Identifying and
Assessing Neglect
Patrick Ayre
Department of Applied Social Studies
University of Bedfordshire
Park Square, Luton
email: [email protected]
Presentation can be downloaded from:
http://patrickayre.co.uk/Presentationd.htm
NEGLECT
Parents who neglect their children basically just
don’t know any better because of their own poor
upbringings. If we send them to a family centre
for Parental Skills training, all will be well.
NEGLECT
Parents who neglect their children basically just
don’t know any better because of their own poor
upbringings. If we send them to a family centre
for Parental Skills training, all will be well.
IF ONLY!!....
NEGLECT
So neglected children who come into care may be a bit
thin, a bit dirty, badly in need of seeing a doctor or
dentist, maybe a bit wild.
But we can place them with foster carers for a bit of
looking after, a bit of TLC, a bit of structure and
everything will be fine. The children will absolutely love
it and will immediately start to thrive. Simple really!
NEGLECT
So neglected children who come into care may be a bit
thin, a bit dirty, badly in need of seeing a doctor or
dentist, maybe a bit wild.
But we can place them with foster carers for a bit of
looking after, a bit of TLC, a bit of structure and
everything will be fine. The children will absolutely love
it and will immediately start to thrive. Simple really!
IF ONLY!!....
Brain development
By the age of 3, a baby’s brain has
reached almost 90 percent of its adult
size.
 The growth in each region of the brain
largely depends on receiving
stimulation.
 This stimulation provides the foundation
for learning.

Experience Affects the Structure
of the Brain
Brain development is “activitydependent”
 Every experience excites some neural
circuits and leaves others alone
 Neural circuits used over and over
strengthen, those that are not used are
dropped resulting in “pruning”

Poor integration of hemispheres and
underdevelopment of the orbitofrontal cortex

Difficulty regulating emotion,

Lack of cause-effect thinking,

Inability to recognize emotions in others,

Inability to articulate own emotions,

Incoherent sense of self and
autobiographical history

Lack of conscience.
Other physiological issues
 Serotonin:
emotional stability and
feeling good
 Malnutrition: cognitive and motor
delays, anxiety, depression, social
problems, and attention problems
 Myelination
 Sensitive periods (infancy &
attachment)
Emotional development

Sensitive period for emotional
development: up to 18 months

Shaped primarily by the way in which
the prime carer interacts with the child

Emotional deficits harder to overcome
once the sensitive window has passed.

How often do we intervene assertively
at this point?
Building a child
Building a child is like building a house,
each new level built on the one below. If
the lower levels are unsound, no amount
of tinkering with the upper floors will make
it stable.
Capturing chronic abuse

Single events often only significant in context;

Can often only understand present by setting
in context of past

Intangible: Difficult to capture and compare

High threshold for recognition

Neglect is a pattern not an event
The pattern of neglect: atypical
The pattern of neglect
Intervention
Intervention
The pattern of neglect
'Good enough' level
Intervention
Intervention
The pattern of neglect
Intervention ceases
'Good enough' level
Intervention
Intervention
The pattern of neglect
Cumulativeness
S
E
X
U
A
L
A
B
U
S
E
P
H
Y
S
I
C
A
L
A
B
U
S
E
N
E
G
L
E
C
T
N
E
G
L
E
C
T
N
E
G
L
E
C
T
Threshold for
intervention
Failure of cumulativeness
S
E
X
U
A
L
A
B
U
S
E
Threshold for
intervention
P
H
Y
S
I
C
A
L
A
B
U
S
E
N
E
G
L
E
C
T
N
E
G
L
E
C
T
N
E
G
L
E
C
T
N
E
G
L
E
C
T
What’s the problem?
 Chronic
abuse and the principle of
cumulativeness
Files very long and badly structured
Patterns missed and ‘chronic abuse’
overlooked
The problem of proportionality
Acclimatisation (case, agency and
geographical)
Why do parents neglect?
We need to understand the interaction
between:

3 Ns: Nurture, Nature, Now

Circumstantial factors and fundamental
factors
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
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
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
Emotional neglect: parents

