Transcript NEGLECT Research. Practice. Direct work.

NEGLECT
LATEST ACADEMIC DEVELOPMENTS
AND THE IMPLICATION FOR PRACTICE
Alice Cook
PhD Student- Disorganised Attachment.
BA (hons)- Psychology and Education.
ADAM Project Member.
Senior Family Support Worker- CP
NEGLECT
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Type of Neglect
-Physical (child’s presentation, home environment,
level of supervision and stimulation).
-Emotional ( appropriate emotional response and
support. Understanding own and others
emotions‘. Emotion Regulation.
-Chronic Neglect (combination of physical and
emotional, intergenerational.
CHRONIC NEGLECT
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‘A way of life rather than a single event’. (Turney and
Tanner 2004).
Hardest to prove, lack of ‘significant’ events. Drift
in the system.
Example- Poor home conditions. ‘Imminent’ ?
Emotional neglect
Lack of supervision
Waiting for an injury or serious incident. Child
remains in environment deemed, ‘good enough’.
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Professor Corinne May- Chahal, co-chair of The
College of Social Work,
‘The point at which social workers can intervene
in cases of neglect is too high, the system, in its
current state, falls short in providing the safety
and security neglected children need’.
Action for Children chief executive Dame Clare
Ticknell,
‘Neglected children and their parents are being
indentified, but neither the professionals nor the
public feel empowered to intervene’.
THE IMPACT OF NEGLECT
Cognitive Development
 Even the most subtle kinds of emotional neglect
have dramatic effects on the children’s
development especially in the early years of life.
(Erickson and Egeland 1996)
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Early intervention- other risk factors, more
aware.
Developmental tasks build on previous
milestones and competencies. Neglected children
fail to achieve important milestones- normal
developmental tasks continue to be challenge.
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Watson (2005) Literature Review of Neglect
‘Passive, withdrawn, apathetic and uninvolved
with their social and physical environment,
revert to helplessness under stress and show
significant developmental delays’.
‘The child internalises the message about their
own worthlessness and assumes they will not
succeed at making friends, learning at school or
being noticed’.
Attachment
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Quality of the parent-child relationship
Secure attachment- reliant on the
responsiveness and sensitivity of the parent to
baby’s cues.
Neglect- lack of predictable and organised
attachment experiences.
Attachment Styles
Bowlby and Ainsworth- 60% Securely Attached
40% Insecurely Attached
Need to be careful, focus should be on, ‘organised
attachment’ , rather than insecure.
Neglected children are equally likely as abused
children to show signs of disorganised
attachment.
(Barnett, Ganiban & Cicchetti 1999)
Internal Working Model
 12 months
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Complex mental representations of how, ‘self ’,
and ‘other’ interrelate.
Unresponsive and insensitive care, causes model
of self as unworthy of love and others as
unavailable or rejecting.
WHAT CAN WE DO?
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Alternative angle- attachment.
Attachment difficulties causing the Neglect.
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Focus on lack of insight and attunement.
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Intervention, practical tools, direct work.
ATTACHMENT FOCUSED
OBSERVATIONS
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Powerful tool, can be overlooked.
Sensitivity and Insight- impact child
development/ attachment.
Relationship between child and carer. Does what
you are seeing match up with what have been
told?
You are sat out of the way, no interaction from
you with child or carer.
1.
2.
3.
4.
5.
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Ask the carer to sit beside child whilst they
play, but not to join in.
Ask the carer to play with their child.
Don’t touch task.
Ask the carer to get the child to tidy away all of
their toys.
Ask the carer to read a story book with their
child.
Total observation time around 30- 40 minutes.
Behaviour of parent during- 3&4
‘Guided parenting task’- ADAM Project.
DISCUSSION WITH CARER
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Attachment related questions.
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Tell me what its like being a mum?
What are your child’s likes and dislikes?
What do you enjoy doing together?
Is there anything that your child is
scared/frightened of?
What do you do to show them that you love them?
What do they do to show you that they love you?
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Mentalization/ Reflective function.
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MENTALIZATION/ REFLECTIVE FUNCTION
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Mentalization-(mind-mindedness)
Ability to recognise that others possess thoughts
and feelings that may differ from your own.
Refective FunctionMentalization in the context of the attachment
relationship.
Parents capacity to recognise what their child is
capable of thinking and feeling and that their
child may be experiencing things differently from
them.
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The term, ‘Parental Sensitivity’, is now used in
attachment research to indicate the extent to
which mothers and fathers demonstrate RF and
Mind-mindedness with their children.
Linking Low Reflective Function and Neglect.
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Example 1:
A child is left for hours in a dirty nappy that is
visibly heavy and in need of changing.
Parent may be aware that it needs changing but
is incapable of placing themselves in their child’s
shoes and considering how uncomfortable that
might feel for the child.
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Example 2:
A parent lives in a cold flat and often walks
around in a thick jumper but she lets her toddler
walk around in just a nappy.
The mother is not cold… so she fails to recognise
that the baby might be.
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Example 3:
Parent does not feed their child as regularly as
they need to simply because the parent
themselves is not hungry.
