Neglect Strategy

Introduction

Neglect remains the most common form of child abuse across the UK and is usually the most common cause for a child being the subject of a child protection plan. It is well documented that neglect can cause significant distress to children and young people and lead to both poor short- and long-term outcomes. This strategy aims to ensure there is a shared understanding of the impact of neglect and how, as a partnership, we work together with children, young people and families at the earliest opportunity to prevent log lasting impact.

This strategy seeks to explain;

• How agencies in Cambridgeshire and Peterborough recognise and respond to “neglect”
• How agencies can work together to reduce the chances of children and young people being neglected.

This strategy has been created to help improve the ways in which needs and risks are understood, recognised and responded to at all stages of the “child’s journey.” It is not a “stand alone” document and should be considered alongside several other strategies, including the CPSCPB Effective Support for Children and Families document and partner agencies Neglect Strategies. Together these reflect the many different aspects of neglect and priority concerns of organisations and professionals.

Definition of neglect

To be able to define, recognise and address neglect it is important there is an agreed shared understanding, across the partnership, of what constitutes neglect.

For the purpose of this strategy, neglect is defined in accordance with the definition contained in Working Together to Safeguard Children (2023):

“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 will 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).
• Ensure access to appropriate medical care or treatment.
• Provide suitable education.

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

It is important to remember that neglect can occur at any time including the teenage years.

Horwath (2007) identified six classifications of neglect which are widely recognised by professionals across England. These should be read alongside the Working Together definitions. The six areas are;

• medical neglect
• nutritional neglect
• emotional neglect
• educational neglect
• physical neglect
• lack of supervision

Horwath (2007), has taken each of the six areas identified above, and mapped them against the continuum of childhood from birth to adolescence. This continuum can be found at Appendix 1.

National picture

• 1 in 10 children in the UK have experienced Neglect (NSPCC)
• Approximately 50% of child protection plans in the UK are due to Neglect (Safeguarding Network)
• Neglect is the most common reason for a child to contact Childline (NSPCC)

Local picture

• In Peterborough 324 children are subject to a Child Protection Plan, 166 are due to Neglect 51% (Peterborough City Council, November 2024)
• In Cambridgeshire 521 children are subject to a Child Protection Plan, 247 are due to Neglect 47% (Cambridgeshire County Council, November 2024)

Why is neglect difficult to define?

Neglect can be difficult to define because most definitions are based on personal perceptions of neglect. These include what constitutes “good enough” care and what a child’s needs are. Lack of clarity around can have serious implications for professionals in making clear and consistent decisions about children at risk from neglect.

Most neglectful families have complex needs so interventions frequently involve different agencies. Practitioners’ understanding of neglect, is often shaped by differing professional backgrounds and can vary within and across different services. This can contribute to vital pieces of information being lost or not being effectively communicated across agencies. Consequently, an effective interagency approach to cases of neglect is essential.

“Sometimes no one believes you or no one comes to your home to see what’s going on so no one might know or can tell from the outside”

Quote from young person

Pre-birth Neglect

Neglect of a child can begin before they are born. The impact of prebirth neglect can include low birth weight, premature birth, increased risk of sudden infant death syndrome (SIDS) and impaired brain development. Warning signs for professionals to look out for might be poor engagement with antenatal services, history of neglect (with previous children or in own childhood), self-neglect, drug or alcohol misuse in pregnancy, mental health difficulties and learning disability.

Neglect in Infants (0-2)

Children of this age are most vulnerable to neglect. The impact of neglect in infants can include failure to thrive, increased infections and injuries, poor attachment and growth and/or developmental delay. Warning signs for professionals to look out for might be routine appointments missed, not gaining weight as expected, not meeting milestones, speech delay, recurring nappy rash, self-soothing behaviours or a baby that is overly clingy or withdrawn.

