Tackling child neglect in Scotland 2: rapid review of intervention literature

Building Blocks of an Intervention or Service

20. The literature identifies several factors to consider when designing or beginning to work with families experiencing neglect.

21. Clarifying the issues. When formulating an appropriate intervention for neglectful families, it is important to distinguish between inadequate parenting as a result of a lack of parenting skills and inappropriate expectations of their children versus inadequate parenting as a result of clear social and environmental, or parental risk factors, for instance parental depression, anxiety, problematic substance use, financial difficulties, homelessness or mental health difficulties. It may be necessary to intervene first with these contextual problems as far as is achievable, before it is possible to embark meaningfully on tackling neglect (Barth 2009; Garshater-Molko, Lutzker and Sherman 2002; Glaser 2011).

22. Individualised child-centred response. Each family should be considered as unique (Gershater-Molko, Luztker and Sherman 2002; Glaser 2011). Different interventions will need to be considered once there is an understanding of the issues and the child’s interaction with the caregiver. For example, Glaser (2011) describes parents who may be emotionally unavailable due to their own difficulties, parents who may exhibit hostility towards the child especially if the child also presents with behavioural problems, parents who have inappropriate, inconsistent or harsh expectations of the child, parents who use the child to fulfill their own needs and parents who fail to promote the child’s health, educational and social development. Each requires skill and expertise by professionals, but may require different interventions or a combination of inputs by several agencies. Interventions should focus on building the strengths of the parent, as well as teaching new skills and should be culturally sensitive, whilst guarding against setting different standards for children from minority ethnic groups (Gershater-Molko, Luztker and Sherman 2002).

23. Engaging the family. The research is clear of the need to engage effectively with families for interventions to have the greatest impact. Trust and respect are key components of effective engagement (Ingram et al. 2015; Pecora et al. 2012) with attention given to immediate needs and concrete services (Hearn 2011). Early engagement is critical to establishing a relationship, which can begin to address the family’s issues (Ingram et al. 2015; Long et al. 2015). The actions of professionals at this early stage are critical for family engagement. In one local service in the District of Columbia, the first 48 hours after the referral focuses on resolving an immediate issue the family has struggled with. The belief is that this quick response demonstrates a worker’s intent to help the family, builds trust and paves the way for further engagement (Ingram et al. 2015) and, no matter the circumstances, parents should be respected in their interaction with all professionals (Pecora et al. 2012).

24. Creating a safe environment. Creating a sense of safety for the child should be one of the first objectives of the intervention and is particularly important to focus for children experiencing neglect. In a more predictable environment, the child will be better able to develop adequate physiological monitoring and start learning from new experiences. This first phase of the intervention, to develop a safer environment at home, should be done in collaboration with those involved with the family. The safety of the living environment must be maintained throughout the interventions with the child and parent (Milot, St Laurent and Ethier 2016).

25. Increasing parenting sensitivity. Parents of neglected children have often been maltreated in their childhood (Milot et al., 2014) and the child’s manifestations of stress might evoke in them powerful feelings that are related to their own past traumatic experiences. Some neglectful parents may require nurturing and parenting themselves by service providers (Gershater-Molko, Luztker and Sherman 2002) as past traumas are likely to interfere with their parental role; parents with unresolved traumas are more at risk of adopting atypical parental behaviours associated with increased risk for the child to develop a disorganised attachment, however, this should be approached with caution as some traumatised parents may be fragile and not yet ready to receive support (Milot. St Laurent and Ethier 2016).

26. Comprehensive, multi-layered and flexible response. Responses or interventions need to be comprehensive multidimensional and flexible and address how child neglect is experienced within a family while acknowledging how issues such as poverty and social isolation may be experienced differently (Barth 2009; Daniel 2015; Hearn 2011; Qualitieri and Robinson 2012). ‘The current collection of interventions reflect attention “to pieces of the puzzle, ” when instead, the field should offer a comprehensive, flexible, and evidence-based approach.’ (Hearn 2011, p.721). This is echoed by Chambers and Potter (2008), who identify a need to think creatively about how to integrate services, rather than stack multiple interventions.

27. Programme design features. The literature identifies features of successful early intervention and prevention programmes: define clear objectives, monitor regularly, set clear achievable goal and modify the intervention based on the family’s needs (Qualitieri and Robinson 2012).

