1.1 Neglect Practice Guidance
- What is Neglect?
- Recognising Neglect
- Effects of neglect
- Factors to assess for neglect
- Top Tips
- Pitfalls to be avoided by practitioners
- Dealing with Concerns about Neglect
- Challenging Decisions about Referrals
- Learning Lessons from National Serious Case Reviews
Neglect is the “most serious type of child maltreatment and the least understood, it is the direct cause of at least one in six deaths and serious injuries in serious case reviews and is a salient feature in many more” (Brandon 2009)1
The purpose of this guidance is to provide clear guidance to all practitioners working with children and families in Buckinghamshire where neglect is an aspect of the children’s care, ensuring:
This guidance has been produced because it is recognised that neglect is a complex and multi-faceted issue. In order to work together agencies need to have a shared understanding of neglect and the best way to effect change. It also reflects practice requirements referred to in ‘Working Together to Safeguard Children’
What is Neglect?
‘the persistent failure to meet a child’s basic physical and/or psychological needs, likely to result in the serious impairment of the child’s health or development. Neglect may occur during pregnancy as a result of maternal substance abuse. Once a child is born, neglect may involve a parent or carer failing to:
Neglect has many causes and is considered a passive form of abuse which is largely due to omissions rather than parental actions or commissions (Child Neglect 2005).3 The recognition of unmet needs may not in itself indicate neglectful parenting; however it may point towards the need for intervention and a ‘joined up’ interagency approach.
It is important to remember that anyone looking after children can be neglectful, including parents, carers, other relatives, child-minders, foster carers, nursery’s, care settings and residential care. Where a secondary carer is neglectful, procedures for Managing Allegations against Staff & Volunteers Working with Children & Young People should be followed.
Categories of Neglect
Medical - minimising or denying children’s illnesses and/or health needs. Failing to seek appropriate medical attention or administer medication and treatments.
Nutritional - inadequate calories for normal growth, sometimes linked to the concept of ‘failure to thrive’ recognising that there are other reasons why a child may not develop physically as well as psychologically. More recently childhood obesity resulting from an unhealthy diet and lack of exercise is increasingly being viewed as neglectful given its serious long term consequences.
Emotional - being unresponsive to a child’s basic emotional needs, including failing to interact or provide affection, failing to develop a child’s self-esteem and sense of identity. This differs from emotional abuse in that it is an act of omission.
Educational -failing to provide a stimulating environment, show an interest in the child’s education, support their learning, or respond to any additional needs or failure to comply with statutory requirements around school attendance.
Physical - not providing appropriate clothing, food, cleanliness and living conditions. There is a need however to avoid confusion with deprivation and in making judgements based on cultural norms and standards of appropriate physical care.
Supervision and guidance - failure to provide an adequate level of guidance and supervision to ensure a child is safe and protected from harm including: leaving a child to cope alone, abandoning them or leaving with inappropriate carers and failing to provide appropriate boundaries about behaviours such as under age sex or alcohol use. This affects children of all ages. (Horwath 2007)4
The recognition and prompt response to indicators of neglect is crucial if the neglected child is to be protected. The longer a child is exposed to neglect, the more difficult it will be to reverse the adverse effects of neglect. Signs and symptoms of abuse and neglect must always be viewed in context and conclusions must not be made without a thorough assessment of the child's individual circumstances.
Neglect is often more than a child being persistently hungry or dirty and practitioners must focus upon the range of needs that children have when considering this question. Although any definition of neglect will always be open to a degree of judgment, there are a number of key factors that, as a rule, are consistent:
Neglect is abuse. The importance of contextual information rather than incidental factors is crucial to the identification of neglect; its presentation as a "chronic condition" requires the collation and analysis of sometimes small and seemingly insignificant events that only when viewed together provide evidence that neglect is an issue of concern:
Evidence should be gathered in a systematic way over time rather than at a specific point in time. Neglect is a long-term developmental issue rather than a crisis caused by a single event.
Effects of neglect
Neglect is known to be damaging in the long and short term. It can seriously impair children’s emotional, physical, cognitive and behavioural development.
