Podcast: recognising and responding to child neglect

Podcast transcript: episode 46

Introduction:
Welcome to the NSPCC Learning podcast, where we share learning and expertise in child protection from inside and outside of the organisation. We aim to create debate, encourage reflection and share good practice on how we can all work together to keep babies, children and young people safe.

Ali:
Hi and welcome to the latest NSPCC Learning podcast. This is the first of two episodes recorded last month, September 2021, that focuses on neglect. Dawn Hodson, the NSPCC's Associate Head of Development, spoke to Mandi Tambourini Moore, a family support worker for Liverpool Children's Services, Lisa Shannon, the Graded Care Coordinator from Stockton-on-Tees Borough Council, and Sharon Graham, an early help manager at Shropshire Council.

In this first episode, Dawn, Mandi, Lisa and Sharon discuss what neglect is, the difficulties with assessments and some of the harder to spot forms of neglect. They then move on to discuss issues and challenges that arise in relation to children's ages and stages, covering early years, adolescence and additional needs. Throughout the conversation, each professional talks about what they've learnt from their experiences working with families and what they found works when supporting families.

Dawn:
We're going to start off by having a little bit of a conversation around why neglect is difficult to understand, difficult to assess and why the word itself - neglect - is difficult for families. So Sharon, do you want to just share something about your understanding of the assessment of neglect and why it's difficult for families to understand what neglect actually is?

Sharon:
Well in my experience, I've worked with families who have had very little understanding of the word neglect. They've been worked with a number of professionals. Over a number of years, around home conditions, around healthy food on the table, around children going to school, around some quite extreme situations of lack of emotional warmth and attachment. But nobody's actually sat down and said to them “this is neglect”. Or neglect has been a term that's been used very much in passing around the type of category of child protection plan they might be on, for instance. Nobody sat down and explained exactly what that means to them and their situation. And when I've spoken to families in those types of situations, the feedback that they've given is, if somebody had sat me down earlier and pointed out what neglect meant to my family and my situation, I might've been able to have put some changes in place.

They've also reflected on the fact that when they've heard the term neglect, they've thought of the black and white NSPCC adverts on the TV, or the child who goes to school in winter without a coat, or the photographs of filthy houses, or the serious case reviews that they've heard about in the news. Nobody's ever stopped and said to them - okay so for you, we are working with you around neglect. It's not a nice word. It's not a nice term. Nobody likes to hear it. It's quite threatening. But this is what neglect means to you, your children and your family's situation. And I think that's quite frustrating because we have seen families who've had services involved for a number of years and the end result is that their children have been removed.

We've seen others that have been successfully worked with but the use of tools such as GCP2 and use of that shared understanding, not jargon, but plain talking and plain, simple support with families works. And I think that the stigma around neglect is what prevents professionals very often from using the term. That doesn't help the families or the children living in those situations. So it's difficult without the explanation to be able to relate that into real life. We've all worked with families who said, but my child has their dinner every night or my child does go to school or they have got shoes. But they don't understand that not giving them a cuddle, sitting down and having conversations with them, interacting with them, walking them to school and being part of that school day - they don't see any of that as being that gap around the parenting and the neglect in their situation.

Dawn:
Yeah, brilliant. So Mandi, is that similar from your experience as a frontline practitioner?

Mandi:
Yeah it is, in the fact that with some of the families that we've worked with, it has been that nobody's actually sat them down. It's this word neglect means a child that sits in a corner and is weeping and crying and it's black and white. But that's not true for them, their child. They've got other siblings to play with so why would they need to go out anywhere? Why would they need to celebrate a birthday because they're all happy themselves? Because I've found that not having any celebrations is something that they think is “okay but we don't need to. They know it's their birthday. They've got a card. It's okay”. And nobody's sat down and said how would that feel if you didn't celebrate that? How does it feel if you're the child who doesn't achieve their goals because you haven't spent the time to sit down with them and to enjoy the time to read a book? To enjoy that time to have homework with them. And they're looking at you. Families are looking at you as if to say “I didn't realise that's what neglect was”. That's a form of neglect that – “I thought it was about me not washing the clothes. Not doing the cleaning up. And I do all of those things”. It's like not saying to them “how's your day been today?”. That emotional warmth and they haven't quite linked neglect to that area of life.

