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1.3.28 Multi-Agency Child Neglect Guidance


Contents

  1. Introduction
  2. What is Neglect?
  3. Factors to Assess in Neglect
  4. Planning to Address Neglect
  5. Pitfalls to be Avoided by Practitioners
  6. Referring Neglect
  7. Health
  8. Social Care
  9. Criminal Neglect
  10. Environmental Health
  11. Using Photographs as Evidence
  12. Recording the Condition of a Property

    Appendix 1: Framework for Conditions of the Home

    Appendix 2: Graded Care Profile

    Appendix 3: Home Safety Referral Form

    Appendix 4: Neglect Flowchart

    Amendments to this Chapter


1. Introduction

The purpose of this guidance is to provide clear guidance to all practitioners working with families where neglect is an aspect of the children’s care, ensuring:

  • Practitioners and the families with whom they work have clear goals to work towards to improve circumstances for the child/ren;
  • Practitioners and families have a clear, shared understanding of what needs to improve and why, and how they’ll know this is happening;
  • And both have a shared understanding of the necessary actions which will be taken if circumstances do not improve/are not maintained.

The Dorset Safeguarding Children Board and the Bournemouth and Poole Local Safeguarding Children Board have completed a number of Serious Case Reviews and Multi Agency Case Audits involving neglect. 

Some of these cases have involved severe Physical Neglect across the age ranges including teenagers and some of these have included more subtle forms of neglect. However, the impact of this has been significant to the children concerned. It is important that neglect is recognised as a form of abuse that can have significant impact on younger and older children’s health, physical, social and psychological development.

Neglect causes significant harm to children and its adverse consequences may last a lifetime.

Lessons from reviews have been that it is important that practitioner intervention across the agencies is purposeful and addresses the underlying causes of neglect rather than compensating for the family’s inability to provide consistent adequate care for the children.

This piece of guidance has been developed to help practitioners and managers to recognise the risk of ‘drift’ and ‘start again syndrome’ and the impact of neglect on teenagers. All of these factors have been identified through the Reviews all of which were factors in the lives of the children involved in the Family S3 Serious Case Review.

In 2015 the two LSCBs carried out Audits into neglect cases and the findings are also reflected in this guidance.


2. What is Neglect?

Working Together 2015 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:

  • 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.

It may also include neglect of or unresponsiveness to a child’s or adolescents basic emotional needs. This is also relevant to older children who may not seem to be as severely impacted by neglect.

Neglect has many causes and is considered a passive form of abuse which is largely due to omissions rather than parental actions or commissions (Child Neglect 2005) (1). It is important to remember that the recognition of unmet needs may not in itself indicate neglectful parenting; however it may point towards the need for intervention and a ‘joined up’ interagency approach.

1 Watson J (May 2005): Child Neglect: Literature Review. Centre for parenting and research.


3. Factors to Assess in Neglect

Focus on the Needs of the Child

Practitioners will use the Framework for the Assessment Triangle in the Assessment Procedure or CAF or other Early help Assessment in order to consider the full range of needs of a child. This assessment will identify whether or not their parents or carers are consistently meeting these needs. If not, then neglect may be an issue.

Analysis requires the collation and evaluation of sometimes small and seemingly insignificant events that only when viewed together provide evidence that neglect is an issue of concern, assessments should triangulate between what is reported by family, what is known by other agencies and what is observed.

Use of Chronologies

Chronologies play an important role in evidence of neglect. Different agencies may have chronologies of their involvement and gathering the information from these will help with gathering a holistic view.

A Bournemouth and Poole LSCB audit identified the need for improved multi-agency chronology guidance and this will be developed in 2016.

Age of The Child

Younger children are more at immediate risk when their needs are being neglected. Neglected babies and toddlers are at most risk in terms of their immediate health and the prospects for their longer-term welfare.

The serious neglect of older children and adolescents is often overlooked, on the assumption that they have the ability to care for themselves. Make sure your risk assessment focuses on the age of the child. Ask the question “what is it like for this child to live in this family/environment?”.

A Case Audit undertaken by the DSCB in 2014 recognised that teenagers are designed to be risk takers and their brains do not enable them to process information to make the changes that practitioners would often want. Consequently, practitioners need real support when working with this challenging group.

