The notion of proportionality: uncomfortable about invoking the full might of the system over a 'minor' incident, even where this incident is just one of a very worrying series.Acclimatised to unacceptably low standards, typified by remarks such as 'What can you expect from this family?' or 'That's the way they are; they've always been the same'. Conditions likely to cause significant harm come to be regarded as the norm and all future incidents come to be judged against this depressed standard with the result that incidents have to be increasingly bad to be identified as causing concern at all and the cumulative effect on the child is overlooked.
67The assessment of neglect An approach based on the Graded Care Profile by Dr OP ShrivastavaGCP provides:Framework for making assessmentBaseline measurementAn element of objectivityJudgement about careReliable standardised evidence
68GCP users Health visitors School nurses Social workers Family centre workersEducation welfare workers
69GCP uses Pre-referral assessments Snapshot assessments Contribution to CAF assessmentsContribution to Core Assessment (parenting capacity)Self-assessment (parents and carers)Young person’s assessment of parentingTool for setting goals and assessing progressTool to facilitate discussion
70Love and belongingness Domains of CareStimulationApprovalDisapprovalAcceptanceSensitivityResponsivityReciprocityOverturesSelf actualisationEsteemLove and belongingnessPresent & absentSafetyAs Prakash said he used Maslow’s work to build on using the four domains and further sub-dividing them.Physical needsNutrition. Housing, Clothing, Hygiene & HealthMaslow, A. 1954
71What to observe Nutrition Housing Clothing Hygiene Health Quality, Quantity,Preparation,Organisation,A. PHYSICALB. SAFETYC. LOVED. ESTEEM
72Grades of Care Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Level of care All child’s needs metEssential needs fully metSome essential needs metMost essential needs unmetEssential needs entirely unmet/hostileCommitment to careChild firstChild priorityChild/carer at parChild secondChild not consideredQuality of careBestAdequateEquivocalPoorWorst
73Example: AREA C: LOVE Sub-areas 1 2 3 4 5 1. Carer A Sensitivity Anticipates or picks up very subtle signals- verbal or nonverbal expression or mood.Comprehends clear signals – distinct verbal or clear nonverbal expression.Not sensitive enough – stimuli and signals have to be intense to make an impact e.g. cry.Quite insensitive – needs repeated or prolonged intense signals.Insensitive to even sustained intense signals or aversive.B ResponseSynchronisationTimingResponses well synchronised with signals or even before in anticipationResponses mostly synchronised except when occupied by essential chores.Not synchronised for own recreational engagement; synchronised if fully unoccupied or child in distress.Even when child in distress responses delayed.No responses unless a clear mishap for fear of incrimination.C Reciprocation (quality)Responses complementary to the signal. Both emotionally and materially, can get over stressed by distress signals from child. Warm.Material responses (treats etc.) lacking, but emotional responses warm and reassuring.Emotional reciprocation warm if in good mood (not burdened by strictly personal problem), otherwise flat.Emotional reciprocation brisk, flat and functional, annoyance if child in moderate distress but attentive if in severe distress.Aversive/punitive even if child in distress, acts after a serious mishap mainly to avoid incrimination, any warmth/remorse deceptive.
