Social Science Assignment I - See attachment for specific assignment details!!

Child Neglect: A Guide for Prevention, Assessment, and Intervention 55

The goal of the initial prevention or intervention

should be to address safety and other emergency

needs and to increase the caregiver’s readiness for

change-oriented practices or behaviors. By the time

families experiencing neglect come to the attention

of CPS agencies, they often have acute and chronic

needs that require long-term intervention. These

families are significantly more likely to experience

recurrence of child neglect than abusive families. In

some CPS agencies, families experiencing neglect are

given less priority than those dealing with physical or

sexual abuse, even though their risk of recurrence may

be particularly high. 224

Effective ways must be found to target and serve

these at-risk families as soon as they are identified to

minimize risks that could lead to child neglect and

abuse. This chapter discusses the principles comprising

the foundation of prevention and intervention, their

theoretical framework, and key steps in implementing

their practice. Examples of successful interventions

are also presented.

PRINCIPLES FOR EFFECTIVE PREVENTION AND

INTERVENTION

Efforts targeting single risk factors may be as effective

in preventing neglect and its recurrence as programs

that are individualized and offer multiple services.225

Either way, services must be based on principles

that empower families, build upon strengths, and

respect cultural diversity. The following are some

CHAPTER 6 Child Neglect Prevention

and Intervention

The Importance of Receiving Services at an Early Age

Programs that promote a positive and responsive parent-child relationship are desirable as prevention and

intervention strategies. Optimally, parents can be assisted when their children are very young and the families

are not yet presenting serious child behavior problems. Chances for better parent-infant relationships are

improved, and the likelihood of child neglect is diminished.226 The intensity of interventions required for

children to catch up is expensive and unlikely to be available. For children of families living in poverty,

the support needed for proper development often exceeds what their parents can provide. These children

may benefit from quality child care or preschool settings, such as Head Start, a component not typically

considered in most interventions for neglected children. These center-based programs can offer the parent

respite from child care and teach the child communication and problem-solving skills that may buffer the

child from some effects of neglect.227

56 Child Neglect Prevention and Intervention

basic principles for practitioners who intervene with

families when children’s basic needs are unmet:

Have an ecological-developmental framework. As

discussed in Chapter 5, Assessment of Child Neglect,

neglect may be viewed within a system of risk and

protective factors interacting at multiple levels,

including the individual, the family system, and the

larger social system. To be most effective, intervention

should be directed at these multiple levels, depending

on the specific needs of the family. Examples include

affordable child care, education and employment

opportunities, low-income housing, and large-scale

drug prevention and treatment initiatives.

Understand the importance of outreach and

community. Because families experiencing neglect

tend to be poor, socially isolated, and lacking access

to resources, interventions must include aggressive

outreach and be designed to mobilize concrete formal

and informal helping resources. Since in-office, one-

to-one counseling by professionals often has proven

to be ineffective with families experiencing neglect,

services provided in the home and within the local

community are essential to understand the family in its

daily environment. It must be a collaborative process

between the family and community in which people

plan and carry out goals together for strengthening

their neighborhood.228

Carry out a comprehensive family assessment.

Caseworkers should conduct an assessment to

determine the type of neglect that has occurred and

its contributing causes (e.g., the child’s parent has

a substance abuse problem or the child lives in a

dangerous neighborhood). Whenever possible, the

caseworker should include other service providers in

the assessment. A comprehensive assessment can be

made using standardized clinical measures of risk and

protective factors, as well as by assessing parenting

attitudes, knowledge, and skills.229 (See Chapter 5,

Assessment of Child Neglect, for more information.)

Establish a helping alliance and partnership

with the family. This is one of the most important

principles for effective intervention. It may be a

challenge, however, because many caregivers with

neglect problems tend to have difficulty forming and

sustaining interpersonal relationships. By attending

to the communication styles of family members, the

caseworker is more likely to engage the family in an

active partnership, thereby helping the family develop

communication skills and build more sustaining

relationships with others.230

Utilize an empowerment-based practice. Teaching

families how to manage the multiple stresses and

conditions of their lives effectively empowers family

members to solve their own problems and to avoid

dependence on the social service system. The role of

the helper becomes one of partner, guide, mediator,

advocate, and coach.231

Emphasize family strengths. A strengths-based

orientation addresses problems, helps build on a

family’s existing competencies, and promotes healthy

functioning of the family system. The intervention

enables caregivers to meet the needs of family

members who then will be better able to have the

time, energy, and resources for enhancing the well-

being of the family.232

Develop cultural competence. Risk and protective

factors for child neglect may differ according to

race and ethnicity. Because minority families are

disproportionately represented in the child welfare

system and neglect cases represent more than one-

half of the caseload of child welfare agencies, it is

imperative to increase the cultural competence of

service providers. Cultural competency requires

acceptance of and respect for differences, diversity

of knowledge and skills, and adaptation of services

to fit the target population’s culture, situation, and

perceived needs.233

Ensure developmental appropriateness.

