Why Neglect Matters
Neglect is damaging to children in the short and long term. Neglect is associated with some of the poorest outcomes. It affects children in the early years, but teenage neglect, often overlooked, is also damaging. Formulating an effective response to neglect still poses national and local challenges.
The Scottish Review
This Scottish review builds on the first review in a series of UK wide reviews of child neglect undertaken by Action for Children in partnership with the University of Stirling and addresses three questions:
- How many children are currently experiencing neglect in Scotland?
- How good are we at recognising children who are at risk of, or are experiencing neglect?
- How well are we helping children at risk of, or currently experiencing neglect?
We gathered evidence for the review by:
- collation of published statistics and a review of policy developments
- analysis of findings from survey questionnaires distributed to all Child Protection Committee Lead Officers in Scotland, with a return rate of over 75% (n=25)
- analysis of findings from telephone interviews with a small number of voluntary sector representatives
- summary of discussions from 15 multi-agency focus groups with practitioners and managers in six areas of Scotland including an urban, rural and island mix
- further consideration of a UK-wide poll undertaken by YouGov in 2011, which asked a range of questions about child neglect of 2,062 adults in the general public and 2,174 professionals.
Political parties across the UK have recognised the impact on an infant between 0-3 years of an environment which is impoverished, combined with parenting which is neglectful or abusive. Policies have been developed on the basis that it is necessary to intervene early in the development of problems or issues as well as early in a child's life, both of which are key in child neglect. A range of policy developments in Scotland have been aimed at developing and improving the welfare and well being of its children and young people. Legislation is now being developed to improve services to children through a proposed Children and Young People Bill.
This policy context is congruent with the evidence that suggests that neglected children's unmet needs often cross disciplinary boundaries and they require an integrated and authoritative response.
Do We Know How Many Children Currently Experience Neglect in Scotland?
The review considered statistics in relation to neglect as defined within the National Guidance for Child Protection and lack of parental care as defined as one of the grounds for referral to the Reporter. One of the key barriers to gauging prevalence is the lack of cross-reference between these two statistical data-bases.
In keeping with recent years, in 2011, neglect remained the most common reason for registration or initial category of those made subject to a child protection plan. The figure of 1,098 (registrations for neglect in 2010) represents 0.12% of the 0-15 population in Scotland. For every thousand children living in our communities, one child has been formally identified as being at risk requiring services because of neglect.
In 2010-2011, 39,217 children were referred to the Children's Reporter (SCRA 2011) representing 4.3% of all children in Scotland. 13,006 of these children (1.4% of those in Scotland) were referred due to lack of parental care. For every 100 children living in our communities, someone has a concern that one child is experiencing some degree of neglect. There is little available information about the children referred to either system but not registered or rendered subject to compulsory measures, the characteristics of their families and communities, or any services they may receive.
Local data collection is most reliable in relation to the requirements of national returns. Only six of the areas surveyed were able to provide us with additional data but no consistent picture of prevalence could be gauged from these. A further ten respondents described ways in which some figures which indicated the wider prevalence of neglect were being or could be collected, although in some cases this would require analysis of data that did not take place as a matter of course. There is interest in developing better systems for collecting and analysing data across adult and child services, but it would be necessary to address the complexities of labelling, double-counting and the range of different systems in use.
How Good Are We at Recognising Children Who Are at Risk of, or Experiencing, Neglect?
The majority of respondents reported that, to their knowledge, the national definition was generally known, helpful, and used by most agencies in their area, although in some areas it was supplemented with additional material. There was some discussion about the use of the term 'neglect' in itself, both in relation to what it encompasses and how it relates to 'lack of parental care'.
The use of the Getting it right for every child (GIRFEC) Well-being Indicators and My World Triangle categories was also seen to have contributed to a shared understanding of children's needs. Some areas were less certain about the extent to which working definitions were really shared by some agencies in practice and that there are still inconsistencies in interpretation about the stage at which children and families require intervention.
The YouGov poll had shown that 30% of the Scottish public asked had been worried or very worried about a child. Survey and focus group respondents asserted that referrals from neighbours and family, who were concerned about a child, were always followed up but commented that there was sometimes a problem if referrals were anonymous or there was insufficient evidence to act. It was felt that the public were as yet unaware of the GIRFEC approach to safeguarding children and that more information about this needed to be conveyed.
The participants in the focus groups identified professionals who are well-placed to recognise when a child is not being cared for adequately. There is evidence that a range of practitioners are now part of the 'identification' network including
- health service staff
- school and nursery staff
- targeted services staff
- police, housing and community/youth workers.
Most areas were able to describe multi-agency groups aimed at the early identification of children who it appeared were not being cared for adequately. Some areas had designed multi-agency groups specifically to meet the requirements of the GIRFEC approach, whereas other areas had continued to use previously existing groups and saw them as being congruent with the GIRFEC approach.
There was an overall message that the ways in which agencies work together was an improving picture, partly due to the implementation of the GIRFEC framework. It was reported that some adult services in some areas were seen as reluctant or unable to adopt the multi-agency approach and share information about families. There was a general consensus that an increasing number of children who are experiencing or are suspected of being neglected are being identified by staff from across all agencies. Emotional neglect was described as often much harder to evidence.
To support assessment the majority of Child Protection Committee areas make use of the Integrated Assessment Framework forms and GIRFEC tools. The view of some was that risk assessment tools were required to give an added perspective to GIRFEC assessment forms. Parenting capacity was also assessed using various frameworks. Respondents reported as struggling with the enduring issue of making decisions about identifying when precisely the level of care being provided could be considered unacceptable, especially in a multi-agency context. Multi-agency training was reported as helpful for supporting development of a shared understanding.
