Report Abuse Report Abuse

1.6.8 Neglect Practice Guidance

SCOPE OF THIS CHAPTER

Sustained abuse or neglect of children physically, emotionally or sexually can have long-term effects on their health, development and well-being.

The Leicester, Leicestershire and Rutland (LLR) LSCBs have developed a LLR LSCB Neglect Strategy and LLR LSCB Neglect Tool-kit. A Word version of the LSCB Neglect score card is available to complete as relevant.

RELATED CHAPTER

Responding to Abuse and Neglect Procedure

AMENDMENT

In June 2016, this chapter was extensively updated following learning from a Serious Case Review.


Contents

  1. Introduction
  2. Definitions
  3. The Rights and Needs of Children
  4. Types of Neglect
  5. Undertaking Assessments
  6. Staff Supervision
  7. Dealing with Concerns Regarding Neglect

    Appendix 1: Predisposing Risk Factors

    Appendix 2: Age Specific Risk Indicators of Child Neglect

    Appendix 3: Learning Lessons from Serious Case Reviews


1. Introduction

This LLR LSCB Neglect guidance has been updated in line with the development of the LLR LSCB Neglect Strategy and LLR LSCB Neglect Tool-kit and messages from SCRs. Neglect was identified as a priority (in 2015) by the LSCBs, due to neglect being a feature in national and local SCRs, Learning reviews and multi-agency case files audits.

Sustained abuse or neglect of children physically, emotionally or sexually can have long-term effects on their health, development and well-being. It can impact significantly on self-esteem, self-image and perception of self and of others. Persistent neglect can lead to serious impairment of health and development, intelligence, and physical ability and long term difficulties with social functioning, relationships and educational progress.


2. Definitions

Neglect of children is one of the most difficult areas in child care and child protection to identify, communicate effectively to professionals and assess and intervene in. It is now emerging as the most common type of harm children experience, although this has not always been the case which is concerning given it is more harmful than many other forms of abuse.

Historically, professionals have struggled to prove neglect for fear of imposing their values on other people. SCRs - including those undertaken locally - have time and again highlighted this and a lack of co-ordinated communication between agencies as factors in neglect. Therefore it is important for all professionals to work within a recognisable framework with agreed definitions.

Working Together 2015 defines neglect as:

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:

  • Provide adequate food, clothing and shelter (including exclusion from home or abandonment);
  • Protect a child from physical and emotional harm or danger;
  • Ensure adequate supervision (including the use of inadequate care-givers); or
  • Ensure access to appropriate medical care or treatment.

It may also include neglect of, or unresponsiveness to, a child’s basic emotional needs.

On 3rd May 2015, the Serious Crime Act 2015 amended s.1 Children and Young Persons Act of 1933 (Child Cruelty) regarding neglect to read:

“If any person who has attained the age of sixteen years and has responsibility for any Child or young person under that age, wilfully assaults, ill-treats (whether physically or otherwise), neglects, abandons, or exposes him, or causes or procures him to be assaulted, ill-treated (whether physically or otherwise),neglected, abandoned, or exposed, in a manner likely to cause him unnecessary suffering or injury to health (including injury to or loss of sight, or hearing, or limb, or organ of the body, and any mental derangement) (whether the suffering or injury is of a physical or psychological nature), that person shall be guilty of an offence“

More than any other form of abuse, neglect is often dependent on establishing the importance and collation of seemingly small, undramatic pieces of factual information. When collated these may present a picture that may identify a child suffering from Significant Harm.

Neglect cannot be defined as a one-off incident such as seeing an untidy kitchen while on a visit. Neglect is evidenced over a period of time with proof usually gathered from a number of agencies/professionals.

It is therefore important for professionals to keep a focus on the child’s journey from needing to receive effective protection from neglect (and abuse).

There may also be other predisposing risk factors such as parental substance misuse or domestic violence (see Appendix 1: Predisposing Risk Factors for further details of pre-disposing risk factors and Appendix 2: Age Specific Risk Indicators of Child Neglect for Age-Specific Risk Indicators of Child Neglect).