Dawn:
So do you think we, when we're working families, need to be clear and honest? Is that what you're saying? That clarity, that honesty in a really understandable way?

Mandi:
Yeah, I think it is. And I'm not saying that that conversation is easy to have either. With some of our families I've got to be honest with you, I've thought “oh I've got to have this conversation”, but actually, what I have found is once you get past that and they begin to understand what it is that we're saying, we're not saying, “you have done this”. What we're saying is “we have noticed this and we can change it”. So it's about saying you know what? That's how it was, that's not how it needs to be. And I've found that with some of the families that I have worked with is it's that light bulb moment of going, “oh my goodness, why didn't somebody just sit me down and say this is where we need to do a little bit more work?”. I need to have that understanding. And with some of those families that I have worked with, it's that they think it takes lots of time and it's time that they haven't got because they're juggling so many balls. But when you sit them down and say it doesn't take that much time, it can be part of everything else that you're doing. 

Dawn:
That's really empowering to hear that. It's such a positive message - where neglect is. Is that your experience Lisa, in relation to some of the difficulties with assessment? Are there particular elements of neglect that you think practitioners might struggle to understand and identify and clarify for families?

Lisa:
Yeah, I certainly do. We've certainly worked with families - and actually thinking about those families from more affluent areas - they may well have a lovely house, a tidy house, the children have got not only good quality clothes, but sometimes designer brands. But the lack of supervision for those children - they're given money to go out, but parents don't know where they are. Some of the elements of safety or some of the elements of emotional warmth, the quality of the relationship. So in a physical world, they have everything they could ever want and more, but emotionally they're being left behind some of their peers from less affluent areas.

And I think the other thing we're wary of is that for some families this is how they were brought up. And you're saying "you're neglecting your children" is the realisation for them that they were neglected as children. And sometimes they're not ready to hear that. Sometimes we are challenging, not only their family and how they're bringing their children up but how their parents brought them up. And sometimes that realisation was “if I'm neglecting my children, I was neglected too”. And they've never seen that before and they've got to work through that themselves too.

Dawn:
That's really powerful, isn't it? Sharon, one of the issues we're aware of is, as you say, you can understand and see the extremes especially if it's in the physical environment, but how do you think practitioners cope with understanding when sub-optimal parenting, stuff which is not that good, becomes neglectful parenting? Because that bit in the middle is quite challenging. Have you got any experience or any thoughts around that?

Sharon:
It's the not quite good enough area, isn't it? That bit in the middle. And I think that practitioners really struggle with that. In my experience, it is a difficult position to be in. Especially where you have a number of professionals working with a family and different people are seeing different things. Communication then is key so that everybody's on the same page. And certainly, there are families that I've been aware of who have had some professionals say “now you're doing a brilliant job, everything's wonderful, your house is clean, everything's great” and then others seeing the different perspective of it. And without that communication that becomes really difficult for practitioners to move families on and out of that grey area.

I think it's really hard. Practitioners - in my experience - find that the word neglect is so negative and has such a stigma attached to it that we try and avoid it as much as possible. But that isn't what should be done. It's all about the transparency. I think things can drift if things are just about good enough. And the earlier identification of neglect is actually quite challenging - it's going back to the filthy children and the filthy houses. And if it gets to that point, it's too late. We've missed an opportunity and this is children's lives that we're talking about. So I think it's a really difficult position for a practitioner to be in. But I do think that that's societal as well. Nobody likes the term neglect, do they? And it does bring the most horrendous images into your mind. But just picking up on something that Lisa said about the more affluent families and particularly with young children, you can go into beautiful homes, but there aren't any toys available for the children to play with. There's a TV, 50-inch screen TV in the corner with the moving wallpaper on it all the time, but no interaction. And I do think that that's really difficult. Having been a practitioner faced with that situation myself in the past and working with families like that, it's really difficult then to have those challenging conversations with parents and trying to then bring in that term neglect, is very difficult. So that bit in the middle is a very challenging area I find.

