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2.2.10 Neglect

Last Modified: 23-Aug-2019 Review Date: 10-Sep-2013

Purpose

To guide child protection workers on the assessment, analysis and intervention in child neglect cases.

Note:  CEO refers to the Chief Executive Officer of the Department of Communities (the Department).

Practice Requirements
  
  • You must assess high risk neglect cases, including children who present with physical injuries or illnesses, failure to thrive and/or lack of adequate supervision immediately. The younger the child the higher the risk.

  • Where a child has, or is likely to have, experienced significant harm from neglect, the Department must provide an appropriate response, irrespective of whether or not inadequate parenting is exacerbated by structural disadvantage, or is the result of or a combination of both inadequate parenting and structural disadvantage.

  • Where a family presents on multiple occasions (including requests for financial assistance) within a short period of time, the case should be intaked. Where an assessment is not undertaken, the rationale for the decision must be recorded and approved by a designated senior officer. At every subsequent contact by the family, you must review the decision to undertake an assessment. 

  • Where appropriate, a chronology of events must be documented and updated regularly to inform current and future assessments, to recognise cumulative harm.

  • You must sight and/or interview the child during a child safety investigation (CSI).  A decision to delay or not sight or interview the child must be approved by your  team leader.  The rationale for this decision must be clearly documented in the CSI.

  • You  must describe the child’s experience and the impact of the neglect using harm and danger statements, and where relevant, provide clear evidence of previous actions taken by us and/or other agencies.

  • Where a safety plan is required, it must include our safety goals, the family’s safety goals, non-negotiable safety rules, different levels of consequences and how and when this will be reviewed.

  • childFIRST must be consulted if, at any stage during the assessment, it becomes apparent that the case involves serious neglect likely to result in criminal charges being laid by the Western Australia Police (WA Police).

  • You must consider using Child Protection Income Management or Voluntary Income Management in circumstances where the parent’s use of their financial resources is contributing to child neglect.

Medical neglect

In addition to the practice requirements stated above, the following practice requirements relate to cases involving childhood obesity co-occurring with other child protection concerns, 'failure to thrive', and to other types of medical neglect. 

  • A CSI must be conducted for all referrals from medical practitioners, and for all other referrals that meet the referral criteria outlined in Managing Referrals on childhood obesity co-occurring with child protection concerns (in related resources). Any decision to not proceed with a CSI should be endorsed by your team leader, and the reasons for this given to the referrer.

  • Where possible, the CSI must be conducted by a senior officer in the district.

  • Before attending the initial interagency meeting you must familiarise yourself with the document on Childhood Overweight and Obesity Information for Department Workers (in related resources).

  • Collaboration with other agencies should occur in planning, intervention and ongoing case management. Signs of Safety meetings must include the participation of relevant stakeholders and family members.

  • Where it is anticipated that decisions will need to be made in an interagency meeting a senior Department officer must be present, such as a team leader or assistant district director.

  • You must document the assessment of:

    • cumulative harm, including the frequency, type, severity, duration, and sources of harm, the impact on the child’s psychological and emotional wellbeing, and/or medical reports detailing the risk of harm, and

    • assessment of further harm that is likely to occur to the child because the parents have not demonstrated sustained behavioural change.

  • Before the Department closes the case , a meeting or teleconference with all relevant agencies should take place. A letter must be provided to all key agencies following the meeting to confirm the decision and the reasons.

Procedures

  • Department's role
  • Duty interaction
  • Initial inquiries (intake)
  • Undertaking an assessment
  • Continuum of neglect responses
  • Department's role

    Te eDepartment's role in relation to neglect is to:

    • conduct comprehensive CSIs that include parental capacity and willingness to change, the impact of parental behaviours and functioning of the child

    • sight and/or interview the child during a CSI

    • prioritise the child’s needs when identifying risk factors and when working with the parents to improve their functioning

    • provide support to at-risk individuals and families to resolve difficulties that impact on their capacity to care for their children, and

    • provide protection of, and care for children who are assessed as being ‘in need of protection’ due to neglect.

