9.9 Neglect

Neglect of children is one of the most difficult areas in child care and child protection to identify, communicate effectively to professionals, assess and intervene in. It is now emerging as the most common type of harm children experience and is the most common reason that children are placed on child protection plans.   

Working Together 2018 defines neglect as:

‘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 (including exclusion from home or abandonment);
• protect a 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.’

On 3rd May 2015, the Serious Crime Act 2015 amended s.1 Children and Young Persons Act of 1933 (Child Cruelty) regarding neglect to read:

“If any person who has attained the age of sixteen years and has responsibility for any Child or young person under that age, wilfully assaults, ill-treats (whether physically or otherwise), neglects, abandons, or exposes him, or causes or procures him to be assaulted, ill-treated (whether physically or otherwise),neglected, abandoned, or exposed, in a manner likely to cause him unnecessary suffering or injury to health (including injury to or loss of sight, or hearing, or limb, or organ of the body, and any mental derangement) (whether the suffering or injury is of a physical or psychological nature), that person shall be guilty of an offence“

Neglect cannot be defined as a one-off incident such as seeing an untidy kitchen while on a visit. It typically arises where there is an ongoing failure of a parent or carer to provide for the basic physical and psychological care needs of a child.  The impact of neglect may become prevalent over a sustained period of time with evidence to support concerns usually gathered from a number of agencies/professionals. It is therefore important for professionals to keep a focus on the child’s journey from needing to receive effective protection from neglect (and abuse). However, neglect can occur in isolated events such as a child left unsupervised or not treated for a medical injury where the family may be in crisis or under the influence of drugs/alcohol. Practitioners need to consider if these one off incidents are part of any patterns that do impact upon the care they receive. The incidents will require assessing using the chronology of any patterns to establish there is coexistence of neglect along with other forms of abuse

In trying to define neglect  we need to understand the followings:

• Neglect is something that is persistent and cumulative and occurs over time with little change, despite intervention.
• That while neglect might occur within a family perceived to be living in poverty, the children at the greatest risk are those who live in families in which the parents’ own emotional impoverishment is so great that they actually do not know how to parent, do not understand their children’s needs and despite intensive intervention cannot provide for their needs.
• When considering the risk of neglect in relation to an unborn child, the neglect of a parents own health or poor self-care not only can define the significant of risk and concern for a child’s development in the womb, but it can also provide a barometer for the likelihood of harm once the child is born.

Children's need for, and rights to, healthy development can be identified within The United Nations Convention on The Rights of the Child (1989). There is an international consensus on the basic needs of children.

The Children Act (1989) does not specify needs or rights. It does, however, assert the general principle of the paramountcy of the child's welfare. These Practice Guidelines are also influenced by the Human Rights Act (2000). See also Statutory Framework Procedure.

The Convention specifically identifies the right to:

• Life and the best possible chance to develop fully;
• An adequate standard of living primarily provided by parents, but with help from the State;
• Day to day care;
• Health and health care;
• A safe, healthy, unpolluted environment with safe nutritious food and unpolluted water;
• Disabled children should be helped to be as independent as possible, and to take a full and active part in everyday life;
• To have their views ascertained and to be listened to;
• To have a standard of living adequate for their physical, mental, emotional, spiritual, moral and social development;
• To have access to education to achieve their full potential.

The assessment of need and provision of services for children by statutory and voluntary organisations should reflect anti-discriminatory practice.

One of the main reasons why neglect is difficult to define is that the term itself is an umbrella for numerous forms of child maltreatment, this will include pre-birth neglect and babies.  In an attempt to overcome the problem, we have broken down the definition into the following:

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.

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.
• Adequatel means sufficient to avoid harm or significant risk of 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?

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.

Further information on the indicators of child abuse neglect can be found in the National Institute for Health and Care Excellence Guidance.

The focus of attention in relation to neglect has been on younger children, however all children can experience neglect at any age – from birth to adolescence. Neglect can cause a range of short- and long-term effects which may vary depending on the age of the child affected.

Brain development

Where a baby is malnourished, neural cells can become weak or damaged and this can cause lowered brain function. If a child has little interaction with their caregiver, it can change how emotional and verbal pathways develop and impact their ability to learn.

