A practical approach to child protection and supervisory neglect

A practical approach to child protection and supervisory neglect

Debbie Scott and Daryl Higgins
11 December 2012

This webinar considered the theoretical understanding of neglect and adequate supervision.

Audio transcript: A practical approach to child protection and supervisory neglect

Audio transcript (edited)

Seminar facilitated & speaker introduced by Ken Knight.

Hello everybody, and welcome to the second webinar from the Child Family Community Australia information exchange. My name is Ken Knight, and I'm the Community Manager at CFCA. It's great to see that so many of you could make it today.

Before I introduce our speakers, we need to quickly cover some housekeeping issues. We will be able to take a limited number of questions during the webinar, which you can enter into the chat box. Debbie will let you know when you can start submitting your questions. We won't be able to get through all of them but we'll certainly try.

On that note, I'd like to encourage all of you to share your insights with us and each other, and to submit any other questions you have to the forum we've set up on CFCA connect. I sent you the link to the forum with the instructions this morning. Also, for those of you who use Twitter, we would love to see your Tweets using the CFCA Webinar hash tag.

I will now introduce our speakers. Dr Debbie Scott is a Research Fellow on the Child Family Community Australia information exchange. She has a nursing background, Master of Public Health and a Doctor of Health Science. Debbie has a history of work in the injury prevention field, particularly as it applies to childhood injury. Her experience in injury surveillance has led to an interest in the child maltreatment area.

Dr Daryl Higgins is the Deputy Director of Research at the Australian Institute of Family Studies. Daryl has extensive experience in managing and supervising research, and has led projects looking at child abuse and neglect, child protection, children in out of home care, child safe organisations, Family Court processes for responding to allegations of child abuse, past adoption practices and a wealth of other projects.

Today Debbie will be discussing recent research she and Daryl have conducted on child protection and supervisory neglect. Daryl is participating from Canberra.

Please give them a warm virtual welcome.


Thanks, Ken. I'd like to start by acknowledging some - the people that contributed to this research. Ruth Walker from the University of Queensland; Richard Franklin from James Cook University in Townsville and the Commission for Children and Young People and the Child Guardian in Queensland.

Just to say that the opinions we express in this presentation are ours, and not necessarily those of the Institute of Family Studies.

To set the scene, injury is the leading cause of death in Australians between one and 44 years of age. The type of injury varies by age group and severity. In children, non-fatal injuries tend to be falls, collisions with people or objects, and they're often associated with activities, like sports. Fatal injuries are most commonly due to transport. Things like car crashes, driveway run-overs, pedestrian or bicycle injury. Drowning, again in bubs, it's bathtubs and containers. In toddlers, it tends to be backyard pools or farm dams, and in older kids, we see other waterways. The other leading cause is assault and homicide, and sadly, it's one of the three leading causes of death in children.

Children are more vulnerable to injury than adults. Their heads are softer and they're bigger than adults. That affects their centre of gravity and protection, if they do fall or bump it. They have smaller arms, legs, hands and feet. They get caught more easily, and they have less muscle strength to extricate themselves. Their skin is thinner so burns are more severe, and grazes and bruises are more likely. They're shorter, so they're less likely to be seen. They have limited knowledge about danger. They haven't learnt to appreciate and understand risk.

So if you combine all of these things, you can see that leaning over a pool, for instance, a fall can happen more easily because their head is heavier. If they were leaning over a bucket, they would have less arm strength to extricate themselves from the bucket. If they're walking through a parking lot or crossing a street, they're not as easily seen, because they're shorter than the surrounding vehicles. They don't have the ability to judge the speed of the oncoming car, relative to the time it will take them to cross in front of that car. They may not even know to move if a car is approaching them, if they're very young.

So we can't rely on children to keep themselves safe.

So children rely on adults to keep them safe and free from injury. Theoretically, all unintentional injury is preventable. Examples of injury prevention strategies that you might be familiar with, are things like environmental modification - this would include things like fencing a pool. Or legislation - so putting car restraints in, requiring people to transport children using car restraints. Education of parents into ways of say safe sleeping techniques.

With engineering, we can use things like putting reverse sensors in cars so we can sense if a child is behind us. Behaviour modification - so getting children to wear mouth guards when they're on the sporting field to help prevent concussion.

But if you look at all of these, if you think about unintentional injuries, ones where another person knowingly harms a child, they must be very different. Because clearly, none of these strategies are going to work if someone sets out to harm them.