The impact of neglect for a particular child, as with other forms of abuse, will be influenced by a number of factors that either aggravate the extent of the harm, or protect against it. For example, a new born baby going 6 hours without a feed would be much more harmful than a 15 year old child going 6 hours without food.
Relevant factors include the individual child’s means of coping and adapting (resilience) and the family support and protective networks available to them or the way in which professionals respond and the success of any intervention initiated to safeguard and promote the welfare of the child.
Generally however, the sustained physical or emotional neglect of children is likely to have profound, long lasting effects on all aspects of a child’s health, development and well-being.
Factors to assess for neglect
Practitioners can use their own agency’s tools for assessment which may include:
This assessment will identify whether or not their parents or carers are consistently meeting these needs. If not, then neglect may be an issue.
Analysis requires the collation and evaluation of sometimes small and seemingly insignificant events that only when viewed together provide evidence that neglect is an issue of concern, assessments should triangulate between what is reported by family, what is known by other agencies and what is observed.
Use of Chronologies
Chronologies play an important role in evidence of neglect. Different agencies may have chronologies of their involvement and gathering the information from these will help with gathering a holistic view.
During any professional contact with a child, consideration should always be given to the presence of the following factors that may indicate neglect is an issue or suggest that the child is at an elevated level of risk:
*A combination of these three factors are identified in around 80% of serious case reviews.
Age of the Child
Younger children are more at immediate risk when their needs are being neglected. Neglected babies and toddlers are at most risk in terms of their immediate health and the prospects for their longer-term welfare.
The serious neglect of older children and adolescents is often overlooked, on the assumption that they have the ability to care for themselves. Make sure your risk assessment focuses on the age of the child. Ask the question “what is it like for this child to live in this family/environment?”
Consider the capacity of parents in assessments, including the impact of their mental and emotional health and any learning disability. Reflect on any past practitioner involvement with the family; what has worked, has it been maintained? Why was it effective or why have things deteriorated? Both past and present circumstances need to be considered as neglect often spans generations; how well has the family maintained progress in the past when practitioners have withdrawn?
The full extent of neglect will only be identified after a thorough assessment of the family. It is important that practitioners are sensitive to different family patterns and lifestyles and to child rearing patterns that vary across different ethnic, cultural and faith groups. Practitioners, however, should guard against myths and stereotypes. Understand the ‘norm’ of different cultures to gain insight into whether this family have diverted from this ‘norm’.
Parents can sometimes be supported by extended family and friends networks to improve care of their children. Family Group Conferences are a positive way of raising with a wider family network the unmet needs and how they can be met.
Guard against the risk of 'excusing' or explaining neglectful care because a family is in poverty. Neglect is not necessarily a consequence of poverty although poverty may make it more difficult to provide good care to a child, with problems accessing services or the financial ability to buy clothes, etc.
Neglect is about a child’s needs being unmet to such a degree that ill-treatment or impairment of health and development, physical, emotional and social occurs. Neglectful care of children may also be found in families considered 'well off' and practitioner should guard against assumptions.
It is known that children whose parents have problematic substance misuse are harmed or are likely to be harmed and that their health, emotional, physical, educational and social welfare compromised.
Remember, the use of illegal drugs is time consuming for the adult; money has to be found to pay for the drugs, the drug supply has to be located and at times the adult will be under the influence or withdrawing. Similarly, the purchase of alcohol may involve a significant proportion of the family budget and the child’s needs may lack priority. Any concerns of substance misuse need to be assessed thoroughly. For example, check for dangers in the house, e.g. where are drugs stored? When are the drugs taken? Who cares for the child when the parent is under the influence?
Assess the risk of immediate harm e.g. is the child exposed to drug paraphernalia or drugs/alcohol, is there a lack of adequate supervision and basic care food/hygiene/clothing. Older children/teenagers may end up caring for a parent who has a substance misuse problem or may find themselves drawn into this behaviour themselves as the parents / carers do not work pro-actively to discourage substance misuse – indeed, they may encourage it and see this as an entry to adulthood. See our procedure on Children living in households where there is substance misuse for further guidance.
Parental Child Relationship
Low maternal self-esteem can affect the 'normal' parental/child interactions and should be considered as an elevating risk factor when neglect is an issue of concern.
