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About this book

Neglect is the most common form of child maltreatment in developed countries and it comes in many forms. From evaluating the effects of neglect on the child to looking at root causes, this wide-ranging book offers evidence-based, practical guidance to support all practitioners in their work with neglected children. In particular:

• It assesses a range of methods of intervention and how these best apply to the various needs of different families.

• It explores the tensions and dilemmas that practitioners can face when working with neglected children.

• It demonstrates ways that practitioners can work together to promote better outcomes for the child.

• It provides frameworks and prompts, such as engaging case studies and reflective questions that can assist practitioners in their work.

Written by a leading authority on child neglect, this book is essential for all students taking courses in child welfare and will also prove an invaluable handbook for practitioners working with families where there are signs of child neglect.

Table of Contents

Introduction

Introduction

Abstract
What causes neglect? Why does it happen? These are natural questions in the mind of the child welfare worker. Our work can be steered more intelligently and will have a more lasting impact if it can be directed to rooting out sources of difficulty, rather than rubbing balm on its symptoms. (Polansky et al., 1972, p. 5)
Polansky et al. posed these questions and made this comment over 40 years ago. Is it as relevant today? We are certainly more aware of the significant and detrimental impact that neglect has, for example, on the development of the brain of the child and adolescent. Moreover, our knowledge and understanding of factors that can contribute to parents neglecting their children is becoming more sophisticated. Nevertheless, we still remain in a situation where practitioners are ‘rubbing balm on the symptoms’ rather than addressing the root causes of neglect. For example, recent studies of serious case reviews following the death or serious injury of a child from neglect in England found that the focus of workers’ attention was on resolving the presenting problem through short-term interventions with little attention paid to the underlying issues, past family history and patterns of behaviour (Brandon, Belderson et al. 2008; Brandon, Bailey et al. 2009). In a recent survey completed in the UK by the NSPCC (2011), 9 per cent of young adults and one in ten young people between the ages of 11 and 17 years reported that they had been severely neglected by parents or guardians during childhood. In an Action for Children study (2010) involving 3,000 eight- to twelve-year-olds, 63 per cent had seen suspected signs of neglect in other children. These included the child looking dirty and unwashed, wearing clothes that did not fit or were soiled, not getting meals at home and having no friends. This pattern appears to be repeated across the developed world. Indeed, the statistics gathered in different countries bear out the fact that neglect is a common experience (Dubowitz, Newton et al., 2005; Gardner, 2008; Mardani, 2010). If one considers the number of children subject to neglect in the developed world it would appear we continue to fail to address the root causes of neglect.
Jan Horwath

Making Sense of Neglect

Frontmatter

Chapter 1. The Neglected Child: Are We on the Same Wavelength?

Abstract
Neglect is essentially parental failure to meet the needs of the child (Greenbaum et al., 2008). The simplicity of this definition, however, belies the complexity associated with identifying neglect and determining when services should be provided to the child and their family. Mennen et al. (2010a), in an American study, found that the one-word term ‘neglect’ described a diverse and heterogeneous range of behaviours experienced by the young people. This is a consequence of neglect being socially constructed and dependent on perceptions of what constitutes good enough parenting at a particular time within a particular society. This social construction goes some way to explaining why operational definitions of child neglect vary across nation states, as shown in Table 1.1. Whilst all the definitions included in the table refer to parental failure to meet the needs of the child, there are variations in the focus on different needs. All the operational definitions mention the child’s basic physical needs and providing adequate supervision. Yet, whilst both the Scottish and Northern Irish definitions include ‘lack of stimulation’, ‘failure to educate in line with that required by law’ is also considered neglect in some American states. However, this specific focus is absent from the UK definitions. These variations occur because a number of factors — such as social and cultural influences, research, legislative frameworks and state thresholds for intervention into family life — influence the way in which neglect is constructed in each state (Daniel et al., 2011; Gilbert et al., 2011). In Australia, for example, operational definitions vary from state to state and consideration is given to ‘cultural tradition’. The way in which neglect is constructed and defined will inform both the children that are labelled ‘neglected’ at a particular time and the interventions required by the community, professionals and the state to meet their needs (Dickens, 2007; Mardani, 2010).
Jan Horwath

Chapter 2. Neglectful Parenting: Ability, Motivation and Opportunities

Abstract
This case example is one that must be familiar to many practitioners, as Gemma’s behaviour and the children’s experiences, according to research studies in a range of countries, are common amongst neglectful families (Gaudin et al., 1996; Dubowitz, 1999a; Schumacher et al., 2001; Erickson and Egeland, 2002; Coohey, 2003; Wilson and Horner, 2005; Stevenson, 2007; Brandon et al., 2008; Brandon et al., 2009; Moran, 2010).
Jan Horwath

