NEGLECT Latest academic developments and the implication for practice

1. NEGLECTLatest academic developments and the implication for practice Alice Cook PhD Student- Disorganised Attachment. BA (hons)- Psychology and Education. ADAM Project Member. Senior Family Support Worker- CP

2. Neglect • Type of Neglect -Physical (child’s presentation, home environment, level of supervision and stimulation). -Emotional ( appropriate emotional response and support. Understanding own and others emotions‘. Emotion Regulation. -Chronic Neglect (combination of physical and emotional, intergenerational.

3. Chronic Neglect • ‘A way of life rather than a single event’. (Turney and Tanner 2004). • Hardest to prove, lack of ‘significant’ events. Drift in the system. • Example- Poor home conditions. ‘Imminent’ ? Emotional neglect Lack of supervision • Waiting for an injury or serious incident. Child remains in environment deemed, ‘good enough’.

4. Professor Corinne May- Chahal, co-chair of The College of Social Work, ‘The point at which social workers can intervene in cases of neglect is too high, the system, in its current state, falls short in providing the safety and security neglected children need’. • Action for Children chief executive Dame Clare Ticknell, ‘Neglected children and their parents are being indentified, but neither the professionals nor the public feel empowered to intervene’.

5. The impact of Neglect Cognitive Development • Even the most subtle kinds of emotional neglect have dramatic effects on the children’s development especially in the early years of life. (Erickson and Egeland 1996) • Early intervention- other risk factors, more aware. • Developmental tasks build on previous milestones and competencies. Neglected children fail to achieve important milestones- normal developmental tasks continue to be challenge.

8. Watson (2005) Literature Review of Neglect ‘Passive, withdrawn, apathetic and uninvolved with their social and physical environment, revert to helplessness under stress and show significant developmental delays’. ‘The child internalises the message about their own worthlessness and assumes they will not succeed at making friends, learning at school or being noticed’.

9. Attachment • Quality of the parent-child relationship • Secure attachment- reliant on the responsiveness and sensitivity of the parent to baby’s cues. • Neglect- lack of predictable and organised attachment experiences.

10. Attachment Styles Bowlby and Ainsworth- 60% Securely Attached 40% Insecurely Attached Need to be careful, focus should be on, ‘organised attachment’ , rather than insecure. Neglected children are equally likely as abused children to show signs of disorganised attachment. (Barnett, Ganiban & Cicchetti 1999)

11. Internal Working Model • 12 months • Complex mental representations of how, ‘self ’, and ‘other’ interrelate. • Unresponsive and insensitive care, causes model of self as unworthy of love and others as unavailable or rejecting.

12. What can we do? • Alternative angle- attachment. Attachment difficulties causing the Neglect. • Focus on lack of insight and attunement. • Intervention, practical tools, direct work. ATTACHMENT FOCUSED

13. Observations • Powerful tool, can be overlooked. • Sensitivityand Insight- impact child development/ attachment. • Relationship between child and carer. Does what you are seeing match up with what have been told? • You are sat out of the way, no interaction from you with child or carer.

14. Ask the carer to sit beside child whilst they play, but not to join in. • Ask the carer to play with their child. • Don’t touch task. • Ask the carer to get the child to tidy away all of their toys. • Ask the carer to read a story book with their child. • Total observation time around 30- 40 minutes. • Behaviour of parent during- 3&4 • ‘Guided parenting task’- ADAM Project.

15. Discussion with carer • Attachment related questions. • Tell me what its like being a mum? • What are your child’s likes and dislikes? • What do you enjoy doing together? • Is there anything that your child is scared/frightened of? • What do you do to show them that you love them? • What do they do to show you that they love you? • Mentalization/ Reflective function.

16. Mentalization/ Reflective Function • Mentalization-(mind-mindedness) Ability to recognise that others possess thoughtsand feelings that may differ from your own. • Refective Function- Mentalization in the context of the attachment relationship. Parents capacity to recognise what their child is capable of thinking and feeling and that their child may be experiencing things differently from them.

17. The term, ‘Parental Sensitivity’, is now used in attachment research to indicate the extent to which mothers and fathers demonstrate RFand Mind-mindednesswith their children. • Linking Low Reflective Function and Neglect.

18. Example 1: A child is left for hours in a dirty nappy that is visibly heavy and in need of changing. Parent may be aware that it needs changing but is incapable of placing themselves in their child’s shoes and considering how uncomfortable that might feel for the child.

19. Example 2: A parent lives in a cold flat and often walks around in a thick jumper but she lets her toddler walk around in just a nappy. The mother is not cold… so she fails to recognise that the baby might be. • Example 3: Parent does not feed their child as regularly as they need to simply because the parent themselves is not hungry.