In trying to define neglect therefore we need to understand two things:

  1. Neglect is something that is persistent and cumulative and occurs over time with little change, despite intervention;
  2. That while neglect might occur within a family perceived to be living in poverty, the children at the greatest risk are those who live in families in which the parents’ own emotional impoverishment is so great that they actually do not know how to parent, do not understand their children’s needs and despite intensive intervention cannot provide for their needs.


3. The Rights and Needs of Children

Children's needs for, and rights to, healthy development can be identified within The United Nations Convention on The Rights of the Child (1989). There is an international consensus on the basic needs of children.

The Children Act (1989) does not specify needs or rights. It does, however, assert the general principle of the paramountcy of the child's welfare. These Practice Guidelines are also influenced by the Human Rights Act (2000). See also Statutory Framework Procedure.

The Convention specifically identifies the right to:

  • Life and the best possible chance to develop fully;
  • An adequate standard of living primarily provided by parents, but with help from the State;
  • Day to day care;
  • Health and health care;
  • A safe, healthy, unpolluted environment with safe nutritious food and unpolluted water;
  • Disabled children should be helped to be as independent as possible, and to take a full and active part in everyday life;
  • To have their views ascertained and to be listened to;
  • To have a standard of living adequate for their physical, mental, emotional, spiritual, moral and social development;
  • To have access to education to achieve their full potential.
The assessment of need and provision of services for children by statutory and voluntary organisations should reflect anti-discriminatory practice.


4. Types of Neglect

One of the main reasons why neglect is difficult to define is that the term itself is an umbrella for numerous forms of child maltreatment. In an attempt to overcome this problem we have broken down the definition into the following:

Physical neglect:

  • Refusal of/delay in health care - Failure or delay in seeking and obtaining appropriate health care services for a child/young person, including dental health;
  • Abandonment/expulsion - Abandoning a child or excluding a child from the family home and refusing to accept their return;
  • Other custody issues - Repeated shuttling of a child from one household to another due to an apparent unwillingness to maintain custody/care, or chronically and repeatedly leaving a child with others for days/weeks at a time;
  • Other physical neglect - inattention to avoidable hazards in the home, inadequate nutrition, clothing, or hygiene and other forms of reckless disregard for a child's safety and welfare.

Emotional neglect:

  • Inadequate nurturance/affection - Marked inattention to the child's needs for affection, emotional support, attention or competence;
  • Chronic/extreme abuse or domestic violence - Chronic or extreme intimate partner abuse or other domestic violence in the child's presence;
  • Allowing negative behaviour - Encouragement or permitting of negative behaviours (such as criminal activity and/or substance misuse) in circumstances in which the parent/guardian was aware of the existence and seriousness of the problem but did not attempt to intervene;
  • Other emotional neglect - Other inattention to the child's developmental/emotional needs not classifiable under any of the above forms of emotional neglect (e.g. markedly overprotective restrictions which foster immaturity or emotional over-dependence, chronically applying expectations clearly inappropriate in relation to the child's age or level of development).

Supervisory neglect:

  • Inadequate supervision - Child left unsupervised or inadequately supervised for extended periods of time.

Educational or cognitive neglect:

  • Permitted chronic truancy - Habitual truancy averaging at least five days a month is classifiable under this form of maltreatment if the parent/guardian has been informed of the problem, but has failed to intervene;
  • Failure to enrol/other truancy - Failure to enrol a child of mandatory school age, causing the school-aged child to remain at home for non-legitimate reasons (e.g. to work or to care for siblings) an average of at least three days a month;
  • Inattention to Special Educational Needs - Refusal to allow or failure to obtain recommended remedial educational services, or neglect in obtaining or following through with treatment for a child's diagnosed learning disorder or other special educational need without reasonable effort.


