Neglect

The neglect of children can happen when their parents or carers fail to meet the basic physical and/or emotional needs of the children they are responsible for.  It is an overarching term that can cover many different aspects.

Neglect may be a deliberate act (commission) or more commonly happens because the parent is unable to put the needs of the child first (omission).  Despite the reason, the impact on the child's health, development and wellbeing can be severe. All children and young people need food, clothing, warmth, love and attention, in order to grow and develop. (Neglect: Steve's story | Childline)

Working Together to Safeguard Children (2023) 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:

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

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

Neglect also includes the failure to ensure access to education or to look after a child because the carer is under the influence of alcohol or drugs. As well as a failure or an inability to:

• ensure a child’s opportunities for intellectual simulation are met;
• prevent the exposure of the child to harmful parental behaviour such as violence or a chaotic lifestyle, often secondary to substance misuse, alcoholism or unresolved mental health issues.
• ensure that the child has opportunities to mix with peers
• late booking of a pregnancy

Childhood neglect can have significant and long-term effects on children physically, behaviourally, educationally, and psychologically. Abuse can stunt the physical development of a child’s brain which can impact on a child's emotional development and lead to mental health issues, low self-esteem, and alcohol/substance misuse in later life. It can also mean that children are more vulnerable to other types of harm such as criminal and/or sexual exploitation.

People who are emotionally neglected as children can grow up to have poor attachment to any care giver and become adults who may not know how to regulate their own emotions.

Research shows the most common effects of childhood neglect in adulthood include:

• post-traumatic stress disorder
• depression
• emotional unavailability
• increasing likelihood for an eating disorder
• shunning intimate relationships
• feeling deeply, personally flawed
• feeling empty
• poor self-discipline
• guilt and shame
• difficulty in managing emotions which may present as unpredictability, anger or aggressive behaviours
• difficulty trusting others or relying upon anyone else

Adults who have experienced childhood emotional neglect may become parents who neglect their own children. Not having a positive, emotionally available role model, or never having learned the importance of their own emotions, they may not know how to nurture emotions in their children.

Listen to the podcast to find out about Recognising and responding to child neglect

InBrief: The Science of Neglect (video)

Protecting children from neglect | NSPCC Learning

Understanding child brain development | NSPCC Learning

Neglect can also go unrecognised in adolescents: Understanding Adolescent Neglect: Troubled Teens | The Children's Society (childrenssociety.org.uk)

There is no statutory definition of educational neglect however, many reports over the years have found links between neglect and poor school attendance. It can happen when parents do not ensure that their children receive an efficient full-time education, suitable to their age, ability and aptitude, their special educational needs if relevant and attend school regularly.

This may be through:

• persistent failure to send children to school or provide a suitable education,
• failure to engage with professionals and act on support to improve,
• Prosecution / legal intervention has failed including parenting orders / At least one court intervention which fails to improve attendance
• Lack of support for education and little improvement over time
• Repeated / chronic / persistent / severe absences, parent or guardian are notified by the school about the issue, and then fail to remedy the situation. Parental passivity.
• The amount of school absences and attendance levels are identified as seriously impeding their development.

Educational neglect in older children and young people can overlap with truancy, and youth crime and exploitation. Parents can sometimes be seen to give up on getting their young person to school as it is too difficult, or they may fear their children’s behaviour around school refusal.

Educational neglect may occur simultaneously or sequentially with other forms of neglect and abuse. One study examined substantiated neglect and abuse investigations and found several examples of educational neglect co-occurring with:

• physical abuse,
• emotional abuse,
• substance abuse,
• child exploitation.

Educational neglect impacts on children and young people in many ways. Poor school attendance is well proven to have an overall impact on educational outcomes and overall life chances. Pupils who do not attend school when school is open (uncoordinated absences) are likely to see a decline in their academic achievement and pupils from low-income households see a larger negative effect from each day of absence.

Attending an educational setting also plays a key link in safeguarding pupils.

