Responding to child neglect

Acting with urgency: responding to child neglect


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Neglect is a particularly challenging concept due to difficulties in definition, seemingly moveable thresholds for intervention and uncertainty about when a line has been crossed

 Child neglect is the most common and enduring form of maltreatment that has significant negative impacts across their lifespan. As such, it is critical that practitioners have a good understanding of “what works” for children and families experiencing neglect. 

Children who experience neglect and their families often receive a lack of appropriate services. This is because neglect may be given lower priority in comparison to other forms of maltreatment and get screened out at various points in the system. 

 Children who experience neglect have higher re-referral rates, multiple substantiations, lower reunification rates and are more likely to re-enter out of home care if they have been reunified. 

Because neglect may occur and reoccur over many years interventions based on other forms of abuse are often ineffective for these families and children who need repeated interventions and long-term support. 

Given the differences in neglect types and causes, no one intervention will be effective. It is critical to ensure that interventions respond to the multifaceted nature of neglect without being disjointed. 

It is also critical to consider the broader context in which neglect is occurring including inequities due to poverty, class, gender or race. Without factoring in these issues, interventions focussing on the parent and child may be limited in their effectiveness because the underlying factors driving neglect may remain unresolved. 

Given the potentially lethal consequences of neglect and its recurrent nature that makes it so destructive to families and children over time, child neglect cases must receive a greater priority in systems... Anything less than unswerving commitment to new policy and practice initiatives for families suffering from child neglect represents an abrogation of social work’s responsibility to its most vulnerable clients

Family and Community Services responses to neglect as a primary issue in 2015/2016 


Barriers to responding to child neglect

There are number of common barriers to responding to child neglect in practice, as follows:

Difficulty assessing need and impact

 The seriousness of child neglect can be underestimated and the consequences of ongoing child neglect can often be minimised. Practitioners may struggle to assess child need in relation to neglect and parenting challenges. In addition, it is difficult to assess the impact of being neglected on long term outcomes.  Assessments are challenging because the impacts may not be obvious but become significant later in a child or adolescent’s life. 

Thresholds for intervention

Making decisions about thresholds for child neglect is particularly challenging. Practitioners must determine when a situation is sub-optimal or harmful and requires intervention. In order to make this judgment practitioners need to “be able to differentiate between what is unacceptable rather than simply undesirable”.  

Value laden decision making

Decision making about neglect and appropriate standards of care can be value laden. Practitioners may be sympathetic towards families and avoid passing judgment particularly when there are questions around cultural norms and differences, ‘lifestyle choices’ and the role of social and structural disadvantage including poverty.

Focussing on incidents not cumulative harm

Neglect is often chronic and persistent, and generally isn’t characterised by discrete incidents or events that trigger action. Focussing on singular events may lead to assessing neglect as ‘low risk’ and therefore not a priority. Failing to consider the historical, chronic nature of neglect masks cumulative harm and the significant negative impact on the child. 

Fatalism and the rule of optimism

Practitioners may have a sense of fatalism and a fixed view that the family won’t change, or that any intervention or effort will be futile. This can result in crisis management rather than deliberate and effective interventions according to need. Conversely, practitioners might become overly optimistic about the situation when it is not actually changing. In these instances, the seriousness of the situation is often overlooked and can have tragic consequences for the child. 

Getting the right balance between avoiding a rush to judgment and making timely decisions, appropriate to a child’s timeframe, is problematic… such decisions might be made with greater urgency if the research evidence concerning the impact of abuse and neglect on early childhood development… were better disseminated

Focusing on the parent

It is common to focus on the parent(s) in cases of neglect, due to their high needs and vulnerability. Conversations about ‘good enough parenting’ encourage this focus on the caregiver and their capacity rather than the impact on the child/young person. Delays in determining whether a parent is able to change and adequately meet their child’s needs can have catastrophic and long lasting impacts on a child’s development.

Failing to explore the child’s experience

Research consistently reports that practitioners fail to observe and talk with children about their daily lived experience of neglect. Practitioners may also interpret some signs of neglect as normal teenage behaviour or believe that a teenager is less vulnerable and able to cope by themselves. 

