Introduction

Neglect can affect anyone, but the majority of national research and local work has focused on younger children because of their vulnerability. However, focus should also be given to adolescents. The Children’s Society says that as many as one in seven teenagers have parents who:

  • do not attend to their basic physical care
  • offer little support with their education or emotional needs
  • rarely show any interest in their social life

The publication ‘Growing up neglected: a multi-agency response to older children’ also calls for more awareness of the neglect of older children. Professionals working in adult social services must be aware of the risk of older children being neglected by parents with complex needs.

Our vision

South Tees Safeguarding Children Partnership’s aim is to reduce the number of cases of neglect locally, as well as reduce the impact of neglect on children. We will offer the right support to children and their families as soon as problems are identified.

Detecting neglect and offering support early enough to prevent harm is central to reducing the impact, and achieving better outcomes for children. We want to get it right first time, and then help families to keep those improvements going. We’ll do this by working with the family to build resilience and the ability to maintain their own improvement.

We’ll make sure staff have the necessary skills and understanding to identify and address the neglect of children. This approach is supported through our practice framework, including restorative practice, Graded Care Profile 2, and Signs of Safety.

What is neglect?

Neglect is defined in Working Together 2018 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 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)
  • ensure access to appropriate medical care or treatment

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

Neglect differs from other forms of abuse because it is:

  • often passive
  • not always intentional
  • more likely to be chronic, rather than the result of a crisis, which impacts on how agencies respond
  • often combined with other forms of maltreatment
  • often a ‘revolving door syndrome’ where families need long-term support
  • often not clear-cut and may lack agreement between professionals on the threshold for intervention

Neglect is rarely a single incident or crisis that draws attention to the family. It is repeated, persistent neglectful behaviour which causes incremental damage over a period of time.

The way we understand and define neglect can determine how we respond to it.

Classifications of neglect

Horwath (2007) identified six different classifications of neglect:

The child’s health needs are not met, or the child is not provided with appropriate medical treatment when needed as a result of illness or accident.

The child is given insufficient calories to meet their physical/ developmental needs. This is sometimes associated with ‘failure to thrive’, though failure to thrive can occur for reasons other than neglect. The child may be given food of insufficient nutritional value (for example, crisps, biscuits, and sugary snacks in place of balanced meals). Childhood obesity as a result of an unhealthy diet and lack of exercise has more recently been considered a form of neglect, given its serious long-term consequences.

This involves a carer being unresponsive to a child’s basic emotional needs, including failing to interact or provide affection, and failing to develop a child’s self-esteem and sense of identity.

Some authors distinguish it from emotional abuse by the intention of the parent.

The child does not receive appropriate learning experiences; they may be unstimulated, denied appropriate experiences to enhance their development and/ or experience a lack of interest in their achievements.

This may also include carers failing to comply with state requirements regarding school attendance, and failing to respond to any special educational needs.

The child has inadequate or inappropriate clothing (for example, for the weather conditions), they experience poor levels of hygiene and cleanliness in their living conditions, or experiences poor physical care despite the availability of sufficient resources.

The child may also be abandoned or excluded from home.

The child may be exposed to hazards and risks, parents or caregivers are inattentive to avoidable dangers, the child is left with inappropriate caregivers, and / or experiences a lack of appropriate supervision and guidance.

It can include failing to provide appropriate boundaries for young people about behaviours such as underage sex and alcohol use.

Experience of neglect at different ages

Horwath also notes that children and young people experience the impact of neglect differently at different ages.

Infancy (birth to two years)

Babies’ growth and development is linked to their interaction with the world and their caregivers.

Emotional and cognitive development can come through play. For example, games like ‘peek-a-boo’, where actions are repeated for social and emotional reinforcement from the reactions of caregivers, and neural connections are ‘fixed’ through stimulation. Disinterest or indifference to such actions and/or failing to offer stimulation will limit the child’s development and growth, and damage infant attachments.

Pre-school (two to four years)

Most children of this age are mobile and curious, but do not understand danger. They need close supervision for their physical protection, which neglected children may not experience.

Children may not be appropriately toilet trained if they are in neglectful families, as this process requires patient and persistent interaction and encouragement.

Children’s language development may be delayed if their caregivers are not interacting with them sufficiently, and physical care may be inadequate, for example dental decay.

Primary age (five to eleven)

For some neglected children, school can be a place of sanctuary. However, if their cognitive development has been delayed and they are behind their peers at school, it can also be a source of frustration and distress.

Signs of neglect, for example dirty or ill-fitting clothing, will be obvious to peers, teachers, and to the children themselves, and may cause embarrassment and difficulties in their social interactions.

Children without clear and consistent boundaries at home can struggle to follow school rules and get into trouble.

Educational neglect can include failing to ensure that children attend school, and high levels of absence can further impair their academic progress.

Adolescence (twelve to eighteen)

Neglect is likely to have an impact on the young person’s ability to form and maintain friendships and pro-social relationships. However, they may be reluctant to talk about their situation if they’re scared of becoming looked after or being split up from their siblings.