• Education is a protective factor; we know children are at more risk of harm and exploitation when they are not in school.
• Nationally there is a clear link between absence from school and crime and disorder.
• Lack of support for education by parents often masks wider vulnerabilities and issues.

Medical neglect can happen when parents do not enable access to appropriate medical care. This may be through:

• Not taking a child to hospital or appropriate medical help for serious illness or injury
• Keeping a child from getting treatment
• Not providing preventative medical or dental care
• Failing to follow medical recommendations for a child

Neglect of the medical needs of a child has been a theme in a number of case reviews locally and nationally:

SCR Hakeem (Birmingham, 2022) : this case relates to the death of a 7-year-old boy with asthma who died from an asthma attack, in the context of chronic childhood neglect and parental substance misuse.

Key learning from this case highlighted that:

 “There was confusion by professionals around significant harm thresholds for neglect where a child has a chronic medical condition that is being poorly managed by a parent.”

 and that “Professionals need to become more aware of the correlation between poor parental management of medication for children with chronic health conditions such as asthma and wider childhood neglect.”

SCR Child LW (Lancashire, 2021) : this case relates to the death of a 17-year-old child with Diabetes Mellitus Type 1, in the context of adolescent neglect and impact of adverse childhood experiences.  Learning from this case is relevant for other adolescents with chronic medical conditions. It also highlighted that:

 “Parental support in situations where an adolescent is dealing with a life-threatening condition is essential”

and that “Was not brought” policies should be in place for all health providers with clear guidance around how to respond and when to contact children social care for additional support where medical neglect is suspected.”

‘Was not brought’ is how we should record children missing medical appointments, rather than ‘did not attend’. This short video shows why this is important - Rethinking 'did not attend'

Clearly recording and tracking missed appointments is essential to helping to identify medical neglect.

Neglect is a prevalent theme in case reviews nationally, even if this is not the main factor of abuse identified in the case (neglect was present in 74% of the 166 reviews carried out between 2017-2019). The key learning from case reviews both in Wiltshire and nationally highlight that professionals from all agencies must be able to:

• Recognise physical and emotional neglect
• Understand the impact of cumulative and long-term effects of neglect
• Take timely action to safeguard children.

Read the NSPCC Thematic summary of learning from case reviews relating to neglect for more information about what case reviews have told us.

Wiltshire SCR Family M highlighted the lack of a local neglect tool available to support professionals in assessing concerns about neglect. The introduction of the GCP2 in Wiltshire was the response to this learning.

Swindon CSPR Bella and Ben identified that “Professionals in universal and some specialist services are not routinely identifying and responding to the early signs of neglect, recognising parents seeking help and the need for early help support to stop neglect becoming pervasive.”

 A summary of the learning from this review can be found in  Practice briefing Bella and Ben

SVPP have recorded a webinar which focuses on learning from local case reviews where Neglect has been a feature, and introduces the Wiltshire Neglect Framework. This recording can be access via Virtual College, please see our Learning Hub - Booking Training Page for links to login or register on Virtual College.

Having one of the signs listed below does not necessarily mean a child is being neglected. But if you notice multiple signs that are persistent, this may indicate a child is at risk of harm. Children and young people who are neglected might have:

Poor Appearance and Hygiene

• being concerningly odorous or dirty
• being hungry or not given money for food
• having unwashed clothes
• having the wrong clothing, such as no warm clothes in winter
• having frequent and untreated nappy rash in infants.

Health and Development Problems

• anaemia
• body issues, such as poor muscle tone or prominent joints
• medical or dental issues
• missed medical appointments, such as for vaccinations
• not given the correct medicines
• poor language or social skills
• regular illness or infections
• repeated accidental injuries, often caused by lack of supervision
• skin issues, such as sores, rashes, flea bites, scabies or ringworm
• thin or swollen tummy
• tiredness
• untreated injuries
• weight or growth issues/ failing to meet their expected developmental milestones

Housing and Family Issues

• living in an unsuitable home environment, such as having no heating
• being left alone for a long time
• taking on the role of carer for other family members

Change in Behaviour

• becoming clingy
• becoming aggressive
• being withdrawn, depressed or anxious
• changes in eating habits
• displaying obsessive behaviour
• finding it hard to concentrate or take part in activities
• missing school
• showing signs of self-harm
• using drugs or alcohol

Neglect is also Child Abuse: Know All About It | NSPCC

Also consider parental risk factors – such as non-engagement with services, domestic violence or abuse, substance misuse, mental health needs, or learning disability.

