Multi-Agency Neglect Strategy 2018-2022

1.1 The Safeguarding Board for Northern Ireland (SBNI) is established under section 1 of the Safeguarding Board Act (Northern Ireland) 2011 (the Act) . The duties placed on the SBNI are stipulated in the Act. The statutory objective is ‘to coordinate and ensure the effectiveness of what is done by each person or body represented on the Board for the purposes of safeguarding and promoting the welfare of children.’ 

The SBNI consists of an Independent Chair and senior representatives from the following organisations: 

• Health and Social Care Board 
• Public Health Agency
• Health and Social Care Trusts
• Police Service of Northern Ireland
• Probation Board of Northern Ireland
• Youth Justice Agency
• Education Authority
• District councils
• National Society for the Prevention of Cruelty to Children 

1.2 The SBNI identified neglect as one of its strategic priorities and established a Sub-Group to address neglect. This Sub-Group produced a Work-Plan in 2016 (see Appendix One) and undertook to achieve the tasks identified. One of these tasks was the development of a regional Neglect Strategy. 

1.3 The SBNI has developed this Strategy to help agencies in Northern Ireland who are involved with children, young people and parents to take actions to prevent, reduce and manage effects of neglect on children and families. This complies with obligations under the Children’s Services Co-operation Act (Northern Ireland) 2015 requiring co-operation amongst agencies to contribute to the wellbeing of children and young people. It is set within the context of the Programme for Government (PfG) which identifies a key desired outcome as “giving our children and young people the best start in life” and the DoH Children and Young People’s draft Strategy. It is informed by the UNCRC, particularly Articles 19 and 37.

1.4 Neglect remains one of the most prevalent forms of child maltreatment. The impact of neglect on children and young people can be wide-ranging, serious, enduring and can potentially continue across the life course. Neglect causes great distress to children, leading to poorer health, educational and social outcomes and is potentially fatal. While its impact can be particularly damaging in the first 18 months of life4 harm is also understood to be cumulative with evidence of dramatic declines in measures of child development with continued exposure to neglect. 

1.5 In all four countries of the UK, neglect is consistently cited as the most common reason for a child to be subject to a child protection plan or placed on a child protection register. At 30 September 2017 in Northern Ireland four out of five (81%) children were on the register due to physical abuse, neglect or a combination of physical abuse and neglect. It is acknowledged that in addition to children subject to child protection plans, there are also a large number of children who are not yet in receipt of statutory child protection services but are being offered early support and intervention due to concerns relating to neglect. It is also known that many children may be living in neglectful situations without any support. 

1.6 While neglect can occur across all social groups, the evidence suggests social disadvantage and poverty have a strong contributory association with all forms of child abuse, including neglect. Northern Ireland continues to face pressures from significant reductions in funding. At the same time there is evidence of increased levels of poverty and deprivation. In this context early recognition, timely and effective responses to neglect is vital in providing families with the help they need. This Strategy will support the four high-level Child Poverty Outcomes identified within the NI Executive’s Child Poverty Strategy, ‘Delivering Social Change’, March 2016. It links with the Children and Young People’s Strategic Partnership 2014 relating to Early Intervention, the Infant Mental Health Strategy and the Early Intervention Transformation Project.

1.7 The findings of the Ofsted’s thematic inspection emphasise a mixed picture in respect of the quality of professional responses to neglect. Overall, the assessments of neglect were found to be inconsistent, with poor planning, lack of professional challenge and insufficient consideration of the impact of neglect on the child. The inspection highlights the need for a strategic approach to neglect, that ensures a sufficient understanding of the extent of neglect that serves to drive improvement in practice and leadership in this field.

2.1 The purpose of this document is to set out clear strategic aims and objectives of the SBNI’s approach to addressing neglect and to improve outcomes for children and young people. This Strategy identifies key principles which should underpin how agencies work together in relation to identifying, responding to and managing the impact of neglect. 

2.2 This Strategy has been developed in conjunction with the SBNI multi-agency partners and should be considered alongside other key strategies, safeguarding policies and procedures, including the Understanding Needs of Children in Northern Ireland (UNOCINI) Framework. 

