Identifying, assessing and understanding neglect Understanding and assessing neglect 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

Understanding and assessing 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.

Understanding and assessing 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.

Understanding and assessing 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.

Understanding and assessing 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.

Understanding and assessing 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.

Understanding and assessing 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!!....

Understanding and assessing 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!

Understanding and assessing 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!!.... The damage is not on the surface, it often runs quite deep and we need to understand how it got there in order to put it right. Painful though it is, we need to understand what it does to you to be neglected.

Understanding and assessing neglect 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 Understanding and assessing neglect 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”

Understanding and assessing neglect

Understanding and assessing neglect

Understanding and assessing neglect

Understanding and assessing neglect 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 Understanding and assessing neglect 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 Understanding and assessing neglect 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?

Understanding and assessing neglect 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 Understanding and assessing neglect 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.

Understanding and assessing neglect Behavioural Constant hunger Constant tiredness Frequent lateness or non-attendance at school Destructive tendencies

Understanding and assessing neglect Low self-esteem Neurotic behaviour No social relationships Running away Compulsive stealing or scavenging

Understanding and assessing neglect Physical Poor personal hygiene Poor state of clothing Emaciation, pot belly, short stature Poor skin and hair tone Untreated medical problems

Understanding and assessing neglect 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)

Understanding and assessing neglect The child's basic needs basic physical care affection security stimulation of innate potential guidance and control responsibility independence

Understanding and assessing neglect Why do parents neglect? We need to understand the interaction between: 3 Ns: Nurture, Nature, Now Circumstantial factors and fundamental factors

Understanding and assessing neglect 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

Understanding and assessing neglect Forms of neglect Understanding and assessing 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)

Understanding and assessing neglect 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 Understanding and assessing neglect 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 Understanding and assessing neglect 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 Understanding and assessing neglect Emotional neglect: children Frightened, unhappy, anxious, low self- esteem Withdrawn, isolated, fear intimacy and dependence Precocious, ‘streetwise’, self-reliant

Emotional neglect: children Understanding and assessing neglect 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

Understanding and assessing neglect 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 Understanding and assessing neglect 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 Understanding and assessing neglect 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 Understanding and assessing neglect 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

Understanding and assessing neglect 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 Understanding and assessing neglect 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 It is a personality trait marked by a pervasive pattern of negative attitudes and passive, usually disavowed resistance in interpersonal or occupational situations. It can manifest itself as learned helplessness, procrastination, stubbornness, resentment, sullenness, or deliberate/repeated failure to accomplish requested tasks for which one is (often explicitly) responsible. It is a defense mechanism, and usually only partly conscious.

Depressed neglect: carers Understanding and assessing neglect 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 Understanding and assessing neglect 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 Understanding and assessing neglect 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 Understanding and assessing neglect 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 Understanding and assessing neglect 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

Understanding and assessing neglect 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 Understanding and assessing neglect 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, over-friendly; relationships shallow, lack reciprocity

Checkpoint 2: case management Understanding and assessing neglect Checkpoint 2: case management How should we manage cases of: Emotional Neglect Disorganised neglect Depressed neglect Severe deprivation

Emotional neglect: case management Understanding and assessing neglect 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 Understanding and assessing neglect 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 Understanding and assessing neglect 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 Understanding and assessing neglect 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 Understanding and assessing neglect 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 Understanding and assessing neglect 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 Understanding and assessing neglect 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 Understanding and assessing neglect 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 Understanding and assessing neglect Our image of assessment

The reality of assessment? Understanding and assessing neglect The reality of assessment?

Capturing chronic abuse Understanding and assessing neglect 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

Understanding and assessing neglect The pattern of neglect

Understanding and assessing neglect The pattern of neglect

Understanding and assessing neglect The pattern of neglect

Understanding and assessing neglect The pattern of neglect

Understanding and assessing neglect Cumulativeness Child protection system is triggered when threshold of likely significant harm has been crossed. Physical and sexual abuse, where a serious precipitating incident comes to light which clearly crosses the threshold at once. Many chronic cases may be characterised by a lengthy pattern of actions or incidents, none of which is in itself sufficient to trigger intervention. They have to get added together like this

Failure of cumulativeness Understanding and assessing neglect Failure of cumulativeness

Understanding and assessing neglect 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) Three principle reasons for this failure of cumulativeness. The first is that the incidents giving rise to concern may lie scattered through the relevant files, recorded and responded to separately with no one making cumulative connections between them. They may lie unshared on the files of a variety of different interested agencies or unremarked within the files of a single agency. Picked up and put down Many 'duty worker' and 'team responsibility' systems may be prone to this failing.   The notion of proportionality: uncomfortable about invoking the full might of the system over a 'minor' incident, even where this incident is just one of a very worrying series. Acclimatised to unacceptably low standards, typified by remarks such as 'What can you expect from this family?' or 'That's the way they are; they've always been the same'. Conditions likely to cause significant harm come to be regarded as the norm and all future incidents come to be judged against this depressed standard with the result that incidents have to be increasingly bad to be identified as causing concern at all and the cumulative effect on the child is overlooked.

