1 Muti-Agency Practice Guidance Practice Guidance for a agencies produced by Nottinghamshire and Nottingham City Loca Safeguarding Chidren Boards (LSCBs)
2 Emotiona Abuse Muti-Agency Practice Guidance Produced by Nottinghamshire and Nottingham City Loca Safeguarding Chidren Boards (LSCBs) Apri 2006
3 THANKS This guidance has been produced by a group of professionas who work for agencies across the City and County. The LSCBs woud ike to thank them for their time and contribution. Thanks in particuar to: - Jonathan Page Syvia Bouton Dr Eizabeth Didcock Dr Rache Leheup - Chid Protection Co-ordinator (Nottinghamshire Socia Services) - Famiy Therapist (Chid & Adoescent Menta Heath Services, Nottingham) - Consutant Community Paediatrician (University Hospita NHS Trust - Consutant Chid & Adoescent Psychiatrist Iustrations by Laura Fairchid
4 Emotiona Abuse: Practice Guidance for A Agencies Produced by Nottinghamshire and Nottingham City LSCBs CONTENTS PAGE NO. 1 Introduction 3 2 Important Points about Emotiona Abuse 3 3 Definitions 4 4 Identification 4 5 Responding to Initia Concerns 9 6 Chidren in Need 12 7 Further Assessment 16 8 Chid Protection Enquiries 21 9 Chid Protection Conferences Working with Chidren and Famiies Where the Chid is Subject to a Chid Protection Pan Ways of Working Consideration of Good Enough Care 27 Appendix 1: Resources and Reference Materia 29
5 3 Emotiona Abuse Muti-Agency Practice Guide 1 INTRODUCTION 1.1. This practice guidance is issued as suppementary guidance to the Nottingham City and Nottinghamshire s Interagency Guidance on the Assessment of Chidren in Need and their famiies incuding the LSCB s Chid Protection Procedures. It shoud be read in conjunction with this document. It considers and advises on particuar difficuties that are often experienced when working with emotiona abuse It is intended for a those who work with chidren and famiies in a agencies and settings. It draws on research into chid emotiona abuse and on the experience of those activey working in this fied. It aims to hep practitioners define and identify emotiona abuse and form judgments about their assessment and intervention It incudes a range of toos, resources and usefu contacts that practitioners may find hepfu in their work with famiies where emotiona abuse is an issue. The ist however, is not exhaustive and practitioners may we add other resources to it that have been found usefu in practice The term parent is used within the document to mean parent or caregiver i.e. those with the primary responsibiity for caring for the chid. The word chid is used but in many situations the word chidren is appicabe. 2 SOME IMPORTANT POINTS ABOUT EMOTIONAL ABUSE 2.1. Emotiona abuse wi be present in a forms of chid abuse and this emotiona aspect may have as damaging a ong term effect on the chid s deveopment as physica and sexua abuse and negect. However, it can aso be present without other forms of abuse as a systematic form of abuse in its own right Emotiona abuse occurs within the context of a parent/chid reationship and can often be directy observed in the reationship between them Many potentiay harmfu interactions are very common. It is the persistent and repeated nature that woud ead to the situation being emotionay abusive It is essentia that interactions are observed and understood over time as it is a process not an event The necessity to separate a chid from a parent on recognition of emotiona abuse is rare. Effectivey the professiona network and the famiy are engaged in a process of working towards protection (Gaser, 1997)
6 Emotiona Abuse Muti-Agency Practice Guide 3 DEFINITIONS 3.1. The definition of emotiona abuse as contained in Working Together to Safeguard Chidren (DoH 2006) is: Emotiona abuse is the persistent emotiona matreatment of a chid such as to cause severe and persistent adverse effects on the chid s emotiona deveopment. It may invove conveying to chidren that they are worthess or unoved, inadequate, or vaued in so far as they meet the needs of another person. It may feature age or deveopmentay inappropriate expectations being imposed on chidren. These may incude interactions that are beyond the chid s deveopmenta capacity, as we as overprotection and imitation of exporation and earning, or preventing the chid participating in norma socia interaction. It may invove seeing or hearing the i treatment of another. It may invove serious buying causing chidren frequenty to be frightened or in danger, or expoitation or corruption of chidren. Some eve of emotiona abuse is invoved in a types of matreatment of a chid, though it may occur aone The terminoogy used within the fied of emotiona abuse varies; other terms used are psychoogica matreatment, emotiona harm, emotiona negect, psychoogica abuse. (O Hagan, 1993, Gabriano et a, 1986, and Brassard et a, 1987) Enshrined within the definition is the centra principe that emotiona abuse, to be considered as such, must be a typica and pervasive feature of the parent/chid reationship. 4 IDENTIFICATION 4.1. There are various aspects of emotiona abuse which to some extent can set it apart from other forms of abuse. These aspects need to be borne in mind when identifying and working with it: There is usuay no discosure from a chid and thus for pure evidence gathering interviewing a chid has imited vaue, athough they may provide through their pay or their presentation indications of the effect of the abuse. It is important to gain the chid s view but within this framework of understanding. Other evidence comes from the pattern of famiy interaction over time, chronoogies and the effect on the chid. There is no bruise or other sign of physica injury, therefore forensic evidence cannot be reied upon (uness there is accompanying physica or sexua abuse). Because there is usuay no discosure from the chid or physica evidence it is important to have a framework within which observations of parent/chid interaction can be understood, in order to carry out an adequate assessment. Emotiona abuse is a description of a reationship not an event. Unike other forms of abuse, with the exception of negect, it often happens in front of workers eyes as it is usuay an ingrained pattern of interaction between the parent and chid with neither being aware that it is probematic. 4
