Noticing and helping the neglected child Brigid Daniel Professor of Social Work University of Stirling Julie Taylor, Professor of Family Health, University of Dundee, and Head of Strategy and Development: Abuse in High Risk Families, NSPCC Cheryl Burgess, Research Fellow, University of Stirling Jane Scott, Independent researcher

Outcomes for children We know that children who are neglected have some of the poorest emotional and cognitive outcomes, are at high risk of accidents and are vulnerable to sexual abuse. 5

Children who are neglected dont ask for help. Parents of neglected children also find it difficult to ask for help – especially from social workers. Childrens unmet needs may often be noticed by others. Many people, including professionals, are uncertain about what to do with their concerns. Traditionally the child protection system has responded better to incidents than to chronic circumstances.

Definitions of neglect can vary according to the purpose. criminal or civil legal proceedings national or local policy research on child development, aetiology, long term outcomes research on the operation and effectiveness of practice determining eligibility for services delivering a service investigation of allegations rationing scarce resources.

Broad definitions Neglect is defined in terms of child needs that are potentially unmet and subsequent impact on child functioning or development (English, 2005 )

Tighter definitions Medical neglect. Nutritional neglect. Emotional neglect. Educational neglect. Physical neglect. Lack of supervision and guidance. (Horwath 2007, p.27).

Working Together (2010) Neglect is the persistent failure to meet a childs basic physical and/or psychological needs, likely to result in the serious impairment of the childs 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 shelter (including exclusion from home or abandonment); protect a child from physical and emotional harm or danger; ensure adequate supervision (including the use of inadequate care-givers); or ensure access to appropriate medical care or treatment. It may also include neglect of, or unresponsiveness to, a childs basic emotional needs.

There have been children I worry about when I go home at night There have been children I worry about when I go home at night Head Teacher

Of course something must be done! The case must reach the threshold, resources are scarce. PRACTITIONER SIMPLE COMPLEX

SCRI: Research Questions What is known about the ways in which children and families directly and indirectly signal their need for help? To what extent are practitioners equipped to recognise and respond to the indications that a childs needs are likely to be, or are being neglected, whatever the cause? Does the evidence suggest that professional response could be swifter?

Filtering process 20,480 16,239 after duplicates removed 1,532 after removal of unrelated items 686 after title and abstract screening 112 after identified as primary study of relevance 63 after scoring for method and usefulness

What is known about the ways in which children and families directly signal their need for help? Very little evidence - most start with substantiated neglect, but Mothers could express concerns about potential neglect parents who misuse substances could identify impact upon their children.

Children dont directly ask for help; some school nurses in Finland noticed children who sought advice; neglected children could be identified on a self- report computer programme. (Combs Orme, 2004; McKeganey, et al., 2002; Paavileinen, et al., 2000; Kantor et al., 2004)

What is known about the ways in which parents indirectly signal their need for help? Much more evidence – many familiar parental factors - impoverished home environment, fewer parental resources, previous history of maltreatment /csa, substance misuse, domestic abuse, mental health, drug-using network, welfare assistance, problems accessing childcare, youth of parent, 2 or more children, previous child removal. Risk increases with number of risk stress factors, especially beyond 4 or 5.

Studies vary in whether prospective or retrospective and what factors are controlled for. No certain, clear and predictable pathways emerge. (Brown et al. 1998; Carter & Myers, 2007; Cash & Wilke, 2003; McGuigan & Pratt, 2001; Nair et al., 1997 & 2003; Ondersma, 2002; Scannapieco & Connell, 2003 & 2005) Nonetheless, all should be noticeable to practitioners as signs of possible need for support.

What is known about the ways in which children indirectly signal their need for help? An example of indirect signs came from two studies of burns which showed, although the burns were similar to those attributable to accidents, it was more likely that: the child had not been given first aid at the time, there was a delay of over 24 hours before seeking help. the burns would be deeper children fared worse than abused children in keeping appointments and receiving adequate wound care. (Chester et al., 2006; Hultman et al, 1998,).

Internalising and externalising behaviour can be seen by age 3 peer problems by 6; behaviour problems, impaired socialisation and problems with daily living skills by 8 (Dubowitz et al., 2002; 2004; 2005) Signs would be evident to many professionals and members of the community.

