Child Neglect: Current Definitions
and Models: A review of child neglect research, 1993_1998
Child Neglect: Current Definitions and ModelsA review
of child neglect research, 1993_1998 was prepared by Susan
Sullivan for the Family Violence Prevention Unit, Health Canada.
Également en français sous le titre La négligence
à l'égard des enfants : définitions et modèles
actuelsExamen de la recherche portant sur la négligence
à l'égard des enfants, 1993_1998.
The opinions expressed in this report are those of the author and
do not
necessarily reflect the views of Health Canada.
Contents may not be reproduced for commercial purposes, but any
other reproduction, with acknowledgements, is encouraged.
This publication may be provided in alternate formats upon request.
For further information on family violence issues, please contact:
The National Clearinghouse on Family Violence
Family Violence Prevention Unit
Health Issues Division
Public Health Agency of Canada (PHAC)
Health Canada
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© Her Majesty the Queen in Right of Canada, 2000
Cat. H72-21/171-2000E
ISBN 0-662-28466-6
Child Neglect: Current Definitions and Models
Table of Contents
Table of Contents
Introduction 1
A Brief History of Child Maltreatment Research 2
Defining Child Neglect 7
Severity of Consequences 10
Chronicity of Neglect 11
Race, Culture, and Community 11
Forms of Neglect 15
Physical Neglect 15
Emotional Neglect 17
Failure to Thrive (FTT) 18
Other Forms 21
Models of Child Maltreatment 23
Medical_Diagnostic 23
Sociological 24
Legal 24
Ecological 24
Developmental_Ecological 25
Parent-Focused Vs. Child-Focused 26
Assessment Tools 28
i
Table of Contents
Causes/Risk Factors 31
Limitations of the Research 31
Personalistic Causes: Gender 33
Personalistic Causes: Mental/Psychological 34
Personalistic Causes: Substance Abuse 37
Personalistic Causes: The Child 37
The Cycle Theory: Intergenerational Transmission
of Maltreatment 39
Economic Causes: Poverty 41
Environmental Causes: Multiple Pathways 45
Environmental Causes: Social Isolation 45
Environmental Factors: Culture 47
Effects of Neglect 49
Prevention and Treatment 53
Conclusion 61
Appendix A: Child Neglect Index 67
Appendix B: List of Acronyms 71
Bibliography 73
ii
Child Neglect: Current Definitions and Models
Introduction
Introduction
Child Neglect: Current Definitions and ModelsA review of
child neglect research, 1993_1998 was produced by the Public Health Agency of Canada's
Family Violence Prevention Unit (FVPU) of the Centre for Healthy and
Human Development. Through the FVPU, Health Canda leads the Family
Violence Initiative (FVI), and coordinates the relevant activities
of 13 federal departments and three central agencies. Under the current
FVI, Health Canada remains committed to addressing family violence
issues, including all forms of child abuse.
In October 1998, the FVPU invited Canadian experts in child abuse
issues to meet to help Health Canada and its partners set future
directions in preventing child abuse. One of the more pressing areas
that the committee recommended be researched was the issue of "neglect."
Dr. Paul Steinhauer, renowned for his work in this field, emphasized
the importance of "neglect" especially in the early years
of child development.
Infant's brains are immature at birth and do not reach full maturity
until the age of two. This is an extremely sensitive and critical
period in the child's development. During this period, certain areas
of the brain show heightened sensitiv
ity to stimulation. Severe or chronic neglect also does long term
damage to brain development with the result being lifelong changes
to the individual's ability to regulate thought, emotions, and behaviour.
In Canada, the definitions of abuse and neglect differ among jurisdictions.
In undertaking the Canadian Incidence Study on Reported Child
Abuse and Neglect, a multi-stage survey design was used because
there is a broad array of agency information, variations in definitions
of child abuse and neglect, and inconsistent file recording standards.
This document builds on past work and complements current activities
in the area of child neglect.
This report summarizes research definitions and child welfare models
for the prevention and treatment of child neglect. The review was
limited to relevant research published between 1993 and 1998. Issues
related to child neglect reveal interesting insights into the current
challenges facing child welfare practitioners and researchers in
Canada.
