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1.4.5 Guidelines for the Recognition and Assessment of Neglect

SCOPE OF THIS CHAPTER

The prime purpose of this document is to provide Guidelines for the assessment of Neglect. This chapter should be read in conjunction with the Recognising Neglect section of the West Yorkshire Consortium Procedures Manual.


Contents

  1. Introduction
  2. Recognition of Neglect
  3. Working Together
  4. Professional Accommodation
  5. Drift
  6. Poverty
  7. Provision of Resources
  8. Focus of the Child
  9. Impact on the Child
  10. Use of Chronology
  11. Legal Intervention
  12. Investigation of Neglect
  13. Assessment of Neglect


1. Introduction

Neglect differs in its presentation from other forms of abuse. With cases of neglect, there is rarely a unique incident or critical event. More commonly a repetition of neglecting behaviour causes incremental damage to the child(ren).

In these circumstances, the need for Section 47 Enquiries can be lost, and the relationship between Section 47 Enquiries and Assessment can become clouded. The point at which the threshold for child protection enquiries is crossed in a particular family is a matter of professional judgement. A series of minor incidents or mounting concern regarding the physical, emotional or behavioural presentation of the child may alert professionals.

These difficulties have led us to develop specific Guidelines for the Recognition and Assessment of Neglect.


2. Recognition of Neglect

The growth and development of a child may suffer when the child receives insufficient food, love, warmth, care and concern, praise, encouragement and stimulation.

Apart from the child's neglected appearance, other signs may include:

  • Short stature and underweight;
  • Re/purple mottled skin, particularly on the hands and feet are seen in the winter due to cold;
  • Swollen limbs with sores that are slow to heal, usually associated with cold injury;
  • Recent diarrhoea;
  • Abnormal voracious appetite (at school or nursery);
  • Dry sparse hair;
  • General physical apathy;
  • Unresponsiveness or indiscrimination in relationships with adults (may be attention-seeking or seek affection from any adult).

A number of other factors may influence the recognition of neglect as a child protection issue.


3. Working Together

Exceptionally, a case of neglect will be recognised by a single agency working in isolation (e.g. children who are taken into police protection following a referral from a member of the community concerned about the conditions they are living in). More usually however, information will need to be shared between all involved agencies to allow the full picture to emerge. Professionals working with a long term case of neglect may form a closed core group. It is essential that the need for outside perspective, and for the full range of professional opinion, is constantly addressed (e.g. the benefit of a paediatric assessment, the need for police support when other professionals are refused access to the home or parts of it, the need to consult mental health professionals re the response of adult family members).


4. Professional Accommodation

It is often observed that professionals want to think the best of families they are working with. In cases of neglect where professionals have worked hard to establish a relationship which is contributing to the maintenance of a just good enough situation, there may be a reluctance to confront unacceptable standards for fear this would jeopardise future working. Workers can become desensitised and fail to differentiate the just good enough from the unacceptable.


5. Drift

This closely allied to professional accommodation. Drift can be identified as a loss of interest or a loss of purpose in a particular case, and it is a particular danger in long term cases of neglect, where much of the necessary work may be repetitious. Supervision, consultation and clear planning with specific objectives are essential to counter this. In addition to the consideration of the need for an "outside perspective" from another agency or professional, it may be beneficial to provide a fresh set of eyes from within the Department, e.g. for another colleague, Team Manger, or Advanced Practitioner to undertake joint visits with the long term worker.


6. Poverty

The relationship between poverty and neglect is problematic. It is important to separate material impoverishment and emotional impoverishment. Neglect can be viewed as a persistent failure to meet the essential needs of a child by omitting basic parenting task and responsibilities despite parents having the economic resources to meet the needs.


7. Provision of Resources

It is dangerous to assume that the provision of material resources will alleviate neglect. This may on occasion be a necessary and appropriate part of a plan of work, but it may also be an inappropriate alternative to confronting more fundamental problems in patterns of care and family relationships. It is essential to analyse the impact of the provision of material resources. (E.g. if a fridge has been provided, had this in fact led to the children being better fed? If a washing machine has been provided, has this led to an appreciable improvement in the presentation of the children?). A chronology should include, where appropriate, an analysis of the impact of the provision of regular Section 17 payments.


8. Focus of the Child

In cases of physical or sexual abuse social workers are used to talking to even young children about their experience of what has happened to them. Neglect cases, by contrast, virtually never start with an allegation from a child. These cases  invariably come to light following an observation by a professional, or perhaps a member of the community.