74Sub-AreaScoresArea ScoreComments(A)Physical1. NUTRITION123452. HOUSING3. CLOTHING4. HYGIENE5. HEALTH(B)Safety1. IN CARER’S PRESENCE2. IN CARER’S ABSENCE(C)Love1. CARER2. MUTUAL ENGAGEMENT(D)Esteem1. STIMULATION2. APPROVAL3. DISAPPROVAL4. ACCEPTANCE
75Targeting Items of Care Targeted AreasCurrent ScoreTarget ScoreTimescaleReviewed Score12345
76Making an assessment Guidance provided (follow up scores of 4 or 5) Evaluates strengths as well as weaknessesAllows progress to be assessedA relatively objective measureAllows help to be targeted where needed
77Making an assessment Common language, common reference Objective measure – child focussedEffective tool to promote partnership assessments and planning with parentsUser friendlyComprehensively covers all areas of careChild and carer specific
78 Scale for Assessing Neglectful Parenting (Northamptonshire) Scale for Assessing Neglectful Parenting (Northamptonshire)179 individual questions under the following headings:Food and Eating HabitsHealth and HygieneWarmth/ClothingSafety and SupervisionEmotional NeedsCognitive DevelopmentEducational Needs
79 Example questions (Health and Hygiene) Example questions (Health and Hygiene)21 The home lacks showering or bathing facilities which work, and are available for maintaining personal hygiene22 The bath and basin are dirty, or inaccessible23 The family lacks a toilet which works24The toilet is regularly left dirty or stained25 Toddler’s potties are left unemptied containing urine and faeces26 The kitchen is dirty (eg cooker ingrained with old food, grime on walls, floor, kitchen utensils, sink)
80Making an assessmentEach statement scored 1, 2 or 3 according to how true it is.Blank spaces for Summary, Conclusions and Action PlanLengthy and comprehensive list of relevant factorsNo guidance on making overall judgmentsStatements all identify weaknessesAllocation of questions to headings a little eccentric at times
81Putting it all together: The chain of reasoning FactsAnalysis/summaryConclusions/recommendations/action
82What happened/what you saw The chain of recordingWhat happened/what you sawWhat this meansWhat you did/what should be done (and why, if this is not clear from the above)
83The chain of recording But how do you know which facts? Must be informed by a basic risk assessment (would not always be spelled out on paper)
84Risk assessment The dangers involved (that is the feared outcomes); The hazards and strengths of the situation (that is the factors making it more or less likely that the dangers will realised);The probability of a dangerous outcome in this case (bearing in mind the strengths and hazards);The further information required to enable this to be judged accurately; andThe methods by which the likelihood of the feared outcomes could be diminished or removed.
85Bias and BalanceInclude information favourable to ‘the other side’ as well as that favourable to yoursIt is your job to make judgements but:avoid empty evaluative words like inappropriate, worrying, inadequateGive evidence for descriptive words like cold, dirty and untidyBeware the danger of factsWere there a couple of unwashed cups in the hearth and a few toys on the floor, or did your feet stick to the carpet, dog faeces in the corner and swarms of bluebottles to meet you when you entered the kitchen.
86Bias and BalanceBorn in 1942, he was sentenced to 5 years imprisonment at the age of 25. After 5 unsuccessful fights, he gave up his attempt to make a career in boxing in 1981 and has since had no other regular employment
87Lies, damned lies and killer bread Research on bread indicates thatMore than 98 percent of convicted felons are bread users.Half of all children who grow up in bread-consuming households score below average on standardized tests.More than 90 percent of violent crimes are committed within 24 hours of eating bread.Primitive tribal societies that have no bread exhibit a low incidence of cancer, Alzheimer's, Parkinson's disease, and osteoporosis.In the 18th century, when much more bread was eaten, the average life expectancy was less than 50 years; infant mortality rates were unacceptably high; many women died in childbirth; and diseases such as typhoid, yellow fever, and influenza were common.Tell the story chronologically without too much editorialisingThe fact should be here either to satisfy the threshold criteria or to justify the recs made.First hand evidence is best but Make sure that the source of any information is given: did you see it, or is it something which you were told or read in files or elsewhere. Where facts are disputed either omit or say so. You may still draw conclusions from disputed facts (if the facts are x my conclusion would be y)
91Understanding and assessing neglect Assessment PitfallsParents’ behaviour, whether co-operative or uncooperative, often misinterpretedInformation from family friends and neighbours undervaluedCoping with aggressive or frightening familiesFailure to give sufficient weight to relevant case history; ‘Start again syndrome’Not enough attention is paid to what children say, how they look and how they behave; maintenance of a wholly child-centred approach
92A child centred approach The purpose of assessment is to understand what it is like to be that child (and what it will be like in the future if nothing changes)
93Information handling pitfalls Understanding and assessing neglectInformation handling pitfallsPicking out the important from a mass of dataFacts recorded faithfully but not always critically appraisedToo trusting/insufficiently critical;Decoyed by another problemFalse certainty; undue faith in a ‘known fact’Discarding information which does not fit the model we have formedDepartment of Health (1991) Child abuse: A study of inquiry reports, , HMSO, London
94Assessment pitfalls Rule of optimism Natural love Cultural relativism Too muchnot enoughAdult services and children’s services (hand-in-hand or hand-to-hand?)