The FVPU has prepared a companion document to this report, Child
Neglect: Promising Approaches, which will be an overview of
current child welfare legislation, prevention, intervention, and
treatment programs.
1
Introduction
The problems identified and the solutions proposed are varied. A lack
of consensus and confusion over definitional issues predominates and,
as a result, the research tends to be fragmented and sometimes contradictory.
As several reviewers have already noted, many of these difficulties
are typical of the study of child maltreatment in general. Human behaviour
and development are complex and many issues remain mysteries to the
research community.
To better understand how we arrived at the current situation, a
short review of the past is illustrative. A Brief History of
Child Maltreatment Research
Douglas Barnett et al. (1993) described the American experience:
In an effort to deter economic destitution, separation of poor
children from their families was encouraged prior to the 20th century.
In these cases, parents were thought to promote poverty and dependency
in their children through their examples of "laziness."
These ethics were slow to change. Not until the turn of the current
century were distinctions made between neglectful parents and impoverished
parents (p. 11).
In Canada,
[T]he category of neglect owes its existence to a set of class
relations that allowed middle class reformers in the earlier stages
of industrial capitalist development to apply legal sanctions to
particular parents who occupied marginal positions vis-à-vis
the larger economy. Reformers viewed these marginalized families,
which were often headed by women, as unproductive, and they saw
in them two potential threats, about which they were explicit. One
was fear of the "contamination" of their own children
via exposure to the children of these families in the school system.
The second was concern about the potential long-term expense to
society of citizens poorly fitted out for productive membership
in the labour force. Child welfare legislation provided the grounds
for intervention into and rearrangement of these families, while
simultaneously preserving the ideal of the private home and family
for those who conformed to their own beliefs and standards (Swift,
1995a, p. 85).
A social reform movement in the 1880s and 1890s addressed itself
to the issue of improving living conditions for deprived children.
One result of this movement was the establishment of the first Children's
Aid Society in Canada, which was founded in Toronto in 1891.
2
Child Neglect: Current Definitions and Models
Two years later came the passage in Ontario of legislation specifically
addressed to the prevention of cruelty to and better protection of
children. This Act became the basis for later legislative views of
the issue of child neglect. The Act defined a neglected child in these
ways:
A child who is found begging or receiving alms.
A child who is found wandering about without any home or
proper guardianship.
A child who is found associating or dwelling with a thief,
drunkard, or vagrant, and growing up without salutary parental control.
A child who is found in any house of ill-fame or the company
of a reputed prostitute.
A child who is found destitute, being an orphan or having
a surviving parent undergoing punishment for crime.
(Swift, 1995a, p. 41)
Swift pointed out that this early definition addresses evidence
of poverty, the need to care for the child, and moral issues concerning
the activities of caretakers and guardians. According to American
researchers Rose and Meezan (1993), the moral aspect of child neglect
has become less important over time (Swift, 1995a, p. 41).
Child neglect was the original concept behind Canadian child welfare
legislation. Swift noted:
[I]t remained the primary organizing idea in child welfare work
until the 1960s. With the publication of work by Kempe et al. (1962)
on "the battered child syndrome," neglect began to assume
a lower profile as the public and social workers responded to this
far more dramatic idea of maltreatment. The identification of the
"syndrome," according to Hutchinson (1990) accounted for
quick passage of extra funding and mandatory reporting requirements
in the United States, with Canadian jurisdictions following suit.
This narrow definition of child maltreatment was soon broadened
to include aspects of neglect, which then reappeared as subcategories
of abuse.... The subsuming of neglect into abuse also reflects a
repriorization of problems in the daily practice of child welfare
work (Swift, 1995a, p. 43).
The "subsuming of neglect into abuse" is described by
Rose and Meezan (1993):
All child maltreatment was considered as a single phenomenon until
1964, when Leontine Young published her landmark study of families
known to child welfare agencies. Young attempted to make clear distinctions
between abusive and
neglectful parents using three factors: interpersonal traits, the
intent of the parent to maltreat a child, and the effects of maltreat
3
Introduction
[J]ournals covering child maltreatment include few articles on child
neglect; in 1993, 6% of the papers in Child Abuse and Neglect were
on neglect. Also, in 1993, fewer than 2% of federally funded research
studies on child maltreatment focused on child neglect (Interagency
Research Committee, 1994) (Dubowitz, 1994, p. 556).