The focus is not on what has been done to the child, but on the standard if care provided to him or her. It is essential that the child is spoken to, and his/her experience explored. Neglect needs to be understood from a child centred perspective, focusing on the child's unmet needs, and on the consequences for the child of parental behaviours.


9. Impact on the Child

The worker's assessment of the environment in which the child(ren) are living must not disregard the impact of the environment on the individual child(ren). Some children may be more resilient than others; a child with additional needs may not have these adequately met; a child may suffer particular emotional, social or intellectual harm because (s)he is ostracised at school.


10. Use of Chronology

The importance of the production of a chronology, and its regular updating, in the cases of chronic neglect is referred to at various points in this document.

It is an essential tool not only to allow the social worker and Team Manager to analyse patterns of care, but to inform decision making by senior managers, advice form LA solicitors etc, who may otherwise be less able to identify patterns of abuse.


11. Legal Intervention

The absence of one acute incident may militate against the consideration of legal intervention. However, legal advice is that neglect is not more difficult to prove in the Civil Court than physical or sexual abuse. Legal advice needs to be informed by a full appreciation of the history of the case. A chronology is vital in this.

It may be particularly difficult to contemplate legal intervention with a family with a large number of children, where workers are acutely aware of the resource implications and the disruption to the family of removal of the children. It is essential that such considerations are separated out form an objective assessment of the need to protect the child(ren).


12. Investigation of Neglect

In all child protection cases the processes of assessment and investigation will overlap. With cases of neglect, where the focus is on the on-going pattern of care rather than a critical incident, there is likely to be a potential greater blurring of boundaries. It is essential therefore that the process of investigation is clearly planned and recorded.

A Strategy Meeting to plan the necessary enquiries should be multi-agency, and reflect the range of workers involved with the family, and those who may be able to contribute to enquiries.

Particularly where the family has been very mobile, parts of the professional network may take time to identify and, an eco-map, mapping all the professionals who are or have been involved with the family, may be beneficial and should be updated as necessary. 

The lack of specific incident does not negate the need to talk to children named in an allegation of neglect. Interviews should explore with the child(ren) their experience of their family and household. Any child too young to be interviewed should also be seen. Detailed observations of the presentation of the child(ren) must be recorded.

The lack of any alleged physical injury or harm does not negate the need to consider a paediatric assessment. A full developmental assessment may identify concerns not apparent to other professionals.

The lack of a specific incident does not negate the need to consider police involvement. In addition to the provision of a different perspective, the police may be able to assist when their concerns about neglect of children in the household is allied to a refusal to allow access to some parts of the house.

The lack of a specific incident does not negate the need to consider whether immediate action is necessary to secure the safety of the child(ren), or whether any other legal action is appropriate. Legal advice about the thresholds for Significant Harm should be considered.

Accurate detailed contemporaneous recording is particularly important in identifying issues of neglect. The nature of its presentation (mounting concerns and minor incidents) means that recording by all professionals, and sharing of information between professionals is crucial to the protection of the child. Apparently trivial events may assume a much greater importance when observed repeatedly by one professional, or put together with the observations of others.

As part of the Children’s Social Work Services collating of findings, a chronology of events within the household should be completed, if one is not already available. This chronology should then be updated to inform future decision making.


13. Assessment of Neglect

Introduction

Child's Perspective

Plans for family support require an understanding of the particular aspects of family interaction and child care which are problematic and require intervention and change. It is important to consider:

  • Precisely what is missing in the care of the child(ren); how many aspects of the child(ren)'s well being are in 'jeopardy'; what appears to be the effects of these omissions on the child(ren)'s development and behaviour; what makes workers hopeful or unhopeful that the situation can be improved enough to make good the omissions of care in time for the child(ren)'s developmental well being to be assured (Stevenson);
  • Family dynamics and relationships as a whole, need to be evaluated and put into a framework for understanding the problems.

Assessment must be consistent, on-going and structured. Multi-disciplinary assessment is indispensable. Social Workers must co-ordinate the overall assessment of the family, taking into account external and internal factors relating to the family and contributory information about, and observations of, parent/child behaviour and interaction. External pressures are often powerful influencing factors on families but individual and family dynamics and a wide range of emotional and psychological considerations need to be understood and evaluated.

