Noticing and helping the
neglected child
Brigid Daniel
Professor of Social Work
University of Stirling
Julie Taylor, Professor of Family Health , University of
Dundee, and Head of Strategy and Development:
Abuse in High Risk Families, NSPCC
Cheryl Burgess, Research Fellow, University of Stirling
Jane Scott, Independent researcher
Outcomes for children
We know that children who are
neglected have some of the poorest
emotional and cognitive outcomes,
are at high risk of accidents and are
vulnerable to sexual abuse.
5
 Children who are neglected don’t ask for help.
 Parents of neglected children also find it
difficult to ask for help – especially from social
workers.
 Children’s unmet needs may often be noticed
by others.
 Many people, including professionals, are
uncertain about what to do with their
concerns.
 Traditionally the ‘child protection system’ has
responded better to incidents than to chronic
circumstances.
Definitions of neglect can vary
according to the purpose.
 criminal or civil legal proceedings
 national or local policy
 research on child development, aetiology, long term





outcomes
research on the operation and effectiveness of practice
determining eligibility for services
delivering a service
investigation of allegations
rationing scarce resources.
Broad definitions
‘Neglect is defined in terms of child
needs that are potentially unmet and
subsequent impact on child
functioning or development’
(English, 2005)
Tighter definitions
 Medical neglect.
 Nutritional neglect.
 Emotional neglect.
 Educational neglect.
 Physical neglect.
 Lack of supervision and guidance.
(Horwath 2007, p.27).
Neglect is the persistent failure to meet a child’s basic physical
and/or psychological needs, likely to result in the serious
impairment of the child’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 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.
Working Together (2010)
There have been
children I
worry about
when I
go home at night
Head
Teacher
The case must
reach the
threshold,
resources are
scarce.
Of course
something
must be
done!
hungry
guidance
sad
tired
PRACTITIONER
CHILD
unloved
SIMPLE
assessment
categories
System
dirty
multiagency
resouces
COMPLEX
SCRI: Research Questions
 What is known about the ways in which children and
families directly and indirectly signal their need for
help?
 To what extent are practitioners equipped to
recognise and respond to the indications that a child’s
needs are likely to be, or are being neglected,
whatever the cause?
 Does the evidence suggest that professional response
could be swifter?
Filtering process
20,480
16,239 after duplicates removed
1,532 after removal of unrelated items
686 after title and abstract screening
112 after identified as primary study of relevance
63 after scoring for method and usefulness
What is known about the ways in which children and
families directly signal their need for help?
 Very little evidence - most start with substantiated
neglect, but
 Mothers could express concerns about potential
neglect
 parents who misuse substances could identify
impact upon their children.
 Children don’t directly ask for help;
 some school nurses in Finland noticed children
who sought advice;
 neglected children could be identified on a self-
report computer programme.
(Combs Orme, 2004; McKeganey, et al., 2002; Paavileinen, et al.,
2000; Kantor et al., 2004)
What is known about the ways in which parents
indirectly signal their need for help?
 Much more evidence – many familiar parental
factors  impoverished home environment, fewer parental
resources, previous history of maltreatment /csa,
substance misuse, domestic abuse, mental health,
drug-using network, welfare assistance, problems
accessing childcare, youth of parent, 2 or more
children, previous child removal.
 Risk increases with number of risk stress factors,
especially beyond 4 or 5.
 Studies vary in whether prospective or
retrospective and what factors are controlled
for.
 No certain, clear and predictable pathways
emerge.

(Brown et al. 1998; Carter & Myers, 2007; Cash & Wilke, 2003; McGuigan & Pratt,
2001; Nair et al., 1997 & 2003; Ondersma, 2002; Scannapieco & Connell, 2003 &
2005)
Nonetheless, all should be noticeable to
practitioners as signs of possible need for
support.
What is known about the ways in which children
indirectly signal their need for help?
•An example of indirect signs came from two studies of
burns which showed, although the burns were similar
to those attributable to accidents, it was more likely
that:
•the child had not been given first aid at the time,
•there was a delay of over 24 hours before seeking help.
•the burns would be deeper
•children fared worse than abused children in keeping
appointments and receiving adequate wound care .
(Chester et al., 2006; Hultman et al, 1998,).
 Internalising and externalising behaviour can be seen
by age 3 peer problems by 6;
 behaviour problems,
 impaired socialisation and
 problems with daily living skills by 8
(Dubowitz et al., 2002; 2004; 2005)
Signs would be evident to many professionals and
members of the community.
To what extent are practitioners equipped to
recognise and respond to the indications that a
child’s needs are likely to be, or are being
neglected?
 Professionals tend to have higher thresholds than the
general public.
 Health visitors are very well equipped to recognise
parental characteristics and developmental signs in
children.
 Some examples of good practice e.g. Finland - ‘active
and firm’ school nurses.