28. Addressing social supports and inclusion. Responses should also identify both existing formal and informal supports and assist families with developing new supports to help sustain gains made during the intervention (Hearn 2011; Qualitieri and Robinson 2012). Interventions need to take account of the fact that neglectful parents may have poor social skills that make it difficult to maintain relationships (Gershater-Molko, Luztker and Sherman 2002). Behavioral interventions have been successful in teaching interactional and social skills (Erickson & Egeland, 1996). The use of modeling, practice, and feedback can significantly enhance social skills and result in a strengthened social network (Gaudin, 1993a).

Summary points: Building an intervention

• It is important to distinguish between inadequate parenting as a result of a lack of parenting skills and inappropriate expectations of children versus inadequate parenting because of social and environmental, or parental risk factors.
• Each family should be considered as unique. Different interventions will need to be considered once there is an understanding of both the issues and the child’s interaction with the caregiver.
• Effective engagement is essential for interventions to have the greatest impact. Early engagement is critical to establishing a relationship and the actions of professionals at this early stage are critical.
• Creating a sense of safety for the child is particularly important to focus on for children experiencing neglect.
• Increasing parenting sensitivity is important and some neglectful parents may require nurturing and parenting.
• Responses or interventions need to be comprehensive, multidimensional and flexible and address how child neglect is experienced within a family while acknowledging how wider issues such as poverty and social isolation may be experienced differently by families.
• Features of successful early intervention and prevention programmes include: clear objectives, regular monitoring, clear achievable goal and modifying the intervention based on family need.
• Addressing social supports and inclusion, and assisting families with developing new supports to help sustain gains made is important.

Working with individual children, young people and families

29. Before considering the range of interventions identified within the research, it is important to remember the children, young people and families at the heart of this.

30. A recent study by Lutman and Farmer (2013) followed-up 138 neglected children in England who had been looked after and reunified after two years and then again three years later. Significant predictors of a child’s future wellbeing were persistent neglect and the presence of emotional and behavioural problems prior to the child returning home. After two years, half of the returns had broken down after two years, rising to almost two-thirds after five years. Rates of repeat neglect and abuse were also high: by the two-year follow-up, 59 per cent of the children had been abused or neglected after reunification and during the next three years, half of the children (48 per cent) with open cases had been abused or neglected. Fifty-seven per cent of the children had behaviour problems before reunification and their wellbeing was much poorer five years later than for the remainder.

31. In addition to the difficulties experienced by children before return, other factors associated with a child’s poorer wellbeing at follow-up were no conditions having been set for parents, lack of clear focus on key problem areas, unplanned reunions including those caused by pressure from the child, continued and lack of specialist help for parents. Although these findings were in relation to children who had been looked after because of neglect, the changes required for both children and adults to impact on outcomes are nevertheless relevant for children who live at home.

32. Much less is known and understood about how neglect is experienced by older children and young people. A recent study (Raws 2016) reported that one in seven (15%) 14–15 year olds lived with adult caregivers who neglected them in one or more ways – they may have shown little or no interest in them, not offered warmth or encouragement, made no effort to monitor or protect them or failed to promote their health. Neglected young people reported low wellbeing and a higher propensity than their peers for behaving in ways that may jeopardise their health or their prospects. The author acknowledges that this finding may underestimate the scale of adolescent neglect as they are based solely on the reports of young people who were attending mainstream schools – and not those in specialist provision, those without a school place or missing from the system, or those in private schools.

33. It is unclear how much a lack of care and support may affect a young person as there is a sense that teenagers have their own natural resilience, and may be making lifestyle choices albeit that those choices may be considered risky. This study revealed that neglected teenagers tend to report doubts about their competence, have little faith that anyone cares about them, feel pessimistic about the future and are dissatisfied with their lives overall. These findings underline the need to take adolescent neglect seriously, because young people who experience it are also likely to suffer a pernicious undermining of their wellbeing regardless of whether they exhibit other negative behaviours.

34. The responses from young people in the study found that adolescents who were deprived were more likely to experience neglect, however, this finding related to how deprived the young people felt themselves in terms of possessions, experiences or resources rather than to household deprivation. This does not mean there is a causal relationship between poverty and neglect as some parents of teenagers may choose not to spend money on goods and materials, but nor can poverty and the stresses it may bring combined with a failure to parent be ignored. The research also challenged notions of supervisory neglect for adolescents. A high level of supervision was found not to be linked to high wellbeing. This aspect of adolescents’ lives – of control, rules, sanctions and curfews – is one where the parent-adolescent relationship may be tested, and where young people themselves will have expectations and a desire to see change as they mature and want to have a stake in negotiating.

