Safeguarding is Everyones Business ISLE OF MAN SAFEGUARDING
Safeguarding is Everyone’s Business ISLE OF MAN SAFEGUARDING FORUM Thursday 21 st September 2017 Sefton Hotel, Douglas
WELCOME
PROGRAMME FOR THE DAY 1. Welcome 1. Opening remarks: Minister for Home Affairs, Mr Malarkey MHK 2. SCB/SAP Update/Safeguarding Bill: Paul Burnett, Independent Chair 3. Self-Neglect: Cath Erine 4. Neglect: Professor Antonia Bifulco 5. Open Forum 6. Workshop Sessions 7. Evaluation and Feedback
Minister for Home Affairs Mr Malarkey
Paul Burnett Independent Chair Safeguarding Children Board (SCB) and Safeguarding Adults Partnership (SAP)
Presentation outline 1. Annual Report 2016/17 2. Safeguarding Bill 3. Jersey Inquiry and Social Affairs Policy and Review Committee Inquiry
Safeguarding Board Effectiveness SCB AND SAP ANNUAL REPORT 2016/17
SCB/SAP KEY STRATEGIC PRIORITIES • Safeguarding is Everyone’s Business • Children, Young People and Adults are safe through effective policies, procedures and practice • Areas of safeguarding risk are addressed • The workforce is ‘fit for purpose’ • The voice of service users is heard and acted on
SAFEGUARDING BILL
Safeguarding Bill Context q Programme for Government 2016 -2021: aim for a society that is both inclusive and caring. q Under theme ‘Healthy and Safe Island’ a key outcome is to have improved the quality of life for children, young people and families at risk. q COMIN agreed one key action to support these intentions was to place the SCB and SAP on a statutory footing through the introduction of a Safeguarding Act
Process q Internal consultation: June/July q Public consultation: 22 August – 3 October 2017 q First reading: October 2017 q Second Reading, Clauses Stage, Third Reading and Legislative Council q Submission for Royal Assent It is anticipated that implementation would take place between April and July 2018.
3 Key Headlines Creation of: q A single statutory Safeguarding Board broadly covering the current work of SCB and SAP q Statutory Duty for those working with children and vulnerable adults to ‘consciously consider the need to safeguard children and vulnerable adults’ when carrying out their work q A duty for partners to co-operate with each other when carrying out safeguarding functions
Relevant Safeguarding Bodies q Department of Education and Children q Department of Health and Social Care q Department of Home Affairs q Department of Infrastructure q Isle of Man Constabulary q Other persons providing services to children or vulnerable adults q Such other persons as may be prescribed
Definitions q Child – any person under the age of 18 q Vulnerable Adult – Has attained the age of 18 – Is in need of care and protection; and – Satisfies a number of conditions in subsection 2 of the Bill
The Board q Statutory Body q Independent Chair appointed by Chief Secretary q Member of the Board – CEOs for DEC, DHSC, DHA – Director of Public Health – Chief Constable – 2 independent members
Board Objectives q To co-ordinate the work done by relevant bodies for the purpose of safeguarding and promoting the welfare of children and safeguarding and protecting vulnerable adults; and q To ensure the effectiveness of work done by each of those authorities for those purposes
Board Functions q Safeguarding policies and procedures q Promoting safeguarding awareness q Reviewing effectiveness relevant bodies safeguarding arrangements q Identifying lessons learned from SCRs/SARs and other case reviews and action to be taken as a result q Promoting communication – including information sharing and data protection – and consultation
Committees and Sub-Committees q Child Death Overview Panel q Case Management Review Panel q Safeguarding Panel q Any other committees it deems to be required
Other matters q Board must present an Annual Report at the end of each financial year and lay before Tynwald q Requests for information by the Board related to their business must be complied with q Duty to co-operate – both between the Board and relevant bodies and vice versa q Duty to safeguard q Regulations to be issued in support of the Act
QUESTIONS
: Launch of the Isle of Man Self Neglect Policy and Procedures Keynote Speaker: Cath Erine
Self Neglect – Isle of Man adopts its multi agency policy Cath Erine
Take a bow! • The Isle of Man has developed a multi agency policy and supported this with multi agency training, despite having no legal requirement to do so • A number of multi agency events have been held over the last 15 months to engage all partners in the development of the policy • Training was provided earlier this year to “test drive the policy and organisational commitment to its implementation. • The conference today is the formal launch of the policy. • Why is it important?
