NSPCC inform - Abuse of children in residential care

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Abuse of children in residential care

By Christine Barter (October 2003)

Key findings

There is a lack of systematic data collection and research in the UK relating to the institutional abuse of children.
American research has highlighted two main themes; firstly that children in residential facilities are more vulnerable to abuse than those who live in families, and secondly, that the under-reporting of institutional abuse incidents is common.
No clear pattern has emerged regarding the type of abuse children in residential facilities most commonly report.
Distinct gender patterns have been identified; the majority of perpetrators are male, boys are over-represented in physical abuse allegations and girls in sexual abuse allegations.
Research has identified a number of factors associated with institutional maltreatment, although it is generally acknowledged that institutional abuse is a multi-determined phenomenon that cannot be explained by any individual factor.

Introduction

UK research has yet to prioritise the area of institutional abuse, thus only a very limited number of relatively small scale-studies exist. This has led to a disproportionate reliance on the evidence of inquiry reports (Penhale 1999, Barter 1999). However, inquiry reports do provide detailed and valuable analysis of what went wrong in large scale abuse scenarios, often involving corrupt regimes, and contain an array of recommendations for preventing such situations from developing in the future.

In contrast the USA has developed a wide body of research literature on the subject. Although this is informative, we need to be cautious when transferring research based on the American experience to our own. Both the nature and extent of US residential care are significantly different to our own, many being large multi-purpose establishments for delinquents. In addition, the social conditions in which residential establishments within the US are embedded differ significantly from those within this country. Research on institutional abuse of children with disabilities has been excluded from this review as this area has previously been covered in the NSPCC Research Briefing on Disabled Children and Abuse by David Miller (February 2002).

Nature of current provision

Both the size and nature of residential provision has changed dramatically over the past 25 years. The number of residents living in children's homes in England on any one day has fallen from some 20,000 a generation ago to nearer 6,000 today (Department of Health 2002, Berridge 1985). Although provision has decreased, large numbers of children still experience some form of residential placement in their care histories, albeit short-term, for example whilst waiting for a foster home to become available or following an emergency placement (Department of Health 1998). As well as placements becoming shorter, homes are now used to accommodate a comparatively small group of children, mostly adolescents, deemed 'hard to place', due to experiencing placement breakdowns elsewhere, or because their behaviour was thought to make them unsuitable for placement in foster care (Berridge and Brodie 1998).

Defining the problem

Within the US research and practice literature, the issue of definitions has been an important element in discussions relating to the institutional abuse of children. Gil (1982) provides a commonly acknowledged starting point, supplying a broad definition:

'...any system, programme, policy, procedure or individual interaction with a child in placement that abuses, neglects, or is detrimental to the child's health, safety, or emotional and physical well-being, or in any way exploits or violates the child's basic rights.' ( p9)

In the UK The National Association of Young People in Care (NAYPIC 1989) states that institutional abuse occurs with '..a system becoming increasingly more punitive in its failure to respond to their (children's) need.' (p1)

Other commentators have highlighted the importance of drawing a distinction between individual acts by abusers within institutions, abusive regimes and examples of poor or bad practice in institutions where abuse occurs (Bennett et al 1997, Utting 1997). Gil (1982) usefully identifies three discrete forms of institutional abuse. The first is overt or direct abuse, consisting of any sexual, physical or emotional abuse of a child by a worker, very similar to familial abuse. However, the second two forms identified are unique to institutional settings. Programme abuse consists of an institution's regime or treatment programme which, although accepted by staff, to an external observer would be viewed as abusive. Unlike with sexual abuse where staff know their behaviour is illegal, perpetrators of physical abuse may, in some instances, mistakenly view their behaviour as a legitimate aspect of the therapeutic programme. The 'Pindown' scandal is an example of this where physical assaults took place under the pretext of restraint and where children were placed in isolation for weeks and sometimes months with inadequate clothing, food and denied external contact (see Levy and Kahan 1991).

