The context of decision-making in cases of child neglect

The Context ofDecision-Makingin Cases of ChildNeglect

This paper explores professional decision-making in cases of childneglect within the context of child protection practice in Britain. Theliterature on the nature of neglect is reviewed. Di�cultiesassociated with decision-making are then examined within aframework that addresses the social, political and organizationalcontext of child protection practice. It is argued that the currentsystem, which focuses on incidents of abuse rather than thecontext of children's lives, provides inadequate protection for manychildren experiencing chronic neglect. Conclusions are drawn withregard to the development of practice that supports vulnerableparents while still remaining the child's welfare as paramount.*c 1998 John Wiley & Sons, Ltd.

Child Abuse Review 7: 97±110, 1998.

KEY WORDS: child abuse; child protection; child neglect; social work

T his paper considers professional decision-making incases of child neglect within the current context of

child protection practice in Britain. Minty and Pattinson(1994) argue that social workers in Britain not infrequentlyunderestimate the seriousness of child neglect. Stevenson(1996) refers to a ``culture of di�dence'' around social workpractice with cases of neglect, particularly regarding the``point of no return'' when compulsory intervention isnecessary. The inquiry report into the death of Paul (TheBridge Child Care Consultancy Service, 1995) demonstratesthat numerous health and welfare professionals failed torecognize and address the extent of neglect Paul and hissiblings were experiencing. This paper considers some of thereasons why children who are neglected by their parents arealso frequently further neglected by the services establishedto protect them from signi®cant harm.

CCC 0952±9136/98/020097±14. $17.50 Accepted 21 July 1997*c 1998 John Wiley & Sons, Ltd.

Child Abuse Review Vol. 7: 97±110 (1998)

`Social workers in

Britain under-

estimate the

seriousness of

child neglect'

Jocelyn Jones1�Anna Gupta2

1Centre Director2LecturerChild Protection Studies Centre,Leicester University, Leicester

*Correspondence to: Jocelyn Jones, Child Protection Studies Centre, LeicesterUniversity, School of Social Work, 107 Princess Rd East, Leicester, LE1 7LA,UK.

In this paper the literature on the nature of child neglect isreviewed and the complexities of decision-making examinedwithin a framework that addresses the social, political andorganizational context of child protection practice. Conclu-sions are drawn regarding the development of e�ectivepractice that maintains the child's welfare as paramount.

The Nature of Child Neglect

De®nitions

Child abuse is a socially constructed phenomenon and allde®nitions are open to interpretation and value judgements.Neglect, however, poses particular di�culties. The de®ni-tions of child neglect vary greatly in the literature. Thede®nition contained in Working Together (DOH, 1991,p. 48) is:

`The persistent or severe neglect of a child or the failure toprotect the child from exposure to any kind of danger, includingcold or starvation, or extreme failure to carry out importantaspects of care, resulting in a signi®cant impairment of thechild's health and development, including non-organic failureto thrive.'

This de®nition is extremely vague and practitioners arecontinually faced with making decisions about what shouldbe considered `persistent' or `severe' and what should beincluded when deciding on ìmportant aspects of care'. It istherefore not surprising that in their study, Birchall andHallett (1995) found that, when establishing a baseline forprotective intervention, di�erent professionals found itharder to reach a consensus with cases of emotional abuseand neglect, as opposed to physical and sexual abuse.Several writers have delineated speci®c aspects of neglect.

The American researchers Polansky, Borgman and DeSaix(1972, quoted in Corby, 1993, pp. 45±46) state that:

Ìt is presumed that the physical, emotional and intellectualgrowth and welfare are being jeopardised when, for example,the child is:1. malnourished, ill-clad, dirty, without proper shelter or

sleeping arrangements;2. without supervision, unattended;3. ill and lacking essential medical care;4. denied normal feelings of being loved, wanted, secure and

worthy (emotional neglect);5. failing to attend school regularly;6. exploited, overworked;

Àll de®nitions are

open to

interpretation'

`Di�erent

professionals

found it harder to

reach a consensus'

98 Jones and Gupta

*c 1998 John Wiley & Sons, Ltd. Child Abuse Review Vol. 7: 97±110 (1998)

7. emotionally disturbed due to constant friction within thehome, marital discord, mentally ill parents;

8. exposed to unwholesome and demoralising circumstances.'