Why is it important? Impact on Adults Impact of workers Denial Guilt Feeling judged Helplessness doubt Self Loss of family, friends, home, status Stress Anger Embarrassment Worthlessness Illness Isolation Sense of failure Helplessness Distress Fear Shock Negative impact on physical and/or mental health Loss of Self esteem “In control” but with negative costs Leaving the profession or team Financial costs Anger Feeling special, the “one” Isolation Denial
Key messages from the research completed by Sussex university for SCIE and the Do. H • Understanding the causation? Links with Physical Health Mental Health issues Impaired physical functioning Depression Pain Impaired cognitive functioning Nutritional Anxiety or Substance Misuse Psycho-social factors Alcohol Limited or non existent social networks (impact of limited resources) Other drugs Poor experience – prescribed of/or access to health and /or or not social care Traumatic
Understanding the lived experience of self neglect Negative Self Image – demotivation I got it into my head that I’m unimportant, so it doesn’t matter what I look or smell like I wouldn’t say I let my standards slip – I didn’t have any. Never had Different Standards – indifference to social appearance I’m drinking, but not washing or eating. I’m not losing the will to live – that’s too strong but I just don’t care what I’ve always people think neglected my own feelings, I didn’t address them. I thought that “my feelings don’t come into it” Inability to Care It makes me tired, daily routines are exhausting even doing the simple things like getting washed or finding clean clothes
The lived experience of self neglect – on the adult’s home environment Influence of the past – childhood, loss The only way I kept toys after xmas was by hiding them When I was a little boy, the war had just started, everything had a value to me – it still has value or potential use now Positive value of hoarding – sense of connection I want things that belonged to people so that they have a connection to me I don’t have time to make a note of everything in the paper I’m interested in so I’m very fearful of throwing anything away in case I lose something important Beyond control – obsessions The distress of not collecting is much greater than the distress of doing it!
Organisational context ü Eligibility Criteria ü Care Management models ü Discharged – non engagement ü Performance management ü Thresholds that limit or preventative work ü Time limited interventions ü Charging policies ü Increased demand limited resources
Self ADULT’S RELUCTAN CE TO ENGAGE “The combination of neglect – the challenges people who are terrified of losing their independence or of state intervention; combined with a state process that is ORGANISATIO desperate to apply NAL eligibility criteria and PRESSURES find reasons NOT to support people, is just lethal. “Oh – you’re saying it is all fine – thank goodness, we can go away and respect
Robust interagency working Shared strategic Ownership Referra Clarity on roles and l responsibilities pathw ays Strategy into operational reality Training, supervis ion and support Interagency policy and governance Commissio ning Time and space for relations hip based work Forum for shared risk managem ent Case coordinati on and leadership
What does the Isle of Man policy say…. • Is based on the six core principles of the Care Act and the Mental Capacity Act and applies to adults aged 18 plus who have mental capacity to make the decisions causing the concern • Single agency interventions have failed to reduce the risks to the adult • The risk(s) to the adult are likely to result in serious harm or risk to the life of the adult • Must make active attempts to engage the adult to identify measures that will reduce the risk, this may mean discussing with the adult the involvement of an advocate and/or family/friends • Choosing the “best person” to have the initial conversation with the adult, who has maintained a trust
What does a trusting relationship look like? ü Interventions delivered as part of an emotional connection/trust – an ability to challenge the adults without judgement working with them at their own pace (on issues they view as “important” to them – which may not be the priority of the workers/organisations” “He has been human, that the only word I can use – human and on my level” ü Support that fits with the individual’s own perception of need with practical interventions when necessary “When X came along they were hands on – we’ve got to do this…. . shall we start cleaning up now” “She got it into my head that I am important that I am on the earth for a reason” ü Respectful and honest engagement “ He’s down to earth, he doesn’t beat around the bush. If there’s something wrong he will tell you. If something needs sorting he will tell you and support you to do it” “Care-frontational” challenges – not discounting unrealistic options but working with any options that are likely to been acceptable to the adult that are have a high chance of success
Mapping the risks • Putting the adult central to the assessment and if agreed involving family/friends – even if professionals believe that they may be “part of the problem” • Once the risks are identified and some agreement reached about their priority, the adult should be asked to explore the impacts (Current and possible if nothing changes), what are the impact of the adult and workers/agencies not taking opportunities to take risks/make changes? • The adult should be supported to say if they are “Keen to try this”, “may be willing to do this” or “ not willing to do this” • From the keen to and may be willing to try agree the roles and timescales of all involved in managing the risks • This mapping needs to be revisited on a regular basis to evidence change and empower the adult to take additional actions.