However, there is common ground between accidental and inflicted injury. Historically, injury researchers tend not to include intentional injury when they're considering injury, because the methodology behind it is so different - the prevention strategies, as I just discussed. But there's also this artificial divide that intentional injury is child abuse, and so is somehow different to the rest. More and more, this divide is being challenged.

For example, a publisher of an injury prevention journal recently rejected a paper discussing research focussing on child abuse related injury. They published paper regularly on assault to young people who drink, but won't cover the child abuse. Once they were challenged, that decision was changed. But the mindset was we don't do child abuse, and we suggest a social work journal.

Peterson and Brown found that low socio-economic status, chaotic, noisy households, crowded living environments, highly mobile families, families with a lack of access to services and families where there is parental substance abuse, are associated with both maltreatment and unintentional injury.

In 2011, Schnitzer et al found that burns, poisonings and drowning related injury in children under four were often associated with maltreatment. If not as if they were inflicted deliberately, then as in the absence of appropriate prevention factors, like supervision.

So we have this grey area, where there was maybe no intent to actually cause harm but harm occurred. In some circumstances, the parent might be assuming something is safe, like for example, using a baby bath seat. A number of parents have assumed that they can leave a child alone in a bathtub if they're in one of these. Even the name of one brand - as I've shown here, Safety First - would make you think that it's a safe thing to do. Perhaps someone goes out of a pool area and leaves the gate unlatched. Or a busy father backs out of a driveway on the way to work, and fails to see the toddler behind the car.

Corporal punishment is seldom intended to cause pain, but to teach a lesson or modify behaviour. A busy mum might be distracted, and not notice the toddler access the headache tablet she's left on the bench. So while harm has occurred, the intent wasn't to cause harm.

So these can be - they can be treated - cause maltreatment, or are they just accidental?

In many child protection publications, the panacea to prevent these injuries is supervision. The papers finish with sweeping statements like injury to children could be minimised with improved parental supervision.

So can supervision really be called an injury prevention strategy?

In an ideal world, children would be monitored 100 per cent of the time. Anyone who has been left alone with a couple of toddlers for more than a few moments knows how unrealistic that is. So the aim is for adequate supervision.

While we have no clear universal definition, we do know that adequate supervision involves a number of things. First, the parent or caregiver must recognise the potential risk in a situation. They have to have the capacity to intervene, to physically be there to change the risk.

The environment changes what might be considered reasonable as well. Consider the difference between walking along a bicycle path in a park versus along a highway. The activity of a child changes what might be considered reasonable. If a child is sitting quietly watching TV or swimming in a swimming pool, you would have to have different supervision.

Then there's the personality of the child. Some kids are just adventure seekers. One child might be quite nervous climbing to the top of a monkey bar in a park, and another might be halfway up a tall tree without a second thought.

So can failure to supervise be considered as neglect?

When Child Protection Agency data is examined, neglect typically forms the largest proportion of substantiations. Neglect also has an emerging importance as we recognise the impact of chronic and multi-type maltreatment. If neglect is considered to be a failure to provide for a child's wellbeing, then what of those parents who want to provide for their children but lack the resources to do so?

Neglect can be influenced by risk factors that may be out of the control or at least unable to be influenced by parents. Impoverished parents might struggle to provide adequate nutrition, medical care and education. Not because they don't recognise the child's needs or want to provide for the child, but because of a lack of access to resources. This lack of access to services mixed in to challenges in supervising the child, for example, due to work constraints.

So definitions for neglect vary according to what purpose they serve and where it will be used. Is it for research purposes in a hospital setting? Is that different to a community setting? Our practice-based definitions are often different again, and often consider whether or not harm or significant harm has occurred because of the neglect. Most definitions include a statement that neglect is as an act of omission rather than commission. Something a parent or caregiver failed to do. A failure to provide for the wellbeing of the child - that might be food, shelter, emotional support and love, education, medical care or a safe environment.

Some definitions include mention of cultural expectations. So a failure to send a girl to school in Australia would be considered neglectful behaviour, but not in some sections of Afghanistan, for instance. In addition, parental circumstances may be taken into account in some definitions. For parents who live in an area, where there is limited access to healthcare, failure to have a child seen by a doctor for minor illnesses or vaccinations may not be considered neglect. But in urban Australia, it may be.

Other definitions may also mention that neglect might be perpetrated by deliberate failure to provide for a child. A parent who chooses to go out drinking, and leaves a three year old home alone for a night. Or through extraordinary inattentiveness, when the parent injects heroin while caring for their child, or leaves drug paraphernalia lying around the home.

