1. copyright J. Horwath March 2010 WORKING WITH NEGLECTFUL FAMILIES IN 2010: PROBLEMS AND POSSIBLE SOLUTIONS JAN HORWATH

2. WORKING DEFINITION ‘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, shelter and clothing, failing to protect a child from physical harm or danger, or the failure to ensure access to appropriate medical care or treatment. It may also include neglect of, or unresponsiveness to, a child’s basic emotional needs’. Working Together to Safeguard Children 2006 copyright J. Horwath March 2010

3. NEGLECT IS NOT A STATIC PHENOMENON Historical changes Acceptable standards of care: Cultural filters Familism Machismo Valuing children Practitioner attitudes Attitudes towards culpability Neglect as chronic or episodic Distinctions between emotional abuse and neglect copyright J. Horwath March 2010

4. TYPES OF NEGLECT: DIFFERENT CHILDREN DIFFERENT NEEDS Medical Nutritional Emotional Educational Physical Supervision and safety copyright J. Horwath March 2010

5. IMPACT OF CHILD NEGLECT Brain development Socio-emotional development: attachments Cognitive and behavioural problems Psychological problems: Anxiety Depression Hostility Isolation Coy coercive strategies Physical development Fatality & ‘agency neglect’ copyright J. Horwath March 2010

6. NEGLECT AND THE DISABLED CHILD Child with additional needs 4 times more vulnerable to neglect (behavioural problems 6.7 times more vulnerable) Are lack of resources contributing? Are loving parents competent parents? Are family circumstances and socio- economic factors contributing? copyright J. Horwath March 2010

7. CHRONIC NEGLECT Desensitised to issues, routinised visits Workers built-up relationships Need to avoid ‘monitoring’ situation Consider: Patterns of behaviour Contacts and plans Significant events Current concerns, parenting issues and socio- economic factors Ways in which parents working to meet needs of child Evaluate: likely outcome, changes required copyright J. Horwath March 2010

8. NEGLECTED ADOLESCENTS Failure to address age specific neglect : Offending and challenging behaviour E-safety Impact on brain development Peer relationship abuse Difference between neglectful behaviours and experiences of neglect: Increasing care responsibilities Impact of poverty on leaving home Tensions in relationships ‘Sofa surfing’ Stein et al 2009 copyright J. Horwath March 2010

9. AGENCY NEGLECT? Neglected adolescents: getting behind the behaviour Perceptions of neglect leaving groups of children vulnerable Importance of early intervention: under 3yrs Re-active rather than pro-active management and practice Revolving door Start again syndrome copyright J. Horwath March 2010

10. LORD LAMING ‘Anxiety undermines good practice’ copyright J. Horwath March 2010

11. PRACTITIONERS: TYPES OF PRIMARY ANXIETY The nature of the task: Cannot address all issues Few damage free decisions Personal histories: Past shaping present Experiences of organisation Personal survival: Maintaining relationships Managing the workload ( adapted from James and Clark 2002) copyright J. Horwath March 2010

12. MANAGING CONCERNS INITIAL ASSESSMENT RAISES CONCERNS MONITOR THE SITUATION REFER TO SERVICES IN THE COMMUNITY REFER TO SOCIAL WORK SERVICES copyright J. Horwath March 2010

13. THE IMPACT ON THE PROFESSIONAL Bad for me I can do better than the system Not reportable Cover my back Zelleman 1990. Horwath 2005 copyright J. Horwath March 2010

14. SIGNALLING NEED FOR ASSISTANCE? Families very unlikely to make direct explicit approaches: May articulate anxieties Aware of impact of substance misuse Children may self-report via creative approaches Indirect approaches: Signs and indicators Issue re fit between professional, parent and child’s issues (Daniels et al 2009) copyright J. Horwath March 2010

15. WORKING WITH NEGLECT ‘..parents tended to avoid agencies, but agencies also appear to avoid or rebuff parents. Evidence of this rebuttal was seen through 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…the end result is a failure to engage with the parents’ fundamental problems in parenting and the children’s experience of direct or indirect harm. (Brandon et al. 2008, p72)

16. THE CONSEQUENCES: DISTORTED DECISIONS Information treated discretely The fixed idea: Selective interpretation of information Pervasive belief systems Concrete solutions Over-optimism Over-pessimism Minimisation copyright J. Horwath March 2010

17. COGNITION AND AFFECT: THE KEY TO GOOD ENOUGH PARENTING COGNITION = UNDERSTANDING EFFECTS OF OWN BEHAVIOURS ON CHILD AFFECT = PROCESSING INFORMATION ABOUT FEELING STATES RESULTING IN APPROPRIATE RESPONSE copyright J. Horwath March 2010

