social work

Child Neglect

The “Neglect” of Neglect

 The concept of neglect has received little research attention until mid 1990s – despite being the most prevalent type of maltreatment substantiated by the Child Protective Services

 Reasons for the lack of attention: - Less “dramatic” than physical and sexual abuse - Intervention strategies are less clear-cut - The perception that it occurs in poor families only

 In recent years, more attention has been given to the concept of neglect by researchers, practitioners, and policymakers

Scope of the Problem  In 2011, an estimate of 3.4 million child abuse

referrals made involving over 6 million children  681,000 children found to be maltreated

 78.5% neglect  17.6% physical abuse  9.1% sexual abuse  10.3% “other,” including psychological maltreatment,

abandonment and congenital drug addiction  Estimated that less than one-third of cases reported  In 2011, it was reported that 1,545 children died

from abuse/neglect http://www.acf.hhs.gov/sites/default/files/cb/cm11.pdf

Neglect Definition  For years, a precise definition of child neglect has

been difficult to be agreed upon.

 Keeping Families and Children Safe Act of 2003, defined maltreatment as:

 “Any recent act or failure to act on the part of a parent or caregiver, which results in death, serious physical or emotional; harm, sexual abuse or exploitation, or an act or failure to act which presents an imminent risk of serious harm”

DCF Definition of Neglect  “Neglect is the failure, whether intentional or not, of the

person responsible for the child's care to provide and maintain adequate food, clothing, medical care, supervision, and/or education.

 A child may be found neglected who: 1. has been abandoned 2. is being denied proper care and attention physically, educationally, emotionally, or morally 3. is being permitted to live under conditions, circumstances or associations injurious to his well- being 4. is being abused.”

(Retrieved from http://www.ct.gov/dcf/cwp/view.asp?Q=316956&a=2556)

Defining and Measuring Neglect

 As other maltreatment types, the definitions of neglect are influenced by cultural values at a specific location and time period

 Several scales/questionnaires have been developed to assess child neglect. Early measures often lacked cultural competence and are now considered inaccurate

 Large variation still exists in the definitions of neglect across the U.S: such variation may influence the likelihood of timely response on the part of the Child Protective Services

Defining and Measuring Neglect

 Examples of variation across the states: - Alabama: “Neglect means negligent treatment or maltreatment of a

child, including the failure to provide adequate food, clothing, shelter medical treatment, or supervision”

- Arizona: “Neglect means: (1) The inability or unwillingness of a parent, guardian, or custodian of a child to provide

that child with supervision, food, clothing, shelter, or medical care if that inability or unwillingness causes unreasonable risk of harm to the child’s health or welfare (2) Permitting a child to enter or remain in any structure or vehicle in which volatile, toxic,

or flammable chemicals are found or equipment is possessed by any person for the purposes of manufacturing a dangerous drug (3) A determination by a health professional that a newborn infant was exposed

prenatally to a drug or substance…and that this exposure was not the result of a medical treatment administered to the mother or the newborn infant by a health professional (4) A diagnosis by a health professional of an infant under age 1 with clinical findings

consistent with fetal alcohol syndrome or fetal alcohol effects”

Defining and Measuring Neglect

 Only 24 states and the District of Columbia include educational neglect as part of their definitions of neglect

 Detailed definitions of medical neglect are provided by 11 states only; others may mention this concept in the statute without providing a detailed definition

 Some states do not include exposure to harmful substances during pregnancy as part of neglect

Types of Neglect  Physical Neglect  Medical Neglect  Educational Neglect  Emotional Neglect  Supervisory  Environmental  Emotional  Often occur together, and with other types

of abuse

Physical Neglect  Food, nutrition  Clothing  Shelter  Inadequate hygiene  Abandonment

 Not picked up within two days  Kicking child out of the home; leaving child

with various caregivers due to disinterest in caring for child

 Is it neglect if parents cannot provide for their child’s basic needs? If neglect is not intentional?

Medical Neglect  Immunizations and preventive care (e.g.,

dental)  Failure to seek timely medical/mental

health care  Failure to comply with medical/mental

health care  Is it neglect if recommended treatment is

refused because of religious beliefs?

Educational Neglect  Truancy  Failure to enroll a child in school  Refusing or not seeking needed special

education services  Is homeschooling a form of neglect?

Supervision Issues  Lack of supervision  Inappropriate caregivers  Exposure to hazards

 Guns, poisons, drug paraphernalia, second- hand smoke, unsanitary household conditions, car seats

 Is it neglect if cultural values support early responsibilities for children (e.g., leaving a toddler in the care of a 10-year-old)

Environmental Neglect

 Neighborhood factors  Do you consider this neglect? Who is

responsible?  Lack of safety

Emotional Neglect  Inadequate nurturing or affection

 Psychological unavailability can lead to deficits in multiple areas (e.g., attachment, language and cognitive development, motor skills)

 Exposure to extreme/chronic domestic violence

 Permitted drug or alcohol use  How bad does this have to be to be

considered neglectful?

