National guidance for child protection 2021: consultation report

Neglect

Q8: Neglect - The draft National Guidance defines 'neglect' as child abuse, where it:

"Consists in 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. There can also be single instances of neglectful behaviour that cause significant harm. Neglect can arise in the context of systemic stresses such as poverty and is an indicator of support needs."

Do you agree with this definition?

Q9: Neglect - Recognising that it is a complex area we also include some discussion about whether neglect should be defined as abuse where it is "a consequence of systemic stresses such as poverty."

Do you agree with this approach?

Stakeholder Event Themes

The main themes raised at the stakeholder events were:

Neglect is a very complex issue and hence is challenging to cover in guidance.

Overall, there was support for the specific coverage – some saw it as a focus – on poverty. However, there was also discussion as to whether linking poverty and neglect (in the definition) could be considered discriminatory?

It will be critical to avoid any stigmatisation of families in the coverage of poverty (and other systemic issues).

Different aspects of neglect could be covered - for example intentional or unintentional, direct or indirect, or emotional neglect.

If neglect is defined as being a persistent failure to meet the child's needs, then by definition, a single instance cannot be neglect. Perhaps there is a need to distinguish between chronic neglect and single episodes of neglectful behaviour?

A small majority of respondents (51% of those answering the question) agreed with the definition of neglect set out.

The largest proportion of respondents (48% of those answering the question) agreed with including some discussion about whether neglect should be defined as abuse where it is "a consequence of systemic stresses such as poverty."

Around 120 respondents made a comment at either or both of Questions 8 and 9. There was some cross referencing between comments made and there were common themes raised across the two questions. A single analysis across the two questions is presented below.

General comments included simply that the definition is clear, concise, appropriate, or inclusive of aspects of significant harm.

A broad and overarching theme highlighted by a number of respondents was that any definition and coverage of neglect should not infer the fault of parents and/or carers. Further comments included that it is vital that an intersectional lens is applied to any definition and where systemic stressors occur, neglect should not be defined as abuse.

Various 'definitions'

Many of the comments focused on there being varying definitions of neglect across the guidance. It was noted that the definition (as set out above) is found in Appendix A - Glossary of Terms, while in Part 1 there are four paragraphs defining neglect, and then neglect is defined again at the beginning of Part 4. The concern was that these definitions and references are inconsistent, including because:

• Part 1 does not reference that 'Neglect can arise in the context of systemic stresses such as poverty and is an indicator of support needs' (as above an at Appendix A).
• The definition at the start of 'Part 4 - Responding to neglect and emotional abuse' is different again, referencing the criminal definition of neglect but not making reference to poverty as a systemic stressor.
• There is inconsistency across the three definitions in the inclusion or exclusion of unborn babies.

There was a view that practitioners are unlikely to look to Appendix A for the definition of neglect, but rather will use the paragraphs in Part 1 as a working definition.

Overall, the consensus was that the definition of neglect should be consistent throughout the document.

There were also occasional references to the 'definition' in Part 4 being the preferred definition, or to a preference for returning to the definition used in the 2014 guidance. Reasons given for preferring the 2014 definition included that it covers omission (elements of unconscious/un-insightful/unknowing neglect etc.) and commission (elements of conscious decision-making a parent takes which prioritises their own needs over their child's etc).

Appendix A definition

Returning to the Appendix A definition (as set out in the question), it was described as clear or as offering a good description of neglect in the context of child protection. It was reported that the opening sentences of the Appendix A definition are consistent with the 'Working Together' definition and that this is welcome.

With reference to poverty, it was noted that the evidence for poverty as a contributory and causal factor in neglect is strong; those who commented generally supported its inclusion in the formal definition, although some respondents did not. One view was that 'Neglect can arise in the context of systemic stresses such as poverty and is an indicator of support needs' is not part of a definition but a contextual descriptor of possible cause. The connected suggestion was that, rather than make poverty stand out, a section on examples of systemic stressors should be added the guidance. A specific concern about including poverty was that it does not account for neglect that happens within more affluent homes.

There were also comments about whether poverty should be the only systemic stressor provided as an example. The relationship between neglect and poverty, along with the wider debate about systemic stresses and neglect, is discussed further below.

