Understanding Adolescent Neglect

1. Understanding Adolescent Neglect Herefordshire SCB conference – May 2018

2. Understanding adolescent neglect The challenges of definitions • 1. What we know about adolescent neglect • 2. • Session content 3. The Children’s Society’s research programme 4. Working to address adolescent neglect

3. The Children’s Society • 135 years supporting the most disadvantaged children and young people. Online archive: • Now services nationwide for young people and families alongside policy, campaigns and research to understand and advocate for improvements to young people’s lives. http://www.hiddenlives.org.uk www.thechildrenssociety.org.uk 3

4. Ambitious Fun Challenges Idealistic Transition Learning Potential Friendship . Growth Well-informed Difficult Anxiety Hedonistic Excited Defiant Grumpy Naïve Self conscious Scary Spotty Insecure Angsty Incoherent Withdrawn Hormonal Worried Excitable Boundaries Identity Pressured Noisy Challenging Misunderstood

5. I hate you! It’s so unfair!

6. Adolescence is … • A time of profound change – physical, psychological and social. • Goal – ‘discovery of self’. • Stereotyped as ‘stress and storm’. • Neurological development – predisposes to risk-taking. • Perameters are hard to pin down (UK research uses 11-17). • ‘Begins in nature and ends in culture.’

7. What is ‘neglect’? Official definition persistent failure? • 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 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 child’s basic emotional needs. serious impairment? emotional harm? adequate supervision? a child’s basic emotional needs? Working Together to Safeguard Children (Dept. for Education, 2015) Working Together to Safeguard Children (Dept for Education, 2015)

8. Adolescent neglect: scale – official figures

9. What is ‘adolescent neglect’? (Extra definitional challenges) What is ‘neglect’? (Research typologies) • Horwath, 2007; Mennen, 2010; Raws, 2016. ‘DEFINITIONAL VACUUM’ (Simmel et al, 2016) Acts or impact? Acts of omission only? Supervisory Educational Neglect Physical Care / Environmental Emotional Cultural relativity Young people’s agency Medical 9

10. Problems with definition Challenges for practitioners in identifying and assessing neglect. Challenges for researchers in studying and measuring neglect. Neglect not identified or responded to … especially for adolescents. The evidence base is poor … especially for adolescents.

11. ? What do you know about adolescent neglect?

12. 1) ‘Neglect’ is the most-commonly recorded form of maltreatment in Child Protection Plan registrations in England … but is the same true for other high-income countries? ü • U.S. Dept. of Health and Human Services, 2016. • Public Health Agency of Canada, 2010. • Gilbert et al, 2009.

13. 2) What does research say is the proportion of adolescents who experience neglect by their parents or carers? ü ü ü ü

14. 3) Which form of maltreatment is more likely to lead to substance misuse among adolescents? ü Past year neglect of 11-16 year olds was found to predict newly-diagnosed substance dependence. Other forms of youth maltreatment were unrelated. Lalayants and Prince (2016)

15. 4) Girls who have experienced which form of maltreatment during adolescence are more likely to have a baby in their teens? ü ü Substantiated maltreatment – specifically sexual abuse and neglect (the latter most strongly) – predicted teenage childbirth after adjusting for identified risk factors in the adolescent population such as family income, ethnicity, number of sexual partners and contraceptive use. Noll and Shenk (2012)

16. 6) Is the outcome of maltreatment worse when it begins and ends during childhood (aged 10 or less) or when it begins during adolescence (aged 11+)? 5) In what proportion of Serious Case Reviews has neglect been a key feature, according to recent research? • Neglect was a significant factor in 60% of SCRs between 2009 – 2011. • Neglect occurred across all ages and was most common for children aged 11-15. • Most of the young people involved were not known to children’s social care. • Brandon et al (2013) ü Maltreatment which begins during adolescence is more damaging than maltreatment which starts and ceases during childhood. It causes problems during late adolescence and early adulthood including involvement in criminal behaviours, substance misuse, health-risking sexual behaviours and suicidal thoughts. Thornberry et al (2001; 2010)

