Working with neglect in child protection (EP.17)

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Hi. Look into which device social work practice, poke class. Hey step by wrench. Odd. It was essential worker. His podcast is about practice related issues, self development and transformation. It will give you knowledge, ideas and practical tools for being a fantastic social worker, supporting you of assessment skills. Direct work, dealing with conflict. And importantly, helping you make a positive difference in the lives of children and families. In this episode, I'm going to be looking at. Neglect and. How we can support. Families where neglect is a concern. It isn't guaranteed to be. A broad systematic. Overview. Rather, I'm just going to reflect and share some ideas. Does that have come to mind when I was recently? Some lovely feedback on apple. Podcasts by. Chris. The username is Rodman. 1 0 1, 9, 8, 6. And he wrote. That he qualified in September 22. With 14 plus years past experience of working. With people in various start to trim volunteer roles in this podcast. Cast steel prompts, new thoughts. Please, can you consider doing something around home conditions? The challenges of Quantis. Quantifying Turlington parents and drawing the line. Great work, Chris. And so. In response to that. I'm going to look at the idea of. Home conditions. In the context of neglect. And just share some. Forts and learnings. Before I get into that. I just wanted to mention. The Bassler child protection, social work practice master class series. That I'll be running. In April, it begins in April and runs through to. December there's one a month. And they're an hour and a half long. And there. Ideally for kind of frontline practitioners. Who wanted to be inspired with highly practical research based. Training that will equipped you. With ideas that you can implement in your day-to-day practice. I'm very much drawing on my own. Practice experience. And integrate an ideas that I think are. Clickable. There's lots of research and ideas that are out there. And some of them are are usable and applicable. And some of them are less so, and so it's about integrate in particular. Ideas. And the areas are be covering is. The first one on the 26th of April is why is it hard to talk to. The children and child protection. In may, I'll be looking at managing conflict in child protection. In June and July, I'll be looking at assessment. In child protection. In August. Top tips on how. How to use attachment theory and trauma. In September, how to survive and thrive. Interpret. Touch him. In November. Skills and principles for cultivating a relational. Or approach to addiction and child protection. And then in December moral distress. Press impossible decisions. And. Removing children. The. Other thing I wanted to mention before. I got into today's topic is a webinar series that I'm doing in conjunction with Tim Fisher. Fisher. And relational activism. We actually filmed. The first one today, which. Which was all around. Implement in parental advocacy within a local authority context. And in March, we're going to be looking at. Inclusive working with fathers in child protection. Best practices and strategies. And we've. I've described this as an enlightening webinar where we'll look at the crucial role of fathers in child protection. We will look at best. Practices and strategies directly from farmers with lived experience. As well as. Professionals and academics, hopefully bring in a unique perspective and insights to the conversation. Say it is completely free and we. Have a series of them where we'll be looking at other topics such as peer parental applicacy participatory. Three approaches to engage in children and young people to hear their voice in child protection. What does. Good family support look like. Looking at open adoption. Transforming the child protection system through co-production and co-design. The use of the family network. And then I'll find a one will be on activating lived experience in child protection. Okay. So, if they sound of interest to you, you can go to the relational activism website. And there's a tab at the top that says upcoming. Coming. And you can click and sign up to those webinars. It'd be great to. See you there. So. To return to. Chris. This question about how do we evaluate home conditions? I think. I am conditions. It's one of those really tricky areas within child protection, social work. That probably doesn't. Get talked about enough, particularly in respect of how it feels. Feels as a social worker. Where you have to make judgements and evaluations about somebody else's home. Because. Because it's easy to get caught up in your own value judgments. About what a tidy and clean home should or shouldn't be. I've also noticed in some of the research. The ivory. I've read. The social workers. Are criticized with conflating poverty. With neglect. So there's. An argument that we overlook the impoverished conditions. Of the family. Really. And that gets kind of classified. And labeled. As an individual problem, rather than a kind of social systemic. Problem. And there may be some. Legitimacy to that. However, in my experience. Uh, Social workers are quite sensitive. Incentive to the impact of poverty. And can be quite cautious in making judgment about the home. Conditions for, as it just mentioned. Due to fear of applying at personal. Standard. Too. Situation and therefore not having an objective way to. Think about the home conditions and the impact. Impact. That they might be having for the children. And. It reminded me of the rule of optimism. The rule of optimism. Has. Picked up currency within the kind