Identifying, assessing and understanding neglect

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Identifying, assessing and understanding neglect

• Patrick Ayre
• Department of Applied Social Studies
• University of Bedfordshire
• Park Square, Luton
• email pga_at_patrickayre.co.uk
• web http//patrickayre.co.uk

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• NEGLECT

• Neglect is the persistent failure to meet a
  childs basic physical and/or psychological
  needs, likely to result in the serious impairment
  of the childs 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
• protect from physical and emotional harm or
  danger
• ensure adequate supervision
• ensure access to medical care or treatment.
• It may also include neglect of, or
  unresponsiveness to, a childs basic emotional
  needs.

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• NEGLECT

• Neglect is the persistent failure to meet a
  childs basic physical and/or psychological
  needs, likely to result in the serious impairment
  of the childs 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
• protect from physical and emotional harm or
  danger
• ensure adequate supervision
• ensure access to medical care or treatment.
• It may also include neglect of, or
  unresponsiveness to, a childs basic emotional
  needs.

4

• NEGLECT

• Neglect is the persistent failure to meet a
  childs basic physical and/or psychological
  needs, likely to result in the serious impairment
  of the childs 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
• protect from physical and emotional harm or
  danger
• ensure adequate supervision
• ensure access to medical care or treatment.
• It may also include neglect of, or
  unresponsiveness to, a childs basic emotional
  needs.

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• NEGLECT

• Neglect is the persistent failure to meet a
  childs basic physical and/or psychological
  needs, likely to result in the serious impairment
  of the childs 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
• protect from physical and emotional harm or
  danger
• ensure adequate supervision
• ensure access to medical care or treatment.
• It may also include neglect of, or
  unresponsiveness to, a childs basic emotional
  needs.

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• NEGLECT

• Parents who neglect their children basically just
  dont know any better because of their own poor
  upbringings. If we send them to a family centre
  for Parental Skills training, all will be well.

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• NEGLECT

• Parents who neglect their children basically just
  dont know any better because of their own poor
  upbringings. If we send them to a family centre
  for Parental Skills training, all will be well.
• IF ONLY!!....

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• NEGLECT

• So neglected children who come into care may be a
  bit thin, a bit dirty, badly in need of seeing a
  doctor or dentist, maybe a bit wild.
• But we can place them with foster carers for a
  bit of looking after, a bit of TLC, a bit of
  structure and everything will be fine. The
  children will absolutely love it and will
  immediately start to thrive. Simple really!

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• NEGLECT

• So neglected children who come into care may be a
  bit thin, a bit dirty, badly in need of seeing a
  doctor or dentist, maybe a bit wild.
• But we can place them with foster carers for a
  bit of looking after, a bit of TLC, a bit of
  structure and everything will be fine. The
  children will absolutely love it and will
  immediately start to thrive. Simple really!
• IF ONLY!!....

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Brain development

• At birth our brains are only 25 developed
• By age 3, a childs brain has reached almost 90
  of its adult size and has accpmplished 80 of its
  total development.
• The growth in each region of the brain largely
  depends on receiving stimulation.
• This stimulation provides the foundation for
  learning.

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Experience Affects the Structure of the Brain

• Brain development is activity-dependent
• Every experience excites some neural circuits and
  leaves others alone
• Neural circuits used over and over strengthen,
  those that are not used are dropped resulting in
  pruning

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Poor integration of hemispheres and
underdevelopment of the orbitofrontal cortex

• Difficulty regulating emotion,
• Lack of cause-effect thinking,
• Inability to recognize emotions in others,
• Inability to articulate own emotions,
• Incoherent sense of self and autobiographical
  history
• Lack of conscience.

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Other physiological issues

• Serotonin emotional stability and feeling good
• Malnutrition cognitive and motor delays,
  anxiety, depression, social problems, and
  attention problems
• Myelination
• Sensitive periods (infancy attachment)

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Emotional development

• Sensitive period for emotional development up to
  18 months
• Shaped primarily by the way in which the prime
  carer interacts with the child
• Emotional deficits harder to overcome once the
  sensitive window has passed.
• How often do we intervene assertively at this
  point?

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Building a child

• Building a child is like building a house, each
  new level built on the one below. If the lower
  levels are unsound, no amount of tinkering with
  the upper floors will make it stable.

