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Neglect and Serious Case Reviews Family size: serious case reviews tend to feature families of a larger size (with four or more siblings) than found in the general population. This is more pronounced where children had a CP plan for neglect (or indeed in any category) where almost one in five families were large in size. Parental drug and alcohol misuse: these parental characteristics (known to be associated with neglect) were higher where children had a past or current CP plan for neglect than in reviews for other children. Rates of domestic violence were not higher. iN what wayS doeS Neglect feature iN theSe caSeS of child fatality aNd SeriouS harm? types of fatality To explore this question we looked, broadly speaking, at the ways in which the children died or suffered serious injury or harm. We also considered the ways that neglect coexisted with other types of maltreatment (particularly physical abuse). Between 2005–2011 there were 57 children with a current or past CP plan for neglect whose death prompted a serious case review. • 13 children died from a physical assault. Most deaths (34) were related to but not directly caused by maltreatment (sudden unexpected deaths in infancy, deaths resulting from accidents, for example fires or accidental drowning, and deaths of young people through suicide). In the deaths related to but not directly caused by maltreatment, the circumstances gave rise to concerns about the child’s safety before the incident. • By contrast, none of the six children who died from extreme deprivational neglect (mostly starvation) had ever been the subject of a CP plan so the severity and dangerous nature of their life threatening neglect had not been recognised. Neglect and physical abuse • Where a child died, there was more often a context of known neglect (over half [56%] with a CP plan, neglect) than known physical abuse (just over a third [37%] with a CP plan, physical abuse). Neglect and physical abuse in cases of serious harm (where the child did not die) • Physical abuse and neglect were found together in almost half of the serious injury cases (44%) where children suffered grave harm but did not die. 10
Neglect iN all ScrS from 2009–11 To capture neglect beyond that formally recognised by a child protection plan, we used wider, but still stringent, criteria to search for neglect. There was neglect in a total of 60 per cent (83) of the 139 available serious case reviews from the two year period 2009–11. In most cases neglect had not been formally recognised but the experiences for the child and the consequences of neglect were as serious as when a CP plan was in place. As in the CP plan cases, neglect featured evenly across the age ranges apart from among 11–15 year olds where it was much more common. Where children died, current or past neglect was evident for almost all whose deaths were related to but not directly caused by maltreatment (SUDI, suicide, accidents and ‘other’). There was neglect in a quarter of the deaths through assault and deliberate homicide. There was neglect in over two thirds of the 43 non-fatal cases (and in five of the seven serious sexual abuse cases). Neglect was evident for two thirds of the children who suffered non-fatal physical assault. a detailed Study of 46 caSeS of Severe Neglect, iN Six themeS malnutrition To understand more about how neglect can be life threatening, we studied anonymised case summaries from 46 neglect related serious case reviews from the eight year period 2003–2011. These included children with and without a CP plan for neglect. We found a six-fold typology of neglect related circumstances. Learning points arose in relation to each of the six individual themes and there were overriding, general points applicable to most: For this research malnutrition is defined as ‘life-threatening loss of weight or failure to gain weight or serious conse quences of neglecting to nourish the child’. Learning points: Executive Summary • None of the children who died or nearly died from malnutrition were in the child protection system. The family’s contact with any agency was almost non-existent by the time of the child’s death or serious harm. • Increased isolation of a family adds to the invisibility of the child or children so malnutrition is not recognised (for example when children are isolated because they cease to attend school or nursery or are home-schooled). Isolation of the child from the outside world means that very poor relationships between the child and caregiver (so poor that the child may have ceased to exist for the adult) cannot be observed by professionals or the public. 11
Page 1 and 2: Neglect aNd SeriouS caSe reviewS A
Page 3 and 4: Contents Executive Summary 7 1. The
Page 5 and 6: tableS Tables and Figures appeNdix
Page 7 and 8: iNtroductioN Key fiNdiNgS Executive
Page 9: fiNdiNgS how ofteN iS Neglect evide
Page 13 and 14: Sudden unexpected deaths in infancy
Page 15 and 16: maintaining a healthy, safe relatio
Page 17 and 18: 1. The context of neglect and serio
Page 19 and 20: Summary 1. The context of neglect a
Page 21 and 22: 2.2 reSultS 2. Neglect in the lives
Page 23 and 24: There are encouraging signs of a dr
Page 25 and 26: figure 2.1: age distribution of chi
Page 27 and 28: 2. Neglect in the lives of children
Page 31 and 32: what did Neglect co-exiSt with? 2.
Page 35 and 36: figure 2.2: incidence of cp plan fo
Page 37 and 38: Summary 2. Neglect in the lives of
Page 39 and 40: what did Neglect coexiSt with? 2. N
Page 41 and 42: 3. A thematic analysis of neglect h
Page 43 and 44: As discussed in Chapter 2, it was n
Page 45 and 46: • There had been a lack of proper
Page 47 and 48: In reading the set of serious case
Page 49 and 50: The SCRs drew our attention to undu
Page 51 and 52: or more of a burden to his mother,
Page 53 and 54: parental learning disability Parent
Page 55 and 56: event prompting the serious case re
Page 57 and 58: themeS aNd learNiNg poiNtS ‘an ac
Page 59 and 60: 3.5 SuddeN uNexpected death iN iNfa
Page 61 and 62:
agency involvement: learning: There
Page 63 and 64:
Sudi riSKS aNd targeted iNterveNtio
Page 65 and 66:
event prompting the Serious case re
Page 67 and 68:
learning: themeS aNd learNiNg poiNt
Page 69 and 70:
uising and rough handling An unders
Page 71 and 72:
event prompting the Serious case re
Page 73 and 74:
themeS aNd learNiNg poiNtS the long
Page 75 and 76:
situation or dangers posed by, for
Page 77 and 78:
Sudden unexpected deaths in infancy
Page 79 and 80:
4 Implications for policy and pract
Page 81 and 82:
maiNtaiNiNg a healthy, Safe relatio
Page 83 and 84:
Bibliography Blair, P., Sidebotham,
Page 85 and 86:
Bibliography Ofsted (2008) Learning
Page 87 and 88:
Appendix Table A.2 Category of abus
Page 89 and 90:
3. extreme Neglect / deprivatioNal
Page 92:
Photography by Jon Challicom, posed
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