5. Undertaking Assessments

A simple and helpful way to view neglect is to consider the needs of a child and whether or not their parents/carers are consistently meeting such needs. If not, neglect may be an issue. 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;
  • The intent to harm the child by the parent or carer is not always present;
  • Neglectful families often face multiple problems;
  • Families leading chaotic lifestyles can lead to neglect, as can families who lead a transient lifestyle where then move between different Local Authority boundaries resulting in a number of agencies being involved making it difficult for services to provided, information to be shared collectively and assessments to be completed;
  • Child neglect can cause serious harm and death.

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.

Agencies will have a range of models to assess cases of neglect. The Framework for the Assessment of Children and their Families provides a universal model and is accompanied by a range of materials to support practice in assessment. These include a pack of questionnaires and scales (The Family Assessment Pack of Questionnaires and Scales (2000)) to assist assessment in particular areas. It is recognised there are common difficulties working with families where there are concerns about child neglect. The LLR LSCB neglect toolkit is useful tool that can assist with these. The Department for Education also has a large Training Resource on childhood neglect consisting of a number of elements that can be used flexibly to produce a range of training courses.

Clarity of purpose:

It is important that parents understand concerns about child neglect. Practitioners must be clear and honest with parents/carers about the changes they must make in their care of the child and why. Practitioners should address personal and difficult issues with parents. SMART objectives and Plans should be set - specific, measurable, achievable and realistic, with clear timescales. Practitioners should consider the impact of learning difficulties on a parent’s level of understanding, paying attention to appropriate methods of communication and assessment.

Maintaining the focus on the needs of the child:

It can be difficult to gain multi-agency agreement about neglect. Sometimes this is because perceived negatives in one aspect of a child's life may be thought to be balanced out by positives in another. The assessment of neglect requires risk and protective factors to be analysed and weighted accordingly. SCRs often refer to the ‘over optimism’ of professionals - this must be guarded against.

Focus on the day-to-day experiences of the child - what is the child’s actual lived experience and what is the impact of this? Look at the world through the child’s eyes. Stand in the child’s shoes. See the world as he or she sees it. Ask the question, “What is life like for this child in this family?”

Be alert to the child’s basic care needs and routinely check aspects of care such as provision of food, hygiene, and sleeping arrangements. Practitioners should be prepared to ask to look in rooms, cupboards etc.

Theories of child development should be used to benchmark concerns about a child’s presentation and welfare. An early paediatric assessment will provide a baseline of the child’s developmental milestones, as well as growth and physical health, and will be helpful in evaluating and evidencing progress or lack of it.

The importance of seeing the child on his/her own and engaging in a meaningful way, as well as observing the child at home, cannot be overstated. It can also be helpful to see the child in a variety of settings, i.e. school, nursery, respite care, to observe any differences in their demeanour and behaviour. Consideration should be given to each child within the family and the impact of the neglect on their development.

It is important to be mindful of circumstances where some children from a family are subject to a child protection plan under the category of neglect and others are not. This may give rise to mixed messages to parents/carers that not all their parenting is poor. However, consideration should be given to those children not subject to Child Protection and the impact on their well-being. In such circumstances all children in the household are experiencing some level of neglectful care by the mere fact that they are observing behaviour/neglect of their siblings and are therefore being emotionally abused as a result.

It is likely that parents will have needs of their own that may require intervention.

Adolescents:

In recent years there has been growing recognition that adolescents can experience neglect. A failure to understand and meet the basic care needs of young people arises from many of the same factors which lead to the neglect of children. Many teenagers have lived with neglectful care throughout their childhood. Factors which can be present are the same as many of those for younger children.

In addition, inappropriate expectations can arise when a young person becomes an adolescent. Parents may become emotionally and physically unavailable. Support may be lacking for the young person at developmental, educational and personal milestones.

Adolescent neglect can have very serious consequences. Young people are more likely:

  1. To be excluded from education;
  2. To become involved in anti-social or offending behaviours;
  3. To be at risk of trafficking, sexual exploitation and going missing;
  4. To face stigmatisation by peers;
  5. To misuse substances;
  6. To experience depression or anxiety;
  7. To have an inappropriate diet;
  8. To self-harm/attempt suicide;
  9. In the worst scenario, to die.