7 5 Emotiona Abuse Muti-Agency Practice Guide 4.2. Cutura differences in famiy ife and reationships need to be understood and borne in mind when considering whether a situation is emotionay abusive. Emotiona abuse can often be subte and a good awareness of chid rearing practices within any given cuture is necessary. There are three main ways that emotiona abuse may come to the attention of professionas. These are exampes of things that might be seen: 4.3. Research indicates that the parent/caregiver and abuser is usuay the same person. Concerns about parenta behaviour E.g. teachers, personne in famiy resource centres etc may witness difficut parenta behaviour towards a chid e.g. a chid being persistenty bamed for everything that goes wrong, persistent shouting, rejection. Concerns about parenta attributes E.g. personne working in adut menta heath, acoho and drug addiction services becoming concerned about how a parent is functioning and the impact this may have on a chid. Concerns about the chid E.g. a schoo nurse, paediatrician, teacher may be concerned about how a chid is presenting e.g. unhappy, bedwetting, poory behaved which may be due to difficut reationships at home. It is important to have a framework to hep with thinking about and identifying the inks between these three main areas of concern. It is important to try and understand the ink between how the parents behave and the effect on the chid. Such a framework heps to make sense of observations. Keeping a og of interactions between parents and chidren can hep buid up an idea of famiy reationships. Parenta Behaviour Categories of I Treatment 4.4 Gaser (2002) suggested the foowing parameters which are argey enshrined in the Working Together definition. Some or a of these can be present in any one famiy to a more or ess severe degree. Emotiona unavaiabiity, unresponsiveness and negect 4.5 Research has indicated that the emotiona unavaiabiity and unresponsiveness of the parent can be particuary damaging to the chid. It can occur if the parent has menta heath difficuties, substance or acoho misuse or is persistenty preoccupied with other difficuties such as domestic vioence. Parents may be ess ikey to compain about their chid in these situations and observations of interactions are particuary important. This is not to suggest that a parents who e.g. have menta heath difficuties are emotionay unavaiabe to their chidren.
8 Emotiona Abuse Muti-Agency Practice Guide Persistent negative attitude towards the chid/ren. 4.6 The chid is repeatedy denigrated; tod they are bad, unwanted and bamed for the probems in the famiy. The chid may be terrorised, mocked, beitted or isoated in confused or frightening situations. This may be specific to one chid or invove a the chidren in the famiy. Deveopmentay inappropriate or inconsistent interactions with the chid The chid may be expected to support the parent, care for sibings or themseves, or perform tasks beyond their deveopmenta abiity. The opposite can aso be a probem as overprotection, taken to extremes, deprives the chid of opportunities to deveop friendships, activities and access experiences that woud promote their deveopment. Parents may promote insecurities in their chid by e.g. threatening to abandon them. Threats of abandonment can be as damaging as actua abandonment e.g. persistent threats to put the chid in care, parents threatening to eave or ki themseves. This can promote insecure attachment behaviours in the chid, which can persist into their wider reationships and impact on their psychoogica and emotiona deveopment. Parents can have inconsistent expectations of the chid and respond unpredictaby to them. The chid may be given confusing messages, which they cannot understand. Sometimes parents are unabe to toerate a chid s distressed feeings and identify them as naughtiness or badness. Any of the above exampes can be commonpace. It is the persistence and reguarity of the behaviour that has an impact on the chid s deveopment. Faiure to recognise or acknowedge the chid s individuaity or psychoogica boundary. 4.9 This can invove the denia of the chid s unique attributes of temperament and personaity. The parents try to activey moud the chid into meeting the parent s emotiona needs. The parent may have compicated misperceptions of the chid and attribute feeings, wishes and motives to the chid that beong in the parent or in their history. If the parent has an enduring, serious menta iness, they may activey invove the chid in their misperceptions of the word about them. Fabricated or induced iness is a variant of this category. 6
9 7 Emotiona Abuse Muti-Agency Practice Guide Faiing to Promote the Chid s Socia Adaptation 4.10 Parents may promote mis-sociaisation e.g. activey invoving their chid in crimina activity. Parents may negect their chid psychoogicay e.g. faiing to provide adequate menta stimuation and/or opportunities for experientia earning. Parenta Characteristics 4.11 Parenta characteristics are risk factors rather than descriptions of i treatment In common with parents perpetrating other forms of abuse, emotionay abusing parents have often had a difficut or abusive chidhood and have probematic reationships with their own parents. It is common in famiies where emotiona abuse is a concern, for there to be itte known about the parents own chidhood. This can be because the parents find it too distressing to discuss, they are unabe to remember or they resent being asked, as they see the probems as residing in the chid. It may take time to deveop a good enough and trusting reationship to obtain a coherent history There are certain parenta attributes that are more ikey to be present in emotionay abusive famiies. Research by Gaser and Pryor (Chid Abuse Review 1997, vo.6, pages ) identified three common parenta attributes; history of menta heath probems, vioence between parents acoho or substance misuse There may be factors pecuiar to the individua famiy, which aso need to be addressed e.g. parents with earning difficuties, troubed aduts who don t have a ceary defined psychoogica probem but whose behaviour is erratic and unpredictabe. There is an overap with fabricated or induced iness with aduts over presenting their chidren with physica/psychoogica symptoms It is important to note that the presence of menta heath probems, earning difficuties or substance misuse does not automaticay mean that chidren are being emotionay abused.
