Practice Guidance

Neglect

Contents

Introduction

Part I
1. Understanding Neglect
2 .Recognising Neglect

Part II
3. Responding to Neglect
4. Factors impacting on Parent’s ability to care

Part III
5. Staff Supervision

Part IV
6. Appendices:
    i) Long Term Consequences of Neglect
   ii) Scale of Assessing Neglectful Parenting
  iii) Assessment Framework Dimensions
  iv) Making Links in Physical and Emotional Maltreatment
   v) Extract from Stevenson (1998) 'Parental Competence and Learning Disability

7. References and Further Reading

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Introduction

This guidance is intended to promote a better understanding of neglect as a potentially serious aspect of abuse. As we shall describe it may involve all aspects of a child’s development. Hence the Assessment Framework for Children in Need and Their Families (DOH 2000) should form the background for consideration of the problem of neglect. This framework provides a foundation for all professionals and agencies who work with children and families.

• Child’s Developmental Needs
• Parenting Capacity
• Family and Environmental Factors

The guidance has been developed by the Leicester, Leicestershire and Rutland LSCB via a multi-agency working group, in response to the recommendations from a Serious Case Review.

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1. Understanding Neglect

1.1 Every child has the right to develop healthily, and to do this their basic needs must be met. A link can be made between impairment of the child’s health and development and neglect of aspects of their care provided by their parents or carers.

Definition of neglect

1.2 There are a number of definitions emphasising different aspects and perspectives of the problem. There is a danger that the plethora of definitions can create professional confusion and inertia both in identifying and in intervening. Meanwhile, children may suffer, or be at risk of suffering from, significant harm as a result of neglect.

1.3 This guidance takes the definition from the Department of Health ‘Working Together to Safeguard Children’ (2006 1:33) as the basis for discussion. ‘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.  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 and clothing, shelter including exclusion from home or abandonment, failing to protect a child from physical and emotional harm or danger, failure to ensure adequate supervision including the use of inadequate care-takers, or the failure to ensure access to appropriate medical care or treatment.  It may also include neglect of, or unresponsiveness to, a child’s basic emotional needs.

Practice Issue

1.4 The key issue in understanding neglect is that healthy child development is a holistic concept within which aspects of physical, emotional, intellectual and social needs interact. Neglect of any one of these may cause significant harm, especially to young children.

Thus, assessment involves an understanding of each aspect of development but also an appraisal of the extent of the deficit in the different aspects.

1.5 Serious neglect, leading to significant harm, creates the need for a child protection enquiry (Children Act 1989 Section 47). However, neglect even when less serious will require a ‘child in need’ assessment (Section 17). Such earlier intervention may have preventative value. Thus, clarification of ‘thresholds’ for concern are a pressing practice issue.

1.6 N.B: Although physical and material standards of care are affected by material and resource factors, neglected children may stand out even within their own economically and socially deprived communities, who may identify neglected children and their families as ‘different’.

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2. Recognising Neglect

2.1 A pre-requisite in recognising neglect in general terms, is a knowledge and understanding of children’s development, of their families, their life events and experiences. This does not initially imply ‘expert knowledge’, although in some instances urgent expert assessment may be needed. Research messages suggest professionals often take a narrow view of family functioning, and fail to assimilate research findings of behaviours, both professional and parental, which are harmful to children.

2.2 Children’s needs which are not being met by their parents, may in the first instance, be identified by those agencies providing universal services i.e. health and education. It may be the failure of parents to use or access healthcare or education that raises concerns. Features of neglect may be apparent to many professionals and others who have contact with the family. It is essential that there is inter-agency and inter-professional collaboration to bring together facets of concern regarding the care of the children. Failure to record accurately, assimilate, and communicate information about the child’s welfare is a recurrent feature of case reviews in which neglect is a factor.

2.3 One or more indicators of neglect may be present, which may be sustained or episodic, and may reflect what is happening in the family at a particular point in time. The impact of neglect on individual children needs to be considered in the context of the child’s age and development. However the outcome may be the same, i.e. it may cause significant harm to the child’s health and development.

The Rights and Needs of Children

2.4 Children’s needs for, and rights to, healthy development can be identified within ‘The United Nations Convention on The Rights of the Child (1989). There is an international consensus on the basic needs of children.

2.5 The Children Act (1989) does not specify needs or rights. It does however, assert the general principle of the paramountcy of the child’s welfare. These Practice Guidelines are also influenced by the Human Rights Act (2000).

