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1.5.4 Childhood Neglect

RELEVANT CHAPTERS

Recognition of Significant Harm Procedure

Referrals Procedure

Neglect Strategy

AMENDMENT

This chapter was updated in October 2016, to include additional information into Section 4.6, Responsibility of Education and a link to updated statutory guidance Keeping Children Safe in Education.


Contents

  1. Aims of this Practice Guidance
  2. Defining Neglect
  3. Identifying Neglect
  4. Agency Responsibilities
  5. Assessment
  6. Supervision


1. Aims of this Practice Guidance

This practice guidance is for use by all those who work with children and families in all agencies and settings. It draws on national and local research into child neglect and its aim is to help practitioners form judgments about their intervention. This practice guidance aims to unravel some of the difficulties experienced when working in this area and to suggest ways to avoid or resolve them. No guidance can, however, provide answers to all circumstances or difficulties, the aim of this guidance is to support the use of professional judgment at all stages of our interventions with families.


2. Defining Neglect

Neglect is a complex issue and therefore difficult to define because it differs in type, frequency, impact and severity. It is important to understand whether the behaviour of the carer is an act of omission or an act of commission. Acts of omission involve the failure to perform an act or acts that are expected to be done by the parent or carer whereas acts of commission is doing an act or acts deliberately designed to cause harm. However it should be recognised that the impact on the child may be exactly the same, whether the failure to have their needs met is an act of omission or commission.

Neglect is generally an act of omission insofar as the parent fails to act in the child’s best interests. However such cases will probably include elements of emotional abuse because parents ignore their child’s basic needs. However emotional abuse can occur without neglect as a result of the child being physically looked after but singled out and subjected to deliberate rejection. Previous Working Together documents have defined neglect as:

‘the persistent failure to meet the child’s basic physical and /or psychological needs and this is likely to result in the serious impairment of the child’s health or development’

However a detailed understanding of the parenting behaviour, ability, motivation and background need to be factors which contribute to an assessment of the circumstances in which the child lives.

Howarth (2007) argues there are 6 types of neglect:

  1. Medical neglect: This involves carers minimising or ignoring children’s illness or health (including oral health) needs, and failing to seek medical attention or administrating medication and treatments. This is equally relevant to expectant mothers who fail to prepare appropriately for the child’s birth, fail to seek ante- natal care, and/or engage in behaviours that place the baby at risk through, for example, substance misuse;
  2. Nutritional neglect: Typically this involves a failure to provide a child with the necessary food and calories to ensure normal growth. Conversely, an un-regulated, unhealthy diet and a lack of exercise resulting in obesity can also be viewed as neglect;
  3. Emotional neglect: This involves a carer being unresponsive to a child’s basic emotional needs for affection and emotional warmth and a failure to develop the child’s self-esteem and identity. The difference here between neglect and emotional abuse is best understood by assessing the carer’s motivation. Emotional abuse is more likely when linked to an act of commission when the carer deliberately, wilfully and calculatingly targets the child in order to cause emotional distress;
  4. Educational neglect: This involves the carer failing to provide stimulation for the child, showing an interest in their educational development, supporting their learning or responding to special needs;
  5. Physical neglect: This involves a carer failing to provide appropriate clothing, food, cleanliness and living conditions. This is sometimes difficult to assess due to the need to consider socio-economic deprivation and because such judgements are subjective in nature. Where poverty appears to be a contributing factor it is vital that the assessment thoroughly explores access to benefits, money management and help that is available to improve the environment of the child;
  6. Supervision and guidance: This involves a failure by the carer to provide adequate levels of guidance and supervision that ensure the child is physically safe and protected. This can affect children of all ages. It is important here to remember that the age of a child should not blur the fact that they are children. Leaving a child to cope alone in a situation for which they are not equipped to manage or a failure to provide appropriate boundaries or appropriate carers should all be considered as neglect.
It is likely that if a parent or carer is neglecting a child in one of the above areas closer examination will reveal that neglectful care will be found in other areas too. The cumulative impact of multiple adverse circumstances and events on the child are very likely to be profound and exponentially serious with pervasive effects on the child’s neurological functioning and endocrine development. (The endocrine system is a network of glands that control our body functions, including metabolism, reproduction, the balance among our body systems, and response to stress and our environment).


3. Identifying Neglect

There are a number of factors which can adversely affect the parent’s ability to meet the needs of their child. Although these factors may be present it should not be assumed that the child is being neglected but they should at the least act as a signal to the professional to explore with the parent and child the impact of their situation or behaviour on the child.