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    Duty interaction

    Clarify information with the referrer

    Use the ‘parent and child’ prompt questions in the Signs of Safety prompts for neglect to gather relevant information from the referrer about whether parental issues are impacting on the safety and wellbeing of the child.

    When determining whether we have a further role, you should clarify with the referrer what interventions that they have tried, any resulting impact, what caused them to contact us, and their expectations.

    Check records in Assist and Objective, Objective and the FDV triage application

    The types of reports received and the sources of information may provide indicators that a child is experiencing cumulative harm.

    When assessing whether we need to undertake initial inquiries and/or a CSI, consider: 

    • previous information and involvement (nature and outcome) via the Chronology Report tool in Assist (refer to the Assist User Guide - Create and View Chronology)
    • indicators which suggest an emerging pattern or escalation of risks
    • DVIRs in the FDV triage application
    • reports from professionals, and
    • evidence of children not meeting development milestones.

    Contact the persons with parental responsibility where possible and appropriate

    Where possible and appropriate, the duty officer should engage with the parent (or person with parental responsibility) to seek their views on the concerns. 

    Referrals requiring a specific response

    When assessing concerns about neglect, child protection workers should refer to Chapter 2.2 Conducting a Child Safety Investigation for specific guidance on the following types of referrals:

    • children under 5
    • children identified with ‘failure to thrive’
    • concerns received about a child before it is born, and
    • Foetal Alcohol Spectrum Disorder.

    To assess and respond to childhood obesity co-occurring with child protection concerns refer to Managing referrals on childhood obesity co-occurring with child protection concerns (in related resources).

    Referrals for chronic truancy alone are outside our mandate, however we may have a family support role if chronic truancy is occurring in combination with a child’s criminal and/or anti-social behaviour.

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    Initial inquiries (intake)

    An intake must be completed to initiate initial inquiries when, based on information received, we may have a role in relation to concerns for a child’s wellbeing (the care, development, health and safety of the child), and/or a concern about the parent’s capacity to protect.

    Where we have a clear ongoing role, the duty officer should move directly to a CSI.

    Duty officers can seek relevant information and make inquiries about the child or the family to determine whether we have an ongoing role.

    Neglect can often co-occur with, or result from, other presenting issues, such as mental health, substance misuse, family and domestic violence and gambling. Therefore in neglect cases, contacting relevant agencies such as the school, child health nurse or a service provider who has worked with the parent (currently or in the past) may elicit relevant information about the level of risks and protective factors. 

    Determining if the current referral links to previous reports or assessments

    At intake, the rationale for ‘no further action’ on previous reports must be re-considered, and a new analysis be developed, based on the information provided in the current report. You must take a cumulative harm perspective by re-examining previous reports in the context of the new report to assess whether a number of low-level risk factors combined are placing the child at risk of significant cumulative harm[1].

    You should be mindful of the tendency to screen out, or minimise, information that challenges previous views that have been held.


    [1] State Government Victoria, 2010, Specialist Practice Guide: Cumulative Harm, Best interests case practice model. Specialist practice resource. Victorian Department of Human Services,

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    Undertaking an assessment

    Assessment is an ongoing process, not an event. It should be used as a baseline to measure change in the family.  Assessment occurs throughout the life of a case including when conducting a CSI or intensive family support work.

    When making assessments you should:

    • use the Signs of Safety Child Protection Framework in Chapter 2.2

    • complete a comprehensive assessment while avoiding assessment focused on specific incidents

    • consider any complicating factors (such as mental health issues and substance misuse) in the case and whether they constitute additional risk and danger for the child

    • identify what is missing, for example, lack of care, and what is not happening in families - acts of omission as well as commission must be considered

    • consider the family’s culture and whether the parenting practices meet the child’s safety needs

    • where you are faced with a significant number of incidents (i.e. chronic neglect, cumulative harm), or presented with a serious event, you should focus on the first, worst and last incidents, and include a description of frequency (pattern of events), and

    • sight and/or talk with the children, spend time in their home environment, listening and building trust and relationships with family members.