10 Emotiona Abuse Muti-Agency Practice Guide Impact on the chid 4.16 The extent and nature of signs of impairment in the chid vary according to the chid s age. There are no specific patterns of symptoms in the chid. The effects can be in any area of their deveopment. Physica There can be heath probems reated to poor growth, deveopmenta deay or psychosomatic symptoms. Emotiona Emotiona deveopment can be impaired with ow sef-esteem, chronic anxiety or anger and acting out behaviour. Behavioura Chidren can present as being oppositiona, attention seeking or overy compiant and withdrawn. Educationa For some chidren, their abiity to think ceary or concentrate may be impaired and this wi have an impact on their educationa achievements. Non schoo attendance or ateness may be a persistent pattern. Peer Reationships. There may be ongoing probems in peer reationships due to aggressive behaviour or the chid being withdrawn or isoated It is unusua for a chid to compain about emotiona abuse. Mosty they take on the negative feeings voiced by parents about themseves and perceive the i treatment as justified, thinking their parents judgment of them is correct Beow are other important factors to consider when assessing the effect on the chid. Chid s Vunerabiity 4.19 In some famiies a the chidren are exposed to the same parenta behaviour. In other famiies the parenta behaviour is chid specific. This can be reated to the attributes of the chid such as the birth order, traumatic circumstances around the birth ike the death of a famiy member, gender, ethnicity, disabiity or deveopmenta probems. Chidren are born with different temperaments making some more demanding and difficut to parent. Some chidren are associated in their parent s mind with a feared or disiked parent. 8
11 9 Emotiona Abuse Muti-Agency Practice Guide Chid s Resiience 4.20 There are some chidren who seem to cope with adverse circumstances we. The components of this resiience are not fuy understood but are reated to temperament, eary experience and reationships. Having a taent or abiity aso heps as it aows for the deveopment of sef-esteem. The avaiabiity of a positive reationship can counterbaance the effects of emotiona abuse. If eary reationships are good there is some suggestion that this increases resiience. It is important for the professiona network surrounding the care of a chid to consider resiience factors and to work activey towards putting more in pace if this is possibe. 5 RESPONDING TO INITIAL CONCERNS 5.1. A professionas who come into contact routiney with chidren and famiies e.g. teachers, G.P.s, midwives, heath visitors, nursery staff, pay eaders etc. have a responsibiity to identify chidren and famiies who are strugging and are in need of extra hep and support. A have a roe to pay in assessing the webeing and deveopment of chidren and the assessment framework can be a usefu too to aid this process Within the Nottingham City and Nottinghamshire Loca Safeguarding Chidren Boards Chid Protection Procedures there are definitions of vunerabe chidren, and chidren in need, incuding those who may need protection. There is a guide to evauating concerns; distinguishing between mid concerns, moderate concerns and serious concerns using case exampes. I am concerned that a chid is being emotionay i-treated. Has this reached the stage of being caed emotiona abuse? 5.3 Usefu questions to hep judge whether the threshod for emotiona abuse has been reached are: What worrying interactions happen between the caregiver and chid and how often do these occur i.e. is the probematic interaction observed or reported typica of the reationship between parent and chid? What effect is it having on the chid? Is the effect on the chid mid, moderate or serious? (remember the effect is cumuative). Is there a ink between how the parent behaves and/or how the parent is, and the chid s functioning? (This ink may not be immediatey obvious)
12 Emotiona Abuse Muti-Agency Practice Guide 5.4. These can be difficut questions to answer and advice and consutation may need to be sought. For detais of an emotiona abuse consutation see under resources section It is important that the worker is cear with the famiy about the area of concern and the famiy is taked to in a constructive, non judgmenta way about the inks that have been perceived between the chid s probem and the parenta behaviour. 5.6 GOOD PRACTICE BOX 1: IDENTIFYING AND EVALUATING CONCERNS Compie a written chronoogy of key events in the chid and famiy s ife, by reviewing own agency records. Record ceary observations of parent/chid interaction. Begin to tak to the famiy about what the concerns are, seek a cearer understanding of any reasons for the difficuties and be cear about what needs to change. Ask the famiy s permission to contact other agencies, checking out whether they aso have concerns. It may be particuary important to tak with those who reguary see the chid and parent together. Think about what other famiy support might be hepfu. Discuss why you are concerned with your manager/designated person for chid protection: Is this emotiona abuse? Is it serious? Is there potentia for improvements in famiy reationships? What are the famiy s strengths? Are there other protective factors? Consider the option of seeking an emotiona abuse forum consutation to hep your thinking at this eary stage. Consider meeting together with a agencies invoved to discuss the concerns emerging. Consideration shoud be given to invoving the parents in such a meeting and they shoud be aware that a meeting is occurring. Incude a genogram to aid understanding of famiy structure. 10