The third form of abuse Gil defines as system abuse which is '..perpetrated not by any single person or programme, but by the immense and complicated child care system, stretched beyond its limits and incapable of guaranteeing safety to all children in care' (p117). Gil illustrates system abuse by referring to numerous cases where children who have been taken into care then remain in care, when this is not in their best interests. Some definitions have been narrower, whilst others reject the concept of system definitions arguing it is individuals not systems that abuse children (Thomas 1990). Ultimately if definitions are unclear and rely too heavily upon individual interpretation this can play a part in both facilitating maltreatment and in impeding its reporting and investigation (Besharov 1988, Rindfleisch and Rabb 1984a). However, much of the research evidence relates to direct abuse by individuals rather than system or programme abuse, although some inquiry reports do focus on this aspect of institutional maltreatment (see Levy and Kahan 1991).

Incidence of institutional abuse

American research into the incidence rates of institutional abuse has consistently highlighted two main themes: firstly that children in residential facilities are more vulnerable to abuse than those who live in families, and secondly, that the under-reporting of abuse incidents within residential settings is a common occurrence.

With the above in mind, the New York State Commission on quality of care (1992) described abuse rates within their facilities as being as high as 87 reports per 1000 children. This figure contrasts sharply with the 28 non-institutionalised children reporting per 1000 in New York State. Rindfleisch and Rabb (1984 b) undertook the first comprehensive study to assess the level of abuse in residential facilities across ten US states. They found an average of 39 reports of maltreatment per 1000 children, with an average confirmation rate of 10 per 1000.

Previous US studies have indicated that the majority of abuse incidents are not reported to the appropriate authorities. Rindfleisch and Rabb (1991) for example found that fewer than one in five complainable situations in out-of-home placements were reported. Evidence from UK institutional abuse enquiry reports show that many of the children who had been abused had either not reported the abuse, or their allegations had not been forwarded to the appropriate authorities (see for example Waterhouse 2000).

Westcott (1991) extrapolates from the literature four main characteristics associated with residential settings that may prevent allegations receiving attention;

institutional abuse viewed as the problem of the individual member of staff, not the institution or care system, thus the incident is treated as a personal rather than a professional problem
the closed nature of institutions - facilities may be reluctant to open their systems to external scrutiny for fear of losing credibility, hence they strive to deal with the allegation internally
belief systems surrounding the provision of institution care, specifically that residential facilities are deemed to provide better care than the child's own parents and therefore their working methods should not be questioned.

Peer abuse

However, UK research has found that that children in residential care are more at risk of physical and sexual assault from their peers than from staff (Barter et al forthcoming, Farmer and Pollock 1998, Sinclair and Gibbs 1998, MacLeod 1999). Sinclair and Gibbs (1998) analysed 223 questionnaires from children in 48 different children's homes. They found that 13 per cent of children had been sexually taken advantage of by a peer whilst in care and that 4 in 10 had been bullied. Barter et al (forthcoming) also found high levels of peer violence and verbal attacks between young people in eleven of the fourteen homes they undertook fieldwork in. Peer violence represents a significantly different phenomena to abuse by staff, including different risk factors and safeguards.

Research has identified a number of organisational, institutional and cultural factors that may contribute to increased levels of peer violence. These include homes having unclear aims and objectives and therefore being unable to meet the diverse needs of their resident group, lack of control over 'inappropriate' referrals, inadequate admission procedures and the acceptance of macho cultures and peer pecking orders (Barter at al forthcoming).

In addition, research has shown that young people who are victims of sexual abuse are often placed alongside young people who exhibit sexually harmful behaviour (Farmer and Pollock 1998, Lindsay 1997, O'Neil 2001). Ultimately it is the responsibility of management and staff to safeguard young people from peer violence, the inability to do so has been described by some as constituting system abuse (Barter 1997).

Dynamics of institutional abuse

Many of the high profile scandals over the last few years have involved the widespread sexual abuse of boys and young men in residential settings (see Kirkwood 1993, Barratt 1998, Waterhouse 2000). However, the degree to which this reflects the national incidence of institutional maltreatment is unclear. Within US research no clear pattern has emerged regarding the type of abuse children in residential facilities most commonly report. Both US research and the limited number of UK studies suggest that sexual abuse is not the most commonly reported form of institutional maltreatment.