The final analysis of case reviews report identified the following practice issues NSPCC learning-for-the-future-final-analysis-serious-case-reviews-2017-2019-caspar-briefing.pdf).

• Evidence of professional’s normalisation of neglect and struggling to identify long term neglect – this meant children were living with neglect for a long period of time
• Professionals not wanting to further stigmatise parents by identifying neglect where a family is experiencing severe poverty
• Unwillingness to challenge parents perceived as ‘difficult to work with’ for fear of alienating them
• Professional optimism (wanting to think parents are doing the best job possible to keep professional relationship/communication) can contribute to an unwillingness to name neglect
• Information exchange – inadequate information sharing leads to no coherent overview of daily lived experience of the child and level of neglect being experienced
• Dealing with difference – gaps in the cultural competence of practitioners
• Patterns of disengagement and withdrawal from services – children being ‘hidden in plain sight’ exacerbated by a lack of professional challenge to parental accounts

Neglect may have been occurring for a while before the impact of this is seen in a child, which is why responding to early signs or early concerns about neglect is critical.

Neglect can also be harder to detect if:

• English is not the first language of the child, young person or their parents or carers;
• The child is educated through Elective Home Education or is missing out on education
• The child or young person has complex needs, autism or a disability.

When a child has a learning disability or other complex needs the professionals can sometimes over empathise with the parent resulting in neglect of the child going undetected. A recent local CSPR also found that:

“There is a tendency that professionals attribute developmental delay as an inevitable part of a child’s disability, rather than either caused by, or exacerbated by neglect and poor parenting. This leads to a response, which focusses on the child and their need for services to bring about improvements, rather than focusses on parenting, positive attachments the child’s environment and the parents need for support.” (CSPR Bella and Ben)

More information about safeguarding children with disabilities can be found here:

Safeguarding children with disabilities - learning from a local case review

Safeguarding deaf and disabled children | NSPCC Learning

The Graded Care Profile 2 (GCP2) Tool is used by professionals in Wiltshire to identify and assess levels of neglect. It is an NSPCC evidence-based tool and is used on license by over 85 local authority areas nationally.

Professionals MUST attend the one-day course to have access to and use the tool. You can apply for a course using the following link Wiltshire Safeguarding Vulnerable People Partnership (SVPP) - Courses (wiltshiresvpp.org.uk)

The GCP2 helps:

• measure the quality of care being given to a child
• spot anything that is putting a child at risk of harm
• support the engagement of parents by identifying strengths and needs and helps to target key areas to work on
• understand parent’s capacity to change

Research has found that the tool helps professionals communicate concerns to families to bring about positive change: Reflections from interviews with parents assessed with the Graded Care Profile 2 | Research in Practice. The tool can be most effective when used as part of early support and a Wiltshire audit identified the following benefits from use of the tool with families:

• Enabling constructive discussion with parents, including a focus on strengths
• Child focused - helped parents see the impact on the child
• The tool helped identify strengths and weaknesses and therefore target support and services better

The Graded Care Profile is a useful tool for facilitating discussions with parent/carers about their child’s welfare and their living conditions. it should be used alongside the parent and with other relevant professionals so that the family have holistic joined up support.

The tool looks at the following areas and sub areas and a grade is placed against each area, using the descriptors provided to help:

Physical care: nutrition; housing; clothing; hygiene; health

Safety: in parents’ presence; when parent is absent

Emotional care: responsiveness; mutual engagement

Developmental care: interactive stimulation; approval; disapproval; acceptance;

1. Always met: All the child’s needs are always met, and the parent goes the extra mile. The child is always first.

2. Met: All essential needs are always met. The child is priority.

3. Met most of the time: Most of the time the essential needs of the child are met. The child and the carer are at par.

4. Not met most of the time: Most of the time the essential needs of the child are not met. Child is considered second.

5. Never met: The child’s essential needs are not met. May be due to intentional disregard. The child is last or not considered.

