Abuse and ‘neglect’ – how is this identified? And what support is offered?

 

I am grateful to this post from one of CPR’s readers, who is parent to an autistic child. She writes about her difficulties in getting help and support for her son and the problems families experience in a system which does not seem set up to identify difficulties and offer support. What happens when children with difficulties arising out of their undiagnosed disabilities are mis-identified as children suffering from parental neglect or abuse?

As she comments:
As it stands, the Child Protection system is a blunt and sometimes cruel instrument often used without much prospect of bringing about positive change because it can only ever work as one part of a system of support for families, and this system of support is largely absent.

Not having met a social worker in our local authority until the day my son with an Asperger Syndrome diagnosis entered Care under section 20 of the Children’s Act 1989, I began to read anything I could find about children with his profile who enter Care. That was the day I accepted that having tried everything else, Care was the only option available to get an integrated package of support for him, something we and he had needed by any measure for some time. He was not going to be someone ‘who didn’t fit within our services’ remit’ nor just another statistic of a disabled young person living rough with poor mental health or worse, something that seemed almost inevitable at that time, without trying everything including Care.

As part of my coping mechanism for the immense grief and desolation I was experiencing, I read report after report to learn about the Care system. Eventually, to cut down on my reading, I’d open reports and papers in pdf format and search within the document with the search facility using terms like ‘disabled, disability, autism, neuro-developmental, ASD, ASC’ and might get one ‘hit’. What I did notice was that if I carried out the same search using ‘neglect’ as a search term I’d get scores of ‘hits’ within the same document. I concluded that for social workers ‘neglect’ was ‘sexy’ and disability anything but. Children like mine, with an autism diagnosis but without an obvious learning disability were a bit of a side show while all the action in Child Protection was around ‘abuse and neglect’ and that didn’t seem to be up for discussion. There were a few reports like the excellent ‘Unprotected, Overprotected’  that made links between disability and core child protection issues but generally these reports were few and far between.

If one looked a little wider to the family unit with an autistic or learning disabled family member there seemed to be almost nothing in terms of research into how to support families with complex difficulties around neuro-disability including poor mental health, different ways of thinking and processing information, mental inflexibility and the need for extreme control to manage anxiety as just some examples.

I came to loathe the word ‘neglect’, surely the reasons why children enter care are multi-faceted yet this word is so un-nuanced and brings with it a mountain of stigma, shame and blame for parents.

One of the things that also became apparent to me, was that there seemed to be a lot of children with extreme difficulties within Care. When I asked why our son hadn’t a social worker from The Children with Disabilities Team I was told they only took on cases of children with multiple and complex disabilities and they had a very full caseload. Similarly when I asked why his case did not have clinical oversight, (something that eventually did come) I was told ‘’All our children have the same kinds of difficulties’. My response was ‘’well, are they being given autism assessments?’’ The answer to that question ( yet more reading..) was that ‘no, children who enter Care are not assessed or even screened for autism – all their difficulties (they are most commonly described as having developmental delay not disability and/or traumatised with poor mental health) unquestionably stem from ‘’neglect and/or abuse by parents prior to entering Care’’. Well that is not my experience so..?

I eventually came to the conclusion that assessments and healthcare for children in Care are not remotely up to the task of meeting the needs of a sizable number of children who are in Care, many with undiagnosed hidden disabilities. There is almost no data collected on children in Care with disabilities and we do not know how many are diagnosed as being autistic before they enter Care or within Care although we know from 2017 Freedom of Information requests there is considerable local variation in their numbers from 0% (Calderdale) -to 12.7% (Walsall). Surely this is Corporate Neglect and why were Child Protection professionals / CQC / Ofsted not making that point? Obviously some types of neglect are more ’sexy’ for professionals working in Child Protection than others.