3.1 Family and environmental factors

Mental illness, alcohol and drug misuse, domestic abuse and learning disability are all known to increase the likelihood of children experiencing neglect. This becomes more likely when they appear in combination. Cleaver, Unell and Aldgate (2011) bring these factors together and their findings are summarised below:

3.1.1 Parental mental health

Parental mental health difficulties can lead to deterioration in their ability to perform parental tasks. Sometimes a preoccupation with their illness makes parents unresponsive to the needs of their child. The professional should consider in these circumstances what support mechanisms are available to the patient to help mitigate any possible deficits in the parent’s ability to meet the child’s needs. It is important that mental health workers including G.Ps consider the potential impact on their patient’s ability to perform their parenting duties and be ready to ensure the needs of the child are met in these circumstances. An absence of any extended support network, inter- partner conflict and financial worries should act as warning signals to professionals.

3.1.2 Maternal or paternal depression 

Maternal or paternal depression is associated with lower sensitivity and may result in disrupted bonding and reduced sensitivity to the child’s need for empathy, warmth and understanding. Research suggests that the impact of depression is most harmful during the first 5 five years of the child’s life. The possible impact on older children should not be underestimated as it can impact on the parent’s response to the child’s behaviour with fewer positive and reinforcing reactions.

3.1.3 Anxiety disorders

Phobias and anxiety disorders have been found to result in negative parental reactions, although the research into this area is limited. Nevertheless in some cases parents suffering from these disorders were found to be less responsive to their child, more likely to be critical or accepting of differences in opinion, less affectionate, smile less, and be more likely to overreact

3.1.4 Psychotic disorders

Serious psychotic disorders involve distorted thinking, perception, communication and limiting emotional response. These disorders are very likely to significantly limit the parent’s ability to fulfil their parenting responsibilities and must be taken extremely seriously by the professionals involved when assessing the parent’s ability to care for children.

3.1.5 Substance and alcohol misuse

Drug and alcohol misuse are serious risk indicators for child maltreatment across the full range of potential mechanisms for abuse. Prior to birth, the effects of alcohol and drug use can impact of the baby’s growth and will probably result in withdrawal symptoms and neonatal distress. The longer term effects for the child are likely to impact on their health and wellbeing.

The impact of substance and alcohol misuse on parenting capacity is likely to manifest in their reduced ability to focus their energies on fulfilling the basic parenting tasks which are replaced with a preoccupation in serving their own needs. Living standards may be affected, income may be misappropriated, parental relationships may be negatively affected and criminal activity may become a feature of their lives. Supervision standards may become lackadaisical, which considerably increases the child’s vulnerability to neglect and other forms of abuse. Where the principle attachment of the parent is to a substance, it follows that their child will inevitably come second and, in some cases involving older children, the family hierarchy becomes inverted with the child caring for the parent. The abuse of substances rarely occurs without other problems relating to mental health, family relationships and socio-economic circumstances.

3.1.6 Parental learning difficulties

The presence of learning difficulties in a parent is a risk factor that requires further assessment. It is incorrect to assume that parents with a learning difficulty will inevitably neglect the care of their child. Research suggests that in the majority of cases adequate care can be afforded to the child providing there is a good understanding of the potential difficulties the parent may find problematic. Support services are crucial and a full exploration of support networks may mean that the outcomes for child will not be adversely compromised.

Factors that need to be considered include their ability to learn how to parent, money management, their own childhood experiences, their view of themselves, vulnerability to abusive relationships, and their ability to unlearn any negative experiences bought forward into their own style of parenting.

Neglect is the most common concern amongst professionals when working with parents who have learning disabilities. Neglect becomes more likely when the parent’s resources, knowledge, skills and experiences are insufficient in meeting the child’s needs. In some cases long term support will be required in order to ensure that the child’s changing needs are not affected by the parent’s adversities. It is crucial, when working with parents who have a learning disability, that professionals do not lose sight of the child’s experience while attempting to help the parent. This has been called ‘fixation error’ and for professionals working with cases such as these, it is important that through supervision appropriate challenge and reflection ensures the child’s experience is not compromised.

3.1.7 Domestic Abuse

Domestic abuse is a prevalent feature in cases of neglect. Domestic abuse is not limited to the use of physical assault and can include forms of psychological abuse. Adult victims are exposed to emotional torment, criticism, humiliation, as well as physical assault. As such adults who experience this form of abuse often feel helpless, disempowered, degraded and depressed. They are frequently socially isolated and alone and may self-medicate or use alcohol more frequently. The impact of domestic abuse on the parent’s ability to care for their child should not be underestimated and can become neglectful. Domestic abuse is closely linked to parental depression and can mean that the child becomes lost in the turmoil of the parents’ relationship.

