4.1.24 Neglect Guidance |
Contents
The Effect of Neglect on the Child
Guidance on Thresholds for Establishing that Neglect is taking Place
Guidance on Working with Families where there is Neglectful Parenting
Guidance on Carrying out Section 47 Enquiries into Cases of Possible Neglect
Definition of Neglect
Neglect is a form of Significant Harm which involves the persistent but unintentional failure to meet a child's basic physical and/or psychological needs, to the extent that it is likely to result in the serious impairment of the child's health, wellbeing or development.
In a case where there is strong evidence to suggest that parents' failure to meet the child's needs is deliberate or malicious and that they understand the likely effect of their actions or inaction on the child, and either intend to cause harm or are reckless as to whether harm is caused, this should be regarded as serious physical and/or emotional abuse, and not be regarded as Neglect.
Neglect during pregnancy may be as a result of maternal substance abuse, or other lifestyle choices which could place the development of the foetus at risk.
Once a child is born, neglect may involve:
- Failure to provide adequate food, clothing, cleanliness and hygiene or care routines;
- Failure to provide shelter, exclusion of the child from the home or abandonment of the child;
- Failure to protect a child from the risk of physical and/or emotional harm or danger;
- Failure to ensure adequate supervision and/or the use of inappropriate care givers;
- Failure to ensure the child has timely access to appropriate medical care or treatment when needed.
Neglect may also involve lack of responsiveness to the emotional and/or social needs of the child.
Neglect may be the result of unintentional failure to meet a child's needs, but the fact that it is unintentional does not mean that it does not merit intervention; the impact of neglect on the child may be seriously damaging, even fatal. Although the experience of chronic and long-term neglect may be different from the impact of a short-lived period of severe neglect, both these circumstances can have equally serious consequences, can impair their development long-term and can endanger or kill a child.
Neglect may be the result of a number of factors, such as lack of knowledge or experience, stressful circumstances, depression, parents feeling overloaded or poverty and deprivation.
Where neglect is a result of parental lack of understanding or ability it should initially be addressed through provision of information, advice, training, support and services.
Child Protection Procedures should only be invoked where these fail to ensure that the child's needs are met appropriately, and where there is evidence that the child is suffering, or is likely to suffer, Significant Harm as a result of the neglect.
This guidance is only relevant to concerns about the care provided by the child's parent's or primary carers. Where the concerns are in relation to secondary carers, such as childminders, the concerns should be reported immediately to the child's parents, so that they can protect their child appropriately, and to the registration authority for the secondary carer (e.g. Ofsted), who can consider the possible implications for other children.
The Effect of Neglect on the Child
Chronic and severe forms of neglect pose a serious threat to a child's survival and are potentially fatal. Neglect causes great distress to children of all ages and is likely to lead to poor outcomes for the child in both the short and long-term. Children suffering neglect in the first months and years of life are likely to suffer damage to all facets of their physical and emotional development. Emotional neglect in which parenting is characterised by low warmth and high criticism is particularly damaging for children.
A neglected child is likely to experience long term problems with:
- Attachment and trust;
- Lack of Self-esteem;
- Problems with impulse control or ability to control behaviour;
- Social interaction and relationships;
- Life chances and opportunities in education and later in employment;
- Problem resolution;
- Neglect in childhood may also lead to difficulties in adulthood with assuming adult responsibilities, self care, and parenting of own children.
The Effect of Neglect in Adolescence
Neglect may occur for a child at any age. Whilst the dangers for babies and young children of neglectful parenting is evident and well recognised by professionals generally, there is increasing evidence that older children and adolescents frequently suffer neglect and that this is not as frequently recognised by professionals. It must be recognised that neglect of adolescents can equally as damaging and can place them at equal, if different, risk to that experienced by younger children.
There is a tendency for professionals to underestimate the effect of neglect on older children and adolescents and to judge any concerns around neglect in relation to this group as less serious.
One fifth of all Serious Case Reviews relate to children over 11 years old.
Professionals need to consider the developmental stages that young people are involved in when considering the impact of neglectful parenting. There is a risk that professionals may see adolescents as contributing to, or exacerbating a situation through their behaviour and may lose sight of the impact of neglectful parenting in adolescence that can lead to problematic adolescent behaviours.