Physical development

Parents and carers need to help young children to develop gross motor skills. If they are being neglected, or if parents don’t know how to stimulate their child, this process may not happen effectively, and the child’s development may be delayed (Horwath, 2013).

Physical health

If a child isn’t given enough food, they will immediately experience hunger and discomfort and may have trouble concentrating. But longer-term malnourishment will also affect their physical health and development.

Having an unhealthy diet can also lead to obesity-related health problems.

Not receiving appropriate medical care can result in poor health, dental decay and in some circumstances, death.

Mental health

Children who have experienced neglect are more likely to experience mental health problems, including:

• depression
• post-traumatic stress disorder (PTSD)
• dissociative disorders
• memory impairments
• panic disorder
• attention deficit and hyperactivity disorder (ADHD) (Child Welfare Information Gateway, 2009).

Relationships and attachment

Children who don’t get the love and care they need may develop problems with attachment – they may struggle to form a strong relationship or bond with their caregiver. This can lead to a child becoming isolated and affect their ability to maintain healthy relationships with others later in life (including their own children) and can impact on the following:

• independent living in the community.
• accepting adult responsibilities.
• life chances and opportunities such as employment and education.
• parenting – children who experience neglect lack a role model for good parenting, and so are at risk of becoming neglectful or abusive parents.
• self-care, for example nutrition, general health, risk-taking behaviour.
• becoming involved in unhealthy and/or abusive relationships.

Risk-taking behaviour

Exposure to Risk

There is growing evidence to suggest young people who have experienced   neglect (not only early child hood neglect - as some young people may experience neglect at any point in their life but not experienced early childhood neglect) may be more exposed  to other risks of abuse and extra-familial harms , such as:

• being exploited
• running away from home
• Anti-social behaviour such as criminality, substance misuse, prostitution.
• abusing drugs or alcohol

The consequences of experiencing neglect can impact negatively on their outcomes and later life chances into adulthood.

Safety

If children and young people aren’t being supervised appropriately by their parents and carers they may have accidents which can cause injury, illness, disfigurement, disability or even death.

Any child can suffer neglect, but research shows that some children are more vulnerable including those who:

• have a disability
• are born prematurely or with a low birth weight
• have complex health needs
• are in care
• are seeking asylum.

Most families come under pressure from time to time. Although many parents are able to provide loving care for their children during difficult periods, increased or continued stress can affect how well a parent can look after their child.

Research shows that parents with a low income, or living in poorer housing and neighbourhoods, are more likely to feel chronically stressed than other parents (Jütte et al, 2014); and parents who are facing complex problems such as domestic abuse or substance misuse can struggle to meet their children’s needs (Haynes et al, 2015).

If parents are feeling particularly isolated, this can make it harder for them to ask for help and increases the risk of child abuse or neglect (Jütte et al, 2014).

Assessment tools can help practitioners get a clear picture of how well parents are able to look after their children. This helps professionals make timely evidence-based decisions to improve the child’s quality of life.

Having a clear framework to assess neglect and its impact on a child is essential to enable a robust and holistic assessment to consider the needs of a child and whether or not their parents/carers are consistently meeting such needs. If not, neglect may be an issue. Neglect is often more than a child being persistently hungry or dirty and practitioners must focus upon the range of needs that children have when considering this question.  Although any definition of neglect will always be open to a degree of judgment, there are a number of key factors that, as a rule, are consistent:

• Neglect is a passive form of abuse. The importance of contextual information rather than incidental factors is crucial to the identification of neglect.
• Its presentation as a ‘chronic condition’ requires the collation and analysis of sometimes small and seemingly insignificant events that only when viewed together provide evidence that neglect is an issue of concern.
• The intent to harm the child by the parent or carer is not always present.
• Neglectful families often face multiple problems.
• Child neglect can cause serious harm and death.

Evidence should be gathered in a systematic way over time rather than at a specific point in time. Neglect is a long-term developmental issue rather than a crisis caused by a single event.

