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Child abuse or neglect can have a long-standing impact across the whole spectrum of the child’s development and life span. Similarly, the physical and psychological effects of abuse or neglect on an elderly also have a substantial impact on their quality of life in their silver years. It is therefore important to ensure strong early intervention and support for families where neglect or abuse are identified, in order to safeguard the vulnerable from harm. This is where social service practitioners play a crucial role in identifying signs of neglect or abuse in their clients and to intervene in a timely manner.
Social service practitioners are trained in identifying signs of abuse or neglect such as delayed development, emotional and behavioural problems and poor socialisation in a child. For older persons, the condition of the skin and the overall countenance of the individual are tell-tale signs of neglect and distress. However, even with these indicators, there are still times when the neglect of children, adults with special needs or older persons are overlooked and are not recognised.
What then are some obstacles to appropriate and timely intervention? For some practitioners, the lack of appreciation for the impact of abuse or neglect may lead them to be slow in intervening. Others may lack updated knowledge on current research and safeguarding responsibilities. Yet for some others, resource constraints such as time and energy, influence their professional behaviour and what they perceive can be achieved when they have concerns about neglect or abuse.
While it may seem obvious to intervene in cases of neglect or abuse, working with such cases are often fraught with dilemmas and difficulties. Professional training should help practitioners reconcile some inherent conflicts in a professional role which requires them to empower the most vulnerable parents and yet take decisive and ultimately disempowering action when child or adult protection concerns become extensive. This must be the most difficult dilemma that the child protection service has to handle. Likewise, practitioners working in the adult protection sphere have the dilemma of respecting the right of the older person to refuse services and the right for the state to intervene where there is a law to protect the individual from abuse and neglect. Training and supervision should aim to help practitioners reconcile theoretical knowledge and practice, with a recognition of the emotional demands practitioners experience.
Another difficulty that arises is when practitioners have a fixed view of the case type which can cloud thinking and openness to take in new information. When this happens, first impressions can lead to a fixed view of the case that is difficult to change. For example, when social workers determine a case type for their client, there could be a tendency to focus on the child (or adult) in need. This focus on a particular child (or adult) rather than the other family members can arise because of his high level of need or vulnerability. It reflects a tension in priorities between protective services and family services. It can also shape the approach and extent to which the child or vulnerable adult will be observed and monitored.
Another area of tension is determining who has the area of expertise or responsibility for the assessment of neglect on the development or well-being of the child or older person, with the caseworker believing that someone else is better placed to make a decision. There is tension posed when the evidence is not yet clear or when there is not yet concrete manifestation of neglect. The dilemma is whether one should seize an opportunity and take a risk in intervening or not to intervene at all. Making judgment while maintaining a working relationship with clients is both emotionally and professionally demanding. Supervision and case consultation is therefore essential. These should help to clarify the differences between risk factors for neglect and indicators of actual neglect in day to day practice. However, there will be issues of interpretation to be aware of and it is important that there is regular discussion about the observations that lead to identification.
What is helpful in assessing cases of potential neglect or abuse is to have an evaluation of the nature of the condition and to determine the options for the next steps. There are three aspects to such an evaluation.
1. Identifying indicators of current neglect or current indicators of neglect;
2. Determining if there is persisting indication of neglect such as frequency or neglect that was never noticed before; assessing the risk to the individual especially when indications are not clear or observed;
3. Evaluating the extent of cooperation from care givers which can be derived from the taking of family history.
Some consistency in standards and practice such as shared models of assessment with clear theoretical foundations would be helpful for practitioners. An example of this is the Structured Decision Making tool for child protective services. These tools help practitioners to analyse different aspects of neglect and produce better assessments and more informed support and protection plans.
Many cases have situations that are dynamic with relationships that are in disequilibrium. Practitioners need to remain focused on what they need to monitor and remain vigilant to seize opportunities to intervene. Such opportunities may take the form of clear indicators of neglect, openness to receiving help and crisis when interventions are welcome, mandated or appropriate. Staying focused after the evaluation and having a plan that is closely adhered to, monitored and driven towards an outcome will always be helpful. It takes away the less systematic engagement with the individuals being helped while remaining open to the changing circumstances and revelation of new information.
Director-General of Social Welfare
Ministry of Social and Family Development