In both Canada and the United States, child protection services
have been struggling to cope with a dramatic increase in the demand
for services, believed to be due largely to heightened public awareness
of maltreatment issues resulting in more reporting of suspected
cases of child maltreatment to authorities in the 1980s and 1990s.
One way in which it appears that increased demand has been dealt
with in the United States is a narrowing of the definition of child
neglect. According to Dubowitz (1994, p. 556), it appears that child
neglect is not a clinical priority and except for very severe or
life-threatening cases, it is screened out at intake by overburdened
child protection services.
However, the most recent national incidence statistics in the United
States appear to contradict this view. The U.S. Third National
Incidence Study of Child Abuse and Neglect (NIS-3) notes that
the 1993 study found large increases in the number of children suffering
from emotional neglect and physical neglect compared with the 1986
study, NIS-2.
The estimated number of children who suffered Harm Standard emotional
neglect in 1993 was
ment. She concluded that neglect was distinguishable from abuse
and conceptualized it as a failure by emotionally needy mothers
to provide adequate care (however unintentional) (Rose & Meezan,
1993, pp. 280_281).
Wolock and Horowitz coined the phrase "the neglect of neglect"
in 1984 and discussed the inattention to child neglect by both professionals
and the media. The reasons that have been cited for this inattention
to child neglect follow:
1. Some believe that neglect
does not result in serious consequences.
2. Many may feel that it is inappropriate to judge parents involved
in poverty-related neglect.
3. Many may be reluctant to become involved in child neglect because
the problem seems insurmountable.
4. Some may find other forms of maltreatment more compelling.
5. Ambiguity and vagueness regarding what constitutes neglect cause
confusion.
6. Child neglect provokes negative feelings.
(Dubowitz 1994) (O. Barnett et al., 1997, p. 109).
The neglect of neglect, while now a cliché, is still true.
4
Child Neglect: Current Definitions and Models
four and one-third times higher than the 1986 estimate. (There was
a 333% increase from the NIS-2 estimated total of 49,200 children
to the NIS-3 estimate of 212,800.) This means that children were at
four times higher risk of this maltreatment in 1993 compared with
their risk in 1986. (There was a 300% increase in the incidence rate.)
At the same time, the number of physically neglected children who
fit the Harm Standard criteria more than doubled, from 167,800 in
the NIS-2 to 338,900 in the NIS-3 (a 102% increase), and there was
an 85% increase in the risk rate per 1,000 for this type of maltreatment.
The only neglect category under the Harm Standard that failed to demonstrate
change since the last NIS was educational neglect.... When the NIS-3
incidence figures are compared with the incidence of Harm Standard
neglect at the time of the NIS-1 [1980], all three types of neglect
exhibit significant increases (Sedlak & Broadhurst, 1996, pp.
3-10_
3-11).
Even less clear are the trends in the Canadian statistics. "In
most Canadian jurisdictions, official statistics on reported child
neglect do not exist" (Trocmé, 1996, p. 152). The federal
government, in concert with the provinces and territories, has begun
to address this gap in knowl
edge by initiating the Canadian Incidence Study of Reported Child
Abuse and Neglect. Until the study reports its findings, however,
Canadian researchers rely on the limited statistics available in
this country and theorize what trends might be evident here.
Recent research confirms that neglect cases remain the largest
single category of cases processed in Canadian child welfare offices
(Trocmé et al., 1994; Federal-Provincial Working Group, 1994)
(Swift, 1995a,
p. 67).
Statistics collected in Quebec in 1991 found the following proportions
among 12,256 retained cases: 77% were
neglect, 10% were physical abuse, and 13% were sexual abuse. The
United States has reported similar statistics, although with a higher
proportion of neglect cases among all cases of child maltreatment.
Among the cases of physical abuse and neglect cases reported to
the New York State Central Registry of Child Abuse in 1988, 93%
were for child neglect (Palacio-Quintin et al., 1993, p. 154).