Services need to be designed that take account of how young people communicate and engage. They will not always keep to regular appointment times and want to choose their moments to reflect on their difficulties. It is important that practitioners feel they are making a difference, but this needs to happen within the context of the realities of the work. Services need to be designed that are sensitive to the needs of teenagers and give robust support to staff to understand the complications and implications of working with this group.

This is further considered in considering the impact of neglect on a teenage parent who may be overlooked as a child as risk of neglect. Once they have given birth, teenage parents are often only as parents rather than children.

Parental Capacity

Consider the capacity of parents in assessments, including the impact of their mental and emotional health and any learning disability. Reflect on any past practitioner involvement with the family; What has worked, has it been maintained? Why was it effective or why have things deteriorated? Both past and present circumstances need to be considered as neglect often spans generations; How well has the family maintained progress in the past when practitioners have withdrawn?

The full extent of neglect will only be identified after a thorough assessment of the family. It is important that practitioners are sensitive to different family patterns and lifestyles and to child rearing patterns that vary across different ethnic, cultural and faith groups. Practitioners, however, should guard against myths and stereotypes. Understand the ‘norm’ of different cultures to gain insight into whether this family have diverted from this ‘norm’.

Parents can sometimes be supported by extended family and friends networks to improve care of their children. Family Group Conferences are a positive way of raising with a wider family network the unmet needs and how they can be met.

Financial Situation

Guard against the risk of 'excusing' or explaining neglectful care because a family is in poverty. Neglect is not necessarily a consequence of poverty although poverty may make it more difficult to provide good care to a child, with problems accessing services or the financial ability to buy clothes, etc.

Neglect is about a child’s needs being unmet to such a degree that ill-treatment or impairment of health and development, physical, emotional and social occurs. Neglectful care of children may also be found in families considered 'well off' and practitioner should guard against assumptions. Research tells us that poor and minority families are more likely become a focus for attention [3].

Substance Misuse

It is known that children whose parents have problematic substance misuse are harmed or are likely to be harmed and that their health, emotional, physical, educational and social welfare compromised.

Remember, the use of illegal drugs is time consuming for the adult; money has to be found to pay for the drugs, the drug supply has to be located and at times the adult will be under the influence or withdrawing. Similarly, the purchase of alcohol may involve a significant proportion of the family budget and the child’s needs may lack priority. Any concerns of substance misuse need to be assessed thoroughly. For example, check for dangers in the house e.g. Where are drugs stored? When are the drugs taken? Who cares for the child when the parent is under the influence?

Assess the risk of immediate harm e.g. is the child exposed to drug paraphernalia or drugs/alcohol, is there a lack of adequate supervision and basic care food/hygiene/clothing. Older children/teenagers may end up caring for a parent who has a substance misuse problem or may find themselves drawn into this behaviour themselves as the parents/carers do not work pro-actively to discourage substance misuse – indeed, they may encourage it and see this as an entry to adulthood.

Further information can be found through Inter Agency Procedures – Children of Parents who Misuse Substances.

Further information about parents with problematic substance misuse and the Hidden Harm agenda may be located on the DSCB website.

Parent Child Relationship

Low maternal self-esteem can affect the 'normal' parental/child interactions and should be considered as an elevating risk factor when neglect is an issue of concern.

Observations of a poor parent-child relationship may indicate some level of neglect; stability and boundaries may have deteriorated through a lack of attachment or a breakdown in the relationship. In some cases a child may become the scapegoat in the family and suffer neglect in this situation.

For teenagers, the poor parent-child relationship can be more complex to assess. Children may be protective of their parents or over-identify with their parents. They may cling to their parents and be overly cautious about taking on their own identity due to poor attachment.

Look out for 'low warmth / high criticism' environments - these are amongst the most damaging to children. Within cases of neglect this concept can be particularly useful to practitioners when considering both the child’s needs and the parental / carer response to these.

Affection, Attention & Stimulation

Evidence of these factors may suggest the psychological neglect of a child. It may be in the teenage years that this factor (either from earlier in life or at that stage of the teenager’s development), really impacts on their behaviour and their interaction with the social world around them and inhibits their development into healthy adulthood.

Guard against cultural stereotypes as some parenting styles may not openly show displays of affection.

