3.9 Responding to Child Neglect in Knowsley - Practitioner Guidance

1. Purpose of this Chapter

The aim of this multi-agency practice guidance is to establish a common understanding and a common threshold for intervention in cases where the neglect of children is a concern. For the purposes of this document, a child is person under the age of 18 years.

This document is aimed at practitioners working with children and families in Knowsley to support an improved understanding of child neglect and how we can respond more effectively to achieve better outcomes for children.

This document is supported by KSCP's Child Neglect Strategy (see Knowsley Safeguarding Children Partnership Multi-Agency Neglect Strategy (2023 - 2026)) and should be read alongside the Knowsley Helping Children Thrive document. Research findings from Child Safeguarding Practice Reviews, both nationally and locally, show that neglect is often the highest category for Child Protection Plans and is often the backdrop for physical, emotional and sexual harm.

2. What is Neglect?

Working Together to Safeguard Children 2018 offers a commonly accepted definition of 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.

Neglect is often about cumulative harm over a period of time but single or episodal neglect can be just as damaging.

3. Neglect in Knowsley

On 31st March 2023:

• 56% of children subject to Child Protection Plans were under the category of neglect; a 6% increase from 2020;
• 60% of children categorised as Children in Need were categorised as experiencing abuse or neglect; a 2% increase from 2020;
• 59% of Cared for Children were categorised as experiencing abuse or neglect; an 11% increase from 2020.

Neglect is a persistent feature of family difficulty in the Borough and it is a priority for the Knowsley Safeguarding Children Partnership.

4. What are the different types of Neglect?

Neglect can take several, sometimes overlapping forms and these are categorised by the NSPCC as:

5. What are the Signs of Neglect?

This list is not exhaustive and the signs of neglect are also influenced by the child's age and stage of development. The NSPCC provides Core Information Leaflets on indictors of neglect in children who are pre-school, 5-14 years and older teens. Further information is available on the NSPCC website.

6. What is the Impact of Neglect?

Chronic and serious neglect can have a damaging effect on all aspects of childhood and have serious repercussions throughout the life of the child. The persistent nature of neglect is corrosive and cumulative and can result in irreversible harm and even death.

Neglected children have some of the poorest long term health and developmental outcomes and are:

• At high risk of accidents;
• Vulnerable to sexual abuse and sexual exploitation;
• Likely to have insecure attachment patterns;
• Less likely than other children to develop characteristics associated with resilience or have access to wider protective factors.

The Impact on brain development

“Our brains are sculpted by our early experiences. Maltreatment is a chisel that shapes a brain to contend with strife, but at the cost of deep, enduring wounds." (Teicher, 2000)

Poor brain development can lead to difficulties in regulating emotion, lack of cause-effect thinking, inability to recognise emotions in others, memory, focus and lack of conscience.

The Impact on the child's relationships and emotional development

The early infant-parent/primary carer relationship or 'attachment' is key to determining a child's capacity to develop positive relationships for the rest of their life. A secure attachment, whereby a child feels confident in their carer's availability and care-giving responses, allows a child to feel safe enough to explore the world, to become more autonomous and to manage difficult feelings and emotions. This helps them to develop their resilience, coping mechanisms and self-confidence as they grow and interact with others.

A neglected child, by contrast, may develop an insecure attachment with a parent/primary carer who is uninterested, inconsistent, unpredictable or even hostile and so will develop coping strategies which will impact on later capacity to form relationships through mistrust, anger, frustration, emotional detachment and anxiety.

The Impact on the child as a learner

Neglect can impair learning throughout a child's life and this can begin even before the child is born. Poor nutrition, lack of stimulation, unmet health and educational needs, poor routines, living in chaotic or frightening environments all contribute significantly to limiting learning, performance and educational outcomes.

The Impact on physical development

There are many ways in which neglect can have a negative impact on a child's physical development and this can begin pre-birth with factors such as foetal addiction to substances and delayed pre-natal growth.

Post-natally, and as children grow, they may fail to thrive, be vulnerable to illness/infections/accidents, have poor access to medical care and suffer non-treated routine conditions such as eczema or headlice. Some may suffer poor nutrition and poor sleep patterns and it is likely that many neglected children will continue to suffer poor health in later life as a result of their childhood experiences in contrast to the non-neglected population.