    Chronology

    When developing a chronology of events, you should focus on identifying and analysing:

    • the type of harm
    • source of harm
    • frequency, duration and severity of adult behaviours
    • impact on the child, and
    • effectiveness or impact of past interventions (what worked, what didn’t work and why).

    If there is a sibling group, consider the above list for each child with a developmental trajectory. This should also include any unrelated children living in the family.

    Your own values and beliefs

    Neglect is a concept that can be particularly subjective and may be influenced by the values and beliefs of individual child protection workers. Furthermore, values and beliefs can affect your relationship with the parent and significantly impact on practice, decision making and child’s outcomes.

    You may find the following tools useful for promoting more objective assessments and responses.

    Structural disadvantage and neglect

    Some parents may be unable to meet the needs of their children due to structural factors that are outside of the parents’ and/or our control.

    Examples of structural factors that could contribute to disadvantage and neglect include:

    • poverty
    • lack of support services
    • unemployment
    • social and geographical isolation
    • social dislocation – particularly for Aboriginal and Torres Strait Islander families, and those from Culturally and Linguistically diverse backgrounds, and
    • shortage of housing or over-crowding.

    Where a child has experienced, or is likely to experience significant harm from neglect, we must assess the concern and provide an appropriate response, irrespective of whether or not this is the direct result of inadequate parenting, the impact of structural disadvantage, or a combination of both.

    Assessing the impact of neglect on the child

    Direct engagement and assessment with the child (when you interview and sight the child) is critical to understanding how the parent’s actions or inactions have made the child feel and the possible trauma arising from neglect. Children may not always have the capacity to express their needs and feelings, or have difficulty doing this because the situation is normalised for them. Refer to Chapter 2.2 Signs of Safety - child protection practice framework for a number of working with children tools.

    The nine dimensions of wellbeing can be used as a guide to identify the impact of neglect on the child, the level of their vulnerability, and whether child developmental milestones are being met. Collecting information over time also helps identify cumulative harm and protective factors. Refer to Signs of Safety prompts for neglect (in related resources).

    You should make use of a chronology to develop an understanding of the meaning attached by the child to traumatic events. You should also be mindful that the impact of cumulative harm on a resilient child may be less visible, and for this reason it is important that you assess the child’s subjective view of the impact on them.

    Recognising emotional neglect in infants and young children is particularly difficult. The following symptoms may suggest emotional neglect in infants, but can also be caused by other medical problems. Children should always be checked by a medical practitioner or nurse if their behaviour is characterised by:

    • inconsolable crying or excessive tantrums that cannot be explained by colic or illness

    • unusual passivity or listlessness, such as lack of eye contact or interest (babies who have been emotionally neglected are sometimes described by caregivers as very “good” babies or that they never cry)

    • altered sleep patterns, such as excessive sleeping for the child’s age, or failure to establish a developmentally expected sleep/wake pattern

    • feeding or digestion problems, and

    • watchfulness or self-soothing behaviour such as rocking, chewing, head banging, or other odd or repetitive behaviour.

    In some cases, multidisciplinary and/or specialist assessments can be useful to determine if the child has a developmental delay or disability, and whether this is due to the environment, genetics or both. District psychologists should be consulted to determine whether a specialist assessment is needed, and the type of assessment required. In addition to identifying the cause of delay or disability it is important that the assessment identifies any additional needs and the core requirements of care. This can add to the understanding of not only harmful consequences, but also of increased probability of harm and vulnerability. It may also identify additional supports that parents may need to adequately care for their children.