Dawn:
So moving on to small children and an assessment of neglect, Mandi, have you got any experience working with really small children around neglect? So nought to five say, maybe pre-verbal or non-verbal, so some of the challenges with the non-verbal babies in relation to neglect. Have you got any thoughts around that?

Mandi:

We've noticed that there's been that non-eye contact or some baby will go to anybody and especially a young child to be soothed. And normally that's not something that would happen. The baby would be in the pram and you could pick the baby up and soothe that child but mum wouldn't even go and look, she'd go “it just cries all the time” and it's kind of like that. They need that bit of soothing but you could see there was no eye contact or wanting to touch the baby or wanting to do anything to try and soothe the baby. And okay, you may have a really bad night's sleep on this occasion, and you may well be tired and worn out, but if you go and you've been on the next occasion and the next occasion and the same thing's happening, you start to think there's no emotional warmth there – we need to have a look at this. 

Dawn:
So have you any experience of trying to understand the lived experience of a very small baby? Because obviously when children grow up and get older and verbal and you can try and understand their lived experience, but it's much more difficult, isn't it, when they're nonverbal. Have you any thoughts about how people can do that?

Mandi:
I would start looking at how that eye contact is and how that physical contact is with the baby. It's having those little toys and playing those little games. And they only may be a couple of weeks or a couple of months old, they can still play with those things. In my experience, what I've found is I've said to them, sing songs to them, they'll watch your mouth movements, you're encouraging them. You may think that they're not getting anything from it but they actually are. They're watching you. They're learning from you. For me when I've been in and worked with families like that, it's looking for those things to see if they happen, to see that engagement and encouraging it. And sometimes they find that they think - or in my experience of that - they've gone “but I feel a bit daft doing that because my parents didn't do that with me so I feel stupid”. And you go “no! You'll get so much when baby smiles, you'll get so much when they try to copy, or it's amazing, just watch!”...

Dawn:
That's brilliant, isn't it? That's really helpful. Sharon, did you want to come in at this point?

Sharon:
Yeah. Just with regards to that, a lot of my work in life has been spent in children's centres, with under-fives predominantly, and a lot of very new parents who may have additional needs themselves, or may as was mentioned earlier, may have been parented not in the best way when they were young. And I think the use of observation and role modelling is absolutely key when we've got practitioners there. Taking families along to toddler groups, for instance, so that they can engage with other families and other children, and they can watch how other parents might be interacting with their children. But the use of observation and role modelling is absolutely key. It's always a concern. And I've worked with many families over the years that when you've gone into the home, the youngest child is always in a playpen, with the same book and the same cuddly toy that they were the week before on the visit and the week before that and the week before that. And the child is always very quiet and that's always an alarm bell for me. If you've got a very quiet child under the age of five then something's not quite right. When you've got a very quiet child that's always in a playpen and has very little interaction with a parent, that's when really practically you can get involved in the “right come on, let's get baby out. Let's see what we can do here. Let's have a look. What toys have you got? What can you do?”. Even if it's a bunch of keys. It's about getting that attachment, building on that. It's so important for the brain development at such an early age. And then getting them out of the house and getting them integrated into society and able to experience from seeing how other families and other parents interact with their children.

It also helps with some of the families that I've worked with where financial pressures have been quite great and they haven't been able to have lots of resources in the home. If they can get out and go to a toddler group or ‘stay and play’ in a children's centre or something like that, they can access all of those opportunities without having the pressure of thinking, “oh gosh, I need to go out and buy that new toy that I've seen advertised on the TV because that's going to do everything I need it to do”. The interaction between the parent or the caregiver on the child is far better than any whiz-bang toy that you could buy that's new on the market. 

Dawn:
Absolutely agree, absolutely agree. Very, very important. Lisa, have you got experience of neglect in the early years?

Lisa:
Yeah, absolutely. I mean a lot of my background is early years too. But for me, it's that demonstrating and telling parents, talking to your baby, even if it's “right we're going to change your nappy, we're gonna to do this” and sort of narrating as you're doing some of the care needs. And then allowing that turn taking in conversation. Yes, baby's babbling, yes, baby doesn't understand so much what we're saying, but it's those starts of that social interactions.

