1. Olive Stevenson Emeritus Professor of Social Work University of Nottingham and Sara Glennie Independent Consultant Neglected Children & their Families “ What do we know and what can we do?”

2. Some Key Issues Understanding the concept of neglect in relation to child development and its evidence base. Appraisal of parenting capacity in relation to the developmental timetable of the children. Timely decisions regarding the adequacy of children’s care at home. Acceptance by all responsible that, if left at home, monitoring and/or intervention is likely to be long term.

3. Key Issues cont. Understanding the complexity of working with parents and other professionals in cases of long term neglect. Recognition by workers and their managers/seniors of the emotional strain such families place on those in the field. Working to improve the understanding of neglect within the legal profession. Working to develop complementary care for children who remain with their families.

4. New Evidence and Policy Trends since 2007… Rutter Wade Farmer &Lutman Demos: In Loco Parentis

5. Full References Rutter et al, English and Romanian Adoptees(ERA) Study: 45 Key Questions. BAAF. 2009 Wade, J., Biehal N., Farrelyn N. and Sinclair, I. University of York SPRU Report. January 2010 DCSF 2392 Farmer,E and Lutman,E. Case Management and Outcomes for Neglected Children Returned to their Parents: A Five Year Follow-up Study. DCSF-RB214 Hannon, C. Wood C and Bazelgette,L. In Loco Parentis, Demos

6. Policy and Practice Implications from the ERA Study (Rutter et al. 2009) Relevance to children neglected in their own homes. The ERA Study: 1. A comparative longitudinal study of children adopted into families in England between February, 1990 and September, 1992 – aged 42 months or younger at time of entry to UK. 2. Special focus on 98 children whose institutional care (in Romania) had continued until at least age 6 months, in contrast to 119 children comprised as follows: 51 adopted in UK not in institutions 21 from Romania, not in institutions 46 not in institutions after age 6 months. 3. Extensive assessment at 4,6,11 and 15 years.

7. Are there reliable pointers to good outcomes? (Rutter et al.) 1. “The most important prediction factor of later psychological problems was the age of the child when leaving institutional care”. (p.8). “Between the age of 6 and 8 months appears to be a watershed, though not absolute and categorical. Half the 98 children in the sample showed long term persisting problems – so half did not! But these children overall did less well than those in the control group.” 2. Evidence of very early beginnings of language (NB what constitutes “beginnings of language” in these early months?) Any language at all was associated with better cognitive outcomes. 3. Psycho-social deprivation and sub-nutrition both had major deleterious, long- lasting effect on head growth – more than other forms of growth. Even when sub-nutrition was not present, psycho-social deprivation had massive deleterious effects. (pp 14-15)

8. Particular Psychological Problems closely associated with Institutional Deprivation (Rutter et al.) 1. Disinhibited attachment problems 2. “Quasi-autistic” features – i.e. alterable in different circumstances 3. Inattention/overactivity 4. Intellectual impairment Slow improvement up to final assessment at 15 years. But, often turned some difficulties into assets, eg. Re: quasi- autistic,musical/athletic prowess; re: disinhibition, lack of shyness can be a social asset. NB link to work on resilience.

9. Outcomes for Children Looked After for Reasons of Abuse or Neglect: The Consequences of Staying in Care or Returning Home ( Wade et al 2010) Key Points in relation to Neglect (Chapter 16) 1. Outcomes vary according to LA and teams within same LA; you can make a difference! 2.. “…where neglect had contributed strongly to a child’s admission, children were less likely to have returned, less likely to have wanted to return and were rather more likely than other maltreated children to be rated as having settled well in care.” (p.241-242) 3. Planning for return home, especially with care orders, is of great importance. However, quality of planning was found to be variable.

10. Child Wellbeing at Follow-up: “the clearest findings concerned neglected children” (Wade et al 2010 cont. ) 4. “Where there had been strong evidence of preadmission neglect, and even taking account of other factors,…these children did best if they remained in care. Those who went home tended to fare worse than other maltreated children.” 5. “Where children have experienced chronic and serious neglect, extreme caution should surround a decision for unification...these children did significantly worse if they went home…for neglected children particularly, remaining in care was an almost unequivocal good.” 6. Research found many children spoke fondly of foster parents and well about other experiences in care.” pgs. 246-249

11. Case Management and Outcomes for Neglected Children Returned to their Parents (Farmer and Lutman, 2010) Outcomes for younger children were much better than for older children. The cut –off age was six at the time of re-unification, after which action to safeguard children and plan for their future reduced. Practice with older children and adolescents needs to be more proactive. In two fifths of cases, children who were subject to CP Plans were not adequately safeguarded. Plans made during care proceedings did not work out in three fifths of cases – often when children were returned to parents because of an over- optimistic view of the possibility of parental change by guardians and expert assessors, in the face of long histories suggesting the contrary. There were major LA variations in how proactively cases were managed, leading to better outcomes in some authorities than others.

12. Three questions to think about:  What can we learn from Serious Case Reviews nationally that will support our work with children who are neglected?  What can we learn from our own Serious Case Reviews?  Do we need to think differently about working together when we share responsibility for children who are neglected?

13. Neglect in Oxfordshire: the current picture (1 st July 2010)

14. Learning from Serious Case Reviews: a cautionary note.  The imperative is political, and….  The population studied is idiosyncratic, not representative of day to day safeguarding practice.  The study is necessarily descriptive and retrospective  Causal connections cannot be made.  There is no matched sample with different outcomes “…more does need to be known about routine child protection work and its effectiveness...comparisons could be made between Serious Case Reviews and matched cases with a similar profile but different outcome…”

15. Biennial Analysis of Serious Case Reviews: 2005-2007 Brandon et al  … to draw out key themes and trends and their implications for policy and practice”.  4th biennial analysis of SCRs in England o Sinclair and Bullock (1999-2001) o Rose and Barnes (2001-2003) o Brandon et al (2003-2005)  Layered approach – intensive sample of 40 SCRs  Ecological-transactional perspective

16. Emergent themes that have particular relevance to working with neglect  Chaotic behaviour in families can be mirrored in professional thinking and action  Both families and professionals can fail to see the child  Professionals overwhelmed by the volume and nature of work  75% of families did not cooperate with services  Past or present domestic violence and/or parental mental ill health and/or parental substance misuse in almost 75% of intensive sample.

17. Local echoes…  Chaotic conditions  The impact of substance misuse on parenting  The challenge of co-operation, compliance and deception  Difficulty in seeing and reading the experience of the child

18. …and further learning about  Inter-agency relationships  Managing our hope and optimism  The nature of “evidence” in relation to neglect

19. Do we need to work together differently?  System consensus across 4 domains  Common tools lead to common assessments  Forums that enable the “why?” question  The critical role of core groups