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What is the child capable of thinking? -negative
intentionality.
Tell me what its like being a mum?
‘You cant give them back. You learn to cope
with whatever they throw at you. A
newborn is the boss, then the tables turn
and they don’t like it.
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At nine months you were the boss
(referring to X), by the time you were one
mum was boss. You can’t just scream and
mum will give you a bottle. X thinks he’s the
boss but he isn’t…..’.
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Examples of higher RF
He had a tantrum in the shop (behaviour)
because he was tired and hungry (physical
state) and I’d been dragging him around all day
and he was sick of it (mental state).
I was just so sad and frightened (mental state)
by the fight I had with my husband. I wasn’t
myself at all (behaviour) and this was so
disorienting to my baby (implies effect upon
baby’s mental state).
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Research suggests this is not related to
intelligence, but can be attributed to insufficient
development of certain areas of the brain during
early childhood (Shemmings and Shemmings
2011).
If the parent is offered regular mentalizing
experiences with a professional, then previously
unconnected pathways may reconnect.
Parent needs to recognize that they need to read
their experience as different from their child’s.
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Concept has been applied to an intervention
developed at Leiden University in the
Netherlands- VIPP.
It uses video feedback to the parent of sessions
with the parent and child interacting together.
Aim is to enhance enhance ‘parental sensitivity’.
Methods such as, ‘speaking for the child’.
5 day courses run at the Anna Freud CentreLondon/ Leiden University, Netherlands.
HOW SHOULD WE BE?
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Practitioners acting as a ‘secure base’
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Increasing the sensitivity, availability and
responsiveness of carers
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Increasing trust, attunement and understanding
between parents and (especially younger)
children
Increasing resilience and ‘emotional scaffolding’:
self-esteem, self-reflexivity, social relatedness
and self-efficacy
Always try to be:
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Available, loving, caring
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Interested, responsive
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Sensitive, accessible
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Co-operative, trustworthy
Aim never to be:
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Unavailable, unloving
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Uninterested, unresponsive
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Neglectful, hostile
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Rejecting, inaccessible
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Ignoring, untrustworthy
DIRECT WORK
Board Game
Relationship building- sharing information.
 Need to draw a board with six squares, a dice,
and two counters.
 3 squares have a picture of a tick (things I like)
 3 squares have a picture of a cross (things I don’t
like).
 Follow up questions.
 Underlying issue (DV).
 Emotions (happy/sad).
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The Three Houses – Developed by Andrew Turnell
(see http://www.signsofsafety.net/)
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1.
2.
3.
Technique used to explore a child’s, worries, the
positives, and their wishes.
House of Worries
House of Good Things
House of Dreams
Family Faces
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At the top of the piece of paper you draw a
number of different facial expressions.
You or the child draw the members of their
family, leaving the faces blank.
The child then picks a face for each family
member.
You ask them questions such as ‘Why has
mummy got a happy face, what makes
mummy happy?
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Example 1
X gave Dad a happy face. I asked him what
makes Dad happy. He said, ‘'When we go to
bed'. He then said, 'he hates us, when we
annoy him he hates us so much'.
X gave mum a happy face, I asked what
makes her happy, he said ‘When she cuddles
us she likes us, she hates us when we wake
up'.
Use of play people
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This technique is based on techniques such as the
Story Stem Assessment Profile (SAAP).
Used for assessment of secure and insecure
attachment in children and requires full training
at the Anna Freud Centre.
However we can still use stories or role play
involving low levels of conflict to give us an
insight into the child’s world. (ADAM Project)
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Example 1
It’s the evening and Mum, Dad and (Child) are
watching TV. Mum says to (Child) ‘OK, it’s time
for you to go to bed now’. (Child) goes to their
bedroom (which has a door) on her/his own and
gets into bed. All of a sudden (s/he) hears a noise
(YOU MAKE SOME LIGHT SCRATCHING
SOUNDS). (Child) gasps and whispers ‘It’s a
monster’ (DON’T SOUND TOO WEIRD OR
GHOSTLY!).
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‘mum was outside having a cigarette and the monster
ate her, but she wasn't dead. The boy then got her
out'.
‘It was dead’ (referring to the monster not clear who
had killed it) Where was mummy? 'she didn't hear it'.
'they are all going to the dentist but they are in the
woods far away but then they went home'. When they
got home Y was in a room and she couldn't get out
because it was stuck with glue, they all heaved to get
it open but they couldn't. Y died because she didn't
have any food or water. She did have a big picnic so
she came back to life but that ran out and then she
died'.
The Islands
1.
The Island of Forever
2.
The Island of Sometimes
3.
The Island of Far Away.
ADAM PROJECT MEMBERS
Lewisham (x3)
 Tower Hamlets (x3)
 Croydon (x3)
 Merton (x2)
 Enfield
 Hounslow
 Essex (x2)
 SW Essex NHS
 PIMH Surrey NHS

Surrey (x4)
 Bedford
 Caldecott Community
 St Michael’s
Fellowship, London
(x2)
 Stockholm
 Dusseldorf
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QUESTION AND ANSWER
SESSION
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