For children living in environments where domestic abuse is a feature, the immediate dangers are significant. The risks of physical assault on the child are increased by intentionally or unintentionally being assaulted. Witnessing or being aware of domestic abuse is, at best, frightening for the child and at times the child can be exploited as a form of aggression. This is a form of emotional abuse.

Although, understandably, allowances are often made for parents experiencing domestic abuse, it is again important that professionals keep the child’s experiences in sharp focus.

3.1.8 Economic and neighbourhood factors

Poverty, housing difficulties, drug and alcohol availability in a particular neighbourhood can increase the likelihood of neglect. Families who are experiencing poverty do not necessarily neglect their children and poverty is not a single causal factor in neglect cases. However, the majority of those cases of neglectful families that come to the attention of professionals working in social care are experiencing poverty. The pervasive impact of poverty on parents’ neglectful behaviour is a recognised feature and as such requires the professional to fully understand the stressors impacting on the parent’s ability to parent appropriately. It is important in these situations that support is made available to the family to ensure benefits are being appropriately received and housing issues addressed where applicable.

3.1.9 Social isolation

A positive mitigation and protective factor is the presence of good family or extended support networks. Conversely, social isolation and lack of readily available support is a further risk factor that can make neglect more likely. Parents who have been in care themselves may neglect their own children because of the absence of a family support network or from family substitutes such as foster carers. In many cases of neglectful parenting, it is the case that the parents suffered dysfunctional relationships with their own parents, resulting in diminished opportunities for supportive relationships with their wider family.

3.2 Child’s development needs

The indicators described above should serve to alert professionals to the possibility of neglect. There are however some signs and indicators that are also suggestive of neglectful parenting.

3.2.1 Faltering growth

This is a complex issue with potentially many causes. However, in terms of meeting the child’s fundamental need for nutrition, a child who does not gain weight and height, or who loses weight for no apparent medical reason, should be a cause for concern amongst professionals. Peter Connelly’s weight dropped very significantly in the months before his death and although noted by the health visitor and school nurse, this indicator of neglect did not result in any immediate action.

Babies and small children who are not fed eventually stop crying -this should not be misinterpreted as a content child.

It is extremely important that in the circumstances described in this section a paediatric assessment is seriously considered and discussed with a paediatrician.

3.2.2 Burns and other injuries

Scalds and burns are potentially a sign of neglectful and careless parenting. They may also be an indicator of physical abuse. With all concerning injuries it is important for professionals to have a clear understanding of the circumstances that led to the injury. Accidents are generally understood to be a sudden, unexpected event taking place without warning. However, the belief that an injury was caused accidentally should not simply be accepted. In neglectful families there is more likelihood of accidents occurring due to the pre-existing attitudes of parents and/or the environment in which the child lives. Further suspicions should be aroused when parents have failed to seek medical attention promptly, fail to keep medical appointments, or where the injury is significant.

Frequent attendance at Accident and Emergency departments, or the GP, for child injuries may also indicate that there is inappropriate supervision within the home, which could be a sign of neglectful parenting and warrant further examination.

3.2.3 Poor hygiene and physical care

In some cases professionals may inadvertently excuse signs of neglect because other positive factors may be in evidence. For example, the child may appear happy and playful, generally well-nourished and seemingly ‘loved’ by their parents. The potential impact of poor hygiene and poor physical care including oral hygiene is nevertheless a concern that should not be tolerated by professionals. Again it is important that professionals hold in focus the experience of the child and how this affects outcomes for them in their school, their community, and upon their development.

3.2.4 Bruising and rough handling in the context of neglect in babies

See also Bruising and Rough Handling in the context of Neglect in Babies Procedure

Marion Brandon in her review of Serious Case Reviews has commented that the use of both the concept and the terminology of ‘rough handling’ may mask the risks of physical injury or even death for babies and older children. A view may be formed that these injuries are less serious acts of omission, indicating inconsiderate and careless parenting rather than a potential indicator of underlying serous concerns and injuries.

In some Serious Case Reviews, where children have died or been seriously injured, professionals had noted previous insensitive ‘rough handling’ of babies, and parents being verbally aggressive and smacking a toddler, and other inappropriate behaviours that imply physical aggression.

In some families’ rough handling was frequent behaviour and formed part of the child’s everyday experience, while in others it occurred in the build-up to an incident of domestic violence or when the parent was experiencing an episode of poor mental health.

In Northumberland, recent case reviews of five young babies who had sustained non accidental injury or harm, indicated that these had occurred in the context of neglect, a situation echoed nationally in Brandon’s 2013 study. The study suggested that categorising children as experiencing neglect may result in less vigilance towards other risks, for example, physical harm or injury.