Impact of neglect on older children and adolescents:
- Poor school performance, low IQ, low achievement, difficulty with problem solving and coping skills;
- Social and Emotional problems - drug and alcohol use, attempted suicide or self harm; Risk taking behaviour;
- Running away;
- At risk of sexual exploitation;
- Anti Social Behaviour.
Guidance for Practitioners around Recognising Behaviours and Parenting Patterns that Indicate that a Child may be Suffering Neglect
Neglect is rarely seen as an observable, single incident or crisis that professionals can identify as evidence that a child is suffering neglect. Characteristically it will be seen as a pattern of repeated, persistently neglectful behaviour causing incremental damage to a child over a period of time.
In spite of this, any concern should be shared with relevant professionals and agreement sought as to how, and at what level, the concern should be addressed.
Where there are emerging or low level concerns around the possibility of neglect, agencies should intervene at an early stage to offer support and advice through the CAF process.
It is important that the outcomes for the child should always be the primary focus of evaluation of the success of any intervention. All workers involved with the family should be aware of the thresholds for action or for referral to Social Care where the concerns reach a level to be considered under Child in Need or Child Protection (see LA Children's Social Care Thresholds and Minimum Standards, Coventry Safeguarding Children Board).
At any time the child may be:
- At risk of becoming a Child in Need;
- A Child in Need;
- In need of protection; or
- In need of immediate protective action.
It is not possible to provide simple criteria for establishing that a child is suffering neglect. Therefore, wherever there is a series of incidents or concerns professionals need to consider whether the child is being neglected. This should lead to full sharing of information between the agencies working with a family to determine whether the child is experiencing neglect and whether he/she is in need of services or of protection.
It is critical that where one professional or agency have concerns about the possibility of neglect, that this information is shared fully with partner agencies working with the family. Information held by one professional may take on new meaning when set alongside information held by others.
When identifying whether neglect is occurring workers should focus primarily on the child's needs and how they are being met, rather than the actions and inaction of the parents. Professionals should approach this in a child-centred way, and consider:
- What are the needs of this child?
- Do the parents understand this child's needs?
- Are the parents able and willing to meet the child's needs?
- Are they in fact meeting the child's needs well enough (i.e. is the parenting they are providing 'good enough' to meet the child's needs?)
All children have a range of basic needs that are determined by their age and developmental level, for food, shelter, clothing, warmth, safety, stimulation, protection, nurture, medical care, education and identity.
Each individual child may have varying levels of need across this range. Professionals concerned about the possibility of neglect need to consider whether those individual needs are being met adequately.
Failure to meet some aspects of the child's needs does not necessarily mean that the parents are neglectful, but it indicates that there is a need for support and intervention at a level appropriate to the impact of the failure on the child's health, development and wellbeing.
It is essential that professionals monitor the outcome of any intervention, and consider whether there has been positive change for the child and whether the parents are more able to meet the child's needs after the intervention?
Indicators that Neglect may be occurring
There is no set pattern to look for when considering whether a child is being neglected but if one or more of the following indicators is present, agencies should consider the possibility of neglect:
- The child is left alone or inappropriately supervised;
(This will vary depending on the child's age, development and individual needs for protection, nurture and opportunities to develop independence); - Failure to provide an adequate diet, evidenced by:
- Malnutrition;
- Always hungry;
- Constantly requests food at school, nursery etc;
- Overeating;
- Stealing food;
- Hoarding food;
- Taking food from bins;
- The parents do not show the child warmth or affection:
- Lack of physical contact, eye contact; and/or
- Lack of verbal contact with the child;
- Is interaction with the child warm or hostile?
- Is interaction with the child frequent and spontaneous or guarded and minimal?
- Do the parents ignore, avoid or reject the child?
- Do they behave in ways that are likely to undermine the child's confidence and self-esteem, e.g. use of insults, threats, taunts and verbal attacks;
- Poor parent/child relationship;
- Do the parents avoid physical contact with the child?
- Does the child avoid physical contact with the parents?
- Does the child show distress in the presence of parents?
- Does the child move away from the parent when under stress?