2.3 Agencies working with children and families in Northern Ireland are committed to improving attempts to effectively tackle neglect. Neglect has been identified as a priority for the SBNI.

3.1 Neglect is defined in Cooperating to Safeguard Children and Young People (revised 2017) as ‘the failure to provide for a child’s basic needs, whether it be adequate food, clothing, hygiene, supervision or shelter that is likely to result in the serious impairment of a child’s health or development. Children who are neglected often also suffer from other types of abuse’. Neglect may involve the parents or carers failing to: 

• Provide adequate food, clothing and shelter (including exclusion from home or abandonment); 
• Protect the child from physical, sexual and emotional harm or danger; 
• Ensure adequate supervision (including the use of appropriate care-givers); 
• Ensure access to appropriate medical care and or treatment; or  
• Ensure engagement with services offered for the benefit of the child e.g. not following therapy programmes, non-attendance, non-compliance with advice and treatment. 

3.2 It may also include neglect of, or unresponsiveness to, a child’s basic emotional social and educational needs. 

3.3 Neglect is characterised by the absence of a relationship of care between the parent/ carer and the child/young person and the failure of the parent/carer to prioritise the needs of their child/young person. Any child or young person can be at risk of suffering neglect. It can occur at any time, during pregnancy, at any stage of childhood, and/or the teenage years. Their basic needs should be recognised across the developmental spectrum. Even when professionals have concerns about neglect, research indicates they may not consider how they can help or intervene, apart from referring to social services.  Research also indicates that social workers’ knowledge of child development may be limited and that as a result they are less likely to understand the impact of neglect and importance of timely decision making to avoid significant harm. These factors contribute to neglect not being well recognised and its impact not being well understood. It is therefore important to have regard to the specific needs of children and young people from various community backgrounds that are often categorised under the term ‘failure to meet basic needs’. These include: 

• medical/health care and dental neglect 
• nutritional neglect, for example children and young people who experience non-organic faltering growth and/or obesity 
• emotional neglect 
• educational neglect 
• physical neglect 
• lack of supervision and guidance 

3.4 There is an overlap between emotional abuse and many forms of child maltreatment and this is especially true of neglect. When practitioners are working with children and young people who are experiencing neglect, an understanding of the link to emotional abuse is also necessary.

3.5 Children and young people who have caring responsibilities for parent(s)/carer, who have for example mental health difficulties, substance misuse, or a learning disability, may be more vulnerable to neglect. This also has implications for other children living in the family. 

3.6 Whilst it is acknowledged that any child or young person from any community background can be at risk of neglect, staff and practitioners need to be aware that there are groups of children who may be more vulnerable, such as Looked After children and young people; those who have a disability; children/young people of prisoners/offenders or from ethnic minority backgrounds, for example those from the Travelling Community; and those who have newly arrived in the country (refugees, asylum seekers, migrants, and unaccompanied children). Consideration needs to be given to children and young people who have parents with mental health issues or families who are dealing with domestic violence/substance misuse.

Setting the Context 

4.1 According to the Office of National Statistics, Northern Ireland has a population of 1.8 million people, 25% of which are children. This is the highest number of the four nations of the United Kingdom (Devaney and McConville 2016). By mid-year 2015, figures released by the Northern Ireland Research Statistics Agency (NIRSA) estimated that Northern Ireland had a population of 1.852 million and children aged 0 to 15 years constituted 20.8% of this figure. 

4.2 Nationally, a survey into childhood maltreatment by Radford et al (2011) (Devaney and McConville 2016)15 found that neglect was the most prevalent type of maltreatment in the family for all age groups- 5% of under 11 year olds, 13.3% of 11-17 year olds and 16% of 18-24 year olds had been neglected at some point in their childhood. In terms of severe neglect, parents reported that this was experienced by 3.7% of under 11 year olds, while 9.8% of 11-17 year olds and 9% of 18-24 year olds self-reported severe neglect. 