2.6 The Convention specifically identifies the right to:

• Life and the best possible chance to develop fully
• An adequate standard of lving primarily provided by parents, but with help from the State
• Day to day care
• Health and health care
• A safe, healthy, unpolluted environment with safe nutritious food and unpolluted water
• Disabled children should be helped to be as independent as possible, and to take a full and active part in everyday life
• To have their views ascertained and to be listened to
• To have a standard of living adequate for their physical, mental, emotional, spiritual, moral and social development
• To have access to education to achieve their full potential

The assessment of need and provision of services for children by statutory and voluntary organisations, should reflect anti-discriminatory practice.

The Nature of Neglect

2.7 More than any other form of abuse, neglect is often dependent on establishing the importance and collation of seemingly small, undramatic pieces of factual information. When collated these may present a picture that may identify a child suffering from significant harm.

2.8 Neglect which constitutes ‘significant harm’ is that which is;

• Persistent
• Cumulative
• Chronic or acute
• Resistant to intervention

2.9 Neglect often occurs in families living in poverty. However the children at greatest risk are those whose parents’ own emotional impoverishment is so great that they do not know how to parent or understand their children’s needs. In spite of considerable intervention from professionals, voluntary and charitable organisations, these parents may be unable to provide for even the most basic needs of their children.

2.10 The persistent nature of neglect is corrosive and cumulative. Therefore there is the danger of irreversible damage. Children who are neglected will not inevitably become neglectful parents to their own children, but research and practice identify the inter-familial nature of much neglect. Appropriate intervention can therefore contribute to the prevention of the cycle of inter-generational neglect.

The behaviour of seriously neglectful parents is frequently characterised by care which lacks consistency and continuity.

2.11 There may be brief intervals when care is marginally improved. This may raise the hopes of those providing services, but improvements are usually short lived creating a sense of hopelessness for those supporting the family.

2.12 Other characteristics include:

• A lack of concern about physical household standards which falls well below ordinary families, quite often associated in part with animals in the household
• A failure to keep routine health appointments for the children (and themselves?)
• Failure to stimulate and/or interact creatively or humorously with the children
• Difficulty in exercising appropriate discipline and control over children
• Lack of judgement about whom to trust with care of children
• Difficulty in putting children’s needs first
• Parental low self esteem
• Poor or destructive relationships with extended family or local community

The quality of parenting can be described as being on a continuum of care;

Appendix 2 provides a useful tool (Stevenson (1998)), to identify areas of strength and weakness in the parenting capacity, or patterns of poor parenting.

It was intended to assess the risk to children under 7 years from neglectful parenting, but it can also be used when there are older children in the family.

2.13 Contributing Factors as sources of stress (identified within Working Together 2006 pp 185-188), may impact on the ability of a parent to care for their children include, but are not limited by:

• Social exclusion
• Drug and alcohol misuse
• Learning disabilities/difficulties
• Domestic violence
• Mental health issues

These factors are becoming increasingly recognised as having an impact on a parent’s ability to provide ‘good enough’ care. Some of these will be explored further in the following sections.

Parent and Child Relationships

2.14 There are many dimensions of these but it is increasingly recognised that there has been insufficient emphasis on the significance of ‘Attachment Theory’ in child protection work.

2.15 All children form attachments, but the attachment which helps them to develop to the best of their ability, intellectually, morally, emotionally and socially is referred to as a ‘secure attachment’. There is powerful evidence to support this and the concept that every child needs such attachments, and that ‘it endures through space and time’ (Fahlberg 1994).

2.16 This ‘secure attachment’ enables children to gradually learn to become independent and confident when dealing with new experiences and challenges. These attachments are dependent upon the child’s parents being physically and emotionally available, dependable and benevolent.

These qualities may be absent in some parents for a variety of reasons, and the attachments their children make will be distorted.

2.17 The impact of this distorted attachment is more readily recognised when the child faces new and challenging situations or when she/he feels under threat.

2.18 Our required level of knowledge and understanding of ‘Attachment Theory’ will largely depend on the work that we do with families. This clearly constitutes a wide spectrum which ranges from a general awareness, to that which requires an in depth understanding which informs professional interventions and treatment. This level is required by a comparatively small number of professionals.

2.19 In terms of general awareness, it is of crucial importance when we observe children and parents interacting, that we do not make assumptions about their relationship at first sight or during a brief contact.

2.20 Some children have ‘distorted attachments’ such as an ‘anxious attachment’, and these children become very clinging to their parents when they encounter a new situation or challenge. Their distress levels may be disproportionate to everyday events. It would be understandable that an observer could mistakenly consider that this clinging behaviour suggests a strong bond between parent and child.