Practitioners must consider the developmental

needs of the children, the caregivers, and the family

as a system in their assessments and intervention

strategies. Children whose physical and emotional

needs have been neglected often will suffer significant

developmental delays. If the caregivers are adolescents,

Child Neglect: A Guide for Prevention, Assessment, and Intervention 57

they may have difficulty assuming parental roles

and responsibilities. The family system also may be

stressed when the family includes caregivers across

generations.234

THEORETICAL FRAMEWORKS AND APPROACHES

The preceding principles of neglect prevention suggest

that when risk factors are present, community groups

or other agencies can assist families to reduce risk and

to strengthen protective factors, thereby preventing

future incidences of child neglect. Effective programs

focus on developing basic problem-solving skills,

providing for the family’s concrete needs, teaching

behavior management strategies, and addressing

environmental factors.235 Specific interventions

should be matched to address the most pressing

needs of each individual family member and to target

individualized family outcomes.

Within a single case of neglect, multiple approaches

and models may be employed depending on the

family members, the circumstances surrounding the

neglect, and local and agency practice standards.

Additionally, these approaches and models are not

mutually exclusive; the strategies employed in each

approach or model may overlap.

Differential Response Strategies

Reliance on an authoritative, investigative response is

not appropriate for many families, but this is often the

only means of entry into the child welfare system of

services. Traditional services often have been criticized

as being too invasive and focused on severe problems

while not providing enough services to children at

low or moderate risk of maltreatment.236 In response

to this concern, some States have implemented a

differential response system in which only families with

the most serious maltreatment or those at the highest

risk are subject to a mandatory CPS investigation.

Other families with less serious maltreatment and

who are assessed at low or moderate risk receive a

voluntary family assessment and a preventive services-

oriented response. Instead of an investigation that

concentrates on determining whether maltreatment

has already occurred, the assessment focuses on

what might happen in the future and on what types

of interventions will best meet the needs of specific

families.

Exhibit 6-1 lists appropriate responses to families

who are assessed by practitioners as being at mild,

moderate, or severe risk for experiencing neglect,

as well as the individuals responsible for providing

services.

This dual-track or multiple-response approach

provides greater flexibility to respond differentially,

considering the children’s safety, the degree of risk

present, and the family’s need for support services.

For example, in cases of severe abuse and neglect or

of criminal offenses against children, an investigation

will commence. In less serious cases where the

family may benefit from community services, a

comprehensive assessment will be conducted so that

the family’s strengths and needs can be matched with

the appropriate community services. States that

have implemented differential response systems have

shown that a majority of cases can be handled safely

through an approach that emphasizes service delivery

and voluntary family participation, as well as the fact-

finding of “traditional” CPS investigations.237

Child-centered Strategies

The focus of child-centered strategies is on providing

children at risk of, or already experiencing, neglect

with necessary services to ensure their safety and

to provide them with the skills and support to

overcome maltreatment successfully. Child-centered

interventions include pediatric care, mentoring,

or behavioral and mental health treatment. For

younger children, preschool interventions, such as

parent-child educational play and Early Head Start,

may be considered. Programs fostering an open and

educational climate are helpful for middle-school

children and can help them enhance self-control,

58 Child Neglect Prevention and Intervention

develop communication and problem-solving skills,

and learn how to resist negative social influences.239

Parent-centered Strategies

The focus of parent-centered strategies is on enabling

caregivers to meet the needs of all family members,

including themselves, in a balanced way, providing

parents with the resources to ensure the safety and well-

being of the family. Strategies focus on the enduring

and underlying protective factors, along with the risks,

to optimize a match of interventions. Examples that

show promise in improving parenting skills and the

parent-child relationship include parenting education

programs, such as Parents as Teacher and Parents and

Children Together (P.A.C.T.), and treatment programs

that address problems such as depression, substance

abuse, and domestic violence.240

Family-centered Strategies

Family-centered strategies involve parents, children,

and other members of the family system, where

appropriate. Coordination of multiple service

providers, as well as faith- and community-based

organizations, may be needed to support a family’s

various needs. Family-centered strategies focus on

enhancing parenting skills and helping families recover

from neglect. CPS caseworkers work with the family

by training parents in behavioral and social skills,

setting short-term goals with clearly defined action

steps, providing in-home teaching and skills training

to parents to improve parent-child interactions, and

teaching home management skills.

Neglectful families often show high rates of recidivism.

In-home instruction is often the best strategy to

prevent recurrence and is also a successful strategy

for working with families at risk for neglect. Parents

tend to respond positively to the more personalized,

outreach nature of the home-visitor approach.241

While providing in-home instruction, caseworkers

can teach behaviors that encourage attachment,

appropriate feeding and child care practices, infant-

Exhibit 6-1

Possible Responses to Families238

Types of Cases Responses Suggested Organizations Responsible

Mild Risk Early intervention, family support, formal

or informal services, parent education,

housing assistance, community neighborhood

advocacy.

Community programs

Moderate Risk Appropriate formal services, coordinated

family support, safety plans, community

support services.

CPS and community programs

Severe Risk Intensive family preservation or reunification

services, child removal, court-ordered services,

foster care, adoption, criminal prosecution.

CPS and law enforcement

For more on parent-centered and other strategies,

see Emerging Practices in the Prevention of Child

Abuse and Neglect at http://www.childwelfare.

gov/preventing/programs/whatworks/report/.

Child Neglect: A Guide for Prevention, Assessment, and Intervention 59

toddler stimulation, successful money management,

and proper nutrition. Providing information related

to child development characteristics and capabilities

is an important element of many in-home services.