It is important that professionals working with adolescents bear in mind the possibility of neglect when responding to the needs of young people.

A useful resource for practitioners is a Government Review that provides an accessible summary of relevant literature on adolescent neglect: Neglect matters: a multi-agency guide for professionals working together on behalf of teenagers

Diversity:

While there should be sensitivity to a child’s racial, religious and cultural background and differing styles of parenting, it is important not to stereotype and make assumptions about the care of children from diverse backgrounds and not to make allowances which may be harmful to the child. The Equality Act 2010 came into force from October 2010 providing a single framework for tackling disadvantage and discrimination. The following protected characteristics are covered in the new Equality Duty on public bodies and other carrying out public function:

  • Age;
  • Disability;
  • Gender reassignment;
  • Pregnancy and maternity;
  • Race – this includes ethnic or national origins, colour or nationality;
  • Religion or belief – this includes lack of belief;
  • Sex;
  • Sexual orientation.

Attachment and parent-child interaction:

Evidence says that there is often an over-emphasis on maternal care and the role of mothers to the complete exclusion of fathers/male carers. Assessment needs to include everyone with a parenting role, regardless of gender or biological link.

Assessments of attachment should be carefully undertaken. It is important to look beyond initial impressions. Attachment theories should be used to assess the nature of parent/child relationships. These theories should be applied across all cultures.

Observations of the parent-child interaction will inform the assessment of attachment. Unrealistic expectations or inappropriate interpretations of a child’s behaviour can be a feature of neglectful parenting, e.g. a child who cries a lot is described as “nasty”, as though the crying is a deliberate action designed to irritate.

A wide range of research now shows that conception to age two is a crucial phase of human development and is the time when focused attention can reap great dividends for society. How we treat 0-2 year-olds shapes their lives - and ultimately our society. For further information please see the DfE document, ‘Conception to age 2 - the age of opportunity’.

Involvement of wider family:

Consideration should always be given to engaging the wider family in the assessment to understand the role they may be able to play in the child’s life.

Family group conferencing is an effective way of involving wider family members in the development of a plan to safeguard and promote the welfare of a child in need. The family is the primary planning group in the process and it creates an opportunity for family members to understand the issues from the professional’s perspective.

Family group conferences do not replace or remove the need for a Child Protection Conference where the child is at risk of significant harm.

The role of significant others within the household is crucial and the need for lateral checks in relation to these individuals.

Chronologies:

Concerns about neglect are likely to have developed over a considerable period of time and chronologies are a valuable tool in highlighting concerns and patterns. It is likely that there will be a number of minor incidences which over time begin to heighten concerns about child neglect. It is important to maintain records which agencies can use to compile a chronology. Chronologies should always be compiled and should record historical and current events and information.

The definition “persistent failure” means that workers need to build up evidence of poor care and damage to a child’s development over time. The challenge is then at what point the poor care becomes a matter of significant harm. The importance of standing back and objectively reviewing developments cannot be over-emphasised.

Start again syndrome:

Research has identified the “start again” syndrome - when there is a change of practitioner insufficient attention is paid to the past complex history/chronology so that assessment and work start afresh and focus on the present. Clearly this is detrimental to the needs of the child (Brandon et al, 2008). Any new assessment or re-assessment of a family must take into account the family’s history in order to make sense of the present.

New Information:

It is important that any new information should be considered in conjunction with previous and current information, regarding a family’s circumstances or the care of the child and considers whether the case needs a different focus or escalating to another level.

Avoidance:

Difficulties in dealing with neglect may be compounded by avoidance by both families and practitioners. This can happen where families may miss appointments, ask to be seen away from their home or visitors may always be present when practitioners visit, making it difficult to discuss confidential issues. Consideration should be given to the possible/likely reason behind this behaviour and attempt to establish level of risks and or impact to the child of failing to comprehensively assess home circumstances.