To what extent are practitioners equipped to recognise and respond to the indications that a childs needs are likely to be, or are being neglected? Professionals tend to have higher thresholds than the general public. Health visitors are very well equipped to recognise parental characteristics and developmental signs in children. Some examples of good practice e.g. Finland - active and firm school nurses. Absence of evidence about schools, teachers and the police.

Does the evidence suggest that professional response could be swifter? Protocols and guidelines are not a sufficient spur. Trust, relationships, communication, anxiety, fear and confidence affect willingness to act on concerns. Many studies referred to the importance of training as a mechanism to raise awareness. Training when coupled with access to on-going consultation and support could increase recognition and referral of child abuse and neglect. (Angeles-Cerezo & Pons-Salvador, 2004)

In summary Response for the general public and professions other than social work/services/CPS tended to mean 'referral Response for social work/services/CPS tended to mean 'investigation'. The main problem lies, not so much in recognition, as in the perceived complexity of the response mechanism.

Annual Review of Child Neglect with Action for Children 1. Do we know how many children are currently experiencing neglect in the UK? 2. How good are we at recognising children who are at risk of, or are experiencing neglect? 3. How well are we helping children at risk of, or currently experiencing neglect?

During 2011 we: collected all the UK statistics we could find about children already officially labelled as neglected as well as those in need and affected by parental substance misuse, mental health issues and domestic abuse analysed policy documents surveyed a total of 47 authorities (or Boards in NI) across the UK carried out 6 focus groups across the UK obtained online poll results from 2062 adults in the general public and 2,174 professionals (including social workers, police, health professionals and teachers).

Do we know how many children are currently experiencing neglect in the UK? It is relatively easy to find out about the tip of the iceberg In March 2010 the most common reason for children being made subject to a child protection plans was neglect: 44% in England and Scotland, in NI it was 29% with a further 21% where neglect was a contributing issue and in Wales the figures were 43% and a further 6% where neglect was a feature (NSPCC, 2011). Less than half of the areas surveyed could give us figures about the larger part of the iceberg.

How good are we at recognising children who are at risk of, or are experiencing neglect? Just over half of the public have worried about a child. 94% feel that people should do something if concerned about a child. 81% of health and education professionals have encountered neglected children. Professionals across the board are increasingly aware of such children and of their responsibilities to these children. Many feel that they cant obtain help for children at an earlier enough stage.

How well are we helping children at risk of, or currently experiencing neglect? We worry that children slip through the net, but many children appear to get stuck in the net. Professionals know about these children, but they and their families are not receiving swift and effective help when needed. The public want services for families to be funded and they want there to be treatment services for adults with problems. Social workers want to carry out direct work with children and families.

1. The answer to the first question is yes and no. We know how many are officially neglected, but we do not have proper figures about the actual number of children whose needs are not being met. 2. The answer to the second question is that there are signs that we are getting better at recognising neglect, but the public are uncertain what to do and professionals often feel powerless to help. 3. The answer to the third question is that there are many services that can help children and families but they are too often disjointed and fragile, leaving neglected children without the help they need.

Need for shift of focus There is still insufficient attention to what would support parents and children to seek help on their own behalf. At the same time, we have focused on improving detection of neglect by staff in universal services– but in reality the problem is more one of appropriate response to their concerns.

Intervention should incorporate relationship building and attachment be long-term rather than episodic be multi-faceted be offered early as well as late consider both protective and risk factors involve fathers or male caregivers as well as female caregivers.

Help-seeking..the … assumption that clients in need will contact the service is negated by data from the client interviews, which reveals how difficult it can be for vulnerable people to seek out professional help (Appleton & Cowley, 2004). p.794). `

…parents with extreme problems such as drug or alcohol related abuse, mental health problems, domestic violence or criminal records were reluctant to be drawn into 'systems'. They were frightened. They did not want to be on anyone's list. They had learned not to trust professionals,…A long timescale is needed to break down such barriers and to establish relationships with families with this level of resistance. (Anning, Stuart, Nicholls, Goldthorpe, & Morley, 2007, p.81-2)

Children and help-seeking Children prefer to seek help from family and friends and are unlikely to turn formal help as a first port of call. They are more likely to speak to adults who appear to care about them and who will listen without taking precipitate action. They lack trust in professionals, are concerned about confidentiality and fear intervention in the family and associated loss of control over the consequences of telling (Gorin, 2004, p.59).