Brigid Daniel , Professor of Social Work, University of Stirling

1. Noticing and helping the neglected child: a systematic review of the literature Brigid Daniel, Professor of Social Work, University of Stirling Julie Taylor, Professor of Family Health, University of Dundee Jane Scott, Independent consultant/Multi- Agency Resource Service

2. Research Questions • What is known about the ways in which children and families directly and indirectly signal their need for help? • To what extent are practitioners equipped to recognise and respond to the indications that a child’s needs are likely to be, or are being neglected, whatever the cause? • Does the evidence suggest that professional response could be swifter?

3. Filtering process 20,480 16,239 after duplicates removed 1,532 after removal of unrelated items 686 after title and abstract screening 112 after identified as primary study of relevance 63 after scoring for method and usefulness

4. What is known about the ways in which children and families directly signal their need for help? • Very little evidence - most start with substantiated neglect • Mothers could express concerns about potential neglect and parents who misuse substances could identify impact upon their children. • Children don’t directly ask for help; some school nurses in Finland noticed children who sought advice; neglected children could be identified on a self-report computer programme. • (Combs Orme, 2004; McKeganey, et al., 2002; Paavileinen, et al., 2000; Kantor et al., 2004)

5. What is known about the ways in which parents indirectly signal their need for help? • Much more evidence – many familiar parentalfactors - • impoverished home environment, fewer parental resources, previous history of maltreatment /csa, substance misuse, domestic abuse, ‏mental health‏, drug-using network, welfare assistance, problems accessing childcare, youth of parent, 2 or more children, previous child removal • Risk increases with number of risk stress factors, especially beyond 4 or 5 • Studies vary in whether prospective or retrospective and what factors are controlled for. • No certain, clear and predictable pathways emerge. (Brown et al. 1998; Carter & Myers, 2007; Cash & Wilke, 2003; McGuigan & Pratt, 2001; Nair et al., 1997 & 2003; Ondersma, 2002; Scannapieco & Connell, 2003 & 2005) Nonetheless, allshould be noticeable to practitioners as signs of possible need for support.

6. What is known about the ways in which children indirectly signal their need for help? • Internalising and externalising behaviour can be seen by age 3; peer problems by 6; behaviour problems, impaired socialisation and problems with daily living skills by 8 (Dubowitz et al., 2002; 2004; 2005) • An example of indirect signs came from two studies of burns which showed, although the burns were similar to those attributable to accidents, it was more likely that: • the child had not been given first aid at the time, • there was a delay of over 24 hours before seeking help. • the burns would be deeper • children fared worse than abused children in keeping appointments and receiving adequate wound care . • (Chester et al., 2006; Hultman et al, 1998,). • Signs would be evident to many professionals and members of the community.

7. To what extent are practitioners equipped to recognise and respond to the indications that a child’s needs are likely to be, or are being neglected? • Professionals tend to have higher thresholds than the general public. • Health visitors are very well equipped to recognise parental characteristics and developmental signs in children. • Some examples of good practice e.g. Finland - ‘active and firm’ school nurses. • Absence of evidence about schools, teachers and the police.

8. Does the evidence suggest that professional response could be swifter? • Protocols and guidelines are not a sufficient spur. • Trust, relationships, communication, anxiety, fear and confidence affect willingness to act on concerns. • Many studies referred to the importance of training as a mechanism to raise awareness. • Training when coupled with access to on-going consultation and support could increase recognition and referral of child abuse and neglect . • (Angeles-Cerezo & Pons-Salvador, 2004)‏

9. In summary Response for the general public and professions other than social work/services/CPS tended to mean 'referral’ Response for social work/services/CPS tended to mean 'investigation'. The main problem lies, not so much in recognition, as in the perceived complexity of the response mechanism.