In the United States, the definition of child neglect has become
narrower since 1980, according to Giovannoni (1993). She noted that
neglect currently comprises about 50% of child maltreatment reports
in the United States, compared to about 80% of reports 15 years
ago (p. 8). According to the 1988 U.S. National Incidence Study,
almost 43% of identified neglect
5
Introduction
was physical neglect, 36% was inadequate supervision and 20% was failure
or delay in providing health care (Gaudin, 1993a, p. 6).
Based on a 50 state survey of CPS [child protection services] agencies
in the US, an estimated 2.7 million children were reported as victims
of child abuse and neglect in 1990. Of those, approximately 45%
were reported for neglect, as compared to 25% for physical abuse,
16% for sexual abuse, 6% for emotional maltreatment (some of whom
experience
emotional neglect), and 8% for "other" forms of maltreatment
(NCCAN, 1992). Approximately 40% of reported neglect cases are substantiated
(Erickson & Egeland, 1996,
p. 8).
The wide variation in statistical trends and the facility with
which agencies may broaden or narrow assessments of child neglect
can be attributed to a host of definitional issues confronting child
neglect research and intervention.
6
Child Neglect: Current Definitions and Models
Defining Child Neglect
Defining Child Neglect
Issues related to definition dominate child neglect research. Defining
neglect is complex and requires an awareness of social, political,
and economic influences and perspectives, as well as an understanding
of scientific knowledge regarding human development and psychology.
Research knowledge bases change over time and it is well recognized
that our present understanding of human behavioural processes is incomplete.
Therefore:
Definitions of child abuse and neglect are not static phenomena,
nor do they reflect issues that will be resolved in the decades
to come (D. Barnett et al., 1993, p. 16).
Definitions influence the way the issue of child neglect is conceptualized
for research, reporting, understanding the causes, and formulating
intervention and prevention strategies. As with other forms of child
maltreatment, child neglect research has many grey areas, characterized
by a widespread lack of consensus. On the "front lines"
of child welfare practice, workers probably do not have much time
to indulge in scho-
larly debates about definition. By virtue of necessity, they frequently
rely on personal discretion and professional judgement.
In fact, there appears to be some impatience with definitional
matters:
After many years of professional involvement in working with emotionally
abused and neglected children and their families the author became
convinced that the term "maltreatment" is the most appropriate
to describe all forms of child abuse and neglect.... [T]endencies
among professionals to compartmentalize aspects of the problem and
place them in watertight compartments create their own problems,
as there are more similarities than differences in the various characteristics
and manifestations of abuse (Iwaniec, 1995, p. 189).
In reality, however, human processes are complex and our understanding
of the causes and effects of certain behaviours changes over time.
The "neglect of neglect" is seen in part as a result of
a lack of definitional clarity and encourages the tendency of researchers
to confound child abuse and child neglect. Most researchers indicate
that abuse and neglect are distinct forms of child maltreatment
and that there is a growing consensus that each requires specific
and different interventions to
7
Defining Child Neglect
treat the effects and to prevent the maltreatment from happening in
the first place or from reoccurring.
Increasingly, researchers are trying to differentiate between abuse
and neglect and to better define the terms used in the field of
child welfare in order to further the understanding of child maltreatment
in general. Definitional clarity is needed, especially since child
welfare and child protection services involve practitioners and
researchers from a variety of backgrounds, disciplines, and perspectives.
Child welfare's definitional issues are operationa-lized on a daily
basis by police, pediatricians, legislators, and child protection
workers. In addition, the system has considerable power over the
families involved with child protection services. Not everyone is
comfortable with having children removed from their homes based
on a child welfare worker's personal judgement about a parent's
suitability or a subjective interpretation of "neglect."
To implement the public agenda of protecting children from harm,
definitional specificity has become increasingly necessary for making
systematic and relatively objective decisions about when intervention
into family life is warranted
(D. Barnett et al., 1993, p. 8).
Some current definitions of child neglect follow:
A condition in which a caretaker responsible for the child, either
deliberately or by extraordinary inattentiveness, permits the child
to experience avoidable present suffering and/or fails to provide
one or more of the ingredients generally deemed essential for developing
a person's physical, intellectual, and emotional capacities (Gaudin,
1993a, pp. 3_4).