of. Social work landscape and has become quite a highly. Influential term that I think has been actually misused to. Blame social workers for inaction. Naive a T and essentially poor decision. Make him. However the term was originally coined. In a book called the protection of children in 1983. By Robert Dingwall and his colleagues and the original meaning. Is very different to how it's often. Interpreted, especially. More recently. Ding will theorized that there were two institutionalized devices. That was a term that he used. That lead to practitioners, justify and risk under certain conditions. One of them was cultural relatives of relativism. And the other one was natural. Love. The reason why I'm bringing this up is because I think. That. Cultural relevant relativism is perhaps a feature of what gets played out when we're working with. Families where there's concerns for neglect. Thing will consider it. The cultural relevant relativism. Is an intellectual position whereby all cultures. I have equally valid ways of conducting relationships. Which is attached to another idea, which is that no one culture has the right to criticize the other. By imposing their own standards or social norms. Onto them. And in social work, what ding will argued was that this translated in problematic ways. As social workers could evaluate the parenting practices of diverse cultures of equal value. Even when the practice is. Obviously harmful and or abusive. And th this could lead to skewed. Judgments of risk. He also made the argument, which I think is an interesting one that this could be applied. Geographically. In that within certain communities, for example, especially deprived communities, lower standards are normalized in ways that. They wouldn't be in other areas. In both instances, the act of child abuse is essentially permitted. Due to the specific circumstances. And I think the idea of cultural relativism has some usefulness. When we're thinking about assessing home conditions. And making judgements about the impact that they may be having on children. Just pick it up on the topic of. I. We'll speak briefly about the other. Institutionalized device that he talked about, which was natural love. He observed if parents have extremely limited capacities. And cause. Evidential harm to their children, that this could be overlooked if they showed love what he referred to as natural love. And I would say. That it has been my experience that when a power and can distract, demonstrate an ability to be emotionally warm. Or attentive or to be able to play with their child. It is almost unintentionally easier to overlook harms in a way that wouldn't be the case. If the parent didn't have those. Relational attributes. So, so. The original term, the rule of optimism. According to Dean wall. Was applied under these kinds of too. Institutionalized devices, cultural, relativism, and natural love. And his argument was that these are kind of built into the system. So it's not necessarily a reflection of any one individual. They're not a kind of psychological bias. But reflect something institutionally. And so because of the challenges of subjectively. Valuate in the home conditions. What I would recommend is the use of standardized methods where that's possible. And there's a couple that I've used over the years. One is the home conditions questionnaire. From the department of health, there was a series of questionnaires. That accompany, the original department of health assessment framework guidance. I believe. This was published back in 2001. You can access the original version of this through social workers, toolbox.com, which is a really brilliant website with loads of resources on. But if you just type in home conditions, questionnaire from the department of health, You can find that. When I did that earlier today, I also. I found that what's the share. I had developed. Or adapted the questionnaire and made it a bit more engaging and it just depersonalizes the evaluation of the home conditions. Which I think helps social workers to be able to have that conversation with parents. The other one that I have used, although not for a while is the graded care pro profile. That's a little bit more complicated. But the idea is the same and that by having a questionnaire that you can go through with the parents, It creates a degree of objectivity and depersonalizes it. So you can have those kinds of conversations. It also allows you to. Have a baseline in relation to the current home conditions. That you can then measure progress against when you start putting in support or. Developing expectations in collaboration with the parents about the changes that need to be seen. Would make two additional points about. Home conditions. The first one. Is that looking after a home. Is I think an extremely complex. Task. And it requires the use of multiple systems that support the maintenance of a clean tidy. And relatively well-functioning home. And. Sometimes we. We'll go in and we will pay for someone to do a deep clean within a family home, or we'll pay for a skip to be delivered. And that will be placed outside the home. There'll be. One-off big clean. And then more often than not, there's a deterioration back into the previous conditions. And I think that reflects. That. Some parents might be capable of cleaning their home. In a one-off kind of stint. But there's a difference between being able to clean your home. As a one-off event compared to developing systems that allow you to maintain. A clean and tidy home. And I think often. About. Children. Who've grown up in really pervasively, neglectful home conditions, and then they become adults and they become