4.3 In a review of serious case reviews in England and Wales by Brandon et al 2012 neglect was found to be a significant factor in the majority (60%) of serious case reviews irrespective of the age of the child. 

4.4 According to Action for Children (2012) neglect may affect ten 10% of children in the UK, and most children in the UK have witnessed neglect. Nearly three quarters (73%) of UK children know another child who is suffering from neglect. Further information is available at Appendix 2.

The Local Context 

4.5 Based on recent research, factors influencing the context of neglect on children and young people include the experience of deprivation and poverty. Within Northern Ireland, nearly a quarter of children (24% or 106,000) are living in low income households and are deprived of four or more items that the majority of the population regard as basic necessities. Northern Ireland is the poorest region in the United Kingdom, with the greatest proportion of children living in poverty (Devaney and McConville 2016).  The ongoing impact of the Troubles on children and young people is also acknowledged.  Neglect is known to be one of the Adverse Childhood Experiences and has been agreed as one of the SBNI Strategic Priorities from 2018 – 2022. 

4.6 A report – ‘Translating Learning into Action – An Overview of learning arising from Case Management Reviews (CMRs ) in NI 2003-2008’- states that neglect is a substantial feature in most, if not all CMRs. 

4.7 Information released by the DoH Information and Analysis Directorate on Children’s Social Care in Northern Ireland for July – September 2017, indicates that on 30 September 2017, 2,115 children were on the child protection register in Northern Ireland which is 48.6 children per 10,000. This is a 3% increase on the previous quarter. In terms of Health and Social Care Trusts (HSCTs), figures range from 40.8 in the Northern HSCT to 58.2 in the Southern HSCT, South Eastern 44.3 and Belfast had 43.5 per 10,000 population under 18. Four out of five children, constituting 81%, were on the child protection register due to physical abuse, neglect or a combination of physical abuse and neglect. Neglect only was the second highest category of abuse, constituting 664 children after physical abuse, which constituted 610 children. Neglect and Physical Abuse totalled 415 children. Yearly statistics released for 2016 – 2017 shows there were 2,132 children registered on the child protection register by 31 March 2017, which is 49 children per 10,000 population under 18 years of age. This is a 1% decrease on the previous year. Figures were as follows:

Table1. NI Child Protection Registration Statistics 

5.1 The key principles which are central to the task of addressing neglect include: 

• Working in partnership and in collaboration with others (acknowledging and valuing different roles, knowledge and skills and the ability to constructively challenge decisions); 
• Focusing on outcomes for children and young people and families; 
• Recognising that risk and uncertainty are features of safeguarding and that risk can never be eliminated fully but it can be managed; 
• Being informed by evidence, research and findings from Case Management Reviews and Inquiries; 
• Adopting a multi-disciplinary and inter-agency approach; 
• Trusting professionals and giving them the scope to exercise their professional judgment in deciding how to safeguard children and young people; 
• Developing expertise and knowledge to effectively safeguard children and young people; 
• Encouraging the participation of children and young people and families in the safeguarding process; 
• Listening to and obtaining the views of children, young people, families, practitioners and the wider community; 
• Adopting a rights-based approach in relation to children and young people and parents; 
• Age appropriate interventions.

6.1 The overarching aims and objectives of the SBNI Neglect Strategy is to improve outcomes for children and young people by ensuring prevention, early recognition and improving agency responses to children, young people and families affected or potentially affected by neglect. This requires strong and effective multi-agency leadership. In order to fully address the issue of neglect in Northern Ireland it is recognised that the cooperation of agencies who are not members of the SBNI will also be required. 