When possible, training should be provided during

subsequent pregnancies for high-risk families and

during the postpartum period.242

Utilization of Concrete Resources

The lack of concrete resources and the stress of

poverty that come from living in neglected and unsafe

neighborhoods are risk factors for neglect. Helping

families access concrete resources is often essential

before they can deal with other factors in their lives

that may affect the care of their children. Examples

of concrete resources include housing; emergency

financial, food, and energy assistance; affordable and

quality child care; transportation; home management

assistance; and free or low-cost medical care. These

resources are needed to help families move beyond

mere survival to optimal functioning.243

Utilization of Social Supports

As discussed in Chapter 4, Risk and Protective

Factors, parents who experience loneliness, lack social

support, and are socially isolated may be more prone

to neglecting their children than families who have

a strong network of social supports. Building social

supports can serve as a means of stress prevention as

well as a stress buffer. Being in the company of others

can enhance self-esteem, provide a sense of belonging,

improve access to healthy role models, and provide

incentives to comply with social norms.244

Social support interventions include any activities or

programs that address social isolation, loneliness, or

other deficits in the social network of families. Social

supports provide the following:

Emotional support through affirmation,

compassion, and empathy;

•

Feedback, advice, encouragement, and guidance

in coping with demands such as managing

emotional stress and child rearing;

Access to information, services, and material

resources and assistance (neighbors and friends

may provide advice about schools and child care

or donate needed items, such as clothing or a car

seat);

Assistance in learning new job skills, making

home repairs, managing household needs, and

creating financial plans using an informal social

network of neighbors, friends, and workplace

colleagues.245

Research suggests that social support interventions,

in combination with casework and case management

services, are effective in improving the functioning of

neglectful families.246 Social support interventions

must be managed carefully to maximize the

advantages of the support while minimizing potential

disadvantages. Excessive social support may not only

foster dependency in the recipient, but also increase

feelings of indebtedness or the need to reciprocate.

Sometimes those offering emotional support find it

difficult to challenge the recipient’s behavior (e.g.,

substance abuse).247 It is crucial for CPS, as well

as community- and faith-based groups, to provide

assistance to the support network of troubled families

to prevent their exhaustion and burnout. Working

in teams on home visitations has been effective in

“supporting the supporters,” while organizing mutual

support groups may provide much needed assistance

for the informal support network.248

Utilization of Community Services

Both informal and formal provision of community

services can help reduce family stresses that can

contribute to child abuse and neglect. To be

effective, social support needs to be integrated with

community services, such as social skills training,

home-based family interventions, emergency

assistance, parenting education, intensive therapy,

•

•

•

60 Child Neglect Prevention and Intervention

and, in some cases, substance abuse treatment.

CPS typically is the lead agency in coordinating

communication between various parties and services

within the community. Other professionals involved

in community prevention and intervention efforts

include law enforcement, educators, early child

care providers, health care providers, mental health

professionals, legal and judicial system professionals,

substitute care providers, the faith community,

community organizations, support services providers,

and other concerned citizens. Integration of these

service systems and providers will help ensure that

families can be supported appropriately across their

developmental life span.249

Assistance programs are most likely to succeed when

they provide an array of benefits to the general

population so that recipients are not stigmatized by

identification with the program. If this is not possible,

assistance can be incorporated into programs that

target a wide-ranging population. Contracting with

community-based services can help meet the needs of

children and families within their own neighborhood,

reducing the amount of time and burden on families

who otherwise may need to travel long distances to

receive such services. Community-based programs

also attempt to do the following:

Prevent the accumulation of risk factors;

Focus on resilience and adaptation;

Facilitate active involvement of parents, children,

and others;

Ensure sufficient services to at-risk populations;

Provide timely, careful, and expert evaluation,

assessment, and follow-up services;

Build safe environments to permit families

to establish structure, routines, rituals, and

organization.250

Examples of community service strategies include:

Public assistance programs offering job

training, subsidized child care, and nutritional

•

•

•

•

•

•

•

support (e.g., the Special Supplemental Nutrition

Program for Women, Infants, and Children

[WIC] program).

Schools providing social support through

programs, such as Head Start, that incorporate

parental involvement into early childhood

education, or after-school programs that provide

social and educational assistance, peer counseling,

and tutoring as well as social support to children

with special needs.

Faith-based and community organizations and

recreational groups offering a variety of services

to assist high-risk families, including community

food pantries, clothing, soup kitchens, and

recreational and related activities.

In-home assistance in which formal helpers

provide families with the opportunity to consider

each person’s viewpoint on family problems and

the development of new modes of interaction.251

Cognitive-behavioral Interventions

Cognitive-behavioral interventions use behavior

modification techniques in individual therapy sessions

with caregivers who have neglected. They include:

Verbal instruction—providing information

about appropriate child care;

Social skills training—demonstrating methods

for managing child care tasks;

Stress management—teaching relaxation

techniques or cognitive coping skills;

•

•

•

•

•

•

For more detailed information on the roles and

responsibilities of various service providers within

the community, see A Coordinated Response to Child

Abuse and Neglect: The Foundation for Practice at

http://www.childwelfare.gov/pubs/usermanual.

cfm.

