Transcript Noticing and Helping the Neglected Child - Propel

Brigid Daniel
Professor of Social Work
University of Stirling
with thanks also to:
Julie Taylor, Professor of Family Health , University of Dundee, and Head of Strategy
and Development: Abuse in High Risk Families, NSPCC
Cheryl Burgess, Research Fellow, University of Stirling
Jane Scott, Independent researcher and Scottish Protection Hub
Morag Redford, Senior Teaching Fellow, School of Education, University of Stirling
SCRI: Research Questions
1. What is known about the ways in which children
and families directly and indirectly signal their need
for help?
2. To what extent are practitioners equipped to
recognise and respond to the indications that a
child’s needs are likely to be, or are being neglected,
whatever the cause?
3. Does the evidence suggest that professional
response could be swifter?
Method
 Empirical studies, published 1995 and
2005.
 Filtered for quality and relevance.
 63 papers, published in English, from
across the world.
Annual Review of Child Neglect
with Action for Children
1. Do we know how many children are currently
experiencing neglect in the UK?
2. How good are we at recognising children who
are at risk of, or are experiencing neglect?
3. How well are we helping children at risk of, or
currently experiencing neglect?
 During 2011 we collected all the UK statistics
about children already ‘officially’ labelled as
neglected as well as those in need and affected by
parental substance misuse, mental health issues
and domestic abuse,
 analysed policy documents,
 surveyed a total of 47 authorities (or Boards in NI)
across the UK,
 carried out 6 focus groups across the UK and
 obtained online poll results from 2,062 adults in
the general public and 2,174 professionals
(including social workers, police, health
professionals and teachers).
Do we know how many children are
currently experiencing neglect in the UK?
 It is relatively easy to find out about the tip of the
iceberg
 In March 2010 the most common reason for
children being made subject to a child protection
plans was neglect: 44% in England and Scotland,
in NI it was 29% with a further 21% where neglect
was a contributing issue and in Wales the figures
were 43% and a further 6% where neglect was a
feature (NSPCC, 2011).
 Less than half of the areas surveyed could give us
figures about the larger part of the iceberg.
There have been
children I
worry about when I
go home at night
Head
Teacher
Scottish operational definition
 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. It may involve a parent or carer failing to
provide adequate food, shelter and clothing, to protect a child from
physical harm or danger, or to ensure access to appropriate medical
care or treatment. It may also include neglect of, or failure to respond
to, a child’s basic emotional needs. Neglect may also result in the child
being diagnosed as suffering from ‘non-organic failure to thrive’, where
they have significantly failed to reach normal weight and growth or
development milestones and where physical and genetic reasons have
been medically eliminated. In its extreme form children can be at
serious risk from the effects of malnutrition, lack of nurturing and
stimulation. This can lead to serious long-term effects such as greater
susceptibility to serious childhood illnesses and reduction in potential
stature. With young children in particular, the consequences may be
life-threatening within a relatively short period of time.
… in reality, neglect is what the school
teacher, physician, social worker,
judge, psychologist, or police officer
“say it is” at the time of the
report...one should not get hung up
on the definition of child neglect but
rather get on with helping these
children, who are being cared for in a
manner far below our society’s
accepted standards.
Helfer, 1987
What is known about the ways in which children and
families directly signal their need for help?
 Very little evidence - most start with substantiated
neglect, but
 Mothers could express concerns about potential
neglect
 parents who misuse substances could identify
impact upon their children.
 Children don’t directly ask for help;
 some school nurses in Finland noticed
children who sought advice;
 neglected children could be identified on a
self-report computer programme.
(Combs Orme, 2004; McKeganey, et al., 2002; Paavileinen, et al.,
2000; Kantor et al., 2004)
What is known about the ways in which parents
indirectly signal their need for help?
 Much more evidence – many familiar parental
factors  impoverished home environment, fewer parental
resources, previous history of maltreatment /csa,
substance misuse, domestic abuse, mental
health, drug-using network, welfare assistance,
problems accessing childcare, youth of parent, 2
or more children, previous child removal.
 Risk increases with number of risk stress factors,
especially beyond 4 or 5.
What is known about the ways in which children
indirectly signal their need for help?
•An example of indirect signs came from two studies of
burns which showed, although the burns were similar
to those attributable to accidents, it was more likely
that:
•the child had not been given first aid at the time,
•there was a delay of over 24 hours before seeking help.