Observations of a poor parent-child relationship may indicate some level of neglect; stability and boundaries may have deteriorated through a lack of attachment or a breakdown in the relationship. In some cases a child may become the scapegoat in the family and suffer neglect in this situation.
For teenagers, the poor parent-child relationship can be more complex to assess. Children may be protective of their parents or over-identify with their parents. They may cling to their parents and be overly cautious about taking on their own identity due to poor attachment.
Look out for 'low warmth / high criticism' environments - these are amongst the most damaging to children. Within cases of neglect this concept can be particularly useful to practitioners when considering both the child’s needs and the parental / carer response to these.
Affection, Attention & Stimulation
Evidence of these factors may suggest the psychological neglect of a child. It may be in the teenage years that this factor (either from earlier in life or at that stage of the teenager’s development), really impacts on their behaviour and their interaction with the social world around them and inhibits their development into healthy adulthood.
Guard against cultural stereotypes as some parenting styles may not openly show displays of affection.
Mental Health and Learning Difficulties
Such difficulties can significantly impact upon parenting capacity. Seek specialist advice whenever this is identified as an issue to ensure the parents / carers are able to understand the information and advice they are being given and appropriate joint assessments of parental capacity are made as early as possible. For Further information see BSCB guidance: Parenting Capacity and Mental illness Guidance
Direct or indirect harm can arise through children being exposed to domestic abuse/ domestic violence (physical or emotional) in the home. Consider the long term implications for children growing up in such environments. Assess the impact of the violence and the atmosphere on the adults’ ability to meet the needs of the children.
Further information can be found through Inter Agency Procedures
Age and Other factors affecting the Parent or Carer
Childhood experience of abuse or neglect will increase the level of risk to the person’s own child. Children who suffer abuse or neglect may become more detached and lack empathy - this can affect their parenting capacity as adults.
Immaturity / lack of experience / apathy / impulsive behaviour can all increase the risk of neglect to a child and the implications need to be assessed and understood to identify protective and harmful factors.
Expecations of Children and Teenagers
Giving children and teenagers inappropriate responsibilities to care for themselves and / or others or restricting activities which will impair health and development.
Leaving children and teenagers in charge of other children in the family at an age inappropriate for the responsibility is emotionally harmful as well as possibly exposing children to physical risk. This includes the child as carer as well as the children being cared for.
It may have immediate and long term adverse consequences for their safety and wellbeing. Assessments should consider what responsibilities the child has, whether these are age appropriate and safe and whether they are having an impact on the child’s outcomes.
Levels of Supervision
The potential risks include those above, when expectations of the child are greater than would be expected for their age and maturity.
Younger children will maybe at significant physical risk however, teenagers when left to their own devices may explore inappropriate behaviours and relationships; they may become vulnerable to exploitation by others, such as child sexual exploitation, radicalisation or criminal behaviours.
It is usual for teenagers to explore and take risks and these behaviours need to be tempered by a present adult who discourages and persuades away from situations of significant risks.
Sometimes children can be neglected because the adult focus is upon the need to sustain / maintain / obtain their own personal relationships, at the expense of the child.
Neglect and Disabled Children
Research evidence indicates that disabled children are more likely to suffer neglect than their peers but that they are less likely to be subject to Child Protection Plans under the category of neglect. When working with disabled children practitioners need to be mindful of the following:
In summary, in assessing neglect for disabled children practitioners should ask: would this situation be acceptable if the child was not disabled?6
Further Guidance on abuse in disabled children is available with the Abuse of disabled children guidance.
In cases of possible neglect early intervention is vital. Research tells us that with all types of neglect, the impact on the child may not be observable until much later and by that stage it is often too late to make a real difference.
Share information with other professionals who may also have concerns. A worrying picture could emerge from which you can take joint action.
Keep a chronology / history for the family and the children as far as you can, accoridng to your role. Again, from this a picture will emerge as to how things have changed over time and will be invaluable for assessment and decision making.
The Assessment Framework for Children in Need can help you highlight strengths and difficulties and is particularly useful to use before making a referral to Children’s Social Care.
Pitfalls to be avoided by practitioners
Neglect can cause serious harm and is linked to the deaths of children. If children are to be protected it is essential for practitioners to effectively identify, assess and plan the interventions to meet the needs of children and their families when neglect is an aspect of their care.