This de®nition still leaves open to interpretation degreesof neglect and highlights a central theme, namely the linksbetween poverty and neglect. For example if a child ishomeless, is this the responsibility of her/his parent(s) or thestate?Dubowitz, Black, Starr and Zuravin (1993) propose a

de®nition that focuses on the basic needs of children notbeing met and argue that the responsibility for meeting theseneeds is shared between parents and the wider community.However Minty and Pattinson (1994: 736) suggest a de®ni-tion that relates speci®cally to parental omission. Theydescribe neglect as being:

`The persistent failure to meet a child's essential needs byomitting basic parenting tasks and responsibilities. The basicneeds that are not usually met are those for: adequate food,clothing, shelter, cleanliness, stimulation, medical care, safety,education and love and control, in spite of parents having theeconomic resources to meet these needs at a basic level.' (Italicsincluded in original)

Dent (1996, p. 39) employs a similar de®nition to refer to`dangerous' neglecters. She also states that neglect cancomprise emotional and physical elements and utilizesattachment theory to suggest that àn emotionally neglectingparent can perform acts of both omission and commissionbecause of a lack of benevolence towards the child'.Child Protection: Messages from Research (DOH, 1995)

identi®es families which are low on warmth and high oncriticism as being potentially harmful for children. It issuggested that chronicity and severity are important factorsin determining the level of harm experienced by the children.In families that are low on warmth and high on criticism,`negative incidents accumulate as if to remind a child that heor she is unloved' and the risk of physical neglect, physicaland, occasionally, sexual abuse is probably at its highest(DOH, 1995, p. 19).In a similar vein, Stevenson (1996, p. 14) argues that ìn

relation to de®nitions we should avoid compartmentalisa-tion, and think across the categories of emotional abuse,neglect and injuriesÐincluding minor ones'. Iwaniec (1995,p. 189) also takes the view that the term `maltreatment' ismore appropriate to describe all forms of child abuse andneglect as `there are more similarities than di�erences in thevarious characteristics and manifestations of abuse'.

Ìf a child is

homeless, is this

the responsibility

of her/his

parent(s) or

the state?'

`Neglect can

comprise

emotional and

physical elements'

Decision-Making in Neglect 99


Factors Associated with Child Neglect

It is now widely recognized that child abuse is a multi-factorial phenomenon, involving individual and familialcharacteristics interacting with wider social and politicalforces. The literature highlights a wide range of factorsassociated with neglect. The work of Polansky and hiscolleagues in America has dominated the medical/psycho-logical literature on child neglect. The focus is on thepathology of parents, particularly mothers. In their bookDamaged Parents: An Anatomy of Child Neglect, Polansky,Chalmers, Williams and Werthan Buttenweiser (1981,p. 117) conclude that:

`The mother's maturity or degree of infantilism was againunderscored, as was its expression in the forms of apathy-futility or impulsivity. The assumption that, among white low-income families the mother's personality plays the major role inhow well the children are protected, proved justi®ed.'

Christensen, Brayden, Dietrich, McLaughlin, Sherrodand Altemeier (1994) looked at the connections betweenmaternal self-esteem and parent±child interactions andfound that low maternal self-esteem appears to be a riskfactor for neglect. A review of studies by Klerman (1993)concluded that a strong link could be drawn between the riskof neglect and the age of the mother at the time of birth, withchildren born to teenage mothers being at increased risk.Certain parental behaviour, such as substance misuse, is seenas a major contributing factor of child neglect (Swadi, 1994).Other writers, such as Mueller and Silverman (1989) and

Moore (1994), all suggest that the causes of child neglect arecyclical in nature. Children who su�er neglect will becomemore detached and lacking empathy towards others. Thiswill a�ect their abilities as parents and lead to the risk of theirchildren experiencing neglect. The Bridge report into thedeath of Paul (1995, p. 4) asserts that:

`The children at greatest risk are those where the adult's ownchildhood was abusive or neglectful, resulting either in aninability to recognise the needs of their own children or thedevelopment of a need to impose their will at the expense oftheir own children.'