    Refer to the following related resources for further information:

    Assessing parental protectiveness – capacity for, and willingness to change, and resources available

    Parents’ capacity and motivation to effectively meet the needs of their children can be affected by a range of issues.  Five common issues associated with child neglect are:

    • mental health issues
    • substance misuse
    • family and domestic violence
    • intellectual disability, and 
    • gambling.

    For more information refer to:

    • Chapter 2.3: Family and Domestic Violence
    • Chapter 1.4: Mental Health and Alcohol and Other Drug  Issues 

    There are three elements of assessing parental protectiveness:

    • capacity to change
    • willingness to change, and
    • the resources available for change.  

    Assessments need to consider how the parent’s/family’s past experiences, including family of origin issues, may have impacted on family functioning. In doing this, child protection workers must still maintain the child’s safety and wellbeing as the central focus. Refer to Signs of Safety prompts for neglect (in related resources).

    Whilst parents should be given every opportunity to improve their parenting, it is crucial that this is not at the expense of meeting the child’s basic needs such as adequate food, shelter, clothing, supervision, hygiene and/or medical attention. Short and long-term effects and cumulative effects of neglect can be significant, whether there is intent to harm or not.

    Improving parenting skills and developing a network of support is important for the wellbeing of the child and promotes sustainable change in parental behaviours. Connecting parents and families with agencies and supports can sometimes be difficult, especially if there is limited availability or the parents are unwilling to engage with agencies. For example, parents who have experienced intergenerational neglect may deny or minimise, or have the attitude of ‘it was good enough for me so it’s good enough for my child’, and not see the need to access agencies and supports.

    Given that assessment is a continuous process, as a family’s level of protectiveness changes, appropriate changes in our approach must also be considered.

    Capacity for change

    Consideration must be given to the parent’s capacity to care for their children. Basic parenting, attachment and bonding should be assessed to assist in understanding the relationship between the child and parent. This will often give an indication of the capacity of the parents to change their interactions with their child.  

    Consider the parent’s capacity to provide the following[1]:

    • Basic care - such as provision of food, drink, warmth, shelter, clean and appropriate clothing and adequate personal hygiene

    • Safety - such as protection from significant harm or danger, and from contact with unsafe adults/other children, and from self-harm. Recognising hazards and danger both in the home and elsewhere

    • Emotional warmth - such as ensuring the child’s requirements for secure, stable and affectionate relationships with significant adults, with appropriate sensitivity and responsiveness to the child’s needs. Appropriate physical contact, comfort and cuddling sufficient to demonstrate warm regard, praise and encouragement

    • Stimulation - such as facilitating the child’s cognitive development and potential through interaction, communication, talking and responding to the child’s language and questions, encouraging and joining the child’s play, and promoting educational opportunities

    • Guidance and boundaries – such as demonstrating and modelling appropriate behaviour, control of emotions and interactions with others, and guidance which involves setting boundaries. This includes:  

      • not over protecting children from exploratory and learning experiences
      • social problem solving
      • anger management
      • consideration for others, and
      • effective discipline and shaping of behaviour.
    • Stability – such as ensuring secure attachments are not disrupted, providing consistent emotional warmth over time and responding in a similar manner to the same behaviour. Parental responses change and develop according to the child’s developmental progress. In addition, making sure children are not socially isolated and are supported to keep in contact with important family members and significant others.

    In cases of neglect, and particularly chronic neglect,you must work with the parents to address underlying issues and improve their capacity to parent over time, as well as addressing immediate needs and safety. Exploring and understanding the caregiver’s views, values and their own experience of parenting can assist with developing strategies to address the concerns.


    Willingness to change

    Prochaska and DiClemente’s Stages of change model may help to identify parent’s willingness to change. It describes five stages of readiness:

    • pre-contemplation
    • contemplation
    • preparation
    • action, and
    • maintenance. 

