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Emotional abuse and neglect: Definitions, impact, and a modular intervention

Prof. Arnon Bentovim & Jenny Gray OBE

Wednesday, 15 May 2024

Introduction

The workshop will introduce participants to the nature, range, and impact of Emotional abuse (EA) and Emotional neglect (EN) (core forms of maltreatment), an approach to assessment and a modular approach to addressing the complex mental health responses associated.


EA and EN are defined as the “Negative perceptions of a parent, intentional behaviour that conveys to the child that they are worthless, flawed, unloved, unwanted, in danger or not valued. They are only of value in meeting another’s needs, justifying harsh criticism, humiliation, physical and sexual abuse. Parental, emotional unavailability, unresponsiveness and neglect characterises EN when parents are preoccupied, for example, with postpartum depression or substance abuse. Further definitions include expectations beyond or below the child’s developmental capabilities, and pressure to accept adult’s belief and wishes are seen in custody disputes, factitious illness, and child sexual abuse. There is a current argument that Verbal Abuse should be considered as a separate sub-type because of its pervasive negative impact (Dube et al, 2023).

 

EA and EN are pervasive in family life and together with associated physical abuse with a child lifetime incidence of up to 40% of children and young people. The percentage is even higher if Adverse Childhood Experiences (ACEs) are considered which can include bullying/victimisation in school and the community.  The diagram below from Winter et al. (2022) demonstrates that emotional forms of maltreatment are a core form of maltreatment associated with all other forms of maltreatment and adversity. They have a profound and stable impact on mental health, developmental status, and somatic health, in the immediate aftermath and remain persistent over the course of the 2-year follow-up, and into adult life. 


Network analyses indicate emotionally abused children suffer significant fear and stress responses, and considerable difficulties in regulating their emotions contributing directly to emotional and behavioural disorders of children and young people including suicidal ideation extending to adult life. Many forms of adverse experiences cluster together (e.g., emotional, physical, and sexual abuse; financial difficulties and parental unemployment), and there is a clustering of emotional and behavioural problems (e.g., bullying victimization, peer rejection and emotional problems). 

The challenge is to identify, assess, and work with the many children, young people and their families seen in practice. 


The event will be equivalent to 2.3/4hrs of CPD.

Content

The workshop will explore with participants their practice experiences of emotional abuse and emotional neglect and how they illustrate the complex dimensions of EA and EN.
The current literature on the impact of EA and EN and related forms of adversity will be reviewed. Traumatic responses of EA and EN have direct impacts on mental health, in association with other forms of adversity, high levels of internalising and externalising responses, in addition to PTSD. Utilising a case example, a seven-stage process of assessment, analysis and assessment will be introduced profiling care and therapeutic needs of children and their families’ capacities to respond to intervention.

The Hope for Children and Families Intervention Resources will be introduced. They are underpinned by an evidence-based modular, common elements approach to address children’s anxiety, depression, conduct and traumatic responses (MATCH-ADTC) reinforced with common elements, a trauma informed approach, to address all forms of maltreatment. The library of modules has been gathered into guides which address the emotional and traumatic responses of children and young people, modify abusive and neglectful parenting, promote attachment and emotional responsiveness, promote positive parenting and the development children and young people. Modules can be selected to meet the profile of complex needs of children and families seen in practice. The process will be demonstrated through the case example.

Learning Objectives

• To understand the nature of Emotional Abuse and Emotional Neglect, and their core role in mediating the adversity faced by many children in the family and in the community.
• To appreciate the complex impact of Emotional Abuse and Emotional Neglect on mental health: up to 40% of children’s mental health responses are associated with adversity.
• To familiarise participants with the seven-stage process of assessment, analysis, planning, intervention, and review.
• To understand the development of modular, common elements approaches, and how the library of interventions can help mitigate the harmful impact on children and families caught in a cycle of abuse and neglect.

Training Modalities

The workshop will include the opportunity for participants to share their own experiences of working with EA and EN via the chat; presentation of research information about the nature of EA and EN, the current information about Adverse Children’s Experiences, the biological embedding of traumatic experiences, and the research on effective interventions. Participants will be invited to observe a video case, formulate how the Hope for Children Intervention Resources could be applied to this case, and consider relevance to their own practice.

Key References

Bentovim A., Chorpita B., Daleiden E., Gray J., Pizzey S, & Vizard E. (2022) The value of a modular, multi-focal, trauma-informed therapeutic approach to preventing child maltreatment: Hope for Children and Families Intervention Resources. Child Abuse and Neglect, 119. 104703

Bentovim A., & Gray J. (Eds.). (2016). Hope for Children and Families Intervention Resources. York: Child and Family Training.

Cecil C.A.M., et al. (2017). Disentangling the mental health of childhood abuse and neglect. Child Abuse and Neglect, 63, 106-119.

Chorpita B.F., & Weisz J.R. (2009). Modular Approach to Children with Anxiety, Depression, Trauma and Conduct Match-ADTC. Satellite Beach FL: PracticewiseLCC

Dube S. et al (2023) Childhood Verbal Abuse as a child maltreatment sub-type. A systematic review of the current evidence Child Abuse and Neglect 144 106394.

Egeland B. (2009) Taking stock of emotional maltreatment and developmental psychopathology. Child Abuse and Neglect, 33, 22-26. 

Glazer D. (2002) Emotional abuse and neglect (psychological maltreatment) A conceptual framework. Child Abuse and Neglect, 26, 697-714.

Macdonald G., et al (2016). The effectiveness, acceptability, and cost-effectiveness of psychosocial interventions for maltreated children and adolescents: an evidence synthesis. Health Technology Assessment, 20(69), 1-508.

Winter S. et al. (2022) Immediate impact of child maltreatment on mental, developmental, and physical health trajectories. JCPP 63, 1027-1045.

About the presenter

Arnon Bentovim is a Child and Family Psychiatrist, and Director of Child and Family Training. He trained as a Psychoanalyst and Family Therapist and worked at the Great Ormond Street Children’s Hospital and the Tavistock Clinic. He is a Visiting Professor at the Royal Holloway University of London. His research on the Family Assessment formed the basis of the tools commissioned by the Department of Health to support the Assessment Framework. Child and Family Training was established to provide evidence-based training, consultation, and materials, that include the Hope for Children and Families Intervention Resources co- edited with Jenny Gray.

Jenny Gray OBE is a Social Work Consultant and was President of the International Society for the Prevention of Child Abuse and Neglect (2012-14). From 1995 – 2012 she was professional advisor to the UK Government on safeguarding children, led policy development on the assessment of children in need, serious case and child death reviews, and commissioned children’s services research. She co-edited the Hope for Children and Families Intervention Resources. She has delivered training extensively both in the UK and abroad.

Who should attend

The workshop will introduce a Common Elements Modular approach to intervention which has been demonstrated to be of value to practitioners across services and levels of experience, from support staff, foster carers and newly qualified staff to experienced practitioners. Practitioners working with children, young people and their families in Family Hubs, Children’s Social Care including those working with Looked After Children, CAMHS, Community Child Health Services, Education and Offending services should attend.

Details coming soon

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