In light of the above:

  • The term “rough handling” should not be used as it may encourage the minimisation of safeguarding concerns;
  • All bruising in a non-mobile baby should be considered suspicious. There should be an assumption that a referral to Children’s social care will be made (see Referrals Procedure) and a paediatric assessment undertaken. The decision not to refer should be made in consultation with the agencies supervising senior with a clear explanation of the reasons for this recorded;
  • The significance of bruising to older children MUST be interpreted in relation to the child’s age, developmental capability and the care being received;
  • An understanding of child development is essential in the interpretation of bruising and injury, but especially so for children living with neglect, who may have less than optimum supervision;
  • A bruise also needs to be considered in relation to the parent’s capacity to supervise in a way that is appropriate to the child’s developmental needs;
  • Children may be described as bruising themselves easily or more often. Any bruise needs to be carefully considered and explained in relation to the child’s age and developmental capability and in the context of the care received;
  • Older babies are more able to bruise themselves through falls and tumbles but where there are pre-existing concerns about neglect and emotional development, for example faltering growth and failure to thrive, workers should be concerned about bruising and consider specialist assessment by a paediatrician rather than a GP;
  • A safe living environment is a pre-condition for a safe relationship between children and their care-givers. If parents have a “good relationship” with the children but their living conditions are not safe, then the child is not safe (Brandon 2013).

3.2.5 Childhood behaviour difficulties

Early indicators of childhood neglect and Emotional Abuse manifest themselves early in life. Attachment difficulties can be an early sign of neglect or emotional maltreatment. Disorientated attachment patterns can manifest themselves through behaviours such as repeated unsuccessful attempts to engage with a parent and failing to seek reassurance when upset or distressed. It is thought that this type of behaviour may occur when the parent from whom the infant may seek attention or comfort is also the parent the infant considers, due to experience, to be a source of fear.

Childhood neglect may also be associated with one of the many causes of language delay and communication, socio-emotional adjustment and behavioural difficulties. Studies have found that such difficulties can manifest themselves in children by their third birthday. The implications of this for the child are likely to be seen in preschool settings with difficulties in literacy, numeracy, and friendships

In older children the signs may include behaviours thought to be harmful to themselves or others, anti-social in nature and a disregard of risk with risk taking behaviour. Older children may typically be involved in crime, use drugs and alcohol or exhibit violent behaviour towards others. Physical neglect is likely to manifest itself in young people becoming stigmatised and bullied.

3.2.6 Disabled children

‘Disabled children are more dependent than other children on their parents and carers for their day-to-day personal care; for helping them access services that they need to ensure that their health needs are met; and for ensuring that they are living in a safe environment. The impact of neglect on disabled children is therefore significant. This is not always recognised in time.’ (Ofsted thematic inspection August 2012).

This statement identifies the potential for disabled children to be neglected, given the reliance some children have on their parents to meet their care needs. Disabled children may also be at increased risk due to communication difficulties, sympathy for carers affecting professional judgement and perceptions that the needs of a disabled child should be viewed differently from other children. The family and environmental factors identified above are no less relevant for disabled children and therefore professionals working with disabled children should always be prepared to have candid discussions when concerns begin to emerge about the care of a child.

3.2.7 Older Children

Children deemed to be in the period known as adolescence are making the transition from childhood into adulthood. As such, it is a period where experiences, over time, are forming and shaping the adult they will become. The time span during which a child might be deemed an adolescent is hugely variable and professionals should hold in focus the fact that children remain children until they are deemed adult in law, that is when the child reaches the age of 18.

The cumulative impact of childhood neglect during this period is likely to become clearer and consolidate into patterns which will generate poorer outcomes throughout the rest of their lives. Adolescents do not grow out of being neglected; in fact the impact of their earlier experiences is likely to worsen. Ventress (2013) stresses that a young person maybe indulging in what might be viewed as extreme risk-taking behaviour sufficient to provoke in the professional a belief that the young person is to blame. Furthermore, some young people who are acting out the impact of years of neglect may be written off as being beyond help. Whatever the manifestation or reasons for such behaviours, it is important to recall that an adolescent’s tolerance of neglect does not indicate a positive choice to be neglected, nor should it be a reason to engage in blaming the young person.

Regardless of whether their childhood experiences have been positive or difficult, young people will seek out opportunities to exercise their autonomy and this will involve making some poor choices. Adult levels of reasoning, rationality, planning and impulse control are not fully developed and there may be many years before development is complete; so even those adolescents who have had an entirely positive upbringing are yet to reach a matured prefrontal cortex.