20. What is the child capable of thinking? -negative intentionality. • Tell me what its like being a mum? ‘You cant give them back. You learn to cope with whatever they throw at you. A newborn is the boss, then the tables turn and they don’t like it. At nine months you were the boss (referring to X), by the time you were one mum was boss. You can’t just scream and mum will give you a bottle. X thinks he’s the boss but he isn’t…..’.

21. Examples of higher RF He had a tantrum in the shop (behaviour) because he was tired and hungry (physical state) and I’d been dragging him around all day and he was sick of it (mental state). I was just so sad and frightened (mental state) by the fight I had with my husband. I wasn’t myselfat all (behaviour) and this was so disorienting to my baby(implies effect upon baby’s mental state).

22. Research suggests this is not related to intelligence, but can be attributed to insufficient development of certain areas of the brain during early childhood (Shemmings and Shemmings 2011). • If the parent is offered regular mentalizing experiences with a professional, then previously unconnected pathways may reconnect. • Parent needs to recognize that they need to read their experience as different from their child’s.

24. Concept has been applied to an intervention developed at Leiden University in the Netherlands- VIPP. • It uses video feedback to the parent of sessions with the parent and child interacting together. • Aim is to enhance enhance ‘parental sensitivity’. Methods such as, ‘speaking for the child’. • 5 day courses run at the Anna Freud Centre-London/ Leiden University, Netherlands.

25. How should we be? • Practitioners acting as a ‘secure base’ • Increasing the sensitivity, availability and responsiveness of carers • Increasing trust, attunement and understanding between parents and (especially younger) children • Increasing resilience and ‘emotional scaffolding’: self-esteem, self-reflexivity, social relatedness and self-efficacy

26. Always try to be: • Available, loving, caring • Interested, responsive • Sensitive, accessible • Co-operative, trustworthy

27. Aim never to be: • Unavailable, unloving • Uninterested, unresponsive • Neglectful, hostile • Rejecting, inaccessible • Ignoring, untrustworthy

28. DIRECT WORK Board Game • Relationship building- sharing information. • Need to draw a board with six squares, a dice, and two counters. • 3 squares have a picture of a tick (things I like) • 3 squares have a picture of a cross (things I don’t like). • Follow up questions. • Underlying issue (DV). • Emotions (happy/sad).

30. The Three Houses – Developed by Andrew Turnell (see http://www.signsofsafety.net/) • Technique used to explore a child’s, worries, the positives, and their wishes. • House of Worries • House of Good Things • House of Dreams

32. Family Faces • At the top of the piece of paper you draw a number of different facial expressions. • You or the child draw the members of their family, leaving the faces blank. • The child then picks a face for each family member. • You ask them questions such as ‘Why has mummy got a happy face, what makes mummy happy?

34. Example 1 X gave Dad a happy face. I asked him what makes Dad happy. He said, ‘'When we go to bed'. He then said, 'he hates us, when we annoy him he hates us so much'. X gave mum a happy face, I asked what makes her happy, he said ‘When she cuddles us she likes us, she hates us when we wake up'.

35. Use of play people • This technique is based on techniques such as the Story Stem Assessment Profile (SAAP). • Used for assessment of secure and insecure attachment in children and requires full training at the Anna Freud Centre. • However we can still use stories or role play involving low levels of conflict to give us an insight into the child’s world. (ADAM Project)

36. Example 1 It’s the evening and Mum, Dad and (Child) are watching TV. Mum says to (Child) ‘OK, it’s time for you to go to bed now’. (Child) goes to their bedroom (which has a door) on her/his own and gets into bed. All of a sudden (s/he) hears a noise (YOU MAKE SOME LIGHT SCRATCHING SOUNDS). (Child) gasps and whispers ‘It’s a monster’ (DON’T SOUND TOO WEIRD OR GHOSTLY!).

37. ‘mum was outside having a cigarette and the monster ate her, but she wasn't dead. The boy then got her out'. • ‘It was dead’ (referring to the monster not clear who had killed it) Where was mummy? 'she didn't hear it'. • 'they are all going to the dentist but they are in the woods far away but then they went home'. When they got home Y was in a room and she couldn't get out because it was stuck with glue, they all heaved to get it open but they couldn't. Y died because she didn't have any food or water. She did have a big picnic so she came back to life but that ran out and then she died'.

38. The Islands • The Island of Forever • The Island of Sometimes • The Island of Far Away.

40. Adam Project Members • Lewisham (x3) • Tower Hamlets (x3) • Croydon (x3) • Merton (x2) • Enfield • Hounslow • Essex (x2) • SW Essex NHS • PIMH Surrey NHS • Surrey (x4) • Bedford • Caldecott Community • St Michael’s Fellowship, London (x2) • Stockholm • Dusseldorf

41. Question and answer session alice.cook00@googlemail.com d.shemmings@kent.ac.uk