    We must assess whether the desire by the parents to change dangerous or neglectful behaviours has been demonstrated by consistent evidence of changed behaviours[2]. These changes must occur within a timeframe that is appropriate to meeting the child’s development needs. Achieving sustained change in the parent’s behavior will not generally happen overnight, therefore utilising a stage-specific model may be more realistic and encourage achievable change over a period of time, rather than a single intervention. This tool should be used with the parents when reviewing progress of actions taken or to explore underlying issues contributing to set back with progress.

    Resources available

    Assessment should consider the socio-economic environment of the family and their community, their access to services, and how the child, family and parenting functions within this. Our case management role may include coordinating other agencies to provide the available services for the child and family.

    Critical decision making – a framework for making decisions

    Where possible the family should participate in the decision making process because:

    • the decisions are being made about them, and
    • their cooperation will increase the chance of plans being successfully implemented.  

    Child protection workers should demonstrate that their decisions, irrespective of the outcomes, are well reasoned and documented - use Form 254 and 255, the  Signs of Safety assessment and planning forms in related resources and refer to Critical decision making (in related resources).

    Identifying significant harm or likelihood of harm

    The impact on children is central to assessing the level of harm for the child.  The following are examples of how a child can be affected by neglectful parenting:

    • disrupted emotional and brain development, particularly during pre-birth and the first three years. To prevent neglect early intervention is essential, as is assertive intervention where chronic neglect is already apparent

    • Foetal Alcohol Spectrum Disorder

    • disorganised attachment

    • complex behaviours such as food hoarding and self-harming

    • failure to thrive (refer to Chapter 2.2 Conducting a Child Safety Investigation and the Overview of Failure to Thrive in related resources)

    • severe obesity, and

    • death.

    Systematic recording of information will lead to a more thorough and transparent analysis process to determine whether significant harm has occurred, or is likely to occur, through the parent’s actions or inactions. Refer to Impact of trauma, neglect and cumulative harm on children for further information about indicators of harm.

    Consideration should be given to providing child centered family support in circumstances where past or current harm to the child is unclear, but there are significant indicators that may contribute to future harm or danger for the child. This assessment is based on family history and/or a current substantiation of harm to another child in the family and the parent’s current presentation. The decision from a SWA is recorded as ‘likelihood of significant harm’.

    Determining when a child is in need of protection due to neglect

    In the context of neglectful parenting, for a child to be considered in need of protection, we must assess that:

    • The child has been abandoned by his or her parents and, after reasonable inquiries, the parents cannot be found, and, no suitable adult relative (or other suitable adult) can be found who is willing and able to care for the child, or

    • The child has suffered, or is likely to suffer, harm as a result of neglect, and:

      • the parents have not protected, or are unlikely or unable to protect the child from harm, or further harm of that kind
      • the child’s parents are unable to provide or arrange for the provision of adequate care for the child, or
      • the child's parents are unable to provide, or arrange for the provision of effective medical, therapeutic or other remedial treatment for the child.

    We are expected to present objective and balanced information to the Children’s Court, by demonstrating evidence of harm. Refer to Documenting evidence for the Children’s Court in related resources.


    [1] Department of Health, 2000, Framework for the Assessment of Children in Need and their Families, The Stationary Office, London, p.20-21

    [2] State Government Victoria, 2010, Specialist Practice Guide: Cumulative Harm, Best interests case practice model. Specialist practice resource. Victorian Department of Human Services, p.27

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    Continuum of neglect responses

    The outcomes of a CSI for neglect can be presented as a continuum from adequate parenting and care, to the child being in need of protection. Refer to Continuum of neglect responses (in related resources). The type of service response required is determined by the level of harm or degree to which the parent is protective, as assessed through the use of the Signs of Safety Child Protection Practice Framework

    The Department's preferred action is to determine and provide or facilitate supports to sustain the child’s safety within the family and kinship group with, or without, the need to take intervention action.