2.21 When there are concerns about neglect, it is important that seemingly small pieces of information about the child and parent behaviour are accurately recorded, together with the context within which the behaviour occurred/was observed. This information should be shared with other professionals involved with the family.

2.22 One study shows ‘distorted attachments’ are particularly evident in neglected children and parents described as ‘psychologically unavailable’. Such children were found to be emotionally and behaviourally disturbed in later years. It is important that workers assess the quality and nature of attachment in considering the future of the child with their parents.

Practice Issues:

• Records of contact with the family and child should clearly identify the behaviour that has been observed between the parent and child
• What does the child’s attachment behaviour tell you of her or his need, and of the parental capacity to offer security for the child to explore?
• Can the parent be helped to provide a better ‘attachment base’?
• If ‘good enough’ attachment is lacking, who else can you identify that can provide some of this security?
• Does the child and family need therapeutic help?
• Characteristically, when there are concerns about neglect, the collation of seemingly small unconnected pieces of information is essential as this may contribute to the understanding of the parent/child relationship, and therefore, to the picture of a child who is suffering or at risk of suffering significant harm

For further help on these issues, see Daniel et al/Howe et al 1999 in bibliography In particular Daniel, Chapter 5 pp 130-134.

Barriers to Recognition of Seriousness of Neglect

2.23 Professionals may fail to identify neglect as serious because of;

• A failure to observe and listen to children
• A belief that neglect can be addressed solely by relieving poverty
• A failure to recognise children as part of a wider community, whose responses to the neglected child may be to socially exclude them
• Taking a collective view of children in the same family, when an individual assessment is required
• A belief that parenting is innate and natural and therefore parental behaviours must be right
• A fear of imposing professional and class values on others
• Making assumptions about race and culture that could under or over state the risks
• Viewing neglect as inevitable as the parents are unable to change their lifestyle/behaviour
• Developing pervasive belief systems that as long as the children seem happy, other omissions of care are of less importance
• A lack of knowledge of results and long term consequences of neglect
• An adherence to a belief in the adults rights to ‘self determination’ which may deny or be in conflict with the rights and/or best interests of the child
• Over identification with vulnerable parents, leading to denial of children’s needs
• A belief that nothing better can be offered to children

2.24 Studies have shown that once the ‘rule of optimism’ develops, it is then difficult for workers to change their views about the family. This may be in spite of compelling evidence of neglect and significant harm.(Wattam, C.(1992) Dingwall (1996).’

Issues, which require further study and consideration

• Neglect is usually seen as the mother’s failure to provide care
• Little is known about the men in neglectful families
• A dominant feature in the mother’s personality is low esteem
• The significance of the mother’s physical health receives little attention
• There is little understanding of why hygiene is extremely poor in some neglectful families

Consideration needs to be given to each child, their personality, needs and problems and how this impacts on their parents. (Stevenson 1998).

Conclusions

2.25 In understanding neglect, the application of the Children in Need Assessment Framework to the concept of significant harm is clearly crucial. Thus, the issue of thresholds of developmental harm is bound to be an important feature of the work. The starting and finishing point which assesses the extent to which the child’s developmental needs are being met, is that part of the framework which outlines ‘Child’s Development Needs’. Questions concerning parenting capacity and family and environmental factors are vital in determining what is to be done. But we must start and finish with the child.

This work will be done in the context of a continuum of assessment, using the idea of the continuum of care .

2.26 There are various tools which are available to assist workers in assessing the seriousness of the neglect. (Appendix 5). However, these are not formal check lists or rating scales and cannot be used as a substitute for judgements based on overall observation. They are useful as a guide, an aide memoir, and a focus for concentration on the detail of a child’s development and family circumstances. The key issue is that long term neglect can cause more developmental delay and impairment than any other form of abuse.

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3. Responding to Neglect

Key aspects of practice

• More than in any other aspect of child protection work, working with neglectful families, from assessment to intervention, requires an inter-agency, inter-disciplinary approach. A holistic approach to the child’s needs necessarily involves contributions from a wide range of statutory and voluntary agencies and professionals
• Practice involvement with neglectful families should be modelled on a concept of family support, with early intervention wherever possible
• Assessment is not only a way to understand neglect, but it should also offer the evidence and justification for the provision of appropriate services
• Structured records, based on detailed assessments (each time they are carried out) are an indispensable tool in reviewing progress and making plans
• The protection of the children from significant developmental harm will sometimes assume the highest priority. Families may move in and out of periods when there is particular anxiety about the harm and risk to the children, therefore they may need consistent continuing support over a relatively long period of time

Referral

3.1 (See LSCB Chapter 4: Early Prevention & Referrals to children’s social care)

3.2 Children’s Social Care as the lead agency, have the responsibility to determine whether the situation requires assessment for support or a child protection enquiry.