Families displaying avoidance in engagement can lead to professionals ‘backing off’ and reducing contact with families to such an extent that they could be seen as effectively abandoning the child. The result is ‘institutional neglect’ (Gardner 2008).

Attempts to engage the avoidant family should be considered using a multi-agency approach Health, housing or educational professionals may already have access to the family, and can help with gaining access to the family. The issue of lack of engagement should be completely explored to identify potential reasons to include, where appropriate areas such as worker confidence or knowledge. Closure of such cases should take place only following consideration of risk using supervision and management oversight.

Disguised compliance:

‘Disguised compliance’ involves a parent or carer giving the appearance of co-operating with child welfare agencies to avoid raising suspicions, to allay professional concerns and ultimately to diffuse professional intervention - NSPCC, (2010). Signs of disguised compliance may be any of the following:

  1. No significant change at reviews despite considerable professional input;
  2. Parents/carers agreeing with required changes but putting little effort into making changes work;
  3. Change does occur but as a result of external agencies/resources not the parental/carers’ efforts;
  4. Change in one area is not matched by change in others;
  5. Parents/carers will engage with certain aspects of a plan only;
  6. Parents/carers align themselves with certain professionals;
  7. A child’s account of events and experiences is in conflict with parents/carers’ reports;
  8. The house is cleaned shortly before a review;
  9. School attendance improves for a period of time;
  10. A family keeps appointments in the time leading up to a review.

Disguised compliance is a common feature in cases of neglect where there is evidence of drift. It can lead to professionals adopting a rule of over optimism and the “start again” syndrome. Disguised compliance is often highlighted in SCRs.

Non-compliance:

It is important appropriate weight is given to non-compliance where assessments are undertaken of families who persistently avoid contact with professionals.

Potential for change:

Families are only co-operative to a point regarding the need for change. Co-operation without understanding and acceptance of the need for change is unlikely to lead to sustained change and therefore outcomes for the child are unaltered.

Consideration should be given to the parent/carer’s capacity to change and to maintain this over time. Practitioners should guard against being over-optimistic about the potential to change and provide consistently good enough parenting to meet the child’s needs. In cases where it can be shown through appropriate parenting and/or psychological assessments that sufficient change is not possible, decisions should be made on the basis of timely outcomes for the child. It is important to balance the parent/carer’s potential for change with the needs of the child. (Howarth and Morrison, 2001).

Consent and Information Sharing:

It is good practice to always seek written consent at the start of any working relationship, practitioners should be open and honest from the outset and share what information will or could be shared and why.

This must been seen in the context of ‘the child’s welfare’ and if a child/YP is at risk of significant harm then information is likely to be shared to safeguard the child/YP. Information sharing is vital to safeguarding and promoting the welfare of children and young people. A lack of understanding about this is a common factor in SCRs.

Sharing information between agencies is crucial in all aspects of safeguarding children, including in cases of neglect where disguised compliance is suspected in order to check assumptions and the parent’s/carers account of events.

Working Together 2015 – effective information sharing between professionals and local agencies is essential for effective identification, assessment and service provision

The LLR LSCB Information Sharing Agreement for Safeguarding Children is available for practitioners to use.

Regularly reviewing progress:

It is important for agencies, individually and jointly with the parents/carers, regularly to review progress and ensure that Plans are SMART. If there has been no change in parenting over a period of time and no improvement on the outcomes for the child on her/his safety plan, then there should be consideration given to what action to take. There is the potential for “drift” and lack of focus when dealing with child neglect due to the fact there are rarely major incidences and agencies need to be involved over a period of time to build up a full picture of concerns. This can lead to a loss of purpose. It is therefore essential that targets and timescales are set and reviewed. Regular reviewing should identify growing concerns. The escalation of concerns including those relating to “drift” and “delay” in meeting safety plans and outcomes for children should be considered. The LLR LSCB Resolving Practitioner Disagreements and Escalation of Concerns provide further information.

