Sinclair and Bullock (2002) noted in their report that the ethnicity of the children subject to serious case reviews was not routinely recorded or discussed within the reports they reviewed making it impossible to discuss the possible impact of racism.
There have been a significant number of well-publicized inquiries into the deaths of black children through abuse and neglect in the UK (London Borough of Brent 1985; Lord Laming 2003; Newham Area Child Protection Committee 2002). Occasional comments have been made by the public inquiry reports or serious case reviews about the impact of a child’s ethnicity on deci-sions made by professionals. For example, the inquiry held after the death of Tyra Henry concluded that the white social workers from Lambeth council tended to be too trusting of the family, and made assumptions about extended family, because they were black. On other occasions, such as in the serious case review report into the death of Ainlee Labonte, the child’s ethnicity was not
acknowledged or commented on (Newham Area Child Protection Committee 2002; Sinclair and Bullock 2002).
Lord Laming acknowledged in his report into the death of Victoria Climbié (2003) that:
Victoria was a black child murdered by her two black carers. Many of the pro-fessionals with whom she came into contact during her life in this country were black. Therefore it is tempting to conclude that racism can have had no part to play in her case. But such a conclusion fails to recognise that racism finds expression in many other ways other than in direct application of preju-dice. (p.345)
However, in the report of more than 400 pages written by Lord Laming, just under three pages of the report deal directly with issues of diversity. He made no recommendation relating directly to issues of diversity.
In fact there is very little research regarding cultural competence in child protection practice generally (Walker 2002), although there is acknowledge-ment of inequitable, oppressive and poor quality services to black and other ethnic minority adults, especially in relation to mental health (Bhui and Olajide 1999; Cole, Leavey and King 1995). Walker (2002) reminds professionals that, although it instinctively feels right, there is no substantive evidence to support the view that cultural or ethnic congruence between clients and staff is a good strategy to improve acceptability and accessibility. Although it is important, simply employing more minority ethnic staff cannot be assumed necessarily to improve services. Evaluations of what works and for whom are important.
Without this there could be an over-reliance on ethnic minority staff to provide
‘cultural and related expertise’ in what is sometimes a rapidly changing context.
Britain is a multicultural society, particularly in urban areas where the minority ethnic population can be as high as 20%–30%. There is evidence that child neglect is more likely to occur in families experiencing multi-deprivation factors and there is a disproportionate presence of minority ethnic communities in areas of high social need. Some of these families will have suffered before their arrival and as asylum seekers will suffer the stigma associated with this.
Accessing services and being honest about problems is inevitably difficult in a place in which you do not feel at home. For other individuals, where they live is indeed where they feel is home, but problems which make people feel different are emphasized by the real or perceived impact of racism even with the advan-tage of adequate finances and a good education. Working with diversity brings added complexity to the already complex work in child protection. However, it seems to us that the following is important in working with minority ethnic neglecting families:
· Make sure you have available to you the language that will enable the family to communicate their needs and views.
· Child development and the factors associated with fuelling distress in children are very similar across all races/cultures. Begin with a thorough initial assessment.
· Formulate a hypothesis but discuss it with others who have experience of the context in which the family live or from which they might have originated. Do this especially if your hypothesis is similar to a commonly held stereotype about that minority ethnic group. For example, ‘she’s running away because her father will not let her socialize with friends’ about a Muslim girl who might, in fact, be running away because of direct abuse.
· Make sure the interventions make sense to the children and families.
Sometimes particular families will give more status to religion, spirituality and perhaps fate than others might.
· Recheck your hypothesis frequently.
We acknowledge that none of this should be different for any client. However, we believe that reminding ourselves of basic good practice in relation to all children whilst acknowledging the increased complexity of working with diversity is important. Managing across race/culture can also be more difficult.
Supervisors have to challenge and be challenged and if evidence is based on
‘cultural knowledge’ held by either one then challenging is more difficult. We believe that a multicultural society is certainly an advantage but we also believe that working with diversity brings with it added complexity (real or perceived) which we have a duty to discuss and be honest about.