There are some other troublesome issues around ‘neglect’

I’ve recently being made aware of this project. Identifying and Understanding Inequalities in Child Welfare Intervention Rates. It is worth watching the You tube video associated with the link as it identifies that in a poor neighbourhood within a wealthy borough there are a lot more children on child protection plans than in a poor neighbourhood in a poor borough. Surely ‘abuse is abuse’ and ‘neglect is neglect’ so how to explain this? Assuming ‘abuse’ is an absolute, maybe the concept of ‘neglect’ is a relative one, so one person’s/team’s idea of neglect is not another’s? I’ve a working lifetime of experience where I’ve learned to never ask anyone in a local authority whether they would like to be involved in decision making unless it falls within their strictly defined statutory remit and I check that myself first rather than asking. This is because I have found that many are tempted to try and control things they have no statutory remit for and ‘it is best not to invite trouble’. This is certainly not unique to people who work in Local Authorities just that when asked for our opinions, most of us have difficulties not telling people what they should be doing based on our own likes/dislikes/perspectives. When it comes to Child Protection, where there is a huge power imbalance and a very diffuse remit, I think this can enter some really dangerous territory.

Take this situation where there are concerns about abuse and neglect by parents of their autistic children :-
‘’ Some families may feel that they accept their child for who they are and allow them to withdraw from the world. Is that neglect? Many people with autism need to have structure and routine in their lives to cope with an unpredictable world. Some parents may allow this to take over and dictate the lives of the whole family, others may rally against it, believing it’s in the child’s best interest for them not to give way to the structure. Is this abuse?

There are many different therapies and interventions available which claim to cure autism. Some of these practices can in themselves ‘appear’ abusive. Some parents pursue these out of desperation and when the claims for some of these therapies and interventions are far from clear, it can be difficult for parents to know what to believe’’

http://www.autismeurope.org/activities/projects/speak-up-publications/guide-for-the-protection-of-children-and-young-people-with-autism-from-violence-and-abuse.html

If social workers working with children have little training about autism, are they really able to make decisions about what constitutes ‘neglect’ when it comes to this group? What if an autistic child doesn’t t have a diagnosis because clinicians do not have resources to carry out specialist assessments? If they do not have very good multi-disciplinary working arrangements that can quickly identify the reasons for a child’s difficulties and help build the child’s capacity, ,not just focus on questions about the parent’s fitness to parent, are they likely to get this right?
Where is the discussion about this in Child Protection circles and if decision-making is wrong why is that not abuse? It is absolutely foreseeable and mostly preventable with good training and good multi-disciplinary working arrangements around diagnosis.

Which brings me to ‘Edge of Care’ support for autistic children.

Autism is a spectrum condition and a child’s difficulties can present in many ways. One of the most difficult to explain is that a child who is very bright and no trouble in school can have extreme difficulties in processing what is happening around them and may develop very poor mental health particularly around anxiety. See this National Autism Society video  explaining how autistic children who have acute difficulties such as these, may end up in secure or forensic settings.

The tone is very much ” Their parents never taught them and because of this..” My response to that would be ”Give parents the tools to help their autistic children and most will.” Autistic children need an autism diagnosis (my son got his at 16 in the most horrendous circumstances) and parents need support (we got none). I also believe billions of pounds of cuts are purposefully being made to Children’s Services, legal aid and the NHS with an unspoken acceptance that naive carers/parents in desperate circumstances will find it almost impossible to access support for themselves and their children. Many pathways to support exist in name only, are supposed to be provided by the market via brokerage or self-funding or unfunded charities, are initiatives or time limited programmes that quietly disappear, unlike the fanfare around their introduction. Services where they exist are understaffed and complaints/appeals processes so difficult to negotiate that only the most committed, resourceful and able persist. All, including professionals who have to somehow work in this environment whilst retaining their own humanity, understand this, so is this the ‘neglect and abuse’ that Child Protection Professionals are concerned about? Maybe.

I could go on and on..

As you will have gathered my own ‘special interest’ is around children who are autistic. See this piece http://www.bbc.co.uk/news/health-41345647
”About 20,000 children have been harmed by valproate medicines in the UK since the 1970s. The medicines regulator said the drug had been kept under constant review. Babies exposed to the drug in the womb have a 40% risk of developing autism, low IQ and learning disabilities.” —Almost 70% of women surveyed about a powerful epilepsy drug have not received new safety warnings about the dangers of taking it during pregnancy.”