A major factor associated with neglect is that of poverty.Most cases of neglect that come to the attention of childwelfare agencies come from the most deprived sections of oursociety. It is often di�cult to separate early indicators ofneglect from those of widespread social disadvantage and

`Low maternal

self-esteem

appears to be

a risk factor

for neglect'

`Most cases of

neglect come from

the most deprived

sections of

our society'

100 Jones and Gupta


poverty (Parton, 1995). Although the majority of familiesliving in poverty do not neglect their children, the stress ofsocial deprivation and exclusion an in some families manifestitself in the neglect of children (NCH Action for Children,1996).Two recent studies have considered the factors associated

with families that have come within the remit of child protec-tion practice in Britain. Stone's (1995) study con®rmed thatneglect was multi-factorial. After considering factors relatingto parents/caregivers, he concluded that a large proportionwere signi®cantly damaged and disadvantaged people, whowere ill equipped, emotionally and practically, to care forchildren. The study con®rmed the importance of emotional/relationship factors as well as poverty and deprivation.Similarly Allsop and Stevenson (1995) highlight charac-

teristics of cases where there were components of neglect andwhich the social workers found particularly complex andchallenging. These families were mostly living in poverty;mostly single parents; nearly all had a long relationship withsocial services and in the majority the parenting washovering on the edge of `not good enough'.

The E�ects of Neglect

There are considerable methodological problems associatedwith research on the consequences of neglect. In particulardi�erentiating between factors that are consequences ofneglect and those associated with poverty and deprivationmore generally (Parton, 1995). However there is generalagreement that neglect has a detrimental e�ect on both themedium and longer term development of children.Much of the research considers the e�ect of physical abuse

and neglect, highlighting short and medium term e�ects onemotional development including low self-esteem andproblems forming attachments. Di�culties in social andintellectual functioning, such as poor peer relationships andschool performance have also been identi®ed. In the longerterm there are more tenuous links between abuse and neglectin childhood and mental illness, drug abuse, o�endingbehaviour and general adjustment to life (Corby, 1993).Where studies have di�erentiated between abused and

neglected children, de®ciencies in development, whensigni®cantly di�erent from the norm, seem to apply toneglected rather than physically abused children (Minty andPattinson, 1994). Dent (1996, p. 40) suggests that the avail-able evidence shows that children who experience neglect`have the most serious school related di�culties and that the

`The majority of

families living in

poverty do not

neglect their

children'

`Neglect has a

detrimental e�ect

on both the

medium and

longer term

development of

children'



signs of cognitive and socio-emotional delays manifest them-selves at a very young age'. A study evaluating parenting incases identi®ed as being about physical abuse found that apredominant style of parenting was not characterized byaggression and over-control, but inconsistency, laxity andunresponsiveness. Many of these children were assessed asbeing highly disturbed, which tended to support researchwhich suggests that such styles of parenting lead toaggressive and behavioural di�culties in the children(Pitcairn, Waterhouse, McGhee, Secker and Sullivan, 1993).Fitzgerald (1996) suggests that one factor that has in-

hibited recognition and appropriate intervention has beenthe belief that children do not die from neglect in the ninetiesin Britain. Paul's apparent slow and painful death fromchronic neglect challenges this view (The Bridge Child CareConsultancy Service, 1995). In their study of 35 child deathinquiries, Reder, Duncan and Gray (1993) found that severeand chronic neglect was the predominant form of abuse by anumber of caretakers.Key themes that can be drawn from the literature on the

nature of child neglect are its chronic nature, the importanceof contextual rather than incidental factors, the associationbetween poverty and child neglect, the multiple problemsfaced by the majority of neglectful families and the seriousharm that can be caused by neglect.

Neglect and Child Protection

The Social, Political and Organizational Context

The inquiry report into the death of Paul (The Bridge ChildCare Consultancy Service, 1995) was the ®rst major inquirydealing with a child death through neglect in the past50 years. However, in the latter half of the seventies and theeighties in Britain there was a series of child abuse inquiriesfollowing child deaths from physical abuse. The concentra-tion on physical abuse compounded the dominance of the`disease model' of child abuse in child protection discourse.This model emphasizes prediction on the basis of a numberof high-risk factors, individualized treatment and cure(Parton, 1990). Child abuse is conceptualized as a patho-logical phenomenon with its roots in the personality orpsychodynamics of the abusing parents. Social factors areseen only in terms of the characteristics associated withabusive individuals or families. The social and economiccontext of the family is not reviewed as being a signi®cantpart of the problem (Parton, 1985).