Messages for practice
Serious case reviews tend to deal with extreme cases where a number of factors are in operation (Reder and Duncan 1999). This means that it is not easy to predict exactly which cases will result in serious injury and/or death (Sinclair and Bullock 2002) or to isolate specific lessons for cases of neglect. However the following lessons are pertinent:
· Chronic neglect can and does kill. In the USA neglect is more likely to result in fatality than any other form of maltreatment, most commonly through physical injury due to lack of care.
· Neglect is viewed as the most damaging type of abuse over the long term. Neglected children face a multitude of risk factors known to impair development. Neglected children’s resilience is constantly under attack and they are at high risk of social exclusion.
· Poverty is unlikely to be the primary cause of chronic neglect.
However, poverty is a risk factor and thus increases the probability
of child abuse and particularly neglect occurring. The impact of this for social welfare and social policy considerations is important.
· Whereas physical and sexual abuse are in the main specific events that children are subject to, neglect and emotional abuse characterize the relationship between the parents and the child (Glaser and Prior 1997).
· Professionals have to share information and work together if risk is to be recognized and addressed. Communication between
professionals has repeatedly been found to be poor in serious case reviews both in relation to relational dynamics and
recording/sharing of information. Recording is generally poor across all professionals in the field of child protection.
· Remember that neglect requires a multi-agency response. It is impossible to conduct good assessments of neglecting families without the co-operation of other agencies. As well as co-operation it also needs a practitioner to take control and to co-ordinate activities.
· A multi-agency integrated chronology of events should be compiled, including background material, which enables all agencies to see a history of the family. This is a necessary tool for ensuring that agencies can then agree when the threshold for concern has been reached. Often one agency can have information that another agency is not aware of. Pulling together pieces of the multi-agency
‘jigsaw’ can change professional perceptions, dependent on the information available.
· Make sure that you have recorded evidence directly from the child and marry your information with measures of usual child
development. Use this in order to set realistic targets and as a constant check on harm to the child and constantly predict forward to assess if harm will become significant.
· Remember that the first few years of a child’s life are crucial in terms of cognitive and other areas of development. Neglect is
characterized by an absence of parental care and attention. Make sure you compensate by arranging a child-minder or nursery.
Children do not have the time it might take for an intervention to work. Make sure other protective factors are in place such as a good enough school. Neglected children may not be the highest on each agency’s priority list but their needs merged together mean that they will find it hard to benefit from interventions if they are not tackled quickly.
· Consider using a risk assessment tool – especially if you have been involved with the family for some time and have completed a comprehensive assessment. It is not easy in cases of chronic neglect to pull out from the mass of information those points that are alerting of danger. Practice wisdom is always important but standardized tools can enable workers to obtain a more objective view of difficulties within a particular family (Bridge Childcare Development Service 1999; Macdonald 2001); see also the tools in the Assessment Framework Pack (Department of Health 2000))
· Remember to use a theoretical model that fits current theories on neglect (see Box 9.2).
Box 9.2 Theoretical models: the work of Peter Reder and Sylvia Duncan
During the last decade Reder and Duncan (Reder and Duncan 1999;
Reder, Duncan and Gray 1993) have published extensively on child deaths and serious case reviews. Over 90% of abusing parents are neither psychotic nor criminal personalities but tend to be lonely, unhappy angry people under heavy stress. They bring with them their own experiences, especially of being parented, and their own resolved and unresolved con-flicts from these experiences. Their children have their own characteristics and psychological meaning for their parents that might or might not fit harmoniously with their parents’ expectations. Other significant factors are the context in which the family live which can exaggerate the situa-tion, as can the level of insight (or lack of it) that the parent shows regard-ing the effects of their parentregard-ing on their children, or particular demands on the relationship at any one time. In order to understand the meaning of the neglecting behaviour for the child, the context in which the behav-iour occurs must be examined.
Reder and Duncan have used this theory to form the basis of review-ing child deaths through abuse and neglect in order to understand what may have gone wrong. We believe that in cases of chronic neglect, this model will guide professionals to look at the various dynamics in the situ-ation, understanding the impact of lots of factors rather than over-emphasising particular factors and dealing with them one by one.