7. What to do if you suspect a child is being Neglected

All professionals, volunteers and agencies working with children and families have a duty to be aware of the signs of neglect and in some cases to 'think the unthinkable' and question whether there is a possibility that a child is being neglected. They should refer to the Knowsley Helping Children Thrive document for further guidance on indicators of neglect.

It is important to note that where there are concerns about the quality of care being provided to a child(ren) professionals should undertake the Graded Care Profile2 tool to determine what intervention/support is needed.

As matter of good practice all agencies working with children should be committed to tackling Neglect and making children SAFER through:

• Sharing Information;
• Assessing and analysing risk;
• Focussing on the child and thinking family;
• Evidencing decisions and reasons for actions;
• Recording work accurately.

The National Multi-Agency Strategic Steering Group on Neglect also recommends that all Practitioners should be prepared to be Professionally Curious

This means:

• Being alert to potential indicators of abuse or neglect and be prepared to act in the child's best interest. This will include referral to Children's Social Care in the Multi Agency Safeguarding Hub (MASH) if a child is at or is likely to at risk of Significant Harm as a result of neglect;
• Without pressing or leading the child, they should be prepared to hear the child's Voice and understand their lived experience to be alert to the risks neglectful or abusive carers pose. They should also be aware of what the impact of such maltreatment might be;
• They should be prepared to talk to parents/care givers (where this does not put the child at risk) to discuss concerns and offer challenge as well as support in seeking their consent and co-operation for intervention from universal, targeted and specialist services (including Children's Social Care when required);
• Think Family and be prepared to sign-post or refer to services which support adults and particularly so if they are experiencing one or more of the 'of Domestic Abuse, mental ill-health of substance misuse' trio of symptoms;
• Be prepared to gather, share and analyse information as part of an assessment of the child's needs. And record this accurately describing concerns and issues in sufficient detail to inform decision making.

8. When to use the Graded Care Profile

In Knowsley the Graded Care Profile 2 (GCP2) is the agreed tool to assess Neglect endorsed by the KSCP and it is a requirement that services supporting families at Levels 3 and 4 as defined within the Continuum of Need (Threshold) document use the GCP to address actual or suspected neglect and devise plans to tackle this 'with' families.

Where there are any concerns about the quality of care being provided to a child(ren) professionals should undertake the Graded Care Profile2 tool. This may be required when children are failing to thrive physically and emotionally, reports are received about poor, unhygienic home conditions, parents are suffering mental ill-health and unable to put their children first or where children are missing from home/education frequently.

The tool identifies areas of parental strength as well as difficulty. It can be used in early intervention with parents and carers to promote their strengths and recognise the areas in which they need to improve. It can also be used with children at higher levels of need to provide evidence of what must change if the child is to develop and be safe. The Graded Care Profile gives clear evidence of neglect.

See Graded Care Profile (GCP2) and Tool.

If you have not been trained to undertake a GCP2 you can use the Knowsley Neglect Screening Tool as a pre GCP2 assessment tool to inform decision making.

9. The Role of Early Help Services

Early Help services such as schools, nurseries and health services, are also strongly encouraged to use the GCP to provide consistency in the assessment and identification of risk associated with Neglect.

A GCP2 may be undertaken when a nursery or school notices a change in a child's behaviour, their appearance or that they seem unusually hungry for example.

In addition the Early Help Assessment should be considered as the primary tool for all practitioners delivering services to families with additional needs, corresponding to Level 2 on the Continuum of Need, to provide consistency in how the whole range of a families unmet needs are identified and addressed through collaborative multi-agency, Team Around the Family (TAF) processes

Partner agencies in Knowsley have also identified the following examples of tools and approaches which can support the practice of identifying potential Neglect at the earliest opportunity: These could be used as a trigger to alert professionals of the need to undertake a GCP2, and should be used to inform the completion of a GCP2 but must not replace it.