Mental Health and Learning Difficulties

Such difficulties can significantly impact upon parenting capacity. Seek specialist advice whenever this is identified as an issue to ensure the parents/carers are able to understand the information and advice they are being given and appropriate joint assessments of parental capacity are made as early as possible.

Please see Pan-Dorset Multi-agency Procedures – Children of Parents with Mental Health Problems and Children of Parents with Learning Difficulties.

Domestic Abuse

Direct or indirect harm can arise through children being exposed to domestic abuse/ domestic violence (physical or emotional) in the home. Consider the long term implications for children growing up in such environments. Assess the impact of the violence and the atmosphere on the adults’ ability to meet the needs of the children.

Further information can be found through Inter Agency Procedures (see Domestic Abuse, Teenage Relationship and Interfamilial Violence).

Age and Other factors affecting the Parent or Carer

Childhood experience of abuse or neglect will increase the level of risk to the person’s own child. Children who suffer abuse or neglect may become more detached and lack empathy - this can affect their parenting capacity as adults.

Immaturity / lack of experience / apathy / impulsive behaviour can all increase the risk of neglect to a child and the implications need to be assessed and understood to identify protective and harmful factors.

Expectations of Children and Teenagers

Giving children and teenagers inappropriate responsibilities to care for themselves and / or others or restricting activities which will impair health and development.

Leaving children and teenagers in charge of other children in the family at an age inappropriate for the responsibility is emotionally harmful as well as possibly exposing children to physical risk. This includes the child as carer as well as the children being cared for.

It may have immediate and long term adverse consequences for their safety and wellbeing. Assessments should consider what responsibilities the child has, whether these are age appropriate and safe and whether they are having an impact on the child’s outcomes.

Levels of Supervision

The potential risks include those above, when expectations of the child are greater than would be expected for their age and maturity. 

Younger children will maybe at significant physical risk however, teenagers when left to their own devices may explore inappropriate behaviours and relationships; they may become vulnerable to exploitation by others, such as child sexual exploitation, radicalisation or criminal behaviours.

It is usual for teenagers to explore and take risks and these behaviours need to be tempered by a present adult who discourages and persuades away from situations of significant risks.

Adult Relationships

Sometimes children can be neglected because the adult focus is upon the need to sustain / maintain / obtain their own personal relationships, at the expense of the child.

Other Agency Information - Working Together

Work with your colleagues in other agencies to collate what they know about the child and the family. Gathering and sharing past & present information to obtain as many details as you can, will ensure assessments are accurate and complete. Without doing this, your assessment are likely lack depth and be ineffective.

Maintain your multi-agency links, communication and consistency of approach. Liaise widely: share/gather information from those involved in the child and family, such as children’s therapists, health visitors and school nurse as well as youth workers, Children’s Social Care, police and education.

Always remember that the family GP may hold a quantity of past and recent history which will help in assessing the needs of the child and the adults in the family as well as extended family. GPs would be expected to share this information with you where appropriate in order to safeguard the child.

If children have disabilities and are receiving care from therapists, be sure to include them in any assessment. Their expertise regarding the necessary care to ensure the best possible outcome for the child, physically and developmentally will be essential.

Expert Help

All Local, District and Borough Councils have Environmental Health departments who have the expertise to assess and advise on the impact of environmental neglect. Practitioners should make referrals to Environmental Health if there is any doubt about the level of environmental neglect, or advice is needed on the appropriate steps that should be taken.  See Section 10, Environmental Health on the role of Environmental Health Departments.

The Fire Service will also carry out Home Safety Checks if you are concerned that fire is a significant risk element – they will often provide and fit smoke alarms free of cost (see Appendix 3: Home Safety Referral Form).

If there are concerns regarding a child’s health, growth or developmental progress, consider discussing with the relevant health visitor or school nurse. Refer to a paediatrician for assessment as appropriate. Paediatricians work with children and teenagers up until their 18th birthday.

Clarify What is Fact and What is Opinion

Practitioners must be explicit when describing concerns of neglect. It is essential to record what they are told and by whom, what they see /hear and their own practitioner opinion. Separating fact from opinion is vital and backing up opinion using evidence from research and/or practitioner knowledge of the home conditions, presentation of the child/ren or observed interactions between parent/carer and the child is required.

It is essential that all practitioners employ an investigative mindset and triangulate information in order to understand the child’s life experiences. Accurate record keeping and communication of plans, interventions and outcomes is essential.