17. The impact of adolescentneglect Linked to problems with … • Mental ill health (e.g. depression, symptoms of PTSD). • Poor general health and well-being. • Difficulties with interpersonal relationships (e.g. with family relationships, early sexual relationships and pregnancy). • Risk-taking behaviours (e.g. aggression, running away, substance misuse, offending / ‘delinquency’). • Problems with education (attendance and attainment). EVIDENCE IS THIN! 19 articles in 20 years (Cardiff / NSPCC review) Rees et al (2011); Cardiff University review for NSPCC (2013)

18. ‘Understanding Adolescent Neglect’ programme • Builds on earlier work – partnership with the University of York Neglect Matters 2010 Safeguarding Young People 2010 Adolescent Neglect 2011

19. ‘Understanding Adolescent Neglect’ programme • National schools online surveys. 1,000 young people in Year 10 (aged 14-15). • Did not ask about ‘neglect’. • Asked about experiences of care and support at home – and about well-being, experiences in school and externalising behaviours. • Hypothesis: Less care = lower well-being, more risk-taking, etc. Neglect can be measured by association. • What is ‘adolescent neglect’? • How much adolescent neglect is there in England? • What are the contexts for adolescent neglect? • What are the consequences of adolescent neglect? Understanding Adolescent Neglect Troubled Teens

20. Parenting behaviours measure

21. Negative associations: risk-taking EMOTIONAL SUPPORT: Differences in behaviour of cared for and neglected young people

22. Negative associations: low well-being Differences in well-being for young people who experienced multiple forms of neglect Source: The Children’s Society Survey, 2014

23. Findings: thresholds and proportions ü More care = positive associations / less care = negative associations (... mostly) Consistent patterns in the data for when infrequent parenting became neglectful C Overall proportion experiencing one or more form of neglect 15%

24. Other headline findings Young people are more supported in some ways than others e.g. Overall more reports of frequent supervisory and physical care inputs – less educational or emotional support. • PARENTING NORMS Characteristics and context make a difference e.g. Boys experience more supervisory neglect. • CONTEXT • 14-15-year-olds • COMPLEXITY Parents can do ‘too much’ e.g. Young people who said their parents ‘always’ did the items under educational support or supervision had lower life satisfaction than those who reported slightly less input.

25. ‘Thinking about adolescent neglect’ • Commissioned by the Luton SCB to support strategy development and training. • Literature review + interviews with specialist workers. • Focus on identification, assessment and intervention. • Posed challenges to the SCB Executive Board for improving local responses to adolescent neglect. • Published in April 2018. Professionals briefing also available. Thinking about adolescent neglect A review of research on identification, assessment and intervention

26. Findings: When is neglect more likely? (Identification) • Contextual factors • Characteristics (gender, disability, family structure). • Domestic situation (issues – ‘toxic trio’; events – e.g. bereavement). • Socio-economics and community profile. … BUT similar to all maltreatment (Stein et al, 2009). • ‘Core association’ with poverty (Bywaters et al, 2016). Material deprivation may exacerbate parental stress and hinder parenting capacity … BUT affluence has been linked to emotional neglect (Luthar and Latendresse, 2007; Bernard, 2017). • Important not to ‘just blame parents’, especially mothers (Flood and Holmes, 2016). Wider context and ‘societal neglect’ play a part.

27. Findings: Identifying adolescent neglect • Professionals may be reticent to identify neglect of adolescents (Assumed resilience? Absence of crisis? Lack of faith in appropriate responses?). • To improve identification, awareness and understanding of the scale, scope and impact of neglect is important …. • … an ‘attuned professional culture’. • The combined effect of multiple factors makes neglect more likely. • Neglect often co-occurs with other forms of maltreatment. • The young person’s lived experience should be central. ‘What is neglectful depends on how parental behaviour feels and affects each individual young person.’ (Rees et al, 2011)

28. Findings: Assessing adolescent neglect • Evidence of variability / subjectivity in decision-making (Horwath, 2005; 2007). • No proven effective assessment tools for this age group. The Assessment Framework can work well ... ... if the user is well-informed about neglect 02 January 2020 28

29. Findings: Addressing adolescent neglect (services)

30. Findings: Addressing adolescent neglect (services) Three tiered framework (Rees et al, 2011; Hicks and Stein, 2013)

31. Findings: Identifying, assessing and addressing adolescent neglect Interagency collaboration is vital … … different services know different things, and provide different support 02 January 2020 31

