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Effective Interventions in Child Neglect:

Messages from English Research

(Originally published November 2024)

Much English child welfare research has notable strengths that make it a pleasure to read: clarity of the writing, an emphasis on utilizing research findings to improve practice, and the value placed on qualitative research.

Because child welfare in England is organized around local authorities rather than states or large counties, researchers appear to lack the same access to large administrative data bases available to American scholars. Perhaps for this reason (and others), child welfare scholars have been interested in formulating messages from research drawn from multiple studies with samples much smaller than those often utilized in U.S. studies. For decades, English child welfare scholars have regularly produced exemplary “Messages from Research” on a wide range of child welfare subjects, reports written for both policymakers and child welfare managers and practitioners, an approach that has never taken root in the U.S. to the same degree.

As in the U.S., child welfare agencies in England have had difficulty developing effective approaches to preventing or mitigating child neglect, especially in its chronic form. Taylor, et al (2016) comment:

“Professionals are increasingly becoming aware that not only is neglect the biggest child protection issues faced by families, but that it also has the biggest impact on the future life course of affected children.”

“For both professionals and lay people though, neglect is a particularly challenging concept … There is often a feeling of fatalism, and that all attempts to intervene will be futile.”

A main goal of messages from research published by English scholars during recent years has been to encourage optimism regarding the prospect of developing effective interventions on behalf of neglected children and their families. English scholars have been insistent that there is sufficient knowledge to guide effective practice, and that promising practices are already being used by multiple local authorities. However, this optimism stands in stark contrast to some distressing research findings regarding the intractability of chronic neglect and the presence of neglect in child maltreatment fatalities.

Early intervention and the rejection of “thresholds”

The need for early intervention before neglect has become “entrenched” in family life has been a major theme of English research studies. However, budget cuts to human services extending over more than a decade under Conservative governments have limited the capacity of local authorities to follow this recommendation. Instead, child welfare agencies struggling with budget cuts have looked for “thresholds,” i.e., clearly defined indicators of severity of maltreatment, which must be met to warrant agency intervention. There has been a similar development in the U.S. where some public agencies have redefined ‘child safety’ to narrow the grounds for CPS intervention, both to manage workload demands and reduce the scope of CPS intervention in families’ lives.

Several English scholars have criticized the use of thresholds to limit child welfare intervention on both conceptual grounds and because intervening early in child neglect is necessary to limit developmental harm to children resulting from pervasive or chronic neglect. Daniel, et al (2014) assert: “A seamless service is one that does not rely on the slippery concept of ‘thresholds’ to trigger action, rather it ensures that practitioners within universal services have the knowledge and support to identify intractable situations quickly and ensures that children receive the help they need, via compulsory measures if required.” There is an insistence that empathetic support for parents can and must be combined “with an unwavering focus on improving children’s lives.”

Striking the balance between voluntary services and legally mandated services

English child welfare law emphasizes the importance of caseworkers developing partnership with parents, whenever possible. Qualitative research studies have sought out parents’ views regarding caseworker behaviors and attitudes that lead to positive working relationships between professionals and parents with child welfare involvement. Parents in England, as in the U.S., emphasize their regard for professionals who can combine a non-judgmental approach with concrete services and practical solutions. Trustworthiness, i.e., honesty in communication and keeping promises, is highly valued by parents.

Children quoted in English qualitative studies have a somewhat different perspective. One young person stated: “Some parents can change and others can’t. Some are given too many chances and we are left too long at home. But when we do have to be moved you need to give us clear explanations about why or we will blame the care service. In some cases, parents are just overwhelmed with their problems and we’re not sure if anything could have really helped them do better. Although some do not get enough chance to change – it depends on the individual circumstances.” (Daniel, et al, 2014)

As discussed in qualitative research studies, child welfare caseworkers in England were often confronted by parental resistance to services, and were pessimistic regarding the prospects of effective interventions. Yet, “… when multidisciplinary groups of practitioners together compare notes about what is possible, and are encouraged to describe actual practice they can identify what has been achieved on behalf of many children and the ways in which they do frequently work with, and overcome, high levels of parental suspicion and resistance.” (Daniel, et al, 2014). In England, as in the U.S., the most difficult challenge posed by chronic neglect is overcoming parental resistance to offers of help, resistance caused both by distrust of professional helpers and lack of hope that that their substance abuse and mental health conditions can be overcome. This challenge is much the same in voluntary service cases and in dependency actions.

