guide to recognising and responding to...

Guide to recognising andresponding to NEGLECT in children and young people

2015

This guide includes:

What is neglect? 4

Who experiences neglect? 4

The impact of neglect 5

Effects on relationships and attachment 5

Effects on brain development 6

How do you know if a child is being neglected? 6

Good practice in responding to neglect 7

Consequences for the child 9

Areas of physical care 10

Areas of care/safety 11

Areas of affection/love 12

Areas of esteem 13

Know your thresholds 14

3

This Neglect Toolkit has been designed to promote goodpractice and assist in the identification and assessment ofneglect of children and young people. It should be usedwhen there is a concern that the quality of care a child oryoung person is receiving is leading to their needs beingneglected. The toolkit should be used alongside the LSCB’s“Early Intervention Model and Threshold Document”available on the LSCB Website –www.southamptonlscb.co.uk.

If you believe that urgent action is needed because, forexample, a child or young person is in immediate danger orneeds accommodation phone the Southampton MASH(Multi Agency Safeguarding Hub) on: 023 8083 3336.

Out of hours: 023 8023 3344.

In an emergency always dial 999.

The Multi Agency Safeguarding Hub (MASH) is the singlepoint of contact for all safeguarding concerns regardingchildren and young people in Southampton. It bringstogether expert professionals, called ‘navigators’, fromservices that have contact with children, young people andfamilies, and makes the best possible use of their combinedknowledge to keep children safe from harm.

4

What is neglect?

The persistent failure to meet a child’s basic physical and/orpsychological needs, likely to result in the seriousimpairment of the child’s health or development. Neglectmay occur during pregnancy as a result of maternalsubstance abuse. Once a child is born, neglect may involve aparent or carer failing to:

• provide adequate food, clothing and shelter (includingexclusion from home or abandonment);

• protect a child from physical and emotional harm or danger;

• ensure adequate supervision (including the use ofinadequate care-givers); or

• ensure access to appropriate medical care or treatment.

It may also include neglect of, or unresponsiveness to, achild’s basic emotional needs (Working Together 2015).

Who experiences neglect?

Any child or young person can suffer neglect, but some aremore at risk, such as those who:

• are in care

• seeking asylum

• live with a parent who

• has problems with drugs or alcohol

• suffers from mental health problems

• witnessing or living with abusive or violentrelationships.

Other things that may make neglect more likely include:

• living in poverty, unsuitable housing or a deprived area(Thoburn et al, 2000)

• having parents who were abused or neglected themselves(Harmer et al, 1999).

But neglect happens for many reasons, and there isn'tusually one single cause. Just because one or more of theseproblems exist, it doesn't mean that a child will beneglected. But we do know that having one or more ofthese issues increases the risk of neglect.

5

The impact of neglect1

Children and young people who have been neglected mayexperience effects that last throughout their life. Childrenwho don’t get the love and care they need from theirparents may find it difficult to maintain healthy relationshipswith other people later in life, including their own children.

Children who have been neglected are more likely toexperience mental health problems including depression andposttraumatic stress disorder.

Young people may also be vulnerable to running away fromhome, breaking the law, abusing drugs or alcohol, orgetting involved in dangerous relationships – putting themat risk from sexual exploitation.

Effects on relationships and attachment

A parent or carer's behaviour has a big impact on a child. Itcan also affect the relationship between parent and child.This relationship, or bond, between a child and their primarycaregiver – usually mum or dad but sometimes anotherfamily member or carer – is described by attachment theory.

When a child is neglected they don’t always have a goodrelationship or bond with their parent. Psychologists woulddescribe this as disorganised or poor attachment.

Poor attachment can significantly affect the relationshipsthat people have throughout their lives, including how theyinteract with their own children. Early intervention canchange attachment patterns, reducing harm to a child andhelping them to form positive attachments in adulthood(Howe, 2011).

1 NSPCC Website 2015

6

Effects on brain development

The first years of a child's life have a big impact on howtheir brain develops. That is why neglect can be sodamaging – the child’s earliest experiences can change theirthought processes and neural pathways.

If a baby is malnourished, neural cells can become weak ordamaged and this can cause lowered brain function.

If a child has a poor relationship, attachment or littleinteraction with a parent then it can change how their braindevelops emotional and verbal pathways.