Blatt (1992) states that the majority of allegations in their study concerned lacerations (35%, presumably related to physical abuse), followed by inappropriate restraint (22%) and then sexual abuse (17%). Rosenthal et al (1991) also found physical abuse to be the most commonly alleged (55%), followed by sexual abuse (24%) and thirdly neglect (21%) . In contrast Blatt and Brown (1986) report that neglect was most often reported (64%), then physical abuse (24%) and lastly sexual abuse (10%). Groze (1990) in comparison found that over half of all allegations (55%) related to inappropriate treatment.

Lindsay's (1997) Scottish study on sexual abuse within children's homes analysed questionnaires from 229 residential establishments, securing a remarkable 94% response rate. She found that some form of sexual abuse allegation had been made against staff in 13 homes within the past year. The author concludes that sexual 'abuse by staff is not a great problem in terms of frequency, but is a great problem in terms of seriousness of the offence, and the uncertainty and anxiety the whole issue creates throughout the service as a whole' (p35).

When viewing these figures it is, however, important to bear in mind that there may exist substantial differences between what abuse occurs and what is reported. Due to the secretive nature of sexual abuse there may be fewer opportunities for external individuals to witness and subsequently report the incident. Children themselves may also be particularly reluctant to report sexual abuse, feeling embarrassed or that they may not be believed.

However, distinct patterns of abuse have found to exist for gender. Both US and UK studies have shown that boys are over-represented in physical abuse allegations, while girls are predominantly involved in allegations of sexual abuse (Groze 1990, Rosenthal et al 1991, Westcott and Clem nt 1992, Barter 1997). Rosenthal et al (1991) found that males reported high levels of physical abuse (71%) and neglect (76%) and females sexual abuse (60%). Some small UK studies on institutional abuse have also identified similar patterns (Westcott and Clem nt 1992, Barter 1997).

Victims

Previous studies have overwhelmingly found that the vast majority of children experiencing institutional abuse are adolescents (Groze1990, Westcott and Clement 1992, Barter 1997, MacLoad 1999), reflecting the general age distribution within residential facilities (Blatt 1992).

Research shows that adults target children for sexual exploitation who are separated from their usual family networks, and who are unhappy, lonely, isolated or feel unwanted. In addition those children who have histories of sexual or physical assaults, or of behaviour difficulties will be at particular risk (Conte 1990, Dobash at al 1993, Colton and Vanstone 1996, MacLoad 1999). Many children in the residential child care system share these characteristics. Blatt and Brown (1985) found that young people who were subjects of institutional maltreatment reports where perceived as more difficult for the residential staff to work with, and in need of higher levels of individual supervision compared to the other children in care.

The enquiries into UK institutional abuse scandals have noted that young people's complaints about abuse were frequently ignored or discounted because of negative assumptions that were made about the character, behaviour and truthfulness of the young people placed in residential care (eg Levy and Kahan 1991, Waterhouse 2000). Other commentators have highlighted the powerlessness that children in care can experience (Moss, Sharpe and Fay 1990, Safe and Sound 1995, Davidson 1995). Similarly, Wardhaugh and Wilding (1993) argue that children in residential care lack value and worth in the eyes of the wider community, leaving them vulnerable to abuse. In response safeguarding guidance has been issued on improving children's rights through for example the establishment of an independent complaints procedure and the provision for independent visitors (Department of Health 1991).

Investigating institutional abuse allegations

Barter (1997), exploring the NSPCC's experiences of investigating 76 allegations of institutional abuse, highlights a number of ways in which these investigations differ from familial ones. These include; the need to ensure independence from the setting under scrutiny, ensuring the investigations' scope and remit is adequate, the need to determine culpability, the provision of support for all parties involved and the need to include a post-substantial phase to determine if any working practices need to be changed to protect children in the future.

Concerns have also been raised in the US concerning the low level of substantiation in institutional abuse investigations. Nunno and Rindflleisch (1991) found a substantiation rate in only 27% of out-of-home investigations they studied. Other studies have found substantiation rates ranging from 14 per cent (Groze 1990), 23 % (New York State Commission on Quality of Care 1992), to as high as 42 % (Spencer and Knudsen 1992). The above study by Barter found a slightly higher substantiation rate of 54%.

