Transcript Child abuse on the front page: Learning lessons from the

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:
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3 Ns: Nurture, Nature, Now
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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
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Emotional neglect
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Disorganised neglect
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Depressed or passive neglect
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Severe deprivation
Each is associated with different effects
and implications for intervention
Emotional neglect
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Sins of commission and omission
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‘Closure’ and ‘flight’: avoid contact,
ignore advice, miss appointments, deride
professionals, children unavailable
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However, may seek help with a child who
needs to be ‘cured’
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Intervention often delayed
Emotional neglect: parents
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Can’t cope with children’s demands:
avoid/disengage from child in need; dismissive
or punitive response
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Six types of response:
– Spurning, rejecting, belittling
– Terrorising
– Isolating from positive experiences
– Exploiting/corrupting
– Denying emotional responsiveness
– Failing medical needs
Emotional neglect: children
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Frightened, unhappy, anxious, low self-esteem
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Precocious, ‘streetwise’
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Withdrawn, isolated, aggressive: fear intimacy
and dependence
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Behaviour increasingly anti-social and
oppositional
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Brain development affected: difficulties in
processing and regulating emotional arousal
Disorganised neglect
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Classic ‘problem families’
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Thick case files
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Can annoy and frustrate but endear and
amuse
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Chaos and disruption
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Reasoning minimised, affect is dominant
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Feelings drive behaviour and social
interaction
Disorganised neglect: carers
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Feelings of being undervalued or
emotionally deprived in childhood so
need to be centre of attention/affection
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Demanding and dependant with respect
to professionals
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Crisis is a necessary not a contingent
state
Disorganised neglect: carers
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Cope with babies (babies need them) but
then…
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Parental responses to children
unpredictable; driven by how the parent
is feeling, not the needs of the child
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Lack of ‘attunement’ and ‘synchronicity’
Disorganised neglect: children
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Anxious and demanding
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Infants: fractious, fretful, clinging, hard to soothe
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Young children: attention seeking; exaggerated
affect; poor confidence and concentration;
jealous; show off; go to far
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Teens: immature, impulsive; need to be noticed
leads to trouble at school and in community
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Neglectful parents feel angry and helpless:
reject the child; to grandparents, care or gangs
Depressed neglect
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Classic neglect
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Material and emotional poverty
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Homes and children dirty and smelly
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Urine soaked matresses, dog faeces, filthy
plates, rags at the windows
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A sense of hopelessness and despair (can
be reflected in workers)
Depressed neglect: carers
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Often severely abused/neglected: own
parents depressed or sexually or
physically abusive
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May have learning difficulties
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Passive helplessness response to
demands of family life
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Have given up both thinking and feeling
Depressed neglect: carers
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Listless and unresponsive to children’s
needs and demands, limited interaction
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Lack of pleasure or anger in dealings with
children and professionals
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No smacks, no shouting, no deliberate
harm but no hugs, no warmth, no
emotional involvement
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No structure; poor supervision, care and
food
Depressed neglect: children
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Lack interaction with parents required for
mental and emotional development
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Infant: Incurious and unresponsive; moan
and whimper but don’t cry or laugh
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At school: isolated, aimless, lacking in
concentration, drive, confidence and selfesteem but do not show anti-social
behaviour
Severe deprivation
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Eastern European orphanages, parents
with serious issues of depression, learning
disabilities, drug addiction, care system at
its worst
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Children left in cot or ‘serial caregiving’
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Combination of severe neglect and
absence of selective attachment: child is
essentially alone
Severe deprivation: children
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Infants: lack pre-attachment behaviours of
smiling, crying, eye contact
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Children: impulsivity, hyperactivity, attention
deficits, cognitive impairment and
developmental delay, aggressive and coercive
behaviour, eating problems, poor relationships
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Inhibited: withdrawn passive, rarely smile,
autistic-type behaviour and self-soothing
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Disinhibited: attention-seeking, clingy, overfriendly; relationships shallow, lack reciprocity
Capturing chronic abuse
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Judging the quality of care is an essential
component of any assessment but how well
do we do it?
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Judgements subjective and prone to bias
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Intangible: Difficult to capture and compare
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High threshold and acclimatisation
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Neglect is a pattern not an event
The pattern of neglect: atypical
The pattern of neglect: typical
Intervention
Intervention
The pattern of neglect
'Good enough' level
Intervention
Intervention
The pattern of neglect
Intervention ceases
'Good enough' level
Intervention
Intervention
The pattern of neglect
Cumulativeness
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Threshold for
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Failure of cumulativeness
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Threshold for
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GCP provides:
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Framework for making assessment
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Baseline measurement
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An element of objectivity
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Judgement about care
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Reliable standardised evidence
GCP uses
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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
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Health visitors
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School nurses
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Social workers
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Family centre workers
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Education staff
Why choose GCP?
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Child focused
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User friendly
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Common language
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Promotes partnership
Why choose GCP?
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Evaluates strengths as well as
weaknesses
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Allows progress to be assessed
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A relatively objective measure
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Allows help to be targeted where
needed
Domains of Care
Stimulation
Sensitivity
Responsivity
Self
actualisation
Reciprocity
Overtures
Esteem
Love and belongingness
Safety
Approval
Disapproval
Acceptance
Present &
absent
Physical needs
Maslow, A. 1954
Nutrition. Housing, Clothing,
Hygiene & Health
What to observe
A. PHYSICAL
B. SAFETY
Nutrition
Quality,
Housing
Quantity,
Clothing
Preparation,
Hygiene
Organisation,
Health
C. LOVE
D. ESTEEM
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
essential
entirely
needs unmet 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
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Rating 1
5
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Use on every child in the family
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Use with different carers
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Complete with the parent/carer
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Use information, observation, records
Scoring
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Complete individual scores for each
sub-area
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Transpose to the record sheet
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Agree action, targets and timescales
Targeting Items of Care
Targeted
Areas
1
2
3
4
5
Current
Score
Target
Score
Timescale Reviewed
Score
Unique Advantages
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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