Normalising the neglect

Due to the ongoing nature of chronic neglect, it is common for practitioners to ‘normalise’ the neglect and become ‘habituated’ to the family and their situation. This may result in case drift and failure to identify and act on the things that need to change for a neglected child. 

Being under or overwhelmed

When practitioners think about issues of structural disadvantage and interpersonal difficulties associated with neglect, they can become overwhelmed about how to respond to the myriad of issues. This may lead to staff feeling a sense of apathy and powerlessness. Alternatively, if practitioners view child neglect narrowly by focussing on incidents or practical issues, they can be underwhelmed. This may result in superficial responses and failure to appropriately respond to important factors that could make a significant difference to the life of that child and their family. 

Resource constraints and referral reluctance or reliance 

Child protection workers are not able to provide all of the supports required by families in cases of neglect, e.g. to overcome structural disadvantage including poverty. A focus on “quick fix” solutions, e.g. organising a skip to remove rubbish from a property, provides some short term benefit, but will not support sustained change.

However, practitioners may be reluctant to refer the family to other services e.g. because previous experience is that referrals aren’t accepted/effective. Alternatively, they may believe that linking families in with support services is the primary solution to the situation. Neither of these approaches best serves the families and their holistic needs. 


Service responses to child neglect

The child protection system should be child-centred, recognising children and young people as individuals, with rights… that the child protection system understands its dual mandate to support families and help them provide adequate care and to intervene authoritatively when children and young people need protection

The literature points to the complex nature of intervening with neglected children and their families, and the need to ensure that any response is based on a comprehensive understanding of the unique needs of each family member. 

 While existing evidence highlights promising interventions for child neglect, including home visiting, parent training, social network support and therapeutic approaches with parents and children, there are very few evidence based programs for neglect specifically. 

Despite the lack of programmatic information there is guidance available about responding effectively to child neglect. Interventions targeting families who have already been identified for neglect can be conceptualised as having three main aims: 

There is a large range of interventions and approaches being implemented for child neglect. Some interventions are multidimensional and aim to target many aspects of child neglect, while others attend to one or two aspects. In addition, some interventions focus on the caregiver only, others on the child, and some work with the family as a whole. Other interventions also attend to the broader contextual issues such as family and neighbourhood poverty and isolation.

Examples of the range of possible interventions for parents and families are outlined in Table 1. below. Interventions for children may be therapeutic, relationship based, peer focussed, or involve linking children in with critical services that they often aren’t accessing, for example health care and early learning services. 

Table 1. Examples of possible interventions for parents and families

Concrete support

Social support

Developmental

Cognitive and behavioural

Individual

Family system

Housing

Individual social support

Therapeutic child care

Social skills training

In/out patient counselling / detox for AOD

Case management

Emergency financial, food or other assistance 

Mentor involvement

Individual assistance with developmental skills

Communication skills and problem skills building

12 step program

Centre based family therapy 

Transport

Social support groups & community supports

Home visits with focus on developmental needs of family members

Teaching of home management, parent-child interactions, meal preparation and other life skills

Mental health in/out patient counselling

Home based, family centred counselling - family functioning, communication, roles & responsibilities 

Clothing, household items

Connection to faith based activities

Peer groups geared to developmental tasks 

Crisis intervention 

Availability or accessibility to community resources

Neighbourhood centred activities

Mentors to provide nurturing, cultural enrichment, recreation and role modelling

Parenting education

Stress management

Enhancing family strengths

Assistance to increase safety & hygiene of home

Social networking

Individual or group therapeutic counselling 

Play therapy

Building nurturing behaviours

Free/ low cost medical care

Recreation programs

 

Employment support

 

Refining family dynamics & patterns

Available / affordable quality child care

Cultural festivals and other activities

 

Financial management support

   

In Australia, the National Framework for Protecting Australia’s children (2009-2020) has a public health approach including three tiers of support: primary, secondary and tertiary supports. 

Scott (2017) advocates for the use of both a socio-ecological framework (child, parent, family and community) and public health framework (universal, secondary and tertiary tiers) when conceptualising potential interventions for child neglect. Table 2. provides an example of how these frameworks can be used in unison. 