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Checkpoint 1 timing intervention

• If we wait until we can see the evidence of
  neglect in a childs behaviour, it may be too
  late to put it right completely.

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Neglect

• Behavioural
• Constant hunger
• Constant tiredness
• Frequent lateness or non-attendance at school
• Destructive tendencies

21
Neglect

• Low self-esteem
• Neurotic behaviour
• No social relationships
• Running away
• Compulsive stealing or scavenging

22
Neglect

• Physical
• Poor personal hygiene
• Poor state of clothing
• Emaciation, pot belly, short stature
• Poor skin and hair tone
• Untreated medical problems

23
Significant harm

• Harm is defined by Children Act 1989
• ill-treatment (including sexual abuse and, by
  implication, physical abuse)
• impairment of health (physical or mental) or
  development (physical, intellectual, emotional,
  social or behavioural)

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The child's basic needs

• basic physical care
• affection
• security
• stimulation of innate potential
• guidance and control
• responsibility
• independence

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Why do parents neglect?

• We need to understand the interaction between
• 3 Ns Nurture, Nature, Now
• Circumstantial factors and fundamental factors

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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

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Forms 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
• (Howe, D (2005) Child Abuse and Neglect,
  Basingstoke Palgrave Macmillan)

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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
• Associated with avoidant/defended patterns of
  attachment

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Emotional neglect parents

• Cant cope with childrens demands
  avoid/disengage from child in need dismissive or
  punitive response
• Children provided for materially but there is a
  failure to connect emotionally
• More rules everyone has a role and knows what to
  do.
• Parents may feel awkward tense when alone with
  their children.

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Emotional neglect children

• When attachment behaviour rejected
• Learns that caregivers physical and emotional
  availability is reduced when emotional demands
  are made
• Caregiver most available when child is showing
  positive affect, being self-sufficient,
  undemanding and compliant
• Reverse roles, false brightness to care for/
  reassure parent.

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Emotional neglect children

• Frightened, unhappy, anxious, low self-esteem
• Withdrawn, isolated, fear intimacy and dependence
• Precocious, streetwise, self-reliant

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Emotional neglect children

• May show compliance to dominant caregivers but
  anger and aggression in situations where they
  feel more dominant.
• May learn that power and aggression are how
  relationships work and you get your needs met
• Behaviour increasingly anti-social and
  oppositional
• Brain development affected difficulties in
  processing and regulating emotional arousal

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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
• Worker may feel agenda co-opted by familys
  immediate needs

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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
• May be regarded as overwhelmed but amenable to
  services
• Crisis is a necessary not a contingent state
• Associated with ambivalent/coercive patterns of
  attachment

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Disorganised neglect carers

• Cope with babies (babies need them) but then
• Parental responses to children
• unpredictable and insensitive (though not
  necessarily hostile or rejecting).
• driven by how the parent is feeling, not the
  needs of the child
• Lack of attunement and synchronicity

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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

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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)

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Depressed neglect carers

• Often severely abused/neglected own parents
  depressed or sexually or physically abusive
• May seem unmotivated, mild learning disability
• Learned helplessness in response to demands of
  family life
• Stubborn negativism passive-aggressive
• Have given up both thinking and feeling

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Depressed neglect carers

• Listless and unresponsive to childrens 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

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Depressed neglect children

• Younger the child, more debilitating the effects
• Lack interaction with parents required for mental
  and emotional development
• Infant Incurious and unresponsive moan and
  whimper but dont cry or laugh
• At school isolated, aimless, lacking in
  concentration, drive, confidence and self-esteem
  but do not show anti-social behaviour

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Depressed neglect case management

• These families need
• Long term involvement
• Supportive approach
• Responsiveness to familys signals and needs
• BUT these need to be balanced with a recognition
  of the childrens needs. (How long is too long?
  How much is too much?)

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Depressed neglect infants and children

• Must experience responsive and stimulating
  environments that also provide human comfort for
  a few hours each day.
• The longer the child is exposed to helplessness,
  the more intense and longer the intervention
  needed to remedy the situation.

