Patrick Ayre

1
Defining child abuseJudging significant harm

• Patrick Ayre
• Department of Applied Social Studies
• University of Luton
• Park Square, Luton
• email pga_at_patrickayre.co.uk
• web http//patrickayre.co.uk

2
Plus ça change

• Every child matters Keeping children safe
• Jasmine Beckford, Kimberley Carlile, Tyra Henry
  Victoria Climbié, Lauren Wright and Ainlee
  Walker,
• Doing the simple things well

3
The research how we started

• Significant harm had become central to decisions
  in child protection
• No definition of whole phrase in the Children Act
  or guidance
• No comprehensive guidance about how to be apply
  in practice
• Not much in literature

4
Significant harm

• Harm is defined by Children Act 1989
• ill-treatment (including sexual abuse and, by
  implication, physical abuse)
• impairment of health (physical or mental) or
  development (physical, intellectual, emotional,
  social or behavioural)

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MEANING OF CHILD ABUSE

• Neglect
• 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. It may
  involve a parent or carer failing to provide
  adequate food, shelter and clothing, failing to
  protect a child from physical harm or danger, or
  the failure to ensure access to appropriate
  medical care or treatment. It may also include
  neglect of, or unresponsiveness to, a child's
  basic emotional needs.

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MEANING OF CHILD ABUSE

• Neglect
• 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. It may
  involve a parent or carer failing to provide
  adequate food, shelter and clothing, failing to
  protect a child from physical harm or danger, or
  the failure to ensure access to appropriate
  medical care or treatment. It may also include
  neglect of, or unresponsiveness to, a child's
  basic emotional needs.

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MEANING OF CHILD ABUSE

• Emotional abuse
• Emotional abuse is the persistent emotional
  ill-treatment of a child such as to cause severe
  and persistent adverse effects on the child's
  emotional development. It may involve conveying
  to children that they are worthless or unloved,
  inadequate, or valued only insofar as they meet
  the needs of another person. It may feature age
  or developmentally inappropriate expectations
  being imposed on children. It may involve causing
  children frequently to feel frightened or in
  danger, or the exploitation or corruption of
  children. Some level of emotional abuse is
  involved in all types of ill-treatment of a
  child, though it may occur alone.

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MEANING OF CHILD ABUSE

• Emotional abuse
• Emotional abuse is the persistent emotional
  ill-treatment of a child such as to cause severe
  and persistent adverse effects on the child's
  emotional development. It may involve conveying
  to children that they are worthless or unloved,
  inadequate, or valued only insofar as they meet
  the needs of another person. It may feature age
  or developmentally inappropriate expectations
  being imposed on children. It may involve causing
  children frequently to feel frightened or in
  danger, or the exploitation or corruption of
  children. Some level of emotional abuse is
  involved in all types of ill-treatment of a
  child, though it may occur alone.

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MEANING OF CHILD ABUSE

• Physical abuse
• Physical abuse may involve hitting, shaking,
  throwing, poisoning, burning or scalding,
  drowning, suffocating, or otherwise causing
  physical harm to a child. Physical harm may also
  be caused when a parent or carer feigns the
  symptoms of, or deliberately causes ill health to
  a child whom they are looking after. This
  situation is commonly described using terms such
  as factitious illness by proxy or Munchausen
  syndrome by proxy

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MEANING OF CHILD ABUSE

• Sexual abuse
• Sexual abuse involves forcing or enticing a child
  or young person to take part in sexual
  activities, whether or not the child is aware of
  what is happening. The activities may involve
  physical contact, including penetrative or
  non-penetrative acts. They may include
  non-contact activities, such as involving
  children in looking at pornographic material or
  watching sexual activities, or encouraging
  children to behave in sexually inappropriate
  ways.

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MEANING OF CHILD ABUSE

• Sexual abuse
• Sexual abuse involves forcing or enticing a child
  or young person to take part in sexual
  activities, whether or not the child is aware of
  what is happening. The activities may involve
  physical contact, including penetrative or
  non-penetrative acts. They may include
  non-contact activities, such as involving
  children in looking at pornographic material or
  watching sexual activities, or encouraging
  children to behave in sexually inappropriate
  ways.

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MEANING OF CHILD ABUSE

• Sexual abuse
• Sexual abuse involves forcing or enticing a child
  or young person to take part in sexual
  activities, whether or not the child is aware of
  what is happening. The activities may involve
  physical contact, including penetrative or
  non-penetrative acts. They may include
  non-contact activities, such as involving
  children in looking at pornographic material or
  watching sexual activities, or encouraging
  children to behave in sexually inappropriate
  ways.