Practice Issues

• A referral to Children’s Social Care may lead to
• No further action being taken by them
• Advice that services or help should be obtained through another agency
• That they will directly provide services or help
• An initial assessment as to whether the child is in need of family support services
• Where the initial assessment quickly indicates that there are concerns about significant harm, then a child protection enquiry will be commenced

As the Initial Assessment progresses, it may indicate that what was initially considered as a child protection enquiry (Section 47), may be more appropriately dealt with as a child in need (Section 17) or conversely that in addition to other welfare needs, there may be a need to protect the child.

• Services for children who have been neglected can be provided as part of a children in need and family support plan or a child protection plan
• The approach to service provision should be multi-agency, multi-disciplinary
• Assessment is undertaken using the Assessment Framework for Children in Need and their Families (DOH 2001)

Children in Need of Protection

3.3 Key Features;

• Follow the LSCB Child Protection Procedures
• Focus on the needs of the individual child and parenting capacity in relation to each child, and not the values and assumptions of agencies and professionals, although these may need some acknowledgement
• Enquiries should always involve separate interviews with each child where age and development permits. If a child is unable to take part in this process, alternative means of understanding the child’s perspective should be used, including observations of very young children
• Particular consideration should be given to address the needs of children whose first language is not English, who have communication difficulties, or physical or learning difficulties/disabilities

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4. Factors which impact on Parents capacity to care

4.1The following factors may impact on a parent’s ability to provide ‘good enough’ parenting, and should always be considered by agency professionals when they have concerns about neglect and throughout the Initial or Core Assessment.

Domestic violence

• Neglect may occur when the mother and children are deprived of food, money and material goods
• The cumulative impact of the above on the mother
• The expectation of agencies/professionals that mothers are always able to care for and protect their children
• Expectations of mothers to deal with crisis in the adult relationships
• In such situations, adults involved may be preoccupied with their relationship  

Adult Mental Health Issues

• Differing impact of chronic or acute illness on the parents capacity to care
• Effects of ‘diagnostic combinations’ – e.g. mental health difficulties, alcohol/drug misuse, learning difficulties etc.
• Impact of medication upon their capacity to care
• Difficulties which professionals may have in working together, different areas of expertise, different roles, different focus  

Alcohol or Substance Misuse

• Parental denial, minimisation, secrecy, manipulation etc.
• Adverse effect of dependency on alcohol and/or drugs, and the availability of financial resources to meet the children’s needs
• Safety and supervision issues
• Professional disagreement/uncertainty re: level of risk
• Possible conflict between professionals in terms of belief systems and values
• Possible conflict between workers re confidentiality  

Parents with Learning Disabilities or Learning Difficulties

• Different professional groups may use differing definitions in relation to the severity of the difficulty/disability
• Learning disabilities or difficulties may be present in those with an above average IQ but associated with specific conditions such as Autism or Asperger’s Syndrome  

Definitions: IQ ratings of:

80 – 129	is the average range and represents 95% of the population.
70 – 90	are borderline and people can have learning difficulties.
Less than 70	the term learning disability is applied. These can be either mild, moderate, or severe and profound. Those with children are unlikely to be in the last category.

Mental health and behavioural problems can mask or accentuate the degree of disability.

4.2 When parents have some degree of disability, the child’s health and temperament may further influence the parents’ capacity or ability to parent. An additional factor would be whether the pregnancy resulting in this child’s birth was planned.

4.3 It seems that a substantial number of parents who seriously neglect their children and are referred to Children’s Social Care are thought to have a degree of learning disability.

4.4 However, it is not always clear whether this in itself causes the problem or whether the parents themselves have been deprived of positive parenting experiences in their own childhood. It is also important to identify precisely the areas of difficulty in parenting which may be attributable to intellectual defects. (For more detail see Stevenson Appendix 6).

