Evidence and Impact: Preventing child neglect
NSPCC
Tuesday, June 26, 2018
The latest in a series of articles about emerging safeguarding practice looks at how the NSPCC develops evidence-based approaches to design systems and services to provide early help to prevent child neglect.
- The NSPCC works with children, young people and families who need help across the UK. Its services aim to protect children today, prevent abuse tomorrow and support wider efforts to make child cruelty a thing of the past. To improve understanding of best safeguarding practice, the NSPCC publishes evaluations of its services and interventions, and undertakes research and literature reviews. These are published on the NSPCC website to contribute to the evidence on what works to protect children and families.
Neglect means that a child's needs for safety, physical care and love are not being met, to an extent that could cause them serious or lasting harm. Parental stress or ill-health, domestic abuse, substance or alcohol misuse, or parents' own experiences as a child can contribute to children not receiving adequate or even basic care to meet any of these needs. Often these situations are longstanding and not quickly resolved. It can be challenging for professionals to identify, measure and monitor neglect (Gardner, 2008).
There has been growing consensus, backed by a wide body of research (Allen, 2011; Munro, 2011; Chowdry & Oppenheim, 2015), that providing children and families with help before a problem emerges or at an early stage prevents children from suffering harm, improves their long-term outcomes and is more cost effective than reactive services.
Learning points
Messages about neglect
Neglect is the main reason adults contact the NSPCC helpline - in 2016/17, around a third of all contacts were from adults worried about children suffering neglect. Nearly half the children they contact us about are under five.
We also know children don't talk about neglect. Each year it's one of the least common reasons to contact Childline. Rather than talking directly about neglect, children tell Childline's counsellors about feeling frightened and anxious, upset, lonely and sad (Turnbull, 2015). Most commonly young teenagers rarely recognise that what they are experiencing is neglectful care - instead this is often identified by the counsellors. Often, the young person had told no one else about their problems; but even when they had, this had not always led to the help they desperately needed.
Tools to identify neglect
In 2012, research by Barlow identified the Graded Care Profile (GCP) as a tool that "could potentially improve both the assessment and analysis of data about children in need". The NSPCC undertook the first national evaluation of the original GCP, and, working with the original author, Dr Srivastava, developed the only authorised update of the tool. The GCP2 is true to the original model but more user-friendly and comprehensive.
The GCP2 was also tested and found to be a reliable and valid assessment tool in aiding the assessment of child neglect.
When used to evidence referrals, practitioners felt that the GCP2 had more of an impact than other methods of assessment for three reasons:
- It clearly articulated a broad range of neglectful behaviours and gave practitioners a shared language so that issues could be clearly communicated and understood between agencies
- The GCP2 increased practitioners confidence and ability to identify neglect
- The evidence provided by the GCP2 was well-respected and carried some weight in the child protection arena, making it more likely to be acted upon.
Putting evidence into practice
The NSPCC is now supporting more than 55 local areas to implement the GCP2 so neglect can be identified earlier on with more children and families.
The NSPCC evaluated how the GCP2 is being implemented in other areas (Smith, 2018). Most sites were still involved in rollout of the neglect assessment tool, and they followed the key principles of the model with fidelity. Many of these provided evidence their GCP2 use would be sustained in the future. However, despite very positive ratings of training only 48 per cent of survey respondents reported using it in practice six to 10 months later. Nevertheless, research suggests that new models can take around two to four years before they are fully integrated into practice, and that training alone rarely changes practitioners' behaviour.
One local area wanted to ensure that the neglect assessment tool was embedded into practice. A health visitor was seconded into a joint venture with the local safeguarding children board at Stockton-On-Tees Borough Council to co-ordinate the rollout of the GCP2. She identified five factors for successful implementation (see box).
Systems change
Universal services
An NSPCC study asked health visitors, school nurses, GPs, midwives, teachers and early years practitioners about what help is provided and what the barriers are to providing early help (Haynes, 2015). The report revealed:
- All the practitioner groups believed that they and other universal services practitioners have a responsibility to be able to both identify neglect and to provide early help in some way.
- The most common way for practitioners to provide early help for child neglect was by signposting families to other agencies, sometimes with little other action taken.
- Strikingly low percentages of practitioners said that they would normally talk to a child about an early concern of neglect, raising concerns about how child-centred practice is.
The research study concluded that a robust model for provision of early help requires:
- Clear accountability
There must be the necessary resources available to enable universal services practitioners to undertake early help. - Clear role expectations
Universal services professions need to be clear about their role in providing early help for neglect and about how they can provide direct support. - Clear pathways to help
Clear and accessible pathways for the provision of early help, including between different universal services, and between universal services, targeted services and children's social services. - Effective information sharing and multi-agency working
Open, dialogue and information sharing among universal services practitioners, and between universal services practitioners and children's social services (where in the child's best interest). - Training, support and supervision
Practitioners need to be confident and able to take early action before referring their concerns to social services. - Relationship building
Universal services need to be delivered with a focus on the importance of relationship building between practitioners and families.
Creating safer communities
Together for Childhood is an innovative, evidence-informed approach that brings local partners and families together to make a community a safer place for children. The vision for the approach imagines communities taking the best of what social care, schools, health, voluntary and community groups, police and the NSPCC are already doing, to prevent abuse.
Together for Childhood is a place-based approach to prevention, co-ordinating jointly planned actions to address the prevention of abuse. The NSPCC is working with partners in two areas: in Grimsby, the initiative is being co-created by building on what the partners - North East Lincolnshire Council, police, the voluntary, community and social enterprise organisations, and others - are already doing to identify family problems early and help prevent child abuse and neglect.
Together for Childhood sites will be places of constant and intensive learning. Each site benefits from embedded evaluation resource, and the NSPCC aims to demonstrate what works in preventing child abuse by robust evaluation of effective and sustainable approaches.
FIVE TOP TIPS FOR IMPLEMENTING THE ASSESSMENT TOOL
- Visible support from management
Staff feel valued if they are listened to and can see management involved in the introduction of a new tool and process. Stockton-on-Tees Safeguarding Children Board and managers remained visible throughout the roll out of GCP2, for example by writing a letter to thank practitioners for taking time out to be trained and for using it in practice. - Comprehensive training
Training needs to be more than a "death by PowerPoint" approach telling staff about a new tool and expecting that they will then go on and use it. For example, staff are encouraged to explore different ways of introducing a GCP2 tool to the families they are working with; this can incorporate some role play. Practitioners are also required to practice using the tool on a current case; this allows them to understand how it fits within their role and ask questions that develop from this. - Follow-up sessions
Staff need time to consider the impact of a new process and may need to refresh what they learnt during the initial training session. People learn from experiences and shared learning, so organising follow-up group training sessions can be really useful. - Coaching and Mentoring
Fixed training sessions are not enough. Staff need to know they can continue to ask questions and not be left "holding the baby" or wondering if the decisions they are making using the tool are correct. Stockton-on-Tees took an informal approach, by providing all practitioners with details of how to contact the GCP2 co-ordinator, who also acted as a mentor. - Supervision
Staff need to have time to reflect on their actions so they are able to offer families and children the best support and interventions possible. Practitioners had supervision within six weeks of the follow-up session.
FURTHER READING
- Implementation Evaluation of the Scale-up of Graded Care Profile 2, Smith et al, 2018
- Realising the Potential: Tackling Child Neglect in Universal Services, Haynes, 2015
- Hurting Inside, NSPCC report on the learning from the NSPCC helpline and Childline on neglect, 2015
- NSPCC video on how abuse and neglect changes childhood: youtu.be/updwQTu4Ncs