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Methods

• Examine systematically the way phrase used by
  experts in practice
•   
• Approach derived from Critical Incident Technique
  (Flanagan, 1954)
•   
• Explore real practice incidents, collect real
  practice factors, not values and principles

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What we did

• We interviewed 25 experienced practitioners about
  how they made judgements about significant harm
• Each had at least seven years experience
• We looked at what they actually did in real
  cases, rather than what they thought they should
  do

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First level in our framework

• Observations concerning the individual parents 
• Observations concerning the family as whole and
  relationships within it
• Observations concerning the child
• Further broken into subcategories resulting in
  four grids

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Observations Concerning the Individual Parent
Types of Indicator
Direct evidence of
Anger, abuse, over-chastisement
Physically abusive behaviour
Emotionally abusive behaviour
Rejection, low warmth, high criticism
Fails to meet basic needs Fails to provide
supervision/exposes to danger Provide
stimulation, guidance Exposes to filthy living
conditions
Neglectful behaviour
Sexually abusive behaviour
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Observations Concerning the Individual Parent
Behaviour and attitude indicative of abuse
Types of indicator
Fails to believe child Fails to accept
responsibility Fails to protect Fails to
compensate for partner Coerces child to withdraw
allegations
Un-protective
Violent, aggressive
Fails to recognise problems Doesnt follow
advice Hostile Unwilling/unable to work in
partnership towards change
Un-cooperative
Unskilled in parenting
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Observations Concerning the Individual Parent
Behaviour and attitude Indicative of abuse
Types of indicator
Not reliable, truthful Unable to give account an
injury or gives conflicting inconsistent account
Untrustworthy or behaviour suspicious
Lacking in knowledge of children

• Lacks characteristics associated with
• parenthood e.g.
• puts own needs first
• fails to display empathy, patience or
• understanding

Un-parental
Unsettled/unstable
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Observations Concerning the Individual Parent
Personal characteristics and history
Types of indicator
Drug and alcohol abuse Mental illness Learning
disability Poor health
Children have been removed from home Children
have been on the child protection register
Brought up in an abusive situation Former child
subject of concern re abuse Was looked after by
the local authority
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Observations concerning the familyas a whole and
relationships within it
Types of indicator
Family structure
Rigid
Step-parent or other main carer not a birth
parent
Reconstituted
Unstructured
Chaotic, lacking boundaries
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Observations concerning the familyas a whole and
relationships within it
Environmental circumstances and stresses
Types of indicator
Poverty/unemployment
Area deprived of resources
Other severe stresses including scrutiny by the
child protection system
Other stresses on the family
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Observations concerning the familyas a whole and
relationships within it
History
Relationships
Social and family network
Entrenched pattern Not a one-off
Marital/carers
Unsupportive/antagonistic
Little progress in responses to input
Parent/children attachments
Un-protective/abusive
Former history of relevant problems
Between siblings
Other problems
Stability over time
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Observations Concerning the Child
Types of Indicator
Category of Concern
Direct evidence of
Physical Abuse
Any evidence indicating directly that the child
or children is/are being abused. Evidence may be
directly observed or contained in referrals,
statements or reports.
Sexual abuse
Direct evidence of abuse (including
allegations or disclosure)
Emotional abuse
Neglect
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Observations Concerning the Child (cont.)
Types of Indicator
Category of Concern
Direct evidence of
Physical
Weight, height, centile charts, physical
milestones
Developmental delay/problems indicative of abuse
Speech Cognitive milestones
Cognitive/language
Ability to play,form relationships,
social milestones. Performing an adult role
whilst still a child
Social/emotional
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Observations Concerning the Child (cont.)
Category of Concern
Types of Indicator
Indicators of
Physical abuse
Behaviour indicative of abuse
Standard signs and symptoms of abuse
Sexual abuse
Emotional abuse
Neglect
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Observations Concerning the Child (cont.)
Types of Indicator
Category of Concern
Indicators of
Behaviour challenging or in some way associated
with abuse
Capacity for self protection History of
abuse Need for special care (age and health)
Personal characteristics and history
Vulnerability
Many changes of carer
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Using the framework making a judgement

• Aid to assembling factors
• Decision remains matter of informed professional
  judgement
• Normally conducted on an inter-disciplinary
  basis.

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What we found

• Losing sight of the child
• Accentuating the negative
• Chronic abuse and the principle of cumulativeness

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What we would hope to find
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What we found
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What we found

• Chronic abuse and the principle of cumulativeness
• Incidents scattered through files
• The problem of proportionality
• Acclimatisation

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What we found

• Making the case
• Underpinning theory

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Recommendations Case review

• The accumulation of three referrals or
  expressions of concern will lead to interagency
  consultation and review
• Any agency identifying serious concern will be
  responsible for ensuring that an appropriate
  review takes place
• As a minimum, a review will be initiated after
  three referrals or expressions of substantial
  concern

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Case review

• A fresh pair of eyes will be used to review
  regularly all cases characterised by long term
  poor parenting
• All cases characterised by long-term poor
  parenting will be reviewed regularly by someone
  not working with the family
• Peer and interagency review will often have
  distinct advantages
• All agencies involved have a responsibility to
  ensure that review takes place
• Reviews should include a full assessment of
  living conditions throughout the house where
  relevant

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Case Recording, Assessment and Reporting

• Cumulative front sheets will be maintained on
  the files of all relevant agencies
• Chronological list of relevant occurrences, each
  entry two or three lines in length
• Shared at all formal and less formal interagency
  meetings, including child protection conferences
• Part of all case reviews
• Monitored within the supervision process

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Case Recording, Assessment and Reporting

• Formats and proformas used for recording, report
  writing, planning, reviewing and supervision
  should direct proper attention to the children,
  their needs, views and experiences
• Practice guidance, training and report formats
  should ensure appropriate assessment of strengths
  as well as weaknesses