Although adolescents can find sufficient food for themselves, they are likely to be drawn to high-fat, high-sugar convenience foods if they’ve never learned to prepare meals.

Risk-taking behaviour may be associated with, attributed to, or worsened by, a lack of parental supervision. This can expose neglected young people to the risk of harm through, for example, alcohol and substance misuse, risky sexual behaviour, or criminal activity.

Resilience to neglectful situations does not increase with age, and can have significant consequences for young people’s emotional wellbeing. In a study of Serious Case Reviews, Brandon et al (2012) noted that ‘past neglect was a factor in eleven out of fourteen reviews conducted after a young person was believed to have committed suicide’.

It’s important to remember that neglect should be seen in the context of each individual’s experiences.

Risk factors

A number of factors (social determinants) increase the likelihood of neglect in some families. Vulnerable families may have a combination of the following risk factors:

Child risk factors

  • disability
  • behavioural problems
  • chronic ill health

Parental risk factors

  • poor mental health, especially maternal mental health difficulties
  • drugs and alcohol (substance misuse)
  • domestic abuse
  • parents’ own exposure to maltreatment and lack of experience of positive parenting in childhood

Wider determinants of health

  • poverty
  • unemployment
  • poor social support

Adverse childhood experiences (ACEs)

A growing body of research is showing the long-term impacts that experiences and events during childhood have on individuals’ life chances.

Adverse Childhood Experiences (ACEs) such as abuse, neglect, and dysfunctional home environments have been shown to be associated with the development of a wide range of harmful behaviours including:

  • smoking
  • harmful alcohol use
  • drug use
  • risky sexual behaviour
  • violence
  • crime

ACEs are also linked to conditions like diabetes, mental illness, cancer, and cardiovascular disease, and ultimately to premature death. As the number of ACEs increases, so does the risk of these negative outcomes.

Types of ACEs

Direct:

  • sexual abuse by parent or caregiver
  • emotional abuse by parent or caregiver
  • physical abuse by parent or caregiver
  • emotional neglect by parent or caregiver
  • physical neglect by parent or caregiver

Indirect:

  • parent or caregiver addicted to alcohol or other drugs
  • witnessed abuse in the household
  • family member in prison
  • family member with a mental illness
  • parent or caregiver disappeared through abandoning the family or divorce

Stable, nurturing environments and adult-child relationships help children to develop strong cognitive and emotional skills, and the resilience needed to flourish as adults. Encouraging such relationships can prevent ACEs, even in difficult circumstances. It’s crucial to support and nurture children and young people as they develop and grow.

Being ACE aware in Middlesbrough will help us to understand the characteristics of children and young people and their families. It will provide agencies with a shared language and understanding, and has the potential to transform systems. It will improve pathways by making sure referrals are made to the most appropriate service, which will prevent people ‘falling through the net’. An ACE-informed service will place greater emphasis on restorative services.

Being ACE-aware is not about routine enquiries or screening, it takes organisational planning, and for staff to be trained and supported in their practice.

Addressing neglect

Working to address the neglect of children and young people is complex, and needs consideration of six key areas (identified by Jane Wiffin):

Persistence and change

Neglect which constitutes ‘significant harm’ is:

  • persistent
  • cumulative
  • chronic or acute
  • resistant to intervention

The behaviour of seriously neglectful parents often includes care which lacks consistency and continuity. There may be brief periods when care is marginally improved. At these times, it’s important not to be over-optimistic. Keep a balanced approach and beware of over-emphasising the positives, especially when standards of care are known to change.

Child’s developmental needs

Gain an understanding the impact of neglect on the child’s biological, psychological, and emotional development. This will include physical care, emotional care, medical needs, supervision and guidance, and stimulation and education.

Impact of neglect on the child and their lived experience

Understand the child’s world through direct, first-hand observation of their everyday life, which includes the child’s lived experience of neglect and any other forms of abuse, and the views of others who may know the child well.

Causal factors

‘Causal factors’ are additional factors which may impact on a parent’s ability to care for a child. These may include

  • parental mental ill-health
  • domestic abuse
  • substance misuse
  • poverty
  • isolation

Parental domestic abuse, mental ill-health, and drug and alcohol misuse are key issues which contribute to neglect. Unless the parents’ issues are identified and supported, the outcomes for their children will be poorer than for their peers.

Acts of omission or commission

Acts of commission are deliberate and intentional. Acts of omission are the failure to provide for a child’s basic physical, emotional, or educational needs, or to protect a child from harm or potential harm, including carer ignorance of neglect.

Further resources

1001 critical days – The Wave Trust research into the effect of neglect in a baby’s early days

World Health Organization guidance on adolescent development

The Children’s Society – Understanding Adolescent Neglect: Troubled Teens

Middlesbrough neglect strategy (coming soon)
Redcar & Cleveland neglect strategy (coming soon)
South Tees adolescent neglect guide/framework (coming soon)