Early single or multi-agency support for children experiencing Neglect in Knowsley can reduce the likelihood of Children's Social Care, police and other specialist services becoming involved in the lives of children and their families. However, if a child is at risk of Significant Harm all practitioners must make a referral via the Multi Agency Safeguarding Hub (MASH) to Children's Social Care using the Knowsley MASH (Multi-Agency Referral Form) (MARF) or calling 0151 443 2600.

Appendix 1: Ten Top Tips for Practitioners

(It is important to note that the use of the GCP2 enables professionals to apply these tips.)

After a Community Care survey revealed many social workers don't feel confident dealing with cases of child neglect, Dr Ruth Gardner, NSPCC head of strategy for neglect came up with the following top tips:

1. The child is the top priority
   
   The key question to ask is, 'are this child's needs being met?' If the answer is no, then meeting the child's needs is the first priority, whether or not the neglect is intentional. Individual children can be lost for a number of reasons – for example, where there are several children or practitioners waiting to see if parents can change or meeting parents' needs first.
   
   
2. Give parents clear messages
   
   Parents usually want the best for their children. They want a clear explanation of what needs to change, by when, and why, as well as the support they can expect to achieve this. Parents' motivation, understanding and capacity for change need to be ascertained as soon as possible if the plan is to be realistic. Small achievable steps often work best but the plan and time frame have to be centred on the child's age and needs.
   
   
3. The child's key relationships
   
   How each parent relates to the child on a day-to-day basis is central to secure and consistent care – both necessities for healthy development. If one parent does not, or cannot, respond to the child, or worse actively dislikes them, then the other adult may feel conflict and the child may end up ignored or victimized. Where you have concerns of this kind, the interactions between key adults and a child should be observed by a trained professional.
   
   
4. Understand the child
   
   Children who are neglected are used to not making demands. They can still appear happy at times, such as when they feel less threatened (perhaps at school), but they are sometimes under threat not to complain. Or complaining seems pointless. The child's daily experiences, and their wishes and feelings, should be sought in a neutral setting by a professional skilled in working directly with children.
   
   
5. Good physical care is a right
   
   Children have a right to basic essentials at all times. A clean bed and bedding, clean clothes and shoes are a top priority. It is essential to see the child's environment. Children who are permanently infested, dirty or smelly may be at risk of infection as well as bullying. It is vital you help families increase their resources and, sometimes, challenge parents' priorities.
   
   
6. Escalate
   
   Punitive child neglect involves deprivation of necessities, like food and water, or enforcement, such as locking a child in a room. It may also involve severe physical punishment or a child not receiving necessary medical care or suffering other abuse. If you have concerns about such treatment, an immediate referral into the MASH must be made.
   
   
7. Research helps
   
   Being aware of the research can help in explaining why change is necessary, and what form of intervention may be most helpful to tackle neglect. There is now strong evidence on the lasting effects of child neglect, which are less easily reversed as the child gets older. Physical and Emotional Neglect are inter-connected and can leave children socially isolated, depressed and/or very angry. This can affect their lives as seriously as any other abuse.
   
   
8. Review the history and look for patterns as you work
   
   It's worth looking at any past history of involvement with a family. For instance, it may save repeating an intervention or assessment that has already been carried out, or a significant event may come to light. Behaviour and events need to be recorded and reviewed – for example, the child who is hungry and sleepy or has 'accidental' injuries or marks on a regular basis. Individually these may seem minor, but repeat patterns are significant.
   
   
9. Test assumptions and be ready to question
   
   Expectations of parenting, and children, differ widely, not only between but within cultures. The culture of the family is the child's daily experience, so question what you are told and check out your understanding with others. It is reasonable to challenge adult behaviour that appears neglectful of a child's needs, and to test explanations you receive against a wider understanding of good parenting.
   
   
10. Reflect, discuss, work together
    
    Professionals from all disciplines tell us that, however experienced they are, neglect can still become accepted as 'normal' and difficult to challenge. Take opportunities to discuss cases with supervisors or colleagues, through group supervision or case presentations. This can provide new insights and ideas. It can also assist a less reactive, more planned approach;
    
    Managers have a vital role in supporting active decision-making. Inertia and low expectations are the main enemies to action on neglect. Professionals often find ways to help parents turn their children's lives around, but need their managers' active support in taking decisions when the child's situation is not improving. (Community Care 1.10.2012).