Reviews have identified a number of pitfalls that practitioners need to guard against:
Focusing on parents / carers exclusively: Parents who neglect their child are often emotionally and materially deprived and they may have many unmet needs. Whilst meeting these needs may be a way of improving their parenting capacity, too much focus on the parents’ needs can detract from meeting the children’s needs. Remember the needs of the child are paramount and any assessment has to recognise the parental needs, identify services for parents and include assessment of whether change can happen in a timeframe to meet the children’s needs and prevent drift and long term damage.
Rule of optimism: Unrealistic practitioner optimism may result when small changes to a child’s circumstances are made which are given too much ‘weight’ when the overall risks remain unchanged.
For a variety of reasons, practitioners can often think the best of families with whom they work, especially when the parents / carers seem well meaning and to be trying hard to improve their situation and the care of their children. This can lead to a lack of objectivity and loss of the focus on the child, minimising concerns, failing to see patterns of ‘relapse’ or abuse and generally not believing or wanting to believe that risk factors are high. The risk is that insufficient change is made, risks are not evaluated in a holistic context and children’s distress remains unchanged.
The motivation of the parent / carer, being ‘well meaning’ with an apparent willingness to ‘try’ to change things, and their own need for support aren’t justifiable reasons for allowing the child to continue in a neglectful environment or receive neglectful care.
Avoid ‘start again syndrome’ where each new episode of neglect is dealt with as a new incident rather than building up a picture of ongoing neglect over time. Producing and maintaining a chronology of actions and outcomes will indicate the level of compliance over time and remember to check with other agencies if they also have chronologies of events. Regularly discuss cases in supervision and prioritise these effectively. Consider what has worked before and when a different approach might be needed.
Engagement: Disguised parental ‘compliance’ may reassure practitioners that the parents share the same concerns and are working towards improving matters, whereas in reality little is changing to improve the life of the child.
Be aware of ‘false engagement’ and ‘feigned compliance’. True engagement by parents shows by changes in their behaviour, measurable improvements in the situation for the child and visible improvements in the child’s health, educational achievement and general well-being. Remember, always think about what this means for the child.
Children and young people will have their own views about engaging with services. Remember, even older teenagers are still children and are not always in a position to decide what is right for themselves. It may be challenging working with this age group and dealing with the type of behaviours that these young people may display.
Values and Differences: Watch out for your own assumptions and do not let them cloud your objectivity. Assess the facts of the case – any opinions you have must be backed up with evidence. ‘Gut feelings’ do not appear without cause! – look at what has made you think like this and there will be evidence (verbal or non-verbal communication – observations etc.).
Ethnicity and Culture: Children from different ethnic and cultural backgrounds will experience different parenting styles. Whilst some of these styles may differ from the White UK perspective of child-care, this does not make them significantly harmful to children. Any judgement of neglect must be based on evidence and not on stereotypes about a family’s culture or ethnicity, which neither explain nor excuse acts presenting a risk of significant harm.
Avoid drift: Ensure that the drift of cases is avoided. Make sure you regularly discuss cases in supervision and prioritise these effectively. Maintain your multi-agency links. If there is an issue affecting your ability to visit (threat of violence / intimidation) make sure you inform your manager at the earliest opportunity to plan how to deal with this and keep up the visits to the child. If you don’t want to visit the home – how does the child feel about living there?
Low Warmth / High Criticism: Think of this when assessing a child’s circumstances – it will help you focus on the child’s overall care and whether their needs (particularly emotional) are being met. It will also help you look at the parenting capacity, i.e. are their responses to their child appropriate?
Always work with other agencies. Share past and present information to obtain as many details as you can about the child and their family. Without doing this, your assessment will be incomplete and probably wrong.
Having targets with timescales in plans will help identify when progress is not being made quickly enough and there should be contingency plans to ensure when things are not making progress there are different approaches identified.
General Good Practice Points
Focus on the impact of the circumstances on the child, including the likely long term impact.
Try to learn more about the history of the family. New incidents can then be seen as part of a pattern.
Build on families’ strengths, while addressing difficulties.
Look at the whole picture – not only what has happened to the child but also the child’s health and development. Also the wider family and environmental context.