35. The review identified one study which focused particularly on the behaviour patterns of neglectful mothers (Wilson, Kuebli and Hughes 2005). The study gathered information on 100 mothers for whom neglect had been substantiated and was the primary referral concern and cluster analysis was used to describe patterns of maternal behaviour. The mothers were rated with differences in maternal confidence, relatedness, impulse control, and willingness to engage verbally. The team anticipated that two clusters would emerge broadly one describing a relatively higher level of desirable maternal characteristics and another describing undesirable maternal characteristics, however, five clusters emerged with mothers exhibiting a range of characteristics, which has implications for the approach to interventions; For some, individual work focusing on emotional support and reassurance is more appropriate while others are motivated to obtain support and produce self-directed change when provided with the needed environmental resources. These mothers are more appropriate candidates for group-based interventions. Once the circumscribed issues are resolved it is suspected that these families will be relatively resilient and be able to maintain the positive growth experienced with intervention.

36. Neglectful mothers were also the focus of a study by Hildyeard and Woolfe (2007) to investigate the cognitive processes underlying neglectful parenting. Based on comparisons of neglectful and non-neglectful mothers on several childrearing tasks, neglectful mothers had significant problems in information processing concerning their child’s emotions and behaviors; for example neglectful mothers did not always recognise the children’s behaviour in ambiguous risk situations. These deficits, such as poor and inaccurate recognition of infant or child emotions, may interfere with neglectful mothers’ ability to recognize infant signals of emotion and understand their behavior. Interventions aimed at improving parents’ abilities to recognise emotions in infants’ facial expressions may be an important part of treatment and prevention efforts.

37. A much less researched group is neglectful fathers One study (Scott and Stewart 2014) explored the dynamics of father-child interaction that may underlie fathers’ risk for abuse and neglect. Data derived from structured interviews of 121 maltreating fathers were used to discern differential patterns of abuse-related problems in parenting. Five patterns of harmful parent-child interaction were explored: (1) emotional unavailability, unresponsiveness and neglect; (2) negative attributions and misattributions to the child, including hostility, denigration and rejection; (3) developmentally inappropriate or inconsistent interactions, including exposure to domestic violence; (4) failure to recognize or acknowledge the child’s individuality and psychological boundary; and (5) failing to promote child’s social adaptation.

38. The team found that for all patterns, except failing to promote children’s social adaptation, problems were noted for at least half of the fathers, with particularly high rates in the areas of emotional connection and psychological boundaries. Analyses also revealed that maltreating fathers were most clearly differentiated by the degree of the severity of dysfunction (i.e., low, moderate, or high) in their relationships with their children. In combination, then, results support the need to consider both the severity of problems evidenced by fathers and the specific pattern of difficulties to be addressed.

39. Fathers in the ‘severe’ group had the greatest difficulties in all five dynamics examined and were the only fathers reported to have problems related to failures to promote children’s social adaptation. Particularly notable about this group was their very low level of emotional availability to their children. A revealing finding was that the most nearly three-quarters of the fathers lacked an emotional connection to their children and described relationships characterized by emotional unavailability and unresponsiveness. The observed problems with responsiveness are in contrast to commonly held stereotypes that tend to emphasize fathers’ rigidity and harshness. While not absent from descriptions, fathers’ lack of responsiveness and emotional connection is not often identified as a risk factor in and of itself (Scott and Stewart 2014).

40. Such results have implications for intervention, pointing to the need to provide fathers with opportunities to build strong emotional connections with their children. Intervention needs to begin by increasing fathers’ awareness of problems in emotional connection, which may need fathers to take responsibility for past harmful and abusive behaviours. Following such awareness, fathers may need to develop skills for responsive parenting in general, or may need support in more limited and specific areas (e.g., discussion of separation or case involvement).