Finding the • Case example “Betty” – Former teacher, no family. In social housing refusing to allow people into the house so utilities cut off. Lots of Key…. books/newspapers. Fire risk to neighbours. Eating poorly due to lack of cooker, only shops once a week buying close to end date food. Landlord considering eviction Mobile library highlight of her week, the only person she has meaningful conversation with Self Neglect risk assessment completed – mobile librarian supported to discuss concerns with Betty who agreed she would like to be able to “stretch her brain”. As a result she joined a local book group after being supported to buy some new clothes (second hand shop). The new network boosted her self worth and led to engaging with housing - utilities
Jack – 47, evicted from temporary accommodation for Case example – finding the key (what fighting with another resident, 7 months ago and isis now living rough. Jack hasself a history of alcohol misuse, which causing the neglect? ) commenced after breakup of his marriage – 10 years ago. Jack is a qualified joiner and had his own business, which collapsed 7 years ago. He has two children, but they refuse to see him due to his alcohol misuse. Jack has diabetes , which is poorly managed. He had a stroke affecting his right side – weakness which leaves him vulnerable on the street. He has been admitted to hospital several times in recent weeks with significant injuries. Jack has refused to name the perpetrators. The admissions to A&E have been linked to complications of his diabetes. There are concerns he may lose limbs if he fails to manage his diabetes more effectively. Key intervention – Offer from son to re-engage with his dad and to support contact with grandchild if he addressed his alcohol issues. Jack was detoxed and has remained largely sober and lives in a supported tenancy and is looking to volunteer with ex-offenders developing
Scoring the risks • Does NOT replace professional opinions but support evaluation of the impact of the work completed with the adult/multi agency response • Two elements – Risk to the adult ( 1, 2 or 3) multiplied by Likelihood of the risk (3, 4 or 5). All cases that score 10 or over should be managed within the self neglect policy and commitment given by all agencies to deliver the agreed action plan • If the score is less than 10 BUT we need a multi agency response the policy should be used • ALL cases will be coordinated by the Safeguarding Adults office • The risk management plan and impact should be evaluated regularly at meetings or virtual meetings
Exiting the self neglect journey • The risks are reduced to a level that all parties feel are acceptable • All interventions have been attempted, by a range of workers/agencies and non professionals and no agreement has been reached with the adult to accept any of the interventions (this decision must be taken in a multi agency forum and documented in detail). The adult must be told how they can make contact, should they choose to • The adult dies or is detained under the Mental Health Act Or criminal justice processes.
Any questions? Thanks for your attention
Launch of the Neglect Pathway Keynote Speaker: Professor Antonia Bifulco
Centre for Abuse and Trauma Studies Academic & Applied research in the digital age UNDERSTANDING CHILDHOOD NEGLECT FOR SOCIAL CARE SERVICES Antonia Bifulco Professor of Lifespan Psychology & Social Science Centre for abuse and trauma studies Middlesex University, London a. bifulco@mdx. ac. uk Isle of Man Safeguarding Forum September 2017
Centre for Abuse and Trauma Studies (CATS) www. cats-rp. org. uk • An interdisciplinary research centre, spanning Psychology and Criminology. • Focus on both academic and applied research. • Investigation of abuse and trauma from family, victim and perpetrator perspectives. • Working with psychological, social care and forensic services. • Run assessment trainings for child protection, adoption and residential care.