`The belief that

children do not die

from neglect in the

nineties in Britain'

`The concentration

on physical abuse

compounded the

dominance of the

``disease model'' '

102 Jones and Gupta


For most of the past two decades Britain has had a Con-servative government. The Thatcher government embarkedon the course of àuthoritarian populism'. This term de®neda politics that was able to link the traditional Tory values offamily, law and order and nation with the values of themarket, competition, aggressive individualism and the rollingback of the welfare state. The state has a dual role: residual inpromoting the market and authoritarian in developing a`strong state' in terms of defence, law and order and socialcontrol (Hall and Jacques, 1983). Within this context, theconcentration on the protection of children from seriousphysical harm has justi®ed the curtailing of wider preventa-tive measures including those aimed at the reduction ofpoverty and the improvement of general child welfareresources. Predicted abusers can be made into social outcastsand deviants, and the extent to which a whole society or classshares many of their problems of housing, income, educationand human relations is able to be ignored (Dingwall, 1989).Blame and guilt are key concepts. However, the attributionof blame is not con®ned to parents who abuse their children.In many of the child death inquiries it is directed towardfront-line workers, particularly social workers. The press,especially the tabloid press, further compounds the scape-goating of social workers. The e�ect of this blame culture onsocial work practice is immense. Sta� become depressed,anxious and demoralised, and as a result their work becomesboth defensive and routinized (Hill, 1990).Hallett (1989) argues that a key issue obscured by the focus

on individual action and responsibility is the resourcing ofthe child protection system. The resource crises in socialservice departments, which are directly and indirectly fundedby central government, contributed to the dominance ofchild protection work over other child care services and thedrift towards authoritarianism in child protection work itself(Frost, 1990).Another related development in child protection discourse

is the dominance of a socio-legal perspective (Parton, 1991).Social workers continue to be seen as central, but theagencies of the law (courts, police and lawyers) play a crucialrole in helping to constitute what the problem is and whatshould be done about it. For example, Gibbons, Conroy andBell (1995) found that other than social workers, policeattended child protection review conferencesmore frequentlythan any other profession.The publicity surrounding child abuse, the intense

scrutiny that departments experience when tragedies occur,the increased emphasis on dangerousness and use of the law

`The protection of

children from

serious physical

harm has justi®ed

the curtailing of

wider preventative

measures'

`The drift towards

authoritarianism

in child protection

work itself '



have all led to the prioritization of child protection work, inparticular the investigative and surveillance aspects ratherthan the therapeutic and preventative ones. Within thiscontext, it is the risk management model of child protectionprocedures which predominates. Risk is de®ned as dangerfrom a well-speci®ed, adverse outcome, with the focus onsafety rather than welfare (Allsop and Stevenson, 1995).

Responses to Neglect

As has been discussed, neglect is of a chronic, rather thanacute nature, and families where neglect is a feature generallyexperience multiple problems, including poverty. Researchand practice experience indicate that these families are oftenreferred to local authorities as `children in need', but due tothe concentration of resources on child protection, theyreceive little or no service (Aldgate and Tunstill, 1995; DOH,1995). For children in need there is no formalized system forinter-agency communication and case review, and the serviceo�ered to these children is often fragmented and piecemeal.At a conference, Little (1996) asserted that only one in10 families referred for neglect receive a service.The study conducted by Gibbons et al. (1995) into the

child protection system found that 17±32% of referrals to theresearch authorities were for neglect. In comparison withphysical and sexual abuse, referrals for neglect were muchless likely to reach the conference stage. Of the 66 sub-stantiated referrals identi®ed as being in the highest riskcategory, 36 (54%) were not conferenced. Although 12 ofthese received protection by other means, bypassing theconference, that left 24 (36%) `missed'. These children,apparently needing support and protection, did not receiveany service. A case conference was only held on Paul's familyfollowing concerns about sexual abuse. The issue of neglectwas discussed, but not seen as serious enough to warrantregistration (The Bridge Child Care Consultancy Service,1995).A study that considered 43 cases identi®ed as being of

concern because of physical abuse found that the parentingstyles of many of the respondents could be characterized asbeing neglectful; however, the focus of intervention was onprevention of further injuries, and the harm caused by theday-to-day management of many of the children failed to beaddressed (Pitcairn et al., 1993).There are many cases identi®ed as child neglect that do

reach the child protection arena. The numbers of casesregistered as neglect increased from 13% in 1991 to 26% in

