SAFEGUARDING BABIES AND VERY
YOUNG CHILDREN FROM
ABUSE AND NEGLECT
COVENTRY LSCB
22 May 2013
Rebecca Brown and Harriet Ward
Centre for Child and Family Research (CCFR)
Loughborough University
Why babies?
Infants under the age of one are:
• Nearly three times as likely as others to be
subjects of child protection plans due to physical
abuse
• More than twice as likely to be subjects of child
protection plans due to neglect
• Subjects of 45% of serious case reviews (into
child death or serious injury)
• Eight times the average risk of child homicide
Safeguarding Children Across Services
(Davies, C. and Ward, H. 2012)
• 15 studies initiated following the death of
Victoria Climbié in 2000; informed by death
of Peter Connelly in 2007
• Key themes:
– Identification and initial response to abuse and
neglect
– Effective interventions
– Inter-agency and inter-disciplinary working
– Focus on neglect and emotional abuse
Safeguarding Babies and Very Young
Children from Abuse and Neglect:
(Ward, Brown and Westlake 2012; Ward, Brown and Maskell Graham, 2012)
• Prospective longitudinal study of 57 babies
identified as suffering or likely to suffer
significant harm
• All identified before first birthdays; almost
two thirds (65%) before birth
• 43 followed until age three; 37 until age five
so far
• Data from case papers; annual interviews
with birth parents/carers; Strengths and
Difficulties Questionnaires
Parents’ difficulties
• Primary risk factors: violence (at home and in
community), substance misuse issues, mental ill
health, learning disabilities, experiences of abuse in
childhood
• Secondary risk factors: housing problems including
homelessness, financial problems including
bankruptcy
• Isolation, poor relationships with extended family
• Twenty mothers and an unknown number of fathers
had already been permanently separated from at
least one older child
Children
• Majority from families already known to children’s
social care through involvement with older siblings
• 65% identified before birth; almost all before they were six
months old
• 63% were boys
• 69% White British; 31% from BME groups: 69% of these
were of mixed heritage. High proportion of BME infants
found in other studies (see Selwyn et al. 2010)
• 14% were identified as having disabilities or special health
care needs. Children with disabilities are 3.4 times more
likely to experience abuse and neglect (Sullivan and Knutson,
2000)
Classifying Families by Risk of Harm
• Based on systematic review of evidence
concerning risk and protective factors and
the likelihood of maltreatment or its recurrence
(Hindley, Ramchandani and Jones, 2006)
• Each child classified according to the level of
risk of maltreatment or its recurrence
• Classification used date at identification by children’s
social care (Time One) at age three (Time Two) and at
age five (Time Three)
• Particular weight given to evidence of parents’ capacity
for change
The Children at Entry
• Severe risk (12:28%): Risk factors, no
protective factors and no capacity for change
• High risk (7:16%): Risk factors, protective
factors and no capacity for change
• Medium risk (21:49%): Risk factors,
protective factors, capacity for change
• Low risk (3:7%): No risk factors (or previous
risk factors addressed, protective factors and
capacity for change. Includes two outliers
At age three
• 37% (16) low risk: adequately safeguarded, living with birth
parents who had sustained positive changes
• 35% (15) low risk: permanently separated
• 28% (12) medium-severe risk: inadequately safeguarded with
birth parents who had not shown capacity to change
• 53% (23) had experienced abuse or neglect
• 37% (16) maltreated in utero
• 37% (16) maltreated while open cases
• 57% displayed emotional problems or substantial behavioural
difficulties
• No evidence that 20 (47%) children experienced
maltreatment by the time they were three
At age five
• Over a third (38%) at continuing risk of harm
• Children who were safeguarded from domestic
violence at three no longer safe at five
• Almost half the separated children in fragile placements
• Widespread developmental delay: poor speech and language
• One in three displaying emotional and behavioural patterns
sufficient to warrant referral for clinical support – three times
expected prevalence
• Behavioural issues: extreme aggression; self harming
• Problems more prevalent amongst late separated children
and those living with birth parents but inadequately
safeguarded
Acceptable and unacceptable
parenting in a civilised society
• Nobody died
• BUT the sample includes children who:
–
–
–
–
–
Were not fed for so long that they ceased to cry
Could explain how to prepare heroin for consumption
Were allowed to taste illicit drugs from a spoon
Were left to forage for food in the waste bin
Were locked in their bedrooms for hours on end with
nothing to do
– Routinely arrived at school unfed and in filthy clothes
• Children’s development and long-term wellbeing
compromised
Messages for Practice
