5.22 Neglect

AMENDMENT

This chapter was extensively revised and updated in November 2015 and new Sections 4, Assessment, Section 6, Legal Advice and Section 8, Supervision were added. The chapter should be re-read in full.

1. Definition

Neglect is defined in Working Together to Safeguard Children 2015 as “the persistent failure to meet a child’s basic physical, emotional 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. When the child is born, neglect may involve the parents or carers failing to:

  • Provide adequate food, clothing and shelter (including exclusion from home or abandonment);
  • Protect the child from physical and emotional harm or danger;
  • Ensure adequate supervision (including the use of inadequate care-givers); or
  • Ensure access to appropriate medical care or treatment.

It may also include neglect of, or unresponsiveness to, a child’s basic emotional needs.

Neglect is characterised by the absence of a relationship of care between the parent/carer and the child and the failure of the parent/carer to prioritise the needs of their child. It can occur at any stage of childhood, including the teenage years”.

Neglect can be defined from the perspective of a child’s right not to be subject to inhuman or degrading treatment, for example in the European Convention on Human Rights, Article 3 and the United Nations Convention on the Rights of the Child (UNCRC), Article 19.

2. Risks

The impact of Neglect during the first two years of a child’s life can have profound and lasting effects on the development of the brain, leading to later problems with self-esteem, emotional regulation and relationships.

Neglect during the first five years of a child’s life is likely to damage all aspects of the child’s development. A neglected child is likely to have difficulties with:

  • Basic trust;
  • Self-esteem;
  • Ability to control their behaviour;
  • Social interaction;
  • Educational attainment; and
  • Problem-solving.

Neglect in childhood is also likely to lead to problems with aspects of adult life such as:

  • Independent living in the community;
  • Accepting adult responsibilities;
  • Anti-social behaviour such as criminality, substance misuse;
  • Increased vulnerability to being in abusive relationships (including the risk of sexual exploitation and being trafficked);
  • Life chances and opportunities such as employment and education;
  • Parenting – children who experience neglect lack a role model for good parenting, and so are vulnerable to becoming neglectful or abusive parents; and
  • Self-care – for example nutrition, general health, risk-taking behaviour.

A particularly damaging combination for children is growing up in an environment of low warmth and high criticism – that is, parents/carers who switch unpredictably between helpless (neglectful) and hostile (abusive) care.

Neglect can affect children of all ages.

Where parents/carers have specific beliefs, which may involve how the child receives health care and treatment or general nutrition, the outcome can be that the child’s health and well-being can be dangerously compromised.

It is important to remember that neglect can be fatal to the child.

“The majority of neglect related deaths of very young children involve accidental deaths and sudden unexpected deaths in infancy where there are pre-existing concerns about poor quality parenting and poor supervision and dangerous, sometimes unsanitary, living circumstances which compromise the children’s safety… these issues include the risks of accidents such as fires and the dangers of co-sleeping with a baby where parents have substance and/or alcohol misuse problems (Brandon et al, 2013).

3. Indicators

Neglect differs from other forms of abuse in that there is rarely a single incident or crisis that draws attention to the family. It is repeated, persistent neglectful behaviour that causes incremental damage over a period of time.

It is important to avoid ‘start again’ syndrome. Neglect should not only be measured by the most recent set of events but should be judged by the cumulative impact on the child of any previous incidents.

There is no set pattern of signs that indicate neglect other than that the child’s basic needs are not adequately met. In this context:

  • The child’s basic needs are for food, shelter, clothing, warmth, safety, stimulation, protection, nurture, medical care, education, identity and play;
  • Adequately means sufficient to avoid harm or the likelihood of Significant Harm;
  • Failure to meet the child’s needs does not necessarily mean that the parents/carers are intentionally neglectful, but it points to the need for intervention;
  • It is essential to monitor the outcome of intervention – are the child’s needs being adequately met after the intervention and is there a sustainable improvement?

The essential factors in demonstrating that a child is being neglected are:

  • The child is suffering, or is likely to suffer, Significant Harm;
  • The harm, or risk of harm, arises because of the failure of parents or carers to meet the child’s needs;
  • Over time, the harm or risk of harm has become worse, or has not improved to the point at which the child is consistently receiving a “good enough” standard of care;
  • Persistent, severe neglect indicates a breakdown or a failure in the relationship between parent and child.

Where there are concerns about standards of care the Graded Care Profile – to follow provides a tool for assessment, planning, intervention and review. This gives an objective measure of the care of the child across all areas of need, showing both strengths and weaknesses. Improvement and/or deterioration can be tracked across the period of intervention. It allows professionals to target work as it highlights areas in which the child’s needs are, and are not, being met. It may also help parents/carers who may have experienced neglect themselves to understand why such behaviours are harmful.