Summary points: Children, young people and families

• Significant predictors of a child's future poor wellbeing was persistent neglect, the emotional and behavioural problems in the child not addressed, lack of clear focus on key problem areas and continued lack of specialist help for parents.
• Less is known and understood about how neglect is experienced by older children and young people. One in seven (15%) 14–15 year olds live with adult caregivers who neglected them in one or more ways and neglected teenagers tend to report doubts about their competence, have little faith that anyone cares, feel pessimistic about the future and are dissatisfied overall.
• How neglect manifests in maternal behaviour varies and is not simply a lack of ‘good’ maternal characteristics. This has implications for interventions to be most effective, for example, whilst some benefit from group based interventions others do not.
• Neglectful mothers do not always recognise the children’s behaviour in ambiguous risk situations and may have poor and inaccurate recognition of infant or child emotions.
• Fathers, who abuse and neglect, range in the severity of dysfunction in their relationships with their children. Fathers with the greatest of difficulties often show very low levels of emotional availability and connectedness to their children. Interventions need to begin by increasing fathers’ awareness of problems in emotional connection.

Evidence-based interventions and programmes

41. A range of interventions and programmes have been subject to differing evaluations from randomised and non-randomised controlled trials through to case studies.

Childhood behaviour problems

42. Many meta-analyses and systematic reviews covering an evidence base of over 100 studies conclude that behavioural parent training is particularly effective in ameliorating childhood behaviour problems, with gains maintained at a 1-year follow up, particularly if periodic review sessions are offered (Carr 2014). Some programmes can be broadly characterised as behavioural parent training including Parent–child interaction therapy ( PCIT), the Incredible Years parent training ( IYPT) and Positive parenting program (Triple P).

43. A critical element of behavioural parent training is helping parents develop skills for increasing the frequency of children’s prosocial behaviour (through attending, reinforcement and engaging in child-directed interactions) and reducing the frequency of antisocial behaviour (through ignoring, time-out, contingency contracts and engaging in parent directed interactions) (Forgatch and Paterson, 2010). Immediate feedback, video feedback and video modelling have been used in effective behavioural parent training programmes which allows parents to be directly coached by the therapist through a ‘bug-in-the-ear’, watching videotaped episodes of themselves using parenting skills with their own children or viewing video clips of actors illustrating successful and unsuccessful parenting skills (Carr 2012). However, as Carr identifies from a meta-analysis of thirty-one studies (Reyno and McGrath 2006 cited in Carr 2012) parents with limited social support, high levels of poverty-related stress, and mental health problems derive the least benefit from behavioural parent training.

44. Another application of technology is through the use of smart phones to deliver one module of a home-based intervention designed to minimise risk of unintended injury of under 5s. SafeCare is an evidence-based program of three skill-based modules that address risk factors for physical abuse and neglect: parent-child interactions, health care, and home safety. One study (Jabaley et al. 2011) focused only on the safety module of SafeCare. Training begins in the room with the greatest number of hazards. Following the initial assessment, the home visitor supports parents as they gradually take responsibility for securing rooms. The effectiveness of iPhone and video was examined using a multiple baseline design across in-home settings replicated across families. Home hazards were reduced dramatically across rooms and across participants. Face-to-face time of the home visitor was progressively reduced and replaced by video data collection. These data suggest smartphones are promising for data collection and for augmenting face-to-face interactions. However, the authors note some limitations in use of technology [video material not always reliable; engagement may have been affected by novelty of access to iphone for participants].

45. The Incredible Years Parent Training Program has been implemented as a universal school-based prevention program. The programme is aimed at children aged 3 to 12 years, is founded on social learning theory and consists of at least 12 weekly, two-hour group sessions delivered by skilled practitioners. The program includes separate training programs, intervention manuals and DVDs for use by trained therapists, teachers and group leaders to promote children’s social competence, emotional regulation and problem solving skills and reduce their behaviour problems. Parents learn child-directed skills (e.g., praise, description, reflection), effective discipline techniques (e.g., ignoring, Time-Out procedure), coping skills, and strategies to promote children's social skills through weekly 2-hour sessions (Baydar et al, 2003).

46. Numerous RCTs of the Incredible Years program have shown statistically significant reductions in child behaviour problems, improvements in parent-child relationships, reductions in harsh parenting, and improvements in prosocial behaviours. By providing dinners, child care, flexible hours, and make-up sessions, reasonable success was achieved at retaining low-income participants (Asawa, Hansen and Flood 2008). The Incredible Years program is in use in 17 countries worldwide including the UK.

