Case Studies of Child neglect: Rehabilitation and Recovery

Child neglect is probably the most common form of child abuse in the UK. It is difficult to determine the exact number of child neglect cases across the country, as child neglect is not a specific offence in itself. Although recognised by authorities, child neglect falls under the umbrella term of child abuse; however, neglect is the most commonly mentioned form of abuse reported to helplines by people who are concerned about a child’s welfare.

One in five adults aged 18 to 74 years experienced at least one form of child abuse, whether emotional abuse, physical abuse, sexual abuse, neglect or witnessing domestic violence or abuse, before the age of 16 years (8.5 million people), according to the Crime Survey for England and Wales (CSEW). The National Association for People Abused in Childhood (NAPAC) estimate that 1 in 100 adults aged 18 to 74 years experienced physical neglect before the age of 16 years (481,000 people); this includes not being taken care of or not having enough food, shelter or clothing, but it does not cover all types of neglect.

Child neglect is the persistent failure to meet a child’s basic physical and/or psychological needs, which is likely to result in the serious impairment of the child’s health and/or development. For example, by failing to:

• Provide a child with adequate food, shelter or clothing, including exclusion from home or abandonment
• Protect a child from physical harm, emotional harm or danger
• Ensure adequate supervision, including the use of inadequate caregivers
• Ensure access to appropriate medical care or treatment
• Ensure access to appropriate education

According to statistics from the Department for Education (DfE) children in need census 2023:

• Council children’s services received 640,430 social care referrals in 2022/23, down 1.5% (9,840) on 2021/22
• 63,870 child protection plans (CPP) were started in 2022/23 (28.3% of enquiries), down from 64,390 (29.6%) in 2021/22 and 52,680 (41.4%) in 2012/13
• 50,780 children were on a CPP as of 31 March 2023, down 0.3% (140) on the year previously, and 25,050 (49.3%) of CPPs had neglect, 19,000 (37.4%) emotional abuse, 3,630 (7.1%) physical abuse and 1,890 (3.7%) sexual abuse, as the initial category of abuse in 2022/23

Serious incident notifications (SINs) are made by local authorities to the Child Safeguarding Practice Review Panel and Department for Education when a child has died or is seriously harmed and abuse or neglect is known or suspected. There were 393 SINs and rapid reviews submitted for serious incidents where abuse and/or neglect is known or suspected that occurred between April 2022 and March 2023.

We are all too familiar with high profile child neglect cases that come to light following child protection scandals, such as that of:

Child Au – life for Child Au, a toddler, was almost unbearably bleak. She was unloved, isolated, underfed, under-stimulated, ignored and left shivering in her cot for hours wearing filthy nappies and she had learned that there was little, if any, point in crying. Health professionals noted that she presented as sad, watchful and frozen. Her mother would refuse to pick her up, or cuddle her, and was witnessed asking the father not to talk to his daughter. There was no social interaction with other children. Her family’s pet dog had toys, but there was no sign of any toys for Child Au. When she was eventually taken into care, after hospital X-rays identified a broken arm and five previous fractures to her legs, the evidently traumatised girl would not smile or talk or cry. Her foster mother noted she had “learned to shed silent tears”. Much of this awful story was documented by health visitors, and later by social workers. However, these months of witnessed neglect never led to an escalation in protection for Child Au. Eventually, there was a social care intervention, which led to a safeguarding practice review of the case.

Kaylea Titford – everyone who knew Kaylea Titford said she was a lovely girl, and living at home with her working parents, there was a feeling everything was OK. Kaylea dealt with challenges after being born with spina bifida, yet loved wheelchair basketball and was talked of as a possible Paralympian. However, In February 2023, Kaylea’s father Alun, a father of six, was convicted of gross negligence manslaughter, a charge her carer mother Sarah Lloyd-Jones, 40, had already admitted. Emergency services told jurors about how they felt “physically sick” as maggots were found feeding on her body as she lay in soiled clothing and bed linen in her fly-infested, dirty and cluttered room. The shocking details about how a morbidly obese teenager, weighing almost 23st (146 kg), was treated by those who were supposed to care for her and the grim circumstances of her death have made international headlines. Dai Davies, former chief superintendent at the Metropolitan Police told BBC Radio Wales Breakfast, “It’s horrific, and serious questions need to be asked, and an audit trail looked back into who could have prevented this and what we can do to stop this sort of thing happening again.” A child practice review, which is a multi-agency safeguarding study, is already underway. 