Aim of session 1. What constitutes neglect 2. Short and long term impacts of neglect 3. Practice implications - multiagency working; early help; resilience 4. Models to aid practice; what works 5. Key messages
Io. M Neglect pathway – issues to be addressed (Policy document Oct 2017) 1. How can the prevalence of neglect be established and tracked to demonstrate the impact of support and intervention? 2. Ensure Neglect training is linked to competency framework, identified, commissioned and delivered to target professional audiences – awareness, signs, symptoms 3. Ensure specific neglect assessment and intervention tool are available and staff trained in them. 18/11/2013`A 1 QA 2 ND 22
Neglect…. and more • Daniel Pelka was a four-year boy from the West Midlands who died in March 2012 from an acute head injury. For at least six months before his death, Daniel suffered from starvation, neglect and physical abuse. A sibling felt compelled to hide food for him while he was being starved by his parents. • Daniel was denied food, force-fed salt, held under the water in a bath until unconscious and regularly beaten. He was also imprisoned in a box-room and died alone in the dark from a head injury. • The mother and stepfather had a long-standing history of domestic violence and substance misuse. • In August 2013, Daniel’s mother and stepfather were 18/11/2013 convicted of murder and sentenced to 30 years in prison.
Service failure… • Police were called to 26 separate incidents at the family home many involving domestic violence and alcohol abuse. • Excuses made by Daniel's "controlling" mother were accepted by agencies. Professionals needed to "think the unthinkable" and act upon what they saw, rather than accept "parental versions" • Daniel's "voice was not heard" because English was not his first language and he lacked confidence. No record of "any conversation" held with Daniel about his home life, his experiences outside school, or of his relationships with his siblings, mother and her partners • There were "committed attempts" by his school and health workers to address his "health and behavioural issues" in the months before his death. But "too many opportunities were missed for more urgent and purposeful interventions" • Two of those chances were when Daniel was taken to an accident and emergency department with injuries – None of the agencies involved could have predicted Daniel's death. 18/11/2013
• What constitutes neglect – Prevalence – Definitions – Severity 2/7/2013 46
Neglect • A persistent failure to meet a child’s basic physical and/or developmental needs. • Includes failing to provide for a child’s health, education, emotional development, nutrition, clothing, shelter, safety and safe living conditions, and includes exclusion of the child from the home and abandonment. Differentiated from poverty. • Neglect is defined developmentally, so indicators can change by age. For unborn child neglect may occur during pregnancy as a result of maternal substance abuse. • Development means physical, intellectual, emotional, social or behavioural development DCSF, 2010, p. 38 18/11/2013
Definition cont. . Neglect includes: • a parent’s or guardian’s failure to provide adequate food, clothing and shelter, • failure to protect a child from physical or emotional harm, or danger • failure to ensure that the child has adequate supervision • failure to ensure the child has access to appropriate medical care and treatment • unresponsiveness to a child’s basic emotional needs 18/11/2013
Prevalence Registrations to child protection registers England 201516 (n=50, 310) % Neglect 46 Emotional abuse 35 Physical abuse 8 Sexual abuse 5 Multiple 6 Neglect most prevalent maltreatment Department for Education (2015) Characteristics of children in need in England, 2014 -15. London: Department for Education (Df. E).
Registrations – comparison previous years 2002 % 2006 % 2015 Neglect 39 43 46 Emotional abuse 17 21 35 Physical abuse 19 16 8 8 5 Sexual abuse 10 Neglect increasing somewhat, whilst Other maltreatment declining Df. ES 2006, 2015
NSPCC report – community lifetime prevalence (2011) Interviews 2, 275 young people aged 11 -17 years and 1, 761 young adults aged 18 -24 years about experiences of neglect or abuse. Maltreatment type Total age 11 11 -17 18 -24 5% (130) 13% (229) 16% (303) Emotional Abuse 4% (74) 7% (116) 7% (131) 1% (34) 7% (119) 8% (159) 7% (188) 21% (358) 23% (436) Maltreatment mixed Sexual abuse All maltreatment 18/11/2013 under age Neglect Physical violence Neglect also most common maltreatment reported in community, not accessing services Total 0. 1% (2) 9% (229) 0. 1% (2) 22% (379) 25% (465)
Assessing neglect • Practice requirements • Research approaches
Assessment Framework (2000) ED S A map of relevant data to be collected PM EL O EV D’ SD CH IL TY CI PA Selfcare Skills Stimulation CA Social Presentation CHILD Safeguarding && promoting welfare G Family & Social Relationships Emotional Warmth IN EN NT Identity Ensuring Safety RE TA L PA Education Emotional & Behavioural Development Basic Care NE Health Guidance & Boundaries Stability FAMILY & ENVIRONMENTAL FACTORS ily Fam y tor His g ily onin Fam uncti &F der Wi ng usi Ho nt me y plo e om Em Inc l cia So ly’s ion mi rat Fa nteg I ity un mm es Co sourc Re
Neglect signs • Appearance – smelly, dirty, not properly clothed, hungry • Health – no treatment illness, injury, poor dental care • Housing and family – unsuitable housing, left alone unsupervised, taking on carer role • Behaviour – withdrawn, change behaviour, anxious, clinging, depressed, self harm, eating problems, wets bed, self harm, aggressive, nightmares.