Assessment needs to include everyone with a parenting role, regardless of gender or biological link. Assessments of attachment should be carefully undertaken. It is important to look beyond initial impressions. Attachment theories should be used to assess the nature of parent/child relationships. These theories should be applied across all cultures.  Observations of the parent-child interaction will inform the assessment of attachment. Unrealistic expectations or inappropriate interpretations of a child’s behaviour can be a feature of neglectful parenting, e.g. a child who cries a lot is described as ‘nasty’, as though the crying is a deliberate action designed to irritate.  The role of significant others within the household is crucial and the need for lateral checks in relation to these individuals.

Consideration should be given to engaging the wider family in the assessment to understand the role they may be able to play in the child’s life.  Family group conferencing is an effective way of involving wider family members in the development of a plan to safeguard and promote the welfare of a child in need. The family is the primary planning group in the process and it creates an opportunity for family members to understand the issues from the professional’s perspective.

Diversity

While there should be sensitivity to a child’s racial, religious and cultural background and differing styles of parenting, it is important not to stereotype and make assumptions about the care of children from diverse backgrounds and not to make allowances which may be harmful to the child.

Clarity of purpose

It is important parents understand concerns about child neglect. Practitioners must be clear and honest with parents/carers about the changes they must make in their care of the child and why. Practitioners should address personal and difficult issues with parents. SMART objectives should be set (specific, measurable, achievable and realistic) with clear timescales. Practitioners should consider the impact of learning difficulties on a parent’s level of understanding, paying attention to appropriate methods of communication and assessment.

Maintaining the focus on the needs of the child

It can be difficult to gain multi-agency agreement about neglect. Sometimes this is because perceived negatives in one aspect of a child's life may be thought to be balanced out by positives in another. The assessment of neglect requires risk and protective factors to be analysed and weighted accordingly. Historical Serious Case Reviews and current Child Safeguarding Practice Reviews often refer to the ‘over optimism’ of professionals – this must be guarded against.

Focus on the day-to-day experiences of the child – what is the child’s actual lived experience and what is the impact of this? Look at the world through the child’s eyes. Stand in the child’s shoes. See the world as he or she sees it. Ask the question: ‘What is life like for this child in this family?’

Be alert to the child’s basic care needs and routinely check aspects of care such as provision of food, hygiene, and sleeping arrangements. Practitioners should be prepared to ask to look in rooms, cupboards etc.

Theories of child development should be used to benchmark concerns about a child’s presentation and welfare. An early paediatric assessment will provide a baseline of the child’s developmental milestones, as well as growth and physical health, and will be helpful in evaluating and evidencing progress or lack of it.

The importance of seeing the child on his/her own and engaging in a meaningful way, as well as observing the child at home, cannot be overstated. It can also be helpful to see the child in a variety of settings, i. school, nursery, respite care, to observe any differences in their demeanour and behaviour. Consideration should be given to each child within the family and the impact of  neglect on their development.

It is important to be mindful of circumstances where some children from a family are subject to a child protection plan under the category of neglect and others are not. This may give rise to mixed messages to parents/carers that not all their parenting is poor and that they only need to improve their parenting in respect of some of their children. In such circumstances all children in the household are experiencing some level of neglectful care by the mere fact that they are observing behaviour/neglect of their siblings and are therefore being emotionally abused as a result.

It is likely that parents will have needs of their own that may require intervention

Use of Chronologies

Concerns about neglect are likely to have developed over a considerable period of time and chronologies are a valuable tool in highlighting concerns and patterns.  It is likely that there will be a number of minor incidences which over time begin to heighten concerns about child neglect. It is important to maintain records which agencies can use to compile a chronology.  Chronologies should be compiled when:

• there is concern about an emerging pattern of neglect
• a Section 47 enquiry is being undertaken.

New information

It is important to give due weight and consideration to any new information regarding a family’s circumstances or the care of the child and consider whether the case needs a different focus or escalating to another level.

Difficulties in dealing with neglect may be compounded by resistance and avoidance by both families and practitioners. For further information and guidance to deal with families in these circumstances practitioners should follow the  link and refer to section 2.13 Disguised compliance, coercive control and families who are hostile or resistant to change.

A whole system approach is vital in dealing with cases of neglect, in order that children and their families receive the right type of services when they need them. Children and their families may need to ‘step up and step down’ through the tiers of support. Practitioners need to consistently evaluate the lived experience of neglect for a child in relation to the various thresholds of intervention.  If children are left in neglectful situations then the cumulative impact of neglect means they will come into contact with statutory services. Practitioners will need to consider the importance of information sharing and consider the need for consent throughout the processes of intervention.