A 12-year-old child who contacted a children’s counselling phone line said, “I can’t stop crying and I don’t know who to talk to about this. My mum isn’t looking after me properly. She never has any money, there is never food in the house, and she doesn’t take me to school. She takes drugs a lot and always asks me for money to get more. After she’s taken drugs, she’s in a really bad mood and is mean to me. Some of my relatives know what is happening but they don’t really do much. I just can’t take it anymore.”

These shocking cases of neglect highlighted above are unfortunately not rare; however, there are many instances where the victims of this type of horrendous treatment, with the right support for recovery and rehabilitation, can overcome their appalling experiences of child neglect to rebuild their lives. 

In this article we examine the various types of child neglect, the short- and longer-term impact that neglect in childhood has on the children, and the importance of recovery and rehabilitation for neglected children. We will also highlight real-life cases where neglected children are overcoming the neglect that they have experienced. 

About Child Neglect

There are several types of child neglect and it is usually typified by an ongoing pattern of inadequate care:

Physical Child Neglect

Physical child neglect is by far the most common type of child neglect. In most cases, the parent or caregiver is not providing the child with all of the basic necessities such as food, clothing and shelter. Physical signs such as poor appearance and hygiene are common among neglected children. Body odour, dirty clothes or clothing inappropriate for the weather conditions, as well as unwashed hair, may mean that the child is not being looked after properly. Neglected children may also show signs of being malnourished, either through visible signs of undernourishment such as weight loss and appearing to be gaunt, or by exhibiting signs of continual hunger.

Emotional Child Neglect

Emotional child neglect happens when a parent or caregiver fails to provide attention, affection and guidance to a child. It involves the absence of emotional responsiveness, nurturing, engagement or adequate responses to distress. When parents are critical, dismissive, invasive, or preoccupied to the point that it communicates to a child, “You don’t matter” or “Your feelings aren’t important”, this makes a child feel unloved, unaccepted and misunderstood. Whether conscious or unintentional, this pattern of negligence leaves children with deep insecurities that can affect them throughout their lifetime.

Medical Child Neglect

Medical child neglect occurs when children do not receive medical treatment for physical and mental health issues. This includes not providing adequate dental care or refusing or ignoring medical recommendations. This is equally relevant to expectant mothers who fail to prepare appropriately for the child’s birth, fail to seek ante-natal care and/or engage in behaviours that place the baby at risk through, for example, alcohol and/or substance misuse.

Educational Child Neglect

Educational child neglect is where children are not receiving education, either because they are persistently missing school or are not registered at a school and not receiving a suitable education. Persistent and severe absence is less than 75% attendance over three terms, which significantly impacts a child’s welfare and/or educational outcomes and is likely to result in the serious impairment of the child’s health, well-being, development and/or life chances. All children aged 5 to 16 are legally entitled to a full-time education, suitable to any special educational need.

Lack of supervision and guidance, or abandonment, occurs when the child is left unsupervised for long periods of time, or left at risk of harm in dangerous situations with no arrangements for care or supervision. It can be usual for a child, regardless of their age, to think the disappearance of their parent is somehow their fault. When parents abandon their children, the children can grow up feeling unsafe in the world and feeling people cannot be trusted. People who have experienced abandonment in childhood might be more likely to have long-term mental health disorders, often based on the fear the abandonment will happen again in their adult relationships.

The environment the child lives in is often but not always the strongest indicator of neglect, and often neglected children will have experienced more than one type of neglect.

