How to deal with emotional abuse and neglect: further development of a conceptual framework (FRAMEA).
OBJECTIVE
To develop further the understanding of emotional abuse and neglect.


METHODS
Building on previous work, this paper describes the further development of a conceptual framework for the recognition and management of emotional abuse and neglect. Training in this framework is currently being evaluated. The paper also briefly reviews more recent work on aspects of the definition, harm caused by emotional abuse and neglect and threshold.


RESULTS
The paper arrives at a working definition as 'persistent, non-physical, harmful interactions with the child by the caregiver, which include both commission and omission.' There are many forms of harmful caregiver-child interactions, which can be placed in five categories, each category reflecting the fulfillment of one of the child's basic psycho-social needs and requiring a different therapeutic approach for its alleviation. The caregiver-child relationship is embedded within a psycho-social context. It is suggested that greater clarity can be gained about the child and family when information is sorted into the appropriate tiers of concerns: Tier 0 - Social & environmental factors, Tier I - Caregiver risk factors, Tier II - Caregiver-child interactions and Tier III - Child's functioning. It is further suggested that while intervention is required, this is directed towards protection, rather than providing immediate protection of the child. The work takes the form of a time-limited trial of therapeutic work to gauge the capacity of the caregivers to change. This initial work focuses Tiers 0-II. Statutory steps might be required in order to encourage the caregivers to engage. If insufficient progress is achieved, active child protection may be required which might include placing the child in an alternative family. However, some, usually older, children will remain in the emotionally abusive environment and they will require ongoing help and support.


CONCLUSIONS
While a greater understanding of emotional abuse and neglect is now possible, further evaluation of the utility of this framework is suggested.
Neurosciences, Main Nurses Home, Great Ormond Street Hospital for Children, London, England, UK.
Danya
D
Glaser
D017028:Caregivers; D002648:Child; D002649:Child Abuse / Q000145:classification / Q000523:psychology; D002652:Child Behavior / Q000523:psychology; D004644:Emotions; D006801:Humans; D007398:Interpersonal Relations; D008960:Models, Psychological; D012307:Risk Factors; D012951:Socialization