Comments from Wiltshire practitioners who have used the tool include:

“Using the assessment helped identify the family’s strengths and weaknesses, which in turn help to identify which other professionals needed to be involved in the case to meet the needs of the family.”

“GCP2 was used to help evidence the concerns around neglect, this appears have helped inform a MASH referral that has resulted in the child being made subject to a CIN plan, although the neglect is part of a wider issue.” 

“… one of the positives of completing the GCP2 with both of the families concerned was that the conversations with both mothers led to a recognition in the mothers about their own poor mental health and subsequent accepting of referral on for mental health support...”

GCP2 – Antenatal (GCP2 -A)

The NSPCC has developed a GCP2-Antenatal (GCP2-A) tool which is currently in the testing phase. This is a practical tool which measures the quality of consideration (awareness and practice) given to the developing baby in the antenatal and early postnatal period.

The tool comprises of three sections: Section 1: Early in the pregnancy – reflect on planning for or becoming/aware of pregnancy & now or when concerns arise; Section 2: During pregnancy; and Section 3 - First 7-10 days. The tool is designed to aid the identification of issues early in pregnancy to allow the implementation of suitable support packages so that long term impacts are mitigated, risks managed, and babies, infants and children can achieve their full potential. The tool is aimed at midwives, health support staff, early help staff and Social Workers. This tool should be available in 2023.

For more information visit Graded Care Profile 2 (GCP2) | NSPCC Learning

It is critical that signs, even early signs, of neglect are not ignored. We need to move away from using terms such as ‘low-level neglect ‘– neglect is neglect and needs to be responded to, whenever it is identified or suspected.

Work in a relationship-based way building trusting relationships with families

Focus on strengths not just on weaknesses or areas of concern – most parents will be doing something well, however small, and we need to identify theses and build on them when addressing concerns in other areas.

Take a restorative approach – provide high challenge with high support

Use assessment tools such as the GCP2– this is a useful tool for facilitating discussions with parent/ carers about their child’s welfare and their living conditions. It should be used alongside the parent and with other relevant professionals so that the family have holistic joined up support.

Voice of the child - keeping them at the heart of your practice and decision making:  make sure you are considering what is the daily life of the child like? What is their lived experience? What are they telling you about their life? How to have difficult conversations with children | NSPCC Learning

Be clear and detailed in your recording of what you are observing; for example rather than saying ‘the house was dirty’ describe what you have observed it in detail so that it is clear what that means.

Challenge parental accounts – do not just rely on what they are telling you

Work with both parents, including fathers – as a system we tend to work with mothers and have lower expectations of fathers. Fathers are often less well assessed and involved by practitioners. This means we do not know enough about them to understand how they can support the mother but also whether they present a risk to the child.

Share and seek information so that a coherent picture of a child’s life can be developed

Be curious in your practice – ask the ‘second question’

Use supervision to discuss your concerns

Use a chronology to record contacts; this will help inform decision, supports the analysis of impact and helps identify patterns of neglect: Completing social work chronologies: Practice Tool (2022) | Research in Practice

Safeguarding under 1s – babies under 1 are our most vulnerable group, locally and nationally. It is important that we can spots the signs that a parent is not meeting the needs of the child or is a risk to them.  This tool can help identify vulnerability and protective factors: Vulnerability and Protective Factors in Pregnancy to Early Parenthood

Over 30% of children in England live in poverty and deep poverty has increased in the last 5 years (Professor Paul Bywaters, 2022). Being poor does not necessarily mean that a child is being neglected and using a tool to help identify areas of strength and areas of concern can help practitioners understand whether the needs of a child are being met, target the areas of concern, and signpost a family to further support.