4.5 The following issues are important:

i) Changing attitudes

Historically there has been concern at the notion of people with difficulties/disabilities having and caring for their children, but these have been changing with a broader understanding of the rights of people with learning disabilities to have children. However, this has to be balanced with an acceptance of the need to protect children’s well being and ensure their proper development.

ii) The role of those providing universal services

Professionals from health and education i.e. midwives and health visitors and teachers may be the first to be involved. It is important that they identify those parents struggling to care for their children and that they have discussions with specialist services in the community, i.e. educational psychologists or Adult Social Care and Children and Family Services.

iii) Continuum of parenting ability

When parents have a degree of learning difficulty, a fundamental factor may be at what point on the ‘continuum of parental care’ (page ) they are identified. They may require additional help in the form of role models, and supplementary support/early assessment. Assistance for prospective parents may be critical.

iv) Co-ordination of services

Co-ordination between services for adults and children, becomes a central issue, and requires discussion and planning. However, it also has to be recognised that many such parents receive little help from over stretched adult services.

Practice Points

4.6 Once the principles of assessment of neglect are secured in the material derived from the Assessment Framework, the following points are key to an effective response:

• Maintain the child’s development as the focus, working towards outcomes that are in hers/his best interest
• Establish and maintain effective interagency communication, ensuring that there is a shared understanding of the problem and of the intervention plans and that roles and responsibilities are clarified, acknowledged and agreed. Wherever possible, promote opportunities for reflective discussion rather than simply passing on information
• Ensure that the up to date information on the child is accurate and readily available
• Identify those who have best knowledge of the family and who can be asked for up to date information
• Identify those aspects of the child welfare and parenting capacity which gives you most concern, and focus observation and intervention on these, and promote those aspects of parenting which are positive
• See the child in his/her home environment. If you cannot gain access for whatever reason, take this seriously and reflect with other workers and managers on what you should do and whether the police should be involved
• An outcome of the assessment should identify family and environmental factors, consider what community and extended family support might be available for particular children and/or parents. Evaluate and review your actions/plans. (See Stevenson 1988. Chapter 9)

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5. Staff Supervision

The Purpose of Supervision:

• The worker is clear about their roles and responsibilities
• The workers meet their agency’s objectives
• A quality service is provided to children and parents
• That a suitable climate for practice is developed
• To assist in professional development
• To manage stress
• That the worker is provided with the resources to do the job
• These goals apply generally. In working with neglectful families, there are some more specific considerations
• For workers (of whatever agency), serious neglect poses worrying problems for practice. It raises anxiety but also can create a kind of numbed despair
• A lack of direction and dangerous drift have been characteristic of a number of cases where neglect has resulted in tragic deaths. Therefore, a key component of effective supervision will be to give focus and purpose to the work
• Firstly the focus and purpose will be on the precise assessment of developmental progress – strengths and defects of particular children, with consideration of when there is a need for expert advice
• Secondly, on the assessment of parenting capacity, with identification of difficulties to be targeted and plans established for how this will be done
• Thirdly, intervention designed to improve parenting should lie alongside plans for supplementary/complementary care for children. Their age and associated developmental needs dictate when particular needs should be met. (See Stevenson 1998. (Chapter 9)

5.1 Supervision when there are concerns about neglect should therefore have these three components as the main agenda. However, the confusion, depression and despair which lies at the heart of some of these families affects workers. Therefore also part of the supervisory process should be to identify these feelings and work on ways of minimising the effects.

• Supervision must always review the state of the children at that time and consider ‘risk’, in a holistic sense, (e.g. Implications of missed medical appointments etc)
• It is unhelpful to assume that case closure in cases of serious neglect is realistic within ordinary time scales. Ordinary processes re registration/de-registration may not be appropriate. Supervision should involve a dialogue on medium and long term goals for the family and plans made accordingly
• Since inter-agency and inter-professional work is essential for these cases, supervision in the conventional sense can usefully be widened, and can on occasion, for example involve managers and workers from other agencies in a case discussion  Consideration should also be given to arranging consultation with ‘expert’
• So far as possible, work with parents, sharing information, identifying their strengths and building upon them
• However, do not fail to make clear to parents the ways in which their care falls short of their children’s needs, and what should be done, not only about immediate safety, but about the conditions for healthy development
• Identify clearly where attempts at ‘partnership’ are failing
• The time scales for work with neglectful families are complex. On the one hand you may expect change to be slow. On the other, there is a danger of drift, through lack of co-ordination and uncertainty about what needs to be done
• Furthermore, it may be that agency involvement needs to be long term. This needs clarity of purpose, i.e., that there is a shared belief in the capacity of the parents to provide ‘good enough care’, probably with supplementary care for the children to make it reasonable for the children to say at home. Supervisors may also have a number of lessons to learn about such cases. Their experience in turn, may influence others in the agency
• Supervision should identify issues which workers need to take forward in training and professional development