Research-based assessment: The Childhood Experience of Care and Abuse (CECA) measure www. cecainterview. com Used extensively in research internationally A version for social workers includes definitions, indicators and Ratings of severity with clear examples The instrument has a factual and investigative orientation. High reliability and validity. Experiences recorded chronologically and a calendar and summary report produced.
CECA Neglect Material neglect and indifference shown by parents and carers to child in relation to: • material care (being fed, clothed) • regular household routines • health & hygiene & medical care • socialisation & friendships, • school work, career options • emotional needs & support These combined in a single score. Severity determined by pervasiveness of neglect and number of areas of neglect Rated: 1. Marked ] Severe 2. Moderate ] Severe 3. Mild 4. Little/none Scored • For each different parent figure • For changes in severity over time
CECA Neglect – marked historical maltreatment Quote: We were basically neglected. We had to steal food from shops because we were hungry and had no money. Mum left us alone in the evening, then she would roll in drunk. It was very rare we had new clothes, the neighbours might give us some. Mum never remembered my birthday or gave me a card or present. I knew I could never go to her if I was in trouble. No one made us breakfast – you did it yourself if there was food there. Sometimes we ‘d oversleep and it was too late to have breakfast…We bathed ourselves, with two of us in the bath. Mum never washed our clothes, we took them down to the launderette. She used to keep me off school Friday to do the washing. Context – mother’s alcohol abuse; discordant parental relationship; father often absent; lived off benefits. Bifulco & Moran 1998: Wednesday’s Child, Routledge Slide 57 57
Maltreatment scales related to poor care (factor analysis) • Neglect is closely associated with other lack of care and abuse experiences CECA scales Poor care factor Neglect . 80 Antipathy . 63 Role reversal . 58 Physical abuse . 47 Psychological abuse . 36 Sexual abuse . 31
Neglect and disadvantage Social • Disadvantage (. 42) • Parental loss (. 35) • Parental Conflict (. 20) Psychological Loneliness (. 51) Helplessness (. 43) Shame (. 46) Felt inferiority (. 22) Neglect is highly related to social disadvantage, parental relationship and negative ‘internalising’ psychological impacts
Centre for Abuse and Trauma Studies Academic & Applied research in the digital age LONG TERM CONSEQUENCES Biological impacts Psychological impacts
Biological findings • Cortisol – stress hormone HPA) – Early adversity relates to stress habituation and difficulties in behavioural and emotional regulation • Brain – restricted development – Smaller overall brain size (smaller with earlier onset of trauma) – Smaller corpus callosum (CC) – white matter in the brain controls arousal, emotion and higher cognitive abilities. – Smaller hippocampus • Genetics – Maltreatment & MAOA genotype – increased risk for antisocial behaviour. – Poorly regulated neural activity to threat cues with increased aggressive response. • 18/11/2013 Mc. Crory et al 2017
Long term psychological impacts The London studies • Adult women studied over a number of years together with their adolescent offspring • Childhood neglect, physical and sexual abuse studied • Lifetime psychological disorder • Attachment framework used to conceptualise these findings. • Bifulco et al 1998; Brown et al 1990; Bifulco & Moran 2012 29/10/2021 Heidelberg seminar 62