Be aware of the many factors that may affect a parent’s ability to care for a child and understand that these can have an impact on the child in many ways. These include parental learning disability, mental health problems, alcohol and substance misuse and domestic abuse.
Guard against over optimism, adopt a balanced approach and beware of over emphasising positives at the expense of negatives, especially in situations where the standard of care fluctuates.
Dealing with Concerns about Neglect
A whole system approach is vital in dealing with cases of neglect, in order that children and their families receive the right type of services when they need them. 3.10.83 Children and their families may need to “step up and step down” through the tiers of service. Practitioners need to take into account issues of consent throughout the process.
Many cases of low level neglect will be managed by services other than social care. Support in learning new skills, advice about risks and harm and reminders help families create change in some situations of neglect where universal or targeted services are involved.
There is no absolute way to judge the threshold for child protection intervention. In cases of neglect, the point at which this threshold is crossed depends upon a number of factors and relies on practitioner judgement and the completion of an accurate and effective assessment. Neglect that constitutes significant harm will usually be characterised by a combination of events. A 'snapshot' view of the child will never be sufficient. The Multi-agency Thresholds Document will be useful in ascertaining which services should address different levels of neglect. See also the Thresholds Guidance.
In view of the impact of neglect on children’s wellbeing and development, early identification of concerns by Universal Services is crucial. Universal Services, such as health and education, can offer early intervention and additional support. Research into Serious Case Reviews has highlighted the role of Universal Services in the early identification of concerns (Ofsted, 2008).
Early Help Assessment
Where intervention for families who require support below the threshold for social care by a single agency does not alleviate concerns, consideration should be given to undertaking a multi-agency Early Help Assessment. This requires consent by the parent / carer and child/young person as appropriate and consultation with other agencies working with the family. It is based on the Framework for Assessment of Children in Need and their Families  and considers the needs of the child and family across a number of contexts. It will assist with the identification of any additional needs of the child and family. The Early Help Assessment tool of choice, endorsed by the BSCB, is the Family Outcomes Star. Where neglect is observed, the use of the Graded Care Profile (and the Home Conditions assessment) is also recommended.
Referral to the Early Help Panel is recommended when there are complex issues in a family which need a co-ordinated, multi-agency response at level 3 of the Threshold document. This should be done via a Multi-Agency Referral Form to First Response.
Children in Need (Section 17)
Section 47 Enquiry
The threshold that permits compulsory intervention in family life, in the best interests of the child, is that of actual or likely significant harm.
In cases of neglect it will be necessary to demonstrate that:
Challenging Decisions about Referrals
‘Children are suffering significant harm due to thresholds, lack of resources, constant changes in social workers and staff sickness. There’s a danger of issues being missed and children being lost in the system’ (Jan, Social Worker) (Action for Children 2014)'
If First Response decides that your concern does not meet the criteria for a S17 or S47 and you disagree with this decision you must escalate it through your line manager following the BSCB’s Escalation procedure.
You have a duty to ensure the child is safeguarded and this duty does not stop once the referral is made. It must be followed up.
Neglect cases are more likely than cases of physical or sexual harm to result in disagreement about the best course of action. When there has been an incident, discussion can be more concrete, but it is more difficult with neglect, as in the majority of cases the harm happens in a more subtle and gradual way.
It will always be necessary to establish the difficulties underlying the neglect of children and young people. Thorough assessment through a recognised tool of the cause of neglect is required rather than practitioners simply acting to relieve its symptoms, which is often the much repeated outcome. The best predictor of future behaviour is past behaviour. Assessment tools commonly used in Buckinghamshire are listed below.
The Family Star Plus
It is an engagement, assessment and outcomes tracking tool that enables organisations to measure and summarise change across a range of services and support families with different levels of needs. It is also a key work tool that can help parents make changes by providing them with a map of the journey they need to take to be more effective parents, and a way of plotting their progress.
Outcome areas: The Family Star plus covers ten areas that have been found to be critical in enabling children to thrive:
Families move through a ‘journey of change’ from being ‘stuck’ to ‘accepting help’ then to ‘trying’, ‘finding what works’ and finally ‘effective parenting’
Graded Care Profile (GCP2)
Graded Care Profile 2 (GCP2) helps professionals measure the quality of care being given to a child. It's an assessment tool that helps them to spot anything that's putting that child at risk of harm.