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6. Appendices

Appendix 1
Appendix 2
Appendix 3
Appendix 4
Appendix 5

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Appendix 1

a) The results and long term consequences of poor standards of home hygiene

b) The long-term results and consequences of failure to provide an appropriate diet for children

c) The result and consequence of failure to supervise and provide a safe environment

d) The results and long term consequences of failure to obtain appropriate health care

e) The result and long-term consequences of failure to provide personal hygiene for the child

f) The result and long-term consequences of failure to provide personal / environmental warmth

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Appendix 2

Neglected Children: Issues and Dilemmas (pdf, 153kb)

Click on the image above to download the pdf document.

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Appendix iii Dimensions of Child's Developmental Needs

Health

Includes growth and development as well as physical and mental well-being. The impact of genetic factors and of any impairment needs to be considered. Involves receiving appropriate health care when ill, an adequate and nutritious diet, exercise, immunisations where appropriate and developmental checks, dental and optical care and, for older children, appropriate advice and information on issues that have an impact on health, including sex education and substance misuse.

Education

Covers all areas of a child’s cognitive development that begins from birth. Includes opportunities: for play and interaction with other children to have access to books; to acquire a range of skills and interests; to experience success and achievement. Involves an adult interested in educational activities, progress and achievements, who takes account of the child’s starting point and any special educational needs.

Emotional and Behavioural Development

Concerns the appropriateness of response demonstrated in feelings and actions by a child, initially to parents and caregivers and, as the child grows older, to others beyond the family. Includes nature and quality of early attachments, characteristics of temperament, adaptation to change, response to stress and degree of appropriate self-control.

Identity

Concerns the child’s growing sense of self as a separate and valued person. Includes the child’s view of self and abilities, self-image and self-esteem, and having a positive sense of individuality. Race, religion, age, gender, sexuality and disability may all contribute to this. Feelings of belonging and acceptance by family, peer group and wider society, including other cultural groups.

Family and Social Relationships

Development of empathy and the capacity to place self in someone else’s shoes. Includes a stable and affectionate relationship with parents or caregivers, good relationships with siblings, increasing importance of age appropriate friendships with peers and other significant persons in the child’s life and response of family to these relationships.

Social Presentation

Concerns child’s growing understanding of the way in which appearance, behaviour, and any impairment are perceived by the outside world and the impression being created. Includes appropriateness of dress for age, gender, culture and religion; cleanliness and personal hygiene; and availability of advice from parents or caregivers about presentation in different settings.

Self Care Skills

Concerns the acquisition by a child of practical, emotional and communication competencies required for increasing independence. Includes early practical skills of dressing and feeding, opportunities to gain confidence and practical skills to undertake activities away from the family and independent living skills as older children. Includes encouragement to acquire social problem solving approaches. Special attention should be given to the impact of a child’s impairment and other vulnerabilities, and on social circumstances affecting these in the development of self care skills.

Dimensions of Parenting Capacity

Basic Care

Providing for the child’s physical needs, and appropriate medical and dental care. Includes provision of food, drink, warmth, shelter, clean and appropriate clothing and adequate personal hygiene.

Ensuring Safety

Ensuring the child is adequately protected from harm or danger.  Includes protection from significant harm or danger, and from contact with unsafe adults/other children and from self-harm. Recognition of hazards and danger both in the home and elsewhere.

Emotional Warmth

Ensuring the child’s emotional needs are met giving the child a sense of being specially valued and a positive sense of own racial and cultural identity.

Includes ensuring the child’s requirements for secure, stable and affectionate relationships with significant adults, with appropriate sensitivity and responsiveness to the child’s needs. Appropriate physical contact, comfort and cuddling sufficient to demonstrate warm regard, praise and encouragement.

Stimulation

Promoting child’s learning and intellectual development through encouragement and cognitive stimulation and promoting social opportunities.

Includes facilitating the child’s cognitive development and potential through interaction, communication, talking and responding to the child’s language and questions, encouraging and joining the child’s play, and promoting educational opportunities. Enabling the child to experience success and ensuring school attendance or equivalent opportunity. Facilitating child to meet challenges of life.

Guidance and Boundaries

Enabling the child to regulate its own emotions and behaviour. The key parental tasks are demonstrating and modelling appropriate behaviour and control of emotions and interactions with others, and guidance which involves setting boundaries, so that the child is able to develop an internal model of moral values and conscience, and social behaviour appropriate for the society within which they will grow up.