`The focus on

safety rather

than welfare'

Ònly one in 10

families referred

for neglect receive

a service'

`Many cases

identi®ed as

child neglect do

reach the child

protection arena'

104 Jones and Gupta


1993 (Parton, 1995). In one inner London borough, duringthe year ending 31/3/96, neglect was the most frequentlyused category for registration (approximately 49%)(Khanam and Taylor, 1996). However, the studies by Mintyand Pattinson (1994) and Allsop and Stevenson (1995) foundthat even when cases of neglect were identi®ed, socialworkers had particular di�culties making decisions aboutwhen a situation had reached the `point of no return' andcompulsory intervention was necessary.It would seem that the present child protection system

frequently fails to identify and address the needs of childrenwho could be signi®cantly harmed by the neglectful contextof their lives: there are many complex and interlinkedreasons for this. The following section examines some of theparticular di�culties faced by practitioners operating withina child protection system developed to respond primarily toacute risks and abusive incidents.

Child Protection Decision-Making

Child protection in British society poses particular problemsand dilemmas for child welfare professionals. While the taskis to protect the child and maintain the child's welfare asparamount, there is a general view and acceptance that thefamily should remain free from state intervention. Theinherent tensions involved in state intervention in familiespose particular di�culties in cases of neglect; over recentyears in Britain there has been an increase in poverty anddeprivation, but a corresponding decrease in the resources ofchild welfare agencies (Parton, 1995).Dingwall, Eeklaar and Murray (1983) suggest that the

`rule of optimism' is used by workers as a way of managingthe inherent dilemmas of child protection practice. Inessence, the `rule of optimism' means that the most positiveinterpretation is put upon the behaviour of parents andanything that may challenge this is discounted or re®ned.The main components of the rule are two ìnstitutionaldevices'Ðcultural relativism and natural love. Culturalrelativism refers to the assumption that all cultures areequally valid and therefore there are no grounds for makingmoral judgements about another culture. Natural love refersto the belief that the relationship between a parent and achild is instinctual and stems from basic human nature.Families referred for neglect are often living in circum-

stances characterized by poverty and deprivation. It could bethat due to `cultural relativism', professionals, who arefrequently middle-class, do not wish to make judgements

`Social workers

had di�culties

making decisions

about when

compulsory

intervention was

necessary'

Àn increase in

poverty and

deprivation, but a

corresponding

decrease in the

resources of child

welfare agencies'



about poor families. Workers may fear being labelled`classist'. An example of the rule of optimism in practice isdemonstrated by the Paul report, where the prevailingperception of the professionals was that the children were`dirty and smelly, but happy' (The Bridge Child CareConsultancy Service, 1995, p. 151).The report into the death of Paul draws on the work of

Rosenberg and Cantwell (1993; cited in The Bridge ChildCare Consultancy Service, 1995, p. 4). They argue that adistinction must be made between neglect caused by materialpoverty, which can be alleviated by ®nancial help, and thatcaused by emotional poverty. These may both exist withinfamilies, but relief of the material poverty does not relieveemotional poverty. In the current climate of limited resourcessuch distinctions are not easily made, and the di�cultiesfacing practitioners deciding when and how to intervene incases of child neglect are compounded.The balance that practitioners need to achieve is to

support and empower parents while still maintaining thechild's welfare as paramount. Workers can, through theiridenti®cation with the oppressed position of the parent, losesight of the needs of the child. Given the multiple problemsmany neglectful parents face, their needs can frequentlydominate and they become the primary client. In a systemwhere issues of blame and guilt are central, workers can ®ndit hard to make judgements about the culpability of vulner-able and disadvantaged parents (Stevenson, 1996).Issues of blame and guilt are also important for parents.