4. Assessment

The Norfolk Safeguarding Children Board has endorsed the use of the Graded Care Profile as the assessment tool to be used in all cases where there are concerns of neglectful parenting. The tool should be used for assessment, planning, intervention and review. It will give a measure of the care of the child across all areas of need, showing both strengths and weaknesses. Improvement and/or deterioration can be tracked across the period of intervention. It allows professionals to target work as it highlights areas in which the child’s needs are, and are not, being met. It may also help parents/carers who may have experienced neglect themselves to understand why such behaviours are harmful.

Parenting Capacity

An essential part of any assessment process is evaluating parent/carers’ ability and commitment to change. This would be characterised by the parent accepting responsibility for their actions, sustaining change and taking up offers of support and resources from services. Practitioners should note evidence of changes and improvements made as a result of previous interventions and assess the parents’ ability to translate information into action.

Practitioners must be aware of disguised compliance, often a feature identified in serious case reviews.

5. Protection and Action to be Taken

In supporting a family in which neglect is an issue, the greatest of care must be taken to resist the pressure to focus on the needs of the parents/carers: intervention should concentrate on ensuring that the child’s needs are being met. This may require action to ensure that the parents/carers have access to specialist (and if necessary independent) advice and assistance, including assistance in communicating with professionals.

Neglect may arise from lack of knowledge, competing priorities, stress or deprivation. It may also be linked to parents/carers who retain cultural behaviours which are inappropriate in the context in which the family is living.

When a child’s needs are unmet because the parents/carers lack knowledge or skill the first choice for intervention should generally be the provision of Early Help services such as information, training and support services. If there is no progress and the assessment by professionals is that progress is unlikely without more proactive intervention a referral to Children’s Services in line with the Referrals Procedure should be considered.

Neglect often occurs in a context in which parents/carers are dealing with a range of other problems such as substance misuse, mental ill-health, learning disability, domestic violence, and lack of suitable accommodation.

On many occasions the birth of an additional child may add to the pressure on the family. The parents/carers may provide an acceptable standard of care until a new pressure or an unexpected crisis arises: then they lose sight of their child’s needs. In this situation the first choice for intervention should be the provision of support in dealing with the competing pressures. This may require referral to appropriate adult services or family support services.

Single Agency Assessment

Where a single agency has concerns about a child and neglect is thought to be a factor, the Graded Care Profile must be used in partnership with the parents. Where the parents do not agree with its use or refuse to engage, then the tool will still be used to assist practitioners decide where best to focus their intervention. The tool may also be used in supervision to inform discussion regarding areas of concern.

Action to take once neglect has been raised as a concern

Once concerns about neglect are identified, practitioners need to make judgement about the level of intervention that is required and what should happen next. The practitioner or agency that has identified the concerns must evaluate the seriousness of their concerns and decide what the appropriate response should be.

Cases that can be managed within universal and early help services

Making a decision not to refer may be an appropriate response if there is felt to be the potential to effect positive change and where the risks to the child do not reach the threshold of actual or likelihood of significant harm. Under these circumstances, it is very important that the parents have a level of understanding and acceptance of the practitioners concerns and demonstrate a commitment and motivation to work to improve things. Those working within community organisations that are outside of the statutory universal or specialist services such as community organisations, housing, council staff, voluntary organisations etc. may well come across situations and circumstances that concern them, but the individual is unclear as to the appropriate action to take. In order to make a judgment on how serious the concerns are, practitioners or individuals from agencies and voluntary organisations may need to access help and support. There are named practitioners within all organisations who are available for consultation and advice.

Practitioners within early help or universal services, both within health and education, may identify concerns that they believe do not meet the threshold for a referral to Children Service’s however it is important that the concerns are shared with the family and that a comprehensive assessment is carried out to identify the seriousness of the situation, the way that the situation is impacting on each individual child and at what point further support may be required by the family. The Graded Care Profile must be initiated to clarify the level of concern. For children under the age of 5, it is likely that the health visitor would be the appropriate person to begin collating information using the graded care profile.

Family Support

It may be appropriate at the same time to consider a family support process with consent from the family using the graded care profile as the main tool for information gathering. If the family support process is agreed as the appropriate intervention following areas must be considered at regular intervals:

  • Is the plan working and is this making a difference within a developmental timeframe for this child?
  • Can practitioners evidence change in parenting and change in situation for the child?
  • Is it appropriate to make a child in need referral to Children’s Social care?
  • Is there an indication that the child is at risk of significant harm? If so refer the matter to children’s social care via the MASH.

Referral to MASH

Following a single agency assessment, if there is no improvement in the care of the child, and the assessment by professionals is that progress is unlikely without more proactive intervention a referral should be made to the MASH, using the GCP to support the information provided.