•the burns would be deeper
•children fared worse than abused children in keeping
appointments and receiving adequate wound care .
(Chester et al., 2006; Hultman et al, 1998,).
 Internalising and externalising behaviour can be
seen by age 3 peer problems by 6;
 behaviour problems,
 impaired socialisation and
 problems with daily living skills by 8
(Dubowitz et al., 2002; 2004; 2005)
Signs would be evident to many professionals
and members of the community.
 Studies vary in whether prospective or
retrospective and what factors are controlled
for.
 No certain, clear and predictable pathways
emerge.

(Brown et al. 1998; Carter & Myers, 2007; Cash & Wilke, 2003; McGuigan &
Pratt, 2001; Nair et al., 1997 & 2003; Ondersma, 2002; Scannapieco & Connell,
2003 & 2005)
Nonetheless, all should be noticeable to
practitioners as signs of possible need
for support.
To what extent are practitioners equipped to
recognise and respond to the indications that a
child’s needs are likely to be, or are being
neglected?
 Professionals tend to have higher thresholds than the
general public.
 Health visitors are very well equipped to recognise
parental characteristics and developmental signs in
children.
 Some examples of good practice e.g. Finland - ‘active
and firm’ school nurses.
 Absence of evidence about schools, teachers and the
police.
How good are we at recognising children who are
at risk of, or are experiencing neglect?
 Just over half of the public have worried about a child.
 94% feel that people should do something if
concerned about a child.
 81% of health and education professionals have
encountered neglected children.
 Professionals across the board are increasingly aware
of such children and of their responsibilities to these
children.
 Many feel that they can’t obtain help for children at an
earlier enough stage.
It’s a feeling…that
something isn’t right. It’s an
instinct and a feeling of
something being terribly
wrong. I guess it comes
from tiny details when you
link one thing with another.
(Paavilainen and Tarkka, 2003)
I’ve seen worse.
It’s not that
bad really.
They’re happy
underneath it.
Children can be
dirty but happy.
I mustn’t
impose my
middleclass values
Does the evidence suggest that
professional response could be swifter?
 Protocols and guidelines are not a sufficient spur.
 Trust, relationships, communication, anxiety, fear and
confidence affect willingness to act on concerns.
 Many studies referred to the importance of training
as a mechanism to raise awareness.
 Training when coupled with access to on-going
consultation and support could increase recognition
and referral of child abuse and neglect.
(Angeles-Cerezo & Pons-Salvador, 2004)
In summary
 Response for the general public and
professions other than social
work/services/CPS tended to mean 'referral’
 Response for social work/services/CPS
tended to mean 'investigation'.
 The main problem lies, not so much in
recognition, as in the perceived complexity of
the response mechanism.
The case must reach
the threshold,
Of course
something must
be done!
resources are scarce.
hungr
y
sad
guidance
tired
CHIL
D
unlove
d
SIMPLE
PRACTITIONER
assessmen
t
categories
System
dirty
multiagency
resouces
COMPLEX
How well are we helping children at risk of,
or currently experiencing neglect?
 We worry that children slip through the net, but
 many children appear to get stuck in the net.
 Professionals know about these children, but they
and their families are not receiving swift and
effective help when needed.
 The public want services for families to be funded
and they want there to be treatment services for
adults with problems.
 Social workers want to carry out direct work with
children and families.
Services
 The general public want services for
families to be funded.
 62% per cent want projects which
support families before problems get
worse,
 47% per cent want health-based services
 42% school-based services and 41%
preventive services.
Practitioners
 Staff in universal services want:
 more treatment services for adults in relation to
substance misuse, mental health problems and
domestic abuse (32%),
 more time (29%), more resources (27%) and more
advice (34%) on how to help struggling families,
 clearer guidance from employers or government
on when to intervene (33%).
 83% of social workers want to undertake more
direct work with children and families.
What does
this child
need?
What does
this child
need me to
think about?
What does
this child
need me to
do?
Action On Neglect:
 developing selected practice messages from the research study
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'Noticing and Helping the Neglected Child'
creation of 'typical' case scenarios as prompts for the development
work
establishment of an advisory group of children and young people
service users
establishment of an advisory group of parent service users
creating 3 multi-disciplinary, multi-agency local working groups in
England comprising managers and front-line practitioners
with these groups undertaking a process analysis to ascertain how
the selected messages can be effectively incorporated into practice
in the short, medium and longer term
developing a series of detailed worked examples setting out
improved 'pathways to help'
dissemination activities.