Just picking up really from what Sharon was saying about resources, it's showing them, let's go and get a wooden spoon, have you got a bowl -  a mixing bowl? What else can we make? Could we put some pasta in some empty pot bottles to make a shaker? Talking about the importance of the interaction as opposed to the toy. The most important thing in a young baby's life is that caregiver. We can do so much as caregivers, singing and I am from a nursery background so I'm happy to sing songs in somebody's house, whether I can sing very well or not, I'm happy to do it and to show them. And show them some of the little bits from the social baby, so sticking my tongue out and waiting for baby to copy and showing them those little things that baby can pick up is really vital for them.

Dawn:
Another interesting thing is that as they get older, they say don't start trying to parent adolescents when they're adolescents. And so, I'm just interested in anyone's thoughts on adolescence really and the challenges with neglect and how it appears for adolescents. Because I think as they get older, the neglect that they have experienced as they're young, it's very difficult to attribute behaviour when they're 14, 15 and 16 to something that happened, the neglect that they've experienced during their life. So has anybody got any thoughts and views around that? Mandi, have you got any thoughts and views around adolescent neglect and working with adolescents?

Mandi:
My background before this was targeted services, so I've worked with a lot of families that historically, they tended to get into that criminality because they're looking for that sense of loyalty, that sense of belonging. And I think that's another thing that people don't really see as linked to neglect. What that gang culture can offer is that closeness, that bond, that sense of belonging, that camaraderie that comes with it. They've got no problem with hugging each other and giving that bit of a nudge. And it's only when you look back, you can actually see that it's that emotional need that it's feeding and it's that bond that they get within that. And it's something that I found whilst working within that sector that whenever you unpicked everything, you usually found that from an early age they were out on the streets playing and not going to school.

Dawn:
Neglect - it's like the horizontal, isn't it? It underpins, underlies a lot of behaviour which is seen as risk taking or getting involved in criminality as they get older. And Lisa, is that your experience? Because I know you've worked with nought to 19 teams as well.

Lisa:
Yes, I think it is and it is difficult for people to track back. And sometimes certainly when we're working with families and we're asking about early years, families don't quite get why we're asking about that. And yet for us, we've seen some of the things that Mandi was talking about there. Actually yes, we can then track back and say this is why some of those behavioural difficulties may be happening. This is why they might be gravitating towards some of the gangs or some of the criminal exploitation. And I think for us, we found having that trusted adult who was a champion for the child sometimes can just bring some of that back. A child needs to know somebody is on their side. And I think especially if they have got behavioural issues, they may well be causing difficulties in schools. It may be that teachers see them as a problem as opposed to looking at what happened. So having somebody in their corner to say, this could just be that they need something extra. They've missed something when they were younger.

Dawn:
Because it's really interesting, isn't it for adolescents, and we know neglect is an adverse childhood experience and we know that anger is a mask-emotion when you're traumatised. And so sometimes when they become adolescents, if we don't understand this or all that society sees are angry young individuals where what they're really seen has traumatised young people who have not had their needs met as they're growing up. Is that your experience Sharon? Is that how you understand adolescent neglect?

Sharon:
Yeah, very much so. A lot of the young people that I've encountered who are involved in criminal behaviours have - when you track back and you look at their histories - the neglect was from very young ages. It's that need to feel needed. They want to become part of a family. And what that family looks, they will want that to look very different to what their family at home looks like. The behaviours go off the scale. We end up with school exclusions which gives them further exposure to risk and exploitation. When you've got young children, young people, who've had no attachment with their parents or little attachment with the parents, the parents don't notice the changes in their behaviours as much. They just think “oh well, they're just being naughty because they've always been naughty”. And for some of the young people that haven't had the best of everything at home, when they become involved with some of the gangs who can then buy them the latest trainers or give them the group of friends they want, or they can get into somebody's car and go off somewhere for the evening, then that's what they're going to do because they've missed all of that. And we also need to remember that teenagers go through another brain growth spurt which impacts on their emotions. It's very difficult to be a teenager, especially in the current climate with society and with the risks out there that there are now and I think that it's really important.

