EVIDENCING NEGLECT: MESSAGES FROM RESEARCHPROFESSOR MARIAN BRANDON

Norfolk Family Justice Board and NSCB Conference, 23rd March 2015

Why does neglect matter?• Neglect the most common form of maltreatment

in England (Radford et al 2011) - almost half (43%) of cp plans are ‘neglect’ (DfE 2013) or 70% in Norfolk (April 2014)

• Potentially the most damaging maltreatment - its impact is far reaching and it is difficult to overcome (Gilbert et al 2009)

• Neglect co-exists with other abuse. It features in at least 60% of SCRs (Brandon et al 2012)

• It affects children of all ages (adolescents are the most neglected age group [Rees et al 2011]).

But …

• Professionals struggle to identify and act on indicators of neglect (Laming 2003; Gilbert et al 2009)

Why? • Uncertainty. How to act? Help at home or in

care? Thresholds. How much risk to tolerate? Mind-sets.

The Neglect ‘filter’

“Not knowing how best to help can create a ‘neglect filter’ which enables neglect to be screened out with thoughts such as ‘it’s not that bad really’ or ‘they are happy underneath it’ or ‘I’ve seen worse.’”(Daniel et al 2011:16)

EVIDENCE IN COURT

Principles of evidence in court(Re A: Munby)

Matter of fact finding and proof: “..the local authority …must adduce proper evidence to establish what it seeks to prove” (beware hearsay, prove it, establish significant harm)Findings of fact – “he appears to have lied” and allegations of “X reports that he did Y” need supporting evidence – so “he lied” or “he did y”

Need to demonstrate why?

Why is the threshold met?

Not obvious where there are risks of suffering neglect

EVIDENCE FOR COURT, EVIDENCE FOR HELPING

Risk factors and indicators (Sidebotham 2003)

Risk of neglect occurring- Risk factors are not predictors of neglect-Risk factors for neglect are also risks for other adverse outcomes not connected with maltreatment (so what causes the harm?)-Families with risk factors for neglect often go on not to neglect their children (prospective studies) But risk factors help us to understand the child’s experience and help agencies to work out priorities for support.

Indicators of neglect

Evidence that the child is experiencing actual neglect (Sidebotham 2003)•Behavioural and developmental indicators in the child•But not all indicators are distinctive characteristics of neglect alone – may signal other or parallel problems (eg post natal depression [mother or father] or inherent conditions in the child)

WT definition of neglect 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. Neglect may occur during pregnancy as a result of maternal substance abuse. Once a child is born, neglect may involve a parent or carer failing to: •provide adequate food, clothing and shelter (including exclusion from home or abandonment);•protect a child from physical and emotional harm or danger;•ensure adequate supervision (including the use of inadequate caregivers); or•ensure access to appropriate medical care or treatment.It may also include neglect of, or unresponsiveness to, a child’s basic emotional needs (HM Government, 2013 p.85).

Persistent: discrete events v chronic experiences?

• Physical and sexual abuse can be one-off incidents and experiences repeated over time. In contrast, WT definition of neglect uses chronicity - “persistent”.

• Reliance on ‘chronicity’ can delay much needed responses (Gardner 2008). Argument that unpredictable or inconsistent caregiving could be as harmful as persistently poor caregiving.

‘Start again syndrome’ vnot giving the family a chance

‘Start again’ traps (Brandon et al 2008)•Re-do a previous assessment, not read the file •Yet another parenting assessment•A ‘fresh start’ with a new baby•Be sent back to ‘start again’ by the courts

Not given a chance (Re A)•“Too willing to believe the worst of the father” •Being dismissive/ not believing what the father is saying•Not acknowledging new (changed) parental relationships •“Parental abuse of alcohol or drugs of itself and without more is no basis for taking children into care” (para 76)

RISK FACTORS IN THE ENVIRONMENT, IN PARENTS, IN CHILDREN

Risk factors: Social and environmental

Poverty (Sedlak 2010; Connell-Carricks 2003), social isolation Connell-Carricks 2003), poor living conditions (Slack et al 2003).

Risk factors: Parents Maternal mental ill-health, learning disabilities, dug and alcohol misuse, domestic violence, especially in combination (Schumacher et al 2001). Men – risk or resource? lack of research evidence (Zanoni 2013)

Risk factors: Children

Pre-term/low birth weight babies, complex health needs, (Strathearn et al 2001).

Age of child (pre-school and adolescents most at risk).

Disabled children (Stalker and McArthur 2012)

Observation of neglect indicators

• Social and environmental indicators• Harmful parent-child interaction• Harmful parental behaviour (including not

meeting child’s health needs, eg dental neglect, missed appointments etc)

• The child’s functioning (age related developmental discontinuities)

Risk factors and Indicators:

Risk factors for neglect? Indicators of neglect?