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.

Universal services

In view of the impact of neglect on children’s wellbeing and development, early identification of concerns by universal services is crucial. Universal services, such as health and education, can offer early intervention and additional support, e.g. parenting classes, extra support at school. This also includes the identification of concerns antenatally and provision of services as appropriate.

Early Help Assessment

Where intervention by a single agency does not alleviate concerns, consideration should be given to undertaking an assessment using the Early Help Assessment. This requires consent by the parent/carer and child/young person as appropriate and consultation with other agencies working with the family.  The Early Help Assessment considers the needs of the child and family across a number of contexts and with the identification of any additional needs of the child and family.  A multi-agency meeting may be convened to discuss the assessment and consider the action necessary to meet these needs.  A plan outlining the actions agreed, with timescales and responsible practitioner, should be put together, with a Lead Professional taking overall responsibility for ensuring the plan is taken forward.

Arrangements should be made to review the plan and whether it is being effective in bringing about change and improving outcomes for the child.  In some situations the outcome of the Early Help Assessment will be increased concern about the welfare and safety of the child.  In such cases consideration should be given to an immediate referral to children’s social care. Information from the assessment process can be used to support the referral with consideration of consent issues.

Child in Need (section 17)

Neglect even when less serious may  require a 'Child in Need' assessment under Section 17 Children Act 1989.  Such early intervention may have preventative value.

In some situations, the Child in Need Plan will not bring about the change anticipated and concerns about the child’s wellbeing will continue or increase. In such cases parent/carer’s consent should be sought for a referral to be made to children’s social care for consideration of an initial assessment as to whether the child is in need under Section 17 of Children Act 1989:

“A child is in need if: She or he is unlikely to achieve or maintain, or have the opportunity to so do, a reasonable standard of health or development without provision of services by a local authority, or if her/his health or development is likely to be significantly impaired, or further impaired, without such services, or she or he is disabled.”

If the child is identified as a child in need, a multi-agency Child in Need plan should be developed. A meeting should be held to review the plan at regular intervals. At each review consideration should be given as to the progress being made in achieving the objectives and whether the child is suffering, or is likely to suffer, significant harm.

Section 47 Enquiry

The threshold that permits compulsory intervention in family life, in the best interests of the child, is that of actual or likely significant harm.

In cases of neglect it will be necessary to demonstrate that:

• the child is suffering or is likely to suffer significant harm, and
• the harm, or risk of harm, arises because of the care afforded to the child and the parent/carer’s failure to meet the child’s needs.

Following the completion of these enquiries, and the assessment of risk to the child, a decision will be made regarding the need for an Initial Child Protection Conference.  This will consider whether the child is at risk of significant harm and in need of a child protection plan.  Research shows that agencies have often had a long period of involvement with children and young people experiencing neglect before child protection processes are started.  In comparison with children who experience other forms of abuse, children experiencing neglectful care will have been known to agencies for much longer periods.

Stepping down

When it is decided a child no longer needs a child protection plan, consideration should be given to how to continue to support the child and family.  It is important that services are not suddenly withdrawn, and that support is provided to support the changes that have been made by the family.

Legal intervention

In cases of neglect where children’s services and other agencies have been working with the family for some time, the threshold for significant harm is thought to be met and there is little likelihood of change, the local authority should consider convening a Legal Planning Meeting (LPM) to consider the need to initiate care proceedings to protect the child. If the LPM agrees the threshold for care proceedings is met, the local authority will send a letter to the parents/carers specifying its concerns, what support will be offered and what changes are needed to avoid the initiation of care proceedings; the letter will say how the parents/carers can get free legal advice and representation.

This letter will invite the parents/primary carers to attend a meeting with their solicitors. A formal agreement will be drawn up if agreement can be reached regarding the changes that need to take place to avoid proceedings. A period of monitoring will then ensue and if there is a failure to co-operate and evidence improvements within timescales the local authority will issue proceedings.

Prior to issue the local authority will complete a chronology, Statement and Interim Care Plan for each child, including information shared by partner agencies.