parents. And they've got no template, no systems, no way of knowing how to look after and to tidy your home. So I do think some of our support needs to. Think about how we can support parents, develop the skills and the abilities to. Tidy the home. And that requires us thinking. Developmentally about parents, even though they're adults. They might not have had the experiences during their childhood and their adolescence. Whereby they've developed some of the skills and abilities to take care of the home. The second point. I wanted to make was around. The social workers don't just become involved. Because of home conditions. And I know that's kind of obvious to everybody that will be. Listening, but I feel like it's important to note because the home conditions often reflect one area of concern. In relation to. Other areas of concern within the family functioning. And before I just. Go into that a little bit further. One of the things that I think is important. As a social worker, when you're working with a case where there's concerns around neglect, is that. In your case notes. That you document what your observations are off the home conditions and have the children. Even if they remain consistently poor during the time that you've been visiting them. Because it will just create an accumulation of evidence in relation to the concerned. And wherever they. Are ameliorated or lessened when you put in place support. And that's important because when you're working with NYCLA, there's often not a one-off. Frightening scary incident, but rather it's the cube cumulation. That causes. The difficulty and the harm for children. And so being. Being mindful of that and monitoring that is quite an important element. If you have to write an assessment or produce evidence. So just to return back to this point about the home conditions. Sometimes being a symptom of a underlying problem. I wanted to share a paper. That's been hugely influential. In my thinking on neglect. I was fascinated by this paper because in my experience. Some of the most severe forms of neglect. In which poor home conditions where one concern and element pointed to. Or seem to point to an underlying problem. And as I just mentioned, the home conditions. Seemed to be a symptom of a underlying problem. And the paper. That I'm going to. Look at is called child neglect, causes and contributors. It's a paper by Patricia Crittenden. And it was published in 1999. So it's quite an old paper. And I'm basically just going to read out. Some. Key sections of this. Paper. And. We'll see if that's. Useful or not. So. In the beginning of this paper. She. And attempt to define the problem. In other words, what's the best explanation for the occurrence of child neglect. And. She argues that. And I'll read this out now. We just haven't made the necessary economic commitment. That our economic relief is below the threshold at which it can begin to take effect. We could even say that a major restructuring of society is naps necessary. Both of these might be true. But it is unlikely that they will impress upon policy makers who must appropriate the necessary funds. Indeed the current political climate has made it very clear that neither politicians. Nor the population that elects them, find these arguments convincing. Moreover. It may be that although economic factors often contribute to neglect. They are neither necessary nor sufficient to cause neglect. A systematic understanding of social familial and personal functioning suggest that those factors, which cause a condition. May not be the same as the factors needed to change or eliminate the condition. Once it exists. A more focused approach to addressing the needs of neglected children. Maybe to seek the critical causes of neglect. That is those causes that when changed will precipitate a pattern of systemic changes that will reduce or eliminate child neglect. And then she goes on to make an argument. As to why economic help isn't enough. And she argues that there are several fallacies in the argument that child neglect is a sufficient or necessary cause of poverty. Firstly that large numbers of families live in poverty. And only some of them neglect their children. So Crittenden's arguing that. Knowing what enables most families to successful successfully calf their children. In spite of poverty and limited education, et cetera, might help us to understand child neglect better. And secondly, Most human children. Over our history as a species. I have been born to poor families. And she makes an argument that even poor families in Western countries. Would be considered rich on a international or historical scale. Therefore it is unlikely. The income or lack of material goods is the primary impediment to. Successful child-rearing. So she's not entirely convinced by. Neglect being caused in all instances by. Poverty, for example, particularly within a Western country. And then she proceeds to make an argument around it, reflect in a failure to establish enduring human relationships. And she writes that leaves being unemployed, unmarried, and socially isolated as parks as aspect. Of low socioeconomic status that might cause child neglect. And she writes that these free countering sticks having common, the failure of individuals to successfully establish enduring and productive social relationships. These are interpersonal problems tied specifically to the failure to engage in enduring relationships. In this context, it would be surprising if the relationship with the children were unaffected. This suggests that there may be something other than socioeconomic status. That is critical to the occurrence of child neglect. Possibly