• Understanding the impact of abuse
and neglect
• Implications of not acting on concerns
• Early identification and swift referral
• Identifying effective interventions and
parents who can change
• Keeping the focus on the child
Early identification and swift referral:
Messages that need wider dissemination
• Close relationships between child maltreatment and
parents’ substance misuse, mental ill health, and
domestic violence, particularly in combination (Cleaver,
Unell and Aldgate, 2011)
• Failure to meet basic needs; emotional unavailability;
inability to protect; inability to focus on the child
• Severe learning disability associated with neglect and
emotional abuse, particularly when domestic violence,
substance misuse and/or mental health problems are
also present
Early identification and swift referral
• 22/53 referred by health professionals
• Only one child referred by drug and alcohol
services
• Tensions between adult and children’s services
• Reluctance to consider impact of adults’ problems
on parenting behaviour and child’s development
• Reluctance to refer: fears of inappropriate or
precipitate response
• Concerns about sharing information
Reasons for swift decisive action
• Brain develops particularly rapidly in the first two years
but majority of neurons formed pre-birth
• Foundations for empathy, trust and impulse control laid
within the first two years
• Quality and sensitivity of mother-child interaction at 6-15
weeks correlates with attachment relationship at eighteen
months
• Witnessing domestic abuse harms babies as young as nine
months; pregnancy can be a trigger for domestic abuse
• Gross neglect in the first three years impairs social and
cognitive development
Timeframes for decision making
(Separation)
• Separation at birth was extremely rare
On average it took:
– 7.5 months for a definitive decision to place away from
home
– 7 more months for this to be fully actioned
– Five months minimum to find suitable adoptive home
• No new permanence decisions between ages
three and five
• Separations at six and seven following pressure
from schools
If adoption is the best solution
• Where children cannot be safeguarded by
birth family:
– Babies placed for adoption before first
birthdays are more likely to become securely
attached to adoptive carers than those place
later
– High proportion (c60%) of permanently
separated infants experience double jeopardy:
delayed separation followed by delayed
permanence
Children placed for adoption:
national timescales
• Average age at permanent separation – 14
months
• Average age at permanent placement – 36
months
• Children aged six months at entry likely to be
placed at 25 months; those aged 6 ½ years at
entry likely to be placed at 9 ¼ years
• 90 (2%) children p.a. adopted aged 10+
Average time between entry to care and
placement with adoptive family: 22 months
Pathway One: (double jeopardy)
• Child has experienced abuse in birth family
followed by stable placement in care
• Develops secure attachment to temporary
carers
• Disrupted attachment when placed with
adoptive carers
Average time between entry to care and
placement with adoptive family: 22 months
Pathway Two: (repeated disruptions)
• Child enters care precipitately and is placed in temporary
placement
• First temporary placement can lead to a sequence,
including repeated, failed returns
• Repeated changes of caregiver replicate previous
experience and reinforce insecure attachment patterns
• Increased difficulties in developing secure attachment to
adoptive carers (see Ward, Munro and Dearden, 2006)
Identifying parents who can change
• Just over a third of parents (16:37%) successfully
overcame adversities to meet the needs of their
children within appropriate timescales
• They received some effective interventions, but
these were often short term, and ended
abruptly
• No evidence of intensive evidence based
interventions designed to address their needs
(eg PUP; MST CAN)
Which parents can change?
(Tentative data)
Parents who successfully changed were:
• Less likely to have experienced abuse in childhood
and substantially less likely to have experienced
childhood sexual abuse
• Able to come to terms with the removal of older
children
• Able to acknowledge the risks posed by their
destructive behaviour patterns
• Able not simply to engage with services but also to
make positive use of the support they offered
• Able to develop supportive informal networks
The birth of a child as a catalyst for change
• No parent overcame substance misuse if they
continued to use drugs after the child had been
born
• All but one set of parents who made and sustained
sufficient changes, had addressed all known risk
factors by the time the child was six months old
• A number of parents, including four of those who
overcame substance misuse, spoke of a ‘wake-up
call’ that acted as a catalyst for change. No parents
in the insufficient change group spoke of such an
epiphany
Simon’s mother: what made
her change?