Sharon:
But again, just to echo what Lisa said, when you go back and you talk to families about the early childhood experiences, they can't see the connection. And then therefore perhaps can't see their role in the responsibility around that. Certainly some young people as well, they don't seem to have the sense of self-respect that they may've had had they have had that relationship as they were growing up. They won't engage then with medical appointments because there was no emphasis put on medical appointments and developmental checks, et cetera, when they were younger. So it's not something that they would see as a high priority.

Dawn:
So when you're assessing neglect in adolescence, it moves from the quality of the care and the effort that the parents are putting into how they're supporting their growth and their development, isn't it? The subtlety changes because if a three-year-old is not being dressed appropriately then that's an issue with the parenting, but when you become an adolescent, you want to make sure that parents are supporting that child. So assessment and working is really difficult for practitioners.

In relation to children with additional needs Lisa, have you got any experience of working where there's been neglect of children who require extra support?

Lisa:
Yes certainly and I think it's difficult because as a practitioner, you have got to have that additional information of what does this child need additionally? What we know with children with additional needs, their needs can be great and sometimes you need to be an expert in those needs which as a practitioner we might not always be. So for me, it's finding who is the expert of that child's needs? How do we work with that expert for us to understand what the child needs? And how does the parent respond to those additional needs? Is the parent interested enough? Have they got an understanding of what the additional needs mean for the child? Do they know what it means if they don't follow through on some of the medical advice? Do they understand the consequences for not following medical advice and opinion? Or is it when they've walked into the room say at a consultants that they haven't understood what the consultant's saying? And how do we make them understand and then to ensure that they're following those needs?

Dawn:
Yeah. So what I've heard from the conversation we've had thus far is around honesty with families. It's around clarity about what each child needs at each part of its development. What it needs as a baby. What it needs as it's growing up. What that child needs as an adolescent and that idea of don't start to parent in adolescence, as you were saying Mandi, when they're an adolescent, you need to start parenting them when they're four. And even for those children who've got additional needs, it's around understanding what those needs are. And so not meeting those needs, not meeting the basic needs for children with additional needs, not meeting those additional needs, that can be all encompassed in the idea of this sub-optimal, neglectful parenting.

Ali:
We hope you found this episode interesting. Please do listen to the second part where Dawn, Mandi, Sharon and Lisa talk about the visibility of the child, early intervention and what can be done to help parents when there is neglect in the family. And a special thank you needs to go to Sam Kyriacou, one of the NSPCC's implementation managers, for getting each of our professionals on board to speak on these two podcasts.

(Outro)

Thanks for listening to this NSPCC Learning podcast. At the time of recording, this episode’s content was up to date but the world of safeguarding and child protection is ever changing – so, if you're looking for the most current safeguarding and child protection training, information or resources, please visit our website for professionals at nspcc.org.uk/learning.

Podcast transcript: episode 47

Introduction:
Welcome to the NSPCC Learning podcast, where we share learning and expertise in child protection from inside and outside of the organisation. We aim to create debate, encourage reflection and share good practice on how we can all work together to keep babies, children and young people safe.

Ali:
Hi and welcome to the latest NSPCC Learning podcast. This is the second of two episodes recorded last month, September 2021, that focuses on neglect. Dawn Hodson, the NSPCC's Associate Head of Development, spoke with Mandi Tambourini Moore, a family support worker for Liverpool Children's Services, Lisa Shannon, a graded care coordinator from Stockton-on-Tees Borough Council and Sharon Graham, an early help manager at Shropshire Council.

In this episode, Dawn, Mandi, Lisa and Sharon discuss why neglect happens, how it's vital to keep children at the forefront when working with families, what can be done to help parents when there is neglect and the importance of early intervention. All of the professionals share their advice, tips and solutions when working with families and talk about how neglect isn't deterministic - that with the right support, families can and do change.

There is also mention of the Graded Care Profile 2 which is an assessment tool to help practitioners measure the quality of care a child is receiving. For more information on this, please look at the links on this podcast's webpage.

Dawn:
Why do we think parents [neglect]... is it an act of commission? Do they parent neglectfully on purpose? Or is it just they don't understand or are they not aware they've not got the skills? Is it a combination of everything? Sharon, what's your thoughts on that?

