Neglect Practice Guidance
SCOPE OF THIS CHAPTER
Neglect of children and young people can have long-term effects on their health, development and well-being. The impact of neglect must be considered in the child's timeframe. Professionals need to reassess their understanding that sustained neglect is assessed with consideration to the child's age and development and not solely a prolonged period of time. For example lack of supervision for a child who is fully dependant of their parent/carer could result in serious harm.
AMENDMENTThis chapter previously called, Safeguarding Children and Young People from neglect has been extensively updated in April 2017 and should be re-read throughout.
The Pan Bedfordshire Neglect procedure has been development in line with the Pan Bedfordshire Neglect Strategy. Neglect is a priority for the three LSCBs as it is a significant factor for children on CP plans across the county and has been a key issue in local SCRs.
Neglect of children and young people can have long-term effects on their health, development and well-being. It can impact significantly on self-esteem, self-image and perception of self and of others. Persistent neglect can lead to serious impairment of health and development, intelligence, growth and physical ability and long term difficulties with social functioning, relationships and educational progress.
Neglect of children and young people is one of the most difficult areas in child care and child protection to identify, communicate effectively to professionals and assess and intervene in. It is the most common type of harm children or young people experience.
Working Together to Safeguard Children defines neglect as:
The persistent failure to meet a child or young person's basic physical and/or psychological needs, likely to result in the serious impairment of the child or young person'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 or young person from physical and emotional harm or danger;
- Ensure adequate supervision (including the use of inadequate care-givers); or
- Ensure access to appropriate medical care or treatment.
It may also include neglect of, or unresponsiveness to, a child's basic emotional needs.
The Serious Crime Act 2015 amended s.1 Children and Young Persons Act of 1933 (Child Cruelty) regarding neglect to read:
"If any person who has attained the age of sixteen years and has responsibility for any Child or young person under that age, wilfully assaults, ill-treats (whether physically or otherwise), neglects, abandons, or exposes him, or causes or procures him to be assaulted, ill-treated (whether physically or otherwise),neglected, abandoned, or exposed, in a manner likely to cause him unnecessary suffering or injury to health (including injury to or loss of sight, or hearing, or limb, or organ of the body, and any mental derangement) (whether the suffering or injury is of a physical or psychological nature), that person shall be guilty of an offence"
More than any other form of maltreatment, 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 or young person is suffering from Significant Harm.
Neglect cannot be defined as a one-off incident such as seeing an untidy kitchen while on a visit. Neglect is evidenced over a period of time with proof usually gathered from a number of agencies/professionals.
It is therefore important for professionals to keep a focus on the child or young person's lived experience (Horwath).
There may be other predisposing risk factors such as parental substance misuse or domestic violence (see Appendix 1: Predisposing Risk Factors for further details of pre-disposing risk factors and Appendix 2: Age Specific Risk Indicators of Child / Adolescent Neglect).
3. The Rights and Needs of Children and Young People
Children and young people'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 and young people.
The Children Act (1989/2004) 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). The Convention specifically identifies the right to:
- Life and the best possible chance to develop fully;
- An adequate standard of living 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 and young people 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 and young people should reflect anti-discriminatory practice.
4. Types of Neglect
One of the main reasons why neglect is difficult to define is that the term itself is an umbrella for numerous forms of child maltreatment. In an attempt to overcome this problem we have broken down the definition into the following:
- Refusal of/delay in health care - Failure or delay in seeking and obtaining appropriate health care services for a child/young person, including dental health;
- Abandonment/expulsion - Abandoning or excluding a child or young person from the family home and refusing to accept their return;
- Other custody issues - Repeated shuttling of a child or young person from one household to another due to an apparent unwillingness to maintain custody/care, or chronically and repeatedly leaving a child or young person with others for days/weeks at a time;
- Other physical neglect - inattention to avoidable hazards in the home, inadequate nutrition, clothing, or hygiene and other forms of reckless disregard for a child or young person's safety and welfare.
- Inadequate nurturance/affection - Marked inattention to the child or young person's needs for affection, emotional support, attention or competence;
- Chronic/extreme abuse or domestic violence - Chronic or extreme intimate partner abuse or other domestic violence in the child or young person's presence or likelihood of hearing;
- Allowing negative behaviour - Encouragement or permitting of negative behaviours (such as criminal activity and/or substance misuse) in circumstances in which the parent/guardian was aware of the existence and seriousness of the problem but did not attempt to intervene;
- Other emotional neglect - Other inattention to the child or young person's developmental/emotional needs not classifiable under any of the above forms of emotional neglect (e.g. markedly overprotective restrictions which foster immaturity or emotional over-dependence, chronically applying expectations clearly inappropriate in relation to the child or young person's age or level of development).
