Relationship between child neglect and forms of sexual harm explored
Derren Hayes
Tuesday, July 5, 2016
Two children's charities have worked with researchers to see if there are links between children being neglected and experiencing other forms of harm, and issued a set of recommendations on how practice can change.
A series of evidence reviews by the NSPCC, Action for Children and Research in Practice explores the relationship between child neglect and three other forms of harm – child sexual exploitation (CSE); adult perpetrated intra-familial child sexual abuse (IFCSA); and harmful sexual behaviours (HSB).
Neglect has been chosen as the focus of the study as it is the most common form of child maltreatment – research shows one in six young people report experiencing neglect in childhood – and its affects can be significant, enduring and heightened by poverty. In addition, the prevalence of neglect is increasing – the NSPCC’s How Safe Are Our Children 2016 report shows neglect cases recorded by police have risen 75 per cent in the past decade.
The three reviews draw on emerging research to outline the characteristics and prevalence of the different forms of harm (see panel), and identify correlations between each one and neglect. It also makes recommendations for how practice needs to change to better address children’s needs.
The reviews are drawn together in a report to be published this month, a summary of which has been shared with CYP Now, to help improve knowledge and practice of frontline workers, service leaders, commissioners and policymakers.
The researchers point out that the evidence to date indicates “connections rather than causality” between neglect and forms of harm. “The scopes are not predictive, but they may help us understand how neglect influences vulnerability to CSE, IFCSA and HSB,” it states.
Another key message is that abuse is the responsibility of the perpetrator. The report does not seek to blame parents, but offer suggestions on how they can be supported to better protect children.
What is neglect?
Neglect is the most common reason for a child to be subject to a child protection plan or on the child protection register.
In England, neglect is defined by the government as “the persistent failure to meet a child’s basic physical and psychological needs, likely to result in the serious impairment of the child’s health or development”.
There are six recognised forms of neglect: when a parent or carer fails to meet a child’s educational, emotional, medical, nutritional, physical or supervisory needs.
The review highlights how neglect can occur over a long period, sometimes making it hard for child protection professionals to spot. “Neglect rarely manifests in a crisis that demands immediate action, it commonly occurs alongside other forms of abuse and practitioners may become accustomed to the chronic nature of neglect.”
The impact of neglect can result in insecure attachments, low self-esteem and confidence, delayed cognitive development, poor school attainment and aggressive behaviour. Longer term impacts include mental health problems, antisocial behaviour and violence, substance misuse, physical health problems and risk of suicide.
Neglect and CSE
Overall research suggests there is a link between neglect experienced in childhood and later experience of CSE – but it is a complex one.
Long-term US studies have found sexual abuse and neglect experienced before the age of 11 each increased the risk of a person becoming a prostitute by age 29. Childhood neglect also increased the likelihood of a child running away from home and being sucked into exploitative relationships, drug misuse and street gangs.
There is strong evidence that neglect impairs cognitive and language skills, and children with learning difficulties are at greater risk of sexual victimisation. “It is plausible that young people with lower cognitive abilities are less able to detect or escape perpetrators’ grooming and entrapment strategies… [who] may specifically target these young people as being easier to exploit,” the review states.
The long-term impact of neglect on a child’s ability to make friends, have a positive view of themselves and enter into exploitative relationships to fill unmet needs for love also increase their vulnerability to CSE.
Practice implications
- All young people identified as being at risk of or experiencing CSE must be offered support to address any vulnerabilities or unmet needs.
- Families of children at risk of or experiencing CSE should be offered support that helps them address the impact of CSE on themselves, their child and their family relationships.
- Local leaders should ensure that CSE policy and strategy is connected to the wider safeguarding agenda.
- The provision of accessible support around housing, education and employment, mental health and substance misuse would help tackle both forms of maltreatment.
Neglect and IFCSA
There is no statutory definition of IFCSA, so the review defines it as: “The sexual abuse of a child by an adult in a family setting.”
There is no evidence base that considers how neglect may increase a child’s vulnerability to IFCSA, so the review draws on findings from research on child sexual abuse (CSA) more generally.
Evidence suggests poverty and social disadvantage are strong factors in all forms of maltreatment. Single parents are a group identified as being at particularly risk of CSA occurring within the family.
“Where single parenthood combines with social isolation and poverty, this may make families especially vulnerable to manipulation by perpetrators who may target stressed and lonely mothers in order to access their children,” the review explains.
