Identifying, assessing and
understanding neglect
Patrick Ayre
Department of Applied Social Studies
University of Bedfordshire
Park Square, Luton
email: pga@patrickayre.co.uk
web: http://patrickayre.co.uk
NEGLECT
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
 protect from physical and emotional harm or danger
 ensure adequate supervision
 ensure access to medical care or treatment.
It may also include neglect of, or unresponsiveness to, a
child’s basic emotional needs.
NEGLECT
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
 protect from physical and emotional harm or danger
 ensure adequate supervision
 ensure access to medical care or treatment.
It may also include neglect of, or unresponsiveness to, a
child’s basic emotional needs.
NEGLECT
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
 protect from physical and emotional harm or danger
 ensure adequate supervision
 ensure access to medical care or treatment.
It may also include neglect of, or unresponsiveness to, a
child’s basic emotional needs.
NEGLECT
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
 protect from physical and emotional harm or danger
 ensure adequate supervision
 ensure access to medical care or treatment.
It may also include neglect of, or unresponsiveness to, a
child’s basic emotional needs.
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
At birth our brains are only 25% developed
 By age 3, a child’s brain has reached
almost 90% of its adult size and has
accpmplished 80% of its total development.
 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 “activity-dependent”
 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.
Checkpoint 1: timing intervention
If we wait until we can see the evidence
of neglect in a child’s behaviour, it may
be too late to put it right completely.
Neglect
Behavioural

Constant hunger

Constant tiredness

Frequent lateness or non-attendance at
school

Destructive tendencies
Neglect

Low self-esteem

Neurotic behaviour

No social relationships

Running away

Compulsive stealing or scavenging
Neglect
Physical

Poor personal hygiene

Poor state of clothing

Emaciation, pot belly, short stature

Poor skin and hair tone

Untreated medical problems
Significant harm
Harm is defined by Children Act 1989:

ill-treatment (including sexual abuse and, by
implication, physical abuse)

impairment of health (physical or mental) or
development (physical, intellectual, emotional,
social or behavioural)
The child's basic needs

basic physical care

affection

security

stimulation of innate potential

guidance and control

responsibility

independence
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
Forms 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
(Howe, D (2005) Child Abuse and Neglect, Basingstoke: Palgrave Macmillan)
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

Associated with avoidant/defended patterns of
attachment
Emotional neglect: parents

Can’t cope with children’s demands:
avoid/disengage from child in need; dismissive or
punitive response

Children provided for materially but there is a
failure to connect emotionally

More rules; everyone has a role and knows what to
do.

Parents may feel awkward & tense when alone
with their children.
Emotional neglect: children
When attachment behaviour rejected:
 Learns that caregiver’s physical and emotional
availability is reduced when emotional demands
are made;
 Caregiver most available when child is showing
positive affect, being self-sufficient,
undemanding and compliant;
 Reverse roles, “false brightness” to care for/
reassure parent.
Emotional neglect: children

Frightened, unhappy, anxious, low selfesteem

Withdrawn, isolated, fear intimacy and
dependence

Precocious, ‘streetwise’, self-reliant
Emotional neglect: children

May show compliance to dominant caregivers but
anger and aggression in situations where they feel
more dominant.

May learn that power and aggression are how
relationships work and you get your needs met
 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

Worker may feel agenda co-opted by family’s
immediate needs
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
 May be regarded as overwhelmed but amenable to
services
 Crisis is a necessary not a contingent state

Associated with ambivalent/coercive patterns of
attachment
Disorganised neglect: carers

Cope with babies (babies need them) but
then…

Parental responses to children
– unpredictable and insensitive (though not
necessarily hostile or rejecting).
– 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 seem unmotivated, mild learning disability

Learned helplessness in response to demands of
family life;
Stubborn negativism; passive-aggressive
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

Younger the child, more debilitating the effects

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 self-esteem
but do not show anti-social behaviour
Depressed neglect: case management
These families need:
 Long term involvement
 Supportive approach
 Responsiveness to family’s signals and needs
 BUT these need to be balanced with a
recognition of the children’s needs. (How long
is too long? How much is too much?)
Depressed neglect: infants and children

Must experience responsive and stimulating
environments that also provide human comfort
for a few hours each day.

The longer the child is exposed to
helplessness, the more intense and longer the
intervention needed to remedy the situation.
Depressed neglect: parents

Must learn appropriate ways to show their
feelings
– Practice smiling, laughing, soothing
– May be mechanical at first
– Genuine feelings will emerge with repetition

As parents learn to show their feelings, the
child’s responsiveness will increase; virtuous
spiral
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, autistictype behaviour and self-soothing

Disinhibited: attention-seeking, clingy, over-friendly;
relationships shallow, lack reciprocity
Checkpoint 2: case management
How should we manage cases of:

Emotional Neglect

Disorganised neglect

Depressed neglect

Severe deprivation
Emotional neglect: case management

Help parents to learn to use others for support.

Teach parents to engage emotionally with their
children.