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Depressed neglect parents

• Must learn appropriate ways to show their
  feelings
• Practice smiling, laughing, soothing
• May be mechanical at first
• Genuine feelings will emerge with repetition
• As parents learn to show their feelings, the
  childs responsiveness will increase virtuous
  spiral

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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

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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

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Checkpoint 2 case management

• How should we manage cases of
• Emotional Neglect
• Disorganised neglect
• Depressed neglect
• Severe deprivation

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Emotional neglect case management

• Help parents to learn to use others for support.
• Teach parents to engage emotionally with their
  children.
• Must be highly structured as neither parent or
  child know how to interact normally
  spontaneously.
• Fear of affect need clear rules roles

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Disorganised neglect case management

• Logic would argue for warding off crises for a
  while so that families can be taught to organise
  their lives, but
• Family may want to have needs met, but cannot
  delay gratification or trust logic and planning
• Without intense demands associated with crises,
  have no way of being important to others
• Will CREATE new crises.

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Disorganised neglect case management

• Feelings must be addressed
• Need a structured, predictable environment with
  no surprises where
• There are rewards for clear, direct, and
  undistorted communication of feelings and
  accurate cognitive information about future
  outcomes
• Family can learn the value of compromise
• Teach parents how to use cognitive information to
  regulate feelings (without denying them)

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Depressed neglect case management

• Involves much more than teaching appropriate
  parenting
• All family members must learn that their
  behaviour has predictable and meaningful
  consequences
• Teach that it helps to share feelings with
  empathetic others.

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Depressed neglect case management

• Our standard approaches dont work
• Threats / punitive approaches particularly
  ineffective
• Parents dont believe they can change so dont
  even try.
• Even most reasonable pressure results in
  shutting down / blocking out all info.
• Parent education may be ineffective because
  judgment impaired and gains not transferable.

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Severe deprivation case management

• Highly unlikely to be in the childs best
  interests to remain in the environment which
  caused the harm
• It is probable that the child and new carers will
  require substantial therapeutic and emotional
  support
• Significant challenges often persist despite a
  move to a caring and predictable environment.

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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 for recognition
• Neglect is a pattern not an event

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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 for recognition
• Neglect is a pattern not an event

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Our image of assessment
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The reality of assessment?
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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 for recognition
• Neglect is a pattern not an event

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The pattern of neglect atypical
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The pattern of neglect
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The pattern of neglect
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The pattern of neglect
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The pattern of neglect
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Cumulativeness
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Failure of cumulativeness
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Whats the problem?

• Chronic abuse and the principle of cumulativeness
• Files very long and badly structured
• Patterns missed and chronic abuse overlooked
• The problem of proportionality
• Acclimatisation (case, agency and geographical)

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Checkpoint 3 Acclimatisation

• Do you ever encounter acclimatisation?
• What do you do about it?

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The assessment of neglect

• An approach based on the Graded Care Profile by
  Dr OP Shrivastava
• GCP provides
• Framework for making assessment
• Baseline measurement
• An element of objectivity
• Judgement about care
• Reliable standardised evidence

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GCP users

• Health visitors
• School nurses
• Social workers
• Family centre workers
• Education welfare workers

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GCP uses

• Pre-referral assessments
• Snapshot assessments
• Contribution to CAF assessments
• Contribution to Core Assessment (parenting
  capacity)
• Self-assessment (parents and carers)
• Young persons assessment of parenting
• Tool for setting goals and assessing progress
• Tool to facilitate discussion