The aim is to enable the child to grow into an autonomous adult, holding their own values, and able to demonstrate appropriate behaviour with others rather than having to be dependent on rules outside themselves. This includes not over protecting children from exploratory and learning experiences.

Includes social problem solving, anger management, consideration for others, and effective discipline and shaping of behaviour.

Stability

Providing a sufficiently stable family environment to enable a child to develop and maintain a secure attachment to the primary caregiver(s) in order to ensure optimal development.

Includes: ensuring secure attachments are not disrupted, providing consistency of emotional warmth over time and responding in a similar manner to the same behaviour.

Family and Environmental Factors

Family History and Functioning

Family history includes both genetic and psychosocial factors. Family functioning is influenced by who is living in the household and how they are related to the child; significant changes in family/household composition; history of childhood experiences of parents; chronology of significant life events and their meaning to family members; nature of family functioning, including sibling relationships and its impact on the child; parental strengths and difficulties, including those of an absent parent; the relationship between separated parents.

Wider Family

Who are considered to be members of the wider family by the child and the parents? This includes related and non-related persons and absent wider family. What is their role and importance to the child and parents and in precisely what way?

Housing

Does the accommodation have basic amenities and facilities appropriate to the age and development of the child and other resident members? Is the housing accessible and suitable to the needs of disabled family members? Includes the interior and exterior of the accommodation and immediate surroundings. Basic amenities include water, heating, sanitation, cooking facilities, sleeping arrangements and cleanliness, hygiene and safety and their impact on the child’s upbringing.

Employment

Who is working in the household, their pattern of work and any changes? What impact does this have on the child? How is work or absence of work viewed by family members? How does it affect their relationship with the child? Includes children’s experience of work and its impact on them.

Income

Income available over a sustained period of time. Is the family in receipt of all its benefit entitlements? Sufficiency of income to meet the family’s needs. The way resources available to the family are used. Are there financial difficulties that affect the child?

Family’s Social Integration

Exploration of the wider context of the local neighbourhood and community and its impact on the child and parents. Includes the degree of the family’s integration or isolation, their peer groups, friendship and social networks and the importance attached to them.

Community Resources

Describes all facilities and services in a neighbourhood, including universal services of primary health care, day care and schools, places of worship, transport, shops and leisure activities. Includes availability, accessibility and standard of resources and impact on the family, including disabled members.

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Appendix 4

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Appendix 5

Extract from Stevenson (1998) Chapter 5 pp 60/61

‘There has been growing interest in the UK in the issue of parental competence and learning disability in the last 5 years or so. (See for example, McGaw & Sturmey 1994) This may well be in part because the number of such parents in the community is steadily increasing. however, parents with only moderate degrees of disability may receive little or no support unless they come to the attention of child welfare services. In that case, until the recent shift of focus towards better services for ‘children in need’, the near exclusive focus on child protection services meant that the only ‘visible’ parents with learning disabilities were likely to be those whose children were seriously at risk, rather than those who needed support.

If we are to find a sensible way forward, one question has to be addressed. Is the fact of learning disability seriously relevant to an understanding of parenting deficits or is it an unwarrantable diversion from the many other interacting factors in cases of neglect? This is to say, should it be a focus for research and professional intervention? There are two ways of considering this. First, it can be viewed as an additional and contributing factor to difficulties in parenting and thus may be one more element in a downward spiral. In general, higher intelligence may make it easier to solve certain problems; bringing up children in modern society requires a range of skills, by no means all of which, as McGaw and Sturmey (1994) point out, are tied simply to parent-child interaction but require ‘parent life skills’ such as obtaining resources, both social and material. The more intelligent person (other things being equal) is likely to find this easier. Thus, it is perverse to deny or minimise the significance of this particular characteristic.