Sharon:
In my experience, I've tended to work with more families where the neglect has been unintentional and it's been around lack of their own knowledge and understanding than those where the neglect is far more intentional. That's around transparency and around families being supported to understand what they're doing and how they're parenting and how they were parented themselves. We know that love is unconditional - and that's one thing that I've heard from a lot of parents - they've said, “but I love my child. I love my children. I couldn't neglect them. I don't know what you mean”. But loving them isn't enough. It is about all of the other things. It's about being a parent and it's about having those skills. And it's about having the availability and the willingness to work with professionals and practitioners to develop those skills. So for me, I feel that it's far more around the lack of understanding and the lack of parenting capacity, rather than the intentional.

Dawn:
Yeah, that's really interesting. Mandi, is that in your experience as well?

Mandi:
I would echo that with Sharon. It is about that lack of understanding and lack of clarity on what neglect means because we have a stereotypical picture in our heads of what it is. So when you speak to parents about neglect, they do say all of those things, “but I really love my child and I do this and I do that”. But it's not about what you do, it's what you don't do that they can't really see as neglect. They just see it as “I didn't do it so why do I need to now?”. And I think part of that understanding as well is - even though they may say that “I didn't do it” or “that's the way it was done when I was a child”, it's about saying to them, “we've moved on”. As professionals, we've got a better understanding of neglect and we're trying to share that with people so that things can change.

Dawn:
What about some of the parenting vulnerabilities Lisa? So domestic abuse and alcohol and substance misuse, does that have an impact on parents' ability to parent?

Lisa:
I think it certainly can and we set out and say parents don't set out to be bad parents generally. But some of those things that are happening for parents or whether it's drug or alcohol misuse, whether or not there's domestic abuse, that can sometimes almost be a reason for some of the neglect. But I think it's really important to set that aside because we need to know what life is like for the child. And yes, some of these things are impacting on what life is like for the child, but we need to understand that child's life and then look at the reasons for it. We do need to support parents who are experiencing those things because if we support them to deal and to cope with what's happening in their life, we know that that then will help them become better parents. But we can't lose sight of the child. That's more important than those difficulties for parents.

Dawn:
Yeah, absolutely. So Sharon, is that what you think as well?

Sharon:
I think it's really important as practitioners working with families that we understand and take the time to understand each family's journey. I think that's really important. We go in there, we don't make judgement, but we take the time to build those relationships and get to know everybody's individual circumstances. And then it's about having the skills to support parents and caregivers to then try and see their child's life through their child's eyes. So it is very much about stripping things back and looking at this is what a day in your child's life looks like. What do you think is missing? What do you think could be done differently? What support do you think you'd need to be able to make those positive changes? And I think that really helps to get an understanding then for families of exactly what is lacking and just going back to what's already been said, it is then about the yes, you do this, you do that and you love your child, but what isn't happening here is what's having the negative impact. So it's really about understanding each family's journey and taking that time to build the relationship and the trust.

And a lot of families who are involved with services have damaged trust with services because of experiences. And that may have been experiences that they had with children or what their parents have said happened. Because we do know, in my experience some of the families that I've worked with, they're second and third generation families on child protection plans, for instance. So they were on plans as children and then when their parents were children, they had somebody involved with them - or it was the local policeman kept an eye on them. I think that it's about breaking that cycle then and until we can build the relationships and build the trust, that's never going to happen. And therefore, the life chances and the experiences for children are never going to improve so it's investment, isn't it?

Dawn:
Absolutely investment in time, isn't it? That's the thing. So Mandi from your experience, how easy is it to keep the lives of the child at the forefront when you go into some of the families I bet you're working with at the moment who were very complex, there's lots of competing things going on and they have their own needs, don't they? We know that inability, as you say, to put the needs of the child before their own, they're not doing on purpose, they just have their own needs. So how easy is it to be able to work with parents to make sure that you see the child and that the parents see the child as well?

Mandi:
I think part of the process that I go through, running alongside Graded Care Profile 2, after explaining it to parents - what's going to happen - I do art sessions with the children. So we're looking at where you do the plate of food and what you like, and what do you eat? What would you wear in the winter? What would you wear? And its all very art-based stuff and I find that when we produce this piece of artwork that says “this is what me life is like and this is how I like my life to do”, when you present that to parents, it's like that secondary thing that backs up the Graded Care Profile that you've done. And then the parents go “oh my God, I just need to change”.