Farmer and Owen's (1995) study considered three dimen-sions of agreement or disagreement between parents andprofessionals about abuse and neglect. These dimensions arecommission, culpability and risk. In a number of cases ofemotional abuse or neglect there was disagreement on allthree dimensions. There was more likely to be agreement incases of sexual and physical abuse. The researchers foundthat in many cases where a number of general concerns abouta child had led to a conference and registration for emotionalabuse or neglect, the parents fundamentally questioned thelegitimacy of child protection intervention. It would seemthat in many cases of neglect, the necessary focus on thecontext of children's lives rather than on speci®c incidentsleads to di�culties in working in partnership with parents toachieve child-centred goals.One ®nal point needs to be made with regard to inter-

vention in cases of child neglect. The Paul report highlightsthe lack of entries in professional records about what thechildren were saying (The Bridge Child Care Consultancy

`But relief of the

material poverty

does not relieve

emotional poverty'

`Lack of entries

about what

the children

were saying'

106 Jones and Gupta


Service, 1995, p. 171). The Memorandum of Good Practice(Home O�ce, 1992) details guidance for social workers andpolice o�cers investigating criminal o�ences; however, thereis no o�cial guidance for social workers interviewingchildren about the context of their home environment. Thepowerlessness of children and the dominant view of thesanctity of the family inhibits the experiences, wishes andfeelings of many neglected children being heard and takenseriously.

The Way Forward

In the past 2 years there has developed a widespread debateabout child welfare provision in Britain, which is consideringhow resources can be shifted from investigative services tothe provision of a wider range of family support services thataddress the welfare needs of children and families. A majorcatalyst for this `refocusing' debate has been Child Protec-tion:Messages fromResearch (DOH, 1995), which encouragesa perspective that views cases às children in need wherethere may be a protection problem' (p. 48).

These changes o�er the possibility of more e�ectiveservice provision for cases of child neglect. A wider range ofsupportive services for children in need should lead to easieraccess at an earlier stage, and closer attention to the contextof children's lives could result in more e�ective identi®cationof children's needs. However, it is crucial to remember thatfor some children the prolonged nature and severity of theneglect they are experiencing will warrant stronger protectivestrategies. Thorough assessments and intervention that haveclear aims and objectives and are reviewed within a multi-agency framework are required for children in need. Workersand supervisors also need to develop a re¯ective style ofpractice that considers how power relationships, such asthose based on class, age, race and gender, may be in¯uenc-ing their ability to maintain a child-focused practice.However, as Parton (1996, p. 10) argues, à whole range of

bodies, including central government, have to both acceptand take responsibility for the current situation and developnew ways of responding'. An understanding of the historical,social and political context of child welfare provision needs tounderpin the debate. In particular, the di�culties faced bysocial service departments in providing support and protect-ive services for children in need when poverty has increasedand local authorities face major resource constraints must beconsidered (NCH Action for Children, 1996).

`For some children

the prolonged

nature and

severity of the

neglect will

warrant stronger

protective

strategies'



Conclusion

This paper has explored the nature of child neglect andreviewed the di�culties professionals face in the currentcontext of child protection practice. The analysis hashighlighted the inadequacies of a system designed primarilyto protect children from acute risk. By examining the social,political and organizational context of child protectionpractice, this paper has demonstrated the necessity forchange at various levels. Universal services aimed atimproving the social conditions of millions of families inBritain who are living in poverty are required, as areincreased preventative family support services.Researchers, policy-makers and practitioners must also

address ways in which the child protection system canfacilitate the development of practice that supports andempowers vulnerable parents while still ensuring the child'swelfare is paramount. When working with neglect, a holisticassessment of the context of a child's life needs to be under-taken over a period of time. Supportive intervention which ispurposeful and regularly reviewed within a multi-disciplin-ary framework is required in order to evaluate the factorscontributing to the neglect, particularly the impact ofmaterial poverty. This `whole picture' approach must alsoinclude the voices of some of the most powerless and vulner-able children in our society, who may also be inhabiting aworld characterized by emotional poverty.

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Documents

The context of decision-making in cases of child neglect