Use Tools

You are advised to use tools such as:

  • The Graded Care Profile (see Appendix 2: Graded Care Profile) which can be downloaded;
  • The Home Conditions Assessment and Parenting Daily Hassles Scale (DoH, Framework for the Assessment of Children and their Families).

The DCSF produced a multi-agency guide for practitioners working together on behalf of teenagers ‘Neglect Matters’ [4]. This guidance remains a useful tool for those working with teenagers.

A current project in Poole will update this list of tools in 2016 update.

[3] Watson J (May 2005): Child Neglect: Literature Review. Centre for parenting and research.
[4] Neglect matters: a multi-agency guide for professionals working together on behalf of teenagers


4. Planning to Address Neglect

  • Be clear about the threshold at which more stringent action may be required to safeguard and promote the welfare of the child. Practitioners should be mindful of the neglect definition when deciding whether child protection enquiries and processes should be implemented;
  • When developing plans and written agreements, be explicit about what action is required of the parents. The parent’s capacity to change and maintain that change is a critical factor. This is especially so in cases of serious neglect;
  • Develop 'contingency plans' that should be implemented as soon as it is clear that parental capacity is not improving;
  • Work with parents to help them understand concerns and the implications for their children;
  • When developing multi-agency plans ensure that all agencies involved understand their role and the role of others in tackling the neglect. Be clear who is visiting the household, where they are expected to observe and indicators that need to be recorded and shared with others. Agencies need to hold each other to account for fulfilling their part of the plan.


5. Pitfalls to be Avoided by Practitioners

Neglect can cause serious harm and is linked to the deaths of children. If children are to be protected it is essential for practitioners to effectively identify, assess and plan the interventions to meet the needs of children and their families when neglect is an aspect of their care.

Reviews have identified a number of pitfalls that practitioners need to guard against:

Don’t Focus on the Parents or Carers Exclusively

Parents who neglect their child are often emotionally and materially deprived and they may have many unmet needs. Whilst meeting these needs may be a way of improving their parenting capacity, too much focus on the parents’ needs can detract from meeting the children’s needs. Remember the needs of the child are paramount and any assessment has to recognise the parental needs, identify services for parents and include assessment of whether change can happen in a timeframe to meet the children’s needs and prevent drift ad long term damage.

“Rule of Optimism”

Unrealistic practitioner optimism may also result when small changes to a child’s circumstances are made which are given too much ‘weight’ when the overall risks remain unchanged.

For a variety of reasons, practitioners can often think the best of families with whom they work, especially when the parents/carers seem well meaning and to be trying hard to improve their situation and the care of their children. This can lead to a lack of objectivity and loss of the focus on the child, minimising concerns, failing to see patterns of ‘relapse’ or abuse and generally not believing or wanting to believe that risk factors are high. The risk is that insufficient change is made, risks are not evaluated in a holistic context and children’s distress remains unchanged.

The motivation of the parent/ carer, being ‘well meaning’ with an apparent willingness to ‘try’ to change things, and their own need for support aren’t justifiable reasons for allowing the child to continue in a neglectful environment or receive neglectful care.

Start Again Syndrome

Avoid ‘start again syndrome’ where each new episode of neglect is dealt with as a new incident rather than building up a picture of ongoing neglect over time. Producing and maintaining a chronology of actions and outcomes will indicate the level of compliance over time, check with other agencies of they also have chronologies of events. Regularly discuss cases in supervision and prioritise these effectively. Consider what has worked before and when a different approach might be needed.

Engagement

Disguised parental ‘compliance’ may reassure practitioners that the parents share the same concerns and are working towards improving matters, whereas in reality little is changing to improve the life of the child.

Be aware of ‘false engagement’ and ‘feigned compliance’. True engagement by parents shows by changes in their behaviour, measurable improvements in the situation for the child and visible improvements in the child’s health, educational achievement and general well being.

Remember, always think about what this means for the child.

Children and young people will have their own views about engaging with services.  Remember, even older teenagers are still children and are not always in a position to decide what is right for themselves.  It may be challenging working this age group and dealing with the type of behaviours that these young people may display.

All practitioners should consider whether the Hard to Engage Families (see Hard to Engage Families Procedure should be used where families and young people are either failing to engage or appear compliant but are actually not making the changes required to stop the abuse from happening.