In a practice situation, this is also woven into the concept of good enough parenting. Where a subjective decision is made on behalf of a professional that is likely to be based on the knowledge of the environment, the child, the parents' abilities and other supports available to the child. It makes a comprehensive definition hard to come by. Especially when this is complicated by socio-economic or cultural factors.

Any assessment for neglect must include the frequency and chronicity of the behaviour. The likelihood and severity of the harm. The maturity of the child, and this must be considered in the context of poverty and parental care giving ability.

Some academics say that without a societal understanding of what constitutes adequate care, a clear definition of neglect isn't possible. They suggest a shift should occur from parental culpability to one of shared responsibility between parents, families, community and society.

Gill goes so far as to say that where there are disadvantaged groups, who lack resources and services, the neglect is not through the parent or family, but the community and the broader society where they sit. Even government policy is reactive to societal expectations. So unless society expects that all those who live within it have equal access to resources, then the government won't enact policy to prevent that. So there will always be losers, who don't fare as well as others.

So neglect is difficult to define and to identify. We can see some of this variability in how various abuse groups generate different considerations by different professional groups. Definitions consider the severity of the abuse and the chronicity of that abuse.

Where these are taken into account, even in the measurement of that abuse is affected. For example, consider sexual abuse and emotional neglect. Child sexual abuse measurement is binary. Either it was sexual abuse or not. The Child Protection response is mitigated by parental failure to protect, to supervise and to respond to the risk.

The criminal response doesn't take into account extenuating circumstances for the definition of the act. Like the perpetrator being poor, abused as a child themselves, or of outstanding character and so not likely to offend again. Either there was a behaviour that was child sexual abuse or not. That's not to say that extenuating circumstances won't be considered in the legal process or the sentencing of the offender. Just not in the definition of the offence.

For emotional or psychological neglect, there's a continuum of severity and chronicity. The Child Protection response considers serious harm now and in the future. Criminal prosecution for something that might occur in the future is unlikely to happen. But always the consideration would take into account the mental health, the stress the perpetrator is operating under, temporal considerations in terms of chronicity. Maybe it only happened over a month or two, or while they were unemployed?

So how do we measure something like that? At what point on that continuum do we consider a child as having been a victim of emotional neglect?

Supervisory neglect is equally or more murky. First of all, we have to consider does harm have to have occurred to consider that a child may be living with supervisory neglect?

A recent study of Child Protection data in Canada looked at supervisory neglect, and found that of all the neglect in a Canadian incidence study, 44 per cent was classed as supervisory neglect. Of all of those supervisory neglect cases, two per cent had a physical injury, and only half of those required medical treatment. Another two per cent had other physical conditions; 26 per cent had signs of mental or emotional harm. Physical harm was most common in toddlers and adolescents, as opposed to those between the ages of there and 11 years old.

So most substantiated supervisory neglect is only a risk of harm in this data set.

Something to consider, before I go into these factors here. If a toddler was found wandering the street alone, in the morning say. Mum and dad are home in bed sleeping and the child isn't missed til 7 am. Would it be different if the child was found at 10 am or at noon? If mum worked nights, the night before, and dad left early for work while the child was still sleeping, would that make a difference? If mum had been drinking heavily the night before? If this was the first time the child had wandered, or the fifth time? What if no harm came to the child - they were just discovered wandering the street? Would that be different if the child had been hit by a car and admitted to hospital with serious injury?

All of these things are things that have to be considered when we start thinking about supervisory neglect. So influences on neglect in terms of a child, does the child have decision-making ability or knowledge of emergency numbers? Do they have any access to a caregiver? How old are they? What's their activity? What's their comfort level with being left alone, and what's their ability to react to problems? Other factors that affect neglect are things like the time of day, the length of time the child is left unsupervised. The caregiver reasoning or understanding behind leaving the child alone. The environmental risk, previous problems with neglect or abuse, the caregiver's ability to care for the children and the number of other children in care.

So we set out looking at these factors and decided that it was worth considering whether different professionals identified supervisory neglect in different ways, and if there was different thresholds to what some would consider as supervisory neglect.

We set out hoping to understand the definitional differences and to develop a workable definition of supervisory neglect.

The Queensland Commission for Children and Young People provided randomly selected case scenarios of deaths of Queensland children in those under 18 years. A blind review and classification was conducted by five professionals with experience in child protection, public health, injury prevention, law and child death review.

So the sample of children that we had, of the 100 - there was 100 children - and 62 per cent were male. The largest proportion of children was under 12 months. The smallest was between five and 12 years. Twenty per cent of the sample was of Aboriginal or Torres Strait Islander descent, and seven per cent were from culturally and linguistically diverse backgrounds. Sixty-five per cent of these deaths were not known to Child Protection Authorities at the time of death.