Processes likely to affect case management over time:

  • Becoming de-sensitised to children’s difficulties through habituation when undertaking medium to long-term work;
  • Normalising and minimising abuse and neglect;
  • Downgrading the importance of referrals about abuse or neglect from neighbours or relatives;
  • Over-identification with parents;
  • Developing a fixed view of cases which discounts contrary information;
  • Viewing each incident of neglect or abuse in isolation and not recognising their cumulative impact.

Context in which these processes operate include:

  • Lack of awareness of children’s personal histories;
  • Drift and delay;
  • Threshold for action set too high;
  • Avoidance of care;
  • Parents deny allegations;
  • Failed appointments (after 3 appointments) should be raised at supervision or escalated.
All agencies should ensure cases of neglect are regularly reviewed in supervision. The complexity of a family’s situation can overwhelm practitioners and they can become desensitised to the effects of neglect or focus on specific issues and ignore others.

6. Staff Supervision

“The risks of recurring maltreatment are higher with neglect than other types of abuse. Practitioners need support to prevent them becoming overwhelmed and to help them to think and act systematically in cases of neglect and to avoid the “start again” syndrome.” Analysing child deaths and serious injury through abuse and neglect: what can we learn? (DCSF, 2008).

The opportunity for staff and supervisors to step back from cases where neglect is a feature and review their judgements and interventions, is vital for the implementation of change in the lives of children for the better.

Practitioners should consider their agency’s supervision policy and procedures.


7. Dealing with Concerns Regarding 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. 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.

Universal Services

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, e.g. parenting classes, extra support at school. This also includes the identification of concerns antenatally and provision of services as appropriate. Research into Serious Case Reviews has highlighted the role of Universal Services in the early identification of concerns (Ofsted, 2008).

Early Help Assessment (previously known as CAF)

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 [2000] 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.

A Team Around the Family Meeting may be convened to discuss the assessment and consider the action necessary to meet these needs. A Team Around the Family Plan, outlining the actions agreed, with timescales and responsible practitioner, should be put together, with a Lead Practitioner taking overall responsibility for ensuring the plan is taken forward.

Arrangements should be made to review the plan and whether it is being effective in bringing about change and improving outcomes for the child. In some situations the outcome of the Early Help Assessment will be increased concern about the welfare and safety of the child. In such cases consideration must be given to an immediate referral to Children’s Social Care.

Click here for more information on how to access the Early Help Assessment Pathways across LLR

Child in Need (Section 17)

In most cases even with less serious cases neglect will require a ‘Child in Need’ assessment under Section 17 of the Children Act 1989.

In some cases Early Help Assessment may not be able to bring about sufficient change in the family and then a referral will be required to Social Care for consideration to a Single Assessment under Section 17 Thresholds for access to services for children and families

In Leicester, Leicestershire & Rutland

The single assessment should be a dynamic process, which analyses and responds to the changing nature and level of need and/risk faced by a child

Practitioners should be rigorous in assessing and monitoring Children in Need/risk of neglect to ensure they are adequately safeguarded over time. They should act decisively to protect children by initiating care proceedings where existing interventions are insufficient (WT 2015)

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:

  1. The child is suffering or is likely to suffer significant harm; and
  2. The harm, or risk of harm, arises because of the care afforded to the child and the parent/carer’s failure to meet the child’s needs.

Following the completion of these enquiries, and the assessment of risk to the child, a decision will be made regarding the need for an Initial Child Protection Conference. This will consider whether the child is at risk of significant harm and in need of a child protection plan. Research shows that agencies have often had a long period of involvement with children and young people experiencing neglect before child protection processes are started. In comparison with children who experience other forms of abuse, children experiencing neglectful care will have been known to agencies for much longer periods.

Children subject to Child Protection Plans

When a child is made the subject of a child protection plan, the Child Protection Team /the Children in Need Team in Leicester City would only recommend ceasing the plan at the first review, i.e. at three months, in very exceptional circumstances. Thus in the majority of cases the child protection plan should continue at least until the second Review Child Protection Conference, i.e. at six months.

This is to ensure that there is sufficient time to demonstrate whether any changes can be sustained. Parents/carers may be able to make immediate changes to their care of the child and home but the important question is whether these changes are meaningful and will be maintained.

