Serious Case Review (SCR) analysis 2020 for the education sector: Neglect
Neglect was found to be a feature in three-quarters of all SCRs considered. It is therefore important for education professionals to understand this learning and how to respond to protect children from the harmful effects of neglect.
Focus on: Poverty blindness
Research has found that professionals who work with children and families sometimes normalise and become ‘blind’ to poverty in their assessment of risk and need for support. Poverty is often seen as an outcome or co-existing factor rather than a potential cause of a family’s difficulties.
Poverty blindness may occur where professionals are working in areas of high deprivation and so poverty becomes the norm and an associated desensitisation to warning signs of poor hygiene, dirty clothes and poor dental hygiene.
For those working in education, and particularly in areas of high deprivation, consideration should be given to how to ensure that lower standards of child care and living conditions are not accepted.
Neglect is consistently the most common initial category of abuse for children on a child protection plan, and the number of children on such plans for neglect has been rising in recent years from 41.8 per cent in 2013 to 48 per cent in 2018.
What is notable throughout this analysis, is the complexity of family circumstances and cumulative nature of harm through neglect.
It is well understood that neglectful parenting is almost inevitably a sign of complex and longstanding problems, such as parental mental health and domestic abuse.
This presents a challenge for educational professionals to keep a wide view of the challenges a family may be facing and the impact on the child, asking questions to explore all of the factors.
There is evidence from a range of studies that suggests a strong link between the socio-economic circumstances of the family and the likelihood of a child experiencing abuse and neglect.
Case example: Poverty blindness
Cara was a two-year-old White British girl who died from ingesting 20ml of her mother’s methadone. She was born the youngest of five children to a mother struggling with long-term drug addiction and domestic abuse. On admittance to hospital she was found to be suffering from neonatal abstinence syndrome. The family had a long history of contact with adult and children’s services; all the children had some degree of developmental needs.
Concerns over poverty and the state of the home had been identified some five years prior to the birth of Cara. At one point the family were living with no furniture or carpets, all the children shared a single bed and there was very little food in the house. On other occasions the younger children failed to attend nursery because of unpaid fees. There were times when Cara’s mother borrowed money from relatives to buy food or depended on charities to supply food parcels.
The primary focus for agencies was to improve the physical conditions of the home and to ensure that the parents continued to attend their drug treatment programme. The parents sometimes struggled to manage their finances. The lack of assessment of the ways in which poverty affected the children, resulted in short-term bursts of activity to clean up the home or provide cash or food for the children. Signs of improvement resulted in the case being closed to children’s social care. The underlying causes of the family’s poverty and its relationship with parental drug addiction were not explored. Perhaps most significant was the lack of any exploration of the children’s experiences and how poverty impacted on their safety, health and overall development.
Early help assessment, intervention and monitoring
The use of early-help assessments by practitioners that work with children and families are a helpful tool for understanding risk and prompting early protective and supportive action. Schools and education professionals are well-positioned to initiate and coordinate this process.
As evidenced through several cases analysed in this review, early assessment and intervention is not always taken early enough.
This is compounded where incidents are seen in isolation and not considered or tracked effectively as part of a pattern of concern.
Lack of professional curiosity can also extend to adolescents showing challenging behaviour or involved in anti-social behaviour or crime, where their actions are not considered in the context of their experience of neglect.
A common feature in the cases of neglect analysed is a so-called ‘spiralling-risk’ – a period of low-level concerns followed by a sudden escalation of risk. A thorough chronology of all historic concerns and incidents, reviewed and monitored regularly, can help to identify cumulating risk and prompt early intervention.
Early help assessments also present an opportunity to create a shared chronology across agencies and thus prevent ‘fractured perspectives’ of different professionals holding information in isolation.
Case example: Spiralling risk
In one SCR of neglect, the reviewers concluded that:
- The use of a chronology identifying missed appointments and untruths should have formed part of the historical information available to professionals working with the family so they could triangulate such information and at least catalogue the extent and nature of the ‘non-compliance’. Whilst this historical information should not determine current thinking, it should have significant impact on decision-making.
- The overview reviewers found there was a tendency to focus on ‘the concern of the moment’ rather than seeing the whole picture. There was an inadequate use of chronologies which, had they been used, may have aided in an earlier identification of problems in this case.
Voice of the child
Empowering children to express their views and talk about their experiences is central to effective safeguarding practice, however, it is something that is all-too-often missing in cases that result in a SCR. Those in schools, both teachers and support staff, have daily contact with children and so are well placed to notice concerning changes and recognise the voice of the child.
Even when a child’s disclosure is responded to, triggering child protection action, their emotional and developmental needs can be overlooked in providing support.