Child Neglect: A Guide for Prevention, Assessment, and Intervention 61

Cognitive restructuring—replacing self-

defeating thoughts with beliefs and behaviors

that lead to improved functioning.

These techniques are especially useful with neglectful

families if they target both the environment and

the individual. For example, Project STEEP (Steps

Toward Effective, Enjoyable Parenting), which was

developed at the University of Minnesota, is an

intensive, individual, in-home counseling and group

intervention program that seeks to change negative self-

perceptions and to break the intergenerational cycle

of maltreatment. (For more information on Project

STEEP, go to http://education.umn.edu/ICD/

harriscenter/STEEPinfo.htm.) Project SafeCare uses

an ecobehavioral approach and reports improvements

in nutrition, home cleanliness, personal hygiene, and

identifying and reporting children’s illnesses.253 (For

more information about Project SafeCare, visit http://

www.friendsnrc.org/downloads/05ConfPres/

Fidelity.pdf or http://www.cdc.gov/ncipc/pub-

res/parenting/ChildMalT-Briefing.pdf.)

The following examples are cognitive-behavioral

methods for addressing child neglect that have been

• shown to improve home safety, affective skills for the

parents, and infant development stimulation.

Home safety. Hazardous physical environments

increase a child’s risk of injury from accidents and

from highly stressed parents who may become

physically abusive while trying to prevent a child

from injuring him or herself from a household

hazard. A safety assessment can be followed by

personalized training and educational activities.

These activities may include audiovisual

presentations of how to resolve safety hazards, use

of self-feedback stickers, and printed guidelines

(e.g., the proper use of safety plates and electrical

tape).

Affective skills training. Parents learn positive

ways of interacting with their children, including

developing the ability to provide corresponding

physical and verbal messages, assuming an equal

position of height with the child, and actively

initiating positive, nurturing physical contact

with the child.

Stimulating infant development. Teaching

parents how to nurture infants can reduce the

•

•

•

Helping Families Accept Assistance to Meet Their Needs

Families at risk of child neglect and in need of support are most likely to regard assistance positively when

they:

Have opportunities to reciprocate (or are required to repay) the aid they receive;

Accept assistance because they perceive the need for help rather than because of external judgments of

inadequacy or incompetence;

Perceive the benefactor’s intentions as a combination of altruism and self-interest (i.e., the benefactor

has a genuine interest in the family, but also is paid or provided other benefits for helping);

Believe that the assistance comes largely from an impersonal source (e.g., agency, organization);

Regard their need for assistance as externally instigated (e.g., job layoff) rather than as stemming from

personal inadequacies;

Receive assistance in circumstances that reduce stigma (e.g., benefits widely shared by community

members);

Obtain aid in a way that does not invade privacy or limit autonomy.252

•

•

•

•

•

•

•

62 Child Neglect Prevention and Intervention

risk of developmental or emotional difficulties

with their babies. Stimulation activities include

frequent use of affectionate words and child-

parent interactive play.254

Systems of Care

A Systems of Care approach is a collaborative effort

on the part of service agencies to support children and

families with complex needs in an integrated manner.

Systems of Care enable cross-agency coordination

of services regardless of where or how children and

families enter the system. Agencies work strategically,

in partnership with families and other formal and

informal support systems and can address neglect

based on a family’s unique needs. This approach has

been a catalyst for changing the way public agencies

organize, purchase, and provide services. It has been

applied across the United States in various ways at

the macro level (through public policy and system

change) and at the micro level (in the way service

providers directly interact with children and families

in need of assistance). To do so effectively, agencies

participating in Systems of Care must:

Agree on common goals, values, and principles

that will guide their efforts;

Develop a shared infrastructure to coordinate

efforts toward the common goals of safety,

permanency, and well-being;

Work within that infrastructure to ensure the

availability of an array of high-quality, community-

based services to support families and children

safely in their homes and communities.255

•

•

•

Interventions with Special Populations

CPS and other organizations that provide neglect

prevention and intervention services serve many

special populations, including families of color and

parents with intellectual disabilities.

Serving families of color through community-

based services. In response to concerns about

the over-representation of minority children in

the child welfare system, the Children’s Bureau

sponsored an exploratory, qualitative study of

the child welfare system’s response to children

of color, specifically, African-American children.

The study identified strategies that child welfare

agencies were using or should use to meet

the needs of minority children and families.

By providing prevention services within the

neighborhood or local community to support

families before they come to the attention of

the system, it is hoped that fewer minority

children would enter the system in the first place.

Establishing strong connections with minority

communities and engaging community leaders

may help child welfare agencies collaborate

more effectively and share resources with local

agencies and organizations. This will hopefully

empower communities to find solutions to their

own problems and build an internal support

system.256

Supporting parents with intellectual

disabilities. Parents with intellectual disabilities

often are identified as being at risk for physical

and psychological neglect of their children.

Expanded services are needed to enhance the

effects of parent education to improve parental

competencies and to reduce the risk of child

neglect and developmental or behavior problems.

•

•

For more information on minority children in the

child welfare system, see Children of Color in the

Child Welfare System: Perspectives from the Child

Welfare Community at http://www.childwelfare.

gov/pubs/otherpubs/children/index.cfm.

For additional information and to communicate

with other professionals about the Systems of

Care approach, visit http://www.childwelfare.

gov/systemwide/service_array/soc/.