Values and Difference

Watch out for your own assumptions and don’t let them cloud your objectivity. Assess the facts of the case – any opinions you have must be backed up with evidence and not informed by personal value judgements. However, be mindful to avoid allowing poorer standards of care because you feel you may be judging by your ‘personal standards’. Seek supervision regularly from your Safeguarding Children lead and/or manager and be open to exploring objectively these standards.

Practitioners can think ‘this is normal for this family / this area / this person / this culture’ and accept the situation. They need to assess and record ‘what is this child/young person’s daily life like here?

Children from different ethnic and cultural backgrounds will experience different parenting styles. Whilst some of these styles may differ from the White UK perspective of child-care, this does not make them significantly harmful to children. Any judgement of neglect must be based on evidence, which is triangulated and not on stereotypes about a family’s culture, faith or ethnicity, which neither explain nor excuse acts presenting a risk of significant harm.

Also remember that within the white British society there is not necessarily a universal ‘norm’; there will be differences based on ‘cultural’ values. Practitioners must explore the power and control issues within a household and the ability of parents to change the way they care for their children. This includes the influence of other family members such as partners, grandparents or other significant people in the lives of the families and communities. Regardless of background, culture, religion, ethnicity or family belief systems, all children have a right to be protected from abuse or neglect. It is never acceptable for any child to be subjected to unreasonable standards of care or for them to suffer abuse or neglect.

Avoid Drift

Ensure that the drift of cases is avoided.  Do both parents/the parent/carer understand the practitioner concerns and agree with the plan? Is the parent able to make the necessary changes i.e. do they have influence/authority/resources within the home to do so? What is the plan? Are all the practitioners involved aware of the plan and of their role? Is it realistic?

Having targets with timescales in plans will help identify when progress is not being made quickly enough and there should be contingency plans to ensure when things are not making progress there are different approaches identified.

Avoid Compensatory Care in Schools or other Care Settings

Compensatory care is providing a child or young person, on a regular basis, help or assistance with basic needs with the aim of redressing deficits in parental care. This might involve, for example, providing each day a substitute set of clothing because those from home are dirty, or providing facilities for a child to shower where their personal hygiene or presentation is such that it is affecting his/her interaction with peers.

It does not include isolated or irregular support such as giving occasional lunch money or washing a child who has had an ‘accident’.

Providing compensatory care might address the immediate and presenting issue but could cover up or inhibit the recognition of neglect in all aspects of a child’s life.

If any agency finds it is regularly attending to one or more aspects of a child’s basic needs then this should prompt a thorough consideration of his/her circumstances within the context of this document and before consideration of referral to social care.

Use escalation processes to challenge agencies where necessary.

Audits and National Serious Case Reviews indicate that practitioners are not always ready to challenge other professionals about practice or decisions that they do not agree with. The escalation process (see Escalation Policy) is a way of raising with another agency the need to review decisions and plans. It should be a way of exploring together concerns until there can be a shared view or understanding.


6. Referring Neglect

Many cases of low level neglect will be managed by services other than social care. Support in learning new skills, advice about risks and harm and reminders help families create change in some situations of neglect where universal or targeted services are involved.

The inter agency threshold protocol will be useful in ascertaining which services should address different levels of neglect.

There is no absolute way to judge the threshold for child protection intervention. In cases of neglect, the point at which this threshold is crossed depends upon a number of factors and relies on practitioner judgement and the completion of an accurate and effective assessment. Neglect that constitutes significant harm will usually be characterised by a combination of events. A 'snapshot' view of the child will never be sufficient.

It will always be necessary to establish the difficulties underlying the neglect of children and young people. Thorough assessment through CAF / PEHA or another recognised tool of the cause of neglect is required rather than practitioners simply acting to relieve its symptoms, which is often the much repeated outcome. The best predictor of future behaviour is past behaviour.


7. Health

Health practitioners, particularly services such as Health Visiting and School Nursing often work with children and families within their own home environment. They are in a position to identify when neglect is a feature of the care of the child and to work with parents to improve the child’s circumstances.

When there are concerns of immediate risk to the child, a referral should be made to Children’s Social Care and/or Police, and a discussion with the organisation’s Safeguarding Children Team should take place.