Can’t cope with children’s 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
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
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
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
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’
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
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)
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
Depressed neglect: carers

Listless and unresponsive to children’s
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
Depressed neglect: children

Lack interaction with parents required for
mental and emotional development

Infant: Incurious and unresponsive; moan
and whimper but don’t cry or laugh

At school: isolated, aimless, lacking in
concentration, drive, confidence and selfesteem but do not show anti-social
behaviour
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
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, overfriendly; relationships shallow, lack reciprocity
The assessment of neglect

An approach based on the Graded Care
Profile by Dr OP Shrivastava
GCP provides:
 Framework for making assessment
 Baseline measurement
 An element of objectivity
 Judgement about care
 Reliable standardised evidence
http://www.lutonlscb.org/index.php?option=com_content&view=article&id=
183&Itemid=52
GCP users

Health visitors

School nurses

Social workers

Family centre workers

Education welfare workers
GCP uses








Pre-referral assessments
Snapshot assessments
Contribution to CAF assessments
Contribution to Core Assessment (parenting
capacity)
Self-assessment (parents and carers)
Young person’s assessment of parenting
Tool for setting goals and assessing progress
Tool to facilitate discussion
Domains of Care
Stimulation
Sensitivity
Responsivity
Self
actualisation
Reciprocity
Overtures
Esteem
Love and belongingness
Safety
Approval
Disapproval
Acceptance
Present &
absent
Physical needs
Maslow, A. 1954
Nutrition. Housing, Clothing,
Hygiene & Health
What to observe
A. PHYSICAL
B. SAFETY
Nutrition
Quality,
Housing
Quantity,
Clothing
Preparation,
Hygiene
Organisation,
Health
C. LOVE
D. ESTEEM
Grades of Care
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Level of care
All child’s Essential
needs met needs fully
met
Some
essential
needs met
Most
essential
needs unmet
Essential
needs entirely
unmet/hostile
Commitment
to care
Child first
Child priority
Child/carer at
par
Child second
Child not
considered
Quality of
care
Best
Adequate
Equivocal
Poor
Worst
Example: AREA C: LOVE
Sub-areas
1
2
3
4
5
Comprehends
clear signals –
distinct verbal or
clear nonverbal
expression.
Not sensitive
enough – stimuli
and signals have to
be intense to make
an impact e.g. cry.
Quite insensitive –
needs repeated or
prolonged intense
signals.
Insensitive to even
sustained intense
signals or aversive.
Responses mostly
synchronised
except when
occupied by
essential chores.
Not synchronised Even when child in
for own
distress responses
recreational
delayed.
engagement;
synchronised if
fully unoccupied or
child in distress.
No responses
unless a clear
mishap for fear of
incrimination.
Material responses
(treats etc.)
lacking, but
emotional
responses warm
and reassuring.
Emotional
reciprocation warm
if in good mood
(not burdened by
strictly personal
problem),
otherwise flat.
Aversive/punitive
even if child in
distress, acts after
a serious mishap
mainly to avoid
incrimination, any
warmth/remorse
deceptive.
1. Carer
A Anticipates or picks
Sensitivity up very subtle
signals- verbal or
nonverbal
expression or
mood.
B Responses well
Response synchronised with
Synchronisation signals or even
before in
Timing anticipation
C Responses
Reciprocation complementary to
(quality) the signal. Both
emotionally and
materially, can get
over stressed by
distress signals
from child. Warm.
Emotional
reciprocation brisk,
flat and functional,
annoyance if child
in moderate
distress but
attentive if in
severe distress.
Sub-Area
Scores
1. NUTRITION
1
2
3
4
5
2. HOUSING
1
2
3
4
5
3. CLOTHING
1
2
3
4
5
4. HYGIENE
1
2
3
4
5
5. HEALTH
1
2
3
4
5
(B)
Safety
1. IN CARER’S PRESENCE
1
2
3
4
5
2. IN CARER’S ABSENCE
1
2
3
4
5
(C)
Love
1. CARER
1
2
3
4
5
2. MUTUAL ENGAGEMENT
1
2
3
4
5
1. STIMULATION
1
2
3
4
5
2. APPROVAL
1
2
3
4
5
3. DISAPPROVAL
1
2
3
4
5
4. ACCEPTANCE
1
2
3
4
5
(A)
Physical
(D)
Esteem
Area
Score
Comments
Targeting Items of Care
Targeted
Areas
1
2
3
4
5
Current
Score
Target
Score
Timescale Reviewed
Score
Making an assessment

