Children are particularly at risk if they become involved in the patient’s delu-sions.
PERSONALITY DISORDER
Individuals with a severe personality disorder tend to suffer from a chronic lack of empathy, and awareness of other people’s rights and feelings. They tend to abuse illicit drugs and alcohol in order to numb the pain of their existence.
They have usually experienced abusive and/or neglectful parenting, and may have a considerable criminal record. Some are prone to making threats of injury to others and self-harm, sometimes in the presence of partners and children.
Some may enjoy hurting other people.
Issues of whether and when it is safe to allow children, especially young children, to live with birth parents with a personality disorder or schizophre-nia, severe depression or bipolar disorder need to be dealt with by multi-disciplinary discussion, involving psychiatrists, social workers, GPs and rela-tives, and not simply by social workers or psychiatrists.
These situations are not the only ones in which children get neglected. The children of parents with moderate or severe learning difficulties may lack adequate care and control unless there are other supports in the community;
and the same could be said of a number of parents who suffer from chronic and severe physical illnesses and disabilities.
recognize it as a reality, and realize that the greater part of child neglect is emo-tional. We need to react in ways that help parents become better parents (where that is possible) and create opportunities for neglected children to catch up, as far as is feasible, on the severe deficits and distortions in their lives and develop-ment. However, there will be cases where parents cannot or will not change, and the only means of protecting a child from further deficits in parenting is his or her long-term removal.
Messages for practice
· Neglect is a serious form of child maltreatment.
· Child neglect (both physical and emotional) is often found with other forms of maltreatment.
· Emotional child neglect can be defined as a persistent failure to attend to children’s basic emotional needs, although physical neglect, by itself, always involves emotional neglect.
· Emotional neglect arises out of failures of omission rather than commission.
· Emotional neglect frequently only comes to light when other forms of child maltreatment are being investigated.
· Emotional neglect implies indifference to the child’s basic emotional needs – to his or her distress and achievements and need for control, guidance, security, protection, praise and affection.
· Emotional neglect seems to occur particularly in situations where the parents are preoccupied with other concerns, for example, in
situations of marital violence, and where marriages end in increased bitterness. It is also frequently found in situations where parents are dependent on alcohol or drugs, or suffer from mental illness or disorder.
· On the whole, emotional neglect is not usually a specific event, or series of events, but the daily atmosphere in which neglected children have to live.
· Certain negative parental styles, for example, a rejecting style, are often associated with emotional abuse and neglect.
· Recognition of emotional neglect often depends on careful
observation and listening. Practitioners need to have a repertoire of questions which elucidate the extent to which parents appear to be adequately and sensitively involved in caring for and controlling their children.
Is This Child Neglect?
The Influence of Differences in Perceptions of Child Neglect on Social Work Practice
Jan Horwath
Introduction
A social worker participating in a research study of child neglect asked the fol-lowing question:
How do I know what I consider to be neglect is the same as everyone else working with the child?
At one level the answer appears obvious; there are both working definitions of neglect and lists of signs and indicators. However, the definitions and the lists are open to individual interpretation and this is where the differences described by the respondent can occur. Lally (1984) notes that different perceptions of child neglect are determined by cultural agreement and belief systems, social systems and the personal views held by individuals. Sullivan (2000) summa-rizes ways in which these views influence both professional and media attitudes towards neglect. In an overview of the literature she found the following beliefs exist about child neglect:
· child neglect does not have serious consequences
· it is inappropriate to judge parents involved in poverty-related neglect
· child neglect is an insurmountable problem
· other forms of child maltreatment are more compelling
· ambiguity and vagueness make it difficult to define neglect
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· child neglect provokes negative feelings and is therefore marginalized.