Ways in which respondents thought the definition, including with its reference to poverty, is helpful included:

• By increasing understanding of poverty as an indicator that children and families may need additional support. It will assist practitioners to carry out appropriate assessment, informing support plans that can better meet the needs of a child and their family.
• The inclusion of 'single instances' within the definition.
• By acknowledging the context of 'systematic stresses'.

However, there were also queries or comments relating to aspects of the definition, including:

• Whether the terms 'persistent,' 'serious' and 'significant' are required as qualifying words within the definition?
• There is a degree of logical inconsistency; if neglect is defined as being a persistent failure to meet the child's needs, then by definition, a single instance cannot be neglect.
• When considering assessment of neglect, does it need to result in 'serious impairment'? Perhaps impairment is sufficient to be considered neglectful.
• If there is reference to 'adequate' to describe aspects of care, further explanation and guidance would be welcomed - either in the section or in a linked document.
• The concept of psychological needs is unclear and will be open to interpretation by different professionals. The distinction between psychological needs and emotional needs is also not clear, with the latter a much more familiar term used in Social Work. If the term psychological is to be used, then it needs to be clearly defined.

Also in relation to emotional abuse, whilst the acknowledgement of emotional abuse and neglect within the document was welcomed, there was a query as to why the guidance also appears to suggest the term should not be used ('Descriptions in plain language are more useful than non-specific general terms like 'emotional abuse'. P.139).

There was reference to the Welsh definition of neglect, that Neglect means a failure to meet a person's basic physical, emotional, social or psychological needs, which is likely to result in an impairment of the person's well-being. It was noted to bring in the element of wellbeing.

Suggestions as to how the Scottish definition could be adapted or changed included:

• It is important to define the stage at which neglect becomes a child protection concern. The definition could read: 'Neglect is a failure to meet a child's basic physical and/ or psychological needs. Neglect becomes a child protection concern when it is has caused, or is likely to cause, significant harm to the child's health or development.'
• Changing the current first sentence to read: 'Failure to meet a child's basic physical and/or psychological needs, likely to result in the impairment of the child's health or development.'
• Amend the last sentence to: 'Neglect can arise in the context of systemic stresses such as poverty and can be an indicator of both support and protection needs.'
• The definition should state that there are two types of neglect: cumulative and persistent neglect or significant single events.
• While understanding the reason for the inclusion of 'single instances of neglectful behaviour', qualifying this statement to ensure it is not interpreted as a lower than intended 'threshold' of child protection intervention.
• The following clarification could be added: 'There may be instances where a single instance of neglectful behaviour by a person in a position of responsibility has resulted in actual serious harm or significant risk of serious harm which would constitute a child protection concern. However, neglect often arises from a persistent (i.e. a continuous or intermittent pattern) failure to meet a child's basic physical and/ or psychological needs which has caused, or is likely to cause significant harm to the child's health or development.'
• The last sentence of the definition, 'Neglect can arise in the context of systemic stresses such as poverty and is an indicator of support needs' should be used as the opening sentence.
• In order to avoid discriminating against families in deprived communities facing poverty, it should be changed to clarify that it is in the "context" of poverty that certain actions would be considered neglect, rather than because of poverty.
• Consideration should be given to including examples - as per the Part 1 and Part 4 definitions.
• Further refinement of the definition should take cognisance of the impending changes to the Children and Young People's (Scotland) Act 1937, section 12 and it would be helpful if the new definition reflected current legal thinking around whether there was sufficient evidence to prosecute or not, where neglect is identified.

It was also suggested that the language of the definition could be translated into 'plain English' for children, young people, and families to fully understand it.

In terms of elements that should be added to the definition, comments included:

• The impact of trauma, not only upon the child subject to child protection concerns, but also the life experiences of parents.
• Reference to non-organic failure to thrive (as per the 2010/2014 guidance).
• A reference to emotional need. Specifically, that 'psychological' should be replaced with 'emotional' to make the definition more user friendly. The intricacies of emotional neglect require further exploration.
• That neglect can be both wilful/intentional or non-intentional.
• That it can take place pre-birth. It was reported that neglect is a harm experienced by a high proportion of children and unborn babies on the Child Protection Register, and the plan to produce practice briefings linked to neglect, and to produce a national neglect framework and mapping resource to support the guidance, was welcomed.
• That neglect can also potentially be an issue for older children.
• That it happens within the online and digital environment.