socio-economic failure and child neglect are both. The result was something else. Specifically, severe difficulties sustaining interpersonal relationships. So what she's kind of arguing is that. Child neglect may actually reflect severe difficulties with sustaining interpersonal relationships. Rather than a result of. Individual or a family socioeconomic status. And she identifies three types of neglect. Which I think are really useful categories and distinctions too. Think about, and they certainly resonated with my experience when I first read this paper. The first. Type of neglect is what she calls disorganized neglect. Living from crisis to crisis. And I'll just read out. This bit now. The first group of neglecting parents offer. Offers inconsistent parenting to their children. These are multi problem disorganized in crisis prone families. Being in their homes is a confusing, frustrating experience to professionals because as one tries to discuss the problems with the mother, there are constant interruptions. For example, a phone rings. So mind that disaster now occupies the mother's attention. Child, right? As in crying, there was a fight outside and another child has hurt him. The mother, when she attends to the visiting professional. Wants help. Insolvent her immediate problems. For example, the electricity being turned off for failure to pay the bills. The school suspend and her oldest child, her husband being fired after getting drunk and fighting with the boss and so on. Indeed. The mother appears. To need and want professional help urgently. In the background is the sound of the TV and the intense emotions at the same proper that in spite of the glamor associated with the wealth mirrors, her own life. The professional ties to discuss the reasons for the visit. But these interruptions leave one feeling that they only have fragments of the mother's attention. Moreover, even when one has finally discussed all the issues that needed to be covered, one is not sure that she really understands or agrees. Indeed. The discussion is often so fragmented and disrupted. That it is difficult to be certain what was sad and decided. Nevertheless in spite of the confusion professionals often feel welcomed in such homes. So I think NAS probably. Description that most social workers. We'll be able to resonate with. And she goes on to write that in these families. Intense feelings, attract family members attention more than less intense feelings. On this space. The basis. The children fighting outside, dominate the mother's attention. Whereas the letters from the phone company, a set aside until a later quieter time. That may never come. Under these conditions. Professionals time and resources. May be hijacked to meet the mothers priorities. This creates an environment in which the parental response to children is unpredictable. We're family members, especially mothers. Responding only to the most immediate, most extreme crisis in that environment. She goes on to write. To receive attention. Their children must become the most demanding, most salient stimulus to their mothers. They accomplished this by themselves, learning pre consciously to emphasize effect and minimize or discard cognitive information. Fat is. The children exact rate that display a feeling so that their needs are seen more dramatic than they really are. In addition, they refuse to listen to explanations, to accept delay or to compromise. They act as though they were always in a crisis situation. In this manner, they improve their chances of getting and holding their parents' attention. And. She writes that. Parents who organized that behavior around feelings and not on planning. That meets future needs. Parents will fail to do some things that need to be done. But that do not come with intense messages. For example, they were put off paying the bills until the frets of court over. Action. They will fail to purchase enough food lead into panic at dinner time. And then they have to make due with snacks and other lash nourishing foods. They will fail to attend to the children's needs of all kinds until the crisis. Arises. They will then run from crisis to crisis frantically trying to solve longstanding problems with quick solutions. Of course, this rarely works. But behaving in this manner keeps feelings intense. It gives the parents, the feeling of being needed. This is important. If in their childhood, they rarely had enough attention from their parents. And that's probably. The critical element. Of this. That. Parents in this situation who didn't receive enough attention. During their childhood develop a strategy where they have a need to be needed. And they create the kind of conditions. And relationships and environment that, that keeps them. In a high level of demand. Albeit with some difficulties and problems that are associated with them. And question rights. This is one type of neglect, disorganized, neglect. It is founded multi problem, crisis praying families. The children are cared for, but never in a predictable or tank timely manner. The family is always on the verge of disaster. The function and of such families is best described as being an effectively organized. And with interpersonal relationships based on the use of a coercive strategy. Forgetting what one once. And. So she asked the questions. What can be done? So she writes. First feelings must be dealt with, especially the mother's need for comfort and reassurance that they are loved and indispensable to family members. Second professionals must provide a structured predictable environment with no surprises. I E they must create an environment in which cognition always works. Always provide accurate