Severity ratings of abuse • The more severe the neglect in childhood, the higher the association with adult depression. % adult depression • Grading experience is important… Severe Severity of neglect in childhood
Adolescents: Neglect or abuse and clinical disorder in 12 months (276 community-based young people aged 16 -25) CECA ‘severe’ experience Odds ratio Clinical disorder P< Neglect 5. 27 . 0001 Antipathy mother 3. 16 . 001 Antipathy father 2. 49 . 01 Physical abuse 5. 03 . 0001 Sexual abuse 7. 88 . 0001 23
Neglect and deliberate self harm - adolescent sample 21% of the high risk offspring exhibited deliberate self-harm – these highly related to presence of emotional or behavioural disorder: • Suicidal ideation/plans/attempts (52%) • Self mutilating (48%): • DSH many times more likely with lack of care experience
Parent maltreating & disorder in adolescents- mothers (Odds-ratios shown) Antipathy From mother Neglect from mother Physical abuse from mother x 4. 16 x 4. 08 x 2. 70 Only mothers maltreatment models depression in offspring Depression in adolescent Antipathy From father x 3. 1 Neglect from father x 2. 1 x 2. 9 Substance Abuse in Adolescent Physical abuse From father Only maltreatment from father models substance abuse
Centre for Abuse and Trauma Studies Academic & Applied research in the digital age RESILIENCE Protective factors are those which are active in the presence of risk factors – to buffer or moderate the impact. 29/10/2021 67
Resilience factors aged 16 -adolescent sample Most young people (80%) had at least one positive factor aged 16 of: Support from friend - 56% Positive peer group - 68% Positive school characteristics - 66% High academic attainment - 51% High felt competence as student - 66% 40% had at time of interview either: • Clearly Secure attachment style - 30% Markedly high self acceptance - 14% Palermo Conference 68 29/10/2021
Positive experience outside the home – self esteem and security Support from friend Self acceptance Secure attachment . 04 . 23 (**) Positive character of peer group . 17 (*) . 19 (*) Positive character of school . 32 (**) . 21 (**) High academic attainment . 08 . 17 (*) ** significant at the 0. 01 level * significant at the 0. 05 level 29/10/2021 Support and school Important correlates of Self esteem and secure attachment style
Positive experience and (absence) case disorder % case disorder p<. 01 p<. 07 p<. 001 p<. 01
Practice implications • Interventions; early help • Assessment; multiagency working • Charting change
Dynamic Risk analysis, Isle of Man model RISK FACTORS IMPACT ON THE CHILD PROTECTIVE FACTORS List actual and/or believed harm Injuries, Developmental delay, failure to thrive, Psychological/behaviour impairment – self harm, fear, distress, absconding, attachment issues Demonstrable protective action – removal from source of harm, compliance with intervention Identify who or what is source of harm Indicate if it is disputed Indicate severity/pattern/ history of harm Complicating factors such as MH/substance misuse/learning disability/domestic abuse Extreme impact = permanent and enduring Serious impact = observable and impairing functioning Concerning impact = immediate, isolated and not persisiting Vulnerability factors- age, disability, awareness of risk Family strength and needs belief of child, responsive carer relationship, empathy, enhanced capacity with support, motivation and competence to protect, care and change Vulnerability factors – family networks, social and community environment, MH/substance use/DA.