There was a call for further clarity as to the intersection of this definition of neglect with legal and criminal definitions of 'cruelty' or 'lack of parental care'. It was also noted that the criminal definition of neglect is later in the document but that it may be beneficial to have this definition sitting alongside the main definition. The term 'wilful neglect' not being used within the guidance was welcomed. However it was noted that this test is currently still relevant from a criminal perspective.

Current coverage of neglect

General comments (either at Question 8 or 9) included that neglect needs a greater presence across the guidance, including through expansion of the section covering neglect in Part 4, through reference to examples to provide a framework for addressing neglect, and to operationalise strengths-based practice in partnership with families, or through grouping the neglect definition and practice information in one section.

It was noted that the word 'neglect' is often referenced alongside abuse, and there was a concern that this could lead to an over identification of neglect as a conscious abusive activity and reduce consideration of neglect as a reflection of either emotional or practical parenting capacity, including but not exclusively related to poverty.

Other concerns about the current framing of neglect included that the guidance needs careful revision to move away from blaming and shaming parents, especially when domestic abuse is involved. It was seen as important to highlight how coercive control and emotional abuse can play a role in the emergence of what might present as parental neglect.

There was a call for the discussion of neglect in cases involving domestic abuse be reframed to reflect the impact of the perpetrator's actions on the parenting of the non-abusive parent. It would be useful to highlight the kinds of perpetrator behaviour that might draw scrutiny and, through further embedding of Safe and Together principles, the coverage of neglect needs to reflect the importance of partnering with the non-abusing parent.

The importance of focusing on harm or risk of harm experienced by the child, irrespective of the motive of the parents or carers and the associated stressors affecting the family, was also highlighted. However, it was acknowledged that the response within a child protection plan will vary depending on the contextual circumstances.

Other comments or queries about the current coverage of neglect within the guidance included that:

• Reflecting some of the issues raised in relation to the definition, it is helpful that the guidance provides insight into single incidents of neglect, and the impact that these can have overall on a child's development. It underlines the importance of early action to support families.
• It is unclear why some health concerns (such as childhood obesity) are referenced with significant detail while others, such as multiple dental extractions and repeated attendances at Hospital Emergency Departments, are not.

Aspects requiring coverage or expanded coverage

In terms of elements that respondents wished to see given greater coverage across the guidance, it was suggested that a fuller discussion around 'significant risk of harm' may be helpful in supporting different agencies to agree on levels of concern and establish a consistent response when considering what support the individual child or family may require to minimise risk.

Respondents were also looking for further coverage on types of risk - physical, medical, educational and emotional, to provide greater clarity around the broad spectrum of concerns that can be encapsulated under the neglect heading. There was also reference to the many situational and factorial presentations of neglect, including the toxic trio of Parental Mental Health, Parental Substance Misuse and Domestic Abuse.

In addition to further coverage on types of risk, it was also suggested that coverage on the impact of neglect would be helpful. Specifically, the potential impact of neglect on physical, social and emotional health across the lifespan, reflecting the understanding of the impact of adverse childhood experiences (ACEs). There was also a call for further coverage of the cause, effect, and impact of neglect throughout a child's lifecycle, including the neglect of older children.

In terms of responses to neglect, comments included that the importance of early and preventative work to avoid circumstances of neglect should be given greater prominence, including the critical role of universal services and communities in identifying neglect at the earliest opportunity. It was suggested that this should reflect all of the Education workforce who hold important relationships with children, as well as Health, Police, the Third Sector, Adult Services, Housing Services and Community Safety. There was also reference to the potential of a 'Social Model of Child Protection'^[7] and to the Graded Care Profile and the recent work by the NSPCC to update it.

Other aspects of neglect that respondents wished to see included or expanded upon within the guidance were:

• Young carers and caring roles, including that neglect is sometimes present in homes where a young person is taking on a caring role, but is often overlooked and assumed to go hand in hand with caring.
• Inappropriate nutrition as a form of neglect.
• Language development and neglect. For example, that language deprivation or language delay, however it may have been caused, can pose a significant barrier to a deaf or disabled child in their ability to disclose abuse or harm.

