Presentation on theme: "Understanding and assessing neglect"— Presentation transcript:
1Understanding and assessing neglect Patrick AyreDepartment of Applied Social StudiesUniversity of BedfordshirePark Square, Lutonweb:
2NEGLECTNeglect 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.
3NEGLECTNeglect 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.
4NEGLECTNeglect 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.
5NEGLECT Behavioural Constant hunger Constant tiredness Frequent lateness or non-attendance at schoolDestructive tendencies
6NEGLECT Low self-esteem Neurotic behaviour No social relationships Running awayCompulsive stealing or scavenging
7NEGLECT Physical Poor personal hygiene Poor state of clothing Emaciation, pot belly, short staturePoor skin and hair toneUntreated medical problems
8SIGNIFICANT HARM Harm 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)
9THE CHILD'S BASIC NEEDS basic physical care affection security stimulation of innate potentialguidance and controlresponsibilityindependence
10Why do parents neglect? We need to understand the interaction between: 3 Ns: Nurture, Nature, NowCircumstantial factors and fundamental factors
11Why do parents neglect? Circumstantial Poverty Particular relationshipsLack of skill/knowledgeTemporary illnessLack of supportEnvironmental factorsFundamentalLack of parenting capacityDeep seated attitudinal/behavioural/ psychological problemsLong term health issuesEntrenched problematical drug /alcohol use
12A scale for assessing motivation Shows concern and has realistic confidence.Shows concern, but lacks confidence.Seems concerned, but impulsive or carelessIndifferent or apathetic about problemsRejection of parental role.
13Shows 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.
14Shows concern, but lacks confidence Parent 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.
15Seems concerned, but impulsive or careless Parent 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.
16Indifferent or apathetic about problems Parent 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.
17Rejection of parental role Parent 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)
18The effects of neglect Howe identifies 4 types of neglect Emotional neglectDisorganised neglectDepressed or passive neglectSevere deprivationEach is associated with different effects and implications for intervention
19Emotional neglect Sins 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 delayed
20Emotional neglect: parents Can’t cope with children’s demands: avoid/disengage from child in need; dismissive or punitive responseSix types of response:Spurning, rejecting, belittlingTerrorisingIsolating from positive experiencesExploiting/corruptingDenying emotional responsivenessFailing medical needs
21Emotional neglect: children Frightened, unhappy, anxious, low self-esteemPrecocious, ‘streetwise’Withdrawn, isolated, aggressive: fear intimacy and dependenceBehaviour increasingly anti-social and oppositionalBrain development affected: difficulties in processing and regulating emotional arousal
22Disorganised neglect Classic ‘problem families’ Thick case files Can annoy and frustrate but endear and amuseChaos and disruptionReasoning minimised, affect is dominantFeelings drive behaviour and social interaction
23Disorganised neglect: carers Feelings of being undervalued or emotionally deprived in childhood so need to be centre of attention/affectionDemanding and dependant with respect to professionalsCrisis is a necessary not a contingent state
24Disorganised neglect: carers Cope with babies (babies need them) but then…Parental responses to children unpredictable; driven by how the parent is feeling, not the needs of the childLack of ‘attunement’ and ‘synchronicity’
25Disorganised neglect: children Anxious 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
26Depressed neglect Classic neglect Material and emotional poverty Homes 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)
27Depressed neglect: carers Often severely abused/neglected: own parents depressed or sexually or physically abusiveMay have learning difficultiesPassive helplessness response to demands of family lifeHave given up both thinking and feeling
28Depressed neglect: carers Listless 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
29Depressed neglect: children Lack 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
30Severe 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
31Severe deprivation: children Infants: 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
32Capturing chronic abuse Judging 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
33Capturing chronic abuse Judging 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
36Capturing chronic abuse Judging 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
42CumulativenessChild 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
44Information handling Picking out the important from a mass of data InterpretationDistinguishing fact/opinion; too trusting/insufficiently criticalMistrusted sourceDecoyed by another problemFalse certainty; undue faith in a ‘known fact’Discarding information which does not fitFirst impressions/assumptionsDepartment of Health (1991) Child abuse: A study of inquiry reports, , HMSO, London
45What’s the problem? Chronic abuse and the principle of cumulativeness Files very long and badly structuredPatterns missed and ‘chronic abuse’ overlookedThe problem of proportionalityAcclimatisationThree 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.
