DSCB Spotlight on Neglect

Teenager sitting alone

The DSCB met to review the issue of neglect and its impact on children and young people in Devon.

Child neglect is a complex public health issue across the UK. Cases of child neglect involve multiple agencies, practitioners, children and parents and these are all affected by socio-economic, cultural and environmental issues such as education, living and working conditions and housing.

In Devon, evidence and indicators of neglect include various health issues in children and young people. For example, poverty, poor oral health, unhealthy weight, domestic abuse, accidental and non-accidental injuries, educational attainment and parental mental health can all be seen as influencers of neglect.

The professional’s perspective

Dr. Gemma Hobson from the public health team presented the Board with an overview of child neglect in Devon.

The rate of hospital admissions due to unintentional and deliberate injuries is higher in Devon than the UK national average. One of the most consistent predictors of unintentional injuries for children under 5 is poverty or deprivation, and can therefore be closely linked with child neglect.

Poor oral health can affect a child’s ability to sleep, eat, speak, and socialise with other children. It can also cause pain, infections and impaired growth. Children at risk of poor oral health include children at risk of neglect or child abuse, children living in deprivation, children with disabilities and looked after children.

Another risk of harm to children is through missed medical appointments, which can lead to ill health due to non-treatment of health conditions, and in some cases may indicate neglect.

Domestic abuse may be seen as another influencer of child neglect. On average, 66% of clients using Devon domestic abuse services have children, and 4% of service users are pregnant. In addition, 96% of children in such families have witnessed abuse and 54% been victims themselves.

Children of parents that misuse substances are likely to experience a range of negative outcomes and potentially face serious harm at every stage of their life. Children of parents or carers who misuse drugs or alcohol are more likely to develop misuse and or mental health problems themselves, and 51% of adults in structured drug treatment in Devon have children under 16.

Poor parental mental health can also have a detrimental effect on the health and development of children, often leading to an increased risk of mental health problems. Within Devon, 33,700 people were registered with depression at their GP practice, and 5,800 persons were registered with a serious mental illness (Quality and Outcomes Framework, 2013). 21% of children under the age of 5 are living with a parent who has mental ill health (Devon Health Visitor Survey, 2012)

Findings

  • Jennie Waldron from the Independent Reviewing Unit (IRU) presented the findings of an IRU neglect themed audit of child protection cases.
  • In 60% of cases a pattern of neglect was identified and the chronology was completed. However, there were missed opportunities to put early intervention in place.
  • In 80% of cases the child protection plan addressed the risks and core group meetings were held regularly, providing the necessary support and monitoring of cases.
  • In 70% of cases, children experienced an improvement in outcomes since being subject of a child protection plan and in one case there was a noticeable change in the child’s behavior.
  • There were mixed results when exploring if there was sufficient focus on the experience of and the wishes, views and feelings of the child. There is some evidence of information being taken from a range of people to gain the child’s views and these were taken into consideration, but not enough evidence showing direct engagement with the child.
  • The quality of multi-agency contributions to the assessment of the child and the plan was varied. In some cases it was found that there was no GP input; the GP was invited but did not attend or send a report or the GP involved in undertaking psychological assessment and other health issues but did not attend review.

Outcomes

As a result of the meeting, the Board will publish an action plan on how Devon will move forward in tackling the issue of neglect in Devon:

  1. The Board needs to look at neglect on 3 levels:
    – Basic level
    – Referring through to Multi-Agency Safeguarding Hub (MASH) enquiry
    – Using specialist tools to identify neglect
  2. The Board needs to get an oversight of current practice by monitoring outcomes of early intervention through the Devon Assessment Framework (DAF) and provide appropriate training for staff
  3. Develop a risk assessment to identify neglect earlier and implement early intervention
  4. What to do differently? The Board can:
    – Give families a voice
    – Develop neglect indicators
    – Involve local communities and alternative sources of help
  5. Ofsted and child neglect strategy
    – The Board will co-ordinate the production of a neglect strategy, together with all agencies