Why have we made neglect so complicated? Taking a fresh look at recognising and helping the neglected children

1. Why have we made neglect so complicated?Taking a fresh look at recognising and helping the neglected children 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

2. We knew all this years ago!

6. ‘From the late 19th century up to the 1970s, child neglect dominated in definitions of maltreatment. Annually, up to 90% of cases were defined as neglect’ (p.29). • Rise in attention to physical and sexual abuse. • Development of a forensic approach. • Shift from ‘inspection’ of homes by NSPCC officers. • Rise in local authority professional social workers working ‘in partnership ‘with families. • Rise in radical social work, highlighting the impact of structural factors. (Ferguson, 2011)

7. This is an unhappy group of children, presenting the least positive and most negative affect of all groups… These same children were also the most dependent and demonstrated the lowest ego control in the preschool and in general did not have the skills necessary to cope with the various situations. (Egeland, Sroufe & Erickson, 1983, p.469)

8. Child maltreatment as a social problem: the neglect of neglect. (Wolock & Horowitz, 1984)

12. 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?

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

15. 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?

16. 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).

17. NEGLECT ‘Neglect’

18. 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 43% and a further 6% (NSPCC, 2011). • Less than half of the areas surveyed could give us figures about the rest of the iceberg.

20. (HM Government 2010) 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.

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

22. … 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

26. 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 on thing with another. (Paavilainen and Tarkka, 2003)

27. How good are we at recognising children who are at risk of, or are experiencing neglect? • 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. ‘Although neglect is less clear-cut than other forms of abuse, there is more awareness than there was and earlier identification. Staff from agencies, such as housing, know what to look for when they are going into homes for other reasons’ (Focus group respondent).

28. 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.

29. 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.

30. Of course something must be done! The case must reach the threshold, resources are scarce. PRACTITIONER SIMPLE COMPLEX (Daniel et. al 2011)

32. All practitioners need to coalesce around: • assessing the child’s unmet needs in all domains, • assessing the reasons for needs not being met, • assessing parental capacity to meet those needs, • assessing parental motivation to meet the child’s needs with support, • assessing parental capacity to adapt and change with support.

33. And distinguish between- • an assessment of a child’s needs and where they are unmet • an assessment of the reason for the needs being unmet and • an assessment about whether compulsory measures might be required and develop plans accordingly.

34. Assessments should include examination of problems, causes, and barriers at all system levels, that is, individual, family, organizational/community, and cultural. It is equally important to identify and acknowledge the strengths, coping skills, and resources of parents and other family members that may be mobilized to reduce the risk of further maltreatment. The availability and accessibility of informal social network supports and formally organized supportive services should also be considered in the assessment. (Gaudin, 1993)

36. As direct or indirect consequences of such social policies, millions of children in our society live in poverty and are inadequately nourished, clothed, housed, and educated; their health is not assured because of substandard medical care; their neighbourhoods decay; meaningful occupational opportunities are not available to them; and alienation is widespread among them. No doubt, these destructive conditions, which result, inevitably, from the normal workings of the prevailing social, economic, and political order and from the value premises which shape that order and its human dynamics, cannot fail to inhibit severely the development of children exposed to them. (Gil, 1975)

37. What we want to know is what services we have been providing for whom and on what basis can we assess whether we are successful. We need a consistent data set, so we can aggregate that data. We have agreed an outline with other agencies what that data set should look like. I am cautiously optimistic that we will have meaningful information and then can plan services accordingly. Survey respondent

38. 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.

39. 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.

42. Since neglecting families often generate multiple reports to protective services, many different protective service workers may be involved with the same family over a period of years. This method of delivery is outmoded and cannot be condoned. Ongoing long-term service given by a given protective service worker with a family can be invaluable. (Helfer, 1987)

43. For those children who remain with their families, these services must continue until they are old enough to fend for themselves. While the cost of this type of intervention, including that which is necessary for the school system, is almost prohibitive, the cost of not caring for these families is enormous. (Helfer, 1987)

45. Framework • What does this child need to grow and develop and what does his or her family or carer need to provide a nurturing environment? • What does this child and their family or carer need me to think about? • What does this child and their family or carer need me to do? • What does this child need me to feel?

46. We knew this years ago! Thank You