So when we looked at the causes of death of the 100 children, most of them, as you can see by this table, were killed in transport related circumstances. Twenty-four died under SIDS or [SIDI], [unclear] classified as due to SIDS or SIDI. There was 17 who died from diseases and other morbid conditions - so that's things like cancer or pneumonia. Something similar to that. Nine drowned, six were deemed accidental. There was three where there was no cause determined.

So in our research, we set out using different classifications for supervisory neglect. Where there was definitely not supervisory neglect, through to perhaps it is supervisory neglect, it's probably supervisory neglect, or there's insufficient information to make a decision about whether or not supervisory neglect was involved in the death.

We asked each of the five panel members to describe the logic behind their decision.

In terms of appreciation of risk factors for individual cases, the person with the Child Protection background was most likely to deem cases not to be supervisory neglect. The person with the Public Health background was most likely to rank a case as being supervisory neglect with a mean of 1.99.

Interestingly, and not shown here, the standard deviations that were calculated showed the widest variation was also in the person with the Child Protection background, and the narrowest in the person with the Child Death Review background. So the Child Death Review person took the broadest perspective, and the Child Protection person stuck most commonly to the same answer.

The person with the legal background was most likely to consider that there was insufficient information to determine the role of supervisory neglect.

We then looked at the text information to identify what factors were associated with agreement or disagreement about the involvement of supervisory neglect. There was a variation in different causes of death, and I've picked a couple here to demonstrate. We don't have time to go through them all, but I can provide some overview.

So the first category that we looked at was medical neglect. An example of this might be a child was ill for a number of days and presented to a doctor. They were given antibiotics for tonsillitis and the parents were told she would improve in five to seven days. When she didn't, parents rang to make another appointment but were told that there were no appointments for another four days. The child died on the third day.

So factors that were agreed between the five researchers were - there was agreement on risk factors saying that a lack of assertiveness, unclear professional advice, a lack of support for parents to ask the question. Protective factors, like they actually sought medical care. So these were all things that - where people agreed that the classification was either neglect or not neglect. Those were the things they were considering.

Where the researchers disagreed, the risk factors were around things like the condition was worsening and no help was sought. They didn't follow medical advice. The protective factors were that medical care was sought, but that it was too late and the condition of the child was obviously life threatening.

So what we can see across these two columns is that similar factors are being looked at and found to be sources of agreement and disagreement, when they're classifying the deaths.

If anyone has any questions about this, if you'd like to start submitting them now, that would - Ken can take them and keep track of them now. Thanks.

So the next category we looked at was safe sleeping. On the left again, we've got the factors that were associated with those cases where we agreed, and on the right, those cases where there was disagreement.

So where there was agreement that a case was either neglect or not neglect, the factors that were associated were things like co-sleeping, alcohol or drug use, the sleep position. Protective factors, like they fell asleep with the babe, or there was no evidence of alcohol.

Where there was disagreement in cases, things like co-sleeping, alcohol or drugs, sleep position, the length of time the child was checked - between the child going to bed and being checked. A family history of problems with SIDS or SIDI. Protective behaviours like the sleep position, the child being in their own bed or no evidence of alcohol were found to be sources of disagreement.

Now, examples of some of these children were things like, mum was breastfeeding at 3 am and fell asleep on the lounge. She woke at 5:00 and the child was dead. Or the child was put to bed at 7:30. The parents were visiting with friends and had a few drinks. The child was found dead at 7 am. The house was messy; there were obvious signs of alcohol consumption and some drug paraphernalia evident.

So another category was parental line of sight. Examples of this, a disagreement were - where a two year old was put to bed in their own bed. The parents never sighted or checked on him for 12 hours. The death was determined to be due to SIDS.

Cases where there was likely to be agreement were things like all drownings. There was - we never disagreed on whether or not a death was supervisory neglect if it was a drowning. So all drownings - pool, dam, bathtub - but also including a number of older children. So things like teenagers, who had disabilities, like epilepsy. There was always agreement. So the type of environment played a role in deciding whether line of sight contributed to the death.

In adolescent independence, again, on the left, those factors that we - that contributed to agreement and on the right, those that contributed to disagreement. A couple of examples for these were a 14 year old who was left home alone while mum went to work. Mum spoke to him about lunchtime and he was fine, but he was found dead when the mum returned. The cause of death was determined to be unexplained.

Another example was a 17 year old in the backseat - who was a backseat passenger in a car at schoolies. The car hit a tree, and speed was thought to be a contributor to the child's death.

