Neglect and the toxic trio

Children and young people are safe through agencies working together effectively to provide the right help to families at the right time

The impact of neglect on children and young people is enormous. Neglect is the most common reason attributed to children and young people becoming the subject of a child protection plan and can be a catalyst to future vulnerabilities for young people.

In Staffordshire the category of neglect for children who are made the subject of a child protection plan remains the highest category and the risk factors associated with children experiencing neglect continue to be related to parental factors that impact on their ability to provide safe care for their children. Local serious case review findings support this national learning and have resulted in this area of work being an agreed priority for both Staffordshire and Stoke-on-Trent Safeguarding Children Boards. Our aim is to ensure there is both early recognition of neglect and a strong multi agency approach to improve partnership effectiveness in tackling neglect and the toxic trio.

Neglect comes in several different forms:

  • Physical neglect: failing to provide for a child’s basic needs such as food, clothing or shelter.

Failing to adequately supervise a child or provide for their safety.

  • Emotional neglect: the omission of love and failing to nurture a child. Emotional neglect can overlap with emotional abuse, but is a different form of maltreatment.
  • Educational neglect; failing to ensure a child receives an education. Medical neglect; failing to provide appropriate health care, including dental care and refusal of care or ignoring medical recommendations.
  • Emotional abuse: the persistent emotional maltreatment of a child. It may involve deliberately telling a child that they are worthless, or unloved and inadequate. It may include not giving a child opportunities to express their views, and may involve serious bullying.

The Toxic Trio:

The impact of parental behaviours and influences can often lead to the neglect of the welfare and safety of children and young people, specifically, domestic abuse, drug and alcohol misuse and parental mental ill health. In combination these factors are known as the ‘toxic trio’. The need for this priority was based on national and local evidence which highlighted neglect as a recurring theme in serious case reviews.

In their review of Serious Case Reviews Ofsted[1] also noted the most common issues relating to children’s families were domestic violence, mental ill-health and drug and alcohol misuse[2]

Working Together 2015[3] notes these issues rarely exist in isolation. There is a complex interaction between the three issues.


The Home Office defines domestic violence as:

“Any incident of threatening behaviour, violence or abuse (psychological, physical, sexual, financial or emotional) between adults who are or have been intimate partners or family members, regardless of gender or sexuality”.

National Institute for the Health and Care Excellance (NICE) describes substance misuse as:

“Intoxication by – or regular excessive consumption of and / or dependence on – psychoactive substance, leading to social, psychological, physical or legal problems. It includes problematic use of both legal and illegal drugs (including alcohol when used in combination with other substances).”

Working Together [4] describes the wide range of conditions covered by the term mental ill health including:

Depression and anxiety, and psychotic illnesses such as schizophrenia or bipolar disorder. Mental illness may also be associated with alcohol or drug use, personality disorder and significant physical illness.

The effects of Domestic abuse on parenting and families creates an inconsistent and unpredictable environment for children. Carers may demonstrate a lack of emotional warmth and / or higher levels of agression. There is a well established link between domestic abuse and the physical abuse of children and gathering evidence of the link between domestic abuse and sexual abuse of children .

It is not inevitable that substance misuse will affect parenting capacity, however it is a significant feature in cases where children have been seriously harmed or killed. Alcohol dependance linked with depression is particularly associated with poorer less consistent parenting.

Parent mental health are also a strong feature of cases where children have been seriously harmed, even conditions such as depression can inhibit a parent’s ability to respond to their child’s emotional cues and offer consistent care. It can cause a parent to be either ‘intrusive and hostile’ or ‘withdrawn and disengaged’.

Links to useful documents:

Joint LSCB Neglect Strategy - April 2018 - Interim version (currently under review)

SSCB Multi-Agency Procedure: Section 4P - Child Neglect

Good Practice Guide - Identifying & Working with the "Toxic Trio"


NSPCC Realising the Potential; Tackling Child Negelct in Universal Services

NSPCC Thriving Communities; a framework for preventing and intervening early in child negelct

Stoke-on-Trent Safeguarding Children Board Priorities 2015-2018 2018


[1] Learning Lessons from Serious Case Reviews Ofsted page 10

[2] Learning Lessons from Serious Case Reviews Ofsted

[3] Working Together to Safeguard Children page 263

[4] Working Together to Safeguard Children pages 265-266