Child neglect is the term used most often to encompass parents'
or caretakers' failure to provide basic physical health care, supervision,
nutrition, personal hygiene, emotional nurturing, education, or
safe housing. It also includes child abandonment or expulsion, and
custody-related forms of inattention to the child's needs (Gaudin,
1993b, p. 67).
There are parents who continually fail to provide for their children's
needs, and usually in many ways. These failures eventually affect
the child's health and/or development adversely. Characteristically,
these parents do not feel guilt over their omissions, and often
simply fail to recognize the harmful consequences of the chronic
neglected state of their children (Hall et al., 1982, p. 6), (Swift,
1995a, pp. 70_71).
8
Child Neglect: Current Definitions and Models
In effect, neglect is a residual category composed of all instances
of child maltreatment other than those explicitly
defined as sexual, physical, and emotional abuse. The limit of the
concept is delineated by the presence of a real or implied choice
on the part of the caregiver. If the harm to the child occurs because
of circumstances which are external to the caregiver's control it
is not a situation of neglect although it may well be a situation
which results in harm to the child
(Reid et al., 1994, p. 12).
Generally, child neglect means the failure of a parent or a caretaker
responsible for the child's care to provide minimally adequate food,
clothing, shelter, supervision, and/or medical care for the child.
Defining "minimally adequate" levels of care, and reaching
consensus on these definitions, however, are not easy processes
(Gaudin, 1993a, p. 1).
Zuravin (cited in Nelson, Saunders, and Landsman, 1990) after analyzing
definitional issues of neglect, concluded that most definitions
agree it is an act of omission "judged by a mixture of community
values and professional expertise to be inappropriate and damaging"
and as "failure to perform parental duties related to supervision
and physical needs of the child" (Downs et al., 1996, p. 182).
Giovannoni (1993) noted that in practical social policy terms,
child neglect is "behaviour by parents or responsible caretakers
that warrants
intrusion into the family's
privacy and autonomy, and
the expenditure of social
resources to remedy the
behaviour."
(p. 8)
Numerous definitions of child neglect have been proposed by researchers
and practitioners. The definitional debates spring from the lack
of consensus on answers to the following questions:
What are the indispensable, minimally adequate types of
care that children require?
What actions or failures to act on the part of the parents
or other caretaker constitute neglectful behaviour?
Must the parents' or caretaker's action or inaction be intentional,
willful or not?
What are the effects of the actions or inactions on the
child's health, safety, and
development?
Is the family's situation a result of poverty, or a result
of parental neglect?
(Gaudin, 1993a, p. 3)
The last question reflects one of the major controversies surrounding
current conceptualizations. As articulated by Giovannoni in 1982,
"Is `it' poverty or is `it' psychopathology?" (Swift,
1995, p. 88)
9
Defining Child Neglect
Does neglect arise from the conditions associated with poverty or
is it the result of personal characteristics of the "child's
prime caregiver" (which in the reality of child welfare research
almost always means "mother")? Researchers cannot agree
and this question has been the subject of debate in Canada and the
United States for over a hundred years.
There is undisputed evidence that the incidence of neglect is more
prevalent in areas of extreme poverty. Some researchers note that
not all children living in such conditions are neglected, however,
and they conclude that poverty may contribute to neglect, but it
does not define it.
Pelton (1997), on the other hand, pointed out "that child
neglect usually has multiple causes and, like accidental injury,
is strongly related to low socio-economic status. Most injuries
to children in child protection cases are not intentional. The emphasis
on parental responsibility and on child protection laws, policies,
and practices has contributed to excessive placement of children
in foster care and to insufficient emphasis on directing resources
toward remedying dangerous conditions and poverty associated with
unintentional injuries and severe harm" (p. 7). Severity
of Consequences
Legal advocates insist on clear evidence of serious harm before
court intervention. Research indicates that
when child welfare workers are determining whether abuse or neglect
exists in a particular situation, the actual focus is on parental
omissions in care that are likely to increase the risk of harm to
the child.
