Tackling child neglect in Scotland 2: rapid review of intervention literature

Conclusion

99. The messages emerging from this rapid review of the literature is that at the outset it is important to understand clearly what is happening in a family. Each family is unique. The reason a parent may be unable or unwillingly to give their child or teenager the care is individual to them and any interventions needs to respond to this. Children and young people may also experience neglect in very different ways. Relationships are key within the family, between the family and professionals, and the family’s interaction with the community and effective early engagement is essential for interventions to have the greatest impact. To address neglect long term needs an individual response to that family which is sustained, multi-dimensional and flexible.

100. A range of interventions has emerged through this review, some of which have been subject to more rigorous examination. Intensive and focused interventions have much to offer in addressing specific and targeted issues, but these alone will not address neglect. Interventions which offer therapy, support and education to all family members have shown to have success in increasing family cohesion, improving family interaction and relationships and improving the prevalence of prosocial and conduct disorders in children. These programmes have been effective at addressing the risk factors associated with abuse and neglect, however, when applied at a population level it is unclear whether an effective dissemination strategy alone is effective in preventing neglect in the first place.

101. The results for parenting and home visitation programmes is more mixed. There is an emerging broad consensus from this review that these approaches also appear more effective in reducing risk factors for child maltreatment, and for promoting healthy child development and school readiness, and positive parenting practices. Fewer programmes documented evidence in preventing actual neglect or its recurrence long term. Fidelity to these approaches is critical particularly seeing the family in the home over a sustained period of time, but this is not always achieved due to complex relationships with families and a lack of the intensive comprehensive packages of support that may be required. The research also identified that parents with limited social support, high levels of poverty-related stress, and mental health problems derived the least benefit from behavioural parent training. These approaches may help a whole range of families in our communities but their impact for our most vulnerable families is perhaps more limited.

102. Communities have an important role to play: when support is normalised within the neighbourhood or community, provided in places that avoid stigma and when it is broadly available rather than targeted, it is more likely that the received support will be perceived as beneficial. The more families can feel they can ask for help, the more we can achieve in responding to neglect.

103. This review has focused on a range of interventions for which there is available evidence, however, there are many more approaches and strategies that continue to be developed. Every day practitioners in Scotland are working effectively with families to address these complex issues. Neglect is complex at all levels and should not been seen in isolation of a family’s wider informal and formal networks. Great care must be taken in assessing and putting together comprehensive, multi-layered and flexible package of intervention and support at each ecological level: individual, family and community. Each member of the family should be recognised in their own right.

104. How neglect is understood, how we recognise neglect and how we respond to each situation is how we will impact our children’s futures. To address fully the impact of neglect in our society we cannot look at changing parenting alone. Children’s lives must be understood within the context of both the strengths and difficulties within families, especially when children are exposed to a range of risks resulting from mental health, substance misuse and domestic abuse, the social order and social capital available within our communities and the wider structural issues, such as poverty and unemployment, within our society. We need to intervene to reduce the neglect experienced by children today, but perhaps we also need to target our energy and resources to consider how we can help prevent neglect for future generations.