13 11 Emotiona Abuse Muti-Agency Practice Guide 5.7. If the concerns are mid i.e. not moderate or serious, agencies that are aready invoved can agree a pan of activity in response to the concerns and coud access some additiona support for the famiy from resources that are avaiabe ocay. E.g: Homestart Surestart Action for Young Carers Famiy Care Schoo Nursing Services Connexions African-Caribbean and Asian Community Organisations Speciaist services for chidren with disabiities Heath Visitor 5.8 It is important to remember that expecting a famiy to access too many services at once can be confusing and counterproductive. 5.9 Because patterns of parent/chid interactions are being ooked at, it is important that the same peope have contact with the famiy and that they gather reevant information from others who have had onger contact e.g. teachers, vountary sector workers Any pan agreed between agencies shoud be time imited and evauated. An identified professiona shoud co-ordinate this. Where there are concerns about emotiona abuse it is particuary important that interventions by the professiona network are panned, monitored and reviewed reguary i.e. evauating capacity for change and reviewing whether there are changes in the desired and stated direction. Case Exampe 1 Two chidren, aged six and eight are often not sent to schoo. They are over presented at the GP s surgery with coughs, cods and other minor aiments. Both chidren are suffering from anxiety symptoms i.e. they have difficuty seeping and are distressed on separation from their parents. Parents fee that the word is a dangerous pace and the resut is that the chidren are grossy overprotected, with parents hoding inappropriate deveopmenta expectations of them. The worker begins to tak with the famiy about the ink between the chidren s anxiety eves and the parents overprotection and discusses the potentiay serious consequences if this pattern continues. The professiona network is engaged in heping the chidren and parents to separate in a supported way, and the worker expores and tries to understand the parenta anxiety. He is cear with the parents what needs to change. The chidren graduay begin to attend schoo more often and gain confidence. The anxieties of the parents begin to reduce.
14 Emotiona Abuse Muti-Agency Practice Guide Case Exampe 2: A singe father with two chidren has a history of depression and binge drinking. His adut menta heath worker becomes increasingy concerned about the impact of father s behaviour and variabe mood on the chidren. He often bames them for his difficuties and the chidren fee responsibe for his care. The eeven year od is overy compiant and rather withdrawn and the nine year od is deveoping serious behaviour probems at schoo. Within the context of the ongoing reationship, the adut menta heath worker begins to tak with the father about how the chidren are doing, emphasising any parenta strengths he has observed, and in a bame free way, makes the inks between the chidren s behaviour and father s difficuties. He is cear with the father about what needs to change and makes contact with agencies who know the chidren. Together they pan interventions; monitoring and evauating any changes occurring. The father s menta state deteriorates and he is admitted to hospita. This crisis brings forward more robust support from the extended famiy which continues and aows the chidren to deveop reationships with a wider range of significant aduts. The behaviour of the nine year od settes down. 6 CHILDREN IN NEED REFERRAL TO SOCIAL SERVICES 6.1 A chid sha be taken to be in need if: He is unikey to achieve or maintain or have the opportunity of achieving or maintaining a reasonabe standard of heath or deveopment without the provision for him of services by a oca authority. His heath or deveopment is ikey to be significanty impaired, or further impaired without the provision of such services; or He is disabed. Chidren Act 1989 Section 17(10) 12
15 13 Emotiona Abuse Muti-Agency Practice Guide Are there indicators that this is a chid in need and if so is a referra to Socia Services required? To make this decision the foowing questions need to be asked: Has the famiy taken seriousy the concerns of the workers and demonstrated a wiingness to change? Have there been discernabe changes in the pattern of parent chid interaction or parenta behaviour with improvement in the chid functioning? Have positive changes been sustained over a period of time? 6.2. If the answer to these questions is no, consut with Socia Services. It may be particuary hepfu to have a discussion with a chid protection coordinator/ independent reviewing officer where the situation is especiay compex. Some cases warrant discussion with Socia Services at an eary point because of the seriousness in terms of the damaging and significant effect on the chid. Others require discussion because of the chronic and unchanging nature of the abuse with cumuative effects on the chid. Unike physica and sexua abuse where protection may need to be immediate, emotiona abuse requires a we monitored and evauated working towards protection. (Gaser, 1997) 6.3. There coud be consutation with the Emotiona Abuse Forum (see detais under resources section) who wi be abe to hep carify the seriousness of the concerns and make suggestions about the way forward Given the difficuty of achieving a cear picture of emotiona abuse within the Socia Services initia assessment time frame of seven days, a more hepfu way forward woud be for Socia Services personne to be invited to attend any muti-agency meetings arranged by agencies aready invoved. The famiy shoud know in advance that Socia Services have aready been invited to such meetings and that it is because concerns are ongoing and significant.