Reflecting both the importance of the coverage of neglect, and also the complexity of the issues, one suggestion was that it may be useful to link the guidance to more specialised information about neglect rather than add to an already very extensive document.

Relationship between poverty and neglect

A common theme was that care needs to be taken in making connections between neglect and poverty, including that representing the link between poverty and neglect it is a difficult balance to strike. As noted above, some supported its inclusion within the definition, although it was noted that this must be covered in a way that does not stigmatise or blame people for being poor. It was suggested that it may be beneficial to include an explanation of what is meant by poverty and perhaps some operational information for practitioners.

There was concern that associating neglect with poverty begins to stigmatise families living in poverty and could create an erroneous assumption that where there is poverty there is neglect. It was reported that while poverty can be a contributing factor to a child experiencing neglectful care, there is no substantive evidence that poverty causes neglect. It was noted that:

• There are many children living in poverty who are not neglected.
• Neglected children may not be in poverty.

Although it was felt that the guidance is helpful in stating that neglect is not always linked to poverty, there was also a view that a broader narrative on the interplay that poverty has on neglect might aid understanding of when it should or should not be considered neglectful, or indeed abusive. It was noted that poverty is complicated by other issues which are more likely to be prevalent under such circumstances and that there is a broader explanation in Part 4. Tying this into earlier parts of the document might help strengthen the message.

It was seen as important to consider the complex interplay of factors which increase pressures on families, that it is critical that the guidance draws attention to the systemic impact of poverty on neglectful actions, and a need for child-centred support to families that addresses these impacts. The importance of being clear on the distinction between neglect arising in the context of systemic stresses such as poverty, which is an indicator of support needs, and neglect as understood as being deliberate or wilful, was highlighted. This distinction was reported as being of particular significance to families where a parent has learning/intellectual disabilities, including because these parents are frequently excluded from employment opportunities.

It was also suggested that the guidance given on neglect and poverty, particularly in Part 2 of the guidance, should include the steps to be taken to support families at a strategic level, such as by Child Protection Committees and Children's Services Planning Groups, and then what measures can be taken to address welfare inequalities at a practice level.

Other suggestions included that:

• It would be helpful if the multi-faceted nature of problems that poverty can lead to were identified and framed using an ecological approach.
• The importance of not missing the neglect of children who are not classed as 'in poverty' was highlighted. The guidance's reference to affluence and neglect, and neglect in adolescents, as areas often overlooked was welcomed.

Considering systemic stresses

While the increased focus on poverty was often welcomed, it was also noted that it is just one contextual factor and that there are many situations in which neglect can arise.

However, while seeing through a wide lens in relation to how neglect interacts with systemic factors was welcomed, it was suggested that here may be many risk factors within any case and the guidance may benefit from providing further clarity on how to separate these out from systemic stresses. For example, it was suggested that practitioners will need to be able to separate and identify risk factors in order to determine whether neglect is the consequence of systemic stresses, or if they are the consequence of other risk factors such as domestic abuse, substance use, relationship issues between parent and child or parental attitudes such as resistance/ hostility/disguised non-compliance with services.

There was a concern that the identification of only systemic stresses as a risk factor could limit understanding of other risk factors that require to be considered during assessment. Further, it may be these other factors that change the threshold from support to child protection. To avoid stereotypical views of neglect being developed, practitioners also need to be aware that neglect can occur in the absence of apparent risk factors.

Other systemic stresses or structural inequalities which respondents identified included:

• Poor housing.
• Low income and unemployment.
• Fuel poverty.
• Food insecurity.
• Geographical location, including differences between urban and rural contexts.

There were also references to parental learning disability, language barriers, parental level of education, domestic abuse, parental alcohol and drug use and disability and ill health.

In terms of the guidance, it was seen as important to emphasise cumulative impact, with connected points made that the added impact of families' interaction with the state and a range of services also needs to be taken into account.

In terms of the appropriate policy responses, as presented through the guidance, suggestions included that the focus should be on supporting and empowering, seeking to support families from the outset and where systemic stressors occur, they should be tackled on all levels and appropriate support provided to help the whole family.