- Failure to provide appropriate routines and boundaries and development opportunities:
- Parents do not meet the child's need for stability?
- Child's day-to-day life lacks the routines which will help her/him develop security?
- Inconsistency between the child's behaviour and the parent's response to this?
- Failure to create opportunities or allow the child to take age appropriate responsibility?
- Failure to provide appropriate boundaries and supervise adolescent behaviour to the extent that child may place him/herself at risk;
- Poor level of stimulation;
- Attention-seeking behaviour;
- Withdrawn or over-placid behaviour;
- Rocking;
- Poor social interaction;
- Poor communication skills
- Anti-social behaviour; and
- Poor attendance, or non-attendance, at pre-school/school;
- Inappropriate sleeping pattern -
- Child is often tired;
- Developmental delay;
- Language delay;
- Poor attention;
- Emotional immaturity;
- Failure to meet child's health needs;
- Failure to attend for routine medical examinations and immunisations;
- Failure to attend to the child's medical needs;
- Failure to seek appropriate treatment, particularly in relation to vision and hearing;
- Refusal of appropriate medical treatment;
- Frequent accidents caused by inadequate supervision;
- Child inappropriately caring for self, or caring for siblings or parents -
- Getting self/others up in the mornings;
- Making meals for self/others;
- Dressing and washing self;
- Getting to and from school;
- Child's presentation or behaviours that may indicate neglectful parenting:
- Poor peer relationships;
- Poor social skills;
- Verbally and/or physically aggressive;
- Poor hygiene/smelly/unwashed clothes.
Adolescents need parenting and support around the development of a positive identity, educational achievement and social, sexual and physical development. Parental neglect in these key areas of development could be seen in:
- Absence of supervision; Harsh parenting/poor attachment;
- Staying out without parental knowledge/agreement;
- Being forced to leave home;
- Failing to ensure a child attends school; Failure to ensure health needs are met.
Guidance on Thresholds for Establishing that Neglect is taking Place
Establishing whether or not neglect has occurred is complex and requires consideration of a number of factors and the careful accumulation of evidence about how frequently, how seriously and for how long, the child's needs have not been met.
The focus should always be on the child's needs, both in terms of the universal needs of all children, and the specific needs of the individual child in question.
The essential factors to consider in demonstrating that a child is being neglected are that:
- The child is suffering, or is likely to suffer, Significant Harm; and
- That this harm, or risk of harm, is the result of the parents/carers' failure to meet the child's needs. This includes where parents have failed to meet any additional needs of the child that would require an increased level of parenting ability;
or - An inability to meet the developing needs of the child over time;
- Appropriate support and intervention has been made available for a reasonable period of time aimed at helping parents to make changes to their parenting and provide 'good enough' care that meets the child's needs; but
- The care of the child has not improved to the point where the child is receiving a consistently "good enough" standard of care or the care has deteriorated.
In establishing the threshold for neglect, medical evidence may be significant, and regular recording of height/ weight, DNA'd appointments, weight gain when the child is living with substitute carers may be crucial in establishing whether neglect is taking place. However, an over-reliance on medical surveillance and evidence is not always helpful, and should always be part of a multi-agency approach to the assessment.
Recording and Information Sharing
Because neglect often manifests itself in a series of minor incidents or concerns, only becoming apparent when patterns are identified, it is critical that all professionals make accurate, detailed and contemporaneous records of their contact with parents and children and that this information is shared fully and regularly with staff from other agencies. Regular, timely and effective information sharing and communication are key to the protection of children.
All professionals within one agency should work from a single set of records for each child.
Because the identification of patterns of concerns or incidents is crucial to establishing whether or not neglect is taking place, records should always include a detailed chronology of each planned intervention and the outcome.
All entries in case notes should:
- Be factual and evidence based;
- Rigorously separate fact and opinion;
- Be dated and timed;
- Give names and agencies in full; and
- State agreed responses and outcomes.
Guidance on Working with Families where there is Neglectful Parenting
In the initial stages of working with a family it can be difficult for workers to know whether a child is suffering neglect because the parents are in need of support and resources, or because they do not have the ability to meet the child's needs adequately.