16 Emotiona Abuse Muti-Agency Practice Guide Case Exampe 3: There are three chidren, a boy aged nine and two haf sisters aged five and three, in this famiy. They ive with their mother and the father of the girs. The boy has been referred to the Chid and Adoescent Menta Heath Services (CAMHS) because of concerns about his difficut behaviour; he is wetting and is said to be overactive and defiant. Mother has a history of depression. The mother and chidren have been seen reguary within CAMHS for eight months. Her partner won t have any contact with the service. From meeting the famiy there has been concern about the observabe persistent baming of the boy for a the famiy s is and the ingrained beief that he is ike his father (who misuses acoho), and that there is something wrong with him. His behaviour at schoo is much better than the description of his behaviour at home, athough he does strugge in his reationships with other chidren. Teachers have been concerned about mother s negativity towards him, which is an ongoing pattern. He has had medica checks to excude any deveopmenta or other physica concerns e.g. Attention Deficit Hyperactivity Disorder. The worker observes a parent being persistenty critica of her son whist favouring her daughters. There is no observabe warmth in their reationship, either physicay or emotionay. The boy presents as profoundy sad, has difficuty seeping and his behaviour deteriorates markedy when his mother criticises him. Members of the extended famiy have been seen and are aso very critica. The worker has been cear about her concerns; chaenging the beiefs about the chid s inherited badness, inking the parent s persistent bame with the chid s increasingy serious difficuties and pointing out that this is emotionay harmfu. Nothing has changed despite this tria of therapeutic intervention. Therefore, a referra to the Socia Services department has been made because of concerns that the chid is suffering significant harm. The Socia Services department were invited to attend the reguar meetings aready hed between CAMHS, the famiy, the schoo, the schoo nurse and the community paediatrician. A core assessment is undertaken by Socia Services because they assess that the threshod for s47 enquiries is met. This serves to emphasise to parents the seriousness of the situation and underpins a further tria of intervention to reduce the eve of harm to the chid. 14
17 15 Emotiona Abuse Muti-Agency Practice Guide 6.5 GOOD PRACTICE BOX 2: EVALUATING SIGNIFICANT HARM When evauating what constitutes significant harm consider: The severity of i treatment (in the categories given above) The degree and extent of harm, is there serious impairment? (Compare with that which coud be reasonaby be expected of a simiar chid) The duration of the harmfu parent-chid interactions (importance of chronoogies) Remember: A finding of actua or ikey significant harm can be made as a resut of i treatment and/or impairment, attributabe to the care given or ikey to be given. (Chidren Act 1989) There may be no cear intent to harm the chid, athough the interaction is ceary harmfu If significant harm is not recognised, there is a temptation to begin to describe (even diagnose) the chid s difficuties without fuy understanding the antecedent circumstances of the emotiona abuse Evidence for emotiona abuse can be coected and presented in a cear systematic way in reports for conference or court with hep and support (see resource section for consutation) As time goes on in assessments, there may seem to be ess reason for taking action (chidren have survived thus far). This may be a barrier to cear evauation of the significance of harm.
18 Emotiona Abuse Muti-Agency Practice Guide 6.6. If somebody beieves that a chid may be suffering, or may be at risk of suffering significant harm, then s/he shoud aways refer his or her concerns to Socia Services The oca authority is under a duty to make enquiries, or cause enquiries to be made, where it has reasonabe cause to suspect that a chid is suffering, or ikey to suffer significant harm A number of agencies may need to be invoved to fuy evauate significant harm in emotiona abuse. 7 FURTHER ASSESSMENT BY SOCIAL SERVICES 7.1. There is increasing evidence of the adverse ong term and significant consequences for chidren s deveopment where they have been subjected to sustained emotiona abuse. It may be as important, if not more so, than other more visibe forms of abuse in terms of the impact on the chid Harm may extend into aduthood, with reationship difficuties, probems with parenting, menta heath difficuties, and acoho and substance misuse probems Chidren who are finay registered under the category of emotiona abuse have usuay been known to Socia Services departments for some years [mean 4.06 years (range: eight months to fourteen years eight months)]. Aso the majority of conferences at which chidren are registered are convened as a resut of escaation of concerns, rather than in response to a specific event. (DOH 1997) Initia Assessment 7.4. When a referra is made to Socia Services, currenty socia workers wi undertake a seven day assessment during which workers from other agencies invoved with the famiy wi be contacted. It has aready been suggested that one effective way of gathering good quaity information is by attendance at a muti-agency meeting which aso may aow a more hepfu introduction of Socia Services to the famiy During the initia assessment it shoud be possibe to coate a famiy chronoogy incuding a history of invovement with agencies. It wi be important to tak with workers from other agencies who have had previous contact with the famiy and who have had the opportunity to witness their interactions over a period of time. 16
19 17 Emotiona Abuse Muti-Agency Practice Guide 7.6. As part of this eary assessment, it wi be important that the socia worker has the opportunity to see the famiy interacting as we as taking to individuas. It is important to remember that a chid is unikey to discose emotiona abuse as they usuay identify with the parenta view and often accept the bame directed at them. 7.7 The abiity of the famiy to change wi be an important part of the assessment. The famiy s response to a discussion about the reasons for the referra and the way the famiy responds to the observations of the worker wi begin to indicate their abiity to change A seven day assessment woud often be insufficient time to estabish whether the famiy situation coud be described as emotionay abusive and a core assessment is ikey to be needed. This shoud normay be competed within 35 days. It is hepfu to have as much continuity as possibe, ideay the same worker, to avoid compromising the assessment process. Core Assessment 7.9. Making sense of observations and information gained takes time There must be observations of the famiy reationships, attachment behaviours, famiy functioning; seeing the famiy together as we as separatey, and being aware of strengths as we as weaknesses. A famiy history may give important cues to the current probems and shoud be sensitivey sought. Checking the chid s deveopment is essentia. It is important to check with other agencies for their observations of change. There must be cear identification of other assessments necessary and an adequate exporation of other expanations for the probems in the chid An assessment of famiy functioning incudes observing actions as we as istening to famiy accounts; sometimes there is a big discrepancy between the two. There is a need to understand conficts and aiances between famiy members, ways of resoving confict that the famiy has deveoped, styes of decision making, predominant mood, famiy beief systems and vaues and attitudes. There may be patterns of interaction which have been prevaent in the famiy over generations and these need to be understood The assessment process itsef is an intervention into famiy ife. It is therefore possibe to begin to expore the famiy s capacity and wiingness to change and whether the changes they can make are hepfu to the chid. The famiy needs to know as eary as possibe the specific concerns identified and what they need to change.