46Assessment PitfallsParents’ behaviour, whether co-operative or uncooperative, is often misinterpretedNot enough weight to information from family friends and neighboursNot enough attention is paid to what children say, how they look and how they behaveAttention is focused on the most visible or pressing problems and other warning signs are not appreciatedWhen faced with an aggressive or frightening family, professionals are reluctant to discuss fears for their own safety and ask for helpIn Cleaver, H, Wattam, C and Cawson, P Assessing Risk in Child Protection, NSPCC, 1998
47Serious Case Reviews Great disquiet over assessment practice Failure to give sufficient weight to relevant case historyFacts recorded faithfully but not always critically appraisedGuidance and thresholdsProtection plans omit objectives and outcomes
48Assessment Practice Use of trained staff Assessment of male carers Maintenance of a wholly child-centred approachToo much mouth and ears, not enough eyesFormal assessment of risk
49Risk 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.
50Bias and Balance Include strengths and weaknesses It 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 facts‘The local authority’s evidence must demonstrate that the course of action it proposes is in the child’s best interests. This must not be achieved by including in its statements only those facts and opinions which support the local authority’s position. The courts have clearly established that where the welfare of children is the paramount consideration, there is a duty on all parties to make full and frank disclosure of all matters relevant to welfare whether these are favourable or adverse to their particular case. This includes the disclosure of information by local authorities to parents which may assist in rebutting allegations against them’.Reporting to the Court under the Children ActWe all know about separating fact as opinion, but don’t think facts are necessarily safer.Were 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.
51Bias 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
52Seeing the whole picture “Kouao always dressed immaculately. Her clothing and jewellery seemed expensive and her hair was very well done. She did not in any way look destitute, contrary to what she always claimed. In contrast, Victoria was poorly dressed. I cannot recall exactly what she wore but there were times when she did not seem to be dressed appropriately. She always appeared to look as if she was in hand-me-down clothes. I thought she looked shabbily dressed”
56Drawing conclusions and making 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.)Draw conclusions from the facts and recommendations from the conclusionsExplain how you arrived at your conclusions (Have you demonstrated the factual/theoretical basis for each?)
57Conclusions 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)Be 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)
58Wirral assessment tool for neglect Based on the Graded Care Profile by Dr OP ShrivastavaGCP provides:Framework for making assessmentBaseline measurementAn element of objectivityJudgement about careReliable standardised evidence
59When do you make a GCP assessment? Concerns about parentingChild exhibiting problemsChildren in need of protectionChildren in needDevising a programme of interventionAny other parenting concernsA tool to be used in many situations. Can be used as a “snapshot”, as a basis for an assessment. At any time there are concerns, but especially for Neglect.
60GCP users Health visitors School nurses Social workers Family centre workers
61GCP 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
62Why choose GCP? Child focused User friendly Common language Promotes partnership
63Why choose GCP? Evaluates strengths as well as weaknesses Allows progress to be assessedA relatively objective measureAllows help to be targeted where needed
64Love 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
65What to observe Nutrition Housing Clothing Hygiene Health Quality, Quantity,Preparation,Organisation,A. PHYSICALB. SAFETYC. LOVED. ESTEEM
66Grades of Care Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Level of care Grade 1Grade 2Grade 3Grade 4Grade 5Level of careAll 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 careBestAdequateEquivocalPoorWorstWirral ratingNo concernRecommend prevention supportChild protectionChild protection and legal strategy meeting