Dynamic Risk analysis, Isle of Man model cont… 29/10/2021
Multiagency working • Neglect multi-causation - social deprivation; parental helplessness; emotional disorder; substance use; attachment problems; marital problems
A SYSTEMIC MODEL Social Adversity: Financial; housing; immigration; Legal difficulty; health/disability: Describe: Father’s psychiatric Mother’s psychiatric: Depression, anxiety, substance abuse; psychosis PD: Depression, anxiety, substance abuse; psychosis; PD: Parental discord: rows, tension; threats. Parental violence: physical attacks; hit, beaten. Parental lack of care: antipathy, neglect, lax supervision; role reversal, Bifulco, Middlesex 75 University Incompetent parenting role: problem interaction; incompetence; hostile; helpless; lack of insight; Parental abuse physical, psychological, Sexual abuse;
Interventions - issues • Neglect often chronic – so no quick fix. – Long term input needed; relationship with service 3 s offering an alternative model of relating • Multifaceted interventions – individual child, family, social systems. Combination of interventions including parenting and mental health, social support and housing. • Early and late: – Intervention at early ages needed, but also to include teenage years. Developmental stage important • Consider protective factors – – supportive relationships, school. • Involve fathers and mothers and wider kin where relevant. – Attachment focus • Moran, 2010, Neglect: Action for Children
Interventions re Neglect – Care: Parenting training; Ensure care improved either through parent behaviour or another responsible adult – Self-esteem: School-based initiatives; therapeutic intervention Enhance self-esteem through specific intervention, or school or leisure activity success and positive feedback Improve peer group relating – encourage friendships (school based initiatives) – Reduce child’s self-blame, over responsibility: therapeutic; school-based; social network - reduce role reversal/young carer activity, but avoid destroying the child’s sense of being needed and altruistic concern – Family interventions – parental attachment, marital discord – family therapy etc
Need for good assessment • Evidence-based tools and models for consistency and transparency. • Information recorded in standardised and accessible ways, both narrative and numeric. • Clarity over definitions and thresholds of ‘significant harm’ around neglect/abuse, for multiagency professionals. RISK FACTORS IMPACT ON THE CHILD PROTECTIVE FACTORS List actual and/or believed harm Injuries, Developmental delay, failure to thrive, Psychological/ behaviour impairment – Demonstrable protective action – removal from source of harm, compliance
Research-based assessments for practitioners – CATS team Training package Service Profession Short courses Attachment style Adoption/Fostering Interview (ASI) Perinatal services Social work; Psychologists CAMHS 4 -day & licensing Adolescent Residential care attachment style Clinical services (ASI-AD) Forensic services Care workers; social workers; CAMHS psychologists 4 -day Childhood Experience of Care and Abuse (CECA) Safeguarding services; Family support Forensic services Social workers Clinical Psychologists Forensic psychologists 1 -day courses (Care: Neglect; antipathy; psychological abuse; role reversal etc) Parenting Role Interview (PRI) Family Support; Social workers, psychologists 2 -day www. attachmentstyleinterview. com; www. parentingroleinterview. com www. cecainterview. com
Using research-based assessments to aid in Safeguarding • CECA – assess risk experience The ‘Case Record’ version of the CECA uses existing case material utilises and applies the definitions and scoring procedure to determine type and severity of maltreatment, relationship to perpetrator and timing. It enables a chronology to be determined. Parenting Role interview – future capacity • The parent’s perception of their parenting - positive and negative • The practitioner estimate of the parents competence • The overall rating identifies parenting level. • It can be repeated to monitor change • Child difficul ties 1. Difficulty 18/11/2013 2. Interaction • Negative • Positive • Competence • Incompetence Felt vs Facts • Insight 3. Competence 4. Overall parenting • Good/ mixed/ poor
Case study A: CECA in CP from parents suspected services • • Neglect Parents both class A drug abusers and were not compliant with efforts to stop drug use. • The issue was whether the parental neglect was severe enough to consider accommodating the child. Signs in child involved- language delay, lack 5 year old boy – on of socialisation with other children, lack of Child Protection stimulation, play behaviour register since aged 3 • Previous court contact recommended family support and monitoring. CECA: Neglect scores showed 2 -‘moderate’ level over the past two years - Mother did not take him to school consistently, and this meant not only that he got behind with school work, - he was not getting the additional speech therapy he needed; - evidence that they left the child unattended when the parents were drugtaking. - Lack of stimulation for child no play, toys etc. However, no evidence of parental antipathy (hostility, criticism, rejection) and parents affectionate to child. CASE OUTCOME: A decision was made for kinship care with grandparents having 81 responsibility and the case moved to the Looked After team.
