Transcript Slide 1
Why have we made neglect so complicated?
Implications for Early Years
Brigid Daniel
Professor of Social Work, University of Stirling With Cheryl Burgess (University of Stirling) Jane Scott (WithScotland) Julie Taylor (University of Edinburgh) Images of children from ‘Early Years’ ©NHS Health Scotland, 2011
What is the problem?
We have lots of evidence about the causes of neglect.
We have lots of evidence about the effects of neglect on children’s development in the short and long term.
We have quite a bit of evidence about what is needed for effective intervention.
But we seem to struggle to find a way to put what we already know into policy and practice.
Evidence from recent projects
Systematic review of literature - part of SCRI Focusing on noticing and early helping.
Development of training materials funded by DfE and Scottish adaptation.
Annual Reviews of Neglect – 2011, 2012, Scottish extension Focusing on prevalence, noticing and helping across the UK.
Action on Neglect – ESRC follow-on project Focusing on overcoming barriers to help in England
What do I need?
What do I need you to think about?
What do I need you to do?
Daniel, B.; Taylor, J. & Scott, J. (2011)
A look back
‘From the late 19 th century up to the 1970s, child neglect dominated in definitions of maltreatment. Annually, up to 90% of cases were defined as neglect’ (Ferguson, 2011 p.29).
Shift from ‘inspection’ of homes by N/ISPCC officers.
Rise in local authority/state professional social workers working ‘in partnership ‘with families. Rise in radical social work, highlighting the impact of structural factors. Anti-discriminatory practice.
Beginning of procedure
From 1960s rise in attention to physical abuse with Kempe’s ‘battered child syndrome’.
‘70s and ‘80s attention to sexual abuse.
Kilbrandon report (1964), Maria Colwell Inquiry (1974), Cleveland Inquiry (1988), Orkney Inquiry ( 1992) -> development of processes and systems, including the forensic approach across many jurisdictions-> focus on incidents and investigation.
This is an unhappy group of children, presenting the least positive and most negative affect of all groups… Minnesota Longitudinal Study ‘75 -> (Egeland, Sroufe & Erickson, 1983, p.469)
Child maltreatment as a social problem: the neglect of neglect.
(Wolock & Horowitz, 1984 )
Backlash of procedure
‘Re-focusing’ debate and attention to ‘need’.
‘Rediscovery of neglect’ (Scourfield, 2000) Introduction of Frameworks for Assessment Neglect becoming high priority for statutory and third sector agencies In Scotland – focus on early years, early intervention, parenting strategy and prevention, GIRFEC We are left with both narrow procedural definitions of neglect and broader concepts of need.
Analysis of serious case reviews
Brandon et al. (2013) ‘Neglect is much more prevalent in serious case reviews than had previously been understood (we found neglect in 60 per cent of the 139 reviews from 2009–2011).
Neglect can be life threatening and needs to be treated with as much urgency as other categories of maltreatment.
Neglect with the most serious outcomes is not confined to the youngest children, and occurs across all ages.’
Paradox of neglect
Recognition of the danger of under-playing the risk to life posed by neglect, especially for very young children – leads to the demands that practitioners become more alert to the dangers, not to accept parental versions of events, to be sceptical AT SAME TIME Drive for more parent-support, awareness of structural pressures, relationship-based practice, empathic support, non-stigmatising services.
BALANCING ACT
Definitions affect how many children we think are experiencing neglect. Narrow – operational definitions: Research on systems, filtering and recognition.
In our annual reviews it was easy to find out about the tip of the iceberg – neglect is the most common reason for registration - around 1 in 1,000 across the UK. Broader – definitions of unmet need: Developmental research on effects of unmet need.
In our reviews it was hard to find the rest of the iceberg although ‘lack of parental care’ is around 1 in 100.
But prevalence studies suggest 1 in 10 (Radford et al. 2011).
NEGLECT
The worries that Health Visitors and other early years services have about the large numbers of babies born in households where there is poverty / substance misuse / domestic abuse / mental health problems / learning disabilities. ‘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.....’
… 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 it like from the child’s perspective?
Young people’s views of neglect
• • • • • • • It’s not enough love My parents not spending time with me Having to look after your brothers and sisters Not getting helped with homework My parents neglecting themselves Having messy hair and clothes , getting judged for my appearance.
My parents having no control “Love is a doing word”
What does neglect feel like?
Putting up a pretence Covering up my feelings Having no friends Other kids not realising how hard it is Loosing focus at school and then getting told off Getting the mickey taken out of you, but I blamed myself not my parents “I didn’t think much about it at the
time but when I look back I think it
shouldn’t have happened”
What does this child need?
Foundations of resilience are laid down in infancy
• attachment to caregiver(s) • language • differentiation of self from environment • self control and compliance (Masten & Coatsworth, 1998)
Attachment issues
Limited and conditional availability of the carer Severe lack of opportunity to explore and reflect on themselves as psychological and emotional beings High levels of stress and little opportunity to express it Avoidant and disorganised attachments
(Howe, 2005)
What does this child need?