    Intervention action means actions that involve:  

    1. making an application for a warrant (provisional protection and care) under s.35 of the the Act.

    2. taking the child into provisional protection and care under s.37 of the Act, or

    3. making a protection application - s.32(2) of the Act.

    Safety planning

    Considerations that may be helpful when developing a safety plan in neglect cases could include:

    • identification of other people in the network who may be able to increase safety
    • daily care of the child (including bathing, feeding, sleep and play routine)
    • strategies to meet the medical or health needs of the child
    • ability of the caregiver to provide, or arrange for, age appropriate supervision, and
    • strategies to address transience.

    Refer to Signs of Safety prompts for neglect (in related resources) for examples of prompt questions to facilitate discussion with the parent.

    Refer to Chapter 2.2 Signs of Safety - child protection practice framework for further information on safety planning.

    Direct work with children and their parents

    Service provision to address child neglect or cumulative harm generally requires a comprehensive and intensive approach. This will often involve more frequent visits when commencing work with the parents (this can be done by the Department in partnership with other service providers), gradually decreasing the input as the parents demonstrate more confidence and ability to undertake parenting tasks. As with any behavioural change process, the parents and children may lapse or relapse, and increased visits for a short period of time may be required.

    Services can be provided by the Department or families can be referred to our funded Intensive Family Support Services in the metropolitan area or Peel. For further information refer to the following:

    Best Beginnings Plus

    For cases of neglect you can refer families where a baby is yet to be born or is up to 12 months of age to the Best Beginnings program. The service focuses on protecting, enhancing and maintaining infant wellbeing, parental wellbeing, family functioning and social connectedness.

    Refer to Chapter 1.2: Best Beginnings - referral and intake for further information.

    Intensive family support

    Intensive family support is an appropriate response where a CSI has identified significant safety concerns for a child or where harm has occurred, but there is potential for the child to remain in the care of their family with a safety plan and intensive support. All casework planning and responses must focus on meeting the child’s needs while work is undertaken with the parents.

    Casework strategies will depend on the identified harm and danger statements, and goals for each family, and will generally include a mix of in-home support and therapeutic interventions, such as:

    • practical in home support such as home and personal hygiene, food preparation, budgeting, provide support and role modelling appropriate parenting strategies and daily routines

    • child management strategies such as:

      • educating parents about the ages and stages of child development
      • explaining where their child should be developmentally, and
      • the reasons why they may not be meeting their milestones
    • enforcing boundaries and consequences for behaviours deemed inappropriate to the family, and

    • engagement of internal and/or external services such as Best Beginnings Plus, Parent Support, Parents Visitors, Youth and Family Support Workers, Intensive Family Support Service, Aboriginal In-home Support Service, Family Support Network.

    Income management

    Consideration must be given to using Child Protection Income Management or Voluntary Income Management in circumstances where the parent’s use of their financial resources is contributing to child neglect. These initiatives are available in the metropolitan area, Peel, East Kimberley and West Kimberley. Staff should consult with their team leader or their district’s Income Management contact person, and refer to Chapter 1.2 Income management for child protection.

    Application for a Liquor Restricted Premises Declaration

    Where excessive use of alcohol is impacting on the child an application for a liquor restricted premises declaration may be appropriate as part of the overall plan to address safety and wellbeing issues.

    Refer to Chapter 1.4 Alcohol and other drug issues – application for a liquor restricted premises declaration for further information.

    Protection order (supervision)

    A Protection Order (Supervision) allows the Department to supervise the wellbeing of a child with a safety plan, without removing the parental responsibility for the period specified in the order. This order is a useful strategy to address neglect concerns by enhancing wellbeing and safety over time, and supporting parents to become more protective while maintaining the stability of the child’s living and care arrangements. The intended client group is those families who present as high risk, but who are likely to comply sufficiently with a Court order to enable sufficient safety to be established for the child.

    Refer to Chapter 3.3 Protection order (supervision) for further information.

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