CASE B –monitoring neglect • Young couple in their mid 20 s with 16 month old son. • Following a phone call from neighbours’ about smell and dirt in house, police and social services went round. The flat was found to be in a serious state – dirty, unsanitary, only use of one room due to bedroom being too messy to use, grease and dirt in kitchen and a cat and dog who messed in the flat. Bathroom door smashed in (said to be during a party). The child was naked on the floor, he slept in a cot in the sitting room with parents, few toys. No fresh food in the house, cigarette stubs everywhere etc. • Rated 2 -moderate neglect on CECA. • Maternal Mental health: Mother suffers from depression, but won’t take medication. Has an issue with her weight and is overweight. Has lost 2 stone in 2 months which she is pleased about, but implication is that she isn’t eating. • Marital relationship seems ok • Child taken away and sent to grandparents on a Child Protection Plan for Neglect. 18/11/2013
Change over 5 months with support Review in April when parents had cleaned up substantially. Parents had signed an agreement to have place clean by 11 th January. By June house better still in better shape but other issues to be resolved: Got rid of cat and dog, but have taken on a kitten. CECA 2 -moderate 3 some neglect • Improvements in state of hygiene of the flat – clean and tidy. • Mother has been going to mother-baby group. (However stopped this week after an incident when her son knocked over a hot drink – she was upset and thought it dangerous and they shouldn’t go back). • Mother had signed up to cookery classes, goes intermittently. • Agreed to go to parenting class, some reluctance because thinks she is a good parent. • Has visited GP with minor complaints Child returned to parents and taken off the plan. 18/11/2013
CECA case B – hidden psychological abuse ‘ 2 -Moderately’ severe Antipathy: • - mother critical, tells teachers and others that child is bad and naughty and bound to fail. • She is observed shouting at him at school and by neighbours. • 2 -‘Moderately’ severe Psychological abuse: • child forced to be rude & swear at religious leaders against his will. Child age 8 • Child overhears mother tell SWs that if he is Mother (foster carer – taken away she will die. arranged in Pakistan) • Mother made child promise to take revenge on has psychosis – her enemies (incl professionals). observed being hostile to • Told him to speak Urdu instead of English at child at school. Child dressed • Tells him his carers (in Pakistan) do not love inappropriately; late him. picked up; anaemic, poor diet. 1 -Marked neglect rated
Case C Parenting improvement over lifetime – historical concerns • Couple in their 40 s; New baby and new partnership; her previous children taken away (5 years ago, aged 13 and 15) due to neglect - her drinking and ex-partner’s violence and substance abuse. Previously no insight into her parenting - neglect • The relationship with the new partner was judged to be close. He is in work, and although they have rent arrears they are managing and are attempting to move away from the sink estate. • Issues: • (i) The mother herself has little social contact, only been to children’s centre a few times and although she takes the baby out for walks this is not for social contact. • (ii) A court case re higher contact with her teenage children, including allowing them to stay overnight. Assessment issues concerned her parenting capacity, and her emotional stability, and likelihood of staying off alcohol. The court case ruled in her favour
Case C Parenting Role Interview – Good parenting • • • No difficulties with 6 month old baby; Positive interaction rated ‘ 1 marked’: reflected her good interaction with the baby. She described herself as an entertainer for the child and interacted well with her older children. She was probably more affectionate and closer to daughter, son more aloof. In anticipation of them coming to the home more often she had done up their bedrooms with play stations etc for them and reported looking forward to their visits. More patient now, more aware of tension in household. Negative interaction – 3 some, occasional bickering with teenage children. Competence 2 - moderate: The baby now into a routine and sleeps through the night and she is very responsive with the baby. She gives the older two as much time and affection as they need. They all eat together. The teenage children have a very good relationship with the baby and her partner makes positive comments about her parenting. Incompetence 3 -some – around lack of socialising with other mother-babies due to her lack of confidence. Good insight into parenting – tendency to be rather self-critical. Overall good parenting 4. Overall 2. Interaction parenting • Child • Competence • Negative • Good/ difficul • Positive mixed/ • Incompetence Felt vs Facts poor ties 1. Difficulty • Insight 3. Competence
Key messages • Neglect is complex due to – associated harms (abuse) and its chronicity – associated risks (family and neighbourhood) • It has long term psychological and social impacts. Protective factors can lessen these. • Important to assess all information as accurately as possible and monitor change. • Interventions help, but multiagency working needed to cover all aspects. • Neglect can be overcome! 18/11/2013
“THANK YOU FOR YOUR ATTENTION” Questions? | 88
OPEN FORUM
QUESTIONS
THANKYOU
- Slides: 91