3.2.8 How children seek help

Research is clearer about why children do not seek out help than how they do. However, children often develop their own methods of communicating a problem or concern with which the professional needs to become attuned.

Gorin ( 2004) identified the reasons for children not seeking help as including fear of the abuser, fear of the consequences, fear of not being believed, and fear of loss of control. The behaviours associated with these fears and designed perhaps as coping mechanisms are likely to include avoidance, inaction, confrontation, risk taking, recourse to informal support.

A key message for professionals here is that children are more likely to speak to adults in whom they have confidence and who care about them. It is important that the adult is able to listen and take a measured response based on presenting risk and bearing in mind the reasons why children don’t seek help. The importance of establishing a strong, respectful and approachable relationship with the child is of paramount significance particularly as children tend to choose who they talk too. Click here to view an extract from Action for Children’s ‘Action on Neglect’ (2013). It is a joint letter compiled for professionals by the children who acted as the researcher’s consultative group.

In the main, professionals will need to be attuned to the ways in which children signal their need for help. The signs of neglect were summarised earlier in this document. These might be understood as unmet need, which should arouse professional curiosity and concern if manifested in a child known to them.

3.3 How parents seek help

The blocks for parents seeking help are strikingly similar to the reasons why children don’t seek out help. However when parents do ask for help it appears that many don’t receive it. In their 2000 study ‘Services for children in need: from policy to practice’, Tunstill and Aldgate found that many families had been struggling for some time before approaching social services, and those who were professionally referred appeared to have a greater chance of receiving a service than those who approached services themselves.

The key message here for professionals is the need to be proactive in seeking support for families who are struggling and not to shy away from engaging such families in constructive dialogue about ways in which help can be provided. Equally important is the role that fathers play in caring for their children. Fathers tend to be excluded from such conversations and as a result their role may be ignored or not fully understood within the dynamics of the family’s functioning.

Click here to view another extract from Action for Children’s ‘Action on Neglect’ (2013).


4. Agency Responsibilities

See also Referrals Procedure

4.1 Responsibility of all agencies

All agencies represented on the NSCB have a responsibility to contribute to the safeguarding of children in Northumberland. Roles and responsibilities are clearly defined in both Working Together to Safeguard Children 2015 and this NSCB Procedures Manual.

4.2 Responsibility of Health

All health professionals must be alert to the signs of neglect in children and young people. Health professionals are involved with children and families throughout their lives, and are well-placed to identify concerning indicators. The nature and impact of neglect is corrosive and cumulative so it is essential that all health professionals maintain accurate, detailed and contemporaneous records. The records will aid the baseline from which to judge progress in cases of neglect. When a practitioner identifies concerns regarding neglect in a family they should seek supervision from a member of the Health Safeguarding Children team.

4.3 Responsibility of Children’s Social Care

Children’s Social Care are responsible for co-ordinating assessments of children’s needs which include the parent’s capacity to meet those needs. The assessment may result in the provision of services designed to address the identified needs of the child through a child in need plan. Where a child is assessed as having suffered, or being at risk of, Significant Harm children’s social care may convene an Initial Child Protection Conference to consider the risks on a multi-agency basis. This may result in an inter-agency plan to safeguard the child. This is known as a Child Protection Plan.

4.4 Responsibility of Adult Services

Children may be at greater risk when they live with parents or carers who have mental health problems, have problems with alcohol and drug misuse, are in violent relationships or have learning difficulties. Professionals working with adults who have difficulties and have children should be particularly alert to how these may impact on the care they give their children. Reference should be made to Safeguarding Families in Northumberland: A Shared Best Practice Guide for Staff in Adult and Children’s social care produced jointly by the Northumberland Safeguarding Children’s Board and Safeguarding Adult Board.

Adults with responsibilities for disabled children have a right to a separate carer’s assessment. The outcome of this assessment should be taken into account when deciding what services, if any, will be provided under the Children Act 1989.

4.5 Responsibility of Police

The police have a duty to protect all members of the community and to bring offenders to justice. The welfare of children is a priority for the service, and although each police area has a specialised child protection team, all officers are responsible for identifying and referring children who are at risk or in need. Any officer can utilise emergency powers to ensure Immediate Protection of children believed to be at immediate risk of suffering significant harm. The police regularly enter people’s homes and are therefore well placed to identify issues that might indicate neglectful parenting. In these circumstances the police should contact children’s social care.

4.6 Responsibility of Education

All schools play an important role in the prevention and identification of abuse and neglect. Schools provide a safe environment for children and often know the child’s circumstances better than most. Schools provide an essential educative environment for the next generation of parents. All education staff have a crucial role in identifying the early indicators of neglect and in referring concerns to school health or children’s social care.