Risk factors

Research has identified a number of factors associated with institutional maltreatment. It is generally acknowledged that institutional abuse is a multi-determined phenomenon that cannot be explained by any individual factor (Colton 2002). Consequently, it is important to remember that while investigations of single variables have contributed to the identification of key variables or 'risk factors' associated with institutional abuse, they have neither produced a causal explanation of institutional maltreatment, nor enabled the identification of causal relationships between associated factors. Many of these factors relate primarily to direct abuse by care staff, however some factors (and in particular the last three ) also impact on programme or system abuse.

Gender

Rosenthal et al (1991) found that a majority of perpetrators (64%) were male in all three types of incidents, physical abuse (62%), neglect (54%) and sexual abuse (77%). Blatt (1992) also found an over-representation of male workers in his US maltreatment sample, with over three-quarters of children identifying their perpetrators as being male.

Rindfleisch and Baros Van Hull (1982) found that female residential workers were less likely to use force in their work compared to male members of staff. UK studies have also found that males were over-represented in all forms of abuse (Westcott and Clem nt 1992 and Barter 1997, MacLoad 1999). Where female staff were involved in physical abuse it was as collaborators rather than instigators (Penhale 1999).

As Berridge and Brodie (1996) state, the major protagonists in nearly all the UK inquiries were male. In comparison only a third to a half of residential workers in both the US and UK are men.

Repeat perpetrators

The extent to which abusers purposely enter care work to abuse children is however unknown. No comprehensive research has specifically addressed this area. Although inquiry reports (Kirkwood 1993, Waterhouse 2000) and UK case studies (Colton and Vanstone 1996) have shown that some male sexual abusers have targeted children's homes knowing that these children may be especially vulnerable, it is however unclear to what extent this occurs and how this may relate to other forms of abuse.

Rosenthal at al (1991) highlights the presence of repeat perpetrators, especially in relation to sexual abuse. The above US study analysed 290 institutional abuse incidents and found that repeat perpetrators comprised 27% of reported and 44% of confirmed cases. A further breakdown of confirmed incidents indicated a previous allegation was cited in 61% of sexual abuse instances, 33% of physical abuse and 29% neglect cases.

Some procedural safeguards, such as adequate vetting of staff (Warner 1992) including police checks and the need to receive a full reference on all new staff have been adopted in response to the problem, however these are obviously reliant on past abuse being reported.

Supervision

The lack of effective and frequent supervision of direct childcare workers has been widely viewed as a significant contributing factor in maltreatment (Spenser and Knudsen 1992, Warner 1992). Reyome (1990) found that directors of institutions reported that the most important factor regarding prevention of residential maltreatment was the provision of regular, open and supportive supervision of residential care staff.

Supervisors can mediate the stresses and pressures that child care workers experience through their work. Supervision should also provide clear guidance of how children in care should be treated. It is therefore imperative that supervisors receive training in how to provide effective supervision rather than simply adopting the role unprepared.

Status in the facility

The literature has shown some association with lack of participation in the decision making process in the facility and the use of increased levels of restraint with children in residential care (Rindfleisch and Foulk 1992).

Blatt (1990) postulates that child care workers are powerless and in professional isolation, told what to do, with little training or incomplete knowledge. Sundrum (1984) and Mercer (1982) concur and indicate that children in care become the target and outlet of this powerlessness.

Various studies have cited the relationship between job stress and 'burn-out' behaviour, with the corresponding influence on the interaction with and depersonalisation of children (McGrath 1986, Wardhaugh and Wilding 1993).

Staffing patterns

The most vulnerable times for institutional abuse was when direct care staff were left alone, without planned activities. New York State commission on quality of care (1992) found that 57% of reported incidents occurred when children were engaged in free-time or activities of daily living e.g. eating, bathing, dressing. They found that free-time incidents where more likely to be associated with physical abuse (39%) and inappropriate restraint and seclusion (45%).

Rosenthal (1991) and Blatt (1992) also found an increased maltreatment pattern during early morning and evening hours when staffing patterns where light and when children and staff were without planned activities. These are also typical times of the day which are often the most chaotic and when senior staff are generally not available to residential care staff.