Failure to provide good enough care by parents may be linked to limitations in ability, chaotic family backgrounds, mental health problems, drug/alcohol misuse or disempowerment through domestic violence and abuse. When chronic parenting is an added factor, it is easy for professionals to feel sympathy and to feel overwhelmed by the family's needs. It is important not to feel over-optimistic about outcomes and to maintain the focus off the impact on the child.

Purpose of Assessment

The primary needs of children are:

  • Health;
  • Education;
  • Identity;
  • Family and social relationships;
  • Emotional and behavioural development;
  • Self presentation;
  • Self care skills.

The purpose of the Child and Family Assessment is to identify these needs, establishing where they are met and unmet; to establish the likelihood of the child suffering Significant Harm from unmet needs; to identify resources in the family; to build on existing family strengths and/or the professional network which can be mobilised to meet the unmet needs; to make recommendations and plans for future actions to secure future protection and ensure their needs can be met in the long term.

At the outset of a Child and Family Assessment, parents need to know exactly what professionals are concerned about and have this explained to them clearly and concisely. Having done this, the next step is to establish what they need to do to bring about the required changes, what help and support will be available to them, and a timescale for achieving goals and outcomes with regular review dates. Written agreements are essential.

Planning

Phase 1

Within an identified Core Group co-ordinated by a Social Worker. This should not exclude other possible sources of knowledge and information:

  • Who will carry out the assessment, where and when. A range of professionals may be involved to provide specific understanding of the child and family functioning. Division of tasks and roles may be useful to avoid workers being overwhelmed by the family's practical needs;
  • Establish timescales;
  • Are extra resources or expertise needed to understand parents abilities to achieve goals?

Read files and prepare chronology. Access to Core Group members information on family members can assist in providing a multi-disciplinary chronology. Police (domestic violence)/probation records should always be checked. The Family Tree Template needs to be completed:

  • Identify key tasks and roles for family and professionals;
  • Written agreement with parents, professionals and child(ren) (where appropriate);
  • What information will be collected and from what source?

Refer to:

Assessments Guidance

Neglected Children, Issues and Dilemmas (Stevenson), Chapters 7 and 8.

Phase 2

Process

  • Interviews/direct work with child(ren) which are appropriate to child(ren)'s age, understanding, development and culture. Direct work and talking to children enables a relationship to be developed so that they can express thoughts, feelings and opinions;
  • An assessment cannot be made without seeing the child(ren) regularly, looking at appearance, physical condition, emotional well being, behaviour and interactions in a range of situations with different people. Listening to children's views and perceptions about life in their family is crucial;
  • Interviews with parents/carers, including individual profiles, parenting history and functioning;
  • Paediatric assessments should be carried out to ensure any medical needs are identified and to establish base line care. Physical and mental health of parents and carers should also be assessed and consent to see medical records should be considered;
  • Assessing home conditions, seeing all parts of the house, including beds and bedding. These should be monitored regularly as should other aspects of physical care - clothing, skin, hair, diet, routines, attachments.

Phase 3

Evaluation and Analysis

  • What is known about the child(ren)/family? What gaps in knowledge/information are there? Are there any recognisable patterns?
  • What is the potential for change, and how will it be tested? Can change be sustained over time?
  • What is (are) the child(ren) saying/demonstrating?
  • What are the parents/carers saying/showing?
  • What has been observed by the core group about the child(ren), parent, network, relationships, home conditions?
  • What appointments were taken up, resources used?
  • What is the evidence to indicate harm or risk of harm?
  • What are the strengths/positives in the family, network, environment?
  • How did the family participate?
  • What is the motivation, prognosis, and ability to change?
  • What has already changed? What evidence is there for this?

Phase 4

Conclusions and Decision Making

  • Co-ordinate all information from Core Group and write up. Analyse the needs of all child(ren) and parents’ capacity to meet those needs. Determine what has happened and whether the child(ren) is (are) in need or suffering or likely to suffer significant harm. This needs to be based on an understanding of the child and family context;
  • Keep chronology updated;
  • Share outcomes/conclusions with child(ren) and family;
  • Plan future intervention, action, timescale and review process;
  • Identify resources needed to secure well being of child(ren). This includes the family network as well as professionals;
  • Effective assessment and intervention involves a recognition of the dynamic interplay of a complex range of factors. Developmental history, personality, partnerships, employment, education, parenting, attachments, networks, child's characteristics, development, housing, health, poverty levels, substance abuse, domestic violence, learning difficulties, etc.

End