Noticing and Helping the Neglected Child

1. Noticing and Helping the Neglected Child Brigid Daniel Professor of Social Work University of Stirling with thanks also to: 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 and Scottish Protection Hub Morag Redford, Senior Teaching Fellow, School of Education, University of Stirling

5. 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 child’s needs are likely to be, or are being neglected, whatever the cause? Does the evidence suggest that professional response could be swifter?

6. Method • Empirical studies, published 1995 and 2005. • Filtered for quality and relevance. • 63 papers, published in English, from across the world.

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

8. During 2011 we collected all the UK statistics 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 and • obtained online poll results from 2,062 adults in the general public and 2,174 professionals (including social workers, police, health professionals and teachers).

9. 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.

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

11. Scottish operational definition • 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. It may involve a parent or carer failing to provide adequate food, shelter and clothing, to protect a child from physical harm or danger, or to ensure access to appropriate medical care or treatment. It may also include neglect of, or failure to respond to, a child’s basic emotional needs. Neglect may also result in the child being diagnosed as suffering from ‘non-organic failure to thrive’, where they have significantly failed to reach normal weight and growth or development milestones and where physical and genetic reasons have been medically eliminated. In its extreme form children can be at serious risk from the effects of malnutrition, lack of nurturing and stimulation. This can lead to serious long-term effects such as greater susceptibility to serious childhood illnesses and reduction in potential stature. With young children in particular, the consequences may be life-threatening within a relatively short period of time.

12. … in reality, neglect is what the school teacher, physician, social worker, judge, psychologist, or police officer “say it is” at the time of the report...one should not get hung up on the definition of child neglect but rather get on with helping these children, who are being cared for in a manner far below our society’s accepted standards. Helfer, 1987

13. NEGLECT ‘Neglect’

14. 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.

15. Children don’t 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)

16. 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.

17. 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,).

18. 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.

19. 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.

20. To what extent are practitioners equipped to recognise and respond to the indications that a child’s 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.

21. 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 can’t obtain help for children at an earlier enough stage.

22. It’s a feeling…that something isn’t right. It’s an instinct and a feeling of something being terribly wrong. I guess it comes from tiny details when you link one thing with another. (Paavilainen and Tarkka, 2003)

23. I’ve seen worse. It’s not that bad really. They’re happy underneath it. I mustn’t impose my middle-class values Children can be dirty but happy.

24. 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)‏

25. 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.

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

27. 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.

28. Services • The general public want services for families to be funded. • 62% per cent want projects which support families before problems get worse, • 47% per cent want health-based services • 42% school-based services and 41% preventive services.

29. Practitioners • Staff in universal services want: • more treatment services for adults in relation to substance misuse, mental health problems and domestic abuse (32%), • more time (29%), more resources (27%) and more advice (34%) on how to help struggling families, • clearer guidance from employers or government on when to intervene (33%). • 83% of social workers want to undertake more direct work with children and families.

38. Action On Neglect: • developing selected practice messages from the research study 'Noticing and Helping the Neglected Child' • creation of 'typical' case scenarios as prompts for the development work • establishment of an advisory group of children and young people service users • establishment of an advisory group of parent service users • creating 3 multi-disciplinary, multi-agency local working groups in England comprising managers and front-line practitioners • with these groups undertaking a process analysis to ascertain how the selected messages can be effectively incorporated into practice in the short, medium and longer term • developing a series of detailed worked examples setting out improved 'pathways to help' • dissemination activities.