Must be highly structured as neither parent or
child know how to interact normally &
spontaneously.

Fear of affect – need clear rules & roles
Disorganised neglect: case management

Logic would argue for warding off crises for a while
so that families can be taught to organise their lives,
but…

Family may want to have needs met, but cannot
delay gratification or trust logic and planning;

Without intense demands associated with crises,
have no way of being important to others;

Will CREATE new crises.
Disorganised neglect: case management

Feelings must be addressed

Need a structured, predictable environment with no
surprises where:
– There are rewards for clear, direct, and undistorted
communication of feelings and accurate cognitive
information about future outcomes
– Family can learn the value of compromise

Teach parents how to use cognitive information to
regulate feelings (without denying them)
Depressed neglect: case management

Involves much more than teaching appropriate
parenting

All family members must learn that their
behaviour has predictable and meaningful
consequences

Teach that it helps to share feelings with
empathetic others.
Depressed neglect: case management
Our standard approaches don’t work
 Threats / punitive approaches particularly
ineffective:

– Parents don’t believe they can change so don’t
even try.
– Even most reasonable pressure results in
“shutting down” / blocking out all info.

Parent education – may be ineffective
because judgment impaired and gains not
transferable.
Severe deprivation: case management

Highly unlikely to be in the child’s best interests to
remain in the environment which caused the harm;

It is probable that the child and new carers will
require substantial therapeutic and emotional
support;

Significant challenges often persist despite a move
to a caring and predictable environment.
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 for recognition

Neglect is a pattern not an event
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 for recognition

Neglect is a pattern not an event
Our image of assessment
Assessment
The reality of assessment?
Assessment
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 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
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P
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Threshold for
intervention
Failure of cumulativeness
S
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X
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A
B
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S
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Threshold for
intervention
P
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Y
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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)
Checkpoint 3: Acclimatisation
 Do
you ever encounter acclimatisation?
 What
do you do about it?
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
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
needs met
Essential
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
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 anticipation
Timing
Comprehends clear
signals – distinct
verbal or clear
nonverbal
expression.
Responses mostly
synchronised except
when occupied by
essential chores.
Not sensitive enough
– stimuli and signals
have to be intense to
make an impact e.g.
cry.
Not synchronised for
own recreational
engagement;
synchronised if fully
unoccupied or child
in distress.
Quite insensitive –
needs repeated or
prolonged intense
signals.
Insensitive to even
sustained intense
signals or aversive.
Even when child in
distress responses
delayed.
No responses unless
a clear mishap for
fear of incrimination.
C Responses
Reciprocation complementary to
(quality) the signal. Both
emotionally and
materially, can get
over stressed by
distress signals from
child. Warm.
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.
Emotional
reciprocation brisk,
flat and functional,
annoyance if child in
moderate distress
but attentive if in
severe distress.
Aversive/punitive
even if child in
distress, acts after a
serious mishap
mainly to avoid
incrimination, any
warmth/remorse
deceptive.
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
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
Putting it all together:
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

Adult services and children’s services
(hand-in-hand or hand-to-hand?)
Children’s services and adult services

Working on the same case but not working
jointly

Mutual incomprehension and
misunderstanding

False expectations and assumptions

Abdicating responsibility

Need for ‘interpreters’
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’
Challenge your dodgy thinking

I am only a… and he is a…, so I had better
keep my opinion to myself.

I am obviously in a minority, so I had better
keep my opinion to myself.

We need to maintain harmonious relations,
so I had better keep my opinion to myself.
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:
what?’
‘So
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
Checkpoint 4: So what?
We have spent some time considering how to
recognise and respond to neglect.
What does this mean for us? What are the
implications for local services? What, if
anything, will be different?
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)
Bonus material
Working with resistance
“In many cases parents were hostile to helping agencies and workers
were often frightened to visit family homes. These circumstances could
have a paralysing effect on practitioners, hampering their ability to reflect,
make judgments, act clearly, and to follow through with referrals,
assessments or plans. Apparent or disguised cooperation from parents
often prevented or delayed understanding of the severity of harm to the
child and cases drifted. Where parents made it difficult for professionals
to see children or engineered the focus away from allegations of harm,
children went unseen and unheard”.
“Families tended to be ambivalent or hostile towards helping agencies,
and staff were often fearful of violent and hostile men. Although parents
tended to avoid agencies, agencies also avoided or rebuffed parents by
offering a succession of workers, closing the case, losing files or key
information, by re-assessing , referring on, or through initiating and then
dropping court proceedings”.
Brandon, M, and others (2008) Analysing child deaths and serious injury through abuse and neglect: what can we learn?
London: Department for Children, Schools and Families
Engagement
“Engagement is the basic task of a child and
families worker but can never be taken for
granted and must always be worked for”
Context
‘Involuntary’ work may be characterised by

Guardedness or reluctance to share
information

Avoidance and a desire to leave the
relationship

Strong negative feelings such as anxiety,
anger, suspicion, guilt or despair.
Context
We need to accept that:

The best we may be able to achieve is
honesty rather than positive feelings and a
high degree of mutuality

Conflict and disagreement are not
something to be avoided, but are realities
that must be explored and understood.
How might resistance show itself?





