Identifying and Assessing Neglect

1. Identifying and Assessing Neglect Patrick Ayre Department of Applied Social Studies University of Bedfordshire Park Square, Luton email: pga@patrickayre.co.uk Presentation can be downloaded from: http://patrickayre.co.uk/Presentationd.htm

2. NEGLECT Parents who neglect their children basically just don’t know any better because of their own poor upbringings. If we send them to a family centre for Parental Skills training, all will be well.

3. NEGLECT Parents who neglect their children basically just don’t know any better because of their own poor upbringings. If we send them to a family centre for Parental Skills training, all will be well. • IF ONLY!!....

4. NEGLECT So neglected children who come into care may be a bit thin, a bit dirty, badly in need of seeing a doctor or dentist, maybe a bit wild. But we can place them with foster carers for a bit of looking after, a bit of TLC, a bit of structure and everything will be fine. The children will absolutely love it and will immediately start to thrive. Simple really!

5. NEGLECT So neglected children who come into care may be a bit thin, a bit dirty, badly in need of seeing a doctor or dentist, maybe a bit wild. But we can place them with foster carers for a bit of looking after, a bit of TLC, a bit of structure and everything will be fine. The children will absolutely love it and will immediately start to thrive. Simple really! IF ONLY!!....

6. Brain development • By the age of 3, a baby’s brain has reached almost 90 percent of its adult size. • The growth in each region of the brain largely depends on receiving stimulation. • This stimulation provides the foundation for learning.

7. Experience Affects the Structure of the Brain • Brain development is “activity-dependent” • Every experience excites some neural circuits and leaves others alone • Neural circuits used over and over strengthen, those that are not used are dropped resulting in “pruning”

11. Poor integration of hemispheres and underdevelopment of the orbitofrontal cortex • Difficulty regulating emotion, • Lack of cause-effect thinking, • Inability to recognize emotions in others, • Inability to articulate own emotions, • Incoherent sense of self and autobiographical history • Lack of conscience.

12. Other physiological issues • Serotonin: emotional stability and feeling good • Malnutrition: cognitive and motor delays, anxiety, depression, social problems, and attention problems • Myelination • Sensitive periods (infancy & attachment)

13. Emotional development • Sensitive period for emotional development: up to 18 months • Shaped primarily by the way in which the prime carer interacts with the child • Emotional deficits harder to overcome once the sensitive window has passed. • How often do we intervene assertively at this point?

14. Building a child Building a child is like building a house, each new level built on the one below. If the lower levels are unsound, no amount of tinkering with the upper floors will make it stable.

15. Capturing chronic abuse • Single events often only significant in context; • Can often only understand present by setting in context of past • Intangible: Difficult to capture and compare • High threshold for recognition • Neglect is a pattern not an event

16. The pattern of neglect: atypical

17. The pattern of neglect

18. The pattern of neglect

19. The pattern of neglect

20. The pattern of neglect

21. Cumulativeness

22. Failure of cumulativeness

23. 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 (case, agency and geographical)

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

25. 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?

26. 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

27. 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

28. 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

29. 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

30. 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

31. 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

32. 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’

33. 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

34. 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)

35. 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

36. 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

37. 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

38. 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

39. 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

40. The assessment of neglect • An approach based on the Graded Care Profile by Dr OP Shrivastava GCP provides: • Framework for making assessment • Baseline measurement • An element of objectivity • Judgement about care • Reliable standardised evidence http://www.lutonlscb.org/index.php?option=com_content&view=article&id=183&Itemid=52

41. GCP users • Health visitors • School nurses • Social workers • Family centre workers • Education welfare workers

42. 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

43. 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

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

45. Grades of Care

46. Example: AREA C: LOVE

48. Targeting Items of Care

49. Making an assessment • Guidance provided (follow up scores of 4 or 5) • Evaluates strengths as well as weaknesses • Allows progress to be assessed • A relatively objective measure • Allows help to be targeted where needed

50. Making an assessment • 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