Children in Distress: Responding to known and unknown needs.

There is a, quite correct, intense focus on the needs of children variously categorised as being at risk, in need of care, or in distress because of neglect or abuse. The numbers of such children varies and has recently been rising. What are the factors within families that are most likely to lead to children being abused or neglected? What is the threshold for statutory intervention? What is the current and likely future scale of the issue? Are there new kinds of abuse emerging, or unrecognised forms that are not yet on the radar of those watching out for such things? How prepared are we, as a society, to respond rapidly to any new sources of distress to vulnerable children?

It is clear that the neglect and abuse of children is far from a new phenomenon. My own first academic contact with the issue was Alec Clegg and Barbara Megson’s book “Children in Distress” in 1968 and the UK White Paper “Children in Trouble” which led up to the 1969 Children and Young Person’s Act.

Children’s everyday experience of distressful lives did not start with their public accounting in such documents. This is an old and extensive problem that continues to take new forms and occur over fluctuating scales – always demanding new attentions and expecting new responses.

Currently the focus is on the expectation that something should be done, immediately and robustly, whenever abuse or neglect is suspected; that preventative mechanisms should be in place for early detection of such risks in order to head things off before they become more serious; that being alert to such situations is the responsibility of everyone and not to be left to particular individuals; and that new forms of neglect and abuse are constantly emerging so that vigilance and foresight are required more than ever.

The threshold between the rigours of childrearing and the spill-over into abuse or neglect is not crisp. The extremes are obvious. Just as healthy contexts for childrearing will ‘make’ children – so there are a number of risky contexts that, if not addressed, can ‘break’ children. Around the boundary between these two are family contexts which may, or may not, turn into something risky – but things cannot always be assumed to be problematic. Family behaviours may simply be transient, may sort themselves out, especially if early help is on offer.

A step-change in this area of concern occurred under the UK government banner of ‘Every Child Matters’ when considerable attention was given to identifying the range of risk factors associated with the varying scale of issue (from everyday risks easily countered by existing universal services; through issues aggregating in families with a number of interlocking social, economic and behavioural difficulties – addressed through interventions targeted at the specific needs of each family; to children in need of some additional focused social care support designed to prevent significant impairment of their health or social developments; to families where there is a need for a statutory enquiry around protection of the child).

Several years ago, as part of this national agenda, research overviews listed the characteristics of parents who were most likely to maltreat their children and the characteristics of children most likely to be at risk of maltreatment. Where the family issues were complex and risks severe, parents were more likely to live in the following contexts:

Have been abused, neglected or had multiple adult carers in their early life – maybe having been in care with multiple placements

Have had multiple partners, often involving violent or abusive relationships

Have alcohol or drug dependencies, with little ability to control the habit

Have a violent nature, with sudden outbursts of violence

Have a strong mental illness or learning difficulty, which they are coping with alone

Have some personality disorder; or controlling/manipulative personality (often linked to low self-esteem)

Show lack of empathy or concern for others

Be isolated, with little family or community support

Be fearful or suspicious of any agency such as social care, schools, health, and police

Clegg and Megson’s “Children in Distress” also made reference to a set of parental characteristics, in their case studies based on the everyday experiences of schools dealing with the issue – even if some of the language is very much of its time: family squalor; human depravity; living with wretchedness; home lives where the main experience is one of drudgery; immorality in the home; quarrelling between parents; attitudes to children because of illegitimacy; work-shy parents; and parents who are tormented, mad, maladjusted or deranged – alongside more familiar references eg to the effects of child poverty. They refer to Twilight Children, to children who have not yet reached the end of an unhappy road but whose lives are strung out along it, and to children serving an apprenticeship of distress on their way to adulthood.

Risks are heightened when the situation is compounded by a child being felt as ‘hard to parent’ because of being fretful, unresponsive, overactive and so on – which themselves may be the result of:

Foetal exposure to alcohol or drugs

Having a particular disability

Having a genetic predisposition for particular behaviours to be switched on by environmental experiences

and so on.

