Understanding Adolescent Neglect: What We Know and How to Address It

1. Different for teens? What we know about adolescent neglect Suffolk SCB conference January 2019

2. Different for teens? ‘Understanding Adolescent Neglect’ The Children’s Society’s research programme Some questions … and a quiz • 2. • Presentation content • 1. Impacts Contexts Working with Scale

3. The Children’s Society • Almost 140years 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 Learning Challenges Transition Idealistic Friendship Potential Growth Well-informed Difficult Anxiety Excited Hedonistic Defiant Self conscious Grumpy Spotty Insecure Naïve Scary Withdrawn Angsty Worried Incoherent Pressured Hormonal Identity Excitable Boundaries Misunderstood Noisy Challenging

5. I hate you! It’s so unfair!

6. Adolescence is … ? • A time of profound change – with the goal of ‘discovery of self’. • Stereotyped as ‘stress and storm’. • Neurological development – predisposes to risk-taking. • Different young people mature at different rates. • Parameters are hard to pin down (UK research uses 11-17) - ‘Begins in nature and ends in culture.’ … complex!

7. ‘Neglect’ is … ? 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 Adolescent neglect: scale – official figures • Neglect often co-occurs with other maltreatment • Only 1 in 20 of young people registered for neglect had no other maltreatment experiences. • (Mennen et al., 2010)

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, assessing and working with 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 25 years (RCPCH review) Rees et al (2011); RCPCH / Cardiff University - NSPCC (2017)

18. ‘Understanding Adolescent Neglect’ • Began in 2013. • Research programme • Grounded in 25 years of prior research on young people’s lives (e.g. on runaways, safeguarding, well-being). • Partnership with University of York. • Informed by increasing knowledge of the scale and impact of neglect on this age group … and the lack of research.

19. ‘Troubled Teens’ • National schools online surveys. • 1,000 young people in Year 10 (aged 14-15). • Asked about experiences of care and support at home – and about well-being, experiences in school and externalising behaviours. • A study of the links between parenting and adolescent neglect Understanding Adolescent Neglect Troubled Teens

20. Not defining neglect: takinga hypothetical approach • Less parental care leads to lower well-being, worse health, more risk-taking, etc. • ‘Neglect’ is the point at which decreasing levels of care link to significant falls in well-being, deteriorations in health, increased propensity to risk-taking, etc. • Parenting takes different forms … so neglect will take different forms – perhaps with different effects. Measuring adolescent neglect by association, rather than by subjective judgement

21. Parenting behaviours measure

22. Parenting behaviours measure: scoring • PHYSICAL • EDUCATIONAL • SUPERVISORY • EMOTIONAL þ þ þ SCORE for emotional support 3 + 3 + 4 = 10 RANGE for all categories is 0 - 12

23. Generating thresholds for neglect • Risk-taking behaviours • ‘Do you ever smoke cigarettes?’ • Psychological health • e.g. Problems with sleeping / feeling depressed. • School • In the last three months have you missed school without permission? • Subjective well-being • Huebner life satisfaction (five item scale e.g. ‘My life is just right’) • ‘Relatedness’ (four item scale e.g. ‘People in my life care about me’) Scores for experiences of parenting … • Emotional support • Educational support • Physical care • Supervision Linked to …

24. 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%

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

26. 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

27. What does ‘Troubled Teens’ tell us? Scale and different forms. Measurement is possible (caveats). Negative associations and ‘hidden’ impacts. Emotional neglect – lowest overall input … but strongest associations to positive indicators. • ABOUT NEGLECT Norms. Inputs skewed towards some forms of support. Over-parenting. Too much input = low life satisfaction. • ABOUT PARENTING MID TEENS

28. ‘Thinking about adolescent neglect’ • Commissioned by the Luton SCB to support strategy development and training. • Literature review + interviews with specialist workers. • Posed challenges to the SCB Executive Board for improving local responses to adolescent neglect. • Published in April 2018. • Available online (alongside a 4-page professionals briefing). Thinking about adolescent neglect A review of research on identification, assessment and intervention

29. ‘Thinking about adolescent neglect’

31. Lots of tools in use – none proven to work with adolescents. • The Assessment Framework can be helpful … … if the user is well-informed about adolescent neglect.

32. Absence of outcomes evaluation. • Some models tested – few proven to be effective … evidence that MST works with severe neglect. Intervention

33. Informing young people (eg in school); supporting parents (education; local campaigns); changing public attitudes towards young people. Family support / early help; youth projects; national initiatives?; FFT / IFPS. Children’s social care (+MST / other specialist services); post neglect support.

34. Working with adolescent neglect Interagency collaboration is vital … … because different services know different things, and can provide different support

35. RESPONDING to adolescent neglect – things to consider 1) Is there a consensus across agencies on what ‘adolescent neglect’ is, and what professionals should do? 2) Do you know what neglect ‘looks like’ in the area? 3) Is there a collaborative professional culture? 4) How do you ensure your response is effective – especially for young people themselves?

36. Young people … • May not know they are being neglected ... or play it down. • Will often be protective of family. • Are not as resilient as they seem. 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)

37. ? Q & A

38. 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

39. Selected references 8 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. 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. Mennen F.E., et al (2010) ‘Child neglect: Definition and identification of youth’s experiences in official reports of maltreatment.’ Child Abuse & Neglect. 34, 647-658. 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. Stoltenborgh, M., et al.( (2013) The neglect of child neglect: a meta-analytic review of the prevalence of neglect. Social Psychiatry and Psychiatric Epidemiology, 48, 3, 345-355. 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 8 8 8 8 8 Available online

40. Different for teens? What we know about adolescent neglect Suffolk SCB Conference – January 2019 *Phil.Raws@childrenssociety.org.uk