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Domains of Care
Stimulation Approval Disapproval Acceptance
Sensitivity Responsivity Reciprocity Overtures
Self actualisation
Esteem
Love and belongingness
Present absent
Safety
Physical needs
Nutrition. Housing, Clothing, Hygiene Health
Maslow, A. 1954
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What to observe
Nutrition Housing Clothing Hygiene Health
Quality, Quantity, Preparation, Organisation,
A. PHYSICAL B. SAFETY C. LOVE D. ESTEEM
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Grades of Care
Grade 1 Grade 2 Grade 3 Grade 4 Grade 5
Level of care All childs 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 second Child not considered
Quality of care Best Adequate Equivocal Poor Worst
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Example AREA C LOVE
Sub-areas 1 2 3 4 5
1. Carer
A Sensitivity Anticipates or picks up very subtle signals- verbal or nonverbal expression or mood. Comprehends clear signals distinct verbal or clear nonverbal expression. Not sensitive enough stimuli and signals have to be intense to make an impact e.g. cry. Quite insensitive needs repeated or prolonged intense signals. Insensitive to even sustained intense signals or aversive.
B Response Synchronisation Timing Responses well synchronised with signals or even before in anticipation Responses mostly synchronised except when occupied by essential chores. Not synchronised for own recreational engagement synchronised if fully unoccupied or child in distress. Even when child in distress responses delayed. No responses unless a clear mishap for fear of incrimination.
C Reciprocation (quality) Responses complementary to the signal. Both emotionally and materially, can get over stressed by distress signals from child. Warm. Material responses (treats etc.) lacking, but emotional responses warm and reassuring. Emotional reciprocation warm if in good mood (not burdened by strictly personal problem), otherwise flat. Emotional reciprocation brisk, flat and functional, annoyance if child in moderate distress but attentive if in severe distress. Aversive/punitive even if child in distress, acts after a serious mishap mainly to avoid incrimination, any warmth/remorse deceptive.
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Sub-Area Scores Scores Scores Scores Scores Area Score Comments
(A) Physical 1. NUTRITION 1 2 3 4 5
(A) Physical 2. HOUSING 1 2 3 4 5
(A) Physical 3. CLOTHING 1 2 3 4 5
(A) Physical 4. HYGIENE 1 2 3 4 5
(A) Physical 5. HEALTH 1 2 3 4 5
(B) Safety 1. IN CARERS PRESENCE 1 2 3 4 5
(B) Safety 2. IN CARERS ABSENCE 1 2 3 4 5
(C) Love 1. CARER 1 2 3 4 5
(C) Love 2. MUTUAL ENGAGEMENT 1 2 3 4 5
(D) Esteem 1. STIMULATION 1 2 3 4 5
(D) Esteem 2. APPROVAL 1 2 3 4 5
(D) Esteem 3. DISAPPROVAL 1 2 3 4 5
(D) Esteem 4. ACCEPTANCE 1 2 3 4 5
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Targeting Items of Care
Targeted Areas Current Score Target Score Timescale Reviewed Score
1
2
3
4
5
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Making an assessment

• Guidance provided (follow up scores of 4 or 5)
• Evaluates strengths as well as weaknesses
• Allows progress to be assessed
• A relatively objective measure
• Allows help to be targeted where needed

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Making an assessment

• 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

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  Scale for Assessing Neglectful Parenting
(Northamptonshire)

• 179 individual questions under the following
  headings
• Food and Eating Habits
• Health and Hygiene
• Warmth/Clothing
• Safety and Supervision
• Emotional Needs
• Cognitive Development
• Educational Needs

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  Example questions (Health and Hygiene)
21 The home lacks showering or bathing facilities
which work, and are available for maintaining
personal hygiene   22 The bath and basin are
dirty, or inaccessible 23 The family lacks a
toilet which works   24The toilet is regularly
left dirty or stained 25 Toddlers potties are
left unemptied containing urine and faeces   26
The kitchen is dirty (eg cooker ingrained with
old food, grime on walls, floor, kitchen
utensils, sink)
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  Making an assessment

• Each statement scored 1, 2 or 3 according to how
  true it is.
• Blank spaces for Summary, Conclusions and Action
  Plan
• Lengthy and comprehensive list of relevant
  factors
• No guidance on making overall judgments
• Statements all identify weaknesses
• Allocation of questions to headings a little
  eccentric at times

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Putting it all togetherThe chain of reasoning

• Facts
• ?
• Analysis/summary
• ?
• Conclusions/recommendations/action

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The chain of recording

• What happened/what you saw
• ?
• What this means
• ?
• What you did/what should be done (and why, if
  this is not clear from the above)

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The chain of recording

• But how do you know which facts?
• Must be informed by a basic risk assessment
  (would not always be spelled out on paper)

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Risk assessment

• The dangers involved (that is the feared
  outcomes)
• The hazards and strengths of the situation (that
  is the factors making it more or less likely that
  the dangers will realised)
• The probability of a dangerous outcome in this
  case (bearing in mind the strengths and hazards)
  
• The further information required to enable this
  to be judged accurately and
• The methods by which the likelihood of the feared
  outcomes could be diminished or removed.