By only being prepared to consider 'safe'
or low priority areas for discussion.
By not turning up for appointments
By being overly co-operative with
professionals.
By being verbally/and or physically
aggressive.
By minimising the issues.
(Egan, 1994)
Potential parental responses

Genuine commitment

Compliance / approval seeking

Tokenism

Dissent / avoidance
(Horwath and Morrison, 2000)
Identifying resistance: 4 categories




Hostile resistance: anger threats,
intimidation, shouting
Passive aggressive: surface compliance
covers partly concealed antagonism and
anger
Passive hopeless: Tearfulness and
despair about change
Challenging: Cure me if you can!
Strategies for enhancing engagement


Before you start, check your mindset (your own
biases and assumptions)
Have realistic expectations:
–
–
–
–
It is reasonable that involuntary clients resent being
forced to participate
Because they are forced to participate, hostility,
silence and non-compliance are common responses
that do not reflect my skills as a worker
Due to the barriers created by the practice situation,
clients may have little opportunity to discover if they
like me
Lack of client co-operation is due to the practice
situation, not to my specific actions and activities
(Ivanoff et al, 1994 )
During initial contacts




Adopt a non-defensive stance
Be clear, honest and direct and
acknowledge the involuntary nature of the
relationship
Clarify roles and expectations, including
what is required of the client
Explain consequences of non-compliance
and the advantages of compliance
(Ivanoff et al, 1994 )
Try to

Invite participation

Understand how the client sees the
problem as well as how we see it

Understand what the client wants, as well
as what we want
(Ivanoff et al, 1994 )
What might we be doing to make it worse?






Becoming impatient and hostile
Doing nothing, hoping the resistance will
go away
Lowering expectations
Blaming the family member
Allowing the family member to control the
assessment inappropriately
Failing to acknowledge our fear
What might we be doing to make it worse?



Becoming unrealistic
Believing that family members must like
and trust us before assessment can
proceed.
Ignoring the enforcing role of some
aspects of child protection work and
hence refusing to place any demands on
family members.
(Egan, 1994)
Avoid

Expressions of over-concern

Moralising

Criticising the client

Making false promises

Displaying impatience
Productive approaches



Give practical, emotional support especially by being available, predictable
and consistent
See some resistance and reluctance as
normal
Explore our own resistance to change and
by examining the quality of our own
interventions and communication style
(Egan, 1994)
Productive approaches



Helping family members to identify
incentives for moving beyond resistance
Tapping the potential of other people who
are respected as partners by the family
member
Understanding that reluctance and
resistance may be avoidance or a signal
that we are not doing our job very well
(Egan, 1994)
Confrontation
In child welfare services, the Children’s
Service Worker must be a skilled confronter.
Confrontation is, basically, facing the client
with the facts in the situation and with the
probable consequences of behaviours
(Texas Department of Human Resources)
A scale for assessing motivation
1.
2.
3.
4.
5.
Shows concern and has realistic
confidence.
Shows concern, but lacks confidence.
Seems concerned, but impulsive or
careless
Indifferent or apathetic about problems
Rejection of parental role.
Shows concern and has realistic confidence.

Parent is concerned about children’s welfare;
wants to meet their physical, social, and
emotional needs to the extent he/she
understands them.

Parent is determined to act in best interests
of children

Has realistic confidence that he/she can
overcome problems and is willing to ask for
help when needed

Is prepared to make sacrifices for children.
Shows concern, but lacks confidence



Parent is concerned about children’s
welfare and wants to meet their needs,
but lacks confidence that problems can be
overcome
May be unwilling for some reason to ask
for help when needed. Feels unsure of
own abilities or is embarrassed
But uses good judgement whenever
he/she takes some action to solve
problems.
Seems concerned, but impulsive or careless



Parent seems concerned about children’s
welfare and claims he/she wants to meet their
needs, but has problems with carelessness,
mistakes and accidents. Professed concern is
often not translated into effective action.
May be disorganised, not take enough time, or
pays insufficient attention; may misread ‘signals’
from children; may exercise poor judgement.
Does not seem to intentionally violate proper
parental role; shows remorse.
Indifferent or apathetic about problems



Parent is not concerned enough about
children’s needs to resist ‘temptations’, eg
competing demands on time and money. This
leads to one or more of the children’s needs not
being met.
Parent does not have the right ‘priorities’ when it
comes to child care; may take a ‘cavalier’ or
indifferent attitude. There may be a lack of
interest in the children and in their welfare and
development.
Parent does not actively reject the parental role.
Rejection of parental role



Parent actively rejects parental role,
taking a hostile attitude toward child care
responsibilities.
Believes that child care is an ‘imposition’,
and may ask to be relieved of that
responsibility. May take the attitude that it
isn’t his or her ‘job’.
May seek to give up the responsibility for
children
(Magura et al,1987)