If a child has also been neglected, they are particularly vulnerable to a perpetrator’s strategy of cultivating a so-called “special relationship”. To compound this, a trait of neglected children is to have poor problem-solving skills, “which may mean that faced with bribery or coercion, they are less able to make clear decisions to seek help”.
Practice implications
- Practitioners working with children and families where neglect or IFCSA are a concern should be alert to the potential for co-occurring forms of harm. Training and high-quality supervision is essential to doing this sensitively with families.
- Practitioners must remain child-centred in order to identify children’s emotional or supervisory needs. IFCSA does not need to be occurring to address these needs. The earlier they are identified the earlier measures can be put in place to prevent future abuse.
- Practitioners working with children and families where IFCSA has occurred should be alert to the potential for negative responses from families to disclosure or revelations of abuse.
- Consideration should be given to how support is provided pre and post disclosure of sexual abuse to enable parents and children to process trauma
- and heal.
Neglect and HSB
The review defines HSB as: “Sexual behaviours expressed by children and young people that are developmentally inappropriate, may be harmful towards self or others and/or abusive towards another child, young person or adult.”
Although it has often been assumed that HSB is related to prior victimisation, the data presents a mixed picture of how child maltreatment precedes development of HSB. For example, studies show the high rate of non-sexual maltreatment in the developmental histories of these children and young people; in some cases, it matches or exceeds that of CSA – a finding, which in terms of sexual abuse contradicts assumptions about a “victim-to-abuser cycle”.
While neglect does not stand out as a particular pathway to the development of HSB, some of the well-established impacts of neglect – such as social isolation, inhibited social competency and disrupted attachments – are well established factors in young people displaying HSB, in particular those who victimise younger children. “For some children and young people, experiences of neglect may represent an indirect developmental precursor to HSB,” it adds.
The reviews also highlight how professionals tend to negatively judge parents, particularly mothers, when a child has perpetrated HSB.
Practice implications
- Government needs to support a shift in thinking away from focusing wholly on children’s offending behaviours. This will avoid young people being inappropriately subjected to requirements such as sex offender registration, custodial sentencing and involvement in programmes.
- Interventions and approaches to HSB should be more holistic and need to actively encourage the family’s participation.
- Service leaders and practitioners should use approaches that both stop HSB and help meet the child’s broader developmental needs, drawing on therapeutic and relationship-based interventions that seek to “reconstruct” positive attachments.
- Addressing ongoing neglect in children and young people’s family and environment is an important part of a systems-based response to HSB. Training and high-quality supervision are essential to ensure practitioners are equipped and confident to explore these issues sensitively with families.
Overarching themes
The review concludes that practice and service responses must not simply address the existence of CSE, IFCSA and HSB in isolation, but “consider whether and how underlying vulnerabilities might be increasing risk for individual children and young people”. It is “essential” to look at the underlying factors that can lead to neglectful experiences when assessing the type of support to put in place to protect against further harm arising.
“Support needs to draw on the strengths of families and communities, while being properly connected to specialist services to allow fluid transition and appropriate protection,” says the review. “It should be focused on promoting resilience, rather than risk management, while ensuring that effective analysis of risk and vulnerability is maintained.”
Practice implications
- Government must prioritise tackling the causes of neglect and ensure there is sufficient resources to intervene early.
- A public health approach to neglect should be considered, involving targeted support.
- Support for families where there is neglect should incorporate therapeutic support and interventions to help children recover from its impact.
- Children’s leaders should consider redesigning pathways and routes to support, drawing on the expertise of family support and community-based services.
- The care system must place the wellbeing of looked-after children, including recovery from trauma, at the centre of all processes and decisions.
- The multi-agency workforce needs support to identify and respond to emotional neglect in particular. Routine wellbeing checks for children would support this.
- Increase the visibility of fathers in practice, policy and research around neglect to improve their protective role.
- All agencies should contribute to plans to tackle neglect.
- Service leaders should consider tailoring support to the needs of disadvantaged groups of children.
Prevalence of harm
16% of young adults reported experiencing childhood neglect
1% of 18- to 24-year-olds reported sexual abuse by a parent or carer
25-33% of all alleged sexual abuse is carried out by children and young people
Source: Child neglect and its relationship to other forms of harm: Responding effectively to children’s needs
Summary report: http://rip.org.uk/neglect-evidence-scopes-summary