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Bias and Balance

• Include information favourable to the other
  side as well as that favourable to yours
• It is your job to make judgements but
• avoid empty evaluative words like inappropriate,
  worrying, inadequate
• Give evidence for descriptive words like cold,
  dirty and untidy
• Beware the danger of facts

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Bias and Balance

• Born in 1942, he was sentenced to 5 years
  imprisonment at the age of 25. After 5
  unsuccessful fights, he gave up his attempt to
  make a career in boxing in 1981 and has since had
  no other regular employment

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Lies, damned lies and killer bread

• Research on bread indicates that
• More than 98 percent of convicted felons are
  bread users.
• Half of all children who grow up in
  bread-consuming households score below average on
  standardized tests.
• More than 90 percent of violent crimes are
  committed within 24 hours of eating bread.
• Primitive tribal societies that have no bread
  exhibit a low incidence of cancer, Alzheimer's,
  Parkinson's disease, and osteoporosis.
• In the 18th century, when much more bread was
  eaten, the average life expectancy was less than
  50 years infant mortality rates were
  unacceptably high many women died in childbirth
  and diseases such as typhoid, yellow fever, and
  influenza were common.

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Incomplete or out of date
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Can you trust a snapshot?
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Assessment Pitfalls

• Parents behaviour, whether co-operative or
  uncooperative, often misinterpreted
• Information from family friends and neighbours
  undervalued
• Coping with aggressive or frightening families
• Failure to give sufficient weight to relevant
  case history Start again syndrome
• Not enough attention is paid to what children
  say, how they look and how they behave
  maintenance of a wholly child-centred approach

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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)

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Information handling pitfalls

• Picking out the important from a mass of data
• Facts recorded faithfully but not always
  critically appraised
• Too trusting/insufficiently critical
• Decoyed by another problem
• False certainty undue faith in a known fact
• Discarding information which does not fit the
  model we have formed
• Department of Health (1991) Child abuse A study
  of inquiry reports, 1980-1989, HMSO, London

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Assessment pitfalls

• Rule of optimism
• Natural love
• Cultural relativism
• Too much
• not enough
• Adult services and childrens services
  (hand-in-hand or hand-to-hand?)

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Childrens services and adult services

• Working on the same case but not working jointly
• Mutual incomprehension and misunderstanding
• False expectations and assumptions
• Abdicating responsibility
• Need for interpreters

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Information handling pitfalls

• Keeping your head down
• Hesitancy to challenge other professionals or the
  conventional wisdom
• Tendency to move from facts to actions without
  showing your working

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Challenge your dodgy thinking

• I am only a and he is a, so I had better keep
  my opinion to myself.
• I am obviously in a minority, so I had better
  keep my opinion to myself.
• We need to maintain harmonious relations, so I
  had better keep my opinion to myself.

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But what is analysis?

• You have gathered lots of information but now
  what?
• All you need to do is ask yourself my favourite
  question
• So what?
• You have collected all this data, but what does
  this mean, for the service user, for the family
  and for my setting?

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Conclusions and recommendations

• Summarise the main issues and the conclusions to
  be drawn from them. (The facts do not necessarily
  speak for themselves it is your job to speak for
  them.)
• Define objectives as well as actions
• Draw conclusions from the facts and
  recommendations from the conclusions
• Explain how you arrived at your conclusions (Have
  you demonstrated the factual/theoretical basis
  for each?)
• Consider and discuss alternative possibilities

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Conclusions and recommendations

• In drawing conclusions be aware of the extent and
  limitations of your own expertise.
• Conclusions may be supported by research (Dont
  go outside expertise be careful with new or
  controversial theories be aware of counter
  arguments)
• Your recommendation should usually be specific
  (not either/or)
• Remember conclusions may be attacked in only two
  ways
• founded on incorrect information
• based on incorrect principles of social work

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Conclusions and recommendations

• Problems
• Unsupported assertions or judgements
• Inability or unwillingness to analyse and draw
  conclusions
• Failure to answer the key question So what?

