1. Identifying Neglect: What professionals can do Patrick Ayre Department of Applied Social Studies University of Bedfordshire Park Square, Luton email: pga@patrickayre.co.uk web: http://patrickayre.co.uk

2. 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)

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

4. 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

5. The effects 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

6. 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

7. Emotional neglect: parents Can’t cope with children’s demands: avoid/disengage from child in need; dismissive or punitive response Six types of response: –Spurning, rejecting, belittling –Terrorising –Isolating from positive experiences –Exploiting/corrupting –Denying emotional responsiveness –Failing medical needs

8. Emotional neglect: children Frightened, unhappy, anxious, low self-esteem Precocious, ‘streetwise’ Withdrawn, isolated, aggressive: fear intimacy and dependence Behaviour increasingly anti-social and oppositional Brain development affected: difficulties in processing and regulating emotional arousal

9. 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

10. 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 Crisis is a necessary not a contingent state

11. Disorganised neglect: carers Cope with babies (babies need them) but then… Parental responses to children unpredictable; driven by how the parent is feeling, not the needs of the child Lack of ‘attunement’ and ‘synchronicity’

12. 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

13. 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)

14. Depressed neglect: carers Often severely abused/neglected: own parents depressed or sexually or physically abusive May have learning difficulties Passive helplessness response to demands of family life Have given up both thinking and feeling

15. 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

16. Depressed neglect: children 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

17. 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

18. 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

19. 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 and acclimatisation Neglect is a pattern not an event

20. The pattern of neglect: atypical

21. The pattern of neglect: typical

22. The pattern of neglect

25. Cumulativeness

26. Failure of cumulativeness

27. GCP provides: Framework for making assessment Baseline measurement An element of objectivity Judgement about care Reliable standardised evidence

28. 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

29. GCP users Health visitors School nurses Social workers Family centre workers Education staff

30. Why choose GCP? Child focused User friendly Common language Promotes partnership

31. Why choose GCP? Evaluates strengths as well as weaknesses Allows progress to be assessed A relatively objective measure Allows help to be targeted where needed

32. Domains of Care Physical needs Safety Love and belongingness Esteem Self actualisation Sensitivity Responsivity Reciprocity Overtures Stimulation Approval Disapproval Acceptance Present & absent Nutrition. Housing, Clothing, Hygiene & Health Maslow, A. 1954

33. What to observe A. PHYSICAL B. SAFETY C. LOVE D. ESTEEM Nutrition Housing Clothing Hygiene Health Quality, Quantity, Preparation, Organisation,

34. Grades of Care Grade 1Grade 2Grade 3Grade 4Grade 5 Level of careAll 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 secondChild not considered Quality of care BestAdequateEquivocalPoorWorst Wirral ratingNo concern Recommend prevention support Child protection Child protection and legal strategy meeting

35. Scoring Rating 15 Use on every child in the family Use with different carers Complete with the parent/carer Use information, observation, records

36. Scoring Complete individual scores for each sub-area Transpose to the record sheet Agree action, targets and timescales

38. Targeting Items of Care Targeted Areas Current Score Target Score TimescaleReviewed Score 1 2 3 4 5

39. Unique Advantages 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