Thorough assessment will be required to evidence that appropriate support has been available to the family for a reasonable period of time and over time the risk of harm has not improved to the point where the child is receiving a “good enough” standard of care.

Legal Intervention

In cases of neglect where Children’s Services and other agencies have been working with the family for some time, the threshold for significant harm is thought to be met and there is little likelihood of change, Children’s Services should consider implementing the steps outlined in the Care proceedings procedure and the Legal Planning Meetings procedure in the LLR Childcare procedure manual. “Where it is felt the local authority needs to consider all its legal options to secure a child’s safety, a Legal Planning Meeting will be necessary (see Leicester City, Leicestershire and Rutland Children and Young People's Service Procedures Manual).

Resolving Practitioner Disagreements and Escalating Concerns across agencies

At no time must professional dissent detract from ensuring that the child is safeguarded. The child's welfare and safety must remain paramount throughout.

Leicester, Leicestershire and Rutland Safeguarding Children Boards (LSCB), The Children Act (2004) and Working Together (2015) set out expectations that people working directly with families work, whether this is with the child or parent, to multi-agency plans and processes.

Good practice includes the expectation that there is professional and constructive challenge amongst colleagues within agencies and between agencies. Where a member of staff from any agency is concerned that concerns or agreed actions regarding a child are not being addressed or acted upon in a timely and consistent manner, it is expected that the escalation procedure should be used to reach a satisfactory outcome that is in the best interests of the child.

Individual agencies are responsible for ensuring robust feedback and completion of recommendations or planned actions. Where these actions are not completed or not within timescales this should be explained at reviews and a new or alternative plan devised with timeframes.

For further information Please see the LLR LSCB Resolving practitioner disagreement and escalation of concerns procedure


Appendix 1: Predisposing Risk Factors

Research suggests that certain family and environmental factors may be predisposing risk factors in child neglect. These include:

Factors in parents/carers:

  • History of physical and/or sexual abuse or neglect in own childhood;
  • History of being in care;
  • Multiple losses;
  • Multiple pregnancies, with many losses;
  • Concealed pregnancy (risk to mother an unborn child relating to emotional attachment between the mother and child and lack of ante-natal care due to non-attendance to ante-natal care;
  • Economic disadvantage/long term unemployment;
  • Parents with a mental health difficulty, including (post-natal) depression;
  • Parents with a learning difficulty/disability;
  • Parents that have chronic ill health;
  • Domestic abuse in the household;
  • Parents with substance (drugs and alcohol) misuse;
  • Early parenthood;
  • Families headed by a lone mother or who has a transient male partners;
  • Father’s criminal convictions;
  • Strong ambivalence/hostility to helping organisations;
  • Mother indifferent, intolerant or very anxious towards her child;
  • Significant stress during pregnancy and perinatal period (e.g. separation, death, loss of employment);
  • Separation of mother and child (for more than one week) during first months of life (hospitalisation, placement);
  • History of child(ren) in family being Looked After.

Factors in the child:

  • Birth difficulties/prematurity/very low birth weight babies;
  • Children with a disability/learning difficulty/complex needs;
  • Children living in large family with poor networks of support;
  • Children in larger families with siblings close in age;
  • Low educational level (less than 11 years);
  • Children < 1 year;
  • Asylum seeking children.

Environmental factors:

  • Families experience racism/discrimination;
  • Family isolated/in dispute with neighbours;
  • Social disadvantage e.g. low family income/low employment status;
  • Multiple house moves/homelessness.


Appendix 2: Age Specific Risk Indicators of Child Neglect

Key Features in infants (0-2)
Physical Development Behaviour
  • Faltering growth, weight, height and small head circumference;
  • Recurrent and persistent minor infections;
  • Frequent attendance at GP and/or casualty departments. Hospital admissions with recurrent accidents/illness;
  • Late presentation with physical symptoms (impetigo, nappy rash).
  • Late attainment of general development milestones.
  • Attachment disorders, anxious, avoidance, difficult to console;
  • Lack of social responsiveness.
If babies are not fed appropriately for their age they may fail to thrive. If they are habitually cold and wet they may take longer to recover from recurrent infections. If they develop nappy rash it may be a sign that they are not being changed regularly.