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Reaching a decision

• Often a decision is made first and the thinking
  done later (Thiele, 2006)
• As humans, we resort to simplifications, short
  cuts and quick fixes!
• We reframe, interpret selectively and
  reinterpret.
• We deny, discount and minimise
• We exaggerate information especially if vivid,
  unusual, recent or emotionally laden and
• We avoid, forget and lose information

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Good Assessments

• Are clear about the purpose, legal status and
  potential outcomes
• Are based on a clear theoretical framework
• Are clear about context and value base
• Are collaborative and promote accessibility for
  service users
• Are based on multiple sources of information
• Value the expertise and understanding service
  users bring to their situation
• Are clear about missing information

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Good Assessments

• Identify themes and patterns about needs, risks,
  protective factors and strengths
• Generate and test different ways of understanding
  the situation
• Give meaning to themes, using knowledge based on
  experience/research
• Lead to an evidence-based conclusion
• Use supervision to assist reflection, hypotheses
  and objectivity
• Are able to record and explain outcomes
• Are reviewed, updated amended in light of new
  information

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Spotting the bad onesOrganisational Clues

• Mythology exists about the family this family
  is/always/behaves like
• Negative stereotypes about other agencies exist
  so their information is discounted
• Sudden changes about view of risk not explained
• Sudden changes of plan not rationally explained

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Worker clues

• Gut feelings says something is wrong
• Worker does not ask difficult questions
• Analysis does not account for facts/history
• Proposed plan does not address issues raised in
  assessment
• Practitioner is working much harder than the
  parents to explain significant concerns
• The childs story is missing

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Inter-Agency Clues

• Agencies have conflicting views of the
  family/risk
• Agencies have strong views but offer
  ambiguous/limited evidence
• Some agencies unwilling to share information
• Pressure to agree suppresses permission to
  question / inter-agency acclimatisation

108
Family Clues

• Parental intentions not supported by actions
• Parental optimism involves denial of difficulties
• Children's accounts conflict with parents
• Parents talk about their child is
  contradictory/lacks coherence
• Co-operation is only on the parents terms

109
Checkpoint 4 So what?

• We have spent some time considering how to
  recognise and respond to neglect.
• What does this mean for us? What are the
  implications for local services? What, if
  anything, will be different?

110
A final thought

• We are guilty of many errors and many faults
  but the worst of our crimes is abandoning our
  children, neglecting the fountain of life. Many
  of the things we need can wait. The child cannot.
  Right now is the time his bones are being formed,
  his blood is being made, and his senses are being
  developed. To him we cannot answer 'Tomorrow.'
  His name is 'Today.'
• Gabriela Mistral (Chilean poet, 1889-1957)

111
Bonus material
112
Working with resistance

• In many cases parents were hostile to helping
  agencies and workers were often frightened to
  visit family homes. These circumstances could
  have a paralysing effect on practitioners,
  hampering their ability to reflect, make
  judgments, act clearly, and to follow through
  with referrals, assessments or plans. Apparent or
  disguised cooperation from parents often
  prevented or delayed understanding of the
  severity of harm to the child and cases drifted.
  Where parents made it difficult for professionals
  to see children or engineered the focus away from
  allegations of harm, children went unseen and
  unheard.
• Families tended to be ambivalent or hostile
  towards helping agencies, and staff were often
  fearful of violent and hostile men. Although
  parents tended to avoid agencies, agencies also
  avoided or rebuffed parents by 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.
• Brandon, M, and others (2008) Analysing child
  deaths and serious injury through abuse and
  neglect what can we learn? London Department
  for Children, Schools and Families

113
Engagement

• Engagement is the basic task of a child and
  families worker but can never be taken for
  granted and must always be worked for

114
Context

• Involuntary work may be characterised by
• Guardedness or reluctance to share information
• Avoidance and a desire to leave the relationship
• Strong negative feelings such as anxiety, anger,
  suspicion, guilt or despair.

115
Context

• We need to accept that
• The best we may be able to achieve is honesty
  rather than positive feelings and a high degree
  of mutuality
• Conflict and disagreement are not something to be
  avoided, but are realities that must be explored
  and understood.

116
How might resistance show itself?

• By only being prepared to consider 'safe' or low
  priority areas for discussion.
• By not turning up for appointments
• By being overly co-operative with professionals.
• By being verbally/and or physically aggressive.
• By minimising the issues.
• (Egan, 1994)

117
Potential parental responses

• Genuine commitment
• Compliance / approval seeking
• Tokenism
• Dissent / avoidance
• (Horwath and Morrison, 2000)

118
Identifying resistance 4 categories

• Hostile resistance anger threats, intimidation,
  shouting
• Passive aggressive surface compliance covers
  partly concealed antagonism and anger
• Passive hopeless Tearfulness and despair about
  change
• Challenging Cure me if you can!