In a study published in 1979, Giovannoni and Becerra examined the
views of both professionals and lay people in response to vignettes
of parental care. They found that the main criterion used in defining
whether abuse or neglect existed was the seriousness of impact upon
the child, and that this criterion was fairly consistent across
groups. Trocmé and Tam's research (1994, p. 16) supported
this view, showing increased likelihood that a case will be substantiated
if "the presence of any form of harm or risk of harm"
to a child is shown (Swift, 1995a, p. 70).
A given behaviour can be interpreted as neglectful or not depending
on the severity of the consequences to the child, the duration and
frequency of neglect, as well as the cultural context in which the
behaviour occurs
(O. Barnett et al., 1997, p. 110).
Crouch and Milner (1993) argued that severity is an important but
overlooked variable. Severity is typically assessed according to
the magnitude of outcomes to children or the degree of demonstrable
harm.
Some negative outcomes are difficult to measure, such as emotional
consequences. Some consequences are neither immediate nor short
term.
10
Child Neglect: Current Definitions and Models
Thus, in 1988 the Department of Health and Human Services (DHHS) added
"endangered" as a category for children who demonstrated
no present evidence of injury but for whom future risk of injury is
a reasonable risk. One difficulty in considering potential harm is
predicting the likelihood that harm will actually occur and whether
that potential harm is significant (O. Barnett et al., 1997, p. 110).
Chronicity of Neglect
Research indicates that frequent and repeated deficits in child
care are more likely to be considered neglectful. Dubowitz, DHHS,
and Zuravin have argued that frequency and chronicity should be
evaluated in the context of the severity of harm involved in a particular
act, as a single omission can have serious consequences and "an
omission in care that harms or endangers a child constitutes neglect,
whether it occurs once or a hundred times" (Dubowitz, Black,
Starr, et al., 1993) (O. Barnett et al., 1997, p. 111).
Chronically neglectful families are typically multi-problem families
with pervasive deficits in knowledge, skills and tangible resources,
whereas nonchronically neglectful families have experienced recent
life crises that have overwhelmed normally sufficient coping strategies
(Gaudin, 1993b, p. 68).
Dubowitz et al. (1993) noted that although estimates of severity
are typically based on the degree of harm
involved, this is not always immediately apparent and/or easy to
assess. Potential harm is more controversial than actual harm and
professionals have been reluctant to rate a situation as maltreatment
unless actual harm was evident (Gelles, 1982) (Dubowitz et al.,
1993, p. 17).
According to Dubowitz et al. (1993), research has demonstrated
long-term psychological harm resulting from neglect and, given that
human nature and life inevitably involve some degree of risk taking,
it makes little sense to see every instance of potential harm as
neglect. Helping families minimize risks is important and potential
harm should be included in a definition of neglect (p. 17). Race,
Culture, and Community
Zuravin et al. (1996) have noted that most current definitions
of child neglect contain an element (recognized or not) of cultural
values. As newer conceptual models tend to acknowledge the existence
of different cultural and social values in both Canada and the United
States, researchers have tried to identify and classify some of
these differences. It should be noted that researchers have stressed
the methodological limits and potential biases in this early research
and have cautioned readers about drawing sweeping conclusions from
the following, somewhat limited, results.
In an effort to determine how cultural and community values might
vary, Polansky compared perceptions of
11
Defining Child Neglect
White and Black, working class and middle class, and rural and urban
mothers and reported significant differences in conceptions of child
neglect. Urban mothers appear to be more concerned with psychological
care, while rural mothers placed more emphasis on physical care. Working-class
mothers were more apt to see physical neglect, whereas middle-class
mothers stressed psychological neglect. Black mothers reported slightly
higher levels of concern regarding incidences of neglect than White
mothers (Rose & Meezan, 1993, p. 286). Similarly, research cited
by Becker et al. (1995) and by Rose and Meezan (1993) also found ethnic
differences: Blacks appeared more concerned than Hispanics who appeared
more concerned than Whites.
Rose and Meezan (1996) explored the perceptions of the seriousness
of specific components of neglect held by mothers from three cultural
groups (Caucasian, African-
American, Latino) with public child welfare workers in Chicago.