Multi agent Assessment

The Graded Care Profile should be used as part of assessment and planning for all cases where the primary concerns are neglectful parenting. These cases may be managed under early help, family support, Child in Need or Child Protection processes.

Referring a child in need

Practitioner/practitioners involved with the family must explain their concerns to the family and clearly inform the family that they believe a referral is required. Consent for a referral under children in need must be sought from a parent with parental responsibility, or an age appropriate young person (refer Fraser Guidelines). If consent is gained, the referral should contain as much information as possible and the graded care profile used to begin the assessment and include within the referral. Further guidance on consent is available in the threshold document (link/reference).

Referring when there are child protection concerns

If it is felt that the concerns have reached the threshold of actual or likelihood of significant harm, a referral must be made immediately to the MASH. If an assessment has been completed using the graded care profile or family support process, this information must be attached to the referral form. It is good practice to not only inform the parent that the referral is being made but request their consent whilst making it clear that the referral will go ahead if they do not feel able to give it. The only exception to having this discussion with the parents is if it is felt that to do so would put the child or another person at risk of further harm.

Response following referral of a child/children to the Multi-Agency Safeguarding Hub (MASH)

Where a Graded Care Profile has been completed prior to referral to MASH and there are scores of 5 this should result in further, formal statutory intervention. A decision will be made within 24 hours as to the actions required on whether further assessment will be undertaken. In all cases where neglect is the cause of concern future assessments will be undertaken using the graded care profile. Prior to embarking on the GCP the assessment must focus on parenting capacity. It is important to clarify the parents’ understanding of the concern and whether they are able and/or willing to undertake the changes necessary to provide ‘good enough’ parenting for the child. Any parenting capacity assessment must consider the child developmental status and the impact of delay on the child’s health and well-being. For children under 5, the health visitor and social worker will complete the graded care profile together. For children over 5, consideration should be given to the social worker completing the graded care profile in collaboration with other professionals who may have contact with the child for example school teachers or health practitioners.

6. Legal Advice

(This section is under review)

Messages for Good Practice

  • Practical resources are often beneficial but their impact on meeting the child’s needs must be kept under review;
  • Relieving financial poverty does not necessarily relieve emotional poverty;
  • Neglectful families are more likely to be isolated and to have weak informal networks. Providing volunteer support, and facilitating better relationship with family and in the community, can be effective in raising standards of care;
  • Dealing with neglect can be overwhelming for professionals: support and regular supervision are crucial;
  • It is important to carry out regular reviews of the rate at which the required change is being achieved in terms of the child’s improved health and development.

7. Issues

Neglect is characterised by a cumulative pattern rather than discrete incidents or crises, and so drift is always a potential problem. Drift may result in a loss of focus on the needs of the child, and a change in professional expectations of what an acceptable level of care might be.

Accurate, detailed and contemporaneous recording by all professionals, and sharing of this information, are crucial to the protection of the child. In any service, professionals should work from a single set of records for each child. All entries in case notes should:

  • Be factual and evidence based;
  • Rigorously separate fact and opinion;
  • Be dated and timed;
  • Give names and agencies in full; and
  • State agreed responses and outcomes.

Records should include a detailed Chronology of what has been tried, and to what effect.

There is a risk of confusion about the difference between style of care and standard of care. Styles of appropriate care vary widely, influenced by gender, class, culture, religion, age etc. It may be difficult to see why the care offered by a particular family does not lie within this range. The common factor in all styles of appropriate care is that they address the needs of the child. Neglectful care may have a host of common factors with various styles of appropriate care, but it fails to address the child’s needs and falls below an acceptable standard.

Non-attendance at or repeated cancellations of appointments and lack of access to the child on visits are indicators that should increase concern about the child’s welfare.

All agencies should be aware of the need for supervision of staff who are monitoring cases of chronic neglect:

  • Professionals often want to think the best of the families with whom they work, and interpret events accordingly;
  • Familiarity with the family’s lifestyle may cause professionals to minimise concerns and accept that the observed standards are normal for this family;
  • Changing the worker also carries risks as it takes time to see the pattern of events that identifies care as neglectful.

Supervision must provide an independent review, keeping the focus on the child’s needs and the adequacy of parenting over time.

If the child appears resilient, professionals should not accept this at face value, but should check for evidence of unmet needs and impaired health and development.

When reviewing progress in cases of neglect it is important to look for evidence of sustainedimprovement in the child’s health and development. Where there is a pattern of short-lived improvements, the overall situation remains unsatisfactory – if adequate standards of care cannot be sustained, the child remains at risk of significant harm.