Non-Organic Failure to Thrive  <5% in weight and height  Baby was once of normal weight and height  Delay in psychomotor development  Flat affect; passivity  Poor ability to suck  Lack of interest in food; vomiting  Unwilling to be held  Lack of eye contact  Delay in language

Psychosocial Dwarfism  Affects children 18 months to 16 years of age  Often associated with emotional deprivation  <5%ile in weight and height  Retarded skeletal maturation  Bizarre eating patterns (e.g., overeating, stealing,

hoarding)  Sleep problems and night wanderings  Hyperactivity  Extreme fatigue  Enuresis and encopresis  Delayed development

(e.g., speech, social skills)

Ongoing Problems  Poor motor skills, delays in language  Severe malnutrition may result in distended

stomach and emaciated limbs  Lack of medical care: routine and urgent care;

immunizations  Pediculosis (lice)  Academic problems: difficulty with advanced

conceptualizations and complicated instructions

 Impaired social skills; impulsiveness

Less Severe Outcomes  Self-stimulating and self-calming (e.g.,

rocking, thumb sucking)  Delayed cognitive development,

including expressive and receptive language

 Delayed social skills  Lack of prosocial behavior  Lack of delayed gratification due to

unpredictability  Others?

Signs of Possible Neglect  Wears dirty or inappropriate clothing  Shows poor hygiene; dirty or decaying teeth  Always seems hungry; hoards, steals or begs

for food; comes to school with little food  Often appears listless and tired  Frequently reports caring for younger

siblings  Unaddressed medical or

dental problems

Family Homelessness: Neglect?  Homeless families are approximately 1/3rd of

homeless population  More than one million children are homeless  On any given day, an estimated 200,000 children

have no place to live  Among all homeless women, 60% have children,

but only 65% live with at least one of their children  Should parents be charged with neglect if their

children are homeless? http://www.familyhomelessness.org/media/306.pdf

Family Homelessness: Neglect?  http://video.msnbc.msn.com/rock-

center/50020452#50020452  What are some of the causes of family

homelessness?  What is the impact on children?  What can we do?

http://www.familyhomelessness.org/media/306.pdf

Is Homelessness Neglect?  https://www.youtube.com/watch?v=dK_

RnxYdrqU

Causes of Neglect

 Economic causes: - Neglect may be a response to economic stress and poverty:

parents are unable to provide adequate care to their children - Studies support the association between neglect and

poverty; however, many poor parents do not neglect their children, while affluent parents may exhibit neglect - Additional factors appear to be at play

 Personality/individual causes: - Certain aspects of parental cognition and affective state

may contribute to the development of neglect - Substance abuse: research (as well as “practice wisdom”)

have shown that substance abuse is involved in many cases of neglect

Causes of Neglect

 Ecological model: - Risk factors at many levels of the system must be considered

(individual, family, neighborhood, cultural values, policies, etc.) - This model allows a comprehensive assessment of the family

and the environment, without placing excessive emphasis on one particular cause of neglectful behaviors - Strengths should also be assessed (at different levels of the

system) - Ecological model is widely used in Child Protective Services

when assessing neglectful parents

Neglectful Parents

 Parents are the most common perpetrators in confirmed cases of neglect; especially mothers

 Neglectful parents are often socially-isolated; have difficulties forming relationships and carrying out the tasks of everyday life. Many have unmet childhood needs

 Some have poor capacity for problem solving and goal-setting, as well as poor impulse control (these factors may also contribute to the association between neglect and poverty)

 Mental health and cognitive problems may be present among some perpetrators

Types of Neglectful Parents  Apathetic-futile: withdrawn; flat affect; appears to

have given up on life; lonely; stubbornly negative; concrete thinker

 Impulse ridden: low frustration tolerance; seeks immediate gratification, and puts own needs ahead of child’s

 Reactive-depressive: inability to cope with some stressor (i.e. birth of a child, partner leaving, death of a loved one)

 Two groups representing a small percentage of abusive parents: Mentally retarded parents need proper supervision and education, and Psychotic parents may be inconsistent due to delusional thinking and poor reality control

Neglectful Parents

 Not all neglectful parents have inherent personality deficiencies: some lack knowledge of proper care for their child (e.g. teen mothers)

 Environmental stress (e.g. poverty, domestic violence) and lack of social support can contribute to child neglect; in these cases, intervention strategies should target these contextual factors

 When assessing neglect, attention to a variety of aspects of the family environment are needed to avoid providing ineffective interventions (e.g. removing the child from home when education about adequate parental practices could have helped)

Neglect and Substance Abuse

 Research has shown that many cases of neglect involve substance abuse: - Prenatal substance use can cause numerous health problems

in infants (fetal alcohol syndrome, failure to thrive, growth retardation, etc.) - Later in life, substance abuse may cause parental inability to

perform daily tasks, including attending to children’s basic needs (food, clothing, clean living environment) - Intervention strategies with these parents must include

attention to their addiction problem

Brain Development  Changes in brain structures are due to

experience  In critical period, energy is high in infant

and parent for receptivity to each other’s cues  www.youtube.com/watch?v=HD3_nHXFkm

w  Secure and insecure attachment patterns

result in differences in brain development