Table 2. Using an ecological and public health framework to understand neglect

 

Child

Parent/family

Environment

Universal services 

(primary prevention) 

e.g. prevention education, early childhood education

e.g. income support, universal health care & screening

e.g. housing services, addressing social stigma

Secondary (targeted for at risk families)

e.g. respite care, services to assist with child emotional self-regulation 

e.g. parenting skills, AOD/ MH services, Intensive family support

e.g. community support, routine screening at critical developmental stages

Tertiary (responding to maltreatment already occurred) 

e.g. trauma based therapy, OOHC, resilience building

e.g. remedial skill building, anger management, AOD/MH services

e.g. longer term therapy, mandatory reporting legislation 

Practice approaches

Daniel (2015) proposes for system wide change in order to better meet the needs of children who are experiencing neglect through asking the following key questions: 

  1. What does this child need to grow and develop, and what does his or her family or carer need to provide a nurturing environment? (child experience)
  2. What does this child and their family or carer need me to think about? (recognition and response)
  3. What does this child and their family or carer need me to do? (intervention)
  4. What does this child need me to feel? (empathy)

More broadly, the literature recommends that interventions for child neglect should:

  • recognise that most caregivers want to be good parents
  • acknowledge that all families are different with unique circumstances
  • accept that all families have strengths on which to build
  • meet a family where they are at
  • be sensitive to cultural diversity
  • be intensive and support and advocate for the concrete needs of the family
  • be multipronged to address the many “causes” of neglect
  • reflect an increased focus on the impacts of neglect on children
  • be purposeful and focused, including the development of clear and achievable goals 
  • celebrate change and successes
  • recognise that many parents will have experienced a lack of nurturing and potentially neglect as children themselves
  • involve both in the home and wrap around support
  • be based on strong relationships between practitioners, parents, children and others.

Practice principles

A number of practice principles are consistent across the literature on child neglect. 

Take neglect seriously

It is critical that practitioners understand the serious consequences of child neglect and its significant lifelong impacts. It is also important to recognise the potential for neglect to be fatal. Act with urgency rather than waiting for a reportable trigger event. 

Be evidence informed

It is important to understand the most current research about child neglect, including the characteristics, risks factors, protective factors, possible interventions and associated issues, in order to effectively respond. Similarly, practitioners need to have knowledge of the evidence on the impacts of neglect to interpret what neglect might mean for the child now and in the future.

Consider history and cumulative harm

It is crucial that we shift from an incident based approach to understanding whether the neglect occurring is chronic, and the associated cumulative harm. To do this look to the family history and patterned nature of behaviours in order to identify whether the neglect is episodic and enduring. Developing a chronology can assist with identifying themes, patterns, risks and strengths that feed into an assessment of caregiver capacity to change. 

 Be child-centred

It is essential to understand a child’s daily experience, assess whether their needs are being met in relation to their developmental stage and consider the potential impacts on their development and outcomes. It is critical that practitioners see the child, communicate with them and observe them in their interactions with their carer. See the Practice Note on working with neglected children for further information. 

A focus on the child includes providing or linking them with therapeutic intervention to help reduce the effects of neglect and improve their outcomes. Ultimately, all decisions should be considered in relation to the timeframe of the child and their developmental needs.

…and family focussed 

The wellbeing of the child is interlinked with their family wellbeing. Practitioners must undertake a holistic assessment of family needs in order to improve family functioning and reduce stress including addressing the problems that may be preventing parent’s meeting their child’s needs as well as addressing any parenting challenges. A key aspect of working with a family experiencing neglect is being clear about what needs to change over what time period in order to ensure that a child’s needs are being met. It is also important to consider the role of male caregivers within the context of neglect.

Assess parent capacity to change - in the child’s time

The literature identifies that parents are often given “too many chances” to change in cases of neglect. Any assessment of capacity to change must be considered within the child’s timeframe in relation to their developmental stage and trajectory.

Some parents can change and others can’t. Some are given too many chances and we are left too long at home... In some cases parents are just overwhelmed with their problems and we’re not sure if anything could have really helped them to look after us better. Although some do not get enough chance to change – it depends on the individual circumstances – A letter from youth in Daniel et al. (2014)

Timely delivery and long term interventions

Timely intervention is critical to avoid neglect becoming chronic. In addition, sustained and long term support beyond a year is generally more effective than short interventions. Longer term interventions should still focus on the child with clear objectives to avoid case drift. 