Child Neglect: A Guide for Prevention, Assessment, and Intervention 63

Behavioral, performance-based teaching

strategies often work well with this population.

Practitioners should receive training on the

impact of intellectual disabilities on adults as well

as behavioral skills training. These techniques

include simple instructions, task analysis, pictorial

prompts, modeling, feedback, role-playing, and

positive reinforcement.

These same techniques also are effective in

teaching parenting skills to parents without

intellectual disabilities. Research has shown that

the rate of child removal dropped considerably

following interventions that increased parents’

child care skills. Furthermore, in-home services

for at-risk children that improve parenting skills

and knowledge of child development may be

more feasible and cost-effective than placing

children in specialized preschools.257 Exhibit 6-

1 summarizes various interventions that can be

used with neglected children and their families.

KEY STEPS IN THE INTERVENTION PROCESS

Regardless of which intervention approaches and

models are implemented, certain steps are necessary

Exhibit 6-1

Interventions for Neglect Cases258

Concrete

Support Social Support Developmental

Cognitive and

Behavioral Individual Family System

Housing

assistance

Emergency

financial,

food, or other

assistance

Transportation

Clothing,

household

items

Availability or

accessibility

to community

resources

Hands-on

assistance to

increase safety

and sanitation

of home (home

management

aids)

Free or low-cost

medical care

Available and

affordable

quality child

care

–

–

–

–

–

–

–

–

Individual

social support

(parent aide,

volunteer)

Connections

to faith-based

activities

Mentor

involvement

Social support

groups

Development of

neighborhood

child care and

respite care

services

Neighborhood-

centered

activities

Social

networking

Recreation

programs

Cultural

festivals and

other activities

–

–

–

–

–

–

–

–

–

Therapeutic child

care

Individual

assistance with

developmental

skills (e.g.,

parenting)

Home visits

with focus on

developmental

needs of family

members

Peer groups

(often at schools)

geared to

developmental

tasks

Mentors

to provide

nurturing,

cultural

enrichment,

recreation, and

role modeling

–

–

–

–

–

Social skills

training

Communication

skills building

Teaching of home

management,

parent-child

interaction, meal

preparation, and

other life skills

Individual or

group therapeutic

counseling

(e.g., regarding

childhood

history)

Parenting

education

Employment

counseling and

training

Financial

management

counseling

Problem-solving

skills training

–

–

–

–

–

–

–

–

In- and

out-patient

counseling

and

detoxification

for substance

abuse

12-Step

programs

Mental health

in-patient and

out-patient

counseling

Crisis

intervention

Stress

management

Play therapy

–

–

–

–

–

–

Home-based,

family-centered

counseling

regarding family

functioning,

communication

skills, home

management,

and roles and

responsibilities

Center-based

family therapy

Enhancing

family strengths

Building

nurturing

behaviors

Refining family

dynamics and

patterns

–

–

–

–

–

64 Child Neglect Prevention and Intervention

to make them appropriate for the needs of the child

and family, including:

Building a relationship with the family;

Developing case and safety plans;

Establishing clear, concrete goals;

Targeting outcomes;

Tracking family progress;

Analyzing and evaluating family progress.

Building a Relationship with the Family

Establishing good rapport with each family member

will help the caseworker understand the family

dynamics as well as build trust in the collaborative

process between the caseworker, family, and other

providers. When families believe their feelings and

concerns have been heard, respected, and considered,

they are more likely to be engaged in the planning

and actions necessary to change the behaviors and

conditions that contribute to neglect. CPS caseworkers

also should be prepared for the often emotionally

draining effect that the apathy of neglectful families

may have on professionals, volunteers, and community

paraprofessionals.259

Developing Case and Safety Plans

Interventions should be structured to increase

protective factors or to decrease risk factors identified

in the family assessment process. That information

can be used to tailor the intervention to facilitate

changes the family must make to meet a child’s basic

needs, to eliminate the risks of child neglect, and to

develop a safety plan, if needed. Flexibility is critical

in designing case plans so that they are responsive to

the family’s changing needs and resources.

The case plan that a CPS caseworker develops with a

family is its roadmap to successful intervention. The

purposes of case planning are to:

•

•

•

•

•

•

Identify strategies with the family that address

the effects of neglect;

Provide a clear and specific guide for changing

behaviors and conditions that influence risk;

Establish a benchmark to measure client progress

for achieving outcomes.260

Establishing Clear, Concrete Goals

In setting the goals of the intervention, family

members and their informal support networks

should be involved in developing plans to maximize

the chances for improving family functioning and

reducing the risk of neglect. Providing concrete,

measurable, and achievable goals with continuous

positive feedback will help families accomplish their

individualized outcomes and goals. Goals should

indicate positive behaviors or conditions that will

result from the change and not concentrate only on

reducing negative behaviors.

