Dr Anne Greer: Consultant Child and Adolescent Psychiatrist Dr Andrew Dawson: Child and Adolescent Psychotherapist Ms Kirsten Davie: Family Therapist MCN Child Protection West of Scotland and Greater Glasgow Clyde Health Board

1. Dr Anne Greer : Consultant Child and
Adolescent Psychiatrist
Dr Andrew Dawson : Child and Adolescent
Psychotherapist
Ms Kirsten Davie : Family Therapist
MCN CHILD PROTECTION WEST of
SCOTLAND AND GGC HEALTH BOARD

2.  Initial Training with Dr Danya Glaser and Dr
Debbie Hindle
 The FRAMEA Document
 A Core Group of Trainers identified from within
CAMHS
 Roll out of Training across the West of Scotland

3.  CAMHS : 6 x training days with 131 participants
 Multidisciplinary : 6x events with 228
participants
 Awareness raising event with Scottish Reporters
Administration : 30 participants
 Total of 389 people
 Train the Trainers event with 10 new trainers
creating a core of 15 trainers available to deliver
FRAMEA
 Aim to extend this to 20 Trainers in 2015

4.  ‘Emotional abuse is persistent emotional neglect or ill
treatment that has severe and persistent adverse effects
on the child’s emotional development. It may involve
conveying to a child that they are worthless or unloved,
inadequate or valued only insofar as they meet the needs
of another person. It may involve the imposition of age-
or developmentally –inappropriate expectations on a
child. It may involve causing children to feel frightened or
in danger, or exploiting or corrupting children. Some
level of emotional abuse is present in all types of ill
treatment of a child; it can also occur independently of
other forms of abuse.’

5. 1. Most harm of child abuse and neglect is
psychological
2. Several forms of child abuse & neglect often
co-exist, but EA can exist alone
3. The child may be harmed without parental
intention to harm the child
4. Explanations help but do not absolve from
need to intervene

6.  Impairment of the child’s physical or mental health
 Or impairment to their physical, intellectual,
emotional, social or behavioural development.
 Caused by acts of ill treatment (omission or
commission) in the provision of their physical and
emotional care

7.  Emotional state
 Behaviour
 Developmental/Educational Attainment
(& opportunity)
 Peer Relationships
 Physical State

8.  Persistent interactions typical of a relationship,
not single event(s)
 Actually or potentially harmful
 Include commission & omission
 Physical contact not necessary
 Many examples within this overall definition
 Intention to harm the child is not required for the
definition
 Explanations help but do not nullify

9.  Severity of ill treatment: determined by
intensity and chronicity
 Effects = result of interaction between
severity of ill treatment & child’s age, gender,
temperament, (mal)adaptive schema
 NO validated measures of severity

10. Sexual
abuse
Physical
abuse
Emotional
abuse/
neglect
Abuse/
interaction
Hidden Hidden or
observed
Observable
Identity of
abuser
Usually
questioned
Sometimes
known
Known
Abuser &
prim. carer
Different
persons
Same/ diff.
persons
Same person
Need for
immediate
protection
Yes Usually No

11. Tier 0
Family & Social Factors
Poverty, social isolation, poor housing, displacement
Tier 1
Parental risk factors
Mental ill-health, domestic violence, substance misuse, unresolved
parental childhood maltreatment
Tier 2
Parent-child interactions
Tier 3
Child’s functioning
and explanations for difficulties (?EAN)

12.  Clearer picture
 Separates description from explanation
 Evidence of actual maltreatment
Tier 0 not enough
Tier 1 not enough
Tier 3 not enough
Need Tier 2 (for emotional abuse and neglect)
 Indicate where and how to intervene

13.  Emotional Abuse
 Psychological Maltreatment
 Harmful Parent-Child Interaction
We need to balance the imperative to protect
the child alongside the understanding that
the interaction may be unintentional and
available for change.

15.  1) Parental emotional unavailability, unresponsiveness
and neglect
 2) Negative attributions to the child
 3) Developmentally inappropriate or inconsistent
interactions with the child
 4) Failure to recognise/acknowledge the child’s
individuality
 5) Failure to promote the child’s socialisation

16.  Descriptions are specific, in contrast to terms
such as neglect or emotional abuse
 Difficult to argue with
 Useful in communicating concerns to the parents
 Helpful in talking with the child about his/her
experiences
 Useful in describing concerns to other agencies
including Childrens’ Reporter Administration.

17. While child in abusive situation
• Abuser = primary carer
 Child loyal to/ dare not upset primary carer
 Difficult to acknowledge awfulness of being rejected,
unloved, exploited
 Threat to own survival and self worth
 Abuse denied, rationalised, reframed
 Child may not realise being used

18. Time limited trial of intervention
 Attending to Tier 0 & Tier 1 concerns
 Remediation of child’s acute difficulties
 Specific treatment approaches for different
categories

19.  Prioritise intervention in relation to parental risk factors
 Psycho-education and parenting work – specific to
presenting difficulties and stage of development
 Interventions that explore family beliefs
 Exploration of parents experience of being parented
 Interventions to enhance the parents empathy with their
child
 Explore child’s perceptions/experience of interaction with
parents
 Explore possible maintaining factors
 Need for services to work together

20. Assessment: time limited trial of
intervention towards change
Sufficient change
and contract for
further work
Insufficient
change
Child remains at
home as least
detrimental
alternative
Child looked after by
alternative carers
Statutory involvement

21.  Explore with other agencies the LEAST
DETRIMENTAL ALTERNATIVE
◦ Exploring child’s experiences
◦ Explaining parents’ difficulties
◦ Problem solving - coping with emotional abuse
◦ Working with child’s emotional life: guilt,
vulnerability, shame
◦ Encouraging and scaffolding relationship with
positive adult (this can be in school).
◦ Ensuring educational attainments

22.  Emotional abuse & neglect is common &
harmful
 Useful to organise information in 4 Tiers
 Description of harmful parent-child
interactions (Tier 2) is the evidence both for
Childrens Panels and Court
 Categories of harmful parent-child
interactions indicate how to intervene
 Trial of family’s capacity to change
 Follow Pathway

23. Glaser, D. How to deal with emotional abuse and
neglect—Further development of a
conceptual framework (FRAMEA)
Child Abuse & Neglect 35 (2011) 866-875
Presentation adapted from source material by D.
Glaser and D.Hindle 2012