Giving evidence in court

The local authority may begin legal proceedings to safeguard the child if evidence-based assessments of risk conclude a child is being neglected and there has been no change by the parents/carers. Professionals involved may be required to give evidence in court. This could include police, health visitors, midwives, school nurses, teachers and social workers.

Assessments are multi-disciplinary in nature and should always represent multi-agency involvement and evidence. A framework and tool to collate this would ensure there is evidence to demonstrate ‘persistent neglect as well as significant agency involvement. A chronology of all agency activity with the family is crucial.  When giving evidence in court these two tools will highlight and evidence that the neglect has been persistent and cumulative over a significant period of time.

Professionals may be required to provide written witness statements detailing their agency involvement. Evidence needs to focus on the child and the child’s world. Therefore, if home conditions are an issue, these should be related back to the Assessment Framework: Family and Environmental Factors. If global developmental delay is an issue, the parenting capacity should be assessed. Evidence should be analytical focussing on the impact on the child.

The chronology may also highlight evidence across all three domains of the assessment framework. An eco-map will also highlight the level and duration of agency involvement and is a good tool to highlight parenting capacity and evidence of compromised parenting.

Immediate protection

There will be situations where concerns about the child or their home environment is such that immediate protective action is warranted, regardless of whether reasonable support has been provided or not. In such circumstances agencies should inform children’s social care or police without delay.

The police have a power under Section 46 of the Children Act 1989 to remove a child to a place of safety (i.e. foster carer or family member), or to ensure the child is not removed from a hospital, or any other place in which the child is being accommodated, to keep them safe from the identified risk. This power to remove, (or prevent removal), of children can be used: ‘where a constable has reasonable cause to believe that a child would otherwise be likely to suffer significant harm’. This is referred to as Police Protection and can last for no more than 72 hours.

It should be noted the police have no power of entry under this act. However, in cases of an emergency Section 17 of the Police and Criminal Evidence Act 1984 should be used.

Children with disabilities

Children with disabilities are more vulnerable to neglect. Sullivan and Knutson (2000) suggest they are 3.8 times more likely to be neglected for various reasons, including the demands placed on the family’s capacity to care and children and young people not being able to communicate their own needs.

Neglect of basic care should not be confused with a lack of resources.

Practice guidance produced by The Children’s Society (Safeguarding disabled children) makes clear that disabled children have the same human rights as anyone else to be protected from harm and abuse.

Adolescents

In recent years there has been growing recognition that adolescents can experience neglect. A failure to understand and meet the basic care needs of young people arises from many of the same factors which lead to the neglect of children. Many teenagers have lived with neglectful care throughout their childhood. Factors which can be present are the same as many of those for younger children.

In addition, inappropriate expectations can arise when a young person becomes an adolescent. Parents may become emotionally and physically unavailable. Support may be lacking for the young person at developmental, educational and personal milestones.

A useful resource for practitioners is a Government Review that provides an accessible summary of relevant literature on adolescent neglect.

Attachment and parent-child interaction

A wide range of research now shows that conception to age two is a crucial phase of human development and is the time when focused attention can reap great dividends for society. How we treat 0–2-year-olds shapes their lives, and ultimately our society. Further information is available in Conception to age 2 - the age of opportunity.

Information sharing

Information sharing is vital to safeguarding and promoting the welfare of children and young people. Sharing information between agencies is crucial in cases of neglect where disguised compliance is suspected in order to check assumptions and the parent’s/carers account of events.

Professionals should follow the seven Golden Rules as highlighted in Government guidance Information sharing advice for safeguarding practitioners.

Resolving professional differences across agencies

When there are differences of opinion about the action to be taken to safeguard a child or young person, the practitioner should discuss them with his or her supervisor or the designated child protection member of staff.

If concerns continue the matter should be discussed with the appropriate manager in the agency with which there is conflict. If it is not possible to resolve the difficulties at a local level, then they should be taken up through the appropriate management structures. Additionally, concerns can be discussed with the Head of Safeguarding.

Serious Case Reviews and child Safeguarding Practice Reviews have highlighted the importance of agencies continuing to pursue any concerns until they are satisfied that the child or young person is appropriately safeguarded.

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
• the registration authority for the secondary carer (for example Ofsted), who can consider the possible implications for other children.