However, and secondly, the existence of a learning disability may of itself cause certain specific problems in child rearing. This is the area which is more controversial yet, as Booth and Booth discuss, even when due caution about the attribution of difficulties to learning disabilities is exercised, there remain important issues about the effects of cognitive limitation on parent-child care, interaction and supervision. It seems important to give more sophisticated and detailed attention to this. To regard people with learning disabilities as in any way a heterogeneous, about whom generalisations can be made, is plainly ridiculous, not least when one is aware of the wide range of reasons for, and the type of, such conditions. It is however, possible to think in terms of the ‘ordinary’ requirements for ‘good enough’ parenting skills and assess the extent to which the deficits in some parents can usefully be seen in terms of cognitive difficulties. It should go without saying that other components of assessment that are customarily investigated should be the same for parents with learning disabilities as anyone else. The work of McGaw and colleagues (1994) has been influential and helpful in this. She has developed the notion of a ‘parental skills model’, based on ‘life skills’, family history, available support and resources, which takes into account for such parents many of the factors common to all similar assessments (McGaw and Sturmey 1994). However, we shall need to be clearer about the possible significant elements in cognitive limitation in relation to neglect. Booth and Booth (p 464 1993), although expressing caution about the reliability of the findings, cite research showing a number of parenting deficits common in people with learning disabilities. These include:

‘the failure to adjust parenting styles to changes in their child’s development, a lack of verbal interaction with the child, insufficient cognitive stimulation, especially in the area of play, a tendency to over-generalise instructions, inconsistent use of discipline, a lack of expressed warmth, love and affection’.

Clearly such deficits are highly relevant to the problem of neglect. But, as they point out, very few of these studies ‘have matched comparison groups to control for other variables, apart from intelligence’ (p. 464).

Nonetheless, those descriptions do accord with some of the observations of experienced practitioners and some seem consistent with the nature of the intellectual limitations we are considering, rather than with the more emotionally rooted difficulties. For example, it is plausible to see ‘over-generalising instructions’, which may mean inappropriate extrapolation from one situation to another, or ‘insufficient cognitive stimulation’ in terms of learning disability, whereas ‘a lack of warmth’ may have a more complex and different aetiology.

It is also important to note the observations of Court (personal communication 1997) that parents with learning disability sometimes have limited knowledge and skills in the provision, as parent, of adequate health care and safety to their children. When to that is added the fact that they are less likely to seek and use professional help than most parents, there is an important pointer to the difficulties there may be in providing good enough protection against health hazards to, and illness in, the children.

More rigorous research and more precise observations will be needed in this area if we are to develop further credible direct connections between specific deficits and effective programmes for skill training in such parents. These are of considerable potential importance as one of the elements in strategies for intervention, especially at an early stage.

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7. References and Further Reading

Allsop, M. and Stevenson O. (1995) Social Workers’ Perceptions of Risk in Child Protection (discussion paper), University of Nottingham, School of Social Work.

The Bridge Consultancy (1995) Paul: Death Through Neglect, London, The Bridge Consultancy.

Cleaver H., Unell I., Algate J., Children’s Needs – Parenting Capacity, London, The Stationery Office 1999.

Daniel B., Wassell S. and Gilligan R., (1999), Child Development for Child Care and Protection Workers, Jessica Kingsley.

Department of Health, Home Office, Department of Education and Employment, (1999), Working Together to Safeguard Children, The Stationery Office.

Department of Health (2000), Framework for the Assessment of Children in Need and their families.

Howe D., Brandon M., Hinings D. and Schofield G. (1999), Attachment Theory, Child Maltreatment and Family Support – A practice and assessment model, Macmillan.

Iwaniec D. (1995) The Emotionally Abused and Neglected Child, Chichester, John Wiley.

Jones J. and Gupta A. (1998), The context of Decision making in Cases of Child Neglect, Child Abuse Review, vol 7, P97 – 110.

McGaw S. and Sturmey P. (1994), Assessing Parents with Learning Disabilities: the Parental Skills Model, Child Abuse Review, vol 3 (1) p27 – 35

McGaw, Beckly K, Connolly N. Ball K (1999) Parent Assessment Manual. To order: phone 01872 356040

Minty B. and Patterson G. (1994), The Nature of neglect, British Journal of Social Work, 733 – 48

Parton N. (1995), Neglect as Child Protection, The Political Context and practical Outcomes, Children and Society, vol 9 No 1 P67-89

Pitcairn T., Waterhouse L., McGhee J., Secker J. and Sullivan C. (1993), Evaluating Parenting in Physical Abuse. In Waterhouse, Child Abuse and Child Abusers, Prevention and Protection, Jessica Kingsley, London.

Polansky N., Chalmers M.A., Butterweiser E. and Williams D. (1981), An Anatomy of Neglect, Chicago, Chicago University Press.

Rosenberg D. and Cantwell H., (1993), The consequences of Neglect – Individual and Societal. In Child Abuse (ed. Hobbs and Wynne) Bailliere Tindall.

Stevenson O., (1998), Neglected children, issues and dilemmas, Oxford, Blackwell.

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