However, when concerns have been identified with the parents as being at a low level of risk, improvements may be made in a timely manner and sustained, with universal services maintaining an overview of progress. The practitioner must make a judgement on whether discussion with the Safeguarding Children Team and /or Children’s Services is required at this point. The means of reviewing progress will vary depending on the discussion with the family but it is expected that the child’s circumstances will be reviewed by home visiting at regularly agreed intervals. Unannounced visiting will ensure that conditions are being maintained outside of planned visits. This is to ensure the parents are not merely providing an effective public appearance, for whatever reason. Should the agreed improvements fail to occur as expected or are not maintained, further review and assessment will become necessary.

The physical care of the child may need to be improved, with the provision of clean clothes, bathing/washing/oral hygiene and/or regular attendance at health or dental appointments.

The failure to have provided this care may include the lack of equipment, and in the worst scenario, the lack of water/electricity; transport difficulties or a lack of understanding of the need for the appointments may exist. Practitioners will need to explore the reasons for the poor physical care of the child with the parents/ carers to provide an effective response.

The Graded Care Profile provides a tool for the practitioner to use to reflect on their involvement with the family, and also as a means of clarifying and agreeing the areas needing improvement with the parents, so both parties share an understanding of what needs to change and why. It provides clear evidence for the parents to see what they doing well and what needs to improve.

To ensure there is a consistent method of recording the home circumstances within the child’s health record, practitioners may also consider the use of the ‘Framework for recording the condition of the home’ found at Appendix 1: Framework for Conditions of the Home. The purpose of this framework is to consider and monitor environmental conditions and provide a method of recording the conditions of the home objectively. It is to be used to avoid  ‘blanket terms’ such as ‘grubby’, ‘good enough’, and ‘improving’ which are all open to interpretation depending on the practitioner.

The framework is not a prescriptive list but may be used as are reference tool; other areas identified by the practitioner may be added. This can be printed, dated and added to the child’s health record to identify work to be completed, and to update progress made. As part of the child’s health record it will remain for reference for those who work with the family in the future. This framework is a recording tool only and must not be used to replace the Graded Care Profile.

Work with the family will be subject to regular, agreed home visits to review progress; the timing of such visits will reflect the need of the family and the concerns of the practitioner. If members of the ‘Skill Mix Team’ are working with the family their work must be supervised; the timing of this supervision will depend on the concerns but should be no less than monthly and carried out by the health visitor/school nurse team lead.

When Health practitioners identify that a family are not maintaining improvements in the home, and the child continues to live in an environment where their health, social and educational needs are not being met, it is important that supervision with their Safeguarding Children Team is taken and their work is subject to regular subsequent supervision to monitor progress being made. Consideration should also be given to contact being made with Children’s Social Care either for advice or to make a referral.

Regular supervision will ensure the practitioner is not becoming desensitised to the conditions in the home, provide an opportunity to reflect on plans to work with the family and to ensure that the work being completed by the parents is improving the child’s life. This will minimise the risk of drift and of practitioner responding to relieve symptoms of neglect rather than addressing their cause.

The Health practitioner should consider whether a specialist opinion about the home circumstances is needed, such as from Environmental Health or Fire Services. If referrals are made to these services, a discussion with Children’s Social Care would be also be expected to take place. A referral to Children’s Social Care may be required following this discussion.

Consideration must also be given as to whether photographic evidence (see Section 11, Using Photographs as Evidence) is needed to ensure there is clear information in the record to establish the level of neglect and to provide evidence of improvements. This will be of value both by those currently involved but will also to provide factual evidence of the home circumstances for those who may have involvement with the family in the future.

If Health practitioners identify home circumstances which are such that this level of detail is required, this should be discussed with Children’s Social Care and their involvement requested. If the practitioner is referring to Children’s Social Care, the request for photographic evidence must be included in the referral form.

The practitioner must obtain Supervision at this point from their Safeguarding Children Team.


8. Social Care

Social Care will receive referrals about children and young people where neglect is present and there are times when neglect is entrenched and has been resistant to input from other services when it becomes a Child in Need matter. The Inter-Agency Thresholds Protocol can be used to support practitioners in this decision making, The impact of neglect on children and young people is significant and may have been going on for some time.  It is however important that Social Care respond in a timely manner and where potential significant harm is identified, follow the appropriate Child Protection Procedures (see Investigating Child Protection Concerns Procedure, Strategy Discussion / Meeting).