What does this child need me to think about?
Noticing and helping
Noticing (‘recognition’) is not that complicated.
The literature review showed that health visitors (public health nurses), for example, are perfectly well able to spot children who may be neglected.
Annual reviews
Around 80% 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.
Their concerns are about how best to respond – especially when parents do accept the concerns.
Children are stuck in the net
THINKING
GIRFEC as an aid to assessment and analysis
the SHANARRI wheel helps in the identification of concern, the My World Triangle prompts the pulling together of key information in an ecological or holistic way and the Resilience Matrix supports in-depth analysis, especially in uncertain or complex circumstances.
Observation
'[a]ssessment begins with observation, and even the first meeting in the waiting room is an opportunity for the professional to observe aspects of the child's development and functioning' (Fitzpatrick et. al, 1995, p. 63).
Observation of a happy pre-school age child in a secure setting where toys are available will provide a scene of happy exploration and play interspersed with excited and questioning interaction with a care-giver: i.e. the secure base provides a springboard from which to explore the world of objects and the world of other people.
Compare with observations of neglected children who at 24 months ‘lacked enthusiasm in problem-solving tasks, showed less flexibility and alternated passive with aggressive behaviour, were more likely to show behaviour consistent with insecure attachment and to demonstrate less affection and initiate less play with mothers’ (Egeland et al 1983): i.e. clear insight into the child’s troubled attachments and compromised development
‘Thresholds’
The issue of ‘thresholds’ seems to be associated with confusion about whether the focus should be on: the severity of the neglect and associated harm to the child or the likelihood of the parents being able to accept help and make changes without the need for compulsory measures .
Understanding and assessing willingness and ability to change is therefore crucial, especially within the speedy timescales of early development.
Seamless services
Relationship coupled with concrete practical and emotional help, can stave off many future disasters.
Some parents are not able to use of this kind of voluntary support for all sorts of reasons: some find it hard to admit to needing help, some don’t really see what the problem is, some deliberately evade all professionals.
Universal services need support to recognise these situations.
What do I need?
What do I need you to think about?
What do I need you to do?
Comprehensive packages that
are based on a working relationship, are focused on the needs of the child, address the issues at each ecological level, provide direct support for children, deal with the factors affecting parenting, pay attention to the processes underlying service use and change, are long-term, not episodic.
...many different protective service workers may be involved with the same family over a period of years. This method of delivery is outmoded and cannot be condoned. Ongoing long-term service given by a given protective service worker with a family can be invaluable. (Helfer, 1987)
...these services must continue until they are old enough to fend for themselves. While the cost of this type of intervention ... is almost prohibitive, the cost of not caring for these
families is enormous.
(Helfer, 1987)
Promoting well-being // promoting resilience
Universal services and community resources for early years benefit all children.
Neglected children are, ironically, those who most often miss out on access to services. They are the most in need of factors associated with resilience.
So keep a careful eye out and pay particular attention to those who miss out and whose parents do find it easy to access services.
Spectrum of support
Because neglect affects every part of children’s lives they need support to develop in every domain.
Intervention has to be within a model that does not split ‘child protection’ from ‘family support’ -
‘Effective family support is protection, effective protection is supportive.’
Three building blocks of resilience
Secure base / sense of security and attachment Self-esteem Self-efficacy
Supporting ‘I have...’
Support early attachment to parents and extended family = secure base + exploration Support parents – materially and emotionally Support children – within the home and beyond - (adult and peer relationships) Support their interaction
Information, reflection, video guidance, games, books, toys, reliability, support, secure home and community environments
Supporting ‘I am...’
Support development of positive values: Conscience, empathy, kindness ie cognitive, emotional and behavioural aspects Support development of self-esteem: self-worth that also incorporates appreciating the worth of others.
Modelling kind behaviour, providing clear boundaries, ‘required helpfulness’, teaching peer and group skills, ethos of care and support, nuanced use of praise.
Supporting ‘I can...’
Support parents: home – early education links, home – community resource links Support children: self-competence, autonomy, problem solving, cause and effect, talents and interests.
Community resources, play schemes, play spaces and resources, libraries, early education, support for hobbies, outdoor activities, opportunities to learn how to try (‘scaffolding’), cognitive development
Continue to pay attention to willingness to change
Discomfort with the language and concepts of ‘resistance’ and ‘dangerousness’.
Naive interpretations of ‘partnership’.
Naive approaches to ‘strengths-based’ work.
Discourse of all parents being well-meaning and just needing some extra help.
Lack of attention to the day to day life of children.
(Tuck, 2012)
Five principle causes of parental resistance social structure and disadvantage, the context of child protection work, parental resistance to change, denial or minimization of abuse or neglect, the behaviour of the social worker
in particular –
conversations.
struggling with having the difficult
Forrester et al.(2012)