Understanding and assessing neglect

1. Understanding and assessing neglect Patrick Ayre Department of Applied Social Studies University of Bedfordshire Park Square, Luton email: pga@patrickayre.co.uk web: http://patrickayre.co.uk

2. NEGLECT 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 • protect from physical and emotional harm or danger • ensure adequate supervision • ensure access to medical care or treatment. • It may also include neglect of, or unresponsiveness to, a child’s basic emotional needs.

3. NEGLECT 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 • protect from physical and emotional harm or danger • ensure adequate supervision • ensure access to medical care or treatment. • It may also include neglect of, or unresponsiveness to, a child’s basic emotional needs.

4. NEGLECT 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 • protect from physical and emotional harm or danger • ensure adequate supervision • ensure access to medical care or treatment. • It may also include neglect of, or unresponsiveness to, a child’s basic emotional needs.

5. NEGLECT Behavioural • Constant hunger • Constant tiredness • Frequent lateness or non-attendance at school • Destructive tendencies

6. NEGLECT • Low self-esteem • Neurotic behaviour • No social relationships • Running away • Compulsive stealing or scavenging

7. NEGLECT Physical • Poor personal hygiene • Poor state of clothing • Emaciation, pot belly, short stature • Poor skin and hair tone • Untreated medical problems

8. SIGNIFICANT 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)

9. THE CHILD'S BASIC NEEDS • basic physical care • affection • security • stimulation of innate potential • guidance and control • responsibility • independence

10. Why do parents neglect? We need to understand the interaction between: • 3 Ns: Nurture, Nature, Now • Circumstantial factors and fundamental factors

11. Circumstantial Poverty Particular relationships Lack of skill/knowledge Temporary illness Lack of support Environmental factors Fundamental Lack of parenting capacity Deep seated attitudinal/behavioural/ psychological problems Long term health issues Entrenched problematical drug /alcohol use Why do parents neglect?

12. A scale for assessing motivation • Shows concern and has realistic confidence. • Shows concern, but lacks confidence. • Seems concerned, but impulsive or careless • Indifferent or apathetic about problems • Rejection of parental role.

13. Shows 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 children • Has realistic confidence that he/she can overcome problems and is willing to ask for help when needed • Is prepared to make sacrifices for children.

14. Shows concern, but lacks confidence • Parent is concerned about children’s welfare and wants to meet their needs, but lacks confidence that problems can be overcome • May be unwilling for some reason to ask for help when needed. Feels unsure of own abilities or is embarrassed • But uses good judgement whenever he/she takes some action to solve problems.

15. Seems 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.

16. Indifferent 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.

17. Rejection 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)

18. The effects of neglect Howe identifies 4 types of neglect • Emotional neglect • Disorganised neglect • Depressed or passive neglect • Severe deprivation Each is associated with different effects and implications for intervention

19. Emotional neglect • Sins of commission and omission • ‘Closure’ and ‘flight’: avoid contact, ignore advice, miss appointments, deride professionals, children unavailable • However, may seek help with a child who needs to be ‘cured’ • Intervention often delayed

20. Emotional neglect: parents • Can’t cope with children’s demands: avoid/disengage from child in need; dismissive or punitive response • Six types of response: • Spurning, rejecting, belittling • Terrorising • Isolating from positive experiences • Exploiting/corrupting • Denying emotional responsiveness • Failing medical needs

21. Emotional neglect: children • Frightened, unhappy, anxious, low self-esteem • Precocious, ‘streetwise’ • Withdrawn, isolated, aggressive: fear intimacy and dependence • Behaviour increasingly anti-social and oppositional • Brain development affected: difficulties in processing and regulating emotional arousal

22. Disorganised neglect • Classic ‘problem families’ • Thick case files • Can annoy and frustrate but endear and amuse • Chaos and disruption • Reasoning minimised, affect is dominant • Feelings drive behaviour and social interaction

23. Disorganised neglect: carers • Feelings of being undervalued or emotionally deprived in childhood so need to be centre of attention/affection • Demanding and dependant with respect to professionals • Crisis is a necessary not a contingent state

24. Disorganised 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 child • Lack of ‘attunement’ and ‘synchronicity’

25. Disorganised neglect: children • Anxious and demanding • Infants: fractious, fretful, clinging, hard to soothe • Young children: attention seeking; exaggerated affect; poor confidence and concentration; jealous; show off; go to far • Teens: immature, impulsive; need to be noticed leads to trouble at school and in community • Neglectful parents feel angry and helpless: reject the child; to grandparents, care or gangs