Any subsequent assessment should take account of this guidance and use the tools available.

What happens when a referral is received from a practitioner who is concerned about environmental neglect?

  • It is of paramount importance that all previous records relating to the family are fully considered;
  • All social work assessments should contain details of the home conditions seen;
  • If photos have not already been taken by environmental health or police, consideration should be given to such a request being made (as appropriate – see Section 11, Using Photographs as Evidence);
  • The assessing social worker should consider using the Framework (see Appendix 1: Framework for Conditions of the Home) for recording home conditions at the beginning of the intervention, with regular reviews against this benchmark, as work with the family progresses.  This framework can be used in conjunction with the Graded Care Profile, but should not replace it.

What happens if fresh concerns are raised on cases already open?

  • In this instance, the social worker should discuss what further action may be required with their line manager, the plan may need to be revised;
  • During this discussion, specific regard should be paid to Section 5, Pitfalls to be Avoided by Practitioners of this guidance to guard against these;
  • Good practice would indicate that consideration be given to the line manager visiting jointly with the social worker in order to give an additional perspective;
  • The social worker should consider whether each new referral/concern received heightens the risk already identified.


9. Criminal Neglect

Section 1 of the Children and Young Persons Act 1993 outlines the offence of ‘cruelty to persons under sixteen’, which incorporates neglect. According to section 1, if anyone who is 16 years or over wilfully assaults, ill treats, neglects, abandons of exposes a child in a manner likely to cause unnecessary suffering or injury to health they will be guilty of an offence. Injury to health includes any injury to or loss of sight, hearing, limb or organ of the body and any mental derangement.

The definition of neglect is outlined in section 2(a) of the Act. The offence is committed if a parent, guardian or other person legally liable to maintain a child has failed to provide adequate food, clothing, medical aid or lodging or has failed to take such steps as to procure these items. The neglect must be deemed to be a manner likely to cause injury to the child’s mental or physical health.

For an offence under section 1 to be committed, there must be evidence that it was ‘wilful’. There is no statutory definition, but the term has been interpreted by the courts. In R v G (2004) 1 AC 1034 it was said that wilful misconduct means deliberately doing something that is wrong, knowing it to be wrong or with the reckless indifference as to whether it is wrong or not. Although there is no definable threshold for when a minor neglectful act becomes a criminal offence, each single incident must be examined in the context of other acts or omissions and the possibility of a criminal offence should be considered. There will be occasions when the issue is one of poor parenting and/or the carer’s lack of knowledge, rather than a deliberate and wilful act.

Where Police involvement is needed to investigate concerns about neglect of children, the Child Protection Investigation Unit of the Police should be contacted.


10. Environmental Health

Environmental Health have powers to deal with a range of issues including substandard housing, public health problems and nuisance issues such as filthy and verminous premises, excessive noise, and dangerous electrics in a rented property etc. Staff will assess each case on its merits with due regard to the legislation. In general, formal action can be taken where necessary to investigate and resolve a problem. Where evidence supports the need for such action, legislation usually allows staff to apply for a warrant to gain access to a property if necessary.  

Environmental Health practitioners visit a wide range of premises in the course of their work. Basic child protection training should be given to all staff making visits to help them identify when a referral should be made to Children’s Social Care. Each case will have to be assessed on its merits but referrals could be in response to living conditions, housing conditions or to other situations that may arise. For example, seizing noise equipment from a property with children present where a parent is unlikely to be cooperative.

In all cases checks should be undertaken to find out if a child/young person is living at the property. This should include checking council records and speaking to neighbours etc. Where evidence suggests a child/young person is living at the property all attempts should be made to gain entry to the property. Liaison with Children’s Services Social Care at this stage would also be helpful to find out if they are aware of this property/child. It is also likely to be helpful to liaise with the police to try and gain access to the property if necessary. Where access to a property has been denied and evidence suggests there might be a problem, formal procedures should be used to try and get a warrant to enter the premises.

Individual District/Borough Council’s will have specific procedures for making a referral to Children’s Services Social Care.  However, in order to contact Children’s Social Care directly; please contact the relevant local office at the numbers detailed in Local Directory.

Referrals should be made to Environmental Health at the relevant District or Borough Council. Speak directly to a Senior Officer working in Environmental Health to agree a plan of action.


