Is neglect different? Social determinants of child protection plans by recorded maltreatment type in England: a longitudinal ecological study, 2014/2015-2022/2023.

OBJECTIVES

Neglect is the leading cause of acute child protection interventions across high-income countries. In England, reducing the number of children subject to these interventions is a policy priority. However, limited evidence on the health and social factors driving recent trends in neglect constrains effective prevention. We aimed to assess the associations of area-level adult mental health, child poverty and employment, with recorded neglect, and to compare these associations with those observed for other forms of maltreatment.

DESIGN

Longitudinal ecological study using panel data.

SETTING

147 upper-tier local authorities in England from 2014/2015 to 2022/2023.

PARTICIPANTS

Children aged 0-17 years.

OUTCOME MEASURES: Primary: annual rate of new child protection plans (CPPs) due to neglect. Secondary: annual rate of CPPs due to other maltreatment types (emotional, physical, sexual abuse) and rate of children entering care. We used two-way linear fixed effects models to estimate associations between each exposure and outcome, controlling for confounders.

RESULTS

Rising adult mental ill health was associated with higher rates of neglect and emotional abuse CPPs at area-level, but CIs included the null. Child poverty was positively associated with neglect CPPs: a one-percentage point increase was associated with around one additional CPP per 10 000 children (95% CI 0.2 to 2.2), equivalent to a model-estimated difference of over 30 000 plans over the study period. Higher employment was associated with fewer physical abuse CPPs, though CIs included the null. Care entry was positively associated with mental ill health and child poverty, and negatively associated with employment.

CONCLUSIONS

Recorded neglect and care entry appear particularly sensitive to wider social conditions affecting caregiving capacity and service response. Preventative policies to support parental mental health and tackle child poverty may help reduce the need for the most common and acute child protection interventions.