Neglect can severely alter the way a child's brain works. Thiscan lead to an increased risk of depression in later life aswell as dissociative disorders and memory impairments.Changes to the brain caused by neglect have also beenlinked to panic disorder, posttraumatic stress disorder (PTSD)and attention deficit and hyperactivity disorder (ADHD)(Child Welfare Information Gateway, 2009).

How do you know if a child is being neglected?

Neglect can lead to some obvious physical symptoms thoughoften it can take years for emotional and psychologicalsymptoms to become apparent. Some of the possibleindicators could include the following, though they may alsobe symptoms of poverty and deprivation, not child neglect:

• frequently going hungry

• frequently having to go to school in dirty clothes

• not being taken to the doctor when they're ill

• regularly having to look after themselves at home aloneunder the age of 16

• being abandoned or deserted

• living in dangerous conditions ie around drugs, alcohol or violence

• finding it difficult to adapt to school

• children who are often angry, aggressive or self harm

• children who find it difficult to socialise with other children.

7

Good practice in responding to neglect

Using the detailed guidance in the LSCB’s “EarlyIntervention Model and Threshold Document” available onthe LSCB Website – www.southamptonlscb.co.ukassessment should be made to identify the most appropriatesupport needed, remember the guidance given on Page 1regarding what you should do where concerned aboutimmediate harm or risks to children and young peopleexperiencing neglect.

Reflecting on the Child’s Experience in making anassessment, ask yourself these questions:

• If you put yourself in the child’s shoes, what is life like?

• Can you describe a day in the life of this child?

• What is it like for this child living in this house?

• Does the child internalise their experience of beingneglected and think they are unworthy of care?

• Is the poor quality care causing any other kinds of abuse,for example:

• Sexual Abuse/Sexual Exploitation

• Physical Abuse

• Emotional Abuse.

A good record through a chronology of events and activitycan identify patterns of behaviour and show where risksmay lie in the present or future. If no chronology exists thenone should be started and kept on the case file/notes.

9

Consequences for the child

There are various tools to monitor or grade neglect basedon the levels of commitment to care. Parallel with the levelof commitment is the degree to which a child’s needs aremet; these can be observed. This is a modified version of thegraded care profile designed by Dr Leon Polnay and Dr O PSrivastava (Bedfordshire and Luton Community NHS Trustand Luton Borough Council). It can be used withparents/carers to reduce neglect and gain lower scores.Professionals can use the tool to discuss or assist withfurther assessment.

Grade 1 Grade 2 Grade 3 Grade 4 Grade 5

1 All child’s needsmet

Essential needsfully met

Some essential needsunmet

Most essential needsunmet

Essentially needsentirely unmet/hostile

2 Child priority Child first most ofthe time

Child and carer equal Child second Child not considered

3 Best Adequate Borderline Poor Worst

There are 4 domains of care PHYSICAL, SAFETY,AFFECTION/LOVE, ESTEEM. The purpose of using the profileis to clarify areas of concern in order to plan appropriatesingle agency or inter agency intervention. It is unlikely thatthe child who is neglected scores low in one or two caredomains but will scores higher in most or all of them. This ishow the grading works:

UHA = Universal Help Assessment

Grade 1 – No concerns Grade 1–2 – No referral/UHA Grade 2–3 – UHA Grade 3–4 – Refer to MASH Grade 4–5 – Refer to MASH/Contactemergency services if appropriate

10

Grade 1 Child priority

Grade 2Child first most of the time

Grade 3Child and carer equal

Grade 4Child second

Grade 5Child not considered

Nutrition (quantity)

Ample Adequate Adequate to variable Variable to low Mostly low or starved

Nutrition (organisation)

Meals carefully organised.Seating, timing manners

Well organised often seatingregular timing

Poorly organised irregular timingimproper seating

Ill organised no clear meal time Chaotic eat what youcan when you can

Hygiene0-4 years

Cleaned, bathed hair brushedmore than once a day

Regular almost daily No routine sometimes bathed andhair brushed

Occasionally bathed seldom hairbrushed

Seldom bathed or cleanhair never brushed

Hygiene 5-7 years

Some independence, alwayshelped and supervised

Reminded and productsprovided for regularly. Watchedand helped if needed

Irregularly reminded and productsprovided. Sometimes watched

Reminded only now and thenminimum supervision

Not bothered

Hygiene age7+

Reminded followed helpedregularly

Reminded regularly andencouraged if lapsed

Irregularly reminded and productsprovided. Sometimes watched

Left to their own initiatives. Provisionminimum and inconsistent

Not bothered

Clothing(Fitting)

