Identifying Neglect: What professionals can do
Patrick Ayre
Department of Applied Social Studies
University of Bedfordshire
Park Square, Luton
email: [email protected]
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Withdrawn, isolated, aggressive: fear intimacy and dependence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