20 Emotiona Abuse Muti-Agency Practice Guide Case Exampe 4 A six year od gir and a two year od boy ive with their mother who is a singe parent. Mother is persistenty using threats of abandonment to try and contro the behaviour of her daughter who is defiant, difficut to get to schoo, bed wetting, smearing faeces. At schoo she is unhappy and withdrawn but doesn t behave bady. She is cingy towards her teacher. Schoo personne have observed mother threatening to eave the chidren on a daiy basis. She has aso been observed to verbay buy her daughter when she coects her from schoo. Mother has continued to behave in this way despite the schoo staff having expressed their concern. There has been an initia assessment by Socia Services and a more in depth assessment is needed given the eve of concern. The socia worker highights the ink between the mother s threats and the chid s difficuties, as we as exporing mother s mood and the reasons for it. The incidence of threatening behaviour is monitored party by checking reguary with schoo. There is an expicit expectation that the threats wi decrease and not be repaced by another form of abusive behaviour. The mother demonstrates a wiingness to change, the seriousness of the situation having been underined. There is a gradua improvement in the reationship between the mother and her daughter and mother attends a parenting course. The chid s symptoms improve. There is no need to enter into chid protection procedures During the core assessment, other agencies need to monitor and feedback their observations of the chid and/or famiy; particuary changes that may be occurring. Some new professionas may become invoved as needs are identified e.g. speech and anguage therapist or a paediatrian. 18
21 19 Emotiona Abuse Muti-Agency Practice Guide Good inter-professiona communication is essentia to construct a network that the famiy can see as hepfu and promoting change, not the feeing of being passed around for endess assessments without action. There are severa potentia obstaces to good communication which may need to be overcome: Lack of carity about different agency s roes and responsibiities. Different agency priorities. Different modes for understanding symptoms. Professiona networks can sometimes reproduce the confict and dynamics of the famiy. This is more ikey to happen if the group of professionas invoved do not reguary work together. There must be a mechanism for recognising and resoving confict if it occurs It is good practice to have a professiona s meeting at the end of the core assessment to which the parents are invited At any point during the core assessment, it may be necessary to move into chid protection procedures (Section 47 of the Chidren Act 1989), and convene an Initia Chid Protection conference GOOD PRACTICE BOX 3: UNDERTAKING A CORE ASSESSMENT See Framework for the Assessment of Chidren in Need and their Famiies (DOH 2000) Compie written chronoogy if not aready done. See the famiy together to observe what happens in reationships; who s cose to/ distant from who, how are chidren discipined/encouraged, how are probems tacked/resoved. Note discrepancies between what peope say and what they do. Note and discuss famiy strengths as we as weaknesses. Be cear about concerns identified and what needs to change. Note any changes occurring with what effects. Promote good inter agency communication and convene/attend a muti agency network meeting which incudes the parents and chid(ren) (depending on age and vunerabiity).
22 Emotiona Abuse Muti-Agency Practice Guide 7.18 USING THE ASSESSMENT FRAMEWORK: Parenting capacity See parents together and if necessary separatey to discuss their parenting and how other difficuties impinge on it e.g. acoho and substance misuse (see practice guidance Drug and Acoho Misusing Parents) Can they provide emotiona warmth and stimuation? How do parents respond to the chid s behaviour and circumstances? What categories of i treatment are difficuties in this famiy? What is the parents understanding of the chid s needs and deveopment? Can they provide basic care and ensure their safety? Do parents understand the necessary tasks, or are they unaware, don t see the probem? What is the impact of past experiences on current parenting? Chid s Deveopmenta Needs See chid to ascertain their functioning (see para.4.1.) Check out the chid s deveopment and identify and refer on for other assessments if necessary. Be aware of the chid s vunerabiities and the meaning this has for the parents. Look for resiience and mitigating factors. Were there eary secure reationships? Does the chid have innate competences? Famiy and Environmenta Factors See the famiy together and in different combinations. Sensitivey seek a famiy history which may give cues to the current probems. Don t assume that reuctance to tak about this is resistance. Parents often fee victim of their own chidren in the way they fet victim of their own parents. In the wider famiy or community, are there significant other aduts who provide hepfu interactions with the chid? Supporting parents with difficuties with housing, income, empoyment may hep them to interact differenty with their chid. Are parents abe to use community resources or are they sociay isoated? 20