So you can see age - what was both considered to be a factor for agreement and for disagreement. Those children, where the child was older, were more likely to be - it was more likely to be a source of disagreement.

Transport, older children were more likely to be a source of disagreement with all children over 13, and those - so for children all over 13, and those in agreement, under 10. Examples were a parent driving under the influence of alcohol, unlicensed, speeding and the child was unrestrained. The parental actions were considered to be a direct contribution to death.

Where we disagreed a P plater, where the driver fatigue was believed to have contributed to a crash at 3 am. There was disagreement over whether it was appropriate, or concerns about violation of P plate conditions, of passenger curfew and of being on that road at all.

The other thing - we can see that similar factors contributed to agreement and to disagreement. The other thing that the analysis demonstrated was that different professional groups had different thresholds and focuses in considering those layers and the holes within them.

Public Health was the least tolerant of risk factors through to Law, with Injury Prevention pretty much in the middle. Those with a Public Health background and Child Death Review put more weight on risk factors, and weren't so interested in the lack of information if there were clear risk factors present. At the other extreme were those with a background in Child Protection and Law. They were less concerned about the risk factors and more focussed on the protective factors. They relied on lots of information on how the protective factors might change to keep the risk factors from influencing the death.

It was interesting to note the professional perspective, and where the professions focussed their roles. Public Health and Child Death were very focussed on the risk and how to change that risk. A primary prevention perspective with a population focus. Child Protection and Law were much more interested in individual focuses on a specific case, and what the strengths were. A tertiary or response focus.

So what we came up with was that perhaps we didn't need a static definition. Or at least, it wouldn't contribute to identifying and dealing with supervisory neglect. We need to recognise that supervisory neglect is dynamic. It changes according to a myriad of factors at any given time. It's all about a balance between the risk and the protective factors, to make sure that the child is as safe as possible in any situation.

So it was apparent that there was careful consideration of risk and protective factors. There was no formula, even though consideration was given to the environment, the age, what the social norms were for that type of death, and the parent capacity around the death.

So we start to see some familiar models emerge. This is an adaptation of the ecological model by the World Health Organisation from the World Report on Violence and Death. In considering the role of supervisory neglect, all of the layers become important. The child factors - things like age, responsibility, activity. The relationship that they have with their caregivers. The family has systems that are relevant to the child's level of development and capacity. Like walking the child to school until they feel safe, and understanding the dangers and working within that to be safe.

The community, so others around the child are monitoring, even if the immediate supervisor isn't for some reason. This can be an example of things like crossing guards at school crosswalks, and society - at the level of society - things like speed limits around schools being enforced.

So what's become apparent through all of this is that it's about layers of protection. A systems approach to protecting children. At each level, systems can be created, implemented and modified. It's not a new concept for Child Protection. Eileen Munro has spoken about a systems approach in her review of the British Child Protection System. This model is created by James Reason. It's used in a number of injury prevention models, especially in airline and in health and medical safety, but it applies here.

So what Reason described was basically that an injury was similar to a piece of Swiss cheese or a block of Swiss cheese. Where the outcome was an injury that occurred to a child, and the starting point was where the child was safe. Where the risk factors lined up, so that would be the holes in the cheese. If all of the holes line up, then you end up with an injury occurring. The solid bits of the cheese would be the protective factors. So where the hole only went partway through a number of layers of cheese but stopped, then the system - the protective factors were in place to prevent that child going through to be considered neglected or to have an injury occur.

So as long as the holes or the risk factors don't line up, and there are protective factors in place for the child, we don't see problems with supervisory neglect.

So Daryl, I can hand over to you, to take up the next two slides.


Thanks, Debbie. I hope everyone can hear me okay. I think one of the things just to highlight before we go on, is that when we were talking about agreement or disagreement, we were talking about whether the five different professionals that were providing their views came to an agreement together. Not about whether we all thought that it was neglect or not neglect. So we can talk about some of the examples, and Deb can give you some information as to whether we all agreed that it was, or whether we agreed that it wasn't.

What we were really interested in was the decision-making process. So to take it beyond the theoretical, I think what became really apparent was that the five professionals, whose views were used in this data analysis, were understanding risk and protective factors. Using that information in different ways to form different judgements sometimes, and in other times, were using it in very similar ways.

So to build on what Deb has just said about the role of - the Swiss cheese analogy. I think you could say that in some cases, some of us were focussing more on the hole, so looking at the risk factors. Whereas others of us were looking more at the layers, so the protective factors. Are there enough layers that even if you've got some holes, if you've got enough layers, the holes are not likely to line up. Therefore children are likely to be safe.