Over the past 25 years, there has been a three-fold increase in the UK incidence of suspected child abuse – or, rather, a three-fold increase in the number of referrals and assessments. Such increases can be for a number of reasons: Heightened public awareness; increased acceptance that referral is something that should be done rather than ignored; more readiness for services to respond – and be seen to be responding – in the wake of high profile cases where such services have been accused of not responding adequately; and publicity given to cases involving public figures creating more confidence in the legal system.

Certainly the number of children officially deemed to be at risk is at an all-time high. Even so, some agencies dealing with at risk children estimate that this severely underestimates the actual level of abuse and neglect – being maybe only 10% of those who suffer but remain outside the official systems.

These are worries for any concerned society. They also pose practical day-to-day managerial issues for the public services involved:

In a world of constrained public finances, what is an effective way of responding to an apparently endless set of needs?

How many specialist workers are needed, and how much can be dealt with by generalists acting more effectively?

What is an appropriate balance to be struck between remedial activities and investing in preventative work?

Is it possible to eliminate the possibilities of people abusing their positions of power to actively put children at risk, or turning away from what is happening to children or families that they have some responsibility for – particularly in a world where increased use of the internet has opened up whole new potentials for abuse?

How do various family factors combine to produce enhanced risks that lead to more children being in distress?

Without getting too Rumsfeldian, how do we know when we have scoped out the full scale and range of risks to children? Are there unrecognised areas of unknown unknowns?

As we have seen above, it is possible to list a range of settings within which the risk of child abuse or child neglect is more likely to occur. Each element on the list may generate a large enough risk, for sufficient numbers of children, to warrant immediate structural changes to the way society deals with such things. Others things may pose a low risk but affect large numbers of children; or create high levels of risk but for only a very small number of children. Some will generate the potential for risks that are already known about. Others may begin to highlight risks that are not yet recognised or sufficiently acted upon.

Whatever the level of risk, or the numbers involved, for each and every element on the list the possibility is that individual children are affected. For them what happens is of vital importance.

A risk-list will cover contexts where parents are coping with multiple stresses; contexts where children are growing up in chaotic, unsafe or criminal households; contexts where children are unwanted, abandoned or unsupervised; contexts where children are surrounded by cultural attitudes at odds with children being safe and nurtured; and contexts where professionals are incompetent or uncaring or exploitative. These varied contexts can each generate several specific situations of risk – it can run into dozens of settings in which children can be in severe distress. (An example of such an extended list is given at the end of this article).

It can feel like an almost overwhelming list – too long to be of any practical use. To get value from it, the list might be used in various ways:

  • Thinking about the degree of risk for each factor and the numbers of children that might be affected. This begins to identify the scale of the problems and identify those that have low-level pervasiveness across the lives of many children and those that need sharp responses for a very limited number of children.
  • Thinking about such issues in a rapidly-changing world; scanning the horizon to identify newly-emerging risks – providing an early alert to dangers that services may not be geared up to deal with.
  • Checking that all likely needs have some potential trigger/solution within current systems – at the pace and scale necessary.  Identifying gaps in any safety nets.
  • Estimating the number and range of generalist and specialist staff needed to give adequate responses to the range of factors deemed to be priorities in any locality.

Whilst planners and managers are busy estimating, checking and thinking, there is always the need to remember that, in practice, each element is in play to some extent for varying numbers of children. The expectation remains that in each case – for each individual child – society will react, rapidly and appropriately, to minimise or eliminate further distress to that child.

The mechanisms for responding are fairly clear:

A child at risk of harm/neglect/abuse is highly likely to display behaviours symptomatic of the condition. These behaviours are able to be picked up early by any one of a network of watchful agencies/individuals. These Watchers know what to do next – When to contact; who to contact; how to contact. This then triggers appropriate referring on; checking; visiting; evidencing; assessing; planning; finding swift and appropriate solutions for the child (and the family) ensuring that any proposed solutions do not unintentionally put the distressed child in other situations of even more distress..