Anyone interested in the law may already know that a number of years ago, legal aid was withdrawn to families trying to take a case against the drug’s manufacturer and it could not proceed. Since then children continued to be born with abnormalities and some died, as a result of their mothers taking this drug without being aware of the risks, causing unimaginable and completely preventable suffering to children. Is that ‘neglect’ by the State? Can it get any more serious if so?

Or is this the kind of ‘neglect and abuse’ that the United Nations has called for action on, United Nations criticises treatment of disabled children in the UK  that concerns Child Protection professionals?

These are rhetorical questions in the main because although Child Protection professionals refer to preventing ‘abuse’ and ‘neglect’ of children what they really mean is intervening in families that are experiencing difficulties with the mind-set that children’s difficulties stem from neglectful or abusive parenting. The reality is that it isn’t possible for parents or professionals to nurture children particularly children with high needs, without the State taking an active role in supporting and protecting families.

As it stands, the Child Protection system is a blunt and sometimes cruel instrument often used without much prospect of bringing about positive change because it can only ever work as one part of a system of support for families, and this system of support is largely absent. I think families are a huge resource – painting us as incompetent, neglectful, not to be trusted, ignorant etc. is just so damaging for our children. My son didn’t need rescuing. We needed to be listened to and we needed help. That our son had to enter Care to get it is my idea of what constitutes ‘neglect’.

 

Further Reading

NHS (2017) Developing Support and Services for Children and Young People with a learning disability, autism or both  ”The Department for Education supports the development of the work undertaken in the Transforming Care Partnership Boards and encourages local authorities to pay regard to this guidance”

Tizard, Challenging Behaviour Foundation (2017) Developing Better Commissioning for Individuals with behaviour that challenges services – A scoping exercise.
The Children Act 1989 – deeply flawed legislation?

19 thoughts on “Abuse and ‘neglect’ – how is this identified? And what support is offered?

  1. Angelo Granda

    Thanks for this post which is very interesting. As the writer suggests, it is true that the professionals refer to ‘neglect and abuse ‘ wrongly without investigating correctly or getting expert opinion.
    However, I assert that they are doing so due to strict directives from LA’s which act with ulterior motives . They need to satisfy criteria for neglect before they can get a care-order. Thus, we should be studying threshold criteria documents to establish how they do so. Alas, these are never published . If they were ,I suggest the LA’s would be laid open to libel charges. To present guesswork and speculation as facts to satisfy threshold is unlawful because it misleads the Court.
    So researchers should examine a cross-section of these documents. A hint – Severe learning difficulties may be cited as a fact to satisfy criteria. Yet autistic children don’t have S.L.D. Even if they did, it does not mean a child has been neglected and abused. Yet a Judge will find it does. This is because they usually have to accept the opinions of SW’s and Guardians .

    Reply
    1. Sarah Phillimore Post author

      The threshold document itself may not be published – but many court judgments are which refer directly and in some detail to the threshold document when it is disputed.

      Reply
    1. looked_after_child

      Not sure if this off or on point but has anyone seen this http://www.op.nysed.gov/prof/sw/swbroch.htm
      Clinical social worker..wonder what that would mean here? I guess this a response to need in a country with almost no free healthcare. Could we head down this road here too. What would it mean if so – DfE would need to change their remit and that would be very challenging for them…really strange to think of SWs doing diagnostic work.

      Reply
        1. looked_after_child

          See https://www.nice.org.uk/guidance/GID-SCWAVE0770/documents/short-version-of-draft-guideline
          This could be a blueprint for Children’s Services if only DfE cared enough to even become a sponser department ( and is probably trying to frustrate things in the background as it would involve an erosion of their power base?)