“My son being born, my son being born, definitely.
And I think the scare what social services gave me
was a kick up the arse and the scare that I
needed…They were going to put [Simon] into
foster care…And I thought to myself, I just cannot,
you know, you know what, it felt like a movie, I felt
like, oh my god, my baby, not my baby. And he was
so tiny, I felt like, oh no my baby, I felt like, and I
thought you’re having a laugh, I couldn’t believe,
you know…A big shock, a big shock, it was a big
wake-up call and it was just a terrible feeling, I
couldn’t believe it.”
Practice Implications
• Risk and protective factor methodology helpful in
identifying who may change – and who may not
• Pre-birth risk assessment would be valuable –
especially if it led to action
• Some parents do not have capacity to change in
time for this particular child
• Change needs effective specialist help and long
term ongoing support
• Some solutions, especially for domestic violence,
are not helpful
Keeping a focus on the child
• Almost all professionals gave parents
every opportunity to demonstrate
capacity to change
• The social workers’ role is to safeguard
the children, not to preserve the family
at all costs
• Children’s rights can be in conflict with
parents’ rights
• The hardest task is to keep the focus on
the child
• Even harder when babies grow older and
new siblings take their place
Possible ways forward: Speeding up
adoption process
• Faster decision-making
• More children placed for adoption
• New targets and benchmarking
BUT
• May lead to more children waiting in limbo – shortage
of adoptive families
• May lead to more children being unnecessarily
separated
• Only ever suitable for very small number of children
• One element in a wider strategy
Possible ways forward: more effective and
more timely services
• Better, more timely assessment
(pre-birth assessment is rare)
• More use of evidence based
programmes (e.g. Parents Under
Pressure; Family Nurse Partnerships;
MST-CAN)
• Better development and integration
of school based interventions
• Better development of processes for
stepping down (and stepping up)
Possible ways forward: addressing
the underlying factors
• Primary risk factors for maltreatment include:
substance misuse, domestic and community
violence; mental health problems; experience of
abuse in childhood, especially in combination
• Secondary stressors include: poverty,
unemployment, poor housing; social exclusion;
inequality
• Addressing the factors that underlie maltreatment is
a necessary step towards reducing the prevalence
References
Davies, C. and Ward, H. (2012) Safeguarding Children Across
Services: Messages from research. London: Jessica Kingsley
Publishers
Hindley, N., Ramchandani, P.G. and Jones, D.P.H. (2006) ‘Risk factors
for recurrence of maltreatment: A systematic review.’ Archives of
Disease in Childhood 91, 9, 744-752.
Jones, D., Hindley, N. and Ramchandani, P. (2006) ‘Making plans:
assessment, intervention and evaluating outcomes’ in Aldgate, J.,
Jones, D. And Jeffery, C. (eds) The Developing World of the Child,
London: Jessica Kingsley Publishers.
Lewis, M., Feiring, C., McCuffog, C., and Jaskir, J. (1984) ‘Predicting
psychopathology in six year olds from early social relations’, Child
Development 55, 123-136
Sullivan, P. and Knutson, J. (2000) ‘Maltreatment and
disabilities: A population based epidemiological study.’ Child
Abuse & Neglect 24, 10, 1257-1273.
Van den Dries, L., Juffer, F., Van IJzendoorn, M.H. and
Bakermans-Kranenburg, M.J. (2009) ‘Fostering security? A
meta-analysis of attachment in adopted children.’ Children
and Youth Services Review 31, 410-421.
Ward, H., Brown, R. and Westlake, D. (2012) Safeguarding
Babies and Very Young Children from Abuse and Neglect.
London: Jessica Kingsley Publishers.
Ward, H., Brown, R. and Maskell-Graham, D. (2012) Young
Children Suffering, or Likely to Suffer, Significant Harm:
Experiences on Entering Education. DFE RR209, London:
Department for Education.
Safeguarding Children Research Initiative
www.education.gov.uk/researchandstatistics/research/scri
Free download of briefing papers, research briefs and the overview book
Ward, H. Brown, R. and Westlake, D.
Safeguarding Babies and Very Young
Children from Abuse and Neglect, London:
Jessica Kingsley Publishers
Thank you
H.Ward@lboro.ac.uk
R.C.Brown@lboro.ac.uk
Website: www.lboro.ac.uk/research/ccfr/