Their findings suggest "that members of minority groups perceive
some types of child neglect as more serious than child welfare workers
and workers of all types see neglect as less serious than the mothers"
(p. 140). This led Rose and Meezan (1996) to make the following
conclusion:
The findings of the study seem to suggest that the practice of
hiring investigators who lack social work backgrounds in the
protective service system should be reviewed.... They view child
neglect incidents as significantly more serious than do service
workers, and seem to operate with a broader definition of child
neglect than their service worker counterparts. Their behaviour
may thus be contributing to the current overload of the child protection
services system (p. 157).
Knudsen pointed to the significance of community perceptions of
child neglect since it "is primarily nonprofessionals who identify,
and thereby define, what events constitute child maltreatment."
In addition, Knudsen and others noted that approximately one third
to one half of all reports to child protection services by lay people
are considered founded reports of maltreatment (Barnett et al.,
1993, p. 25).
Dubowitz et al. (1998) compared views on child neglect among
African-American and White community members of middle and low socio-economic
status and with child maltreatment professionals' views. There were
small but significant differences: both middle-class community groups
expressed greater concern for psychological care than the lower-class
African-American group. Both groups of African-Americans were more
concerned than Whites about physical care.
Overall, there is considerable agreement among the commu
12
Child Neglect: Current Definitions and Models
nity samples in their views of what circumstances are harmful to children;
professionals in the field appear to have a higher threshold for concern
(p. 235).
Discussion of race and culture in research conducted in other countries
may be of limited application to the Canadian situation. However,
child welfare in Canada has been marked by unique cultural biases.
As Swift (1995a) has noted, child welfare is
...a system well suited to keeping order, the order required for
existing power and economic relations to be maintained, and child
neglect is a concept well suited to justifying processes through
which order is maintained. Child welfare is not, however, a system
well suited to meeting the needs of Aboriginal people; surely several
decades of destructive outcomes resulting from our efforts provide
sufficient evidence of this. Nor is neglect a
category that actually serves Aboriginal people or saves Aboriginal
children, although it may appear this way in individual cases. Child
welfare work with Aboriginal people, in fact, illustrates very well
the way Althusser's concepts of repressive and ideological apparatuses
operate in concert to produce desired effects, purposes captured
in the phrase "teaching Mom a lesson." Bureaucratic processes
work simultaneously to produce the appearance of equal treatment
and "business as usual" for workers in the system. Workers
apply the schema of neglect in more or less the same way to specific
families and, most of the time, are unable to see beyond their own
fragmented work processes to observe the part this classification
process plays in the subjugation and racialization of the whole
group (pp. 147_148).
13
14
Child Neglect: Current Definitions and Models
Forms of Neglect
Forms of Neglect
Physical Neglect
Different researchers have proposed a wide range of different subtypes
of child neglect. Rose and Meezan, and Swift have noted that until
recently, physical neglect predominated as the first concern. Swift
(1995a) commented:
This concern is mirrored in practice; as we will see, it is usually
the traditional physical signs of neglect that predominate in both
case records and in workers' talk about neglect
(p. 72).
In the United States, state legislation "solidified the idea
that the lack of adequate food, clothing, shelter, medical care
and supervision, or abandonment were the cornerstones of a definition
of neglect." Specific references to emotional well-being were
not included in the legislative definitions of neglect until the
early 1970s (Rose & Meezan, 1993,
p. 281). This appears to be similar to the Canadian experience.