47. Positive parenting program (Triple P) is a parenting and family support system designed to prevent – as well as treat – behavioural and emotional problems in children and teenagers. It aims to prevent problems in the family, school and community before they arise and to create family environments that encourage children to realize their potential. It was developed by Matthew R. Sanders and colleagues at the University of Queensland in Australia and its five core principles of positive parenting are: (1) ensuring a safe, engaging environment, (2) promoting a positive learning environment, (3) using assertive discipline, (4) maintaining reasonable expectations, and (5) taking care of oneself as a parent. The emphasis is on parents learning how to apply these skills to different behavioural, emotional and developmental issues in children to more intense challenges.

48. The programme is delivered through five levels: Universal Triple P (Level 1) is a communications strategy designed to reach a broad cross section of the population with positive parenting information and messages. It is not a course or personal intervention delivered directly to parents; Selected Triple P (Level 2) is described as a "light touch" intervention providing brief one-time assistance to parents who are generally coping well but have one or two concerns with their child's behaviour or development. It is available for parents of children from birth to 12 years and for parents of teenagers; Primary Care Triple P (Level 3) is targeted counselling for parents of a child with mild to moderate behavioural difficulties. It is available for parents of children from birth to 12 years and for parents of teenagers. Level 3 interventions deal with a specific problem behaviour or issue; Standard and Group Triple P (Level 4) is for parents of children with severe behavioural difficulties. It is available for parents of children from birth to 12 years and 12–16 years; and Enhanced Triple P (Level 5) is for parents whose family situation is complicated by problems such as partner conflict, stress or mental health issues. Pathways Triple P – for parents at risk of child maltreatment - covers anger management and other behavioural strategies to improve a parent's ability to cope with raising children.

49. The evidence base for Triple P is extensive and includes, to date, includes 43 controlled trials addressing efficacy, effectiveness, and dissemination, as well as 22 service-based field evaluations. Triple P has been evaluated as a universal, whole of population strategy and shown to strengthen parenting, increase family cohesion and reduce the prevalence of conduct problems in preschool-aged children from high-risk neighbourhoods, and to reduce coercive parenting practices through the implementation of multiple levels of Triple P (Sanders et al. 2008 cited in Prinz et al. 2009; Ting Wai Chu et al. 2015). One quasi-experimental study researched the preventive impact of Triple P on future child maltreatment at a population level using evidence-based parenting interventions in 18 counties in the US with families randomly assigned to Triple P or services as usual - approximately 85,000 families in any given year. Effects were assessed by comparing trends between the intervention and comparison counties of child maltreatment. There were fewer cases of abuse and neglect, fewer out-of-home placements, and fewer children with injuries requiring hospitalisation or emergency room treatment in the areas using Triple P at the time of the study and 24 months later. However, it would be important to determine whether these effects are maintained over time (Prinz et al. 2009 cited in Daro and Dodge 2009). Triple P is now used in 25 countries worldwide.

50. Early Head Start provides early, continuous, intensive, and comprehensive child development and family support services to low-income infants and toddlers and their families, and pregnant women and their families. It is designed to nurture healthy attachments between parent and child (and child and caregiver), emphasise a strengths-based, relationship-centered approach to services, and encompass the full range of a family's needs from pregnancy through a child's third birthday. Programme options are determined through the data collected from their community needs assessment and conversations with families and include centre-based services, home-based services, family child care services and a combination of some or all three.

51. A national randomised trial in the US found EHS to be effective in improving parent and child outcomes, but its effectiveness in reducing child maltreatment was not assessed. Results from a subsequent study, which focussed on the impact on child maltreatment and tracked children until the age of ten, indicated that children in EHS had significantly fewer child welfare encounters between the ages of five and nine years than did children in the control group, and that EHS slowed the rate of subsequent encounters. Additionally, compared to children in the control group, children in EHS were less likely to have a substantiated report of physical or sexual abuse, but more likely to have a substantiated report of neglect. This unexpected finding was thought to be due to increased and longer-term contact with the family and increased visibility of the child (Green et al. 2014).

Problems in adolescence

52. Carr’s review of the literature in relation to neglect (Carr 2014) reported that previous reviews had identified that young people with persistent antisocial behaviour fared better in family therapy compared with non-treatment control groups and somewhat better than treatment as usual or alternative treatments. These results showed that the average case treated with family therapy fared better than 76 per cent of untreated patients and 58 per cent of patients who engaged in alternative treatments.