However research shows a link between poverty and child abuse and neglect; and that poverty and inequality are key drivers of harm to children and can increase the likelihood of domestic abuse, poor mental health, and substance misuse, all of which present a risk to children.

To understand more about this go to:  The relationship between poverty and child abuse and neglect: new evidence - Nuffield Foundation

Neglect in affluent families – although we might not think about neglect in relation to wealthy families it may present itself in the following ways:

• Emotional neglect
• Supervisory neglect
• Educational neglect
• Sexual abuse
• Sexual exploitation
• Technology assisted harmful sexual behaviours

Professionals can find it harder to work with these families, who may be quite powerful, well-educated, and resistant to accepting concerns raised. Using an evidence-based tool can help as it can highlight the areas of concern and reinforce what is working well. The following attributes have been identified through research as the most important in raising neglect concerns with affluent families:

• being confident as a practitioner;
• being experienced;
• having good understanding of all areas of neglect - including emotional neglect;
• having access to good supervision and supportive management.

To find out more: An Exploration of How Social Workers Engage Neglectful Parents from Affluent Backgrounds in the Child Protection System | www.basw.co.uk

Neglect and other forms of abuse often co-exist.

Child neglect and its relationship to other forms of harm - responding effectively to children’s needs: Evidence Scopes | Research in Practice – this set of resource explores the links between neglect and CSE; neglect and intrafamilial sexual abuse, and working with harmful sexual behaviour

When working with adults we talk about self-neglect. The Care Act 2014 describes self-neglect as ‘a wide range of behaviour, neglecting to care for one’s personal hygiene, health or surroundings and includes behaviour such as hoarding.’

Types of Self-Neglect are:

A lack of self-care, examples of which are:

Poor hydration and diet, having little fresh food.

• Not actively seeking medical attention when needed.
• Not maintaining personal hygiene e.g. showering, cleaning teeth or washing clothes.
• Extreme distress or feeling ashamed / overwhelmed due to their self-neglect.
• Extensive debts due to not managing money.

A lack of care of environment:

• Not having a cleaning routine resulting in extreme uncleanliness, such as removing rubbish
• Infestations of vermin or insects due to a lack of routines
• Neglect of household maintenance, creating hazards e.g. structurally unsound flooring.
• Obsessive hoarding of objects or pets or both

Refusal of Services (that would alleviate the above)

• Not agreeing to any treatment or care relating to medical, household or personal hygiene needs.
• Person now requires treatment for preventable conditions.
• Aids or adaptions are refused.

Wiltshire has developed Self neglect Guidance and an accompanying Hoarding Protocol.

If you are worried about an adult or if you have concerns about a vulnerable adult, please contact the adult Multi Agency Safeguarding Hub (MASH)

Telephone: 0300 456 0111

Monday to Thursday 08:30 - 17:20 or Friday 08:30 - 16:20

Email: adviceandcontact@wiltshire.gov.uk 

Five to thrive: Five to Thrive is a trauma informed approach and will help you working a way that supports secure attachment; building healthy relationships which are essential to wellbeing

FACT - Five to Thrive: Attachment, Trauma and Resilience Training - Wiltshire Council

Training - in addition to training within your own organisation you can access the following multi-agency training

GCP2 Training – this course will enable you to have access to and use the GCP2 assessment tool

Neglect – multi-agency course for any practitioner working with children and families

Wiltshire Safeguarding Vulnerable People Partnership (SVPP) - Courses (wiltshiresvpp.org.uk)

The Department for education has produced a range a of resources that can be used to support training within your organisation: Training resources on childhood neglect: handouts - GOV.UK (www.gov.uk)

ACEs: https://www.eif.org.uk/files/pdf/aces-building-consensus-on-what-should-happen-next.pdf

Listen to the NSPCC podcast to find out about Recognising and responding to child neglect

SVPP have recorded a webinar which focuses on learning from local case reviews where Neglect has been a feature. This recording can be access via Virtual College, please see our Learning Hub - Booking Training Page for links to login or register on Virtual College.