Chapter 3. Impact of Neglect on Children and Young People

Abstract
Hildyard and Wolfe’s (2002) summary of the literature on child neglect stresses, as is apparent when considering Dylan’s life, that neglect affects all aspects of children’s development — physical, socio-emotional, cognitive and behavioural. This finding is supported by a study of frontline practitioners’ experience of neglect (Action for Children, 2009). The practitioners indicated that in their experience neglect impacts on poor attainment at school, emotional and mental health problems, poor social skills, isolation and poor physical health. The effects of neglect continue to manifest themselves in adolescence and can persist into adulthood, having a wide-ranging impact. For example, the study by Currie and Widom (2010) of the long-term consequences of child abuse and neglect highlights that neglected individuals were more likely than a control group to be unemployed or in menial or semi-skilled jobs, with women being particularly vulnerable.
Jan Horwath

Assessing the Potential for Change and Planning Interventions

Frontmatter

Chapter 4. Assessing Readiness to Change: The Neglected Assessment Task

Abstract
Irrespective of whether one is identifying emerging concerns or risk of significant harm in cases of child neglect, the fundamental purpose of an assessment is to understand how the safety of the individual child and their health and wellbeing are affected by the neglect. Drawing on this knowledge, practitioners can then determine how to intervene to ensure the needs of the child are met. In the UK each nation has its own assessment framework. The Framework for the Assessment of Children in Need and Their Families (DH et al., 2000), commonly known as the Assessment Framework, is used in England and Wales; in Scotland it is the My World Triangle; and in Northern Ireland UNOCINI (Understanding the Needs of Children in Northern Ireland). All of these frameworks are underpinned by an ecological perspective that recognizes that the development of the child is influenced by both the capacity of the parent or carer to meet their needs and the environment in which the child is brought up (Bronfenbrenner, 1979). This means that practitioners, whether identifying emerging concerns about neglect or assessing the risk of harm to a child, should consider: the developmental needs of the child; parenting capacity to meet those needs; and the family and environmental factors that affect family life. An ecological approach towards assessing the needs of children is also taken in Canada, Romania, the Russian Federation, Slovakia, Sweden, Ukraine, Malta, Croatia, the Republic of Ireland and some parts of the United States of America and Australia (Daly, 2007; Rose, 2010).
Jan Horwath

Chapter 5. Identifying a Pathway for Change: The Child Protection Conference

Abstract
In Chapter 4, I considered ways in which the assessment process can facilitate or inhibit parental acceptance of the changes they may be required to make in order to meet the needs of their child. Readiness for change, however, as Prochaska and DiClementi (1982) argue, is only the first step in the change process. Once parents have recognized the need to change they have to work out how to make the necessary changes. In the novel A Cupboard Full of Coats, the main character reflects on her ambivalent relationship with her young son and, whilst accepting the need to change, concludes:
I did not know how to change it. It felt like something needed to happen inside me. But I was not a magician. There was no quick-fix abracadabra available to change me into anybody else. (Edwards, 2011, p.35)
Jan Horwath

Chapter 6. Plans to Safeguard Neglected Children from Harm

Abstract
In this chapter, having considered the assessment process and the initial child protection conference, I move to the next stage of the child protection process: implementing the child protection plan. For professionals implementing the plan there is a tension to be managed between care and control. Professionals have to collaborate with and empower parents to change behaviours, lifestyles and attitudes in order to meet the needs of the child. At the same time both the professionals and the family are aware that parental non-engagement can lead potentially to the removal of the child from the family. The way in which professionals manage this tension can have a significant impact on securing the engagement of parents in the implementation of the plan (Turney, 2012). Ferguson (2011) argues that effective management means being clear with parents about professionals’ authority but also identifying opportunities to maximize the influence of the parent over the plan.
Jan Horwath

Intervening: What Works?

Frontmatter

Chapter 7. Interventions: When and How?

Abstract
Thus far in this book I have considered the needs of neglected children and their families and ways in which professionals can assess and plan to meet those needs. In the previous chapters I have paid particular attention to the importance of trying to develop plans that not only improve the daily lived experience of the neglected child but also support parents in making changes to behaviours and attitudes necessary to ensure they meet the needs of their child. The quality of the plan will inevitably depend not only on parents’ engagement in the change process but also on the services that are available to families and the way in which these services are delivered. In the third part of the book, therefore, the focus shifts to consider the range of interventions available to assist families where there are concerns about neglect. In this chapter I consider different levels of need and explore the factors that influence receipt of services at the different levels.
Jan Horwath

Chapter 8. Preventing Neglect: Population-based Services Pre-birth and in the Early Years

