Identifying Neglect: What professionals can do

Patrick Ayre

Department of Applied Social Studies

University of Bedfordshire

Park Square, Luton

email: pga@patrickayre.co.uk

web: http://patrickayre.co.uk

A child centred approach

The purpose of assessment is to understand what it is like to be that child (and what it will be like in the future if nothing changes)

Why do parents neglect?

We need to understand the interaction between:

3 Ns: Nurture, Nature, Now

Circumstantial factors and fundamental factors

Why do parents neglect?

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

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

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

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

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Withdrawn, isolated, aggressive: fear intimacy and dependence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

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

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

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’

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

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)

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

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

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

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

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

Capturing chronic abuse

Judging the quality of care is an essential component of any assessment but how well do we do it?

Judgements subjective and prone to bias

Intangible: Difficult to capture and compare

High threshold and acclimatisation

Neglect is a pattern not an event

The pattern of neglect: atypical

The pattern of neglect: typical

Intervention Intervention

The pattern of neglect

'G ood enough' level

Intervention Intervention

The pattern of neglect

Intervention Intervention

'G ood enough' level

Intervention ceases

The pattern of neglect

Cumulativeness

T h r es h o ld f o rin te r v en tio n

SEXUAL

ABUSE

PHYSICAL

ABUSE N

EGLECT

NEGLECT

NEGLECT

Failure of cumulativeness

T h r es h o ld f o rin te r v en tio n

SEXUAL

ABUSE

PHYSICAL

ABUSE

NEGLECT

NEGLECT

NEGLECT

NEGLECT

GCP provides:

Framework for making assessment

Baseline measurement

An element of objectivity

Judgement about care

Reliable standardised evidence

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

GCP users

Health visitors

School nurses

Social workers

Family centre workers

Education staff

Why choose GCP?

Child focused

User friendly

Common language

Promotes partnership

Why choose GCP?

Evaluates strengths as well as weaknesses

Allows progress to be assessed

A relatively objective measure

Allows help to be targeted where needed

Domains of Care

Physical needs

Safety

Love and belongingness

Esteem

Self actualisation

Sensitivity

Responsivity

Reciprocity

Overtures

Stimulation

Approval

Disapproval

Acceptance

Present & absent

Nutrition. Housing, Clothing, Hygiene & Health

Maslow, A. 1954

What to observe

A. PHYSICAL

B. SAFETY

C. LOVE

D. ESTEEM

Nutrition

Housing

Clothing

Hygiene

Health

Quality,

Quantity,

Preparation,

Organisation,

Grades of Care  Grade 1 Grade 2 Grade 3 Grade 4 Grade 5

Level of care All child’s needs met

Essential needs fully met

Some essential needs met

Most essential needs unmet

Essential needs entirely unmet/hostile

Commitment to care

Child first

Child priority

Child/carer at par

Child second Child not considered

Quality of care

Best Adequate Equivocal Poor Worst

Wirral rating No concern

No concern

Recommend prevention support

Child protection

Child protection and legal strategy meeting

Scoring

Rating 1 5

Use on every child in the family

Use with different carers

Complete with the parent/carer

Use information, observation, records

Scoring

Complete individual scores for each sub-area

Transpose to the record sheet

Agree action, targets and timescales

Targeting Items of Care

Targeted Areas

Current Score

Target Score

Timescale Reviewed Score

1

2

3

4

5

Unique Advantages 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