Several factors were identified as getting in the way of neglected children being identified, including:
- obtaining and collating sufficient evidence
- cultural acceptance of neglect in some areas
- overwhelming numbers of neglected children within a context of entrenched poverty
- lack of clarity about parental capacity to change
- insufficient time spent with children and families
- issues being masked by children or members of the extended family
- over-focus on adults at the expense of children
- difficulty in identifying emotional neglect
- transient families moving on when problems are identified
- home educated children not in contact with any professionals
- inadequate recognition of the needs of children of parents with learning difficulties
- lack of recognition of children and young people in some 'middle-class' families.
How Well Are We Helping Children at Risk of, or Currently Experiencing, Neglect?
Data collection to inform service planning most often makes use of Performance Management Data rather than prevalence data; most areas thought that data collection was adequate or improving.
A network of services is in place to support families and to try to ensure that children are not experiencing neglect. Overall, information about services is fairly widely available with the use of leaflets, directories and websites. However, it was acknowledged that information about services can soon become out of date. The routes by which these services are accessed by children and families themselves and by professionals seeking a service on their behalf vary in different areas. To an increasing extent the organisation of routes to services is being shaped by the ways in which the overarching GIRFEC framework is being adopted. There is increasing recognition that some neglected children and their families need long-term support and the GIRFEC approach is designed to provide ease of movement from intensive to 'maintenance' type support. In general, some areas stated that they were relatively well provided for although there would always be more children whose needs were less pronounced who could be helped. Just under half the survey respondents indicated that more services would be welcome.
The YouGov poll indicated that the general public are in support of services being provided to help children and their parents including projects that support families and children before problems get worse and services to support parents affected by substance misuse.
Respondents described the challenges of moving towards early intervention whilst retaining attention upon neglected children at risk of harm. There were strong views expressed that there needed to be greater capacity at universal service level to attain the goal of early intervention. GIRFEC was described at the framework within which services was developing, albeit in three different ways.
- Partial or incremental, where there are different child protection and family in need routes and ongoing use of 'referral onto services' and the Named Person and Lead professional roles are not yet in place
- Partial GIRFEC model (mixed pathways), using a mixed model of parallel pathways with some elements of a 'meeting around the child' system
- GIRFEC practice model in place, described in over a third of local authority areas, implementation of Named Person and Lead Professional system with multi-agency collaboration and move away from the use of 'referral'.
Respondents from at least half the areas felt that children and families were able to get help. Where children were recognised to still not be receiving help several reasons were ascribed, including:
- Lack of agreement between professionals about whether the care the child is receiving is acceptable or not
- Capacity, funding and resource issues and fears about imminent cuts in services and staff
- Knowing how best to help children experiencing chronic neglect at a level which did not warrant removal from home
- Legal challenges and evidence issues, including a perception that some Children's Panel members, Reporters and Sheriffs need more training in this area, in particular about the short and long term impact of neglect on a child.
There are a range of ways in which areas are measuring service outcomes including performance management indicators, quality improvement processes, proxy measures such numbers of children accommodated and case file audits. Individual outcomes are measured by using children's plans and the reviewing system, children's and service users' views of the impact services and individual outcome measurement tools, mostly based on GIRFEC well-being outcomes.
Reflections and Discussion
The review suggests that there is better recognition of children in Scotland who are experiencing neglect although this is only helpful if accompanied by an effective response.
There is still a long way to go in improving information sharing for the purposes of service planning. Greater use of linkage across existing data bases to collate routinely collected data on health, education and well-bring would be a helpful development. Bringing together the SCRA statistics and the child protection statistics would help with establishing the scale of neglect. Better linkage of adult and child databases would also be helpful.
The GIRFEC framework is now being implemented and has the potential to work well, as long as it is adequately resourced to enable provision of support services across the spectrum from earlier intervention to intensive help. Forensic investigative approaches that are embedded within broader service responses are optimal for situations of child neglect because of the extent to which the risks flow from the damage caused by unmet needs. Separate 'family support' and 'child protection' pathways are not helpful for neglect; instead they should both be seen as stages on the one pathway. Effective family support is protection, effective protection is supportive.
The perceived problem with thresholds can be addressed by ensuring that in each case there is clarity about:
1. the severity of the neglect and associated harm to the child or
2. the likelihood of the parents being able to accept help and make changes without the need for compulsory measures.
Models for assessing capacity and willingness to change are especially helpful in cases of neglect. Developing agreed understandings of what 'early intervention' means is also important because it can mean early in the stage of the problem, early after recognition of the problem or both.
To be effective intervention needs to be concrete, comprehensive, sustained and brokered by good relationships. There needs to be more extensive sharing of examples of developing practice across Scotland and sharing endeavours to better capture outcomes more consistently. This would appear to be a good time to bring together the learning from across Scotland and to create an integrated approach within the GIRFEC structure.
The review highlights some priorities in relation to the three original review questions.
1. Develop a co-ordinated national and local data collection, management and linkage strategy, building on existing pockets of good practice
2. Synthesise the learning from different areas developing different models of multi-agency responses to neglect within the overarching GIRFEC framework
3. Draw together the learning from the range of services being developed to address neglect with the evidence from the literature on effective intervention.
Email: Philip Raines