Children who are and/or have been neglected and survive, might experience short-term and long-term effects from the neglect. They may also display damaging behaviours that result from the neglect. These effects and behaviours can include:

• Neglect can have a negative impact on a child’s physical development such as their actual body growth, their height, weight, body hair, breasts, hips, etc. and the development of the body structure, including muscles, bones and organ systems.
• Neglected children perform poorly academically, and significantly worse than their peers on achievement testing. This impacts their cognitive development of thought, judgement and perception, and their ability to process information and problem solve, which may influence the rest of their lives. This might lead to risk-taking, alcohol and/or substance abuse, or forming inappropriate and/or dangerous relationships.
• Neglected children often also struggle socially. In preschool and during middle childhood, neglected children are more likely to be socially withdrawn and experience negative interactions with their peers. They may have difficulties developing relationships throughout life, including with their own children.
• Neglected children can experience a long-term breakdown or failure in the relationship between themselves and their parent(s)/caregiver.
• Neglect in childhood damages a child’s sense of self-worth, and they may suffer from issues with self-confidence.
• Children who have experienced child abuse or neglect are four times more likely to develop serious mental illnesses such as anxiety, depression, psychoses, schizophrenia and bipolar disorder.
• Child abuse of all kinds including neglect creates trauma, and flashbacks are a symptom of Post-Traumatic Stress Disorder (PTSD).
• In some extreme circumstances, neglect can also be fatal both when it occurs in isolation and when it happens in combination with other forms of maltreatment.

Child neglect is not only harmful to the child and their family, but it can also have wider societal implications. Neglected children may require more healthcare, social services and criminal justice resources as they grow older. The long-term consequences of neglect can result in lost productivity and increased costs to society. Neglected children may also struggle with academic and employment opportunities, which can lead to reduced economic growth and social mobility.

As we have seen from the shocking cases of neglect highlighted above, early intervention may have prevented, or at least minimised, the negligent treatment that these children suffered. Child neglect cases can present professional challenges greater than those in other forms of ill treatment and abuse. This means that decisions about when and what action should be taken may be highly contentious. A high proportion of professionals told Action for Children that they felt powerless to intervene in cases of suspected neglect, citing factors such as other professionals not taking concerns seriously and families not engaging in attempts to help them.

Action for Children point out that over 60,000 opportunities to offer early help are missed every year and that there is a lot of variation between local authorities providing targeted early help. Early help is the name for services that support children and families before they meet the threshold for intervention from children’s social care. These services might include parenting support, play and activity groups, or more intensive services like counselling and disability support. Every year, hundreds of thousands of families in the UK access early help support in some form or another. 

However, for every two children receiving early help, there are three children receiving more costly and intensive social care services. Accessing early help services can prevent children from coming to harm and needing to go into care. Because of this, it can also save local authorities money.

The Role of Recovery and Rehabilitation

Creating supportive environments for children with experiences of neglect is essential for their well-being. Addressing the challenges faced by these children requires a multidisciplinary and trauma-informed approach. It involves collaboration between social workers, psychologists, educators and other professionals to create a supportive environment that promotes the child’s well-being and recovery.

In health and social care, there are various effective solutions for supporting children experiencing neglect. These include:

A trauma-informed approach – a trauma-informed approach begins by understanding that a child’s early life experiences can have a profound impact on how they view and see the world. This means that a traumatic moment or series of moments, regardless of what developmental stage it occurs at, can go on to impact a child’s behaviour in a number of different and varied ways. If a child has the buffering impact of a nurturing caregiver alongside them when trauma occurs, then the negative impact is lessened. Key principles of a trauma-informed approach are:

• Safety – ensuring that the child feels physically and psychologically safe. That the physical setting is safe and interpersonal interactions promote a sense of safety.
• Trustworthiness – that practices and decisions are conducted with transparency and that there is a goal of building and maintaining trust among health and social care staff, the child, and family members of the child.
• Collaboration – that there is true partnering and levelling of power differences between health and social care staff and the child, and among organisational staff, from direct care staff to administrators. There is recognition that healing happens in relationships and in the meaningful sharing of power and decision-making.
• Empowerment – that the child’s strengths are recognised, built on, and validated and new skills developed as necessary.
• Choice – recognising that every person’s experience is unique and requires an individualised approach.