Once goals are identified, the next step is to break

them down into small, incremental tasks. These tasks

describe what the children, family, caseworker, and

other service providers will do and identify timeframes

for accomplishing each task. Families should be able

to understand what is expected of them and what

they can expect from the caseworker and other service

providers. Caseworkers should attempt to anticipate

potential obstacles to task performance and to devise

strategies for overcoming them.261

Targeting Outcomes

Outcomes should be targeted so that both the risks

and the effects of neglect are reduced due to changes

in the behaviors or conditions that contributed to

it. Outcomes should address issues related to four

areas—the child, the parents or other caregivers,

the family system, and the environment—and be

designed to contribute to the achievement of safety,

permanency, and family well-being.262

•

•

•

Child Neglect: A Guide for Prevention, Assessment, and Intervention 65

Child outcomes. Outcomes for children focus

on changes in behavior, development, mental

health, physical health, peer relationships, and

education. Examples of desired outcomes would

be improved behavior control (as evidenced by

managing angry impulses) or developmental

appropriateness and adjustment in all areas of

functioning (as evidenced by an improvement in

the child’s physical development within the range

of the chronological age).

Parent or caregiver outcomes. Outcomes for

parents or caregivers can focus on many areas,

such as mental health functioning, problem-

solving ability, impulse control, substance abuse

treatment, and parenting skills. A sample desired

outcome would be improved child management

skills, such as establishing and consistently

•

•

following through with rules and limits for

children.

Family outcomes. These outcomes focus on issues

such as roles and boundaries, communication

patterns, and the level of social support received.

A sample desired outcome would be enhanced

family maintenance and safety (as evidenced by

the ability to meet family members’ basic needs

for food, clothing, shelter, and supervision).

Environmental outcomes. These outcomes

focus on factors such as social isolation, housing

issues, or neighborhood safety. A sample desired

outcome would be utilizing social supports.264

Exhibit 6-2 provides some examples linking identified

problems to possible outcomes.

•

•

Goals Should Be SMART

Specific—The family should know exactly what has to be done.

Measurable—Goals should be measurable, clear, and understandable so everyone knows when they have

been achieved.

Achievable—The family should be able to accomplish the goals in a designated time period given the

resources that are accessible and available to support change.

Realistic—The family should have input and agreement in developing feasible goals.

Time limited—Time frames for goal accomplishment should be determined based on an understanding of

the family’s risks, strengths, and ability and motivation to change. The availability and level of services also

may affect time frames.263

66 Child Neglect Prevention and Intervention

Exhibit 6-2

Matching Risks to Outcomes265

Risk or Problem Desired Client Outcomes

Condemned housing (no heat or running water,

children diagnosed with lead poisoning, safety

hazards for young children)

Household safety

Financial management skills

Problem-solving skills

•

•

•

Acting out behavior (refusing to listen, throwing

temper tantrums, fights with peers)

Behavioral control

Social skills

Impulse control

•

•

•

Communication problems or conflicts (domestic

violence, parent-child conflict)

Conflict management skills

Decision-making skills

Impulse control

Family functioning

•

•

•

•

Frequent moves (in and out of placement,

numerous schools, numerous caregivers)

Financial management

Problem-solving skills

•

•

Parental addiction Recovery from addiction•

Inappropriately harsh parenting, inappropriate

expectations of children

Parenting knowledge

Emotional control

•

•

Fear of expressing feelings, verbally abusive, not

recognizing feelings of others

Communication skills

Empathy

•

•

Lack of social supports Supportive linkages with sources of formal and

informal support

•

For more on outcomes and interventions, see Child Protective Services: A Guide for Caseworkers at http://

www.childwelfare.gov/pubs/usermanual.cfm.

Child Neglect: A Guide for Prevention, Assessment, and Intervention 67

Tracking Family Progress

Determining the extent and nature of a family’s

progress is central to CPS intervention. Monitoring

change should begin as soon as the intervention is

implemented and continue throughout the life of a

case until the targeted outcomes have been achieved.

Caseworkers should evaluate family progress regularly

by following these steps:

Review the case plan. Outcomes, goals, and

tasks must be written so that they can be used

to determine progress toward reducing risk and

treating the effects of maltreatment.

Collect and organize information on family

progress. Once the case plan is established, each

contact with the children and family should focus

on assessing the progress being made to achieve

established outcomes and to reassess safety.

Collect information from all service providers.

Referrals to service providers should clearly specify

the number, frequency, and methods of reports

expected. The caseworker also must communicate

clearly any expectations for reporting concerns,

observable changes, and family progress. It is the

caseworker’s responsibility to ensure the submission

of these reports and to request meetings with the

service providers, if indicated.

Engage the child and family in reviewing

progress. Using the case plan as a framework

for communication, the caseworker should meet

with the family to review progress jointly. Family

members should be asked about their perceptions

of progress.

Measure family progress. Change is measured

during the evaluation of family progress on two

levels. The most critical risk factors (identified

during the family assessment) should be reassessed.

The second level of measurement evaluates the

extent to which specific outcomes have been

accomplished by the family, caseworker, and

service providers.

•

•

•

•

•

Document family progress. Thorough

documentation allows the caseworker to measure

family progress between the initial assessment

and the current evaluation. This documentation

provides the basis for case decisions.266

Analyzing and Evaluating Family Progress

Once the information has been collected, the

caseworker should analyze it to help determine

progress and to decide on further actions. The

evaluation of a family’s progress should address the

following issues:

Is the child safe? Have the protective factors,

strengths, or safety factors changed, thereby

warranting the development of a safety plan or a

change in an existing safety plan?

What changes have occurred in the factors

contributing to the risk of neglect?

