Title: Developing an effective response to neglect and emotional harm to children
Author: Ruth Gardner
Institution: Ruth Gardner is a senior research fellow at the Centre for Research on the Child and Family, University of East Anglia and at the NSPCC.
The experience of neglect and associated emotional harm can be extremely damaging to all aspects of a child’s development and characterises the lives of many children in the UK today. Neglect was the largest category for registration on the child protection register and increased from 39% in 2001-2 to 44% in 2006-7. A number of writers, most notably Olive Stevenson, have raised issues about the “neglect” of neglect, as well as difficulties in identification, decision-making and the provision of effective interventions. It is within this context that this collaborative study between the University of East Anglia, the NSPCC and Local Safeguarding Children’s Boards (LSCB) in England was undertaken. The study’s aims were to:
● Profile current challenges and achievements in work with children and families where neglect and associated emotional harm are issues.
● Review recent research and theory-based practice development.
● Provide concrete examples of improvements to joint practice.
Work on a further aim to develop an all-agency strategy for addressing neglect in the short, medium and long terms with one or more LSCBs is planned.
This study includes a literature review, questionnaires and interviews with professionals, and seminar group discussions. The literature review draws upon national and international studies that have had a major influence on this subject area.
In order to access professionals, the project aims were sent to LSCBs across England and 100 practitioners and managers from a range LSCBs were interviewed using a questionnaire to structure the discussion. Areas covered included their understanding of neglect and emotional harm what helped or hindered a successful resolution and specific tools or training in the field of neglect and emotional harm.
Mainly individual interviews were conducted however a minority of participants (19) were interviewed in groups because of time constraints. Of the 100 professionals interviewed, 53% were from children’s social care, 16% health, 15% education, 9% police and 7% other, including from voluntary, community or legal resources. In addition group discussions with professionals attending a national seminar were transcribed. All of the individual and group discussions were analysed using nVivo, an analysis software package.
Findings and Conclusions
The study concludes that neglect is a major form of child maltreatment and has not been effectively addressed either in prevention or treatment in the UK. The information gained from questionnaires and interviews confirmed findings in the literature that child neglect is multi-faceted and all forms (physical, emotional and environmental) can lead to significant and enduring developmental harm, including impairment of children’s emotional and social functioning. Without effective intervention, neglect can lead to chronic maltreatment over many years and in some cases death, including through the child’s suicide.
Parents who neglect their children often struggle with a range of deep-seated and interacting problems that can include a history of abuse and neglect domestic violence mental health difficulties substance misuse learning difficulties multiple births multiple losses socio-economic hardship and a lack of supportive networks. Some may also have a history of negative associations with professional intervention, or lack of it. The challenges posed for workers needing to engage and work effectively with families and other professionals are considerable, but necessary to address in order to effectively safeguard and promote the welfare of children.
The study explores some of the dynamics surrounding professional responses to the identification, assessment and treatment of neglect and emotional harm. As with other studies, Gardner found confusion and uncertainty surrounding definitions and thresholds for interventions, which is likely to contribute to unacceptably high thresholds for service provision, uncertainty about appropriate responses and delay in preventive action. She argues that the terms “chronic” or “long-term” can be misleading when included in definitions, especially in the context of inter-agency work that fails to recognise and collate early signs for their cumulative effect. Incidents are frequently seen in isolation and families deemed not to meet the thresholds for involvement of both children’s and adult services. It is also argued that deficits in key characteristics such as poor attachment, inconsistency of care and a lack of support systems can be as harmful as the duration of the neglect. Sympathy for parents, who are struggling with very difficult lives, can lead to a failure to act. However, Gardner argues that this should not be a reason to justify no intervention, but can be a start to helping parents and children. Some of the other challenges faced by professionals working with neglect include loss of momentum and follow through of plans desensitisation and demoralisation of workers difficulty with legal thresholds and lack of training and reflective practice.
A high level of re-referrals and re-registrations for children experiencing neglect is noted. One explanation for this could be too superficial assessments that fail to analyse and adequately address the underlying issues. While we have become more aware of the damaging effects of neglect, improvements in identification and monitoring would not seem to be matched in terms of treatment services.
Fathers and father figures have been largely absent from the academic work, policy and practice debates in relation to neglect, but there is a growing interest in this area. Gardner stresses the importance of engaging with fathers and father figures.
The report discusses a number of practices and policies at different levels of service provision where there is evidence of success. The multi-faceted nature of families’ problems in cases of neglect requires skilful assessments, analysis of problems and well co-ordinated multi-agency responses. Some key issues include:
● a common language and structure across agencies
● a focus on achieving a joint understanding, including with family members, and
● a sharing of risk and responsibility for change, including transparency of decisions and what is expected of the family.
Gardner argues that the concept of parental responsibilities can potentially clarify the meaning of neglect and provide an asset rather than a deficit model for practice, which is inclusive of all those with caring responsibilities for the child.
The Every Child Matters framework, including the five outcomes and focus on early intervention is seen as a useful for LSCBs developing a multi-agency strategy in the area of child neglect. In addition the report identifies a Cabinet Office (2007) study (see resources) which focuses on “families at risk” who experience multiple problems as being of relevance to work with child neglect.
This document stresses the importance “thinking family” and extending the logic of integration of Every Child Matters beyond children’s services to better co-ordination of all services, including adult services working with families at risk. Gardner’s report makes many recommendations for improving joint work on neglect and emotional harm for practitioners and managers across different levels of service provision, including developing clear working protocols across services having transparent procedures and thresholds for action reviewing and adapting existing tools for their application to work with neglect providing training and other opportunities for inter-agency discussion and reflection.
There is evidence that structured and intensive intervention can achieve good outcomes for children experiencing neglect and their families, particularly if accessible support is also available after intensive provision ends. However, this requires confident and skilled professionals working together in well-resourced services. The arguments that our society should urgently address the current deficits in service provision for child neglect in systematic and systemic ways are compelling.
The alternative, as Gardner states, is “acceptance of the massive yet largely avoidable human cost of developmental difficulties in children, who as a result of neglect, are unable to achieve their potential in terms of happiness, health, education and social functioning, quite apart from the costs to family life (p4)”.
Analytical assessments Frequently families where there is child neglect experience multiple problems that interact and vary in intensity over time. Assessments need to critically analyse the underlying difficulties as well as strengths in the context of past and present information on relationships and family functioning
Thinking family Practitioners need to be supported in their work by clear protocols and joint working practices across children’s and adult services in order to meet the range of problems that many parents are struggling with
Engaging parents Mothers, fathers and other significant adults need to be involved in assessments and offered services as early as possible. Parents and carers should be engaged in a discussion of what success will look like and the process for getting there
Reflective practice Professionals require opportunities to reflect on and be challenged about their practice, including the dynamics of inter-agency work with neglect. This could be via training, consultancy, action learning sets or proactive case reviews.
Anna Gupta lectures at the Department of Health and Social Care, Royal Holloway, University of London
Links and Resources
Published in the 19 June edition of Community Care under the headline Responses to Child Neglect