Adolescents may be especially vulnerable to the effects of neglect on their mental health, behaviour and vulnerability to exploitation with a correlation seen in self-harm and suicide.
Whilst listening to the views of children and young people is essential, the child’s wishes must be balanced with the responsibility to ensure their welfare and safety.
Any assessment of a child’s competency to make decisions should be based on a full understanding of their life experiences and vulnerabilities.
Case example: Voice of the adolescent
One example of neglect and subsequent suicide included in the reviews is that of an adolescent who took a fatal dose of opiates aged 15 years. Born with serious narcotic withdrawal symptoms into a family with a long history of substance misuse, sex work, alcohol-fuelled violence and domestic abuse, the harmful influence of the family shaped this child’s life. Signs of distress and self-harm were first identified by a schoolteacher when the child was 12 years old. When asked about the cuts on her arms the teacher reported being told ‘when I am feeling this pain, I am not feeling anything else’.
Examples of self-harm escalated to the extent that prior to the fatal overdose, 32 episodes had been recorded. Although all the professionals working with this child were aware of her extreme vulnerability, there was little recorded of what life was like for her or her perspective, views and wishes, in the SCR.
In this particular case, if the incidents of self-harming had been managed as safeguarding concerns, there is greater likelihood that the police and children’s services along with other professionals would have engaged in a strategy meeting that focused on the nature of risk and supported a much clearer sharing of information.
Wider family and community support
A child’s wider family and community can be a valuable source of support and intervention, and perhaps especially so in cases of neglect where its longstanding nature may take greater resources to combat. Schools may be both a key resource themselves, and a point of expertise and coordination of support networks available in the community. However, all-too-often, these opportunities are ignored or downplayed by professionals.
The invisibility of men in parental roles and the issue of absent fathers persists in the sample of cases analysed here.
Professionals can overlook gaining an understanding of the risks (and potential strengths and protective factors) posed by men in a child’s life in their assessment and support plans.
The commitment of relatives was noted in a number of SCRs. However, their perspectives, voice and the significance of their relationship can be easily lost and should be actively sought out as part of establishing the context of a child’s life and experience.
A consideration should be made, when planning support, of not only the statutory agencies that should be involved, but also the voluntary or community resources that might be available and engaged for the benefit of the family
Focus on: Role of the school nurse
Cases considered in this analysis showed how school-based assessments by the school nurse can be helpful in ensuring that the child’s voice is heard. School nurses are often well-placed to do this and trusted by the child. However, this does not always mean that this voice is used to initiate meaningful intervention. In one example:
'A child was observed to be very tired and wearing a dirty ill-fitting school uniform; his face was unwashed and nose dirty. He reported the children were given biscuits or crisps with tea instead of an evening meal. He contrasted this with the proper cooked dinners (meat and pasta) whilst fostered. This led to a social worker being tasked with monitoring their evening meals.'
In this case, an assessment of concern did not lead to suitable protective action with a clear outcome. The child’s voice was lost in the reactive response that it generated, without taking a holistic approach.
Key learning for education
- Professional curiosity is all-too-often lost and seemingly small incidents or concerns not fully explored.
- Cumulative harm is often poorly recognised, with action being triggered only on a sudden escalation of risk.
- Early assessment, intervention and monitoring can help to track risk and provide timely support; however, it is often not done early enough.
- Schools need to understand how poverty may affect children and work to actively avoid the desensitisation that can result from working in areas of high deprivation.
- Whilst some interventions, such as providing food through breakfast clubs, can help to address the manifestations of poverty and a chaotic lifestyle, they do not assure safety.
- School staff are uniquely placed to capture the voice of the child and notice distress or behaviour changes through the development of trusting relationships.
- Whilst non-compliance of parents or caregivers should be noted, there is a danger in labelling individuals as resistant or hard to engage. Instead, professionals should explore the underlying issues that are limiting engagement and try to address them.
- The role of men in a child’s life, the wider family and community are often overlooked – both in terms of risk and as a protective or supportive resource.
- In cases of persisting self-harm or disturbing behaviour, a reactive approach is all-too-often taken, instead of proactively exploring underlying factors and issues.
Questions for education settings to consider
- How confident are you that your processes and recording system for child protection and safeguarding allows you to effectively record low-level concerns and track and monitor cumulative risk?
- How do you ensure that you both capture the voice of the child routinely in your contact with them, and keep it at the front of decision-making and support planning?
- How do you actively enable children with additional needs, such as learning and communication difficulties, to express their wishes and feelings?
- How can teachers, support staff and others working with children be trained on the signs and significance of poverty and neglect to ensure that they do not become desensitised to it?
- What is your approach to early assessment and intervention? Are resources effectively allocated to ensure that it can take place meaningfully?