Really that's pointing to a systems approach. Trying to understand the various levels in an ecological model, where we can try and have both prevention efforts - so you can think about at the societal level, wanting to make sure that there are public health messages around what are risks that children might face? What are appropriate ways that parents, communities, organisations like schools and child care centres and so forth, how we can all play a role in trying to minimise those risks and put in place appropriate protective factors.

Of course, you can then look at the community level; you can look at the individual parents and the relationships that occur at the family level. Obviously, factors at the individual level and clearly risks are going to be very different for a child with a disability, a child who is very young, and as Deb said, is not able to move away from a risky situation or judge what the risks might be.

So what's important is to be able to evaluate that. When we're in a context where, as professionals, we have to make judgements, it's about being able to demonstrate what it is that was the reasons behind us making that particular judgement. Then to be able to modify our assumptions and work out whether in fact we have tested those.

So to turn to the big picture. One of the things that I've had a chance to do in the past is to look at how we can learn from other models. One of the ones that's very relevant to the issue of safety for children is situational crime prevention. What we know from this model is that - which has been developed particularly in relation to things like car safety. What it says is that it's about the situation, and how can we modify that situation in order to be able to reduce the chance of a crime occurring?

The example of car safety, what we've done is we've improved the locking devices, whether they be the visibility of locks that go across a car steering wheel, or electronic locking devices. Public health messages about parking in a safe place, where things - where the car is clearly visible. Not leaving valuables, be they keys or money or other things that are able to be seen. All of those things go to a reduction in car theft.

Which if we then apply into a situation relating to children, the focus becomes not about identifying which people are risky and which people are safe. But rather, how can we make an organisation or a community, or in fact a family, safe for a child? So that involves taking together the complexity of risk factors that may be evident in a particular situation, and trying to ameliorate those risk factors. Either by removing them - by having some intervention that addresses those, be that through knowledge or through skills, or through the actual circumstances of the family.

Because one of the very common themes that we identified in reviewing these 100 cases was the problem of poverty and disadvantaged and multiple complex problems that many of these families were facing. It was in the context of that that an additional circumstance led to the particular death of the child.

That's a very similar kind of approach to what we know from a public health model, and as is reflected in the national framework for protecting Australia's children. It's really underpinned by a public health approach, where the most important thing is to try and get universal or population level services to address things at that whole of population level.

So examples there are our - for example, Maternal and Child Health services, Early Child Education and Health services, schools, et cetera. Where we're able to address many of the risk factors before they occur, to prevent them from developing into real problems.

But a public health model also has the capacity to be able to ramp things up, where the level of risk has been identified as being higher. So if you've got a Maternal and Child Health Nurse that's in touch with a family where some problems are identified - for example, it becomes evident that the mum or the dad might be struggling with drug or alcohol issues. Or where there's extreme poverty, and the only option for employment is night time work and therefore, that makes supervision of children much more difficult, in terms of being able to have access to appropriate childcare. It means that there are different issues that emerge in terms of being able to address some of those risk factors.

So that's our secondary service system. Where someone is at higher risk, we say how do we intervene appropriately to address those risks, when they become apparent? Really that all points to the importance of taking collective responsibility.

So I think the key message that came out of this analysis was the importance of not trying to blame individual parents. But saying how can we collectively take responsibility?

So to finish up with, I think what I'd like to challenge each of you too - and I'd love to hear your feedback on this - is how can we, in each of the different services that we're operating in, think of the ways in which we might be able to better support vulnerable families and parents to be able to reduce the risks and put in place some more protective factors?

I think Nelson Mandela has got some interesting words for us - Deb, if you want to just flick to the next slide - which reminds us of the importance of this. He said safety and security don't just happen. They're the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear.

So thank you for listening to our presentation today…



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Slide outline: A practical approach to child protection and supervisory neglect