- Inadequate supervision – Child or young person left unsupervised or inadequately supervised for extended periods of time or lack of adequate supervision for a child who is fully dependant of their parent/carer could result in serious harm.
Educational or cognitive neglect:
- Permitted chronic truancy - Habitual truancy averaging at least five days a month is classifiable under this form of maltreatment if the parent/guardian has been informed of the problem, but has failed to intervene;
- Failure to enrol/other truancy - Failure to enrol a child or young person of mandatory school age, causing the school-aged child or young person to remain at home for non-legitimate reasons (e.g. to work or to care for siblings) an average of at least three days a month;
- Inattention to Special Educational Needs - Refusal to allow or failure to obtain recommended remedial educational services, or neglect in obtaining or following through with treatment for a child or young person 's diagnosed learning disorder or other special educational need without reasonable effort.
Historically, professionals have struggled to identify neglect for a variety of reasons including a fear of imposing their values on other people. SCRs - including those undertaken locally - have time and again highlighted this, alongside failings to join up information and a lack of co-ordinated communication between agencies as factors in neglect. Therefore it is important for all professionals to work within a recognisable framework with agreed definitions.
The Bedford Borough, Central Bedfordshire and Luton LSCBs have developed a Pan Bedfordshire Neglect Strategy and the three Local Authorities & Partners (including voluntary agencies) are in the process of implementing the Licenced Graded Care Profile 2 (GCP2). More information about this will be available via the LSCB websites:
- Central Bedfordshire Safeguarding Children Board;
- In Luton Borough Council there is an expectation that, in all cases where neglect is suspected or identified, professionals will have completed a GCP2 before making a referral to either the Early Help Services or the MASH unless there is a good reason for that not to have happened;
- Bedford Safeguarding Children Board.
The Graded Care Profile 2 is one of several tools available that provides professionals with a common tool to objectively measure neglect, to facilitate discussion with the parent/carer and agree interventions to make changes to improve the outcomes for their own children. The Graded Care Profile 2 will provide professionals with a common baseline measure to identify and assess the effectiveness of professional interventions.
The Graded Care Profile 2 can be used by professionals along the continuum of need from Universal to Statutory intervention. However it is anticipated that the Graded Care Profile Two will be used to identify neglect at the earliest opportunity to ensure early intervention. It can also be used to escalate to statutory intervention including Public Law Outline processes. Please see relevant LSCB Multi-agency Threshold documents. Where professionals have concerns that require statutory intervention consideration must be given to the need for a paediatric medical opinion. This should always be considered at the strategy discussion in consultation with the on call paediatrician for child protection medicals. Please see Child Protection Medical Assessments:
- Central Bedfordshire Assessment and Threshold Guidance;
- Bedford - A Child Centred System Understanding Thresholds;
- Luton - Meeting the Needs of Children, Young People and Their Families.
Graded Care Profile 2
Graded Care Profile 2 is a validated tool (NSPCC) that helps those working with children, young people and families to measure the quality of care being given to a child. It's an assessment tool that can help practitioners and families to identify anything that's putting that child at risk of harm. It is important to identify this risk as early as possible so we can get the right help and avoid children living with neglect for a long period of time.
Graded Care Profile 2 shows:
- What needs to change.
Helping practitioners to objectively measure neglect and to identify areas where parents need to improve their care should result in better outcomes for children and by working out what parents can do better; it's easier for the person working with a family to get them the right support to improve the life of their child.
Purpose of the GCP2:
- Where neglect is suspected:
- To assess the current quality of care and give a base line measurement;
- To target intervention;
- To monitor progress after interventions.
- Where quality of care is of interest:
- In targeting resources;
- In understanding educational outcomes for a child;
- In understanding emotional or behaviour outcomes for a child.
The Graded Care Profile 2 can be used by licenced practitioners.
Practitioners are specially trained to use the tool when visiting families at home to do an assessment. It's called Graded Care Profile 2 because different aspects of family life are 'graded' on a scale of 1 to 5.
Questions are broken down into 4 areas:
- Physical, such as quality of food, clothes and health;
- Safety, such as how safe the home is and if the child knows about things like road safety;
- Love, such as the relationship between the carer and child;
- Esteem, such as if a child is encouraged to learn and if they a praised for doing something good.
By providing a clear, objective framework for evaluating a family's strengths and weaknesses, Graded Care Profile aims to:
- Help professionals manage and monitor their caseloads more effectively;
- Direct the right support to the families who need it the most;
- Protect more children from neglect.