53. Family-based treatments including functional family therapy, multisystemic therapy and treatment foster care were more effective than routine treatment. These family-based treatments significantly reduced the time the young person spent in institutions, the risk or re-arrest and recidivism 1–3 years following treatment.

54. Functional family therapy was developed initially by James Alexander at the University of Utah in 1972 and more recently by Tom Sexton at the University of Indiana (Wiggens 2012). It is a model of systemic family therapy held over a three month period for young people (10 – 18 years) with a strong history of offending (or violent, behavioural, school and conduct problems). Between eight and 30 one-hour sessions (average 12 sessions) are held over a three to six month period. It involves distinct stages of engagement where the emphasis is on forming a therapeutic alliance with family members, behaviour change, where the focus is on facilitating competent family problem-solving and generalization, where families learn to use new skills in a range of situations and to deal with setbacks. Whole family sessions are conducted on a weekly basis.

55. Functional family therapy has been the subject of one RCT (1973), a quasi-experimental efficacy study (1985), and a trial in 1988 and has been rolled out in 13 mental health organisations in New York (Wiggins, Austerberry and Ward 2012). All three trials showed reduced criminal offending and activity, and improved family communication in follow-up periods which ranged from six months to over two years (Carr 2014; Wiggins, Austerberry and Ward 2012). Functional family therapy has been implemented in Belgium, England, Netherlands, New Zealand, Norway and Sweden. Critical to its success was fidelity to the model and the solution focussed approach helped build trust between the FFT therapist, young person and family.

56. Multisystemic therapy was developed in the US by Scott Henggeler and Dr Charles Bordin. Multisystemic therapy combines intensive family and community based therapy with targeting young people aged 12-17 with serious conduct disorders and offending behaviour. Multisystemic therapy involves helping adolescents, families and involved professionals understand how adolescent conduct problems are maintained and aims to increase the skills of caregivers and parents to disrupt these patterns and change behaviours. Multisystemic therapy involves regular, frequent home-based family and individual therapy sessions with additional sessions in school or community settings over 3 to 6 months. Therapists carry low caseloads of no more than five cases and provide 24-hour, 7-day availability for crisis management.

57. Reviews (Carr 2014; Wiggins, Austerberry and Ward 2012) have reported that rigorous RCTs in a range of countries, including England, and a meta-analysis of eleven studies found significant improvements in family relationships and a reduction in re-offending rates both in the short and long terms; effects which were maintained up to 4 years after treatment. The recent RCT in England found that families had thought that the interventions had come to an end too soon or abruptly and recommended that future implementation might consider a longer intervention for some young people or some follow-up sessions (Tighe et al 2012 in Wiggins, Austerberry and Ward 2012). Multisystemic therapy has been implemented in Australia, Canada, Denmark, Ireland, Netherlands, Norway, Sweden and the UK. Fidelity to the programme was key to outcomes identified.

58. Multidimensional treatment foster care was developed at the Oregon Social Learning Centre by Patricia Chamberlain and her team in 1983. Multidimensional treatment foster care combines procedures similar to multisystemic therapy, with specialist foster placement for young people who have engaged in serious, chronic anti-social behaviour, youth offending and conduct problems. The programme provides young people with a ‘wrap-around’ service of support which includes placement for six to nine months with specially trained foster parents, an individually tailored structured programme, weekly sessions with a behavioural therapist, support from an educational therapist and family therapy with the young person’s birth family. Adolescents also engage in individual therapy, and wider systems consultations are carried out with the youngsters’ teachers, probation officers and other involved professionals, to ensure all relevant members of youngsters’ social systems are cooperating in ways that promote their improvement.

59. Multidimensional treatment foster care has been subject to a series of RCTs in the US, England and Sweden. The studies showed that this approach significantly reduced running away from placement as well as psychiatric distress and depression. Multidimensional treatment foster care has been implemented in Canada, Denmark, England, Ireland, Netherlands, New Zealand, Norway, Scotland and Sweden . Fidelity to the programme was again critical to successful implementation as well as strong leadership to both implement and sustain the programme, and recruitment and retention of foster carers (Carr 2014; Wiggins, Austerberry and Ward 2012).