One of the main sources of referrals about children is schools, which means all schools whether maintained, non- maintained or independent schools, including academies and free schools, alternative provision academies and pupil referral units. ‘School’ includes maintained nursery schools.

All schools and colleges must have regard to the statutory guidance Keeping Children Safe in Education (2016) when carrying out their duties to safeguard and promote the welfare of children.

‘Keeping children safe in education’ contains information on what schools and colleges should do and sets out the legal duties with which schools and colleges must comply. It should be read alongside the statutory guidance ‘Working Together to Safeguard Children’ 2015, which applies to all the schools referred to above, and departmental advice ‘What to do if you are worried a child is being abused advice for practitioners’.

The different schools and education settings for all age groups should have systems in place to promote the welfare of children and a culture of listening to children taking in to account their views and wishes.

Each establishment should have a designated professional lead for safeguarding. This role should be clearly set out and supported with a regular training and development program in order to fulfil the child welfare and safeguarding responsibilities. Arrangements within each school should set out the processes for sharing information with other professionals and the local LSCB.

All school and college staff have a responsibility to provide a safe environment in which children can learn.

All school and college staff have a responsibility to identify children who may be in need of extra help or who are suffering, or are likely to suffer, significant harm. All staff then have a responsibility to take appropriate action, working with other services as needed. All school and college staff members should be aware of the signs of abuse and neglect so that they are able to identify cases of children who may be in need of help or protection. Staff members working with children are advised to maintain an attitude of ‘it could happen here’ where safeguarding is concerned. When concerned about the welfare of a child, staff members should always act in the interests of the child.

In addition to working with the designated safeguarding lead staff members should be aware that they may be asked to support social workers to take decisions about individual children.

4.7 Responsibility of Housing

The Housing Department may have important information about families, identifying cases of neglect or contributing information to assessments. The Housing Department has a critical role in cases of poor home conditions, social isolation, and domestic abuse. Staff have an important part to play in reporting concerns where they believe that a child may be in need of protection to children’s social care.

4.8 Responsibility of Probation Services

In discharging its statutory responsibility, the Probation Service, through its work with offenders and their families, may become aware of children who are at risk through neglect. All Probation staff have a responsibility to be aware of the signs of child neglect and to refer appropriate cases to the children’s social care. Probation staff will work in collaboration with other agencies in contributing to assessments and will follow all relevant child protection policies, procedures and protocols.

4.9 Responsibility of Youth Offending Service

The Youth Offending Service aims to prevent offending and re-offending of children aged 10-17. All YOS staff have a responsibility to be alert to safeguarding issues in their work with children and their families. Concerns should be raised with the manager and where appropriate will be referred children’s social care.

4.10 Responsibility of the Voluntary and Community Sector (VCS)

The VCS undertake a range of programmes some of which are designed to assist parents in their parenting role. The VCS are therefore well-placed to identify early concerns that relate to neglectful parenting and to work with the family in addressing issues quickly. In some cases improvement may not be achieved in sufficient time for the child, or the situation may be judged sufficiently chronic in nature to warrant a referral to children’s social care.

4.11 Responsibility to Share Information

All agencies within Northumberland, whether in the statutory or voluntary sector, have a duty to share information about children who are suspected to be at risk of harm from neglect and to make a contribution, where appropriate, to the assessment process, whether as part of an ‘early help assessment’ or statutory assessment. Information Sharing and Confidentiality Procedure sets out when and how information should be shared between agencies. The Eight Golden Rules accompanied by a flowchart of key questions the eight golden rules will help support decision making that information is being shared legally and professionally. If you answer ‘not sure' to any of the questions, you should seek advice from your supervisor, manager, nominated person within your organisation, or from a professional body.


5. Assessment

Neglect is a corrosive and significantly damaging form of child abuse. The signs of neglect may not be immediately obvious to the professional and are often part of a complex family picture that can on occasions be explained away or that simply overwhelm the professional. Sometimes symptoms can be masked by apparently good or warm care from the parent. The cumulative impact of a series of seemingly minor incidences can sometimes be lost but, when considered together, warrant a coordinated professional response. Parental needs can also potentially blind professionals to the impact of neglectful parenting on the child. Children who are in neglectful environments require the same robust and structured assessment process as children who are in other abusive situations.

5.1 Early Help Assessment

Working Together to Safeguard Children 2015 emphasises the importance of local agencies working together to help children who may benefit from early help services. Early help assessments should identify what help the child and family might need to reduce the likelihood of an escalation of needs to the level that will require interventions through a statutory assessment conducted under the Children Act 1989.