95Children’s services and adult services Working on the same case but not working jointlyMutual incomprehension and misunderstandingFalse expectations and assumptionsAbdicating responsibilityNeed for ‘interpreters’
96Information handling pitfalls Keeping your head downHesitancy to challenge other professionals or the conventional wisdomTendency to move from facts to actions without ‘showing your working’JB (Late 2006)Wirral Children and Young People's Services (Social Care) should seek to ascertain whether assessment practice and judgments about thresholds in child safeguarding cases across the borough as a whole currently accord with recognised accepted local and national standards… The findings of Children and Young People's Services’ enquiries this enquiry should be reported to LSCB, together with an action plan identifying the steps to be taken to remedy any shortfalls which are identifiedJLS (late 2008)The LSCB should consider auditing both core assessments and common assessments in order to ensure that staff, on a multi agency basis, are adequately trained and have sufficient skills to undertake good quality assessments. In the light of this audit training needs should be identified and a training programme implemented.SCRs are not individual events but should be viewed as a cumulative repository of knowledgeFailure to use case history (JB) New file started despite 12 years of involvement.A couple of months for cases to arrive may lead to a ‘start again syndrome culture.Use of case history (JB) when there were acute concerns about the care she received from her father, teenager placed with grandmother and grandfather with severe drink problems, he had masturbated in front of her, she had assaulted her; when this broke down, placed with her father who used to send her out to buy drugs for him and may have encouraged her into a sexual relationship with his dealer.
97Challenge your dodgy thinking I am only a… and he is a…, so I had better keep my opinion to myself.I am obviously in a minority, so I had better keep my opinion to myself.We need to maintain harmonious relations, so I had better keep my opinion to myself.Incomplete Remember, this is a sales pitch (give the client what they need) Always think of your audience, what do they need to know? In this case:
98But what is analysis? “So what?” You have gathered lots of information but now what?All you need to do is ask yourself my favourite question:“So what?”You have collected all this data, but what does this mean, for the service user, for the family and for my setting?
99Conclusions and recommendations Summarise the main issues and the conclusions to be drawn from them. (The facts do not necessarily speak for themselves; it is your job to speak for them.)Define objectives as well as actionsDraw conclusions from the facts and recommendations from the conclusionsExplain how you arrived at your conclusions (Have you demonstrated the factual/theoretical basis for each?)Consider and discuss alternative possibilities
100Conclusions and recommendations In drawing conclusions be aware of the extent and limitations of your own expertise.Conclusions may be supported by research (Don’t go outside expertise; be careful with new or controversial theories; be aware of counter arguments)Your recommendation should usually be specific (not either/or)Remember: conclusions may be attacked in only two waysfounded on incorrect informationbased on incorrect principles of social workBe aware of the extent and limitations of your own expertise. Acknowledge both expertise and experience and be prepared to draw on them appropriately to generate a professional opinion. May be supported by reference to research, dealt with later. (Don’t go outside expertise; be Careful with new or controversial theories; be aware of counter arguments)
101Conclusions and recommendations Problems:Unsupported assertions or judgementsInability or unwillingness to analyse and draw conclusionsFailure to answer the key question: ‘So what?’
