A Review of Child Neglect in Scotland

DO WE KNOW HOW MANY CHILDREN CURRENTLY EXPERIENCE NEGLECT IN SCOTLAND?

Definition

In order to gauge the extent of neglect it is important to know what it is. In Scotland, all Child Protection Committee (CPC) areas use a formal definition of neglect, most commonly that used in the National Guidance for Child Protection in Scotland:

Neglect is 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. It may involve a parent or carer failing to provide adequate food, shelter and clothing, to protect a child from physical harm or danger, or to ensure access to appropriate medical care or treatment. It may also include neglect of, or failure to respond to, a child's basic emotional needs. Neglect may also result in the child being diagnosed as suffering from 'non-organic failure to thrive', where they have significantly failed to reach normal weight and growth or development milestones and where physical and genetic reasons have been medically eliminated. In its extreme form children can be at serious risk from the effects of malnutrition, lack of nurturing and stimulation. This can lead to serious long-term effects such as greater susceptibility to serious childhood illnesses and reduction in potential stature. With young children in particular, the consequences may be life-threatening within a relatively short period of time.
(Scottish Government, 2010a, paragraph 36)

It is also important to consider the grounds for referral to the Reporter as set out in the Children (Scotland) Act, 1995. Given the wide-ranging effects of neglect it could be the backdrop to any or all of the grounds. For example, neglected children may be beyond parental control, failing to attend school, committing offences or misusing substances. The ground at 52(2)(c) may appear to be the most directly equated with neglect and it is this that we have explored in more detail in this report to analyse prevalence:

...that the child - ...
is likely-
(i) to suffer unnecessarily; or
(ii) be impaired seriously in his/her health or development, due to a lack of parental care.

The ground is elaborated in the 'requirements of referrals'^[1] thus

• There must either be some lack of care of the child or a likely future lack of care, by a person who has parental rights and responsibilities, or by someone who ordinarily cares for the child, or would/will care for the child;
• The lack of care, or likely lack of care, need not be intentional
• There must be a link between the lack of care, or likely lack of care and the effect, or likely effect, on the child
• The effect, or likely effect, on the child must amount to unnecessary suffering or serious impairment of health or development. (There is a legal interpretation of these terms that the Reporter is in a position to assess)
• The child's physical, mental or emotional health is relevant
• The parental care of other children may be relevant
• Living in a family environment characterized by domestic abuse may have a significant effect on a child where the child's exposure to the domestic abuse is due to a lack of care on the part of his/her parent or carer
  (eg. the domestic abuse is perpetrated by the father on the mother).

National statistics

According to the most recent estimates of population released in 2011 by the General Registrar Office for Scotland for the year 2010, there were 911,794 children and young people living in Scotland under the age of 16.There is no one statistical source to tell us how many of these children are, or may be, experiencing neglect in Scotland. Instead we need to consider a variety of responses to help piece together this complex jigsaw.

Child protection statistics

In 2009-2010 a total of 13,523 children were referred to local authorities for child protection concerns, but the national statistics do not tell us what proportion of these were as a result of concerns about neglect. Statistics are recorded for the primary reason for registration on the Child Protection Register, not all the reasons; consequently, cases where neglect may be a contributory but not the principal cause of concern are not recorded as 'neglect cases'. We also do not have national figures about children who are not on the child protection register, but are receiving services from local authorities as a result of lack of parental care. Finally, there is little information about the experiences of the children referred but ultimately not registered, the characteristics of their families and communities, and the services they receive.

What we do know is that in 2011, neglect remained the most common reason for registration or initial category of those made subject to a child protection plan. The figures differ between the four nations of the UK, which is partly due to how the information is recorded, however table 1 shows that concerns about neglect have steadily risen or remain high in terms of the percentage of total registrations or child protection plans.

