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"Joanna Nicolas Child Protection Consultant and Trainer www.joannanicolas.co.uk The Impact of Neglect Homelessness and Neglect It would be quite wrong to state that homelessness = neglect, just as it is wrong to state that poverty = neglect but just as there is a correlation between poverty and neglect, there is also a correlation between homelessness and neglect. Although Local Authorities have a duty to house children there will be families who do not have recourse to public funds, whose children may slip under the radar. In these families there may well be issues of neglect, as well as poverty. In addition to this there will be young people who have run away, who are homeless, whose needs are being neglected. These are the people who may be rough sleepers but there are also thousands of children living with their families in temporary accommodation. These families may be living in a single room, with no cooking facilities, no carpets, no beds and a shared bathroom. This paper is not about blame, or judgement. The purpose of it is to highlight to professionals the impact of living with neglect, regardless of what has led to the adults / children being in that situation. The History of Neglect Although children have been abused and neglected for centuries it is only in the last fifty years that abuse has been seen as a social problem and therefore something to which society needs to respond. The response to neglect has lagged behind, even though neglect is more prevalent than abuse and research has shown that neglect, as a form of maltreatment, is just as damaging as abuse. Society’s view remains that we view maltreatment that is intentional as worse than that which may not be, even though the impact on the child may be the same, or worse. If we are to be truly child-centred in our work we need to focus on the impact on the child, regardless of whether the cause of the maltreatment is by commission (abuse), or omission (neglect). The public’s interest remains in the shocking physical assaults and the number of horrific injuries a child sustains because that is tangible. The way that persistent neglect manifests itself results in a child who is a challenge, who may be hard to love. Emotional neglect leaves no physical marks. Where is the public interest in that? According to Erickson and Egeland “It was only in the late 1980’s that public awareness began to expand to include recognition of the often profound psychological consequences that stem from even the most subtle neglect.” Defining Neglect One of the difficulties is how to define neglect. The government guidance for England, Working together to safeguard children (HM Government, 2010), defines neglect as: \"…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. Neglect may occur during pregnancy as a result of maternal substance abuse. Once a child is born, neglect may involve a parent or carer failing to provide adequate food, clothing and shelter (including exclusion from home or abandonment); protect a child from physical and emotional harm or danger; ensure adequate supervision (including the use of inadequate care-givers); or ensure access to appropriate medical care or treatment. It may also include neglect of, or unresponsiveness to, a child\'s basic emotional needs.\" Within the academic field it is widely accepted that there are different types of neglect:- Physical neglect – this is the easiest to identify and respond to. Typically it will be a caregiver who does not adequately feed, clothe or shelter their child and whose actions result in a child being in physical harm or danger. Emotional neglect – this is much harder to define and to evidence. It happens in the home and the young child is unable to tell, as well as believing as they get older that what happens in their home is what happens in every home. Typically there will be a primary carer who is not emotionally available to their child, who is unable to pick up on what their child needs. Erickson and Egeland talk of a parent who is “psychologically unavailable”. There would be a different view in different cultures as to what constitutes emotional neglect. For example in most other cultures the Industrial Western view that an infant should sleep in a room alone would be anathema. (In one study of 186 cultures not one of the other cultural groups had a child under one sleeping in a room alone) . Educational Neglect – in the UK this would refer to a parent’s legal duty to ensure their child receives an education. Medical Neglect – A primary carer who fails to give their child prescribed medical treatment, including required medication, surgery or other type of required intervention in case of serious injury or illness. The Research Most of the earlier research looked at physical abuse. One of the earliest pieces of research which took neglect into consideration was by B.F.Steele in 1977 who concluded that neglected children were more likely to have “learning problems, low self-esteem and in subsequent years a high incidence of juvenile delinquency”. There is now a substantial body of research, with no conflicting research, that sets out clearly that the short-term and long-term consequences of suffering neglect are life-changing, in terms of a child’s physical, emotional, cognitive, social and educational functioning. In the words of the NSPCC “Neglect has adverse short- and long-term effects. In extreme cases, neglect kills”. There is now a considerable body of research that considers the impact of neglect to be as pernicious and life-affecting as other types of maltreatment. In the UK just under half of all children who are subject to child protection plans are under the category of neglect in spite of this. We would not leave an infant in a home where there was evidence of on-going physical or sexual abuse, so why is it acceptable when the category of maltreatment is neglect? The conclusion seems to be that because neglect is an act of omission and not commission, we react differently. Generally parents who neglect their children are dealing with their own issues of mental ill-health, domestic abuse, substance misuse, parental learning difficulties / disabilities. These are all issues that can lead to homelessness. Many of these issues are the manifestations of their own childhoods and all of these often run alongside poverty. From serious case review data the evidence seems to be that professionals feel compassion for the primary carer, who is neglecting their child but may very well be doing their best, usually in very difficult circumstances. Our attention is diverted away from the child and our focus in on the primary carer and how we can support them. But let us dispel the myth that neglect is not as damaging as other forms of maltreatment when all the research tells us differently. In the US there is a research project called “The Minnesota Parent-Child Project” which is being undertaken by Professor Byron Egeland et al. It is a longitudinal study that has followed a sample of 267 children since 1975, born to mothers identified as being at risk of parenting problems due to unstable life circumstances, youth, poverty, lack of support and low education. A major focus has been on the antecedents of abuse and neglect, as well as the long-term consequences of maltreatment on children’s development. The project has found that:- - At age one 2/3 of the neglected children had an anxious, or insecure attachment to their primary carer. (Highly dependent on but unable to be soothed by their primary carer). - At age 2 neglected children were easily frustrated, non-compliant and displayed considerable anger - At 3 ½ neglected children displayed poor impulse control, rigidity, a lack of creativity and more unhappiness than any of the other groups. - At 4 ½ neglected children displayed poor impulse control, extreme dependence on their teachers and general maladjustments in the classroom. As the children became older the neglected children were more socially withdrawn, unpopular with their peers and became more aggressive and less attentive as they grew up. They performed significantly lower than their peers academically. Only 5% of the children were not receiving some level of special education. At age 17 ½ 90% of the maltreated children received a diagnosis of mental illness. The highest rate was the “psychologically unavailable” group in which all but one child received a diagnosis of at least one psychiatric disorder and 73% were diagnosed with 2 disorders, or more. The researchers say “Maltreatment in the early years had devastating consequences for the children’s overall functioning in adolescence. In many ways our study shows the consequences of emotional neglect to be even more profound than physical neglect, or other types of maltreatment. At 4 ½ their nervous signs, self-abusive behaviour and other behaviours are all considered to be signs of psychopathology. Although the maltreatment they suffered was the most subtle of all the groups, the consequences for the children were the most striking”. When they became adolescent the children whose primary carer was psychologically unavailable scored highly in terms of delinquency, aggression and social problems and were more likely to attempt suicide than all the other groups. The findings from this research project are similar to the work of others in this field but to my mind this project shows clearly and starkly the impact of living with neglect. Conclusion Having spent months researching this field and 20 years working in it, it is clear that our response to neglect should be no different to other forms of child maltreatment and yet it continues to be so. In terms of homelessness the Government has a responsibility to acknowledge the impact there is on the children of today and there will be on the parents of the future. Cuts in the short-term will only create more problems, and therefore greater costs, in the long-term Joanna Nicolas December, 2012"
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