6.2 To that end, the Strategy has 9 core objectives to: 

1. Secure collective commitment for addressing neglect across all SBNI member agencies; 
2. Demonstrate effective leadership in driving any required systems and process changes forward; 
3. Improve awareness and understanding of neglect across all SBNI member agencies. This includes a common understanding of neglect, the impact of neglect and the thresholds of need and intervention; 
4. Promote early intervention with the aim of preventing children and young people from experiencing neglect; 
5. Improve the recognition, assessment, use of assessment tools and responses to children, young people and families experiencing neglect; 
6. Agree common outcomes, measures and metrics on the effectiveness of single agency and multi-agency service provision; 
7. Ensure that the views of children and young people, parents and carers and staff inform practice and interventions; 
8. Improve awareness, understanding and action on neglect for all organisations that work and come in contact with children, families and others including the Judiciary, those providing foster care and looking after ‘children living away from home’; and 
9. Increase awareness of the general public in relation to the issue of neglect.

7.1 Neglect remains the most prevalent form of child maltreatment. The impact of neglect on children and young people can be wide-ranging, serious, enduring and can potentially continue across the life course. Neglect causes great distress to children and young people, leading to poorer health, educational and social outcomes. It is potentially fatal. 

7.2 Research has shown that children under the age of 3 years suffer the most significant, permanent damage as a consequence of neglect. During these years there is significant brain development and growth that occurs in healthy children, which can be adversely affected if children are not nurtured. 

7.3 Parental nurturing of adolescents is also crucial. Research has shown that neglect and emotional abuse of adolescents can have severe and lasting effects, however this is often misunderstood and misdiagnosed by professionals.

7.4 Children and young people who have a disability and those who are Looked After are particularly vulnerable to abuse and neglect. Evidence suggests that children and young people of prisoners/offenders are also a ‘high risk’ category for inclusion on the child protection register. 

7.5 The work will take account of the views of those who have particular expertise in the area of neglect and be informed by research.

8.1 The views of practitioners from all agencies are important. It is intended that a number of focus groups will be undertaken with practitioners through the SBNI Safeguarding Panels and wider organisations. This information will inform the work being undertaken in relation to neglect.

9.1 It is recognised that existing information is limited within the Northern Ireland context and therefore participation and engagement of children and young people and families from a wide range of backgrounds and situations will be promoted to inform the work being undertaken. Information that is available and which has informed this Strategy is provided by the Halley Stewart Trust which was based on a series of focus groups from three projects (University of Stirling and Action for Children 2013; Burgess et al 2014). Children identified that the practicalities for living were ‘really important’. They talked about the need for food, money, houses, doctors, dentists, being safe, making friends and ‘cuddles if you are a baby’. A few added that love and hugs were really important but more thought that attention, love, praise, and other people’s relationships were quite important. 

9.2 Parents felt that it was ‘really important’ for children to have a roof over their head and that children need love, to be talked to and to be there for them. The participation and engagement of children and young people and families is crucial to informing this Strategy and the work being undertaken on neglect within Northern Ireland. This will be undertaken through the SBNI Safeguarding Panels and the feedback used to inform the on-going work.

10.1 An awareness-raising campaign and communications strategy will be developed to raise public awareness of the factors relating to neglect.

11.1 The importance for staff to have access to relevant knowledge and continuing professional development in relation to neglect is recognised and acknowledged. Training for staff is essential to equip them in the recognition and assessment of neglect and how to intervene in cases of neglect. Supervision and consultation is crucial in supporting staff in relation to neglect. 

11.2 Training on neglect will be undertaken in accordance with the SBNI Learning and Development Strategy and Framework. Liaison will take place with Universities regarding undergraduate training and with professional bodies.

12.1 It is important that measures of success are established and agreed in an Outcomes Based Accountability Framework. The indicators and outcomes will be informed by the Programme for Government (PfG), the Children and Young People’s draft Strategy and the four high-level Child Poverty Outcomes identified within the NI Executive’s Child Poverty Strategy, ‘Delivering Social Change March 2016’. Links will be made with the Children and Young People’s Strategic Partnership work relating to Early Intervention in regard to the issue of neglect. The following outcome indicators will demonstrate the effectiveness of the Strategy and its implementation: 

• Map those children who have <85% attendance at school by those on the CPR under the category of neglect to identify any links; 
• Reduction in the number of re-registrations (within three years of original deregistration) on the child protection register under the category of neglect; 
• The % of children on the CPR by HSCT under the category of neglect compared with the Northern Ireland population; 
• Increase in the number of dental registrations in respect of children by Health and Social Care Trust (HSCT) 0-2 years and 3-5 years; 
• Reduction in the number of child dental caries & extractions by HSCT by Age Group; 
• Reduction in the number of referrals made to Gateway Services from Family Support Hubs where neglect is an issue; 
• Reduction in the number of children escalated to Gateway from EISS where neglect is an issue; 
• Monitor/review the number of children needing to become Looked After Children as a result of neglect; 
• Reduction in the number of NSPCC Helpline referrals. 