Guidance provided (follow up scores of
4 or 5)

Evaluates strengths as well as
weaknesses

Allows progress to be assessed

A relatively objective measure

Allows help to be targeted where
needed
Making an assessment






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
Scale for Assessing Neglectful
Parenting (Northamptonshire)
179 individual questions under the following
headings:
 Food and Eating Habits
 Health and Hygiene
 Warmth/Clothing
 Safety and Supervision
 Emotional Needs
 Cognitive Development
 Educational Needs
http://northamptonshirescb.proceduresonline.com/chapters/p_lscbn
_neg.html
Example questions (Health and Hygiene)
21 The home lacks showering or bathing facilities which
work, and are available for maintaining personal
hygiene
22 The bath and basin are dirty, or inaccessible
23 The family lacks a toilet which works
24The toilet is regularly left dirty or stained
25 Toddler’s potties are left unemptied containing urine
and faeces
26 The kitchen is dirty (eg cooker ingrained with old
food, grime on walls, floor, kitchen utensils, sink)
Making an assessment






Each statement scored 1, 2 or 3
according to how true it is.
Blank spaces for Summary,
Conclusions and Action Plan
Lengthy and comprehensive list of
relevant factors
No guidance on making overall
judgments
Statements all identify weaknesses
Allocation of questions to headings a
little eccentric at times
The chain of reasoning
Facts

Analysis/summary

Conclusions/recommendations/action
The chain of recording
What happened/what you saw

What this means

What you did/what should be done (and
why, if this is not clear from the above)
The chain of recording

But how do you know which facts?

Must be informed by a basic risk
assessment (would not always be
spelled out on paper)
Risk assessment





The dangers involved (that is the feared
outcomes);
The hazards and strengths of the situation (that is
the factors making it more or less likely that the
dangers will realised);
The probability of a dangerous outcome in this
case (bearing in mind the strengths and hazards);
The further information required to enable this to
be judged accurately; and
The methods by which the likelihood of the feared
outcomes could be diminished or removed.
Bias and Balance
Include information favourable to ‘the
other side’ as well as that favourable to
yours
 It is your job to make judgements but:

– avoid empty evaluative words like
inappropriate, worrying, inadequate
– Give evidence for descriptive words like
cold, dirty and untidy

Beware the danger of facts
Bias and Balance
Born in 1942, he was sentenced to 5
years imprisonment at the age of 25. After
5 unsuccessful fights, he gave up his
attempt to make a career in boxing in
1981 and has since had no other regular
employment
Lies, damned lies and killer bread
Research on bread indicates that
 More than 98 percent of convicted felons are bread users.
 Half of all children who grow up in bread-consuming
households score below average on standardized tests.
 More than 90 percent of violent crimes are committed within
24 hours of eating bread.
 Primitive tribal societies that have no bread exhibit a low
incidence of cancer, Alzheimer's, Parkinson's disease, and
osteoporosis.
 In the 18th century, when much more bread was eaten, the
average life expectancy was less than 50 years; infant
mortality rates were unacceptably high; many women died in
childbirth; and diseases such as typhoid, yellow fever, and
influenza were common.
Incomplete or out of date
Can you trust a snapshot?
Assessment Pitfalls
Parents’ behaviour, whether co-operative or
uncooperative, often misinterpreted
 Information from family friends and neighbours
undervalued


Coping with aggressive or frightening families

Failure to give sufficient weight to relevant
case history; ‘Start again syndrome’

Not enough attention is paid to what children
say, how they look and how they behave;
maintenance of a wholly child-centred approach
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)
Information handling pitfalls