Relationship based practice

The importance of building relationships to achieving positive and real change cannot be overstated. This is particularly the case for child neglect, with evidence suggesting that neglecting families disengage from services at a higher rate than other maltreating families.

Understand risks and indicators, and address underlying causes

It is important for practitioners to be able to distinguish between a risk of neglect occurring, indicators of neglect and the underlying causes contributing to the situation. Practitioners must deliberately identify and target the unique factors underlying the neglect for each family, rather than just the presenting indicators or risk factors. Without this, interventions will be superficial and children are likely to experience neglect again. 

Maintain good quality documentation

The need for quality case records, chronological histories, and eco maps have proven essential in cases of neglect. It is important to clearly name and describe neglect in records when it is occurring, and outline the cumulative nature of the neglect and its consequences. Case files should also clearly document how a practitioner is monitoring a child’s progress, and explicitly note what they are witnessing in parent-child interactions. 

Collaborate and partner 

Due to the complexity of child neglect, there is a  need for increased collaboration across systems, for example to address poverty, health or educational needs. Service providers and informal supports must actively work together to share the responsibility of meeting a child and family’s needs. This includes effectively sharing information and drawing on each other’s professional expertise. 

It is important that together partners maintain a focus on the child in order to develop a shared understanding of what is required and most appropriate. A shared definition of neglect and acceptable care is also needed. In order to support collaboration, assessments and case planning must be holistic with long-term goals supported by a comprehensive set of interventions.

Utilise good quality supervision

Supervision is crucial and must support caseworkers to be focussed and purposeful in their wok when dealing with neglect. Supervision should play a strong role in helping practitioners to reduce any professional uncertainty, identify any value laden decision making, case drift, the ‘rule of optimism’ or the ‘start again syndrome’. 

The practical and emotional difficulties of working with complex neglect cases have important implications in terms of supervision. For those who manage front-line workers, the question ‘who cares for the carers’ is unavoidable and constitutes one of the major challenges facing care providers


References 

Brown, R. & Ward, H. (2014). Cumulative jeopardy: How professional responses to evidence of abuse and neglect further jeopardise children’s life chances by being out of kilter with timeframes for early childhood development, Children and Youth Services Review, 47, 260-267.

Daniel, B. (2015). Why have we made neglect so complicated? Taking a fresh look at noticing and helping the neglected child, Child Abuse Review, 24, 82-94. 

DePanfilis, D. (2006). Child Neglect: A guide for prevention, assessment and intervention, U.S. Department of Health and Human Services. Retrieved from: https://www.childwelfare.gov/pubPDFs/neglect.pdf 

Gaudin, J.M. (1993). Child neglect: A guide for intervention (unpublished doctoral thesis). U.S. Department of Health and Human Services Administration for Children and Families. Retrieved from www.childwelfare.gov/pubPDFs/neglect_1993.pdf 

Horwath, J. & Tarr, S. (2015). Child visibility in cases of chronic neglect: Implications for social work practice, British Journal of Social Work, 45, 1379-1394. 

Long, T., Murphy, M., Fallon, D., Livesly, J., Devitt, P., McLoughlin, M. & Cavanagh, A. (2014). Four-year longitudinal impact evaluation of the Action for Children UK Neglect Project: Outcomes for the children, families, Action for Children, and the UK, Child Abuse & Neglect, 38, 1358-1368.

Office for Children, Youth and Family Support (OCYFS). (2010). Practice Paper: Focus on neglect. Department of Disability, Housing and Community Services ACT. Retrieved from 

Scott, D. (2017). Practice responses to neglect. Paper presented at the Family and Community Services Research to Practice: Act with Urgency: Responding to Neglect. 

Stone, B. (1998). Child neglect: Practitioners’ perspectives, Child Abuse Review, 7, 87-96. 

Taylor, J., Brandon, M., Hodson, D. & Haynes, A. ( 2016). Child neglect: Policy, response and developments in England, Research, Policy and Planning, 32(1), 32-51.