Attachment-based intervention – for example Attachment and Biobehavioural Catch-up, offered to parents or carers who have neglected a child under five. The intervention is delivered in the parent or carer’s home and aims to:

• Improve how they nurture their child, including when the child is distressed
• Improve their understanding of what their child’s behaviour means
• Help them respond positively to cues and expressions of the child’s feelings
• Improve how they manage their feelings when caring for their child

Comprehensive parenting intervention – for example SafeCare, for parents and children under 12 if the parent or carer has physically or emotionally abused or neglected the child. The interventions should be delivered by a professional trained in the intervention and comprise weekly home visits for at least 6 months that address:

• Parent–child interactions
• Caregiving structures and parenting routines
• Parental stress
• Home safety
• Any other issues that caused the family to come to the attention of services

Multi-systemic Therapy for Child Abuse and Neglect (MST-CAN) – this is an intensive treatment for families who have recently been reported to Child Protection Services for physically abusing and/or neglecting a child between the ages of 6 and 17. This provides the family with tailored individual and family support and therapy over a six- to nine-month period with the aim of helping parents learn how to parent their child in a way that is not abusive or neglectful. MST-CAN has initial evidence of reducing parents’ maltreating behaviour and out-of-home placements.

Short-term fostering – this means providing a child or young person with a place to stay until they can return to their own family, or until it becomes evident that they need a more permanent foster placement or possibly adoptive parents. During a short-term placement, foster carers provide a safe and secure environment for children to carry on their day-to-day lives, continuing to attend school and see their friends and family wherever possible.

An intensive Family Support Service – this aims to help families make positive changes, overcome difficulties and ultimately prevent children’s needs from being neglected. This service is provided on a one-to-one basis with the aim to: 

• Build a trusting, respectful and cooperative relationship so that families engage with the programme
• Provide challenge, practical help and support through one-to-one work so that families develop changed behaviours. This includes developing routines, keeping the home clean and safe, providing safe and stimulating activities, providing a balanced diet, keeping children safe, and managing money and debt
• Strengthen family relationships
• Make parents more confident and capable
• Achieve better mental health for the whole family
• Reduce the risk of child neglect

Health and social care professionals are important in supporting neglected children by providing early identification and intervention. Their role extends beyond medical care to include early intervention, coordination of services, and advocacy for the child’s well-being. By providing comprehensive assessments, trauma-informed care, and support for families, healthcare professionals play a critical role in addressing the complex needs of neglected children and promoting their health and safety.

Case Study 1 – Journey to Healing

This is the case study of Rhys, a 15-year-old living in North Wales, a confident, happy young man who has been on quite a journey to become who he is today with the help and support of Action for Children.

At the age of 10, Rhys went into care due to neglect. He had endured eight placement moves before finally arriving at the Action for Children’s home, Tan y Bryn. Move after move, Rhys found it difficult to settle down anywhere, and despite having seven siblings he was unfortunately never placed with any of them. School wasn’t easy either. Rhys was often bullied for being in care and ended up missing out on two years of education.

Rhys told Action for Children “It was very hard to get friends, because you couldn’t stay in a place for that long. I had one placement, where I had a best friend there, and then I got moved to the opposite side of the country. [I] always had the wish to be treated as normally as possible, attend mainstream school and have friends in the community.”

Rhys’s time at Tan y Bryn has provided him with the stable childhood he always longed for. He has received lots of encouragement and support from the resident youth workers. One in particular has had a big impact, Dave, who formed a strong connection with Rhys from the beginning. It has all been essential in enabling a positive environment for Rhys.

