CHILD NEGLECT: KEY CONCEPTS AND RISK FACTORS A REPORT TO THE NSW DEPARTMENT OF FAMILY AND COMMUNITY SERVICES OFFICE OF THE SENIOR PRACTITIONER 2017 SAMANTHA PARKINSON, LEAH BROMFIELD, STEWART MCDOUGALL, MARY SALVERON 1 Table of Contents BACKGROUND ................................................................................................................................ 3 1. KEY CONCEPTS IN DEFINING NEGLECT ............................................................................................ 4 1.1 AN ACT OF OMISSION.................................................................................................................. 4 1.2 TYPES OF NEGLECT AND NEGLECTFUL BEHAVIOURS ........................................................................ 4 1.3 INTENT TO HARM........................................................................................................................ 6 1.4 THRESHOLD FOR INTERVENTION ................................................................................................... 7 1.5 NEGLECT IS OFTEN CHRONIC ........................................................................................................ 8 1.6 NEGLECT OFTEN CO-OCCURS WITH OTHER MALTREATMENT TYPES ................................................... 8 1.7 CUMULATIVE HARM .................................................................................................................... 9 1.8 CHILD DEVELOPMENT AND NEGLECT ............................................................................................. 9 1.9 EMOTIONAL NEGLECT: MOST LIKELY TO BE MISSED? .................................................................... 11 1.10 NEGLECT AND CULTURE............................................................................................................. 12 1.11 NEGLECT AND GENDERED PARENTING ROLES ............................................................................... 13 1.12 CHILDREN AND YOUNG PEOPLE’S DESCRIPTIONS OF NEGLECT ........................................................ 14 2. COMMON RISK FACTORS FOR NEGLECT ........................................................................................ 15 2.1 THE DEVELOPING CHILD ............................................................................................................ 24 2.2 PARENT FACTORS (INDEPENDENT OF THE CHILD) ......................................................................... 27 2.3 THE FAMILIAL ENVIRONMENT .................................................................................................... 32 2.4 NEIGHBOURHOOD FACTORS ...................................................................................................... 34 2.5 BROADER SOCIETAL FACTORS ..................................................................................................... 36 3. REVIEW SUMMARY AND PRACTICE CONSIDERATIONS ...................................................................... 38 3.1 MANY FACTORS ARE ASSOCIATED WITH INCREASED RISK OF NEGLECT ............................................ 38 3.2 FACTORS OFTEN OCCUR TOGETHER (CUMULATIVE RISK) ............................................................... 39 3.3 CORRELATION DOES NOT IMPLY CAUSATION SO CASE CONCEPTUALISATION IS CRITICAL ................... 39 REFERENCES ............................................................................................................................................ 40 APPENDIX A: LITERATURE SEARCH METHODOLOGY ...................................................................................... 45 A.1 LIMITATIONS ..................................................................................................................................... 46 2 BACKGROUND The NSW Department of Family and Community Services (FACS) Office of the Senior Practitioner commissioned the Australian Centre for Child Protection to work in partnership with FACS to provide evidence from the research literature to inform the development of an updated FACS policy on neglect and other practice resources. Specifically, the Australian Centre for Child Protection were contracted to provide a brief report comprising two components: 1. An overview of the key concepts in defining neglect; and 2. A systematic review of reviews investigating the common risk factors for neglect Simultaneously, the NSW FACS Office of the Senior Practitioner will undertake a review of the literature on the impacts of neglect. As the purpose of this report is to inform NSW FACS, the focus (particularly within Section 1: Key definitional concepts) is on identifying issues of particular relevance to statutory child protection and their implications for practice. 3 1. KEY CONCEPTS IN DEFINING NEGLECT Neglect is a broad term describing one of the primary maltreatment types that refer to deprivation, or “the absence of sufficient attention, responsiveness, and protection appropriate to the age and needs of a child” (National Scientific Council on the Developing Child, 2012, p 2). In section 1 of this report, key concepts related to neglect of particular relevance to statutory child protection are defined. The authors draw on their experience and expertise to consider how and why these definitional concepts relate to child protection practice. 1.1 AN ACT OF OMISSION Child abuse and neglect (including all maltreatment types) involves any act or series of acts of commission or omission by a parent or other caregiver that results in harm, potential for harm or threat of harm to a child (Gilbert et al., 2009). Broadly child abuse involves acts of commission through words or overt actions that have the potential for harm to a child. Child neglect, on the other hand involves acts of omission where there is a lack of care to provide for the development of a child including their basic physical, emotional or educational needs, and failure to protect them from harm or potential harm (Connell-Carrick, 2003; English, Thompson, Graham, & Briggs, 2005). Practice considerations As an act of omission practitioners need to be alert to what may be missing or lacking for children in order to identify and substantiate neglect. It is much more difficult to observe and name the absence of parental actions or behaviours and to demonstrate that those omissions of care have caused or are likely to result in significant harm to the child. This is particularly so when harm as a result of care and attention which has not been provided accumulates incrementally, such as developmental delay or attachment difficulties. 1.2 TYPES OF NEGLECT AND NEGLECTFUL BEHAVIOURS There is general consensus regarding five widely recognised domains or sub-types of child neglect: supervisory neglect, physical neglect, medical neglect, educational neglect and emotional neglect (Allnock, 2016; Blumenthal, 2015; Dubowitz, 2013; English et al., 2005; Hibbard, Barlow, & MacMillan, 2012; McSherry, 2007; Naughton et al., 2013; Scott, 2014). Examples of neglectful behaviours for each of these sub-types are presented in Box 1. 4 Box 1. Widely recognised domains (or sub-types) of child neglect Domains of Child Neglect Definition Supervisory Caregiver, guardian or parent of child are unable or unwilling to exercise adequate supervision and control of the child or young person. Examples include: children left alone for extended periods of time, exposure of children to drugs and inadequate protection from environmental changes, lack of appropriate supervision, exposure to hazards, inappropriate caregivers (leaving child in care of someone who is unable or should not be trusted to provide care for a child such as a young child, a known child abuser or someone with a substance abuse problem). Physical Basic physical needs are not met as the child is not provided with necessary food (resulting in hunger, malnutrition, failure to thrive), adequate clothing or adequate shelter. Parents provide inadequate hygiene (e.g. child may be extremely dirty or unbathed, have severe nappy rash or other persistent skin disorders or rashes from improper care or lack of hygiene) or show reckless disregard for child’s safety and welfare (e.g. driving while intoxicated, leaving a young child in a car unattended). Child experiences abandonment, expulsion, or shuttling (child is repeatedly left in the custody of others for days or weeks at a time). Medical Denial or delay of health care: The child is not provided with medical care, parents fail to comply with health care recommendations, or fail to seek appropriate health care. Educational Parent or caregiver fails to ensure their child’s formal educational needs are being met. For example, a school-aged child is not regularly attending school and this may be a result of failure to enrol or permitted and chronic truancy. Also includes inattention to special education needs. Emotional Inadequate nurturing or affection: The lack of care experienced by children when their parents or caregivers fail to provide conditions, contexts or environments conducive to their feeling secure, wanted, loved and worthy Emotional neglect is characterised by an absence of parent-child interactions, such as not being hugged, validated or told they are loved. Children may be isolated, permitted to use drugs or alcohol, or permitted to engage in other maladaptive behaviour. Sources: Allnock, 2016; Blumenthal, 2015; Dubowitz, 2013; English et al., 2005; McSherry, 2007; Scott, 2014; Hibbard et al., 2012; Naughton et al., 2013 5 In addition to these five widely recognised sub-types, there is continuing conceptual