Slide outline

  1. Applying a systems approach to the child protection context of supervisory neglect....
    • Debbie Scott (AIFS)
    • Daryl Higgins (AIFS)
  2. Acknowledgements:
    • Ruth Walker (UQ)
    • Richard Franklin (JCU)
    • Commission for Children and Young People and Child Guardian
  3. Disclaimer
    • The Australian Institute of Family Studies (AIFS) is committed to the creation and dissemination of research-based information on family functioning and wellbeing.
      Views expressed here are those of individual authors and may not reflect those of the Australian Institute of Family Studies or the Australian Government.
  4. Setting the scene
    • Injury leadingcause of death in Australian 1-44 year olds
    • Varies by age group:
      • Children: transport, drowning, assault/homicide
      • More vulnerable than adults
    • (image - Toddler pulling over chest of drawers.)
  5. Injury Prevention
    • Preventable
    • Interventions
      • Environmental – pool fencing
      • Legislation – use of car restraints
      • Education – safe sleeping techniques
      • Engineering – reversing sensors in cars
      • Behaviour – wearing of mouth guards
  6. Common ground between accidental and inflicted injury
    • Low socio-economic status
    • Chaotic/noisy households
    • Crowded home environment
    • Highly mobile families
    • Lack of access to services
    • Parental substance abuse/ mental health issues
  7. Grey area
    • No intent to actually HARM, but harm has occurred
    • (images - Plastic baby walker; Old fashioned illustration of mother smacking child on bottom; Illustration of a busy mother with a vacuum cleaner in one hand and a telephone in the other. She is in the kitchen where a young child is playing with blocks at her feet and a baby is in a high chair. in the background there is a fridge, a full laundry basket and a table with a computer and hot cup of coffee; Illustration of girl leaning to reach a ball floating in a swimming pool. Behind her we see the gate of the pool fence has been left open; Young child holding a ball, squatting behind a car in a driveway.)
  8. Supervision
    • Injury prevention strategy?
      • Ideal world vs real world
    • Adequate supervision
      • Risk recognition
      • Capacity to intervene
      • Environment
      • Activity
      • Personality
    • (image - Parental supervision means watching.)
  9. Neglect
    • Australia2010-2011 = 29% of substantiated maltreatment
    • Lack of parental control over some risk factors
      • Poverty
    • Access to services
      • None available
      • Failure of services
  10. Definition of neglect
    • Varies by purpose and jurisdiction
      • Research
      • Practice - harm
    • Generally includes:
      • Failure on behalf of caregiver or parent
      • Provision of requirements for wellbeing and/or development
  11. Definition of Neglect
    • May include:
      • Consideration of cultural expectations
      • Parental circumstances
        • where they are in a position to do so
        • deliberate or through extraordinary inattentiveness
    • ‘Good enough’ parenting
    • Societal neglect
  12. Muddy waters
    • Different types of abuse = different considerations
      • severity
      • chronicity
      • measurement affected
      • criminal prosecution varies
    • Sexual abuse vs emotional neglect
      • supervisory neglect very murky
  13. Supervisory neglect
    • Of all neglect in Canadian Incidence Study
      • 44% = classed as supervisory
    • Of all supervisory neglect cases
      • 2% had physical injury (only ½ required medical treatment)
      • 2% other physical conditions
      • 26% signs of mental or emotional harm
      • Physical harm most common in toddlers and adolescents (compared to 3-11 year olds)
    • Source: Ruiz-Casares M, Trocme N, and Fallon B. (2012) Supervisory neglect and risk of harm: Evidence from the Canadian Welfare System. Child Abuse and Neglect, 36 (6) 471-480
  14. Influences on supervisory neglect
    • Child
      • Decision making ability
        Knowledge of emergency numbers
      • Accessibility to a caregiver
      • Age
      • Activity
      • Comfort
      • Ability
    • Other
      • Time of day
      • Length of time
      • Caregiver reasoning/understanding
      • Environmental risk
      • Previous neglect/abuse
      • Caregiver ability to care for child
      • Number of other children
    • Source: Hymel K and Committee on Child Abuse and Neglect (2006). When is lack of supervision neglect? Pediatrics, 118, 1296- 1299
  15. This study:
    • AIM: to understand definitional differences in supervisory neglect develop a ‘workable’ definition
    • DATA: 100 randomly selected scenarios of deaths of Queensland children under 18 years provided by CCYPCG
    • METHODS: blind review and classification by 5 professionals with experience in child protection, public health, injury prevention, law and child death review
  16. Sample (n=100)
    • 62% male
    • Largest proportion under 12 months (36%), smallest 5-12 years (12%)
    • 20% Aboriginal or Torres Strait Islander
    • 7% CALD
    • 65% not known to child protection authorities at time of death
  17. Causes of death research category
    • Causes of death research category
      Cause of death %
      Transport 41
      SIDS and SUDI* 24
      Diseases and morbid conditions 17
      Drowning 9
      Accidental 6
      Undetermined or unknown 3
      Total 100
    • * Sudden infant death syndrome or Sudden unexplained death of an infant
  18. Classifications
    • Possible:
      • Definitely not/not supervisory neglect
      • Possible supervisory neglect
      • Probable supervisory neglect
      • Insufficient information
    • Logic behind each decision
  19. Results
    • RESULTS Injury Prevention Legal Child Protection Child Death Review Public Health
      Not supervisory neglect 31 25 45* 16 28
      Possible/probably supervisory neglect 62 49 52 64 66*
      Insufficient information 7 26* 3 20 6

