Identifying Neglect: What professionals can do

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Identifying Neglect What professionals can do

• Patrick Ayre
• Department of Applied Social Studies
• University of Bedfordshire
• Park Square, Luton
• email pga_at_patrickayre.co.uk
• web http//patrickayre.co.uk

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A child centred approach

• The purpose of assessment is to understand what
  it is like to be that child (and what it will be
  like in the future if nothing changes)

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Why do parents neglect?

• We need to understand the interaction between
• 3 Ns Nurture, Nature, Now
• Circumstantial factors and fundamental factors

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Why do parents neglect?

• Circumstantial
• Poverty
• Particular relationships
• Lack of skill/knowledge
• Temporary illness
• Lack of support
• Environmental factors

• Fundamental
• Lack of parenting capacity
• Deep seated attitudinal/behavioural/
  psychological problems
• Long term health issues
• Entrenched problematical drug /alcohol use

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The effects of neglect

• Howe identifies 4 types of neglect
• Emotional neglect
• Disorganised neglect
• Depressed or passive neglect
• Severe deprivation
• Each is associated with different effects and
  implications for intervention

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Emotional neglect

• Sins of commission and omission
• Closure and flight avoid contact, ignore
  advice, miss appointments, deride professionals,
  children unavailable
• However, may seek help with a child who needs to
  be cured
• Intervention often delayed

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Emotional neglect parents

• Cant cope with childrens demands
  avoid/disengage from child in need dismissive or
  punitive response
• Six types of response
• Spurning, rejecting, belittling
• Terrorising
• Isolating from positive experiences
• Exploiting/corrupting
• Denying emotional responsiveness
• Failing medical needs

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Emotional neglect children

• Frightened, unhappy, anxious, low self-esteem
• Precocious, streetwise
• Withdrawn, isolated, aggressive fear intimacy
  and dependence
• Behaviour increasingly anti-social and
  oppositional
• Brain development affected difficulties in
  processing and regulating emotional arousal

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Disorganised neglect

• Classic problem families
• Thick case files
• Can annoy and frustrate but endear and amuse
• Chaos and disruption
• Reasoning minimised, affect is dominant
• Feelings drive behaviour and social interaction

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Disorganised neglect carers

• Feelings of being undervalued or emotionally
  deprived in childhood so need to be centre of
  attention/affection
• Demanding and dependant with respect to
  professionals
• Crisis is a necessary not a contingent state

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Disorganised neglect carers

• Cope with babies (babies need them) but then
• Parental responses to children unpredictable
  driven by how the parent is feeling, not the
  needs of the child
• Lack of attunement and synchronicity

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Disorganised neglect children

• Anxious and demanding
• Infants fractious, fretful, clinging, hard to
  soothe
• Young children attention seeking exaggerated
  affect poor confidence and concentration
  jealous show off go to far
• Teens immature, impulsive need to be noticed
  leads to trouble at school and in community
• Neglectful parents feel angry and helpless
  reject the child to grandparents, care or gangs

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Depressed neglect

• Classic neglect
• Material and emotional poverty
• Homes and children dirty and smelly
• Urine soaked matresses, dog faeces, filthy
  plates, rags at the windows
• A sense of hopelessness and despair (can be
  reflected in workers)

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Depressed neglect carers

• Often severely abused/neglected own parents
  depressed or sexually or physically abusive
• May have learning difficulties
• Passive helplessness response to demands of
  family life
• Have given up both thinking and feeling

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Depressed neglect carers

• Listless and unresponsive to childrens needs and
  demands, limited interaction
• Lack of pleasure or anger in dealings with
  children and professionals
• No smacks, no shouting, no deliberate harm but no
  hugs, no warmth, no emotional involvement
• No structure poor supervision, care and food

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Depressed neglect children

• Lack interaction with parents required for mental
  and emotional development
• Infant Incurious and unresponsive moan and
  whimper but dont cry or laugh
• At school isolated, aimless, lacking in
  concentration, drive, confidence and self-esteem
  but do not show anti-social behaviour

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Severe deprivation

• Eastern European orphanages, parents with serious
  issues of depression, learning disabilities, drug
  addiction, care system at its worst
• Children left in cot or serial caregiving
• Combination of severe neglect and absence of
  selective attachment child is essentially alone

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Severe deprivation children

• Infants lack pre-attachment behaviours of
  smiling, crying, eye contact
• Children impulsivity, hyperactivity, attention
  deficits, cognitive impairment and developmental
  delay, aggressive and coercive behaviour, eating
  problems, poor relationships
• Inhibited withdrawn passive, rarely smile,
  autistic-type behaviour and self-soothing
• Disinhibited attention-seeking, clingy,
  over-friendly relationships shallow, lack
  reciprocity

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Capturing chronic abuse

• Judging the quality of care is an essential
  component of any assessment but how well do we do
  it?
• Judgements subjective and prone to bias
• Intangible Difficult to capture and compare
• High threshold and acclimatisation
• Neglect is a pattern not an event

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The pattern of neglect atypical
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The pattern of neglect typical
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The pattern of neglect
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The pattern of neglect
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The pattern of neglect
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Cumulativeness
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Failure of cumulativeness
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GCP provides

• Framework for making assessment
• Baseline measurement
• An element of objectivity
• Judgement about care
• Reliable standardised evidence

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GCP uses

• Pre-referral assessments
• Snapshot assessments
• Contribution to CAF assessments
• Contribution to Core Assessment (parenting
  capacity)
• Self-assessment (parents and carers)
• Young persons assessment of parenting
• Tool for setting goals and assessing progress
• Tool to facilitate discussion

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GCP users

• Health visitors
• School nurses
• Social workers
• Family centre workers
• Education staff

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Why choose GCP?

• Child focused
• User friendly
• Common language
• Promotes partnership

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Why choose GCP?

• Evaluates strengths as well as weaknesses
• Allows progress to be assessed
• A relatively objective measure
• Allows help to be targeted where needed

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Domains of Care
Stimulation Approval Disapproval Acceptance
Sensitivity Responsivity Reciprocity Overtures
Self actualisation
Esteem
Love and belongingness
Present absent
Safety
Physical needs
Nutrition. Housing, Clothing, Hygiene Health
Maslow, A. 1954
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What to observe
Nutrition Housing Clothing Hygiene Health
Quality, Quantity, Preparation, Organisation,
A. PHYSICAL B. SAFETY C. LOVE D. ESTEEM
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Grades of Care
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Scoring

• Rating 1 5
• Use on every child in the family
• Use with different carers
• Complete with the parent/carer
• Use information, observation, records

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Scoring

• Complete individual scores for each sub-area
• Transpose to the record sheet
• Agree action, targets and timescales

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Targeting Items of Care
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Unique Advantages

• Common language, common reference
• Objective measure child focussed
• Effective tool to promote partnership assessments
  and planning with parents
• User friendly
• Comprehensively covers all areas of care
• Child and carer specific