Identifying Neglect: What professionals can do

1. Identifying Neglect: What professionals can do Patrick Ayre Department of Applied Social Studies University of Bedfordshire Park Square, Luton email: pga@patrickayre.co.uk web: http://patrickayre.co.uk

2. A child centred approach The purpose of assessment is to understand what it is like to be that child (and what it will be like in the future if nothing changes)

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

4. 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?

5. 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

6. 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

7. 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

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 Emotional neglect: children • Frightened, unhappy, anxious, low self-esteem • Precocious, ‘streetwise’ • Withdrawn, isolated, aggressive: fear intimacy and dependence • Behaviour increasingly anti-social and oppositional • Brain development affected: difficulties in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

9. 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

10. 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

11. 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’

12. 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

13. 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)

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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 and acclimatisation • Neglect is a pattern not an event

20. The pattern of neglect: atypical

21. The pattern of neglect: typical

22. The pattern of neglect

23. The pattern of neglect

24. The pattern of neglect

25. Cumulativeness

26. Failure of cumulativeness

27. GCP provides: • Framework for making assessment • Baseline measurement • An element of objectivity • Judgement about care • Reliable standardised evidence

28. GCP uses • Pre-referral assessments • Snapshot assessments • Contribution to CAF assessments • Contribution to Core Assessment (parenting capacity) • Self-assessment (parents and carers) • Young person’s assessment of parenting • Tool for setting goals and assessing progress • Tool to facilitate discussion

29. GCP users • Health visitors • School nurses • Social workers • Family centre workers • Education staff

30. Why choose GCP? • Child focused • User friendly • Common language • Promotes partnership

31. Why choose GCP? • Evaluates strengths as well as weaknesses • Allows progress to be assessed • A relatively objective measure • Allows help to be targeted where needed

32. Domains of Care Stimulation Approval Disapproval Acceptance Sensitivity Responsivity Reciprocity Overtures Self actualisation Esteem Love and belongingness Present & absent Safety Physical needs Nutrition. Housing, Clothing, Hygiene & Health Maslow, A. 1954

33. What to observe Nutrition Housing Clothing Hygiene Health Quality, Quantity, Preparation, Organisation, A. PHYSICAL B. SAFETY C. LOVE D. ESTEEM

34. Grades of Care

35. Scoring • Rating 1 5 • Use on every child in the family • Use with different carers • Complete with the parent/carer • Use information, observation, records

36. Scoring • Complete individual scores for each sub-area • Transpose to the record sheet • Agree action, targets and timescales

38. Targeting Items of Care

39. Unique Advantages • Common language, common reference • Objective measure – child focussed • Effective tool to promote partnership assessments and planning with parents • User friendly • Comprehensively covers all areas of care • Child and carer specific