Neglect in preschool children (2-5)

Children are becoming more independent and should be safely learning about the world. The impact of neglect in preschool age children can include speech and language delay, increased infections and injuries, difficulty in managing emotions or behaviour. Warning signs for professionals to look out for might be lack of routines, developmental delay, delay in toilet training, under or overweight, untreated health issues, withdrawn or over-familiar with strangers.

Neglect in school age children (5+)

This is the stage where the impact of earlier neglect can become apparent. The impact of neglect in over 5s can include poor social skills, limited attention span, lacking in confidence, difficulty in following rules, difficulty in regulating behaviour and/or emotions, not reaching academic potential. Warning signs for professionals to look out for might be poor hygiene and presentation, low school attendance, withdrawn or very demanding of adult attention, hunger, dental decay, under or overweight.

Adolescents

The impact of neglect in adolescents can include poor educational attainment, low self-esteem, mental health difficulties, difficulty in forming healthy relationships, risk of exploitation. Warning signs for professionals to look out for might be poor school attendance, inability to concentrate, withdrawn of disruptive behaviour in school, self-harm, involvement in criminal or antisocial activity, drug and/or alcohol misuse.

Lived experience of children and young people

There are numerous reasons for children not disclosing abuse, these include fear of the abuser, fear of the consequences, fear of not being believed, and fear of loss of control.

Children are more likely to disclose abuse to adults who they trust and have a relationship with. It is important that the adult can listen and take a measured response based on the presenting risk and bearing in mind the reasons why children don’t seek help.

However, often the child will not make a disclosure. The lived experience is what a child sees, hears, thinks and experiences on a day-to-day basis that impacts on them emotionally, physically, educationally, developmentally etc.

An important principle is to put yourself in the shoes of the child and think ‘what is it like for the child right now.’ Observing the child and their interactions with others is particularly important when children are pre-verbal or when children have speech and language communication needs.

‘..don’t make assumptions about us, our situation and stories – we are more than what you read in our case files, and you can’t always believe everything that’s in them. You do know some things about us but probably not all, although you sometimes seem to think you do. Our situations can be complex and may be hard for you to understand, so you need to take time to get to know us as individual human beings’

Quote from 14 year old

How parents seek help

The blocks for parents seeking help are like the reasons why children don’t seek out help. However, when parents do ask for help it appears, many don’t receive it.

The key message for professionals is the need to be proactive in seeking support for families who are struggling. Equally important is the role that fathers/ male carers play in caring for their children. Fathers/ male carers are often excluded from conversations and as a result their role may be ignored or not fully understood within the dynamics of the family’s functioning.

“The first impression we get when we meet you is very important. Whether you speak to us clearly and respectfully and whether you show an interest in us and our children as individuals. We would like you to listen to us and talk with us rather than at us. We sometimes feel patronised and made to feel small by professionals, especially if we’re young and we didn’t have good parents ourselves. Sometimes, you make us feel that we can’t ever be a good parent. We need encouragement so we don’t end up feeling that we’ll never move forward”

Our Local Principles

To ensure neglect is addressed consistently and effectively, all agencies interventions whether early help or statutory intervention should work to the following principles:

1. The child is at the heart of what we do. This means that we need to listen / observe the child’s views and experience to understand the impact neglect has had and is still having on their lives.
2. All professionals have a responsibility to identify needs and concerns in relation to children and take action to ensure those needs and concerns are addressed at the appropriate level of intervention. This should always be at the lowest possible level to address the issues.
3. Interventions will be conducted openly and honestly with children and families and all agencies will work in partnership with children, parents and carers.
4. Assessments will be holistic, taking account of all views including parents that do not live with their children. Assessments will be evidence based and identify strengths as well as areas of concern. Assessments will focus explicitly on each child in the family.
5. Plans will be clear and directly related to the strengths and concerns identified in the assessment. All plans will have clear timescales that will be reviewed regularly.
6. All agencies will work together positively to address the identified needs and risks for the child and their family. Any concerns about the effectiveness of the interventions with the child should be raised using the ‘resolving professional differences policy’

Assessment

Protecting children and young people involves professionals in the difficult task of analysing complex information about human behaviour and risk. It is rarely straightforward, and responses should be based on robust assessment, sound professional judgement and where appropriate statutory guidance.

