Lesson 3 : Forms of Abuse

In the August edition of the Webmag, we explained that a study of social work files covering the last three or four decades had suggested that there were lessons for today’s practitioners. For the purpose of this series, six topics have been chosen, and in each case, David Lane describes what he has found out from the files, and Chris Durkin comments from the viewpoint of current practice and teaching about social work. The first two Lessons covered the need for good standard practice and the value of comprehensive assessments. It should be emphasised that the Lessons will all focus on general issues, and will not disclose any confidential information.

David Lane :

During the period covered by the records with which I have had to deal, we have moved through several phases in which professional practice and language has changed.

In the 1960s there was talk of incest. Baby-battering (previously considered unthinkable) was talked about in the 1970s. In the 1980s emotional abuse was added to the three notifiable types of abuse already recognised by the Department of Health and Social Security – sexual abuse, physical abuse and neglect. We were also informed of the organised sexual abuse of children by rings of paedophiles. There were the events in Cleveland, Rochdale, the Orkneys and Nottingham. There was also the North Wales inquiry by Sir Ronald Waterhouse which investigated the organised abuse of children in residential and foster care. In the 1990s there was the flurry of interest in the concept of ritual abuse.

It was as if the profession had had to think the unthinkable time and again, and had become accustomed to having to face new unpalatable areas of knowledge.

Then there was retrenchment. Some of the child protection action was discredited. The swoops on unsuspecting parents accused of abuse gave the social work profession an unwanted image. The reputation of medical experts was dented, with doubt cast on the significance of anal dilatation. Professor Jean la Fontaine wrote a report to say that ritual abuse did not exist.

Standards and perceptions have therefore changed during this period. Indeed, it could be said that social work has been subject to fashions, some of them temporary. Ritual abuse came and went, for example. The language we use now and the assumptions we make are quite different from those in currency only two or three decades ago. Allowance has to be made, therefore, if judging the quality of services provided at the time. Nonetheless, some messages for today do emerge from the historical cases I have dealt with.

The first is that local authorities usually took prompt action to protect children when there was clear evidence of physical or sexual abuse, but the impact of long-term neglect seems to have been widely ignored, perhaps because the living standards of many families in poor areas were low, and it would have been simply impossible to take all the children into care. It may, however, have been that social workers genuinely did not see grubby home conditions as constituting real abuse, and the associated implications of poor health on the part of the children and lack of stimulation in such homes were simply not appreciated.

Once poor standards were seen as acceptable, it was often easier to overlook further reductions in standards and to fail to take firm action, with a preference instead for taking practical steps to help the family return to a standard that was already borderline at best.

Very often neglect entailed poor clothing and poor hygiene, which resulted in social isolation, teasing or bullying at school for the children. Poor health care led to lack of attention to teeth, frequent illnesses and failure to get conditions such deafness treated, and the children also often suffered high levels of accidents. These factors often led to absences from school. The overall outcome was a downward spiral, consigning the family to the underclass and conditioning the children to replicate the same standards in the next generation, allowing them little chance to escape the cycle of deprivation.

Acceptance of the unsatisfactory standards in some homes may in part have come from a reaction against the more directive paternalistic approach of Victorian welfare agencies, where the professionals knew best. The outcome appears at times to have been reluctance to act, even when standards were appalling, with children undernourished and ill-clad. The social workers may have seen it as a question of the danger of imposing middle-class standards, but there were plenty of working class families with much higher standards at that time.

The lesson is that neglect should be taken more seriously, and where it is severe or long-term, intervention in the life of the family needs to be more positive. I am not suggesting that the children should necessarily be removed, but intervention could include the provision of respite residential care for children or with childminders during the day, to provide relief and offer the children not only alternative standards but also the opportunity to build close relationships which might enable them to disclose abuse. There is a major role too for day nurseries, Sure Start, Home Start and family aides.

It is also my impression that there is a link between neglect and other forms of abuse which, as far as I am aware, is insufficiently unrecognised.

Chris Durkin :

David’s opening few remarks illustrate the fact that there is no objective definition of child abuse; it is something is ever changing, influenced by social attitudes, professional knowledge, legislation and ‘scandals’. As Harry Ferguson, (2004) says, “What all countries have in common is the construction of child protection in terms of ‘scandal politics’, which refers to the pattern of increased stress on public disclosures of welfare failures and revelations in news media that are shaming for public figures and services” . The mention of the media is particularly pertinent in the United Kingdom context where Nigel Parton has put forward the notion of the ‘mediaisation of social work’ to reflect the influence of the media on the public, and politicians on practice.

If we look more specifically at the issue of neglect, there are a number of areas that need to be looked at. First of all we need to define the term which Working Together does as follows,

“Neglect is the persistent failure to meet a child’s basic physical and/or psychological needs, likely to result in the serious impairment of the child’s health or development.

Neglect may occur during pregnancy as a result of maternal substance abuse. Once a child is born, neglect may involve a parent or carer failing to:

  • provide adequate food, clothing and shelter (including exclusion from home or abandonment)
  • protect a child from physical and emotional harm or danger
  • ensure adequate supervision (including the use of inadequate care-givers)
  • ensure access to appropriate medical care or treatment.

It may also include neglect of, or unresponsiveness to, a child’s basic emotional needs” . (H.M.S.O 2006: 38).

We can see from the above definition that neglect is not just about dirty houses. It includes so many different aspects, and what distinguishes it from other forms of abuse is that it is can be about commission or omission, in that carers can make a deliberate decision to harm their child or through lack of knowledge they may harm their child unintentionally.

The very breadth of the definition is perhaps a shortcoming, in that it tries to include everything in one definition. Other writers have tried to subdivide the whole concept into categories, for instance, medical neglect, emotional neglect, or failure to thrive. Neglect may also be a part of other forms of abuse, e.g. it is often linked to emotional abuse. Like emotional abuse, neglect is a process that takes place over a period of time, in contrast to physical or sexual abuse where there will be specific incidents.

It is this very process of abuse that makes it a very difficult area of work and which can lead to drift, in which practitioners allow standards to slip. Neglect is an area that has not been widely researched and has not been given sufficient attention.

Good recording, regular reviews and evaluations together with supervision are all aspects of case management which may help to identify neglect and pinpoint the need for action. It is also vital that all child care workers are aware of some of the risk factors, which can include: families living in poverty; drugs or alcohol abuse; mental heath issues, and families living in areas with considerable crime, poor housing and high unemployment.

Ferguson, H (2004) Protecting Children in Time p.6 Palgrave Macmillan, Basingstoke

H.M.S.O (2006) Working Together to Safeguard Children A guide to inter-agency working to safeguard and promote the welfare of children http://www.everychildmatters.gov.uk/_files/AE53C8F9D7AEB1B23E403514A6C1B17D.pdf (accessed 15/10/2007)

See HMSO (2006: 17) http://www.everychildmatters.gov.uk/_files/AE53C8F9D7AEB1B23E403514A6C1B17D.pdf (accessed 15/10/2007). See also Evans, H. (2002) Child neglect http://www.nspcc.org.uk/Inform/research/Briefings/childneglect_wda48222.html (accessed 15/10/2007)

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