26. Depressed neglect • Classic neglect • Material and emotional poverty • Homes and children dirty and smelly • Urine soaked matresses, dog faeces, filthy plates, rags at the windows • A sense of hopelessness and despair (can be reflected in workers)

27. Depressed neglect: carers • Often severely abused/neglected: own parents depressed or sexually or physically abusive • May have learning difficulties • Passive helplessness response to demands of family life • Have given up both thinking and feeling

28. Depressed neglect: carers • Listless and unresponsive to children’s needs and demands, limited interaction • Lack of pleasure or anger in dealings with children and professionals • No smacks, no shouting, no deliberate harm but no hugs, no warmth, no emotional involvement • No structure; poor supervision, care and food

29. Depressed neglect: children • Lack interaction with parents required for mental and emotional development • Infant: Incurious and unresponsive; moan and whimper but don’t cry or laugh • At school: isolated, aimless, lacking in concentration, drive, confidence and self-esteem but do not show anti-social behaviour

30. Severe deprivation • Eastern European orphanages, parents with serious issues of depression, learning disabilities, drug addiction, care system at its worst • Children left in cot or ‘serial caregiving’ • Combination of severe neglect and absence of selective attachment: child is essentially alone

31. Severe deprivation: children • Infants: lack pre-attachment behaviours of smiling, crying, eye contact • Children: impulsivity, hyperactivity, attention deficits, cognitive impairment and developmental delay, aggressive and coercive behaviour, eating problems, poor relationships • Inhibited: withdrawn passive, rarely smile, autistic-type behaviour and self-soothing • Disinhibited: attention-seeking, clingy, over-friendly; relationships shallow, lack reciprocity

32. Capturing 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 bias • Intangible: Difficult to capture and compare • High threshold for recognition • Neglect is a pattern not an event

33. Capturing 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 bias • Intangible: Difficult to capture and compare • High threshold for recognition • Neglect is a pattern not an event

34. Our image of assessment

35. The reality of assessment?

36. Capturing 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 bias • Intangible: Difficult to capture and compare • High threshold for recognition • Neglect is a pattern not an event

37. The pattern of neglect

38. The pattern of neglect

39. The pattern of neglect

40. The pattern of neglect

41. The pattern of neglect

42. Cumulativeness

43. Failure of cumulativeness

44. Information handling • Picking out the important from a mass of data • Interpretation • Distinguishing fact/opinion; too trusting/insufficiently critical • Mistrusted source • Decoyed by another problem • False certainty; undue faith in a ‘known fact’ • Discarding information which does not fit • First impressions/assumptions Department of Health (1991) Child abuse: A study of inquiry reports, 1980-1989, HMSO, London

45. What’s the problem? • Chronic abuse and the principle of cumulativeness • Files very long and badly structured • Patterns missed and ‘chronic abuse’ overlooked • The problem of proportionality • Acclimatisation

46. Assessment Pitfalls • Parents’ behaviour, whether co-operative or uncooperative, is often misinterpreted • Not enough weight to information from family friends and neighbours • Not enough attention is paid to what children say, how they look and how they behave • Attention is focused on the most visible or pressing problems and other warning signs are not appreciated • When faced with an aggressive or frightening family, professionals are reluctant to discuss fears for their own safety and ask for help In Cleaver, H, Wattam, C and Cawson, P Assessing Risk in Child Protection, NSPCC, 1998

47. Serious Case Reviews • Great disquiet over assessment practice • Failure to give sufficient weight to relevant case history • Facts recorded faithfully but not always critically appraised • Guidance and thresholds • Protection plans omit objectives and outcomes

48. Assessment Practice • Use of trained staff • Assessment of male carers • Maintenance of a wholly child-centred approach • Too much mouth and ears, not enough eyes • Formal assessment of risk

49. Risk 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; and • The methods by which the likelihood of the feared outcomes could be diminished or removed.

50. Bias and Balance • Include strengths and weaknesses • It is your job to make judgements but: • avoid empty evaluative words like inappropriate, worrying, inadequate • Give evidence for descriptive words like cold, dirty and untidy • Beware the danger of facts