Data and research has led to a growing recognition that adolescents can experience neglect. Many teenagers have lived with neglectful care throughout their childhood. Factors which can be present are the same as many of those for younger children.
In addition, inappropriate expectations can arise when a young person becomes an adolescent. Parents may become emotionally and physically unavailable to the young person yet inappropriately rely on the young person for their own support and needs. Support may be lacking for the young person at developmental, educational and personal milestones.
Adolescent neglect can have very serious consequences. Young people are more likely:
- To be excluded from education;
- To become involved in anti-social or offending behaviours;
- To be at risk of trafficking, sexual exploitation and going missing;
- To face stigmatisation by peers;
- To misuse substances;
- To experience depression or anxiety;
- To have an inappropriate diet;
- To self-harm/attempt suicide;
- In the worst scenario, to die.
It is important that professionals working with adolescents bear in mind the possibility of neglect when responding to the needs of young people.
Luton LSCB has published some guides for practitioners.
A useful resource for practitioners is a Government Review that provides an accessible summary of relevant literature on adolescent neglect: Neglect matters: a multi-agency guide for professionals working together on behalf of teenagers.
Practitioners need to be able to differentiate between issues of care that are related to medical / disability related and those that derive from maltreatment. This is not simple and requires multi –agency working to ensure that assessments accurately consider the causes. For example a young person with complex needs demonstrated aggressive behaviour for a number of years and had led to no dental care over that period. Due to dental decay he had to have them removed. Staff noted that a significant improvement in behaviour afterwards and recognised dental pain had been a significant factor.
Appendix 1: Predisposing Risk Factors
Research suggests that certain family and environmental factors may be predisposing risk factors in child neglect. These include:
Factors in parents/carers:
- History of physical and/or sexual abuse or neglect in own childhood;
- History of being in care;
- Multiple losses;
- Multiple pregnancies, with many losses;
- Concealed pregnancy (risk to mother an unborn child relating to emotional attachment between the mother and child and lack of ante-natal care due to non-attendance to ante-natal care;
- Economic disadvantage/long term unemployment;
- Parents with a mental health difficulty, including (post-natal) depression;
- Parents with a learning difficulty/disability;
- Parents that have chronic ill health;
- Domestic abuse in the household;
- Parents with substance (drugs and alcohol) misuse;
- Early parenthood;
- Families headed by a lone mother or who has a transient male partners;
- Father's criminal convictions;
- Strong ambivalence/hostility to helping organisations;
- Mother indifferent, intolerant or very anxious towards her child;
- Significant stress during pregnancy and perinatal period (e.g. separation, death, loss of employment);
- Separation of mother and child (for more than one week) during first months of life (hospitalisation, placement);
- History of child(ren) or young people in family being looked after by Local Authority, extended family or friends.
Factors in the child or young person:
- Birth difficulties/prematurity/very low birth weight babies;
- Children or young people with a disability/learning difficulty/complex needs;
- Children or young people living in large family with poor networks of support;
- Children or young people in larger families with siblings close in age;
- Low educational level (less than 11 years);
- Children < 1 year;
- Asylum seeking children or young people.
- Families experience racism/discrimination;
- Family isolated/in dispute with neighbours;
- Social disadvantage e.g. low family income/low employment status;
- Multiple house moves/homelessness.
Appendix 2: Age Specific Risk Indicators of Child / Adolescent Neglect
|Key Features in Infants (0-2)|
|If babies are not fed appropriately for their age they may fail to thrive. If they are habitually cold and wet they may take longer to recover from recurrent infections. If they develop nappy rash it may be a sign that they are not being changed regularly.|
|Key Features in Pre-School Children (2-5)|
Persistent neglect during the pre-school period often results in poor growth (height and weight). Poor language development and emotional immaturity are also common to the neglected child.The attention span of neglected children is often limited and may be associated with hyper-activity. Peer relations can be difficult to make and sustain as neglected children may not have the ability to develop the social skills necessary for co-operative play. Some children may elicit intimate contact from complete strangers and crave physical contact ("touch hunger").
|Key Features in School Children and Young People (5 - 16)|
In the child or young person who has reached school age the effects and main indictors of long-term neglect are usually found in poor social and emotional development, behavioural problems and learning difficulties.
In many cases there is no direct evidence of an effect on growth. Schools may be unable to compensate for the long-term lack of cognitive stimulation at home because neglected children or young people have huge difficulties attending to learning tasks. This may be exacerbated by poor attendance.Neglect should be considered as a possible cause in children or young people who are disruptive and difficult to manage.