One of the noteworthy features of English messages from research has been a persistent interest in developing caseworkers’ parental engagement skills, along with a realistic appraisal of parents’ resistance to change. One of the most distressing studies published during the past decade, “Working Effectively with Neglected Children and Their Families – What Needs to Change?” (Farmer & Lutman, 2014) examined outcomes for 138 children from seven local authorities placed in foster care due to neglect and subsequently reunited with a parent or parents. This study tracked re-entry into foster care and recurrent maltreatment for five years following reunification.

The authors state: “At the two-year follow-up, 59 per cent had been abused or neglected after reunification. During the next three years, nearly half (48%) of the children with open cases had been maltreated, even though most had been on a child protection plan or supervision order at the time. By the five-year follow-up, two-thirds (65%) of the returns had broken down.” Farmer and Lutman assert that “Parents were difficult to engage, and over time abuse and neglect were minimized so that referrals about harm to children did not lead to sufficient protective action. Parents were given too many chances to change, and files lacked information on the development of children on which decisions about intervention could be based.”

A deficiency of this study is the lack of information regarding what happened to children when they were in foster care and information about school age children’s attitudes regarding separation from their parents. The study’s strength is its insight into the processes and dynamics that often led to failures of child protection: “… it can be difficult to maintain an accurate perspective on the extent of children’s difficulties because of the habituation associated with medium to long term work. … workers can become desensitized to the adversities that children face and normalize and minimize abuse and neglect.”

This is an accurate description of how caseworkers in the U.S. often come to accept the developmental harms of chronic neglect and chronic multitype maltreatment, i.e., developmental harm to children is normalized as an ineradicable part of a family’s life, and after a period of time is barely noticed and implicitly accepted.

Sustaining the morale of professionals

One of the most important messages from English research is the need for collaborative relationships that can sustain the morale of professionals working with difficult to engage, troubled families. Daniel, et al comment:

“… there was an aura of them feeling overwhelmed by the vastness of the spectrum from the needs of a first time young parent in need of a little advice about nutrition to the needs of a pregnant woman whose previous children are looked after elsewhere.”

Practitioners could become paralyzed by the extent of a family’s needs and challenges, and have difficulty knowing even where to start work with families who had a multitude of needs and challenges. Caseworkers and other professionals reported feeling most effective and supported when working in multi-agency collaborations.

Taylor, et al, describe the use of Multi-Agency Safeguarding Hubs (MASH) which “are designed to prevent children from slipping through the net, allowing better decision making and more timely intervention.” MASH teams are co-located with a shared data system. “…the aim is to build capacity in universal services, while not taking responsibility off the worker.” The first MASH teams were established in 2011 and have been positively received by human service agencies. However, “as yet we do not have enough information to ascertain definitively whether they are effective for neglected children,” Taylor, et al assert.

Despite the recognition that “effective response is facilitated when local arrangements are deliberately facilitated to improve collaborative responses” (Daniel, et al, 2014), both practitioners and researchers have been frustrated by bureaucratic obstacles to multi-agency collaborations. Daniel, et al comment:

“One of the most frequently discussed barriers was the Common Assessment Framework (CAF) form, which ironically was developed as a way to smooth integrated multidisciplinary responses to children. … the issue revolved around the need to obtain a signed consent from parents and children for progression of an assessment.”

Some agencies have developed “CAF champions and social care staff whose role is to model the most effective ways of encouraging parents to take part in completing them … In some areas, there are multiagency groups that review CAF forms to see if they are really needed…”

Disagreements among professionals about thresholds for intervention have impeded the CAF process, according to these authors.

Maintaining a focus on the child

One of the most surprising messages from English research of child neglect has been the difficulty of maintaining a focus on the needs of children and on the developmental harms resulting from chronic neglect. “A review of studies … suggested that the systems have developed in England can get in the way of neglected children getting help promptly and have lost sight of the child,” Taylor, et al assert. This is true in the U.S. as well for reasons not adequately described by these research studies.