 Absence of evidence about schools, teachers and the
police.
Does the evidence suggest that
professional response could be swifter?
 Protocols and guidelines are not a sufficient spur.
 Trust, relationships, communication, anxiety, fear and
confidence affect willingness to act on concerns.
 Many studies referred to the importance of training
as a mechanism to raise awareness.
 Training when coupled with access to on-going
consultation and support could increase recognition
and referral of child abuse and neglect.
(Angeles-Cerezo & Pons-Salvador, 2004)
In summary
 Response for the general public and professions
other than social work/services/CPS tended to
mean 'referral’
 Response for social work/services/CPS tended
to mean 'investigation'.
 The main problem lies, not so much in
recognition, as in the perceived complexity of
the response mechanism.
Annual Review of Child Neglect
with Action for Children
1. Do we know how many children are currently
experiencing neglect in the UK?
2. How good are we at recognising children
who are at risk of, or are experiencing
neglect?
3. How well are we helping children at risk of,
or currently experiencing neglect?
 During 2011 we:
 collected all the UK statistics we could find about
children already ‘officially’ labelled as neglected as
well as those in need and affected by parental
substance misuse, mental health issues and
domestic abuse
 analysed policy documents
 surveyed a total of 47 authorities (or Boards in NI)
across the UK
 carried out 6 focus groups across the UK
 obtained online poll results from 2062 adults in
the general public and 2,174 professionals
(including social workers, police, health
professionals and teachers).
Do we know how many children are
currently experiencing neglect in the UK?
 It is relatively easy to find out about the tip of the
iceberg
 In March 2010 the most common reason for children
being made subject to a child protection plans was
neglect: 44% in England and Scotland, in NI it was
29% with a further 21% where neglect was a
contributing issue and in Wales the figures were 43%
and a further 6% where neglect was a feature
(NSPCC, 2011).
 Less than half of the areas surveyed could give us
figures about the larger part of the iceberg.
How good are we at recognising children
who are at risk of, or are experiencing
neglect?
 Just over half of the public have worried about a child.
 94% feel that people should do something if concerned
about a child.
 81% of health and education professionals have
encountered neglected children.
 Professionals across the board are increasingly aware of
such children and of their responsibilities to these
children.
 Many feel that they can’t obtain help for children at an
earlier enough stage.
How well are we helping children at risk of,
or currently experiencing neglect?
 We worry that children slip through the net, but
 many children appear to get stuck in the net.
 Professionals know about these children, but they
and their families are not receiving swift and effective
help when needed.
 The public want services for families to be funded
and they want there to be treatment services for
adults with problems.
 Social workers want to carry out direct work with
children and families.
1. The answer to the first question is ‘yes and no’. We
know how many are ‘officially’ neglected, but we
do not have proper figures about the actual
number of children whose needs are not being met.
2. The answer to the second question is that there are
signs that we are getting better at recognising
neglect, but the public are uncertain what to do
and professionals often feel powerless to help.
3. The answer to the third question is that there are
many services that can help children and families
but they are too often disjointed and fragile, leaving
neglected children without the help they need.
Need for shift of focus
 There is still insufficient attention to what would
support parents and children to seek help on their
own behalf.
 At the same time, we have focused on improving
‘detection’ of neglect by staff in universal services–
but in reality the problem is more one of appropriate
response to their concerns.
Intervention should
 incorporate relationship building and attachment
 be long-term rather than episodic
 be multi-faceted
 be offered early as well as late
 consider both protective and risk factors
 involve fathers or male caregivers as well as
female caregivers.
Help-seeking
‘..the … assumption that clients in need
will contact the service is negated by data
from the client interviews, which reveals
how difficult it can be for vulnerable
people to seek out professional help’
(Appleton & Cowley, 2004). p.794).
`
‘…parents with extreme problems such as drug
or alcohol related abuse, mental health
problems, domestic violence or criminal
records were reluctant to be drawn into
'systems'. They were frightened. They did not
want to be on anyone's list. They had learned
not to trust professionals,…A long timescale is
needed to break down such barriers and to
establish relationships with families with this
level of resistance.’
(Anning, Stuart, Nicholls, Goldthorpe, & Morley, 2007,
p.81-2)
Children and help-seeking
 Children prefer to seek help from family and friends and
are unlikely to turn formal help as a first port of call. They
are more likely to speak to adults who appear to care
about them and who will listen without taking precipitate
action.
‘They lack trust in professionals, are concerned about
confidentiality and fear intervention in the family and
associated loss of control over the consequences of
telling’
(Gorin, 2004, p.59).
• ‘Hard to
reach’
• ‘Hard to help’
Unhelpful
labels
Service
analysis
• ‘Hard to
access’
• ‘Hard to use’
• Accessible
• Responsive
Improved
Services