Abstract
In the previous chapter I made reference to ‘the river of child neglect’ (Daniel et al., 2011, p. 150) and to the importance of finding ways of preventing children falling into this river. Universal or population-based services should be designed in such a way that they not only prevent children falling into the river but keep them safe on the bank. These services are important because they are accessible to all and, therefore, use of these services should be non-stigmatizing for families (Davies and Ward, 2012). Yet whilst being of particular value to children at potential risk of being neglected, accessing these services can be challenging for their parents. In this chapter I consider the reasons why parents at risk of neglecting their children may struggle to make use of universal or population-based services and identify ways in which service providers can improve parental engagement. The focus will be on the take-up of services for parents-to-be and new parents, as universal services, particularly in the early years of a child’s life, are important in terms of laying the foundations for a happy childhood, adult psychological and social wellbeing, educational achievement and an ability to make a positive contribution to society (Field, 2010; Allen, 2011; Munro, 2011a).
Jan Horwath

Chapter 9. Addressing Emerging Concerns about Neglect in Under-Fives through Early Help

Abstract
One great merit of Early Intervention is that it can help so many families under stress fulfil their mission of giving children a secure and loving space in which to grow up. It can keep families together and save many children from the trauma of break-up and removal. When all is said and done, enabling every child to develop social and emotional capability is nothing less than what most parents routinely do for their own children. (Allen, 2011)
Jan Horwath

Chapter 10. Chronic Neglect: Working with Complexity

Abstract
In the previous two chapters the focus has been on population-based services to prevent child neglect occurring and early help interventions to address emerging concerns. But what if these services fail to address concerns about neglect and the parents’ behaviour is causing or is likely to cause significant harm to the child? This chapter seeks to answer this question with a particular focus on those situations which are particularly challenging to practitioners — cases of chronic neglect. For the purposes of this book, chronic neglect is defined as a persistent failure on the part of the parent to consistently meet the needs of the child or children in the family, despite the provision of services. There are a range of services that are available to meet the diverse needs of these families. They are usually referred to as ‘family preservation services’ and are designed to prevent further child maltreatment, improve family functioning and thereby avoid out-of-home placement of the children. In many nation states, as discussed in Chapter 6, these services are delivered as part of a child protection plan by statutory services.
Jan Horwath

Chapter 11. Addressing Parenting Issues within Neglectful Families

Abstract
Child maltreatment, including neglect, is often accompanied by what is frequently described as the ‘toxic three’: domestic violence, mental health problems, alcohol and drugs misuse. This would seem to be the case irrespective of jurisdiction. Butchart et al. (2006) highlight, for example, the strong links between child abuse, neglect and alcohol misuse in countries as diverse as South Africa, Columbia, Latvia, Lithuania, Moldova, the USA, Germany and the UK. In Canada 34 per cent of child welfare investigations included reports of alcohol and drug use; in Western Australia alcohol or drug misuse were considered a contributory factor in 57 per cent of out-of-home care applications (Butchart et al., 2006). In England and Wales, 2–3 per cent of children under 16 are living with one or both parents with a serious drug problem, whilst in Scotland it is believed to be between 4 and 6 per cent (Advisory Council on the Misuse of Drugs, 2003). Concerns about mental health issues were evident in between 10 and 42 per cent of child protection cases in the UK, Western Europe, Australia, Canada and the USA (Darlington et al., 2005; Parrott et al., 2008).
Jan Horwath

Chapter 12. Meeting the Needs of Neglected Children and Young People

Abstract
The neurobiological tools for thoughtful choice are damaged as a result of adult thoughtlessness. Yet, we point the finger of blame and watch the child like a trapped circus animal fail to perform to our expectations. (Batmanghelidjh, 2006, p. 156)
Batmanghelidjh, in the quote above, summarises vividly and poignantly how, as the child grows up, the focus for professionals becomes their presenting negative behaviour rather than the cause of that behaviour. In the earlier chapters of this book I have considered interventions specifically designed to address emerging concerns regarding neglectful parenting of babies and preschoolers. In this chapter I concentrate on addressing the negative impact of neglect on school-age children and young people. For convenience I will continue to use the umbrella term ‘children’ to refer to this group. It is evident from statistics that many children of primary school age become or continue to be subject to neglect. Moreover, neglect remains the most common category of maltreatment for older children between 10 and 15 years of age, despite the effort of providers to address issues within early years interventions (Rees, 2011).
Jan Horwath

Chapter 13. Meeting the Needs of the Neglected Child through Out-of-Home Care

Abstract
Thus far in this book I have focused on interventions that are designed to keep the neglected child within the family home. But what happens if these interventions fail to improve the quality of the child’s daily lived experience? The short answer to the question is that out-of-home care has to be considered. However, what is essential is that the child receives the type of care placement that will meet their needs. The term ‘out-of-home care’ is used to describe a range of different interventions and approaches. The placement may result from parents making a request to have their child taken into the care of the state through to the state making the decision that the child needs to be removed from the home; the arrangements can be temporary or permanent. Moreover, the care may be provided by extended family, foster carers, care workers in a residential setting or adoptive parents.
Jan Horwath
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