          ”Local authorities and clinical commissioning groups should jointly designate a single lead commissioner who is responsible for commissioning health, social care and education services for children, young people and adults with a learning disability, including for those whose behaviour is described as challenging. This commissioner should have in-depth knowledge and experience of working with people with a learning disability and behaviour that challenges.
          Local authorities and clinical commissioning groups, acting through the single lead commissioner, should consider jointly commissioning the most specialised behaviour support services across areas for people with particularly complex needs”

          Reply
          1. looked_after_child

            When you’ve dehumanised people who need services to the extent this is happening in children’s social care is it possible to do this?-
            ”Commissioners should establish a multi-agency group, including experts by experience and providers, to monitor the quality of services and the outcomes achieved. Commissioners should use these as part of their performance management of services”

          2. looked_after_child

            This guidance with no statutory force ( so a govt. promoted ‘wish list’ from the Department of Health, would make anyone who has experience of the issues weep.
            Imagine what this would mean if Children’s Services could do this for families (although some are getting around to it for paid carers out of necessity)?

            Support for families and carers
            Local authorities should ensure that parents and carers of children, young people and adults with a learning disability and behaviour that challenges have support to care for that person from the following specialist services:
             psychology  speech and language therapy  occupational therapy  behaviour analysis and positive behaviour support, including training on
            restrictive interventions and how to reduce their use.
            Specialist staff should provide information and training to families and foster carers of children and young people in line with recommendations 1.7.1 and 1.7.2 in NICE’s guideline on challenging behaviour and learning disabilities: prevention and interventions.
            Local authorities should provide information, guidance and support for families and carers of people with a learning disability and behaviour that challenges which addresses different aspects of their life. This support could include:
             peer support  parent and carer groups  email support  individual phone and in-person support  family networks  managed email networks (a shared discussion forum).

            Our children are not important. We are not important. Policymakers have made that evalution/choice because all know what good practice is but that is as far as it goes…the realms of fantasy only.

      1. looked_after_child

        Quote:-
        What are we doing about it?

        We are very aware of the increasing numbers of parents who find themselves subjected to child protection procedures as a result of asking for support, challenging professionals or having a child with a condition that someone working with them does not understand.

        Tania and I have already spoken openly to ministers, journalists, child protection experts, medical experts and parents about our concerns surrounding the anti-parent language used in publications and guidance around child protection and the lack of adequate monitoring and accountability for safeguarding personnel.

        We have also raised concerns about the lack of evidence supporting much of the guidance published by the government, as well as numerous journal articles listing ‘risk characteristics’, such as a parent asking for a second opinion or disagreeing with a doctor.

        Also concerning is the focus of safeguarding training encouraging practitioners to rely on lists of risk indicators that have had no rigorous independent scrutiny or any fact-based evidence to support them. Given the heavy price that parents and children have to pay when practitioners follow these guidelines and get it wrong, we simply cannot understand why no one is demanding the same rigorous scrutiny and quality control as we expect of the scientific community.

        Reply
        1. looked_after_child

          quote:-

          ”This guideline on handling and responding to abuse and neglect caused us serious concern that it was directly discriminating against disabled children and their families, and would lead to specific developmental disorders being targeted. We believed that the evidence gathered, including the testimonies of expert witnesses, was not representative of all the people on whom these guidelines will impact. For example, it fails to properly explore the likelihood that these guidelines will be applied in error and what the unwarranted consequences of this might be to children and their families.

          The evidence search also failed to properly explore the consequences and possible harm that could be caused by incorrectly accusing parents of abuse and the expert witnesses and committee members did not include any experience of childhood disability and its presentation and did not invite input from experts dealing with false allegations of abuse.”

          Reply
          1. looked_after_child

            quote: ”Isn’t it time we stopped being so scared of having an open and honest conversation about child protection? Isn’t it time we stopped demonising all parents, and stopped putting child protection ‘experts’ on untouchable pedestals?”

          2. looked_after_child

            ”It is the most terrible thing to be accused of as a parent, and the weight of the accusation should not be lost because we hide behind the pretence that we are acting in the best interests of the child, because we are not.