GCP2 is a national document and is recognised as a ‘standard’ assessment tool, providing fidelity on what is assessed.
It's important we find children who are at risk of harm as early as possible so we can get them the right help.
By working out what parents can do better, it's easier for the person working with a family to get them the right support to improve the life of their child.
Professionals are specially trained to use the tool. They visit families at home to do an assessment, which is a bit like filling in a questionnaire. It's called Graded Care Profile 2 (GCP2) because different aspects of family life are 'graded' on a scale of 1 to 5. Questions are broken down into 4 areas:
GCP2 is designed to be used with families where someone is concerned about the care of a child.
Home Conditions Assessment
This is a short assessment of the home conditions and their impact on the child/ren that live there. It considers 20 aspects such as odour, cleanliness and home maintenance. It concludes with a decision about the level of concern, what actions need to be taken, what tasks need to be done and who needs to do them.
Anyone who visits the home can carry out a home conditions assessment, however care must be taken to accept that organisations can adapt the tool to meet their needs and more than one version may exist in each area.
What Children Need
Children should be consulted about what they think they need and their views respected. But it is the job of the adults who care for them to make the final decisions about what is in their best interests.
A simple example is that young children may wish just to eat sweets or stay up very late but it is not in their best interests to do so.
It can be helpful to think about neglect in terms of what children need and out of the following list what the child is not receiving.
When thinking about possible neglect consider the list below and whether there are concerns in any of these areas. This tool will contribute to an evidence-based assessment from which further action can be taken.
Learning and Understanding:
General Good Practice Points
Make full use of existing sources of information, e.g. own agency files and databases (is the child subject to a child protection plan or a child in need plan?), others who know the child, the family themselves.
Be specific in relation to the changes you expect and clear about the timescales in which you expect changes to be achieved. This is important from early intervention to when there is a child protection plan.
Families find it helpful to start with specific, small, achieveable goals, for example, preparing a suitable lunch box for children, getting them to school on time, keeping doctor’s appointments.
Once small goals are reached build on these to strengthen parent’s confidence, but a the same time keep a check on whether these goals are sustainable.
Record everything so that you can give evidence of progress and positive outcomes for children. For example you can say they have arrived at school on time with suitable lunchbox for three weeks running.
Be creative in how you work with the family. Use a range of techniques and resources in communicating and working with them. This is particularly important if the parents or children are disabled.
Learning Lessons from National Serious Case Reviews
A key message for professionals is the need to be alert to any changing patterns of cooperation with families: this is not always given the significance it merits, nor weighed up in terms of potential risk. When families withdraw, or there is poor or even non-attendance at appointments, they become less visible and this may mask rapidly deteriorating home conditions and signs of potential harm to the child or unborn baby.
Professionals are reluctant to reappraise a case and change their view when new information becomes available.
The label of ‘low level neglect’ can downgrade thinking and activity and when coupled with parental hostility this can keep professionals at bay.
There is often a failure to involve men/fathers as potentially protective influences who can contribute to a child’s wellbeing.
Some assessments focus almost exclusively on the parents’ needs rather than analysing the impact of the adults’ behaviour on the child.
Written plans are too variable, there is evidence of some very good support for children that are meeting the short term needs of the family, however very little evidence of longer term support.
There will be a variety of situations where you might have worries about neglect and it is not possible to cover all of these here. However, it is hoped that some of the information will assist you making judgements and coming to decisions on the most advisable course of action.
If in doubt pick up the phone and call First Response for advice!
First Response: 01296 383962
Out of Hours: Please contact the Emergency Duty Team on
Thames Valley Police: Non-Emergency on 101
Education Safeguarding Advisory Service: 01296 382912
- Understanding Serious Case Reviews and their Impact: A biennial analysis of serious case reviews 2005-7 M. Brandon et al 2009
- Working Together to Safeguard Children HM Government 2015
- Child Neglect: Literature Review: Centre for Parenting and Research 2005
- Howarth J: Child Neglect Identification and Assessment: MacMillan 2007