102Reaching a decision‘Often a decision is made first and the thinking done later’ (Thiele, 2006)As humans, we resort to simplifications, short cuts and quick fixes!We reframe, interpret selectively and reinterpret.We deny, discount and minimiseWe exaggerate information especially if vivid, unusual, recent or emotionally laden andWe avoid, forget and lose information
103Good AssessmentsAre clear about the purpose, legal status and potential outcomesAre based on a clear theoretical frameworkAre clear about context and value baseAre collaborative and promote accessibility for service usersAre based on multiple sources of informationValue the expertise and understanding service users bring to their situationAre clear about missing information
104Good AssessmentsIdentify themes and patterns about needs, risks, protective factors and strengthsGenerate and test different ways of understanding the situationGive meaning to themes, using knowledge based on experience/researchLead to an evidence-based conclusionUse supervision to assist reflection, hypotheses and objectivityAre able to record and explain outcomesAre reviewed, updated & amended in light of new information
105Spotting the bad ones: Organisational Clues Mythology exists about the family – ‘this family is/always/behaves likeNegative stereotypes about other agencies exist so their information is discountedSudden changes about view of risk not explainedSudden changes of plan not rationally explained
106Worker clues Gut feelings says something is wrong Worker does not ask difficult questionsAnalysis does not account for facts/historyProposed plan does not address issues raised in assessmentPractitioner is working much harder than the parents to explain significant concernsThe child’s story is missing
107Inter-Agency Clues Agencies have conflicting views of the family/risk Agencies have strong views but offer ambiguous/limited evidenceSome agencies unwilling to share informationPressure to agree suppresses permission to question / inter-agency acclimatisation
108Family Clues Parental intentions not supported by actions Parental optimism involves denial of difficultiesChildren's accounts conflict with parents’Parents’ ‘talk’ about their child is contradictory/lacks coherenceCo-operation is only on the parents’ terms
109Understanding and assessing neglect Checkpoint 4: So what?We have spent some time considering how to recognise and respond to neglect.What does this mean for us? What are the implications for local services? What, if anything, will be different?
110Gabriela Mistral (Chilean poet, 1889-1957) A final thought“We are guilty of many errors and many faults but the worst of our crimes is abandoning our children, neglecting the fountain of life. Many of the things we need can wait. The child cannot. Right now is the time his bones are being formed, his blood is being made, and his senses are being developed. To him we cannot answer 'Tomorrow.' His name is 'Today.'”Gabriela Mistral (Chilean poet, )
112Working with resistance “In many cases parents were hostile to helping agencies and workers were often frightened to visit family homes. These circumstances could have a paralysing effect on practitioners, hampering their ability to reflect, make judgments, act clearly, and to follow through with referrals, assessments or plans. Apparent or disguised cooperation from parents often prevented or delayed understanding of the severity of harm to the child and cases drifted. Where parents made it difficult for professionals to see children or engineered the focus away from allegations of harm, children went unseen and unheard”.“Families tended to be ambivalent or hostile towards helping agencies, and staff were often fearful of violent and hostile men. Although parents tended to avoid agencies, agencies also avoided or rebuffed parents by offering a succession of workers, closing the case, losing files or key information, by re-assessing , referring on, or through initiating and then dropping court proceedings”.Brandon, M, and others (2008) Analysing child deaths and serious injury through abuse and neglect: what can we learn? London: Department for Children, Schools and Families
113Engagement“Engagement is the basic task of a child and families worker but can never be taken for granted and must always be worked for”
114Context ‘Involuntary’ work may be characterised by Guardedness or reluctance to share informationAvoidance and a desire to leave the relationshipStrong negative feelings such as anxiety, anger, suspicion, guilt or despair.
115Context We need to accept that: The best we may be able to achieve is honesty rather than positive feelings and a high degree of mutualityConflict and disagreement are not something to be avoided, but are realities that must be explored and understood.
116How might resistance show itself? By only being prepared to consider 'safe' or low priority areas for discussion.By not turning up for appointmentsBy being overly co-operative with professionals.By being verbally/and or physically aggressive.By minimising the issues.(Egan, 1994)
118Identifying resistance: 4 categories Hostile resistance: anger threats, intimidation, shoutingPassive aggressive: surface compliance covers partly concealed antagonism and angerPassive hopeless: Tearfulness and despair about changeChallenging: Cure me if you can!