Where possible early help needs are identified, the Early Help Assessment should be used as a framework for identifying and responding to the child’s needs. Any professional who knows the child can carry out the assessment and liaise with other professionals who might need to be involved. A lead professional, who knows the child and can coordinate the delivery of services, should be identified. This could be a GP, teacher, health visitor - the decision should be made on a case by case basis and be informed by the views of the child and family concerned.

The assessment should be undertaken with the agreement of the child and family and requires honesty about the reasons for completing the assessment as well as clarity about the presenting concerns. Should the child or family decline the offer of an assessment, the professional who identified the concerns should discuss the case with their local children’s social care team to determine if the circumstances warrant a statutory assessment by children’s social care.

The Lead Professional should ensure that the circumstances of the child improve as a result of coordinating the delivery of services. Where improvements do not occur, in a timescale appropriate for the child, a referral to children’s social care should be considered. Where the situation is judged to be within the definition of a Child in Need or the child has suffered or is likely to suffer Significant Harm, a referral should be made to children’s social care immediately (see Referrals Procedure).

For further guidance please see Multi-Agency Thresholds Procedure.

5.2 Statutory Assessment

See also Referrals Procedure

Where the above criteria are thought to be met, a referral should be made to the local children’s social care team who will consider the need to undertake a statutory assessment. Where an assessment is deemed appropriate, the social worker will complete the assessment within 45 working days.

Any thorough assessment should cover the following areas which are particularly relevant to childhood neglect:

  • Exploration and understanding of the family history - including the parent’s own childhood experiences and memories of how generational parenting has been undertaken;
  • A detailed Chronology of events known across agencies;
  • Exploration of the impact, known and likely, of specific behaviours or abilities exhibited by the parents including substance misuse, learning disability, mental health;
  • Exploration of support networks and the extent to which these can be seriously viewed as ‘protective’ in nature;
  • Tested and evidenced views regarding parental ability to, and motivation to, maintain sustained change in a timeframe appropriate for the child;
  • An understanding based on discussion with the parents, about their view of the situation, what they see as the issues, how they think services can help and the extent to which they maintain focus on the child;
  • An identification of the individual needs of the child and their anticipated needs as they move through childhood and adolescence;
  • An evidenced and observed view of the quality of the attachment and bond between the child and the parent;
  • An exploration of the impact of socio-economic factors as they directly relate to the care of the child. This is more than simply stating the socio-economic context in which the family live;
  • An understanding of the child’s view of their situation, how this affects them, what they would like to change and what they would like to stay the same. To gather a meaningful rather than superficial understanding of this, the professional is encouraged to spend time with the child using appropriate approaches and tools for communicating with children;
  • Set an evidenced benchmark from which to evaluate progress over an agreed timescale. For example; height and weight, routines, interactions, speech and language development, cleanliness and so forth;
  • An evaluation of risk that:
    • Evidences concerns and strength;
    • Demonstrates an understanding of causal factors and impact on the child now and in the future should nothing change;
    • Provides an evidenced opinion regarding the potential for sustained change in keeping with the child’s timescale;
    • Expresses an evidenced opinion on parental cooperation and motivation to change.
  • A plan that is child focused and designed to affect change in a timescale appropriate for the child. The plan should address the causal factors as well as symptoms. Any proposed services should be directly linked to improving the circumstances for the child and specify the time frame in which improvements must be evidenced.
The plan should be subject to regular review to ensure that it is achieving what is required in the timescale agreed as appropriate. Drift is something that professionals should be wary of, particularly as other family events are likely to distract from, and complicate, the focus of work.


6. Supervision

Supervision is an important aspect of working with children and families who are experiencing difficulties. It is an opportunity for reflection and challenge between the supervisor and supervisee and forms one of the checks and balances in working with children and families. When working with children at risk of harmful neglect, supervision can be a way of ensuring the professional’s focus remains on the needs and experiences of the child.

Errors and confused thinking are more likely to occur when professionals are fatigued, stressed, ill, overwhelmed, inexperienced, or complacent. The supervisor should check out how the professional is and take action to support the supervisee where any of the above characteristics are evident. Brandon et al (2009) recognised that ‘the chaos, confusion and low expectations encountered in many families were frequently mirrored in the organisational response and in professionals’ thinking and actions so that both families and workers were overwhelmed and failed to see or take account of the needs of the child’.

Munro (Munro, E. (1999) Common errors of reasoning in child protection work) states the following:

‘errors in professional reasoning in child protection work are not random but predictable on the basis of research on how people intuitively simplify reasoning processes in making complex judgements. These errors can be reduced if people are aware of them and strive consciously to avoid them. Aids to reasoning need to be developed that recognise the central role of intuitive reasoning but offer methods for checking intuitive judgements more rigorously and systematically.’