      *highlighted field

  20. Medical neglect
    • Agreement
      • Risk Factor
        • Lack of assertiveness
        • Unclear professional advice
        • Lack of support for parents to ask question
      • Protective
        • Med care sought
    • Disagreement
      • Risk Factor
        • Condition worsening and no help sought
        • Did not follow medical advice
      • Protective
        • Med care sought but too late
        • Condition of child not obviously life threatening
  21. Safe Sleeping
    • Agreement
      • Risk
        • Co-sleeping
        • Alcohol or drug
        • Sleep position
      • Protective
        • Fell asleep with bub
        • No evidence alcohol
    • Disagreement
      • Risk
        • Co-sleeping
        • Alcohol or drug
        • Sleep position
        • Length of time
        • Family history
      • Protective
        • Sleep position
        • Own bed
        • No evidence alcohol
  22. Parental ‘Line of sight’
    • Agreement
      • Risk
        • Alcohol/drugs
        • DV or CP history
        • Clarity of supervisor role
        • Child in unsafe area
        • Age
      • Protective
        • Recognition of dangerous environment
        • Age
    • Disagreement
      • Risk
        • Length of time
      • Protective
        • Age
  23. Adolescent Independence
    • Agreement
      • Risk factors
        • Time of day
        • Activity type
        • Length of time
        • Illegal/risky behaviour
      • Protective
        • Age appropriate
        • Parent ‘permission’
    • Disagreement
      • Risk factors
        • Peers
        • Illegal/risky behaviour
        • Parent knowledge of previous risky behaviour
      • Protective
        • Age (older)
        • Time
        • Use of protective equipment
        • Sport
  24. Transport
    • Agreement
      • Risk
        • Drinking
        • Speeding
        • Unrestrained
      • Protective
        • Age
        • No evidence of illegal behaviours
        • Age
    • Disagreement
      • Risk
        • Drinking
        • Drugs
      • Protective
        • Driver fatigue
        • Age
        • P plates
        • History of ‘troubled’ life
  25. Findings
    • Child death review/Public health
      • More weight to risk factors
      • Low burden of proof
      • Focus – primary/prevention
    • Law/Child protection
      • More weight to protective factors
      • High burden of proof
      • Focus – tertiary/response
  26. And so
    • Weighing up of risk and protective factors
    • No formula - risk might also be protective
    • Considered:
      • Environment
      • Age and child characteristics
      • Social norms
      • Parent capacity
  27. Layers of protection
    • (image - 4 rings sitting inside one another. The first, smallest ring is labelled 'Individual', the second ring is labelled 'Relationship', the third 'Community' and the fourth, outer ring is 'Society'. )
    • This diagram is from: Krug, E., et al., eds. World report on violence and health. ed. WHO, 2002, WHO: Geneva. (page 12).
  28. Systems Approach
    • (image - Four slices of Swiss cheese and an arrow showing where the holes line up illustrating Reason's 'Swiss Cheese' model.)
    • Reason, J. BMJ;320:768-770
  29. Beyond the theoretical
    • Consider:
      • Risks
      • Protective factors
      • ‘Systems’ at various ecological levels that can be implemented
      • Evaluate
      • Modify
  30. The big picture
    • Situational crime prevention model
      • Child-safe organisations/communities…
        • Not risky people vs safe people
    • Public health model
      • Universal (population) services
      • More focus where risk is higher
    • Collective responsibility
  31. "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear." Nelson Mandela

This webinar was held on 11 December 2012.

There is no universally accepted definition of "neglect" or "adequate supervision", however both play a role in child wellbeing, particularly in terms of injury prevention.

In this webinar, Debbie Scott and Daryl Higgins considered the theoretical understanding of neglect and adequate supervision, and explored differences in identification of supervisory neglect between diverse groups of professionals. The use of a public health systems approach was proposed as a practical strategy to minimise the occurrence and outcomes of supervisory neglect.

The feature image is by 55Laney69, CC BY-NC 2.0.

About the presenters

Debbie is a Research Fellow with the CFCA information exchange at the Australian Institute of Family Studies.

Associate Professor Daryl Higgins was the Deputy Director (Research) at the Australian Institute of Family Studies, where he had responsibility for the Institute's research program and its knowledge translation and exchange functions.