Professionals must resist the temptation to “start again” at key points such as the birth of a new child or a change of worker. It is important to see current events in the light of the full history of child protection issues, including previous responses to support. The family histories of neglectful families are often complex and confusing, and professionals may be tempted to set them aside and concentrate on the present. This can result in an over-optimistic approach to a family with deeply entrenched problems.

As noted above, neglectful adults are often enmeshed in a complex network of problems. The clamour of the parents’/carers’ needs tends to draw professional attention away from the unmet needs of the children. When addressing the needs of neglectful parents/carers, it is necessary to ask repeatedly:

  • Do they understand what action is needed and within what timescales?
  • Are they able and willing to meet the child’s needs?
  • Are they doing so?
  • Are they able to access appropriate support services?
  • Is anything changing for the child? Is the change enough to bring the standard of care up to an acceptable level?

If adult services are supporting the parents/carers, it is important to stress the need for them to notify children’s practitioners if the parents/carers fail to engage with the services offered.

If there is a vulnerable adult living in the same household as a child whose needs are neglected, then their needs may also be neglected or unmet. Practitioners should report any concerns about the welfare of vulnerable adults to adult social care.

8. Supervision

Supervision is central to the management and oversight of working with families where there are concerns about child neglect.

The supervision process should ensure;

  • The workers are clear about their roles and responsibilities;
  • The workers meet their agencies objectives;
  • A good quality service is provided to children and parents;
  • Workers are supported in challenging both parents and professional behaviours which are not in the child best interest;
  • Continuous assessment and consideration of timescales and whether there is drift within the case;
  • The child is kept at the centre of supervision and there is continuous assessment of whether change is happening within the child developmental timeframe;
  • There is an understanding of the impact on the child of the parenting.

The importance of supervision for cases of neglect cannot be over emphasised. Effective supervision is an important resource for reflection, information and support and the process by which practitioners can identify areas for adjustment in their practice in order to overcome misplaced optimism or the start again syndrome.

Intentional Neglect

Where there is strong evidence that the parents/carers know and understand the likely effect of their actions or inaction on the child, but intend to cause harm or are reckless as to whether harm is caused to the child, this should be regarded as serious physical and/or emotional abuse. In these cases support is unlikely to reduce the risk to the child. Unintentional neglect should not be confused with deliberate or malicious failure to meet the child’s needs in the full knowledge of the potential effects on the child.

One Child Singled Out

Serious Case Reviews have demonstrated that in some instances a child in a family may be singled out and cared for in a manner which amounts to serious neglect. Where a school or other agency raises concerns about the child the parent’s response and first assessments of the family may mask the particular treatment in the home of that child, particularly if the siblings appear well and cared for. Assessments where there are concerns of neglect should include speaking to the specific child on their own and viewing their sleeping arrangements for example.

Defining Adolescent Neglect

The current definition of neglect refers to children and young people up to the age of 18, but the  adolescent neglect’ contributed to the following as part of a neglect guide aimed at those working with teenagers (Hicks and Stein, 2010). These are points for consideration, but highlight some of the issues around defining and working with adolescent neglect.

Themes from Research Review Issues for Practitioners
Neglect is usually seen as an act of omission For adolescents, in particular, some acts of commission may be seen as neglect, or contribute to young people being neglected e.g. being abandoned by parents or being forced to leave home
Neglect from different viewpoints There may be differences between viewpoints, for example between the views of social workers, other professionals and young people themselves. Awareness of these different viewpoints is a starting point for establishing a working consensus
Young people may under-estimate neglect This may be related to young people’s acceptance of their parents’ behaviour, young people’s sense of privacy, or their loyalty to their families
Neglect is often seen as a persistent state It is necessary to look at patterns of neglect over time and recognise the impact of both acute and chronic neglect
There is a difficulty in making a distinction between emotional abuse and neglect These are associated, inevitably, especially when neglect is seen as an omission of care. What matters is not the label but the consequences for the young person’s health and development
Neglectful behaviour and experience of neglect Defining neglect should include both maltreating behaviour as well as how the young person experiences neglect i.e. the consequences for them

Neglect by Secondary Carers

This guidance relates only to the child’s primary carers. Neglectful care may also be found in secondary carers such as childminders, foster carers, day care or residential settings. In this situation concerns should be reported to:

  • The child’s primary carers, so that they can take appropriate action to protect their child;
  • The LADO team in Children’s Social Care; and
  • The registration authority for the secondary carer (for example Ofsted), who can consider the possible implications for other children;
  • In the case of emergencies see Referrals Procedure.

9. Further Information

Missed Opportunities; Indicators of Neglect – What is Ignored, Why, and What Can be Done? November 2014.

Please see also the NSCB Neglect Strategy and resources available on the NSCB website.

< Previous Next >