Key Features in Pre-School Children (2 - 5)
Physical Development Behaviour
  • Faltering growth, weight and height affected;
  • Unkempt and dirty/poor hygiene.
  • Language delay, attention span limited;
  • Socio-emotional immaturity.
  • Overactive, aggressive and impulsive;
  • Indiscriminate friendliness;
  • Seeks physical contact from strangers.

Persistent neglect during the pre-school period often results in poor growth (height and weight). Poor language development and emotional immaturity are also common to the neglected child.

The attention span of neglected children is often limited and may be associated with hyper-activity. Peer relations can be difficult to make and sustain as neglected children may not have the ability to develop the social skills necessary for co-operative play. Some children may elicit intimate contact from complete strangers and crave physical contact ("touch hunger").


Key Features in School Children (5 - 16)
Physical Development Behaviour
  • Short stature, variable weight gain;
  • Poor hygiene, poor general health;
  • Unkempt appearance;
  • Underweight or obese;
  • Delayed puberty.
  • Mild to moderate learning difficulties;
  • Low self-esteem;
  • Poor coping skills;
  • Socio-emotional immaturity;
  • Poor attention.
  • Disordered or few relationships;
  • Self-stimulating or self-injurious behaviour or both;
  • Soiling, wetting;
  • Conduct disorders, aggressive, destructive withdrawn;
  • Poor erratic/attendance at school;
  • Runaways, delinquent behaviour.

In the child who has reached school age the effects and main indictors of long-term neglect are usually found in poor social and emotional development, behavioural problems and learning difficulties.

In many cases there is no direct evidence of an effect on growth. Schools may be unable to compensate for the long-term lack of cognitive stimulation at home because neglected children have huge difficulties attending to learning tasks. This may be exacerbated by poor attendance.

Neglect should be considered as a possible cause in children who are disruptive and difficult to manage.


Appendix 3: Learning Lessons from Serious Case Reviews

Ofsted’s Learning Lessons from SCR’s publication from 2009/2010 documents the following in relation to cases of neglect:

  1. Out of 194 children subject to an SCR, 104 of them were involved in a serious incident, such as an injury or an attempted suicide following a history of concern by the agencies involved, including being subject to a Child Protection Plan. One of the most common characteristics was long-term neglect;
  2. Reviews found there had been insufficient challenge by the professionals involved. The statements of parents or others in the family were accepted at face value; individual professionals and agencies should have questioned their own and others’ views, decisions and actions; and there were shortcomings in the supervision and intervention by managers;
  3. Too often focus on the child was lost; adequate steps were not taken to establish the wishes and feelings of children and young people, and the child’s voice were not sufficiently heard. Most of the SCRs identified sources of information that could have contributed to a better understanding of the children and their families. This included information about or from fathers and extended family, historical knowledge, information from other agencies, cultural background and research findings;
  4. A frequent lesson was that practitioners had been affected by what is known as the ‘rule of optimism’. This is a tendency by social workers and healthcare workers towards rationalisation and under-responsiveness in certain situations. In these conditions, workers focus on adults’ strengths, rationalise evidence to the contrary and interpret data in the light of this optimistic view. They confuse participation by parents with co-operation;
  5. Agencies found instances where there had been a lack of management oversight and supervision. These gaps were significant because they could have provided opportunities to reflect on practice, for professional challenge to the practitioners, and for influencing changes in decisions about individual children and their families;
  6. Nine SCRs concerned cases where it was found that death had resulted from natural causes. These cases included children and young people who were disabled or who had long-standing illnesses and where there had also been concerns that neglect might have been a contributory factor. In some cases it was felt that professionals had been so focused on the complex health needs of the child that they had failed to spot the possibility of neglect.

End