It is against this backcloth that social workers, together with other profession-als, have to struggle as they make assessments and plan interventions in cases of child neglect. Social workers have a key role to play in assessing cases of child neglect. If the family, members of the community or other professionals are concerned that the needs of a child are not being met as a consequence of neglect then the child should be referred to the social services department for an assessment of the needs of the child and the parents’ ability to meet these needs. The social worker is usually responsible for co-ordinating this assess-ment through working together with the child, the family and other profes-sionals. The early 2000s have been a period when significant attention has been given to standardizing assessment practice in Great Britain; this is exem-plified by the introduction of the Framework for the Assessment of Children in Need and their Families (Department of Health 2000) in England and Wales. The Framework emphasizes that standardized practice is most likely to occur if the use of professional judgement is informed by an evidence-based approach towards a case. However, if social workers are to achieve better outcomes for children and families, it is necessary to reflect on the factors that can influence the way in which they make judgements. Using the findings of an Irish study of social workers’ practice in cases of child neglect together with other reported studies in this field the chapter begins with an analysis of the factors that can influence social workers’ assessments and interventions in cases of child neglect. The chapter concludes with a practical exploration of the lessons learnt from the studies together with a framework for assessment to assist social work practitioners in identifying ways in which their beliefs influence their practice.
Child maltreatment services in Ireland are managed on a regional basis by ten local authorities known as health boards. Each region divides into commu-nity care areas with social work teams working in child care. The team is made up of three different types of workers: social workers who take the lead respon-sibility for investigating cases of child maltreatment, family support workers who work in the home with carers to develop their parenting skills, and com-munity child care workers who work primarily with vulnerable children. The study details are included in Box 5.1.
Four themes were identified as a result of the analysis which give some insight into the ways in which differences in perception of child neglect influ-ence the way social work departments define and work with cases of child neglect. These are:
· the effect of individual beliefs
· the influence of the team in establishing working definitions of child neglect
· the assessment process: differences between theory and practice
· the use of language.
Box 5.1 The study Aims
The study sought to:· identify front-line workers’ understanding of child neglect
· increase understanding of the factors which inform decision-making when assessing cases of child neglect
· explore professionals’ perceptions of their professional and organizational needs
· make recommendations to the senior management team regarding ways of standardizing agency responses to the assessment of child neglect.
Methodology
· An audit of case files was completed. The aim was to identify ways in which front-line child care workers actually worked with child neglect. The advantage of an audit is that it provides recorded information about the child and family, details of their involvement with the health board and an outline of the services provided.
· An anonymous postal questionnaire was designed to collect quantitative and qualitative information regarding ways in which staff believe they work with child neglect. The questions were designed:
· to elicit detail regarding themes that emerged from the case audit
· to begin to explore the attitudes of respondents towards child neglect
· to identify the professional and organizational factors they believe influence practice.
· Peer-based focus groups provided opportunities for staff to explore the themes that emerged from both the case audit and questionnaire and to consider ways in which both themselves and the managers within the health board could develop practice in cases of child neglect.
THE SAMPLE AND DATA COLLECTION
A randomly selected sample of 57 cases from the different social work teams designated as cases of child neglect were read and qualitatively analysed by the researcher using a standardized content analysis frame-work. The framework was developed based on knowledge of file content obtained from reading a randomly selected sample of child care files prior to the case audit.
All front-line child care staff, practitioners and managers, were sent the questionnaire. There are potentially 75 front-line staff employed in child care teams. However, long-term sickness and staff vacancies meant the potential sample size was reduced. Information was not available regarding the actual level of absenteeism and unfilled posts at the time the questionnaire was sent out. Based on a sample size of 75 a response rate of 40 meant a 53% response rate. However, it would seem the actual response rate was higher than this bearing in mind the number of avail-able staff.
Four focus groups were held. All staff working in child care fieldwork teams at the front line were invited to attend the focus groups. Three child care teams operate within the health board. Each team had its own focus group. This provided opportunities for data to be obtained to compare and contrast the views held by members of the different teams. Managers were invited to a separate group to avoid practitioners being placed in a position of being intimidated in expressing their views because of the presence of their manager. Nine managers attended this focus group.
Analysis
· The researcher collated the data regarding the case audit using the standardized content analysis framework. An analysis of themes and sub-themes of the framework content was completed.
· The quantitative data in the questionnaire was analysed using SPSS and content analysis was used to identify themes from the qualitative data.
· Content analysis was also used for the focus group data.
Limitations
The study is small-scale and based on the views of social work practitio-ners and managers working in a region of the Republic of Ireland. One cannot make national or international generalizations about social work practice in cases of child neglect based on the findings from this study.