            When you accuse a parent, you are taking away their ability to advocate for their child. You are removing and discrediting the best source of information you have about how to help the child. You are taking away the expertise of the person that knows them the best. This is not in the best interests of anyone.
            quote
            ”So let’s stop repeating the same mistakes and learn from best practice rather than guidance that tells us to ignore our instincts and use an assessment tool that is no more accurate than rolling a dice. Let’s approach child protection from a position of kindness, compassion, and communication, then all the money we save by not overwhelming social services with pointless assessment referrals, could be ploughed back into supporting families and helping give children positive outcomes rather than dragging families through the dirt and then blaming them for being too broken to cope”

  2. Planet Autism

    “Assuming ‘abuse’ is an absolute” – which *is* done, even though clearly it isn’t. Considering the ethereal and frequently subjective definitions of ’emotional harm’ being misused against some parents and in all too many instances fabricated harm based on a social workers’ ignorant opinions, we can say hand on heart that abuse is not an absolute. Emotional harm and FII are being widely misused against parents and especially those witith autistic children and who are themselves autistic parents. The highest numbers of children termed as being abused or at risk of abuse are in the emotional harm category (https://www.theguardian.com/society/2017/jan/18/children-parents-foster-social-care-families-adoption).

    It happens all the time with autistic children that the state uses a tick-box ‘ideal’ that if they don’t match it there is something wrong and the parents are blamed as you describe. It is also far from accidental, parents are more and more frequently falsely accused of abuse by LAs in retribution for parents seeking SEN support or going to SEN tribunals against the LA.

    Parents are also being abused by their autistic children and the the parents are blamed for that too. Yvonne Newbold has received emails from many parents in this position. There is a nasty, punitive, negative and blaming attitude in social services across the UK. It seems to be about justifying their actions and nothing else. CAMHS doesn’t want to diagnose autistic children because it gives them access to expensive support. The Government has known (via Parliament) about this problem for 26 years and has done nothing. How can so many social workers get away with this behaviour? Because they can. Because judges don’t find them guilty of perjury, police don’t investigate reports of perjury, abuse of procedures happens on a daily basis without any action against guilty parties and procedures are written without sufficient safeguards built in. What a lovely job for vindictive people with an axe to grind, or those who have a personality disorder, become a social worker and get away with anything you want pretty much. If it leaks out, you will simply be moved to another area to continue your dirty deeds. You might have to dodge a bullet once in a while as the HCPC will now and again make an example of someone for the sake of show. But how lovely eh, all that power to abuse without any consequences to you.

    And as always, it’s the most vulnerablewho are targeted. So autism families and those with other invisible disabilities like Ehlers Danlos syndrome which causes easy bruising and bone issues, or chronic fatigue syndrome, where parents are accused of FII and enabling the child’s mental ill-health (because of course it’s all in their head) are the ones who suffer.

    You covered a lot in your post and I’m glad you pointed out the UN’s findings against the UK. What’s going on in this country is disgusting and evil.

    Reply
  3. Angelo Granda

    Sarah, Was I correct in law to say that IF threshold criteria documents were distributed openly and/or published it would render LA’s open to a legal action for libel ( just as a newspaper would be when it issues false reports )?

    Clearly the secret documents and lack of publicity, transparency etc. is not to protect any children; it is to protect LA’s, in my opinion and allows the Authorities to libel and slander citizen’s without any comeback!

    Reply
    1. Sarah Phillimore Post author

      No. It is unlawful to publish threshold documents because they reveal considerable details about the private lives of families and the particular abuse and trauma it is alleged that children have suffered. If they were to be published far and wide there would need to be strong safeguards against identifying children who have a right to grow into adulthood without all their family’s dirty laundary being hung out to dry for many years to come.

      Reply
      1. Angelo Granda

        Yes, Sarah, but please answer my question which I asked in the spirit of constructive discussion. We we already know the rationale behind the Court’s rules but is one of the side-effects ( planned or unplanned) that Local Authorities can make false allegations of neglect, abuse and trauma in these Court documents without any come-back? Thus it cannot really be said that such rules protect children but the opposite. To my mind when LA’s issue false documents and assessments of any kind under oath to be distributed amongst other professionals they should be open to the same level of public censure as the press etc. Thus Public Law threshold documents should be published in the children’s best interests. It is mere speculation that families will be harmed by having alleged dirty laundry made public. It is a fact that there must be strong safeguards against false allegations and misrepresentations because they cause immense harm and degradation. We should really get our priorities right and cease pandering to the Authorities,in my opinion.
        All comments welcome.

        Reply

Leave a Reply

Your email address will not be published. Required fields are marked *