67Scoring Rating 5 25 Use on every child in the family Use with different carersComplete with the parent/carerUse information, observation, records
68DO NOT JUSTIFY BY REASONS ScoringScore as actually fits the manual –DO NOT JUSTIFY BY REASONSIf there is a score of 20 or 25, this overrides any other scoresScores between 5 and 15, record the one which crops up mostIf there is an even split, the highest score is entered
69Scoring Complete individual scores in the manual Transpose to the record sheetAgree action, targets and timescales
70AREAS A PHYSICAL CARE 1 ? Items a b c d 15 10 15 5 2 ? a b c 20 10 10 Sub-areas1?Itemsabcd15101552?abc2010103?abc510154155?abcd15151010
71DO NOT JUSTIFY BY REASONS ScoringScore as actually fits the manual –DO NOT JUSTIFY BY REASONSIf there is a score of 20 or 25, this overrides any other scoresScores between 5 and 15, record the one which crops up mostIf there is an even split, the highest score is entered
72AREAS A PHYSICAL CARE 1 ? Items a b c d 15 10 15 5 2 ? a b c 20 10 10 Sub-areas1?Itemsabcd15101552?abc2010103?abc510154155?abcd15151010
73AREAS A PHYSICAL CARE 1 15 Items a b c d 15 10 15 5 2 20 a b c 20 10 Reference SheetSub-areas115Itemsabcd1510155220abc201010315abc51015415515abcd15151010
76Targeting Items of Care Targeted AreasCurrent ScoreTarget ScoreTimescaleReviewed Score12345
77Unique Advantages 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
78What helps in working with neglect Proactive assessmentAddressing causes not symptomsAn ecological frameworkMultidisciplinary assessmentUnderstanding histories and patterns
79What helps in working with neglect Matching interventions to identified needsClear objectives and timescalesWork with parentsWork with children in a resilience framework
80Substance use and neglect Experimental drug usersRecreational drug usersPeople who use legal substancesPeople who are dependent on illegal drugs or alcoholBut we focus on ‘the stage when the use of drugs or alcohol is having a harmful effect on a person’s life’
81Some statisticsBetween 50% and 90% of families on social workers’ child care caseloads have parent(s) with drug, alcohol or mental health problemsGlasgow 1998/9: 40% of Child Protection Orders cited drug abuseDundee: Child protection conferences involving parents with problems over drug or alcohol use rose from 37% in 1998/9 to 70% in 2000
82Effects vary, but: Substance misuse may become central preoccupation Reduce or alter appetiteReactions to pain and discomfort dulledSelf-neglectSocial relationships narrowTrouble with money, housing and the lawPoor physical and mental healthInterpersonal conflict and poor family relationships
83Effects on children‘Parental substance misuse alone is neither a necessary nor sufficient cause of problems in children’ (Mountenay, 1998)“International literature on the children of drug users does not support an assumption that child abuse and neglect automatically follow when a parent uses drugs” (Hogan,1998)But, families need comprehensive assessment and active support to promote resilience and repair damage
84Effects on childrenAlcohol and/or substance misuse greatly increase the likelihood of family problems (Sher 1991; Zeitlin, 1994)Substance use can become the central focus of the adults’ lives, feelings and social behaviour.CAMH services report substantial risk of poor childhood mental health (Mountenay, 1999)Poor long-term outcomes for children (Rutter and Rutter, 1992)
85Effects on children“I hated weekends when mum had all her friends round drinking all night.”Sarah – daughter of problem drinker“She was just always dead moody, she was always in her bed all the time and she would never go out and buy food and she would never have money to go out and get it.”(Barnard 2002)the children of problem drinkers: ‘forgotten children’, a ‘hidden tragedy’, and or ‘unseen casualties’ (Wilson 1982)
86Specific effects (mainly US Studies) High risk of maltreatment, emotional or physical neglect or abuse, family conflict and inappropriate parental behaviour Famularo, Kindscherff and Fenton, 1992; Wasserman and Levanthal, 1993, Barlow, 1996).Exposed to drug-related activity and associated crime (Hogan, 1998)Inconsistent and lukewarm care, ineffective supervision and overly punitive discipline (Kandel, 1990; Boyd, 1993).