119Strategies for enhancing engagement Before you start, check your mindset (your own biases and assumptions)Have realistic expectations:It is reasonable that involuntary clients resent being forced to participateBecause they are forced to participate, hostility, silence and non-compliance are common responses that do not reflect my skills as a workerDue to the barriers created by the practice situation, clients may have little opportunity to discover if they like meLack of client co-operation is due to the practice situation, not to my specific actions and activities(Ivanoff et al, 1994 )
120During initial contacts Adopt a non-defensive stanceBe clear, honest and direct and acknowledge the involuntary nature of the relationshipClarify roles and expectations, including what is required of the clientExplain consequences of non-compliance and the advantages of compliance(Ivanoff et al, 1994 )
121Try to Invite participation Understand how the client sees the problem as well as how we see itUnderstand what the client wants, as well as what we want(Ivanoff et al, 1994 )
122What might we be doing to make it worse? Becoming impatient and hostileDoing nothing, hoping the resistance will go awayLowering expectationsBlaming the family memberAllowing the family member to control the assessment inappropriatelyFailing to acknowledge our fear
123What might we be doing to make it worse? Becoming unrealisticBelieving that family members must like and trust us before assessment can proceed.Ignoring the enforcing role of some aspects of child protection work and hence refusing to place any demands on family members.(Egan, 1994)
124Avoid Expressions of over-concern Moralising Criticising the client Making false promisesDisplaying impatience
125Productive approaches Give practical, emotional support - especially by being available, predictable and consistentSee some resistance and reluctance as normalExplore our own resistance to change and by examining the quality of our own interventions and communication style(Egan, 1994)
126Productive approaches Helping family members to identify incentives for moving beyond resistanceTapping the potential of other people who are respected as partners by the family memberUnderstanding that reluctance and resistance may be avoidance or a signal that we are not doing our job very well(Egan, 1994)
127ConfrontationIn child welfare services, the Children’s Service Worker must be a skilled confronter. Confrontation is, basically, facing the client with the facts in the situation and with the probable consequences of behaviours(Texas Department of Human Resources)
128A scale for assessing motivation Understanding and assessing neglectA scale for assessing motivationShows concern and has realistic confidence.Shows concern, but lacks confidence.Seems concerned, but impulsive or carelessIndifferent or apathetic about problemsRejection of parental role.
129Shows concern and has realistic confidence. Understanding and assessing neglectShows concern and has realistic confidence.Parent is concerned about children’s welfare; wants to meet their physical, social, and emotional needs to the extent he/she understands them.Parent is determined to act in best interests of childrenHas realistic confidence that he/she can overcome problems and is willing to ask for help when neededIs prepared to make sacrifices for children.
130Shows concern, but lacks confidence Understanding and assessing neglectShows concern, but lacks confidenceParent is concerned about children’s welfare and wants to meet their needs, but lacks confidence that problems can be overcomeMay be unwilling for some reason to ask for help when needed. Feels unsure of own abilities or is embarrassedBut uses good judgement whenever he/she takes some action to solve problems.
131Seems concerned, but impulsive or careless Understanding and assessing neglectSeems concerned, but impulsive or carelessParent seems concerned about children’s welfare and claims he/she wants to meet their needs, but has problems with carelessness, mistakes and accidents. Professed concern is often not translated into effective action.May be disorganised, not take enough time, or pays insufficient attention; may misread ‘signals’ from children; may exercise poor judgement.Does not seem to intentionally violate proper parental role; shows remorse.
132Indifferent or apathetic about problems Understanding and assessing neglectIndifferent or apathetic about problemsParent is not concerned enough about children’s needs to resist ‘temptations’, eg competing demands on time and money. This leads to one or more of the children’s needs not being met.Parent does not have the right ‘priorities’ when it comes to child care; may take a ‘cavalier’ or indifferent attitude. There may be a lack of interest in the children and in their welfare and development.Parent does not actively reject the parental role.
133Rejection of parental role Understanding and assessing neglectRejection of parental roleParent actively rejects parental role, taking a hostile attitude toward child care responsibilities.Believes that child care is an ‘imposition’, and may ask to be relieved of that responsibility. May take the attitude that it isn’t his or her ‘job’.May seek to give up the responsibility for children(Magura et al,1987)