Excellent fitting Proper fitted even if handeddown

Clothes too large or too small Clothes clearly the wrong size Grossly improper fitting

Clothing(insulation)

Well protected with highquality clothes

Well protected even if withcheaper clothes

Adequate to variable weatherprotection

Inadequate weather protection Dangerously exposed

Health(opinionsought)

Illness and other genuinehealth matters thought aboutin advance with sincerity

From professionals orexperienced adults on matters ofgenuine and immediate concern

On illness severity or frequentlyunnecessary consultation and/ormedication

Delayed consultation, only whenillness becomes moderately severe

When illness becomescritical or even thenignored

Health checksandimmunisation

Visits in addition toscheduled health checksimmunisation up to date Up to date with schedules

health checks and immunisationunless exceptions plans in placeto address

Omissions for reasons of personalinconvenience takes up ifpersuaded

Omission because of carelessnessaccepts if accused at home

Clear disregard of child’swelfare. Blocks homevisits

Housing(facilities)

Essential and additionalfixtures & fittings, goodheating, play and learningfacilities

All essential fixtures andfittings efforts to consider thechild (if lacking due to practicalconstraints)

Essential to bare no effort toconsider the child

Adults needs for safety, warmth andentertainment come first

Child dangerouslyexposed or not providedfor

Areas of physical care


11

Areas of care/safety




Grade 4Child second


Awareness Good awareness of safetyissues however remote the risk

Aware of important safety issues Poor awareness and perceptionexcept for immediate danger

Oblivious to safety risks Not bothered

Practice pre-mobilityage

Very cautious with handling &laying down, seldomunattended

Very cautious with handling &laying down, frequently checks ifunattended

Handling careless. Frequentlyunattended when laid within thehouse

Handling unsafe. Unattendedeven during care chores (bottleleft in the mouth)

Dangerous handling leftdangerously unattendedduring care chores like bath

Acquisition ofmobility

Constant attention to safetyand effective measures againstperceived dangers whenmoving

Effective measures against anydanger about to happen

Measures taken against dangerabout to happen of doubtful use

Ineffective measures if at all.Improvement from mishapssoon lapses

Inadvertently exposes todangers

Infant school Close supervision indoors andoutdoors

Supervision indoors nosupervision outdoors if known tobe in a safe place

Little supervision indoors andoutdoors. Acts if in noticeabledanger

No supervision intervenes aftermishaps which soon lapseagain

Minor mishaps ignored orchild is blamed, intervenescasually after major mishaps

Junior & Senior school

Allows out in known safesurroundings withinappointment time. Checks ifgoes beyond set boundaries

Can allow out in unfamiliarsurroundings if thought to besafe and in knowledge.Reasonable time limit, checks ifworried

Not always aware ofwhereabouts outdoors believingit is safe as long as returns intime

Not bothered about daytimeoutings, concerned about latenights in case of child youngerthan 13

Not bothered despiteknowledge of dangersoutdoors- railway lines,ponds, unsafe building orstaying away until lateevening/nights.

Traffic 0-4 years old

Well secured in the pram,harness or when walking,hand clutched. Walks at child’space

3-4 years old allowed to walk butclose by, always in vision, handclutched if necessary in crowd

Infants not secured in pram. 3-4years old expected to catch upwith adult when walking,glances back now and then ifleft behind Babies not secured.

3-4 year old left far behindwhen walking or dragged withirritation

Babies unsecured carelesswith pram. 3-4 years old leftto wander and draggedalong in frustration whenfound

Traffic5 and above

5-10 years old escorted byadult crossing a busy roadwalking close together

5-8 years old allowed to crossroad with a 13+ child. 8-9allowed to cross alone if theyreliably can

5-7 years old allowed to crosswith the older child (but below13) and simply watched. 8-9crosses alone