87Specific effects (mainly US Studies) More likely to:display behavioural problems (Wilens et al, 1995),experience social isolation and estrangement from family and peers, and stigma (Kumpfer and De Marsh, 1986),misuse substances themselves when older (Hoffman and Su, 1998; McKeganey 1998)In the longer term: isolation, difficulties with change and learning to have fun (Barlow, 1996)
88Pre-birth, infancy and pre-school Risk of physical harm pre-birthNeglect and injury through drugged state of parent, access to drugsInappropriate emotional care through unhappiness, tension, irritability, preoccupationCognitive and emotional development affected by lack of stimulation and inconsistent/unpredictable behaviour, unstable environment
89Pre-birth, infancy and pre-school Poor contact with other childrenMaterially deprived environmentSelf-esteem and positive sense of identity affected by physical and emotional neglectExperience violenceWhere parents’ behaviour is particularly unpredictable and frightening, symptoms of PTSD
90Pre-birth, infancy and pre-school “Baby Adele was carried along the harbour wall by her father who was under the influence of alcohol. Neighbours thought this carried the risk of dropping her in the water.”(Scottish Executive 2002)“My parents started giving me alcohol when I was 1 (year old) to put me to sleep. I got taken into hospital to have my stomach pumped.”Helen, aged 12
91Primary school Symptoms of extreme anxiety and fear of hostility Boys more quickly exhibit behavioural problems (but girls equally affected)Self-blame and poor self-esteemAcademic attainment and social development affected by neglect and poor attendance, poor concentrationShame and embarrassment lead to isolationYoung carers
92Primary school“I used to feel angry when my Mum was on drugs ‘cause I used to think how could this have happened to me? I was just sad all the time and then I would get angry. And we would have arguments all the time.”Anne, aged 11“I used to get really embarrassed at school when mum turned up drunk to collect me. I knew that I would have to make the tea when I got in.”Billy, aged 9
93Secondary school Puberty without parental support Increased risk of conduct disorders, bullying and sexual aggressionBeyond parental control and increased risk of injury by parentsSocialised into substance misuse
94Secondary school“I knew they loved me but they just didn’t care that I was there and I needed stuff as well”Elaine, aged 14“At school, if your pals know your ma’s on drugs you get called a junkie”(Aberlour 2002)
95Protective factors Sufficient income A consistent caring adult Regular monitoring and respiteRefuge from violenceRegular school/nursery attendanceSympathetic and vigilant teachersOrganised out of school activities
96The significant harm threshold The threshold is probably passed when:Parental drug and alcohol use is adversely impacting on the child’s health and developmentThere is no one parental figure able to provide a stable secure environment for the childThere is no evidence that parental behaviour will change within a timeframe congruent with the needs of the child(Luton LSCB Safeguarding Inter-Agency Procedures, 2006)
97When enough is enoughWhen a parent consistently places procurement and use of alcohol or drugs over their child’s welfare and fails to meet a child’s physical or emotional needs, the outlook for the child’s health and development is poor. Problem alcohol or drug using parents themselves acknowledge this and it is the duty of professionals to act in the child’s best interests when parents cannot.(Getting our priorities right, 2003)
98Referral triggersUse of the family resources to finance the parent’s dependency, characterised by inadequate food, heat and clothing for the childrenChildren exposed to unsuitable caregivers or visitors, e.g. customers or dealersThe effects of alcohol leading to an inappropriate display of sexual and/or aggressive behaviourChaotic drug and alcohol use leading to emotional unavailability, irrational behaviour and reduced parental vigilance
99Referral triggersDisturbed moods as a result of withdrawal symptoms or dependencyUnsafe storage of drugs and/or alcohol or injecting equipmentDrugs and/or alcohol having an adverse impact on the growth and development of the unborn child(LSCB Safeguarding Inter-Agency Procedures, 2006
101Assessment principles Focus on the childConsider outcomes for the child, not the intent of the parentFocus more on the child’s lived experience than on specific incidentsAdults’ management of their own lives is a good indicator of their ability to look after a childTake full account of historical informationInformation from a variety of sources is better than information from one
102Working together Complex network of intervention: Support parents and parentingStabilise/reduce substance misuseReduce risk and harmful effects on childrenThese objectives may not always be compatible, especially with regard to timescales
103Substance misuse workers vs child care workers Mutual incomprehension and misunderstandingWorking on the same case but not working jointlyFalse expectations and assumptionsAbdicating responsibility (both ways)Need for ‘interpreters’
104Working with parentsIt is good practice to work in partnership with parentsProfessionals should be open and honest with parents about the problems and risks they perceiveWorking with parents as partners does not mean their wishes determine decisions, but that their views are sought and taken into account.
105Working with parents It is important to recognise that: Parents will often hide the extent of their problem for fear of the consequencesThey may find it very hard to change, despite the consequencesThis means testing and checking their accounts