Not a static list – It is how the indicators and risk factors impact on the parent-child relationship which is crucial for practitioners’ understanding and decision makingA complex narrative of difficulties and strengths

Explanatory relationships between 4 tiers of concern (Glaser 2011)

Tier 0 Family & environmental risk factors

Tier 1 Parental risk factors

Tier 2

Parent-child interactions

Tier 3 Child’s functioning

Conclusions

• Maltreatment is relationships gone wrong (Glaser)

• With neglect this manifests as a caregiving environment that is either emotionally or physically unsafe – or both

• Emotional and physical safety (health, development, experiences) are the sites for evidence and for helping

REFERENCES

• Brandon, M, Glaser, D., Maguire, S., McRory, E., Lushey, C., and Ward, H (2014) Missed opportunities: indicators of neglect – what is ignored, why, and what can be done? Department for Education. DFE-RR404.

• Brandon, M., Sidebotham, P. Bailey, S., Belderson, P. Hawley, C., Ellis, C and Megson M (2012) New learning from serious case reviews, Department for Education. Research Report DFE-RR226.

• Daniel B, Taylor J, Scott J. Recognizing and helping the neglected child: evidence based practice for assessment and intervention. London: JKP, 2011.

• Connell-Carrick K (2003). A critical review of empirical literature: identifying correlates of child neglect. Child and Adolescent Social Work Journal, 20, pp. 389-425).

• Connell-Carrick K., and Scannapieco (2006). Ecological correlates of neglect in infants and toddlers, Journal of Interpersonal Violence, 21,3,pp 299-316.

• CORE-INFO (2012) Emotional neglect and emotional abuse in pre-school children, www.nspcc.org.uk/inform

• Egeland B. and Sroufe A. (1981). Developmental sequelae of maltreatment in infancy. In R. Rizley & D. Cicchetti (Eds.), Developmental perspectives in child maltreatment (pp. 77 – 92).San Francisco, CA: Jossey Bass, Inc.

• Gardner R. (2008) Developing an effective response to neglect and emotional harm to children. London: NSPCC,2008.http://www.nspcc.org.uk/inform/research/nspccresearch/completedrese arch/DevelopingAnEffectiveResponseToNeglectPDF_wdf56700.pdf

• Glaser D. (2011) How to deal with emotional abuse and neglect—Further development of a conceptual framework (FRAMEA) Child Abuse and Neglect, 35,10 pp. 866-875.

• Gilbert R. Widom CS, Brown K, Fergusson D, Webb F and Johnson S. (2009). Burden and consequences of maltreatment in high income countries. Lancet, 373, pp: 68-81.

• Laming L. (2003). The Victoria Climbie Inquiry. Norwich: HMSO.

• Naughton, A.,Maguire, S., Mann, M.,Lumn, C., Tempest, V., Gracias, S., and Kemp, A. (2013). Emotional, behavioural and developmental features indicative of neglect or emotional abuse in pre-school children: a systematic review, JAMA Pediatrics 167,8 pp769-775.

• Norman RE, Byambaa M, De R, Butchart A, Scott J. and Vos T. (2012). The Long-Term Health Consequences of Child Physical Abuse, Emotional Abuse, and Neglect: A Systematic Review and Meta-Analysis. PLOS Medicine, 9, pp. 1-31.

• Radford, L., Corral, S., Bradley, C., Fisher, H., Bassett, C., Howat, N., Collishaw, S. (2011). Child abuse and neglect in the UK today. London: NSPCC.

• Ramchandani P, Stein A, O’Connor T, Heron J Murray L and Evans J (2008) Depression in Men in the Postnatal Period and Later Child Psychopathology: A Population Cohort Study, J American Child Adolescent Psychiatry, 47 (4) pp 390-398.

• Rees, G., Stein, M.,Hicks, L. and Gorin, S. (2011) Adolescent Neglect – Research Policy and Practice, London: Jessica Kingsley Publishers.

• Sidebotham, P. (2003) Red skies, risk factors and early indicators. Child Abuse Review, 12, pp.41–45.

• Schumacher, J., Smith-Slep, A., and Heyman, R. (2001). Risk factors for child neglect.Aggression and Violent Behavior, 6, pp231-254.

• Sedlak, AJ, Mettenburg, J, Basena, M, Petta, M, McPhersona, K., Greene, A., and Li S. (2010). National Incidence Study of Child Abuse and Neglect (NIS-4), 2004-2009: Report to Congress. Washington DC: Department of Health and Human Services, Administration for Children and Families.

• Slack, KS., Holl, JL., Altenbernd, L., McDaniel, M.,Bush Stevens, A (2003) Improving the measurement of child neglect for survey research: issues and recommendations, Child Maltreatment, 8, pp.98-111.

• Stalker, K., and McArthur, K. (2012). Child abuse, child protection and disabled children; a review of recent research, Child Abuse Review, 21,1,24-40.

• Strathearn, L., Gray PH, O’Callaghan M, Wood DO. (2001). Childhood neglect and cognitive development in extremely low birth weight infants: a prospective study. Pediatrics. 108, pp.142–151.

• Zanoni, L., Warburton, W., Bussey, K., and McMaugh, A. (2013) Fathers as ‘core business’ in child welfare practice and research: An interdisciplinary review. Children and Youth Services Review, 35, 1055-1070.