Rhys’s placement at Tan y Bryn is the longest he has had. Before, Rhys struggled with his temper and was often restrained. Dave spoke of the difference in Rhys’s behaviour: “He’s progressed, massively. [He’s] mature, but [he’s] more relaxed here.”

Rhys explained how the support helped him to grow and manage his emotions: “I have a lot more freedom. I’ve gained a lot more trust. Here, because I’m 15 and I have the respect, if I do walk away, five minutes later, I’ll come back, I’ll apologise.” When speaking of his relationships within the home, Rhys told Action for Children that they are “as close as a family can get, considering we’re in care. Action for Children have helped me a lot. Before I was in Action for Children, as I said, I wasn’t doing too well. Since coming here, they’ve helped me a lot. They’re obviously really good at choosing staff to hire.”

Rhys is now doing extremely well in all areas of his life. He attends school full time, is a peer mentor for some of the other children and is part of the school council. Rhys shared that despite struggling himself, he enjoys helping others. “I’ve got my own issues, but it is quite good to know that I can help other people, like I got help before off other people. It’s just quite nice to feel like they’ll go home feeling less terrible.”

Rhys now speaks highly of the future and shared his new life goals with us: “[I’ll] hopefully living by myself, hopefully further on in the future [and] owning my own restaurant.” Dave is also excited to see what Rhys can achieve with his potential. He shared, “He’s streets ahead of everyone else. He can cook, he can do anything.”

Case Study 2 – Overcoming Adversity

This is the case study of Steve. Steve’s home became unsafe when his mum started dealing drugs and disappearing for days at a time. Steve related his story to Childline when he was 13 years old.

“My home life got increasingly worse from the age of about 8 years old when mum’s drug dealer partner moved in. Drugs took over family life. My brother and I were always locked in our bedroom as soon as we got home from school and then let out to go to school the next morning. Sometimes we didn’t see mum for days at a time. We made our own breakfast and were given takeaway for dinner all the time, also in our bedrooms. I could hear the drug dealing going on. There was a constant stream of people dealing drugs at all hours in the flat and some of them were pretty scary, so mum and her boyfriend just wanted us out of the way. The flat was regularly raided by police, sometimes in the middle of the night. They would bang down the door, yelling and ordering us around. That was really rough. Money wasn’t a problem: I had new clothes, plenty of toys, computers, but no mum in my life. She only thought about drugs and her boyfriend was very controlling. I didn’t really have any parenting.

“Once a teacher dropped me home and mum told me not to let anyone come around, or my brother and I would be taken away into care. That was my greatest fear because it seemed really unknown and I didn’t know what it really meant. I learnt to keep agencies out: they weren’t to be trusted. I made sure I went to school and covered up any problems. I tried to be good at school as much as I could. I think everyone knew about my family’s drug problem and no-one talked about it. I think it was obvious to teachers that we didn’t have the right clothes sometimes, had a lot of cash for children of our age and that no-one was looking out for us. I felt out of place at school. My brother and I did our own thing, sometimes staying out really late, whenever we wanted to. I would fall asleep at school sometimes after staying up late. Looking back, it was really unsafe, anything could have happened to us.

“Things reached a real crisis point when I was about 11 years old. Mum was sent to prison and when she came out a couple of years later, I went back to live with her again. Things were okay with mum for about six months then it got much worse because mum would smoke heroin in front of me. After doing it in front of me a couple of times, it was like she thought it was OK and normal. That felt really horrible. Sometimes I would find her passed out. When I couldn’t wake her up, I thought she was dead and it was really scary. I ran away once. I just didn’t know what to do. By this age, I had started to think what was happening at home really wasn’t right and that other children didn’t live like this. Luckily for me, I had other family to rely on and I went to live for good with my aunty. She made me healthy meals, made sure I washed and went to bed on time. I really liked it there and felt really cared for. Looking back, I think if the school or social services had recognised the situation and our family had got help earlier maybe it might have been better for me.