So very much, I think alongside the Graded Care Profile 2, I don't feel that it's a tool that you should go out and do with parents. You do it with the family in whatever way that can be done. And for me, it's about that art and craft sessions with the younger ones. And if it is just smudges of paper and favourite colours, so be it. You're letting them know this is how the child sees their life. This is how the child would like their life to be. And that sometimes breaks down those barriers as well with those professionals coming in and saying “we're going to do this to you” and you're like no we're doing it with you and letting you hear your child because your life is so chaotic that you're forgetting to hear the child's voice and I'm just allowing you to hear the child's voice so that we can change.

Dawn:
Wow, that's so powerful. That is a really good idea that you work on the logic and this is what you do and by using the tools such as Graded Care Profile 2, but also you're engaging with their emotions and their understanding of the world from their child's perspective. Even if the child's language is limited which it often is in cases of trauma. They don't have the language to describe. But what a fantastic way of using art to break that language barrier down. That's such a great idea.

And so the last bit I'd like to have a talk about, I'd like to end and be able to know what Mandi's been saying around how you can engage with families and how you can work with families where neglect is an issue. Have you got any experiences or anything you can share Lisa around where you have been able to change the life course of a family or you believe you've changed life course by the work that you've done? And what did you do and how did it help?

Lisa:
Yes. And on a few occasions, it's been able to show parents in a really easy way, things that they do well, because actually what we know when parents are told the things that they do well, when we're then telling them the things that aren't going quite so well, we can say “but you do this so how can we apply it to this area? What else can we do?”. And working through the Graded Care tool with them to say “you're a four here, how do you think we could get to a two?”. And almost it's that solution focused thing so they're coming up with their own solutions. I'm not the one saying “you must do this and you must do that”. It's parents and families making those decisions for themselves - coming up with the solutions themselves. Effectively coming up with their own plan. I'm there as a practitioner but it's to support their own planning for the future. We've had parents then understand the need for medical appointments, so begin changing them. We have parents being able to plan their day so the house is in a better condition. We've had parents starting to spend some one-to-one time with children and that could be just playing a game once a week initially. But what happens is the children encourage the parents more because the children's behaviour may change because they're not fighting for parents’ attention because parents are giving it naturally.

The importance of working with schools… Schools can be a huge support for parents. We're lucky in Stockton that a lot of our schools are often masses of things for them to access. And sometimes getting past the barrier of working with the school for parents if they've had a bad experience in school themselves, just so that we can all come together to make things better.

Dawn:
So everybody's understanding what their role is and everybody's supporting parents. Sharon, from your experience, how do you find is a really good way to work with parents? Because there's sometimes the sense of hopelessness or there has been in the past around neglect, that these are the cases that quite often come back in to child protection. You go in, you do a piece of work, things get better, you leave and within a year, the family's back in again because of neglect. Have you any words of wisdom to break that cycle?

Sharon:
Celebrate the positives. Just on the back of what Lisa said, it doesn't matter how dire a situation may appear, there's always something positive that you can pull out of that. We use whole family assessments alongside the Graded Care Profile 2 and recently, some of them have been reviewed with families and that's really important. It's about the review process as well and giving families ownership in that review process. Giving families ownership in the whole process. The assessment, the planning, the doing and the reviewing, is so important. And we've heard families say, “no one's ever sat me down before and told me or shown me that I've improved. They've always said that there's always something that you could still need to change, but they've never focused on the stuff that I have changed and that I have made better”. And I think that's really key. It's about pulling those positives through. Because we all know ourselves, if you start a conversation with a negative, you think “oh okay then”. And all you hear is the negative and it's about that.

It's also about having those conversations with the children and the young people as well and getting them to be engaged. What Mandi was saying before and engaging the children in demonstrating to parents what their needs are and what is good, but what needs to improve. And really breaking down the barriers with other agencies as well. You need a team of agencies around a family. It's not just down to one worker going in and putting the time in. Everybody that's involved with that child and family needs to be able to take some share of the load and do some of the work and build up and sustain the positive relationships. Because when targeted services and social care pull out, those other agencies will still be involved. And if they've had positive engagement and they've been able to have conversations with families and they've been part of planning, then that will sustain the change at a lower level and universal level services. But I think it's really about those subtle changes and celebrating the positives and getting the changes to routine and getting everybody singing from the same song sheet. And that's what sustains the change.