Professionals should not assume that the provision of resources and supports will ensure that the child's needs will be met. It is essential that professionals monitor the effect of any intervention and its impact in terms of meeting the child's needs.
It is dangerous for professionals to be unrealistic or over-optimistic about the families they work with, and there is a risk that familiarity with the family's lifestyle may lead them to minimise concerns, fail to identify emerging patterns and not recognise the child's experience of neglect.
Because neglect tends to be characterised by a pattern of lower level concerns that gradually build up a picture of neglect, there is a risk that drift and delay in identification and action may occur.
For the same reasons it is possible that professionals may confuse different styles of care and standards of care. Styles of appropriate care vary widely, influenced by gender, class, culture, religion, age etc. However the critical consideration is that whatever the style of care, it meets the needs of the child appropriately.
Assessing progress in working with neglectful families
During intervention with families at any level - from CAF, Child in Need or Child Protection - a clear focus needs to be maintained on how the work is affecting outcomes for the child. Although most of the work will be directed towards parents, towards enabling them to develop more effective parenting skills and patterns, and enabling them to care for and protect their children, assessment of how successful this work has been should be measured primarily in terms of whether there has been a positive change in the care provided for the child.
This is a challenge for all professionals working with neglectful adults who are generally needy individuals, who will tend to draw professional attention away from the unmet needs of their children.
In assessing whether progress has been achieved with parents, workers should consider:
- Do they understand what action is needed and within what timescales?
- Are they able and willing to meet the child's needs?
- Are they actually meeting the child's needs better than when the concerns arose?
- Is anything changing for the child?
- Is the change enough to bring the standard of care up to an acceptable level?
Parents with learning disabilities
Where one or both parents have learning disabilities there are often concerns about possible or actual neglect. It is important to note that there is no simple relationship between intellectual and parenting ability.
However, parenting is a very complex and demanding task which requires an ability to adapt to the ever changing needs of a growing child and anticipate and plan how to meet those developments.
In assessing the parents' ability to meet the child's needs, it is essential to consider:
- Do they have the necessary knowledge and skills to meet the child's current needs and, if not, can they be helped to develop these?
- Are they able to develop the knowledge and skills necessary to meet the child's changing needs throughout childhood?
- What support services would be necessary to improve their parenting abilities and/or to develop positive parenting skills?
- Do the parents themselves need advice and assistance to help them to work with professionals? and
- Are they able, with appropriate support, to understand the work well enough to benefit from professional advice and assistance?
Guidance on Carrying out Section 47 Enquiries into Cases of Possible Neglect
Careful planning, meticulous recording and effective multi agency communication are key principles to be observed in Section 47 enquiries into possible neglect.
It is essential at an early stage to identify all professionals and agencies in touch with the family, and all family and social contacts able to contribute to the enquiries.
- Consideration should always be given to whether a paediatric assessment of the child is needed;
- A comprehensive observation of the home should always be undertaken;
- All children of the household should be seen and interviewed;
- If a child has communication difficulties or other disabilities, or where there is doubt about the interpretation of "normal development", specialist advice must be sought;
- Care must be taken to resist the pressure to focus on the needs of the parents. If necessary the parents should have access to specialist (and, if necessary, independent) advice and assistance, including assistance in communicating with professionals.
The assessment must address:
- The needs of the child (including any particular needs which require an increased level of parenting ability);
- The child's wishes and feelings about any plan to protect their welfare;
- The parents' ability to meet the child's needs, including the effect of any parent who stays at the home intermittently, and their ability to benefit from professional advice and assistance;
- The risk of Significant Harm to the child arising from unmet needs;
- The parents' capacity to change to meet the child's unmet needs;
- The resources in the extended family/social network/professional network which can be mobilised to meet the child's needs; and
- The action necessary to ensure that the child's needs are met in the future
Full consideration should be given to social, racial, cultural and religious factors. Where necessary, consultation should be sought by workers to develop an understanding of cultural or religious beliefs and how these can be worked with positively. However, this should always be considered within the primary context of the child's needs and the parents' ability to meet them. Where there is evidence that parenting practices are demonstrably damaging to the child's health, welfare or development, they should not be condoned or explained away on the basis of cultural norms or beliefs.
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