Checkpoint 3: Acclimatisation Understanding and assessing neglect Checkpoint 3: Acclimatisation Do you ever encounter acclimatisation? What do you do about it? Three principle reasons for this failure of cumulativeness. The first is that the incidents giving rise to concern may lie scattered through the relevant files, recorded and responded to separately with no one making cumulative connections between them. They may lie unshared on the files of a variety of different interested agencies or unremarked within the files of a single agency. Picked up and put down Many 'duty worker' and 'team responsibility' systems may be prone to this failing.   The notion of proportionality: uncomfortable about invoking the full might of the system over a 'minor' incident, even where this incident is just one of a very worrying series. Acclimatised to unacceptably low standards, typified by remarks such as 'What can you expect from this family?' or 'That's the way they are; they've always been the same'. Conditions likely to cause significant harm come to be regarded as the norm and all future incidents come to be judged against this depressed standard with the result that incidents have to be increasingly bad to be identified as causing concern at all and the cumulative effect on the child is overlooked.

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

Love and belongingness Domains of Care Stimulation Approval Disapproval Acceptance Sensitivity Responsivity Reciprocity Overtures Self actualisation Esteem Love and belongingness Present & absent Safety As Prakash said he used Maslow’s work to build on using the four domains and further sub-dividing them. Physical needs Nutrition. Housing, Clothing, Hygiene & Health Maslow, A. 1954

What to observe Nutrition Housing Clothing Hygiene Health Quality, Quantity, Preparation, Organisation, A. PHYSICAL B. SAFETY 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 Sensitivity Anticipates or picks up very subtle signals- verbal or nonverbal expression or mood. 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. B Response Synchronisation Timing Responses well synchronised with signals or even before in anticipation Responses mostly synchronised except when occupied by essential chores. Not synchronised for own recreational engagement; synchronised if fully unoccupied or child in distress. Even when child in distress responses delayed. No responses unless a clear mishap for fear of incrimination. C Reciprocation (quality) Responses complementary to 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 Area Score Comments (A) Physical 1. NUTRITION 1 2 3 4 5 2. HOUSING 3. CLOTHING 4. HYGIENE 5. HEALTH (B) Safety 1. IN CARER’S PRESENCE 2. IN CARER’S ABSENCE (C) Love 1. CARER 2. MUTUAL ENGAGEMENT (D) Esteem 1. STIMULATION 2. APPROVAL 3. DISAPPROVAL 4. ACCEPTANCE

Targeting Items of Care Targeted Areas Current Score Target Score Timescale Reviewed Score 1 2 3 4 5

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)   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)   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

What happened/what you saw 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 Were there a couple of unwashed cups in the hearth and a few toys on the floor, or did your feet stick to the carpet, dog faeces in the corner and swarms of bluebottles to meet you when you entered the kitchen.

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. Tell the story chronologically without too much editorialising The fact should be here either to satisfy the threshold criteria or to justify the recs made. First hand evidence is best but Make sure that the source of any information is given: did you see it, or is it something which you were told or read in files or elsewhere. Where facts are disputed either omit or say so. You may still draw conclusions from disputed facts (if the facts are x my conclusion would be y)

Incomplete or out of date

Can you trust a snapshot?

Understanding and assessing neglect 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 Understanding and assessing neglect 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’ JB (Late 2006) Wirral Children and Young People's Services (Social Care) should seek to ascertain whether assessment practice and judgments about thresholds in child safeguarding cases across the borough as a whole currently accord with recognised accepted local and national standards… The findings of Children and Young People's Services’ enquiries this enquiry should be reported to LSCB, together with an action plan identifying the steps to be taken to remedy any shortfalls which are identified JLS (late 2008) The LSCB should consider auditing both core assessments and common assessments in order to ensure that staff, on a multi agency basis, are adequately trained and have sufficient skills to undertake good quality assessments. In the light of this audit training needs should be identified and a training programme implemented. SCRs are not individual events but should be viewed as a cumulative repository of knowledge Failure to use case history (JB) New file started despite 12 years of involvement. A couple of months for cases to arrive may lead to a ‘start again syndrome culture. Use of case history (JB) when there were acute concerns about the care she received from her father, teenager placed with grandmother and grandfather with severe drink problems, he had masturbated in front of her, she had assaulted her; when this broke down, placed with her father who used to send her out to buy drugs for him and may have encouraged her into a sexual relationship with his dealer.

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. Incomplete Remember, this is a sales pitch (give the client what they need) Always think of your audience, what do they need to know? In this case:

But what is analysis? “So what?” 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 Be aware of the extent and limitations of your own expertise. Acknowledge both expertise and experience and be prepared to draw on them appropriately to generate a professional opinion. May be supported by reference to research, dealt with later. (Don’t go outside expertise; be Careful with new or controversial theories; be aware of counter arguments)

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

Understanding and assessing neglect 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?

Gabriela Mistral (Chilean poet, 1889-1957) 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 Understanding and assessing neglect A scale for assessing motivation 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. Understanding and assessing neglect 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 Understanding and assessing neglect 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 Understanding and assessing neglect 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 Understanding and assessing neglect 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 Understanding and assessing neglect 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)