Dawn:
That's brilliant. Mandi, I have a feeling you've worked with lots and lots of families and you've got lots of tips to share. So have you got any tips building on what Sharon said and what Lisa said and what you said about art? I'd like you to share some of your great tips about how you engage with these chaotic families who you know want to change but find it difficult?

Mandi:
I know that I've worked with quite a few families and some of them have created their challenges - shall we say. But going back to what you said about looking at the family's achievements and another thing that I do, I'm probably a bit crazy and out there, but each time a family moves from a score and goes up, I get them a little certificate. And I write on “you have moved to here from here”. And you know the way you get the sheet on the back with the certificate, I put all the things that they've done to move along. It's not just “you were a five and now you're a three”, I go, “you are now a three” and on the back - the way you do when you get a certificate at college or uni - I put “you've changed this, this, this...” and there's a whole list of things. I laminate it and take it out and I usually have a little cupcake as well -  it's a celebration, isn't it, come on - and then I take a little cupcake and I have my certificate and I go “I am so pleased, I have got something for you”. Again, it feeds into the next bit where you then say, “this is how your child feels when you spend ten minutes reading a book”, so it links back. And sometimes it is because you've read that book with a child, you can see the difference.

Dawn:
What I've heard during the last hour is that you can still be honest and you can bring clarity. But at the same time, be solution focused and build on the strengths. They're not separate. Just because you're talking about neglect doesn't mean you're going to be negative. What I'm hearing is that you identify and bring clarity to what the issues are. And you say “but this is what you're doing well. This is where some of the struggles are and this is how I'm going to work with you”. And I love the idea of giving a certificate and recognise it in a really formal way - we all love a certificate, don't we? I mean, everybody loves some form of recognition and I imagine one of Mandi's certificates is something really special to those families. And I'm sure in many years’ time you'll be walking around Lime Street in Liverpool and somebody will stop you and go “I got a certificate from you back 10 years ago” which is just fantastic.

So just to finish off, have you got one sentence or one thing you want to say to the listeners around the importance of neglect or a tip you can share or some little things for people to take away? Because what I want to take away, from me personally, what I want to say is neglect is not deterministic. We can be hopeful about the future for these families and that's what I want to leave with. Mandi, have you got anything you want to say?

Mandi:
I would say that neglect is a scary word. But it's a word that can change lives if we work with families and not 'do' to families.

Dawn:
Brilliant. Thank you. Lisa?

Lisa:
A little bit similar I suppose to Mandi. But for me, building up relationships with families. So we need to be honest regardless but if you can build a relationship, they appreciate your honesty and take on board what you're saying and much more open to working with you, as opposed to people beating them with a big stick to say, “you will do this”. It's about showing them what do we need to do and supporting them to do it. That high challenge, but high support.

Dawn:
Brilliant. That's excellent. And Sharon?

Sharon:
Early identification needs to be out there as well. I do think that perhaps we do still, as professionals, think of neglect in the same way that families often do, as the most dire of situations. It's looking for those early signs to try and get in there before things do deteriorate. And that's where the importance of services like early help and early intervention services do come in. Neglect isn't just about moving families into the social care landscape. This is about catching things early and making the changes far earlier. Not only to mean that families are not having those experiences, but to improve their experiences of working with services. Early identification is key. 

Dawn:
That's fantastic. Any final words from anybody before we finish?

Sharon:
I think for me it's about investment. Investment in time, in building relationships and listening. Listening to people's journey's and experiences but properly listening. Not listening and assuming - it's about really investing in that time to listen and understand. Neglect is a very negative word. It is a very scary word. But you can always, in the most dire situation, turn things around. People do have the ability to change with the right support. And what you might find from being in a very disempowering situation when they first start working with a service, is that come the end of that intervention, that family can be empowered to not only make those changes, but to sustain them. And that will change the lives of their children.

(Outro)

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