119
Strategies for enhancing engagement

• Before you start, check your mindset (your own
  biases and assumptions)
• Have realistic expectations
• It is reasonable that involuntary clients resent
  being forced to participate
• Because they are forced to participate,
  hostility, silence and non-compliance are common
  responses that do not reflect my skills as a
  worker
• Due to the barriers created by the practice
  situation, clients may have little opportunity to
  discover if they like me
• Lack of client co-operation is due to the
  practice situation, not to my specific actions
  and activities
• (Ivanoff et al, 1994 )

120
During initial contacts

• Adopt a non-defensive stance
• Be clear, honest and direct and acknowledge the
  involuntary nature of the relationship
• Clarify roles and expectations, including what is
  required of the client
• Explain consequences of non-compliance and the
  advantages of compliance
• (Ivanoff et al, 1994 )

121
Try to

• Invite participation
• Understand how the client sees the problem as
  well as how we see it
• Understand what the client wants, as well as what
  we want
• (Ivanoff et al, 1994 )

122
What might we be doing to make it worse?

• Becoming impatient and hostile
• Doing nothing, hoping the resistance will go away
• Lowering expectations
• Blaming the family member
• Allowing the family member to control the
  assessment inappropriately
• Failing to acknowledge our fear

123
What might we be doing to make it worse?

• Becoming unrealistic
• Believing that family members must like and trust
  us before assessment can proceed.
• Ignoring the enforcing role of some aspects of
  child protection work and hence refusing to place
  any demands on family members.
• (Egan, 1994)

124
Avoid

• Expressions of over-concern
• Moralising
• Criticising the client
• Making false promises
• Displaying impatience

125
Productive approaches

• Give practical, emotional support - especially by
  being available, predictable and consistent
• See some resistance and reluctance as normal
• Explore our own resistance to change and by
  examining the quality of our own interventions
  and communication style
• (Egan, 1994)

126
Productive approaches

• Helping family members to identify incentives for
  moving beyond resistance
• Tapping the potential of other people who are
  respected as partners by the family member
• Understanding that reluctance and resistance may
  be avoidance or a signal that we are not doing
  our job very well
• (Egan, 1994)

127
Confrontation

• In child welfare services, the Childrens Service
  Worker must be a skilled confronter.
  Confrontation is, basically, facing the client
  with the facts in the situation and with the
  probable consequences of behaviours
• (Texas Department of Human Resources)

128
A scale for assessing motivation

• Shows concern and has realistic confidence.
• Shows concern, but lacks confidence.
• Seems concerned, but impulsive or careless
• Indifferent or apathetic about problems
• Rejection of parental role.

129
Shows concern and has realistic confidence.

• Parent is concerned about childrens welfare
  wants to meet their physical, social, and
  emotional needs to the extent he/she understands
  them.
• Parent is determined to act in best interests of
  children
• Has realistic confidence that he/she can overcome
  problems and is willing to ask for help when
  needed
• Is prepared to make sacrifices for children.

130
Shows concern, but lacks confidence

• Parent is concerned about childrens welfare and
  wants to meet their needs, but lacks confidence
  that problems can be overcome
• May be unwilling for some reason to ask for help
  when needed. Feels unsure of own abilities or is
  embarrassed
• But uses good judgement whenever he/she takes
  some action to solve problems.

131
Seems concerned, but impulsive or careless

• Parent seems concerned about childrens welfare
  and claims he/she wants to meet their needs, but
  has problems with carelessness, mistakes and
  accidents. Professed concern is often not
  translated into effective action.
• May be disorganised, not take enough time, or
  pays insufficient attention may misread
  signals from children may exercise poor
  judgement.
• Does not seem to intentionally violate proper
  parental role shows remorse.

132
Indifferent or apathetic about problems

• Parent is not concerned enough about childrens
  needs to resist temptations, eg competing
  demands on time and money. This leads to one or
  more of the childrens needs not being met.
• Parent does not have the right priorities when
  it comes to child care may take a cavalier or
  indifferent attitude. There may be a lack of
  interest in the children and in their welfare and
  development.
• Parent does not actively reject the parental role.

133
Rejection of parental role

• Parent actively rejects parental role, taking a
  hostile attitude toward child care
  responsibilities.
• Believes that child care is an imposition, and
  may ask to be relieved of that responsibility.
  May take the attitude that it isnt his or her
  job.
• May seek to give up the responsibility for
  children
• (Magura et al,1987)