I. Targeted Support (Early Help)

Working Together 2023 emphasises the importance of local agencies working together to help children who may benefit from early help services. Early help assessments should identify what help the child and family might need to reduce the likelihood of an escalation of needs to the level that will require interventions through a statutory assessment conducted under the Children Act 1989.

Professionals should work within the guidance contained in the Cambridgeshire and Peterborough Threshold Document : Continuum of help and support when undertaking an Early Help Assessment or Professionals – Making a Referral | Cambridgeshire and Peterborough Safeguarding Partnership Board

Where families are identified as having ‘Emerging’ or ‘Complex Needs’, Cambridgeshire and Peterborough promote the completion of an Early Help Assessment in order to identify any support needs required. An Early Help Assessment must be completed at the earliest possible opportunity after the identification of unmet needs and must be a holistic assessment, considering the whole family. Any professional who knows the child/ren can carry out the assessment and must liaise with other professionals who might need to be involved. The professional completing the Early Help Assessment will act as ‘lead professional’ for the family and will conduct an initial Team Around the Family (TAF) meeting to coordinate the support around the family.

This could be a G.P, teacher, health visitor – the decision should be made on a case by case basis and be informed by the views of the child and family concerned.

An Early Help Assessment must only be undertaken with the agreement of the child and family and requires honesty about the reasons for completing the assessment as well as clarity about the presenting concerns.

Saying no to early help services does not mean that specialist safeguarding services will become involved, except where there is a risk of significant harm to the person concerned, or where they may present a significant risk to others.

Assessment Tools

In addition to the Early Help Assessment, Cambridgeshire and Peterborough recognises and encourages the use of a variety of other tools to both assist with the assessment process and also as alternative ways of engaging with families and encouraging their participation in the Early Help Process.

In cases of neglect, Cambridgeshire and Peterborough promotes the use of the Graded Care Profile. This assessment model was specifically designed to look at neglect and help professionals and parents to focus on the key areas that need intervention. It supports open discussions with families and enables a very clear baseline of current functioning to be taken. Focussed plans to address difficulties are easier to develop, and “rescoring” at key intervals enables all involved to measure progress objectively.

II. Statutory assessment

Where the above criteria are thought to be met, a referral should be made to Cambridgeshire or Peterborough Children’s Social Care who will consider the need to undertake a statutory assessment. Where an assessment is deemed appropriate, the Social Worker will complete the assessment within 45 working days. For further guidance around thresholds for early help and statutory intervention please refer to the Effective Support for Children and Families in Cambridgeshire and Peterborough (Threshold) Document^[1].

III. Resources to support assessment

Visual tools such as the clutter image rating (CIR) Tool Appendix-5-Clutter-Image-Rating-CIR-Tool.pdf can be useful alongside statutory assessments. Additional resources to support practitioners working with families where there is evidence of neglect can be found on the partnership boards; website Cambridgeshire & Peterborough Safeguarding Partnership Board

Agency responsibilities:

No one agency can address the complex elements of neglect on its own. Effective interventions, whether targeted support, child in need or child protection depend on professionals developing working relationships based on trust.

All agencies represented on the Cambridgeshire and Peterborough Safeguarding Children Partnership Board have a responsibility to contribute to the safeguarding of children across Cambridgeshire and Peterborough. Roles and responsibilities are clearly defined in both statutory guidance and the CPSCPB Procedures and include the following:

• To view the safety and wellbeing of children as paramount.
• To ensure that achieving the best outcomes for the child is the primary focus when working with childhood neglect.
• To ensure that their workforce understand the significance of neglect on children and equip their workforce effectively in situations where neglect is a feature.
• To share relevant information and collaborate with other agencies and work together to ensure accurate assessments and the early identification of needs.
• To harness and develop resources to ensure that interventions are proportionate, effective, and delivered sufficiently early to reduce the risk of harm.