What progress has been made toward achieving

the case goals and outcomes?

How effective have the services been in achieving

the outcomes and goals? Specific questions that

should be considered are:

Have services been provided in a timely

manner?

Has the family participated in services as

scheduled?

Has the service provider developed rapport

with the family?

Is there a need to alter the plan of service

based on changes in the family?

What is the current level of risk in the family?

Have the risk factors been reduced sufficiently

so that the parents or caregivers can protect their

children and meet their developmental needs,

allowing the case to be closed?

•

•

•

•

•

–

–

–

–

•

•

68 Child Neglect Prevention and Intervention

For children in out-of-home care, is reunification

likely in the required time frame, or is an alternate

permanency plan needed? 267

PROMISING PRACTICES FOR INTERVENTION

Several programs have shown promise in providing

effective interventions for reducing the risks and

effects of child neglect.

Family Connections Program

Family Connections in Baltimore, Maryland, was

designated by the Children’s Bureau as the only

nominated child maltreatment prevention program

proven effective by a rigorous evaluation (see

Emerging Practices in the Prevention of Child Abuse and

Neglect at http://www.childwelfare.gov/preventing/

programs/whatworks/report). Family Connections

targets families with children between the ages of 5

and 11 who are considered to be at risk for child abuse

and neglect, but have no current CPS involvement.

The program promotes the safety and well-being of

children and families by identifying and developing

formal and informal supports to address each family’s

individual needs and to build upon its strengths. Staff

members work with families on problem-solving,

positive disciplinary methods, coping strategies,

developmental social supports and community

connections, and opportunities for positive family

interactions through community activities.

• Evaluation results showed that children in 90 percent

of the at-risk families in the program served in 2000–

2001 were not suspected of being abused or neglected.

Other outcomes included:

A decrease in risk factors and an increase in

protective factors for neglect;

An increase in social support for caregivers,

caregiver satisfaction with parenting, and

appropriate parenting attitudes among

caregivers;

A decrease in caregiver stress, drug use, and

depressive symptoms;

A decrease in child behavioral problems.268

Nurse-Family Partnership

Nurse-Family Partnership (NFP) is a prenatal and

early infancy project that originated in Elmira, New

York and has been replicated in other cities. NFP

is one of the most well-known, evidence-based

programs addressing child neglect. The program

incorporated randomized clinical trials evaluating the

efficacy of intensive, nurse home-visitation during

pregnancy and the first 2 years of a child’s life. Initial

outcomes and analyses of a 15-year follow-up of

families who received home visitations indicated that,

in comparison to the control families, there was a 48

percent reduction in child maltreatment and a 59

percent reduction in arrests. Other program benefits

included better prenatal health and improved school

readiness.269

Although this study did not specifically target

neglect, the NFP project documented that providing

professional support in difficult transition periods

for high-risk families is an effective strategy for

developing family strengths and preventing negative

outcomes. Because of the encouraging findings, the

Office of Juvenile Justice and Delinquency Prevention

of the U.S. Department of Justice made NFP part of

its “Weed and Seed” Initiative. In 1999, the National

Center for Children, Families and Communities was

•

•

•

•

While listed in a U.S. Department of Health

and Human Services publication, a program or

organization’s inclusion does not in any way connote

its endorsement.

For more information on Family Connections, visit

http://www.family.umaryland.edu/community

_services/fc.htm.

Child Neglect: A Guide for Prevention, Assessment, and Intervention 69

established to disseminate the program nationwide.

Currently, more than 700 nurses participate in

NFP programs with more than 13,000 families in

approximately 250 counties.270 For more information

on NFP, visit http://www.nursefamilypartnerhip.

org.

Parent Empowerment Program

In 1996, the Child Protection Center of the Division

of Community Pediatrics at Montefiore Medical

Center in New York City initiated the Parent

Empowerment Program, a social support educational

intervention targeted to socially isolated and resource-

poor teen mothers in the South Bronx. The program

included a 6-month parenting group that focused

on accessing medical services and building a social

support system. Practices considered effective in this

program included home visitation that helped build

rapport between clinicians and the young women,

a flexible parenting skills curriculum that could be

modified to meet the pressing needs of program

participants, and the provision of immediate medical

and mental health services.271 For more information

on the Parent Empowerment Program, visit http://

montekids.org/programs/cpc.

Project SafeCare

From an ecobehavioral perspective, child neglect

is best addressed within the context of the family

environment. Project SafeCare has been tested

extensively to determine the key components of

effective intervention with parents at risk of child

maltreatment. The program is a modified version of

the model, Project 12-Ways. Whereas the original

project contained 12 areas of intervention, Project

SafeCare focuses on three areas that are particularly

relevant to neglect and young parents: home safety,

infant and child health care, and bonding and

stimulation.

The model, which involves 15 weeks of intervention

with 5 weeks concentrating on each area, is conducted

on a one-on-one basis with social workers or nurses

who often use videos. Parents are given instructions,

view modeling of various skills and activities, and

practice these skills with feedback from an in-home

counselor. Since child neglect often is associated with

dangerous or unclean conditions at home, parents are

taught about safety hazards, cleanliness, and creating

a safe and clean environment for infants and children,

including the use of latches and locks. They also are

taught specific tasks, such as recognizing when a child

is ill, seeking emergency treatment, calling the doctor,

and self-treating an illness. Project SafeCare also

trains parents to increase positive interactions with

their infants or children by learning skills to structure

activities and to plan stimulating play, interactions,

and daily living activities (e.g., bathing and dressing).