Picking out the important from a mass of
data
Facts recorded faithfully but not always
critically appraised
Too trusting/insufficiently critical;
Decoyed by another problem
False certainty; undue faith in a ‘known
fact’
Discarding information which does not fit
the model we have formed
Department of Health (1991) Child abuse: A study of inquiry
reports, 1980-1989, HMSO, London
Assessment pitfalls

Rule of optimism

Natural love

Cultural relativism

Too much
not enough
Information handling pitfalls

Keeping your head down

Hesitancy to challenge other
professionals or the conventional
wisdom

Tendency to move from facts to
actions without ‘showing your working’
But what is analysis?
You have gathered lots of information but now what?
All you need to do is ask yourself my favourite question:
“So what?”
You have collected all this data, but what does this
mean, for the service user, for the family and for my
setting?
Conclusions and recommendations





Summarise the main issues and the
conclusions to be drawn from them. (The
facts do not necessarily speak for
themselves; it is your job to speak for them.)
Define objectives as well as actions
Draw conclusions from the facts and
recommendations from the conclusions
Explain how you arrived at your conclusions
(Have you demonstrated the
factual/theoretical basis for each?)
Consider and discuss alternative possibilities
Conclusions and recommendations

In drawing conclusions be aware of the
extent and limitations of your own expertise.
 Conclusions may be supported by research
(Don’t go outside expertise; be careful with
new or controversial theories; be aware of
counter arguments)
 Your recommendation should usually be
specific (not either/or)
 Remember: conclusions may be attacked in
only two ways
– founded on incorrect information
– based on incorrect principles of social work
Conclusions and recommendations
Problems:

Unsupported assertions or judgements

Inability or unwillingness to analyse and
draw conclusions

Failure to answer the key question:
‘So what?’
Reaching a decision

‘Often a decision is made first and the
thinking done later’ (Thiele, 2006)

As humans, we resort to simplifications, short
cuts and quick fixes!

We reframe, interpret selectively and
reinterpret.

We deny, discount and minimise

We exaggerate information especially if vivid,
unusual, recent or emotionally laden and

We avoid, forget and lose information
Good Assessments







Are clear about the purpose, legal status and
potential outcomes
Are based on a clear theoretical framework
Are clear about context and value base
Are collaborative and promote accessibility
for service users
Are based on multiple sources of information
Value the expertise and understanding
service users bring to their situation
Are clear about missing information
Good Assessments







Identify themes and patterns about needs, risks,
protective factors and strengths
Generate and test different ways of understanding
the situation
Give meaning to themes, using knowledge based on
experience/research
Lead to an evidence-based conclusion
Use supervision to assist reflection, hypotheses and
objectivity
Are able to record and explain outcomes
Are reviewed, updated & amended in light of new
information
Spotting the bad ones:
Organisational Clues

Mythology exists about the family – ‘this
family is/always/behaves like

Negative stereotypes about other agencies
exist so their information is discounted

Sudden changes about view of risk not
explained

Sudden changes of plan not rationally
explained
Worker clues

Gut feelings says something is wrong

Worker does not ask difficult questions

Analysis does not account for facts/history

Proposed plan does not address issues
raised in assessment

Practitioner is working much harder than the
parents to explain significant concerns

The child’s story is missing
Inter-Agency Clues

Agencies have conflicting views of the
family/risk

Agencies have strong views but offer
ambiguous/limited evidence

Some agencies unwilling to share
information

Pressure to agree suppresses
permission to question / inter-agency
acclimatisation
Family Clues

Parental intentions not supported by actions

Parental optimism involves denial of
difficulties

Children's accounts conflict with parents’

Parents’ ‘talk’ about their child is
contradictory/lacks coherence

Co-operation is only on the parents’ terms
A final thought
“We are guilty of many errors and many faults
but the worst of our crimes is abandoning our
children, neglecting the fountain of life. Many of
the things we need can wait. The child cannot.
Right now is the time his bones are being
formed, his blood is being made, and his
senses are being developed. To him we cannot
answer 'Tomorrow.' His name is 'Today.'”
Gabriela Mistral (Chilean poet, 1889-1957)
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Assessing Neglect Workshop (Bridgend)