18. DISORGANISED NEGLECT Affect dominates: their feelings come first Gain attention through crises Experienced emotionally deprived and undervalued childhood: insecure, anxious ambivalent attachment Inconsistent responses to the child: develop attention-seeking behaviours Professionals: Hooked in to good intentions Rationalise crises get in way of change Over-optimism copyright J. Horwath March 2010

19. EMOTIONAL NEGLECT Mental processing dominated by cognition: an emotional desert Carer experienced insecure avoidant attachment Children experience high criticism low warmth: Loners Bullied Unable to express emotion or form relationships Dilemma for professionals copyright J. Horwath March 2010

20. DEPRESSED NEGLECT Cognition and affect are low Carer is flat and unavailable May be linked to drug misuse and mental health issues Children: Carer does not respond to attachment signals Lack of supervision Poor basic care Children become carers Professionals: Use caution Remove from home Create a good enough parenting environment copyright J. Horwath March 2010

21. ASSESSING ENGAGEMENT IN CHANGE PROCESS Talk the talk & walk the walk Walk the walk Talk the talk Walk away Commitment: low high Effort: high low

22. copyright J. Horwath March 2010 ASSESSING PARENTING CAPACITY PARENTAL ABILITY PARENTAL MOTIVATION PARENTAL OPPORTUNITY ENGAGING PARENTS IN PLANNING

23. copyright J. Horwath March 2010 PARENTAL ABILITY Are there factors affecting ability to understand and make sense of knowledge and develop skills? Does the parent recognise the specific needs of the child? What quality of information is available: how have messages been reinforced and prioritised? Are parents able to make informed decisions based on the information?

24. copyright J. Horwath March 2010 PARENTAL MOTIVATION Whose needs dominate? What is influencing this? Individual beliefs and experiences Past present and future expectations The influence of others The promoters and inhibitors for change

25. copyright J. Horwath March 2010 PARENTING OPPORTUNITIES How has the caring environment influenced parenting? What has been the influence of family, community, faith and culture? What role have professionals had in creating a safe environment? Is societal neglect an issue?

26. copyright J. Horwath March 2010 THE MISSING DOMAIN: THE PRACTITIONER THE FRAMEWORK FOR ASSESSING CHILDREN IN NEED AND THEIR FAMILIES The service user 40% Relationship with worker 30% Method of intervention 15% Verbalised confidence of service user 15% (McKeown 2000)

27. copyright J. Horwath March 2010 WHAT IS REQUIRED OF WORKERS: THE 4 ‘Cs’ Collaboration Consistency Containment Contingency (Morrison 2009)

28. copyright J. Horwath March 2010 ACHIEVING EFFECTIVE OUTCOMES FOR CHILDREN IDENTIFIED ISSUES: CAUSES OF CONCERN ‘PROCESS’ OBJECTIVES ‘OUTCOME’ GOALS WHAT DO WE NEED TO DO AND WHY? WHAT INDICATORS CAN WE USE TO MEASURE OUTCOMES?

29. copyright J. Horwath March 2010 MEETING THE NEEDS OF NEGLECTED CHILDREN & THEIR FAMILIES: A LONG TERM MULTIFACETED APPROACH Concrete resources Social support: Formal and informal networks Cognitive-behavioural interventions: Parenting programmes Interventions focused on individual family members Family-focused home based interventions

30. ‘In cases of neglect..often there is no single event that triggers matters escalating to an application for a court order. In such cases parents may or may not be cooperating and the extent of the risk of harm to the child may increase over time. Realistic timescales need to be applied for these cases to ensure a child is not subjected to long-term neglect. Signs of non-compliance by parents, or indeed threat or manipulation, must form part of the decision to protect a child’. Laming 2009 P30 3.12 copyright J. Horwath March 2010

31. Relevant texts by author Horwath, J.(P) (2007) The Neglected Child: Identification and Assessment. London: Palgrave. ISBN 978-1-4039-3346-1 pp 281 Horwath, J. (ed) (2009) The Child's World A comprehensive guide to assessing Children in Need and their Families London: Jessica Kingsley Horwath, J (2005) Is this child neglect? The impact of difference in perceptions on social work practice, in Daniel, B. and Taylor, J. Neglect. Practice Issues for Health and Social Care. pp. 73-96. London: Jessica Kingsley Horwath, J. (2007) ‘The missing assessment domain: practitioner subjectivity when identifying and referring child neglect’ British Journal of Social Work. 37 1285-1303. copyright J. Horwath March 2010