Responsibility to share information

Information sharing is essential to safeguard children, it is imperative practitioners can confidently share information as part of their day-to-day practice.

It is important to remember there can be significant consequences to not sharing information as there can be to sharing information. Practitioners must use professional judgement to decide whether to share, and what information is appropriate to share.

Data protection law reinforces common sense rules of information handling. It is there to ensure personal information is managed in a sensible way. It helps agencies and organisations to strike a balance between the many benefits of public organisations sharing information and maintaining and strengthening safeguards and privacy of the individual.

It also helps agencies and organisations to balance the need to preserve a trusted relationship between practitioner and child and their family with the need to share information to benefit and improve the life chances of the child.

Partnership priorities

The partnership has identified four key neglect priorities.

Priority 1: Strategic commitment across all agencies to understand, prevent and reduce the impact of neglect.

• Leaders across the partnership will drive neglect as a key priority and will raise awareness of neglect and its effects.
• Education and training around neglect will be delivered to all agencies working with children, young people, and families. This will include those working primarily with the adults in a family to ensure the child’s lived experience is not overlooked.
• The Partnership will engage with children and families to empower them by ensuring they are involved in public health and education campaigns and supported in meeting their children’s needs.

Priority 2: Improve the capability of the multi-agency workforce to recognise and act on the signs of neglect.

• Professionals and practitioners will use the Effective support for children and families document to assist their professional judgements in assessing which level of need a child is at and determining the actions required to meet a child’s identified needs.
• Professionals and practitioners will use a range of tools to support their practice to identify signs of neglect at an early stage.

Priority 3: Improve the effectiveness of assessment, planning and interventions to reduce neglect and respond to neglect in a consistent and timely way.

• Leaders across the partnership will ensure that neglect is identified and addressed at an early stage.
• Professionals and practitioners will ensure that young people and families know how to access services at the earliest opportunity, this includes signposting families to appropriate services.
• The Partnership Board will hold statutory partners to account and will challenge the effectiveness of multi-agency working to tackle early neglect at the earliest opportunity.

Priority 4: Evaluate our practice and continually improve its effectiveness so we can reduce the neglect of children and young people.

• Leaders across the partnership will evaluate the quality of practice in relation to neglect: early identification, strength-based approach, and a clear focus on the child’s lived experience to inform decision making.
• The partnership’s Quality Assurance and Performance Group will regularly examine data and quality assurance information to enable them to monitor the quality of practice across early help, child in need and child protection interventions.
• The Partnership Board will ensure that practitioners and their managers have access to training on the recognition and management of parental non-compliance and disguised compliance.

Progressing the priorities

Governance is provided by the Cambridgeshire and Peterborough Safeguarding Partnership Board and scrutiny of progress against the strategic aims and objectives and performance management indicators will be undertaken through the CPSCPB Quality and Performance Sub-Group.

All Board members are responsible for implementing and embedding this strategy within their own agency and the Cambridgeshire and Peterborough Safeguarding Partnership Boards will hold members to account over this.

The impact of the strategy will be assessed using a range of quantitative and qualitative measures. Some of the performance indicators that will be used to measure impact will include:

• Increased take up of free early education for eligible 2-year-olds –
• A reduction in the number of re-referrals to Children’s Social Care, where neglect is a concern
• A reduction in the number of children subject to child protection plans under the category for neglect for a second time or more over a 12-month period
• Improved rates of school attendance for children open to Early Help (EHM system)

Audit activity will evaluate the quality of the partnership response to neglect including the child’s lived experience. We will also seek feedback from children following the closure of plans. The relaunch of the neglect strategy will be owned, implemented, and supported by an action plan drawn up by the Neglect Workstream Group.

Appendix 1. Community Care Inform Resource, Horwath. Experiences of Neglect by age group

[1] The CPSCB’s Threshold Document can be found at Updated Threshold Documents for Cambridgeshire and Peterborough Children | Cambridgeshire and Peterborough Safeguarding Partnership Board