Hammond (1996) states that ‘intuition is a hazard, a process not to be trusted, not only because it is inherently flawed by ‘biases’ but because the person who resorts to it is innocently and sometimes arrogantly overconfident when employing it ‘.

The list of hazards below demonstrates some of the general vulnerabilities professionals might inadvertently fall foul of and supervision can help to mitigate:

  • Loss of situational awareness: Situational awareness, in simple terms is the unique mental picture of what is happening around us at any moment in time. This mental picture is made up of all the information that is going on in our brain that is picked up though our five senses. It is our personal understanding of what is happening, what others are doing, and what will happen next. In aviation almost 90% of all accidents are due to the crew losing situational awareness. In applying this to work with children and families, the following issues are examples of how professionals could lose situational awareness:
  • Confirmation bias: This is where the professional uses existing evidence to confirm their own belief rather than challenge it. In practice what may happen here is that the worker forms a view and only takes evidence that supports that view. The supervisor in this situation will need to carefully challenge the assumptions made and support the professional in considering other evidence that may have a bearing on their view;
  • Fixation bias: This describes behaviour in the professional that becomes overly obsessed in a single task or focus to the detriment of other important and relevant issues. In practice the professional might concentrate on helping the parents rather than the child, concentrate on administration rather than visiting the child, pursue a specialist assessment and lose focus on the family’s changing circumstances and so on. The supervisor in these situations needs to challenge the professional and help re-orientate their practice to prioritise appropriate activities;
  • Normalising: This is when the professional or professionals fail to react appropriately to changes in circumstances. In practice this is likely to be a factor when the professional becomes accustomed to or acclimatised to the child and family’s world. This is particularly concerning in cases of neglect where the professional may not see or consider relevant the cumulative effects of neglectful parenting on the experiences of the child. The supervisor in this situation needs to explore at each meeting with the professional what has changed and how it has changed keeping in sharp focus the impact of any changes on the child. A situation that remains changed or has got worse should signal the need to consider other action;
  • Automation: This is where the professional draws on their own professional experience and uses intuition to direct their action along sub-consciously laid down patterns or pathways. Of course experienced professionals by definition have many years of professional practice upon which to draw. The danger here is that the professional may ‘pattern match or mis-match’ to the exclusion of evaluating sometimes relevant or new and important information or evidence. In practice the supervisor should help the professional to reflect on this behaviour and help them to acknowledge the behaviour by supporting them in developing countermeasures to guard against it in the future. Most importantly is the message that a professional who changes their view is not a sign of weakness, incompetence, or indecision;
  • Self-reported progress: This describes a family who report that things are better and have improved and the professional appears to accept this without question. It is important that the supervisor explores with the professional what evidence they have to support the family’s assertion. Self-reported improvements should be listed and evidence for or against each improvement recorded and analysed with the professional.’ Normalising ‘and ‘self-reported progress’ are frequently in evidence together when examined with the supervisee;
  • Distraction and misdirection. This describes behaviour in the family that is either deliberately or sub-consciously designed to cause the professional to lose focus. Typical behaviour employed by the family might include hostility, accusations against the professional, counter allegations against neighbours, overt ingratiation behaviours, avoidance, non-compliance and so forth. In practice the supervisor should consider asking another professional to work alongside the allocated professional, be sure the professional is feeling in control of the case and recognises the tactics for what they are, and/or consider forming a supportive professional group to support the professional. See also Working with Hostile and Uncooperative Families Guidance;
  • Fixed labelling: This is similar to confirmation bias but relates more to team or organisational bias. This is where the team or organisation has a set view of ‘these types of cases’. Because organisations and teams are formed around established cultures this is a difficult position to shift. Errors in judgement concerning decisions are made in these circumstances without a proper understanding of or analysis of the presenting information. Once a particular view has been expressed, particularly by a trusted or confident professional or leader it becomes more difficult for other team members to disagree. What can happen is that the team begins to engage in ‘group confirmation bias’ behaviour often led by the strongest opinion. The manager in these situations needs to ensure that the discussion is inclusive bringing all relevant staff into the discussion, the discussion is conducted respectfully and with an open mind, framed on the understanding that all views are important, with a focus on the facts and evidence. For the referrer it is important that all the information relevant to the concern is clearly set out and referenced with evidence. For the receiving team or professional it is important that any doubts are shared and explored with peers, senior managers with reference to this guidance and Multi-Agency Thresholds Procedure.

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