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Who is at risk and why

Background papers: children :: Looked After Children :: Who is at risk and why

There are a number of well-known risk factors associated with child abuse and neglect that can consequently lead to a child becoming “Looked After” by the local authority. Some of these risk factors are:

• Parental substance abuse [1][2]
• Teen parenting [3][4]
• Domestic Violence [5][6]
• Environmental and social factors [7][8]
• Lack of secure attachments
• Chronic and enduring mental health illness of parents

Substance abuse–Overall in 2011/12 there were an estimated 293,879 opiate and/or crack users in England; this corresponds to approximately 8 per thousand of the population age 15-64.[9] In Medway there were an estimated 1,291 opiate and/or crack users which corresponds to approximately 7.27 per thousand of the population age 15-64.[9] In 2012 The Medway Drug and Alcohol Team commissioned a report to determine the needs of this population.[10] What they found amongst other things was that use of some drugs like Cocaine had become “normalised” and that treatment and support services for users were many and varied. Crucially however the services were not joined up or well-resourced and as such did not meet the needs of this population.

Teen parenting–During the period 2010–2012 there were 621 conceptions in Medway for females aged under 18 years of age.[11] This represents a rate of 38.9 per 1000 of girls and young woman in that age group. This is above the national rate for England of 30.9 per 1000 of girls and young women in that age group. It is now recognised that one of the key failings of the Governments 1999 ten year strategy to tackle teenage pregnancy was that none of the strategies were aimed at addressing social disadvantage.[12] As such in 2007 the rate of teenage pregnancy had reduced by only 11.8% and was showing no signs of reaching the 2010 target of 50%. The rate of teenage pregnancy in Medway remains higher than the national average despite the fact that it has fallen year on year since 2010.

Domestic violence–In 2013-14 the police recorded 887,000 domestic abuse incidents in England and Wales .[13] It is estimated that 140,000 children live in homes where there is a high risk of domestic abuse .[14] 62% of children living with domestic violence are directly harmed by the perpetrator of the abuse. After a peak in 2013 the rate of referral to children's social service per 10,000 of the population has decreased and in 2014 was lower than the national average and statistical neighbours.

Environmental and Social Factors–There is a well-known link between deprivation and children coming into care such as unemployment, low income lone parents and inadequate accommodation. All of these factors, either individually or in combination, can lead to family breakdown. In 2011 Medway was ranked within the 41% most deprived boroughs nationally and when broken down further by child poverty, employment, health and disability, crime and income deprivation was amongst the worse in the England.[15]

Lack of secure attachments–Many looked after children suffer ongoing trauma as a result of developing insecure attachments in their early years. The lack of a secure attachment has effects on the development of the child's emotional intelligence and their ability to cope with the complex feelings that can be involved with separation and loss.[16][17] We know that the main function of attachment behaviour is to keep the primary attachment figure (usually the mother) close by. For looked after children this basic human need can remain unfulfilled and the resulting distress can lead to children lacking resilience to cope with life's inevitable challenges.

Chronic and enduring mental health issues of parents–In May 2014 the health and Social Care Information Centre reported that there were 963,769 adults in England who were in contact with secondary mental health services. Of these 23,646 were in patients in a psychiatric hospital (2.5 per cent). 16,352 were subject to the mental Health Act 1983 and of those 11,965 were detailed in hospital (73.2 percent).[18] The data in relation to mental illness across England has shown that an ever increasing number of adults experience some form of mental distress. The NSPCC have determined that across the UK 1:5 babies live with a parent with a common mental health disorder, which may place them at increased risk of harm .[19] In Medway in at the end of April 2014 there were 4005 adults in contact with mental services.[18]

Figure 1: Deprivation affecting dependent children under 20 years, Medway 2012.
Figure 1: Deprivation affecting dependent children under 20 years, Medway 2012[20]

Figure 1 shows that Gillingham North, Chatham Central and Luton and Wayfield wards had the highest proportion of children living in low income families in 2012, with 33.5%, 33.2% and 31.8% children respectively in those wards living in low income families.

It is safe to assume that the effects of these risk factors are reflected in the number and complexity of Looked After Children and young people in Medway.

We know that coming into care itself; and the child or young person's previous experiences can have a profound and ongoing impact on their emotional and physical health, ability to learn and settle in such a way that they develop and grow into confident healthy individuals. In addition Looked After Children and young people are significantly more likely than their peers to leave school with few or no qualifications. These young people are at higher risk of becoming involved in offending, becoming a teenage parent and of not being in education, employment or training once they have left school.


[1]   Wells K. Substance abuse and child maltreatment Pediatric Clinics of North America 2009; 56 (2): 345-62.
[2]   Donohue B, Romero V, Hill HH. Treatment of co-occurring child maltreatment and substance abuse Agression and Violent Behaviour 2006; 11: 626-640.
[3]   Afifi TO, Brownridge DA. Physical Abuse of Children Born to Adolescent Mothers: the continuation of the Relationship Into Adult Motherhood and the Role of Identity. In Child Abuse and Violence 2008;
[4]   Goerge RM, Harden A, Lee BJ. Consequences of Teen Childbearing for Child Abuse, Neglect and Foster Care Placements. In Kids Having Kids: Economic Cost and Social Consequences of Teen Pregnancy (2nd ed.) 2008;
[5]   Salisbury EJ, Hanning K, Holdford R. Fathering by partner-abusive men: attitudes on children's exposure to interparental conflict and risk factors for child abuse. Child Maltreatment 2009; 14 (3): 232-42.
[6]   Casanueva C, Martin SL, Runyan DK. Repeated reports for child maltreatment among intimate partner violence victims: findings from the National Survey of Child and Adolescent Well-Being. Child Abuse and Neglect: The International Journal 2009; 33 (2): 84-93.
[7]   Houshar S. Addressing the Needs of Vulnerable Families During an Economic Crisis 2008; FirstFocus.
[8]   Cancian M, Slack KS, Y YM. The effect of family income on risk of child maltreatment Social Service Review 2013; 87 (3): 417-437.
[9]   Hay G, Rael dos Santos A, Worsley J. Estimates of the prevalence of opiate use and/or crack cocaine use, 2011/12: sweep 8 summary report 2012; Liverpool John Moores University and Glasgow Prevalence Estimation.
[10]   Council KC. Medway Substance Misuse Service Commissioning 2014;
[11]   for National Statistics O. Conception to women aged under 19 in England and Wales: July to Sep 2013. 2014;
[12]   Teenage Parenthood: What's the Problem? 2010;
[13]   for National Statistics O. Crime Survey for England & Wales 2015;
[14]   SafeLives. Getting it right first time: policy report 2015;
[15]   Council M. Index of Deprivation 2010 2011;
[16]   Howe D. Attachment Theory for Social Work Practice 1995;
[17]   Carpendale J, Lewis C. How Children Develop Social Understanding (Understanding Children's Worlds) 2006;
[18]   HSCIC. Monthly Mental Health Minimum Data Set (MHMDS) Reports, England - May 2014 summary statistics and related information 2014;
[19]   Manning V. Estimates of the number of iinfant (under the age of one year) living with substance misusing parents 2011; NSPCC.
[20]   Child Poverty Unit. Personal tax credits: Children in low-income families local measure: 2012 snapshot as at 31 August 2012 2014;