Table 1 Number of children on child protection registers or subject to a child protection plan for neglect (as primary or only reason) at 31 March 2011 (or 31 July 2011 in Scotland)						% of registrations or child protection plans where neglect is the primary or only reason
Nation	2007	2008	2009	2010	2011	2011
England	12,500	13,400	15,800	17,200	18,700	44%
Scotland	1,275	1,166	1,249	1,098	1,050	41%
Wales	1,125	1,095	1,120	1,180	1,265	44%*
Northern Ireland	569	665	706	682	654	27%*

* Both Wales and Northern Ireland collect information where neglect only is the reason for registration and also record the number of cases where neglect is one of several reasons for registration. If all cases are considered then neglect features in 50% of registrations in Wales and 47% in Northern Ireland.

Looking at Scotland in more detail we can see that although there is a slight reduction in the numbers from 2009, neglect still accounts for the major reason that children are registered (see table 2).

TABLE 2 Number of children in Scotland on child protection registers by category or abuse/risk identified
Category of abuse/risk	at 31 March				at 31 July
	2007	2008	2009	2010	2011
Physical injury	585 (23%)	509 (21%)	554 (21%)	485 (19%)	481 (19%)
Sexual abuse	240 (9%)	160 (7%)	190 (7%)	202 (8%)	231 (9%)
Emotional abuse	472 (18%)	572 (23%)	678 (25%)	727 (29%)	721 (28%)
Physical neglect	1275 (49%)	1166 (48%)	1249 (47%)	1098 (44%)	1050 (41%)
Failure to thrive	7 (0%)	10 (0%)	*	*	*
Unknown	14 (1%)	16 (1%)	*	*	*
TOTAL	2593	2433	2682	2518	2571

* represent small numbers that are suppressed to maintain confidentiality.
Source: Scottish Government (2012) Children's Social Work Statistics Scotland, No.1: 2012 Edition, CP 2010-11 - Additional Tables 6 and 7. Edinburgh: National Statistics

There are issues of accuracy and concerns about how information is interpreted by individual authorities which will impact on the figures:

It should be noted that different local authorities may classify child protection referrals differently. For example, some local authorities start the referral process at a different point and some local authorities do not include unborn children. As a result of these differences, comparisons across years and across local authorities should be made with caution.
(Scottish Government, 2010a, p7)

Prior to 2011 Child Protection Register returns had categorised neglect as a registration reason and were aggregated by Local Authority. They are now individualised and use a range of different indicators, including causal factors, as reasons for registration. The fields should allow for identification of children where neglect is the primary reason for referral, but also where neglect is a backdrop for other concerns, which could give a better picture of the true extent of neglect. However, this suggests that more sophisticated methods of analysing the returns will need to be developed.

With these limitations in mind it is possible to estimate the prevalence of neglect as formally identified within the child protection system. The figure of 1,098 (registrations for neglect in 2010) therefore represents 0.12% of the 0-15 population in Scotland. For every thousand children living in our communities, one child has been formally identified as being at risk and requiring services because of neglect. This represents only a small proportion of the approximately one in a hundred children who are referred for a range of child protection concerns.

Scottish Children's Reporter Administration figures

In 2010-2011, 39,217 children were referred to the Children's Reporter (SCRA, 2011) representing 4.3% of all children in Scotland. 13,006 of these children (or 1.4% of children in Scotland) were referred due to lack of parental care. Not all of the cases referred to the Reporter are referred onto the Children's Panel, but there were clearly sufficient concerns about the adequacy of the parental care received by these children to warrant a referral to the Reporter.

Currently, there is no cross-referencing of the data held by SCRA and the national child protection statistical returns. This means that we do not know how many of the children appear in both sets of statistics. A child should only be referred to the Reporter when there is a likely need for compulsory measures for the child, which suggests that the numbers should, in fact, be smaller than those on child protection registers rather than higher. Either way, it would be surprising if some children did not appear in both sets of statistics. Further, the child protection statistics tell us how many children are registered because of neglect, but not how many are referred because of neglect; whereas the SCRA figures tell us how many are referred for lack of parental care, but not how many are subject to compulsory measures of because of lack of parental care.