· The Assessment Framework (Department of Health 2000) does seek information relating to the parent, the child and the context in which they live. However we believe that useful though this information is, it will need to be seen in the context of fuelling factors in order to be a dynamic rather than a mechanical tool. The interactional model described by Reder and Duncan (1999) is a means of doing this.
· Attachment is a fundamental aspect of child development and understanding the parent–child relationship in the context of attachment theory and disorders is important (Ainsworth et al. 1978;
Bowlby 1969; Howe et al. 1999).
· Remember that in order to use theoretical models properly you need to know who is in the family and obtain information about
significant others. Draw a family tree and make a chronology. Look at risk factors in the adults and the children. Think about the whole family. Do not forget, as often happens, the men involved.
· Remember the difference between material neglect and emotional neglect. The provision of finance and services will improve the situation of children in need but will not improve the situation of those children maltreated through neglect.
· Remember that most children who die of abuse and neglect die when they are young. Look for risk factors even in the ante-natal period.
· Acknowledge that there is a shortage of experts in the field of child protection. Arrange for observations from different sources to be brought to a forum with a consultant/s from another discipline/s.
Observations can also lead to hypothesizing about the quality of attachment. Intervention may need to address this as simply working on a practical level may not improve the quality of attachment for the child with her/his parents.
· Remember to consider the hypothesis that developmental delay may be the result of maltreatment through neglect.
· If a case is frequently opened but equally frequently closed because it does not meet the threshold for risk (often referred to as the
‘revolving door family’) then do something different, for example seek consultation, read the file(s), use a risk assessment tool.
· Remember that although some children die of neglect, many survive but live dreadful lives. Remember the poor outcomes for children with chronic neglect. Put protective factors in place but recognize
that leaving the child in chronic neglect for too long will have effects that are not easy to reverse.
· Provide adequate social welfare in order that this can be a backdrop to the assessments in general.
· In considering resources required for practice and intervention, recognize that in many circumstances there is a rapid turnover of staff and that families move. Neglect and its consequences require relatively long-term intervention and so excellent recording is required if risk is to be assessed properly. Make interventions time-limited, clearly stating intended outcome, how you will recognize it and the hypothesis driving the intention. Make sure other professionals know and agree and that your actions are based on evidence-based practice. Make sure you put resources into the initial assessment as often the initial hypothesis sticks. Make sure you regularly review cases.
· Remember to consider auditing neglect cases within your organization. We know that neglect cases are frequently on the child protection register for the longest period. An audit of cases may raise issues that you can then follow up at a local level.
Conclusion
Serious case reviews can tell us a great deal about where practice can be improved in relation to neglecting families. Although the majority of child abuse deaths were probably not predictable, the literature suggests that repeat-edly the same mistakes are made. These relate to multiprofessional communica-tion, issues of confidentiality, lack of staff expertise and continuity and resources generally.
We contend that if children are to be better protected then there are some fundamental changes required both from individuals and from the agencies in which they work.
Social workers need to take personal responsibility for their work but they cannot by themselves perform all the tasks required. Believing that adults can do the unbelievable to those children that are desperate for their love needs a wider skills base than any one professional can bring.
Neglected children are amongst the least resilient. Advocating for them is important. In too many cases the large and busy nature of the school system mitigates against a nurturing approach that is so important to vulnerable children and the process of entry into secondary school still means that the most vulnerable children continue to have least choice. This ultimately affects
the self-esteem and self-efficacy of the child concerned, potentially leading to social exclusion.
Neglect is often, though not always, associated with those that are poor and deprived. This means that there needs to be the political will to help people overcome their problems, in order that they can care for their children safely, if this is possible. This in turn means respecting those that are brave enough to try work with them to stop child abuse and neglect. In the current climate social workers in particular are criticized for not intervening enough or intervening too much. Child neglect is complex. When the outcome of neglect can be as terrifying as death, society needs to appreciate the complexity of the issues raised and consequently the complexity of the solutions. Time and time again reviews completed after child deaths appear to point to simple solutions.
However the solutions are in reality not that simple.