12.2 It should be acknowledged that in the short to medium term, through improved recognition of neglect, there may be an increase in some of the above indicators.

13.1 The Chair of the SBNI Neglect Sub-Group will report to the Independent Chair of the SBNI. 

13.2 Members will report to their respective organisations through their existing governance structures. 

13.3 There will be an expectation that all SBNI member agencies will translate this Strategy into an individual action plan that will be reviewed by the SBNI.

14.1 The SBNI Neglect Sub-Group Work Plan outlines the activities required to deliver the objectives of this Strategy. See Appendix One.

SBNI Neglect Sub-Group Work Plan 2016 – 2022 

The Safeguarding Board for Northern Ireland (SBNI) is the key statutory mechanism for agreeing how member agencies will cooperate to safeguard and promote the welfare of children and for ensuring the effectiveness of these and other safeguarding agencies. 

Introduction 

The issue of neglect has been agreed as one of the Safeguarding Board’s priorities. The overall aim of the SBNI regional Sub-Group on neglect is to provide strategic leadership to ensure safeguarding practice in relation to neglect and particularly vulnerable children is effective. 

Objectives of the Sub-Group: 

• Secure collective commitment of addressing neglect across all SBNI member agencies; 
• Demonstrate effective leadership in driving any required system and process changes forward; 
• Improve awareness and understanding of neglect across all SBNI member agencies. This includes a common understanding of neglect and the thresholds of need and intervention; 
• Promote early intervention with the aim of preventing children and young people experiencing neglect; 
• Improve the recognition, assessment, use of assessment tools and responses to children, young people and families experiencing neglect; 
• Agree common outcomes, measures and metrics on the effectiveness of single agency and multi-agency service provision; 
• Ensure that the views of children and young people, parents and carers and staff inform the work and effectiveness of the Sub-Group; 
• Improve awareness and understanding of neglect for organisations outside of the SBNI member agencies that work and come into contact with children, families and others including the Judiciary, those providing foster care and looking after ‘children living away from home’; and 
• Increase awareness of the general public in relation to the issue of neglect.

Values 

The SBNI Neglect Sub-Group should create an ethos that ensures: 

• The child’s welfare is paramount; 
• Respecting diversity (race, religion, culture and disability); 
• Promoting equality; 
• Children and young people’s wishes, feelings and experiences are placed at the centre; 
• Respect; 
• Confidentiality. 

Principles 

The principles which are central to the task of the SBNI Neglect Sub-Group are: 

• Working in partnership and in collaboration with others (acknowledging and valuing different roles, knowledge and skills and the ability to constructively challenge decisions); 
• Focused on outcomes for children and young people; 
• Recognising that risk and uncertainty are features of the safeguarding system and that risk can never be eliminated by but it can be managed; 
• Informed by the view of practitioners, evidence, research and findings from Case Management Reviews and Inquiries; 
• Multi/inter-agency in approach; 
• Trusting professionals and giving them the scope to exercise their professional judgment in deciding how to safeguard children and young people; 
• The development of professional expertise to work effectively to safeguard children and young people; 
• Encouraging the participation of children and families in the safeguarding process, listening to and obtaining the views of children, young people, families, the wider community and practitioners, to identify any gaps, problems and opportunities in relation to Policy and Procedures; 
• Rights-based approach in relation to children and young people and parents; 
• Age appropriate interventions.

Data available at Safeguarding is everyone's business (safeguardingni.org)