32. Findings: Working with young people and families • Retain a keen focus on remedying neglect – on the needs of the young person – throughout the work. • Ensure voluntary, and active, participation by parents and young people. • Maintain close, mutually-respectful collaboration and consensus between agencies on how adolescents' and parents' different needs will be assessed and accommodated within the work. • Establish clear agreements around what support will be provided, what change needs to take place (including how and when this will be measured), and what will happen if progress is not made. Adapted from Daniels (2015) Adapted from Daniel, 2015

33. Fun Idealistic Challenges Transition Learning Friendship Potential Growth Well-informed Young people want to be listened to respectfully, have account taken of their views and have a stake in decision-making. Work with them as ‘assets and resources’. (Hanson & Holmes, 2014)

34. Resources Sarah-Jayne Blakemore TED talk on the adolescent brain. http://www.ted.com/talks/sarah_jayne_blakemore_the_mysterious_workings_of_the_adolescent_brain#t-152217 Department for Education – Childhood neglect training resources (2012) https://www.gov.uk/government/collections/childhood-neglect-training-resources Flood S & Holmes D (2016) ‘Child neglect and its relationship to other forms of harm – responding effectively to children’s needs: Executive summary.’ https://www.actionforchildren.org.uk/media/6762/child_neglect_evidence_scope_executive_summary_july16-1.pdf Hanson E & Holmes D (2014) ‘That Difficult Age: Developing a more effective response to risks in adolescence.’ Dartington: Research in Practice. http://cdn.basw.co.uk/upload/basw_24144-4.pdf Hicks, L. & Stein, M. (2010) ‘Neglect Matters: a multi-agency guide for professionals working together on behalf of teenagers.’ London: DSCF. http://www.york.ac.uk/inst/spru/research/pdf/NeglectMatters.pdf Raws, P. (2018) ‘Thinking about adolescent neglect: A review of research focusing on identification, assessment and intervention.’ AND ‘Adolescent neglect: Professionals Briefing.’ London: The Children’s Society. https://www.childrenssociety.org.uk/lutonscbreport

35. Selected references Brandon, M. et al. (2013) Neglect and Serious Case Reviews: A report from the University of East Anglia commissioned by NSPCC. London: NSPCC. Daniel, B. (2015) Why Have We Made Neglect So Complicated? Taking a Fresh Look at Noticing and Helping the Neglected Child. Child Abuse Review, 24, 82-94. Hanson, E. and Holmes, D. (2014) That Difficult Age: Developing a more effective response to risks in adolescence. Evidence Scope. Totnes: Research in Practice. Hicks, L. and Stein, M. (2009) Neglect Matters: A multi-agency guide for professionals working together on behalf of teenagers. London: HM Government. Horwath, J. (2007) ‘The missing assessment domain: Personal, professional and organisational factors influencing professional judgements when identifying and referring child neglect.’ British Journal of Social Work, 37, 1285-1303. Radford , L. et al. (2011) Child abuse and neglect in the UK today. London: NSPCC. Raws, P. (2016) Troubled Teens: A study of the links between parenting and adolescent neglect. London: The Children’s Society. Rees, G. et al. (2010) Safeguarding Young People: Responding to young people aged 11-17 who are maltreated. London: The Children’s Society. Rees, G. et al. (2011) Adolescent Neglect: Research, policy and practice. London: Jessica Kingsley Publishers. Simmel, C. et al. (2016) ‘An Exploratory Study of Neglect and Emotional Abuse in Adolescents: Classifications of Caregiver Risk Factors.’ Journal of Child and Family Studies, 25, 2372-2386. Thornberry, T.P. et al. (2010) ‘The causal impact of childhood-limited maltreatment and adolescent maltreatment on early adult adjustment.’ Journal of Adolescent Health 46, 4, 359-365 Thornberry, T.P. and Henry, K. (2013) Intergenerational Continuity in Maltreatment. Journal of Abnormal Child Psychology 41(4) 555-569.

36. Understanding Adolescent Neglect Herefordshire SCB Conference – May 2018 *Phil.Raws@childrenssociety.org.uk