If it is as clear as this, why does it not work this way in all cases, all of the time, across all people, in all agencies? Are we, as a society, ever going to be able to respond adequately to children in distress?

 

 

A possible extended list of risk contexts:

In the following, ‘child’ is taken to be any age 0-19 – but with particular emphasis (in most cases) where the child is 0-3 years old. Some of the elements are clearly more applicable to older children.

 

Each example is not meant to be taken as deterministic of abuse/neglect. The various factors are correlational – but with some having a higher likelihood of causality. Many children overcome their situation without longer-term damage; and distress can be caused by a number of other factors. They are also cumulative: family pressures stack up on top of each other one element at a time. Families may well be resilient in the face of 1, 2 or even 3 stresses but then adding one more leads to catastrophic implosion of relationships.

Going well beyond the contexts identified by Clegg and Megson, or by the Every Child Matters research, such a list is likely to include:

  • Child and deeply depressed parent
  • Child and inadequate/ incapable parents
  • Child of suicidal parent unwilling to leave living dependents
  • Disabled/mentally-ill child with parents unable to continue coping
  • Child of parent with severe alcohol/drug issues
  • Unborn child whose mother habitually uses drugs/alcohol
  • Child is in a physically/culturally very isolated family
  • Child has a parent who is unresponsive to others; unsympathetic to children’s immediate needs
  • Distressed child of extra-strained parents (>3 key stresses)
  • Child of heavily-indebted parent
  • Child of parent with psychotic illnesses
  • Child caught up in domestic violence between parents
  • Child whose parent is receiving recurring threats from ex-partner
  • Child is in a chaotic household – with varying combinations of adults
  • Child living in household with adults who have criminally violent lives and unable to contain anger at home
  • Child in families where there are few moral rules; where antisocial behaviours are the norm
  • Child has one or more parent/close relative who were themselves abused or neglected
  • Child has one or more parent who themselves had poor parental role-models and who did not get own needs met as child
  • Child being groomed for sexual exploitation/ actively being sexually exploited (by people in/outside the family)
  • Child who is in the midst of gang-related violent/risky behaviours
  • Child with parent involved in terrorist/illegal extremist activities
  • Child sent out to steal, work, or undertake illegal activities
  • Child open to (online or face-to-face) grooming to take part in illegal or extreme behaviours
  • Child of parent who has strong interest in recreational pornography or violence
  • Child in inappropriate relationship with professional (eg teacher)
  • Child attends organisation (especially school) with weak safeguarding processes
  • Child has parent/close relative interested in selling images of children online
  • Child is in closed/unsupervised situations with adults who feel ‘rights of power’/ moral imperatives that contravene the law
  • Child living in dangerous/unsafe housing
  • Ill child with unrecognised/ misdiagnosed condition
  • Child exposed to professional (eg medical) incompetence or malpractice
  • Child exposed to inappropriate religious practices (eg belief in malign spirits that need to be forcibly removed from child)
  • Child caught up in family disputes re ‘honour’/ tradition etc
  • Child subject to female genital mutilation, under-age forced marriage, and other dangerous cultural practices
  • Child abandoned/ unsupervised by parents for periods of time
  • Child where parent is absent through death, imprisonment or long-term illness
  • Child of parent with rigidly harsh beliefs about child development
  • Child exposed to parental punishment/ disciplinary regimes that are extreme
  • Child perceived as ‘slave’ to do bidding of parents/others
  • Child clearly seen as ‘unwanted’ / ‘unnecessary’ by unwilling parents
  • Child stays away from home for substantial periods of time – with risky relatives/others
  • Child is homeless; street-dwelling; squatting temporarily with others
  • Child often plays unsupervised in dangerous settings
  • ….. other new risks as they emerge

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