Barter et al (forthcoming) found that many of the most serious incidents of peer violence occurred at night time when staff supervision was minimal. Blatt and Brown's (1986) study discovered increased levels of reporting when admissions rose enough to dramatically worsen staffing ratios.

Training and qualifications

Many inquiry reports have identified the association between lack of appropriate training and the occurrence of abuse (Levy and Kahan 1991, Utting 1991, Williams and McCreadie 1992, Warner 1992, Kirkwood 1993, Waterhouse 2000), however research has not identified any causal association.

Although training is important, it does not in itself guarantee an abuse-free environment (Utting 1991). Nevertheless, findings from UK research (Sinclair and Gibbs 1998, Berridge and Brodie 1998) indicate that whilst training is not directly related to the quality of care provided, the existence of a positive training policy may be a central component in ensuring that staff feel valued.

Management style

Both Sundrum (1986) and Thomas (1990) stress the central role that leadership styles have upon the occurrence of maltreatment. These writers stress the importance of management holding children in high regard, open communication and setting clear expectations of staff. Utting (1991) stated that the heads of residential homes are the biggest single influence upon an institutions culture, ethos and practice.

This finding has also been mirrored in UK research (Sinclair and Gibbs 1996, Berridge and Brodie 1998). Berridge and Brodie (1996) and Jones (1995) both note that a common feature in UK inquiry reports was the 'macho', authoritarian leadership style used by the heads of homes. Ultimately an administration/management that is unresponsive to needs of its staff can create an atmosphere where staff are unresponsive to the needs of children (Blatt 1990).

Organisational factors

Berridge and Brodie (1996) upon reviewing three major UK institutional abuse inquiry reports, identify a range of organisational factors associated with the abuse occurring. These included lack of adequate line management, the homes having no clear objectives, inadequate or no complaints procedures, unsatisfactory placement policy and processes, poor recruitment processes and inadequate or no specialist external professional advice.

Wardhaugh and Wilding (1993) identify management failure across most responsibilities and all levels as a key contributory factor in abuse of both adults and children in residential institutions. Commenting on the US situation, Krantz and Frank (1990) identify similar organisational and structural factors, such as the facilities' mission, organisation and operative goals, the directors' leadership styles as affecting the potential for abuse and neglect in a particular facility.

A lack of consistency of practice and systematic monitoring systems have been highlighted (Levy and Kahan 1991, Kirkwood 1993), as has poor multi-agency cooperation, especially between police and social services (Levy and Kahan 1991).

Safeguarding children in residential care

Foremost is the need to create a protective, trusting and open environment, based on a commitment to listen to children and young people and take their complaints and views seriously (Kahan 1994, Barter 1997). A range of strategies have been suggested, that taken together, can contribute to establishing such an ethos or culture:

Children's rights and participation: involving and consulting with children on decisions alongside strategies for increasing workers participation in the decision making process.
Contact: regular contact between children and families (where appropriate), independent visitors, advocacy services and the local community.
Better recruitment procedures: including vetting of staff and participation of young people in the selection procedure.
Training: a nationally accredited qualification that is specific to the demands of residential child care work.
Supervision: regular, open, supportive supervision by properly trained supervisors, which is systematically recorded and reviewed.
Monitoring: regular monitoring and assessments of staff and managers working practices, spot checks by social services and statutory bodies (although see Cawson [1997] on why inspections have failed to safeguard children in the past).
Safeguards: protection for whistleblowers.
Staffing patterns: ensure senior staff are present at the most vulnerable shift times - early mornings and late at night - adequate staff/child ratios.
Leadership Style: head of home's leadership style should be based on consultation and respect, where a clear vision of the establishments' aims is shared by managers and staff.
Complaints: Complaints procedures should be independent, child friendly and well publicised.
Organisational Factors, including:

the establishment of interdisciplinary working practices
the development of open, effective and participatory line management, including regular contact with young people
external professional input
placement policies should ensure that all children's needs can be fully met and that a 'good' residential mix can be achieved.

Cultural: the irradiation of 'macho' and hierarchical peer cultures based on inequality.

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This research briefing is based on a review of research and literature. It reports the findings and views of a range of authors. These views are not necessarily the views of the NSPCC.

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