Practitioners in various agencies frequently encounter parents with hopeless/ helpless attitudes and resistance to help. They must learn how to engage with parents in service planning, a difficult challenge. Caseworkers interact much more frequently with parents or other caregivers than with children. Service plans are likely to focus on the behavioral health and substance abuse treatment needs of parents, often with scant attention to parent-child relationships which may have been greatly affected by lengthy periods of pervasive neglect. Developmental harm, as discussed above, is often taken for granted and may not be assessed or become a focus of service plans.

One of the simplest and most important messages from English research is to stay focused on the needs and well-being of neglected children, not just their immediate safety. To this end, the Action on Neglect initiative in England conducted focus groups with neglected children to discover their perspective, something which to my knowledge has not occurred during recent years in the U.S., despite the emphasis among scholars and advocates on paying attention to “lived experience.” Older youth in England delivered a straightforward message regarding their experience of neglect: It’s important to feel loved. “Love is a doing word,” and “It’s one thing to say they (the parents) love you but they have to do things to show it.” The authors reflect: “This indicates that assertions of love are not sufficient to ameliorate the lack of practical acts of care.” (Taylor, et al, 2014) Children and youth emphasized the emotional dimensions of neglect, not dirty houses, lack of supervision or erratic care of basic needs. It is emotional neglect beginning in early childhood, combined with pervasive physical neglect, that results in the harm to physical and mental health of children across the lifespan.

Programs used in England

Taylor, et al, discuss three programs that have been widely used in England to prevent or mitigate child neglect: Video Interaction Guidance, Triple P and Safe Care. These programs share a focus on parent-child interactions and on the use of coaching. Many parents who participated in research studies were positive about these programs, but as in the U.S., there were also high rates of attrition. Interestingly, Taylor, et al, comment that “As with all such programs, those discussed here are based on wider principles of what we know works for neglected children – sustained interaction over the long term.” This would be news to program developers and experts on evidence-based practice in the U.S. who have sold EBP’s as effective time limited practices that do not require long term involvement with families.

The value of discussions of programs and of use of legal action in this research is limited by the lack of a typology for neglect that clearly distinguishes situational, sporadic and chronic neglect. Responding to neglect as a homogenous phenomenon leads to confusion and contradictory messages for practitioners. U.S. scholars have used large administrative data bases to develop operational definitions of chronicity, e.g., five or more referrals of families over 4-5 years. However, something more is required: an understanding that it is the pervasiveness of neglect over multiple child care domains, including nurturance, that defines chronic neglect. Programmatic interventions need to be connected to a typology of neglect that makes distinctions in service planning for situational, sporadic and chronic neglect.

Summary

There is evident frustration in these research summaries with the political and bureaucratic obstacles in England to implementing messages from research on child neglect:

Intervene early before neglect is embedded in a family’s life.
Develop long term supportive relationships with families when needed.
Utilize multi-agency collaborations for assessment, case management and service delivery.
Maintain a focus on the developmental harms of ongoing child neglect; include developmental testing as a standard part of family assessments.
Make persistent efforts to engage parents in voluntary service plans, combined with realistic appraisals of parents’ interest in services and motivation to change.
Take timely legal action when necessary to prevent extensive development harm to a child.

The authors of these research summaries might be surprised to learn that in the U.S. during recent years the harms of child neglect have been minimized or denied by some scholars and advocates to support an abolitionist agenda.

References

Brandon, M., Bailey, S., Belderson, P., Larsson, B., “The Role of Neglect in Serious Injury,” Child Abuse Review, Vol. 23, pp. 235-245.

Daniel, B., Burgess, C., Whitfield. E., Derbyshire, D., Taylor, J., “Noticing and Helping Neglected Children: Messages from Action on Neglect,” (2014), Child Abuse Review, Vol. 23, pp. 274-285.

Farmer, E. & Lutman, E., “Working Effectively with Neglected Children and Their Families – What needs to Change?” (2014), Child Abuse Review, Vol. 23, pp. 262-273.

Taylor, J., Brandon, M., Hodson, D. & Haynes, A., “Child neglect: policy, response and developments in England,” (2016) Research, Policy and Planning, 32(1), pp. 39-51.

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©Dee Wilson

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