The number of children with child protection plans as a result of concerns about neglect has risen steadily over recent years and now forms the dominant criteria of abuse. It accounted for 39% of new Child Protection plans in 2001. The definition of neglect within Working Together 2006 makes it clear that neglect is to be seen as a chronic, long term condition and spells out the potential for harm on the physical, psychological and cognitive development of children who are neglected.
Childhood neglect leads to a higher risk of school failure, socio-emotional difficulties, behavioural disorders and development of anxiety and mental disorders. Neglect as an area of work has been problematic for a number of reasons; judgements about the degree and seriousness of neglect are often seen as value laden and set against differing class, cultural or social norms and it is not unusual for there to be disagreement about the threshold for intervention. Practitioners often see parents as inadequate and ill prepared for parenting rather than deliberately subjecting their children to sustained abuse. But neglectful care is often deeply ingrained within the family, coupled with a sense of helplessness and hopelessness that becomes pervasive and workers often become enveloped within the family dynamics in their efforts to raise the living standards to a good enough level. Several recent articles and publications have contributed to the growing body of knowledge about evidence based practice with neglectful parents and helpful theoretical frameworks to understand causal factors. Here we look at two complementary articles (Tanney & Turner 2003; Berry, Charlson & Dawson 2003) with additional material from other publications.
Causes of neglect
There are a number of views on causal factors which can lead to neglectful parenting; the four main levels are described below, they encompass a number of theoretical approaches:
1. Intrapersonal:
drawing from psychiatric and psychological approaches such as learned helplessness, where the individual exhibits characteristics such as immaturity and a sense of powerlessness, or there maybe mental health difficulties or alcohol and substance misuse. Depression, low self worth,hopelessness and dissociation may result in both acts of neglect or failure to protect. Neglectful mothers are found to have higher rates of depression and to experience very high levels of stress, often relying on their own children for emotional nurturing.
2. Interpersonal/family:
which includes psychological or psycho-social models, where parents show low levels of empathy and warmth and parenting is shaped by patterns of family behaviours. Past and current relationships are shaped by unresolved marital or family conflicts. Many neglectful mothers are also victims of domestic abuse.
Attachment theory: where there may be a pattern of disordered relationships between parent and child and perhaps parent and grandparent.
- Child Development: where parents ability to function is linked back to their own histories and psychological wellbeing.
3. Social/societal:
Sociological theory and the impact of poverty, unemployment, deprivation, social isolation or exclusion, societal or community neglect all contribute to neglectful care.
4. Integrated model:
Drawing mainly from ecological theory and the interaction of the intra and inter personal factors within a social and environmental context.
What are the effects of neglect?
Persistent neglect has significant neuro- developmental consequences for young babies, potentially affecting all areas of cognitive, social and emotional functioning, … the effects appear to be cumulative (with) pervasive and persistent damage in terms of health, education, emotional and behavioural development, identity, family and social relationships and social presentation and self care skills (Tanner & Turney, 2003)
The experience of neglectful care is likely to seriously impair the child’s ability to form secure attachments, develop good self esteem or a sense of self efficacy, all key contributory factors to building resilience. The potential for building the child’s resilience may provide the most useful approach to both assessing the degree of harm or likely harm and deciding on which aspects to focus interventions and services.
Intervention models
Approaches to tackle neglect will to some extent reflect the theoretical models favoured by the practitioner. Some may choose to concentrate on individual work with caregivers, others on family work or neighbourhood initiatives, but the extensive and pervasive nature of neglect probably requires an approach which combines both tangible services and therapeutic elements, sustained over a long period of time. The argument for a carefully coordinated, individually tailored approach, based on a full assessment of the family is made by Crittenden (1996) and others. Here the role of the caseworker assumes significance and the relationship between the worker and the client takes on the nature of a nurturing alliance which may need to endure over a lengthy period of time.
There are some cautionary notes to consider. Much of the research and literature fails to fully consider the impact of poverty on ethnic minority families and communities, or to properly explore the relevance of white, Eurocentric models of healthy family functioning as applied to diverse cultural and developmental norms. Practitioners need to be aware of alternative normsand then consider them in the light of the child’s specific developmental needs and the impact of parenting styles within their family setting.
Key Messages from Research
- Neglect does powerfully and negatively affect children’s lives
- Chronic neglect is unlikely to stem from one single cause
- It needs a rigorous, multidisciplinary assessment that considers the child’s cognitive, social,
- emotional and physical development
- Interventions need to address practical, emotional and social/structural factors
- Long term intensive support of between 12-18 months is likely to be required
- Work needs to be focused, measured and evaluated
- The case worker relationship can act as a remodelling or re-parenting experience
- All interventions need to keep the child centre stage.
What works?
- Focus on the family – an holistic approach to assessment and intervention
- Mental health services which address the specific needs of parents or carers such as maternal depression; individual or group counselling around parent’s own issues, such as past or current abuse
- Substance abuse treatment – ante and post natal outreach services which can integrate treatments with other, wider needs
- Concrete services – formal and informal help with housing, furniture, repairs, employment, benefits, transportation, childcare
- Services in the home – demonstrating practical and parenting skills, health advice,
- Community and social support – help to build supportive networks, social skills training, strengths based approaches
- Individual or group work that focuses on three aspects:
- Safety in the home, identifying risks or hazards and creating a safe and clean – environment
- Infant and child health care where parents are taught about hygiene, recognising,treating or reporting illness
- Bonding and stimulation where parents learn to play and engage in daily activities with their child
- Individual or group work with parents to promote self esteem, learn problem solving skills and identify choices, explore relationships, practice assertive behaviours and social skills, improve self image and develop coping strategies.
We see that affecting positive change in the lives of neglected children is an urgent but difficult task where the needs of parents often demand significant attention in their own right and yet systematic progress fails to materialise. The importance of multi faceted assessments and interventions is stressed, where the individual skills of different professionals can be drawn on and where a multi disciplinary approach can provide encouragement when individual work appears to be ineffective. At the same time, the importance of an emotionally consistent and nurturing relationship between those who are trying to help is highlighted and may fill some gaps in the emotional experiences of parents who were themselves neglected or abused. For the neglected child, experiences that affirm their worth in other settings and alternative, emotionally secure relationships with relatives, professionals or peers may begin to compensate for their absence at home.
References:
K Tanner & D Turney: What do we know about neglect? in Child & Family Social Work, Vol. 8,
Issue 1, Feb 2003
Berry, Charlson & Dawson: Promising practices in treating child neglect: as above
Olive Stevenson: Neglected Children: issues and dilemmas: 1998, Blackwell Science
Cawson et al. Child Maltreatment in the UK: A study of the Prevalence of Abuse & Neglect;
NSPCC 2000
B Daniel, S Wassell & R Gilligan: A Framework for Considering the Nature of Emotional Abuse
& Physical Neglect and Effects on Development (appendix 1) in Child Development for Child
Care and Protection Workers, 1999, Jessica Kingsley
M Calder & S. Hackett, Eds. A Framework for Assessing Neglect in Assessment in Child Care:
Using and developing frameworks for practice, 2003, RHP.
Julie Taylor & Brigid Daniel, Eds. Child Neglect: Practice Issues for Health and Social Care:
2004, Jessica Kingsley