“When I was 13 years old, I joined a group for children of parents with substance abuse problems and it really changed my life. Most importantly, I met other young people who had been through similar experiences and I wasn’t alone. It helped me make the most of my life and I stayed at school and did well. As I got older, I helped many of the younger children in the group who had similar problems.”

Case Study 3 – Building a Brighter Future

This is the case study of Chloe who went off the rails at school because of her neglectful parents, but with the support of her friends she’s turned her life around and is now on her way to university.

Chloe outlines her own story:

“When I was little, we lived on a new-age traveller site. It was such a tight-knit community – my sister and I loved it. But when I was about seven, mum wanted to move into a house. That’s when she and dad started arguing. I had a baby brother by then, but my dad moved out. He came back, and we moved to a new village to make a fresh start. They had another baby, but it didn’t work. They would row all the time, so loudly the neighbours called the police. They never had time for us.

“When dad moved out for good things got really bad. I was 13. Mum was depressed and took multiple overdoses. She could get us up for school, but was drunk by the time we came home. She was also verbally abusive. My sister went to live with dad, but I felt responsible for my brothers. One day, mum smashed up the house, something she often did. My six-year-old brother was so upset, so I convinced him I was his guardian angel. I was always on edge waiting for something bad to happen, and ready to make it better. I resented my friends with stable homes.

“Mum didn’t care what I did, so I would stay out late with older kids. They thought I was cool because I had so much freedom. They admired the amount of alcohol and drugs I could take. I craved that attention. No one ever told me things like: ‘You’re really good at maths’. Or when I got lead roles in plays at school, mum never said she’d be there in the front row. So I thought being the party animal was my role in life. I really went off the rails. Sadly, my sister copied me and ended up on heroin. After school, I had a few difficult years trying to decide what to do.”

Chloe eventually found support when she made close friends with three girls at school at 16. Although she never really spoke to anyone about what life was really like, these friends understood her. When she would get upset, self-harm and contemplate suicide, they would always calm her down. 

Her relationship with her mother deteriorated, and for a time she went to live with her father, she also lived in a tent for a while. Eventually, the local council put her in touch with YMCA, and they gave her a room in a hostel. This is when Chloe was able to start to turn her life around. 

Chloe’s relationship with her mother is better now. Her mother has a new boyfriend and is providing a better home environment for Chloe’s brothers, taking care of them, cooking meals, even socialising with them. Although pleased for them, Chloe commented that she couldn’t help feeling a little resentful towards them.

However, with a stable home environment of her own now, Chloe’s life and prospects are improving; she is now studying childcare and plans to go to university.

Common Themes and Lessons Learned

In all three case studies there appears to have been a lack of early intervention and the children highlighted in the case studies endured neglect for some time before seeking help. Early intervention has been shown to deliver wide-ranging improvements in a variety of important child outcomes, including increases in mental well-being, school achievement and physical health, and may, in the case of Chloe, have prevented her drug and alcohol abuse, and self-harming.

There are early intervention programmes that have been shown to reduce child maltreatment either by addressing the risk factors associated with this or by providing intensive support for vulnerable families through early help. 

All the children featured in the case studies demonstrated high levels of strength of character and resilience to be able to seek help, and despite adversity in their early lives have the ability, with the right support, to rebuild their lives and move forward.

Despite its prevalence in safeguarding cases, responding to neglect appears to remain challenging for social workers, especially when refused access. However, responding to neglect in a timely way provides children with the support that they need, so inter-professional multi-agency practice is crucial to safeguarding.

Conclusion

In this article we have highlighted some very shocking cases of child neglect, and unfortunately in some cases there were shortcomings in the system, and help arrived too late. However, the stories of Rhys, Chloe and Steve show that with protection and support, children can survive and flourish. 

Safeguarding children is everyone’s responsibility, so if you have any concerns about a child who may be being neglected, don’t wait for someone else to do something, contact the children’s social care team at your local council. An early intervention can prove to be vital.