23 21 Emotiona Abuse Muti-Agency Practice Guide 8 CHILD PROTECTION ENQUIRIES 8.1. If there is, in the view of the oca authority, reason to beieve a chid may be suffering, or at risk of suffering, significant harm (Section 47, Chidren Act 1989), enquiries wi be undertaken, bringing together the avaiabe assessments, famiy and agency professionas views. This marks a significant change in the reationship between professionas and famiy, refected in the anguage used (abuse / mistreatment, protection / safeguarding, etc.) The purpose of these time imited enquiries is to estabish whether the risk of harm is ikey to continue or is being satisfactoriy deat with. This may or may not depend on parenta insight and wiingness to co-operate. 9 THE INITIAL CHILD PROTECTION CONFERENCE 9.1. In order to initiate a Chid Protection Conference, the chid must be assessed as being at continuing risk of or suffering significant harm. When there has been no significant change during the assessment, and parents are unabe or unwiing to co-operate, the Chid Protection Conference can be hepfu to underine the seriousness of the chid s situation The criteria for convening an Initia Chid Protection Conference are isted in the LSCB Chid Protection Procedures. The conference acts as a forum where parents and professionas openy share their concerns about the safety and webeing of the chid The pattern of parent-chid interaction, it s persistence and impact on the chid s heath and deveopment are a examined and a decision made as to whether the criteria for the chid needing a Chid Protection Pan are met (LSCB Chid Protection procedures). The category Emotiona Abuse is used where the definition of emotiona abuse is satisfied, whether aone or in combination with another category (LSCB Chid Protection procedures) It wi be important to estabish the nature and pattern of the emotiona abuse and what parents are being expected to do to initiate change. The form of i treatment needs to be expicity stated in straightforward anguage to expain the category of the Chid Protection Pan. Agencies, for their part, wi need to consider what input they can give to promote these changes. The conference s anaysis of the assessment information provided to it wi ead to an agreed pan, focused on safeguarding the chid and promoting his / her wefare.
24 Emotiona Abuse Muti-Agency Practice Guide 10 WORKING WITH CHILDREN AND FAMILIES WHERE THE CHILD IS SUBJECT TO A CHILD PROTECTION PLAN A Chid Protection Conference shoud specify the types of changes that need to occur. A further period of intervention can then take pace with the process being monitored and evauated within the chid protection structure Conferences and Chid Protection Pans usuay add pressure to a famiy aready under stress. If the parents support the Chid Protection Pan, this can ead to increased focus and co-operation, if they don t it can sometimes resut in decreased functioning and attempts to disengage The Chid Protection Pan needs to be taiored to the particuar issues for change in the famiy, acknowedging positive things aready happening which are good for the chid. It needs to specify how these changes wi be monitored. The tasks expected of parents need to be reaistic, cear and propery sequenced. Care shoud be taken that the famiy are not required to be invoved in too many activities simutaneousy; the potentia confusion that this can create gets in the way of change Centra to the work wi be deveoping a cear understanding between parents and workers about the connection between famiy reationships, parenta behaviour and the chid s difficuties. Part of the core group s function is to recognise changes in the themes and issues as the work progresses Sometimes different opinions and actions amongst the professionas can cause confusion and, if they remain unresoved, ead to the pan becoming ineffective or even counterproductive. The process whereby professiona opinions become divergent is an important diagnostic too in the work with famiies where emotiona abuse of chidren is a pattern. It may therefore be necessary to hod some professionas ony core group meetings from time to time in order to understand these differences and manage them constructivey when face-to-face with the famiy. 22
25 23 Emotiona Abuse Muti-Agency Practice Guide 10.6 GOOD PRACTICE BOX 4: WORKING WITH CHILDREN AND FAMILIES WHERE THERE IS A CHILD PROTECTION PLAN Intervention shoud be guided by the type of emotiona abuse assessed as prevaent in the famiy. The Chid Protection Conference minutes wi stipuate what s wrong and what needs to change; this may need to be transated into specifics i.e. specific behaviours and what change ooks ike. Emphasise changes made which are in a hepfu direction by focusing on how they happened, who s noticed, what effect they ve had etc. thus identifying the ingredients of positive change in the hopes of encouraging more of it. If work needs doing with parents especiay about their own experiences as chidren, remember to keep a focus on the chid s needs. Even if the work being done is with individua famiy members or the parenting coupe, see the famiy together periodicay to evauate directy whether famiy reationships have changed. Address any conficts in the professiona network and examine whether these tensions might refect tensions within the famiy. A we co-ordinated, consistent professiona network provides a usefu mode for change especiay where inconsistent parenting is the issue. Consider resiience factors for the chid especiay and put more in pace if possibe. There shoud then be ongoing monitoring to ascertain whether this has been hepfu to the chid rather than assuming that this has been the case. Seek a speciaist consutation if advice is needed about work pans etc (see resources section)
26 Emotiona Abuse Muti-Agency Practice Guide Case Exampe 5 There are four chidren in this famiy aged nine, seven, four and three. They ive with their birth parents. Mother has used amphetamines for severa years and her behaviour is erratic and unpredictabe. Father misuses acoho periodicay. The coupe frequenty separate and there is domestic vioence. Neither parent is emotionay avaiabe to the chidren, and there are inappropriate deveopmenta expectations with the chidren being expected to meet the parents needs rather than visa versa. The nine year od is behaving bady. The seven year od is anxious, doesn t seep we and is tearfu in schoo. There are signs of deveopmenta deay in the two younger ones. Father owns his anger and mother her drug use. Both can begin to imagine what it s ike for the chidren. The Chid Protection Pan encompasses mother accessing hep for her drug use (inked expicity to her desire to be a good parent), father accessing hep for managing his anger. There is an expectation that father won t drink when with his famiy. The chidren are seen reguary and the famiy is seen reguary together to monitor and evauate changes