5-7 years old allowed to crossa busy road alone in belief thatthey can

A child 7, crosses a busyroad alone without anyconcern or thought


12

Areas of affection/love




Grade 4Child second


CarerSensitivity

Looks for or picks up verysubtle signals-verbal ornonverbal expression ormood

Understands clear signals-distinct verbal or clear nonverbalexpressions

Not sensitive enough-messages and signals have tobe intense to make an impacte.g. crying

Quite insensitive needsrepeated or prolonged intensesignals

Insensitive to even sustainedintense signals or dislike child

Timing of response Responds at time of signalsor even before anticipation

Responds mostly at times ofsignals except when occupied byessential chores

Does not respond at time ofsignals if during own leisureactivity. Responds at time ofsignals if fully unoccupied orchild in distress

Even when child in distressresponses delayed

No responses unless a clearmishap for fear of beingaccused

MutualengagementBeginninginteractions

Carer starts interactions withchild. Child startsinteractions with carer, carerdoes this more often

Carer starts interactions withchild. Child starts interactionswith carer. Equal frequency,positive attempt by carer even ifchild is defiant

Child mainly startsinteractions sometimes thecarer. Carer negative if child’sbehaviour is defiant

Child mainly startsinteractions. Not very oftenthe carer

Child does not attempt tostart interactions with carer.Carer does not startinteractions. Child appearsresigned or apprehensive


13

Areas of esteem




Grade 4Child second


0-2 years Plenty of appropriatestimulation, plenty ofequipment

Enough and appropriateintuitive stimulation

Inadequate and inappropriate-baby left alone while carerpursues own amusements,sometimes interacts with baby

Baby left alone while adult getson with pursuing ownamusements unless stronglysought out by bay

Absent even mobilityrestricted (confined inpram/chair) for carer’sconvenience. Cross if babydemands attention

2-5 years 1. interactive stimulationtalking to, playingreading, plenty and goodquality

2. toys and gadgets Including uniform, sportsequipment, books –plenty and good quality

3. outing (taking the childout on recreationalpurposes)Frequent visits to childcentred places locally andaway

4. celebrations Both seasonal andpersonal child made tofeel special

1. interactive stimulationsufficient and of satisfactoryquality

2. Provides all that is necessaryand tried for more

3. outingEnough visits to childcentred places locally andoccasionally away

4. celebrations Equally keen and eager

1. interactive stimulationvariable adequate if usuallydoing own thing

2. toys and gadgets Essential only no effort tomake do if unaffordable

3. outingChild accompanies carerwhenever carer decidesusually child friendly places

4. celebrations Mainly seasonal (Christmas)low key personal (birthday)

1. interactive stimulationScarce even if doing nothingelse

2. toys and gadgetsLacking on essentials

3. outingChild simply accompaniesholiday or locally, plays outdoors in neighbourhood

4. celebrations Only seasonal low key

1. interactive stimulation Nil

2. toys and gadgets Nil unless provided byother sources gifts or grant

3. outingNo outings for the childmay play in the street butcarer goes out locally e.g.to pub with friends

4. celebrations Even seasonal festivitiesabsent or dampened

5+ years Education – active interestin schooling and supportive

Education- active interest inschooling support at homewhen can

Maintains schooling but littlesupport at home even if hasspare time

Little effort to maintain schooling Not bothered not evenencouraging


14

Know your thresholds

EnhancedLevel 2

SpecialistLevel 3

UniversalLevel 1

Consultation

Two-thirds children or young people approx have needs addressed by Universal Services

Offers services in parallel with assessment of need

Visit: www.southamptonlscb.co.uk Tel: 023 8083 2300

TAC/

TAF M

eetings

Specialist Meetings

Ensuring

Children

’s Needs Are Met At The Earliest Stage

UniversalHelpAs

sessm

ent

Single Assessment

More information and further details aboutthis matter and how to respond can be found at the following:

www.southamptonlscb.co.uk

Working Together to Safeguard Children 2015:www.gov.uk

www.nspcc.org.uk

Contact the Local Safeguarding Children Board:

023 8083 2995email: [email protected]

If you believe that urgent action is needed because, forexample, a child or young person is in immediate danger orneeds accommodation phone the Southampton MASH(Multi Agency Safeguarding Hub) on: 023 8083 3336.

Out of hours: 023 8023 3344.

In an emergency always dial 999.

If you are worried about the safety of a childor young person contact:

Southampton MASH 023 8083 3336email: [email protected]

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