information about the relationship between behavior and outcomes. Thirdly professionals must maintain an emotional relationship with the parents even after, especially after the parents gain competencies. If pear. If professionals withdraw too soon, it is likely that the families will revert to the problems that brought them to the attention. The first place. So that is. The first of three types of neglect, disorganized, neglect, living from crisis to crisis. And Christian tern puts forward free ideas for supporting those families. One is around me in the. Mothers or the fathers. Need to be needed. And maybe understanding where that stems from probably in some respects in their childhood. The second is to provide a really clear, structured, predictable environment. Which will involve the consistency of workers sufficiently. Intensely involved. For example, once a week is probably not going to be enough, maybe a couple of times a work a week, but it, but what's critical of that is that there is consistency over prolonged period of time. And then thirdly, that there may need to be. A sustained relationship, even when there's been some improvement. So that that can be stabilized. The second type of neglect, which I'm only going to touch upon. Briefly because it is relatively rare. Which is emotional neglect and she writes emotional poverty in the land of plenty. Defendant against effect. And. I'll just read out this bit now. Although both physical and psychological neglect are usually associated with poverty. Parents who provide materially for their children can be emotionally neglectful. The failure to connect emotionally with others is at the heart of emotional neglect. Moreover. Failure to connect emotionally. Is inherently painful tissue humans. The pain comes from being unable to share feelings with others. Especially feelings of fear, desire, anger, and even joy and love. The pain in other words has its basis in effect. Of course, the problem varies in intensity, but for clarity. It will be presented here in fairly bold terms. And. She explains that. In contrast with the common knowledge of the nature of neglect. These homes are often advantaged with respect to material and educational. Things that the children may have lots of toys and clothes. That will have their own room. They may go to expensive schools. But the, in the cases that contain emotional neglect, these advantages are used as a material expression of parental love and concern. In the absence of Expression. She writes often the activities cover the fact that the parents feel awkward and tense when left alone with their children. Although most of us know such families and we're often aware that the children's emotional needs are not met. We probably do not think of such parents is neglectful. Nevertheless, there are many things that children need to develop and a failure to provide. An essential class of them is neglect. So. That's the second type of neglect. And she provides. Much more detailed about how we can support those. Parents. And then the third and final type of neglect is called depressed, neglect. And I'll just read this out. Depressed. Neglecting families reflect the classic image of child neglect. The individuals in these families are withdrawn and DOE. They show little interest in us when we visit. Neither friendliness nor anger. They seem not to understand why. Why we are coming nor to comprehend our advice to them. Worst of all, they do not seem motivated to work for their child's benefit. This is not because they do not love their children. They do. It is that they do not perceive that children's needs. Even after we have explained them. In addition, they do not believe that anything that they do. Or that we could do we'll change the situation. They are. In other words, passive and helpless. And she outlines the developmental pathway to this. And I'll read this out because I think it's really. Interesting. She writes, some parents are so withdrawn that they do not respond to their children at all. Of course. The infants are fed changed and moved from place to place. But the contact is infrequent and rarely in response to signals from the infant. In addition. There is little affectionate play or soothing contact between parent and child. Such infants first protests, that condition. If we've increasing protests. There was still no parental response. The infant usually gives up and become silent limp. Doll and depressed. Without feedback about the meaning of their behavior to others. Infants can not learn. If this is applied to both affective and cognitive signals. Infants eventually learned that their feelings and actions have no meaning they're helpless. When people of any age learn that their behavior has no meaning this human mind shuts down it ceases to perceive or interpret information. Without thoughts and feelings that can be shared with others. Human humans become hollow shells. In this vacuum. Parents do not perceive the occasions, the call for action. So they don't act. Because they do not act either on their own behalf or on that of their own children. They may both sink into poverty and also neglect their children. Although this pattern of helplessness, most commonly begins in infancy. It can occur at any age. When first learned at later ages, however, the child has already learned that feelings and behavior do have implications. So it will take a long period of parental failure to result in child depression. Consequently infancy lacked prior normative experience are more vulnerable to the impact of neglectful child. Remember. And so she's kind of laying out the developmental pathway for how some parents. Can present as