11. Using Photographs as Evidence

The use of photography can support assessment processes. Photographs can provide a clear record of the home conditions that are causing concern. Written description of household conditions can give an outline, but more detail is captured in photographs and will allow for further scrutiny and evaluation.

Photographs can support work with families by helping them to see the conditions from another person’s perspective, to motivate them and they act as a useful ‘before and after’ tool for families to see the progress they have made. Photographs can provide opportunities to set clear objectives with families.

The objectivity of photographs assists different practitioners to compare conditions without different personal standards which can be found in recording. Their use in supervision can assist the supervisor to understand the conditions that are causing concern. They can also assist in reflection about the situation as the conditions of the house can lead to practitioners feeling overwhelmed, so analysing the risks present in these conditions can be helpful after the visit. There may also be opportunity to identify strengths, such as the presence of cleaning materials or areas which are maintained tidily.

When there are repeat referrals as conditions improve and deteriorate, photographs can help different workers to gauge whether the conditions are better or worse than at previous referral points.

Photographs can also assist when seeking input from colleagues in other agencies, such as environmental health/housing. They provide evidence of conditions that may not have been identified by practitioners visiting the accommodation or in requests for service.

Photographs can assist where parents deny the conditions that have caused concern and refute records made by practitioners involved.

If you require photographs to be taken of a property as pictoral evidence of the poor conditions in which a child is living, a referral should be made to environmental health or the police. Supervision should be taken at this point from your Safeguarding Lead who will consider consulting Children’s Social Care for advice or to make a referral. There should be multi-agency planning and agreement about who is doing what to contribute to the assessment.

It is unlikely that any agencies apart from Police and Environmental health will be able to use photographs in any legal proceedings. 

It is expected that environmental health and police will provide copies of photographs to social care and health for their records.

If your agency has a clear expectation that you should take photographs, you should be provided with the appropriate equipment and there should be a detailed protocol in place covering the taking, storage and use of photographs.

Photographs should never be taken on mobile phones or other personal equipment.


12. Recording the Condition of a Property

A framework is available at Appendix 1: Framework for Conditions of the Home which may be used to accurately record the condition of the home in your relevant agency notes.  The framework will enable a consistent multi agency approach to recording conditions in the home and avoid the use of subjective blanket terms such as ‘grubby’, ‘good enough’ and ‘satisfactory’.

Practitioners must continue to use their practitioner judgement to decide if the child’s home conditions are such that a referral to Children’s Social Care is needed.

This tool is not intended to be definitive but simply a table laying out the levels of living conditions from 1 to 4 broken down by areas of a property. It is not anticipated that all the factors will be present at any one time.  You should be able to repeatedly use this framework to review and record what you see when visiting the child’s home, and make a quick comparative assessment. It will be a matter of practitioner judgement as how this framework is used and the comments box may be used to justify the level given.

This framework may be photocopied and the practitioner may ‘tick off’ areas relevant to the family they are visiting.  It may then be signed and dated and added to the records for future references and comparison.

Alternatively, practitioners may simply use it as a reference guide in order to help them more accurately record conditions in their notes. It may be taken to supervision for practitioners to reflect on the work in progress with the family.

If you have concerns about the home conditions or progress being made you may decide to make a referral to Children’s Social Care.

If the conditions of the home are poor but do not meet the threshold for a referral to Children’s Social Care your recording will be vital when assessing whether the conditions are deteriorating over a period of time. The circumstances may then meet the criteria for referral to Children’s Social Care.

This framework is particularly relevant for those working with families and monitoring properties where it may not currently meet the threshold for a referral but are subject to regular reviews. The framework will help to clarify when parents are not engaging meaningfully to improve/maintain circumstances for the child/ren.

This framework is a recording tool only and must not be used to replace the Graded Care Profile. (see Appendix 2: Graded Care Profile).

You are still required to use your practitioner judgement as to whether the conditions in which a child is living warrant a referral to Children’s Social Care.


Appendices

Click here to view Appendix 1: Framework for Conditions of the Home

Click here to view Appendix 2: Graded Care Profile

Click here to view Appendix 3: Home Safety Referral Form

Click here to view Appendix 4: Neglect Flowchart


Amendments to this Chapter

This chapter was reviewed and substantially rewritten in February 2016. It should be read in its entirety.

End.