in reationships. Parents decide to separate but safe contact arrangements are made for father to see the chidren. Mother s drug usage decreases and she becomes a more avaiabe, consistent parent. The chidren s symptoms decrease. This work takes pace over a period of 18 months during which the Chid Protection Pan is discontinued after positive change has been consoidated and thereafter a chid in need framework is used. 11 SOME IDEAS ABOUT WAYS OF WORKING There is no checkist of methods: the foowing guiding principes can be appied to intervention in each individua famiy In matching input to needs, cear pans shoud be agreed about who wi be working with the famiy for change. That worker/those workers wi then need to decide whether to work with the whoe famiy on reationships and communication, with both parents on their parenting, or with one parent perhaps on background issues or current difficuties which are affecting how they behave towards their chid. Working individuay with a chid in isoation carries with it the danger of confirming to the famiy that a probems reside in the chid. It is normay important that such work is done in parae with work with parents. 24
27 25 Emotiona Abuse Muti-Agency Practice Guide Emotiona abuse is about famiy reationships therefore continuing to work with famiy members together can promote usefu/essentia change. Buiding up a working reationship with the famiy is essentia and provides the context within which change can take pace. The work needs to encompass a baance of support and chaenge in such a way that the famiy can accept both. Drawing attention to what is going we in a famiy can hep parents confidence, create a ess defensive atmosphere, and enabe them to accept more readiy the worker s chaenges about negative aspects To hep buid up trust, the imits of confidentiaity need to be cear at the outset Neutra anguage and a focus on interaction remains important, but with the expectation that, as aduts, it is the parents who need to begin the change, rather than expecting their chidren to Another guiding principe is that workers shoud use the skis they aready possess. If not sure which direction to take, it may be usefu to seek consutation, either with a muti-agency consutation group (see reference beow) or oca CAMHS Eiciting ideas from famiies about what their chid s needs are in genera terms, and then ooking at how these needs can be met within their famiy, can be a usefu starting point. Obstaces to meeting these needs can then be addressed in a more bame free way In the same way that the cumuative effects of adverse factors is important, so is the cumuative effects of protective factors, thus taking into account and buiding up resiience is important. This is achieved by emphasising strengths and activey ooking for support in the chid s network Using genograms (maps of famiy members and significant others) can be very hepfu. They provide a quick visua way to record and grasp ots of information about famiy patterns over generations. They can be an important way of joining with famiies, and can enabe them to see themseves in a new way. Famiies may begin to see the arger picture, and begin to map their own strengths and vunerabiities It is usefu to be cear about the type or types of emotiona abuse prevaent in the famiy, as this wi guide interventions. For exampe, where there are persistent negative attributions to a chid, it may be necessary to work on buiding up empathy in parents towards him / her. However, this needs to be carefuy approached. It often invoves the worker taking the initiative to show some empathy towards the parents, but without compromising the chid s emotiona safety by osing sight of their needs. If i-timed, going on to encourage a parent to imagine what it s ike to be in their chid s shoes can simpy resut in a backash against the chid.
28 Emotiona Abuse Muti-Agency Practice Guide Direct work on parenting may be indicated. The Parent / Chid Game, Fun with Famiies, Positive Parenting and the Webster-Stratton approach, are exampes. Expertise on these is often found in famiy centres, CAMHS teams and Chid Psychoogy services It is we recognised that emotiona abuse has its origins in the troubed chidhoods of parents and this may be a necessary focus of the work; working with them about how this affects their parenting. Unfortunatey, encouraging parents to tak at ength about their eary experiences may have the opposite effect from that intended and make it harder for them to function and to be good parents on a daiy basis. Some parents wi repeatedy draw attention to their own unmet needs, but the focus of this work is on improving attention to the needs of each of their chidren. It is essentia to remember that whist it may be reativey straightforward to understand reasons for parenta i-treatment, uness this understanding is shared and produces necessary change, the damaging effect on the chid wi continue. Case Exampe 6 A five year-od gir ives with her mother who is a singe parent. This was an unpanned pregnancy. There is no contact with the chid s father. Mother has suffered a very abusive chidhood and has no famiy support. Mother and chid are very sociay isoated. She drinks to excess and is depressed. She is convinced there is something psychoogicay wrong with her chid who she sees as a greedy monster. Mother is emotionay unavaiabe and persistenty negative. The chid is unhappy, withdrawn, not seeping, not putting on weight and has speech and anguage deay. Foowing registration, the famiy resource centre personne become invoved aong with CAMHS because of mother s contention there is something wrong with the chid. Joint work is undertaken on the parent chid reationship which invoves joint sessions and individua time with mother. The work focuses on a aspects of parenting and tests out whether mother can graduay buid up empathy with her chid, addressing the obstaces to this. Mother seeks hep with her depression and goes on a parenting course. Despite intensive hep, the reationship continues to deteriorate and aternative care has to be sought for the chid. 26