Taken alone, though, without scrutiny of figures in relation to the other grounds, these SCRA figures show that for every 100 children living in our communities, someone has a concern that one child is experiencing some degree of neglect. This is a much larger figure than the picture from registration. It is, however, closer, although still less than the findings of a comprehensive study of prevalence of maltreatment in 2009 across the UK. The NSPCC surveyed 4,036 respondents: 1,761 young adults aged 18-24 years and 2,275 children aged 11-17 years (Radford, 2011). The report concluded that almost one in ten of young adults (9%) and children (9.8%) had been severely neglected by parents or guardians during their childhood; or for every ten children living in our communities one had experienced some degree of neglect.

Local data collection

Our survey asked for information to help gauge the nature of data collection across services locally; that is, what statistics are collected and how they are collected in order to estimate the numbers of children at risk of or experiencing neglect.

As expected, respondents from all the areas (25 returns from a possible 32) reported that statistics were collected in relation to national statistical returns. However, we were also interested in finding out how services recorded the numbers of children they worked with who were experiencing or were at risk of experiencing neglect, over and above those appearing on Child Protection returns, in order to capture prevalence in a broader sense. A number of respondents to the survey commented on the complexities of this and of gathering information from across the range of child-focused and adult-focused services.

Nonetheless, six areas out of 25 were able to provide some figures from sources additional to child protection registration. These figures were described as being sourced from agency performance management data, from referrals to the Reporter to the Children's Hearing System or from referral information presented to early screening groups.

We do collect broader figures from various sources: mainly in relation to referrals from the NHS child protection unit at..., from... Police through the Vulnerable Persons' reporting system, from SCRA (referrals to and from the Reporter on care and protection grounds) and health visitor stats (the HP1 categories relating to core, additional and intensive support required). We can pull out which ones have neglect as the main or one of the categories identified, or at least lack of parental care which is arguably the same thing.
Survey respondent

Ten respondents, who said they did not collect figures over and above child protection registration information, did describe ways in which this wider information, or at least some of it, was being or could be collected. This was primarily through analysis of referral information and in some cases, required some 'drilling down', which was not currently being undertaken as a matter of course. In some areas this might involve looking at individual case records, but this was considered to be time consuming unless a system was put in place to do this.

Three areas stated that they were actively interested in developing data systems which would enable children's circumstances, including whether the child was at risk or experiencing neglect, to be recorded and collated. The same system would ideally be able to record children's progress towards identified outcomes and incorporate information useful for monitoring the effect of the GIRFEC approach. Consideration was being given to how this might be set up:

Currently we would have the numbers of children referred to social work but it is otherwise held in lots of different systems and not collated. It will be a challenge, too, in relation to tracking the impact of the Named Person system coming in. We would like a Framework for collecting such data and also for outcomes. We are developing a CareFirst front page so that health and education can complete referral info on the same system as social work.
Survey respondent

The phone interview with the voluntary sector representative indicated that data systems for recording reasons for referral and assessment outcomes, both of which included neglect as a category, were in place and could provide statistics at service, regional and national level. These agencies have been providing, and are increasingly required to provide, information about the numbers of families they work with and measurable outcomes for funding and commissioning purposes. Two local authority services reported that they are working with voluntary sector partners to develop systems that can be used by all services working with a family within their area.

We asked whether proxy data was collected in each area. For example, it is known that neglect is highly associated with any, or combinations of, parental substance misuse, mental health problems and domestic abuse; and it is also associated with parental learning disability (Cleaver et al., 2011). So we asked whether adult-focused services collected statistics of children whose parents' difficulties might mean that they were at greater risk of experiencing neglect. Three areas were able to provide some proxy figures, primarily from mental health, domestic abuse and substance misuse services although some of these related to incidents reported to the Police and some of the children would have been recorded within social work data systems and therefore likely to be counted twice. Other areas did not routinely collect this information:

This information is not routinely available for children experiencing neglect. Some adult services could tell you how many service users have contact with children and are good at assessing if there's a need to make a referral to Children and Families social work but this is not collated into an overall figure. It could be complicated with double-counting and would involve a nightmare of cross-referencing and there would be statistical inconsistencies.
Survey respondent

Several concerns were raised about the process of retrieving information, for example, double-counting can be a problem in the absence of single unique identifiers being used across systems:

If adult services are recognising neglect or potential for neglect of children of adults they work with they would be speaking to children's services anyway so will be recorded, numbers wise, within the referrals system. So there would then be a danger of double-counting. But also there may be neglect happening but it wouldn't necessarily be recorded as a referral due to neglect. And the adult service might be supporting parents and having a positive impact on the child's life so then they won't refer anyway. It's the same in schools - there's no mechanism for recording this if the school is dealing with it themselves. So we can't gauge the size of the problem through collection of proxy figures but we do it in other ways.
Survey respondent

The interpretation of terms and language has an impact, for example, if the term 'neglect' can be assumed to equate to the category of 'lack of parenting capacity' as used by some local authority data systems and 'lack of parental care' as used by the Scottish Children's Hearing System, then figures can be retrieved from sources such as 'reasons for referral' within services database systems. But more evidence would be required to test this assumption.

There are also differences across areas in the ways in which factors that may be associated with neglect or seen as causal factors (such as parental substance misuse) are recorded, and the outcomes (such as neglect) are recorded. Sometimes they are used inter-changeably, sometimes recorded separately. The meaningfulness of headers (and figures) needs to be clarified where there is an overlap between, or conflation of, labels of 'causal' factors and neglect.

Bearing these caveats in mind, table 3 highlights some of the sources for proxy data, but also how different areas may collect information in different ways, and that this currently is unlikely to be sufficiently reliable for estimating the prevalence of neglect locally.

Table 3 Data collected about children for whom there are concerns of neglect 2010-2011
Area	Child concern reports or referrals	Referrals from police, health or education	Multi-agency referral groups	Referrals to SCRA on grounds of care and protection	% of 0-15 population in area
Area A	2,230 (not only neglect)	955 (incident of domestic abuse involving children or parental mental as part of referral)	379 (pre-birth referrals and drug-related incidents involving parents)	421	20%
Area B	20 (S.22 referral)	166 (incident of domestic abuse involving children or parental mental as part of referral)	665 (parental substance misuse as part of referral reason	--	4.6%
Area C	239 (from parental substance misuse service)	305	163	--	1.3%

Some current developments, particularly in relation to measuring the numbers of children affected by parental substance misuse, are seen as having the potential to be applied more widely and if possible at a pan-Scotland level. This would require all services to sign up to information sharing and would at best incorporate local data collection which would incorporate 'areas of concern' for the child and measures of progress resulting from services involvement with the child and their family. One suggestion is that children's needs could be collated using the Named Person or Lead Professional system that is being put in place; the reasons for children being allocated to each Named Person or Lead Professional could be aggregated.

Summary

Both the national child protection statistics and the figures from SCRA provide information that is relevant to gauging the extent of neglect in Scotland. However, the absence of linkage across the datasets means that the extent of overlap is unknown.

The figures from the child protection statistics show that approximately one in a thousand children is on the register for the primary reason of neglect. The SCRA figures show that approximately one in a hundred is referred for reasons of lack of parental care. We do not know the extent of unmet need of children about whom people were worried, but whose circumstances were not judged to warrant registration or compulsory measures of care.

Local data collection is most reliable in relation to the requirements of national returns. Only six of the areas surveyed were able to provide us with additional data but no consistent picture of prevalence could be gauged from these. A further ten respondents described ways in which some figures which indicated the wider prevalence of neglect were being or could be collected, although in some cases this would require analysis of data that did not take place as a matter of course. There is interest in developing better systems for collecting and analysing data across adult and child services, but it would be necessary to address the complexities of labelling, double-counting and the range of different systems in use.