Ch Child neg ild neglect: lect: How ow hea ealth lth vi visi sitors tors id iden entify, tify, ass sses ess s and manage age neg eglect lect le Fiona na Miele
Complex and multi-faceted Distinction between different types of neglect Influence of personal and organisational perspectives that influence how practitioners understand neglect
Medi dical al negl glect ect Nu Nutri riti tional onal neg eglect ect Emotional onal negl glect ect Educ ucation ational al negl glect ect Ph Phys ysic ical al negl glect ect Lack k of supervis pervision ion and d gu guidan ance (Horwa wath th 2007) 7) (Horwarth 2007)
Denial of health care Delay in health care Indicators of poor health drowsiness, easily fatigued puffiness under the eyes Frequent untreated upper respiratory infections Itching, scratching, long existing skin conditions Frequent diarrhoea Untreated illness es Physical complaints not responded to by parent
Begging for or stealing food Frequently hungry Rummaging through rubbish bins for food Gorging self, eating in large gulps Hoarding food Obesity Overeating junk food
Disturbed self-regulation Negative self identity Low self-esteem Clinical depression Substance misuse
Have gaps in their education General learning disabilities Poor problem solving abilities Poor reading, writing and maths skills Be socially isolated Little confidence and can be Disruptive or overactive in class Be desperate for attention, or Desperate to keep out of the limelight Try too hard Blame themselves for a wide range of issues Adapted from Aggleton, Dennison & Warwick (2010)
Inadequate supervision Inadequate guidance Children left alone Inappropriate boundaries e.g. Allowing under-age sex or alcohol use
Physical neglect often includes emotional neglect Emotional neglect may not include physical neglect To talk of physical neglect can be shorthand for both physical and emotional neglect Physical neglect is a cognitive and emotional matter (Taylor and Daniel 2005)
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 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 developmental milestones and where physical and genetic reasons have been medically eliminated. In its extreme form children can be at 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 2010)
Whilst the complexity of defining neglect is acknowledged, in its simplified form practitioners, as well as members of the community know when a neglected child is living amongst them (Stevenson 1998)
Alterations in the body’s stress response Insecure attachments Delayed cognitive development Low self-esteem and confidence Behavioural problems and poor coping abilities Socially isolated – difficulty making friends (Brandon et al 2014)
Depression, anxiety Dissociation Poor emotion regulation ADHD symptoms Anti-social behaviour including violence and delinquency Substance abuse and addiction Poor educational achievement Social isolation Mental health problems - suicide Physical health problems ( O’Hara et al 2015)
Cumulative harm may be caused by an accumulation of a single adverse circumstances and events The unremitting daily impact of these experiences on the child can be profound and exponential, and diminish a child’s sense of safety, stability and wellbeing (Bromfield & Miller 2007)
Universal service Holistic approach to assessment of need Named Person role
Aim and objectives Literature review Research Methodology Data Collection Sample Group Ethical Considerations Validity and reliability Data Analysis Findings
To gain an understanding about how health visitors identify, assess and manage childhood neglect within their practice
To explore the nature of health visitors understanding of childhood neglect To explore how health visitors identify neglect and the process of assessment used to assess the nature and level of neglect To explore when health visitors refer to social work and any barriers to this To ascertain if the Named Person role has changed the way health visitors manage cases of neglect
To identify previous work in the area of health visitors working with childhood neglect
Qualitative study Phenomenological approach
Semi-structured face-to face interviews Sample group: Experience ranged from 5 years to 19 years, with an average of 10 years experience
Preparation of the data Familiarity of the data Interpreting the data (developing codes, categories and concepts) Verifying the data Representing the data (Denscombe 2007)
Health visitors’ understanding of what const stitut itutes es childh dhoo ood d negl glect: ect: Confident responses Rich descriptions Focus on physical signs in child and environment
“Well you would be looking at the child within the home situation as a whole. You would be looking at their physical care, whether they are being fed, clothed appropriately, given enough time to sleep in an appropriate place as well as their engagement with the parent or carer. You would be looking at he house set up as well, making sure with regard to carpet, appropriate bedding, hygiene to reduce the risk of becoming unwell and never getting out the bit with coughs, colds, flu, diarrrhoea and vomiting, that sort of thing..” (HV1)
Hesitancy in their descriptions Articulated difficulty with describing emotional neglect Acknowledged difficulty dealing with issue
“I think the neglect that has the biggest impact on me is the emotional bit and that is so difficult to quantify than if you have got physical neglect which is easier to see and document....well from experience, I had a family and that little boy’s face I will remember forever” (HV 3)
Knowledge Skills Experience and intuition/gut feeling The use of assessment tools
HV Training Child protection knowledge and specifically training about neglect Child development knowledge Attachment
Communication skills Interpersonal skills that include the ability to deal with challenging and difficult situations whilst maintaining a relationship with the client. Observations skills Listening skills
Experience informs assessment process – personal and professional Experience and gut feeling or intuition seen as inter-related Five of the ten HVs identified that gut feeling or intuition was the first indicator of neglect
“that gut feeling...yes, I always think it’s the first thing probably that I employ, you know, when I go into a house and look around. You either think well, yes, this is ok or you just think mmmm ... Something just doesn’t feel quite right here. Then you have got to start using your other skills around you, questioning, listening, observing, to come to some sort of assessment of what might be happening with that particular family and child. So intuition plays a big part of that” (HV2)
SOGS SHANARRI National Risk Assessment Framework National Practice Model My World Triangle Wellbeing Wheel Action for Children Assessment tool for neglect
Allows clarification of thoughts Used to formalise findings for reports Helps to communicate concerns to other agencies Gives an objective assessment of concerns Helps to identify gaps in knowledge of family Allows the development of a plan Gives a fuller picture of what life is like for a child
Support Home visiting Practical support: < parenting classes e.g. PEEP < baby massage classes < local community activities < referral to other agencies and services
Lack of confidence in the response from SW and lack of confidence in referral system Difference in thresholds between agencies about what constitutes neglect Lack of confidence in making a referral Concern that referral to SW will damage relationship with family
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