depressed, disconnected. Withdrawn. And fundamentally helpless. And that can stem from themselves. Having their own needs neglected. And experiencing uniformally disappointing. Relationships. And they just haven't had the experiences where they believe that. Their actions or what they do makes a difference, or that they can use relationships to improve their circumstances or other people's circumstances. And in that context, Parents just become disconnected from their own emotional state. And so they're in no position to be able to connect with their children's emotional states and that isn't because they don't want to. Is because they've spent their whole childhood. Disconnected from their own feelings because it was too painful. To deal with the rejection and the unavailability of their parents. And so they have difficulties in their ability to. Empathize with their children. So. Critic. And give some ideas around case management. And I'll read this out now. Restarting this mental system. Involves much more than just teaching people the appropriate parental behavior. First and foremost, all individuals in the family must learn that their behavior. Has predictable, meaningful consequences and the affective states can be showered by empathic others. It is essential. The infants experience responsive as stimulating environments. That also contain human comfort for at least a few hours a day. Given such conditions, they are likely to recover rapidly and to be able to make developmental progress. Children beyond infancy are also able to benefit from such environmental changes. But the longer they've experienced debilitating environments. And the earlier in their life such experiences began the longer and more difficult will be the recovery. For parents, of course the task is most difficult. This is partly because of their longer exposure to helplessness. In addition, however, it is far more difficult to place adults in new and responsive environment. Secondly, parents need to learn. The use of appropriate expressions of emotion. They need to practice smiling in appropriate situations. Laughing when others laugh. And looking soothing and concerned when their children are distressed. Of course, this will be quite mechanical at first. It is likely, however, the after many repetitions actual feelings will begin to fit expressions of effect. The effect, if displays will increase their children's responsiveness and liveliness, thus initiating an upward spiral of mutual reinforcement. The children. Of course the pace of change is more rapid. Then for adults. Nevertheless, even with adults changes can be made. Some of our commonly used approaches, however, are likely to be counter productive. Frightening punitive strategies that are tied to parents learn and to use new and more appropriate parenting behavior. I particularly likely to be ineffective. There are two reasons for this. First, the parents do not believe themselves to have the ability to change. So they may not even try second. Even the most reasonable pressure is likely to elicit their familiar response to danger of blocking out all information. A longer term, more supportive approach is needed. Similarly parental education is likely to be wasted on such severely involved parent. And because judgment would not be exercised in the context of feelings and outcomes. It could be counter productive. So. Hopefully that was helpful. I appreciate that there was a lot of reading from this article by Chritton child, neglect causes and contributions. I just found the two. Types of neglect, the disorganized neglect, the multi problem, disorganized crisis prone, family. And the depressed disconnected kind of emotionally Baron. Family really useful typology to apply. And resonates a lot with my own experiences. And also reveals some kind of indications about how we can help. So in the disorganized neglect conditions. There may be issues around the home conditions being chaotic and unpredictable. And there's a need for the support to be consistent and reliable. And probably endure for a sustained period of time. With the. Depressed neglect. Where the parents are emotionally switched off. They may not be invested in taking care of their home. And that may reflect a lack of investment. In themselves. And so I think a critical element of support in those parents. Is to think about what support we could offer the children. For example. Enabling them to access. Nurseries or childminder. And then also thinking about. How we can find somebody for the mom to have emotional and practical support. So that somebody amplifies him with her. From somebody empathizing with her. She might eventually be able to. Empathize with her children. Ideally, I would write a blog about this and I might try and do that soon to try and integrate some of these ideas. I would also just know. That there's some literature around. The impact of poverty. On the rates of children's subject to top touch and plans that I haven't included into the discussion. And so that might be just something that's worth bearing in mind. As I mentioned, this isn't completely. Comprehensive systematically fought through. Episode rather. It's me sharing some thoughts and I'm read. And a paper that I found particularly influential. If you found. This episode. Helpful. And I would be super appreciative. If you could leave a review, even if you just leave. 2 3, 4, 5 star review. He only takes a couple of seconds. I believe when you're on the app, whether that be Spotify or apple podcasts. And it would be gratefully received. If there are any other topics that you would like me to cover. Then by all means, please do get in touch. Goodbye for now.