Program evaluation data have consistently shown

that families served by Project SafeCare are at lower

risk for recidivism during and after treatment than

matched comparison families who also are involved

with CPS agencies and who receive services other

than Project SafeCare.272 For more information on

Project SafeCare, visit http://www.cdc.gov/ncipc/

pub-res/parenting/ChildMalT-Briefing.pdf.

Head Start, Early Head Start, and the Early Head

Start/Child Welfare Services Initiative

Head Start (HS) is designed to foster healthy

development in low-income children. Program

grantees and delegate agencies deliver a range of

services that are responsive and appropriate to each

child’s and to each family’s heritage and experience and

that encompasses all aspects of a child’s development

and learning. For more information about Head Start,

visit http://www2.acf.dhhs.gov/programs/hsb.

Early Head Start (EHS) promotes healthy prenatal

outcomes, enhances the development of infants and

toddlers, and promotes healthy family functioning.

For more information about Early Head Start, visit

the Early Head Start National Resource Center at

http://ehsnrc.org/.

The Early Head Start/Child Welfare Services (EHS/

CWS) initiative provides a unique opportunity for

70 Child Neglect Prevention and Intervention

a select group of EHS grantees, in partnership with

their local CPS, to demonstrate how to serve children

in the child welfare system best using the Early Head

Start model. The EHS/CWS initiative was established

through a partnership between the Head Start Bureau

and the Children’s Bureau. The goal of EHS/CWS is

to expand the service network in local communities

so that it meets the needs of this unique population.

EHS/CSW target populations vary from site to site.

Some grantees serve infants and toddlers, while others

may target only infants or only toddlers. Programs

may also choose to focus on children in the child

welfare system who remain at home, but receive

ongoing services, children who were removed from

the home and placed in out-of-home care, or children

in the child welfare system because they are at-risk for

abuse or neglect. In addition, programs may choose

to focus on children whose parents have certain

problems, such as being incarcerated or being in a

substance abuse recovery program.

Although each grantee is developing its unique theory

of change and a locally designed evaluation, most

EHS/CWS projects are addressing outcome objectives

that include safety, permanency, and well-being for

children. Many of the grantees also have developed

evaluation plans to measure intermediate outcomes

that are expected to occur prior to these longer-term

outcomes. These include improved parenting skills,

parent-child interactions, and coping strategies for

dealing with stress.

While each of the grantees is expected to conduct

its own local evaluation and is being provided with

evaluation technical assistance, as necessary, the

Children’s Bureau is sponsoring an independent

evaluation of the initiative as well. For more

information about the EHS/CWS initiative, visit

http://www.ehsnrc.org/highlights/childwelfare.

htm.

Legal Intervention with Neglectful Families

The involvement of law enforcement and the courts occurs less frequently with neglectful families than in

cases of physical and sexual abuse and, therefore, is not always a key step. More often, the confrontation

that comes from the neglect report and the CPS investigation is sufficient to move the family toward

needed change.273 Legal intervention is sometimes necessary, however, to ensure the safety of the neglected

child and to bring about the needed changes in the family. Formal confrontation in court of the family’s

failure to meet minimally adequate standards of care may create the tension necessary to move the family

toward providing adequate care for the children.

CPS caseworkers must balance an official, authoritative stance with a helper role, which requires the

caseworker to incorporate the use of confrontation and challenging skills with empathy and supportive

help. A neglectful family must understand that the care of its child is unacceptable, yet still be encouraged

by the caseworker’s readiness to help them improve.

In extreme cases of child neglect, when persistent intervention efforts have failed to bring about a

minimally adequate level of care, and the family’s response offers little hope of providing adequate care,

court action to terminate parental rights is necessary to free the child for adoption or other permanent

placement. Termination proceedings in court require the CPS or foster care caseworker to be prepared

with factual observations, written documentation, and witnesses, if available, to convince the court of the

wisdom and justice of this action. The presumption in most juvenile and family courts is in favor of the

rights of the biological parent. Convincing evidence must be presented to prove that parental care is less

than minimally adequate, likely to remain so, and that adoption is the least detrimental alternative for the

child.274

Child Neglect: A Guide for Prevention, Assessment, and Intervention 71

CONCLUSION

Although child neglect is the most common type

of maltreatment, its causes, effects, prevention, and

treatment often are not as prominently discussed and

explored as are those for physical or sexual abuse.

Neglect, like other types of maltreatment, has many

contributing factors at the individual, familial, and

community levels. The complexities of neglect

present difficulties not only for an overburdened

child welfare system, but also for community- and

faith-based programs, researchers, legislators, and

other service providers. It is key, therefore, that these

groups work collaboratively to develop promising

and effective practices for preventing neglect and for

mitigating its effects on children and society. Part

of this process is providing individuals, families, and

communities with the knowledge, resources, and

services to deal with the challenges associated with

neglect. Child welfare agencies can only provide a

part of the solution. Neglect must be viewed not only

as an individual or a family problem, but also as a

community issue requiring a community response.