The following are some examples
of the different categories of child neglect that have been used
by
researchers in the past 20 years:
Becker et al. (1995) noted that Giovannoni and Becerra divided
neglectful behaviours into four categories:
educational neglect
abandonment
failure to provide
fostering delinquency
(p. 29)
Becker et al. (1995) further noted
K. Miller's four classifications of neglect:
educational neglect
medical neglect
intentional drugging
abandonment
(p. 29)
These subcategories of neglect were suggested by Falconer and Swift:
physical
medical
education
supervision and guidance
abandonment
(Swift, 1995a, p. 72)
Zuravin and Taylor later proposed eight categories of neglect:
lack of physical health care
lack of medical health care
15
Forms of Neglect
inadequate supervision
child abandonment
shelter hazards
lack of household sanitation
lack of hygiene
lack of nutrition
(Crouch & Milner, 1993, p. 50)
Daro listed the following as typologies of neglect:
physical neglect
deprivation of necessities
educational neglect/deprivation
medical care neglect
intentional drugging
abandonment/lack of
supervision
failure to provide
fostering delinquency
(Becker et al., 1995, p. 29)
Hegar and Yungman proposed three main categories of neglect:
Physical deprivation of basics, such as clothing,
shelter, hygiene
Developmentaldeprivation of experiences necessary
for growth and development, including supervision, education, medical
and mental health care
Emotionalincludes
a) General emotional neglect: parental incapacity to recognize
the child's need for attention, security, self-esteem, and to recognize
emotional needs
b) Non-organic FTT (failure to thrive)
(Palacio-Quintin & Éthier, 1993, pp. 155_156)
According to O. Barnett et al., 1997, at least 11 subtypes of neglect
have been "consistently described":
health care neglect
personal hygiene neglect
nutritional neglect
neglect of household safety
neglect of household
sanitation
inadequate shelter
abandonment
supervisory neglect
educational neglect
emotional neglect
fostering delinquency
(p. 112)
The current definition of child neglect used by the U.S. Department
of Health and Human Services when conducting national incidence
studies of child maltreatment is probably the most well-known categorization
in North America. Gaudin (1993) reported that the subcategories
of neglect, according to the second National Incidence and Prevalence
of Child Abuse and Neglect Study, are
Physical neglect:
refusal of health care
delay in health care
abandonment
16
Child Neglect: Current Definitions and Models
expulsion
other custody issues
other physical neglect
Supervision:
inadequate supervision
Emotional neglect:
inadequate nurturance/affection
chronic/extreme abuse or
domestic violence
permitted drug/alcohol abuse
permitted other maladaptive behaviour
refusal of psychological care
delay in psychological care
other emotional neglect
Educational neglect:
permitted chronic truancy
failure to enrol or other truancy
inattention to special education need
It is notable that "excluded from these definitions are cases
where the parent was financially unable to provide reasonable safe,
hygienic living conditions" (Gaudin, 1993a,
p. 6).
According to the 1988 U.S. National Incidence Study (NIS-2),
almost 43% of identified neglect was physical neglect, 36.6% was
inadequate supervision, and 20.8% was failure or delay in providing
health care (Gaudin, 1993a, p. 6). Emotional Neglect
Despite the apparently few substantiated reports of emotional neglect
in the United States, Swift noted that "emotional issues have
begun to take the stage in recent years" (1995a,
p. 72). The greatest disagreement exists over emotional neglect.
Although most experts agree on broad conceptual parameters of emotional
neglect that include failure to provide support, security, and encouragement,
they disagree on the operationa-lization of such behaviours
(O. Barnett et al., 1997, p. 112).
Emotional neglect is specifically mentioned in child protection
legislation in some North American jurisdictions. According to Rose
and Meezan (1993), its inclusion was based on the assertion that
a child's early emotional care affected later behaviour and psychological
adjustment (p. 283).
Garbarino, Guttman and Seeley used multi-dimensional scaling with
a combination of categories of psychological abuse and neglect to
identify and empirically define five distinct subtypes of psychological
maltreatment. The five subtypes are spurning, terrorizing, isolating,
exploiting/corrupting, and denying emotional responsiveness. However,
this definition has not yet been universally accepted in the field
of maltreatment (Becker et al., 1995, p. 28).
17
Forms of Neglect
Swift reported that emotional
neglect
...is an extension or replacement of moral neglect, according to
Gordon, but a more "psycholo-gical and scientific" category
than moral neglect. The term "emotional neglect" has been
in use by social workers since the 1950s, was codified by 1960,
but has eluded the specificity required for wide legal usage (Gordon,
1988, p. 162). Polansky et al. brought emotional neglect to the
forefront as a child welfare issue in the Childhood Level of Living
(CLL) Scale [a tool used to assess the existence of child neglect];
36 per cent of the items in this measure concern emotional or cognitive
care of children (Gordon, 1988, p. 163) (Swift, 1995a, p. 72).
The lack of definitional clarity and overlap that characterizes
neglect in general is amplified within discussions of emotional
neglect in particular (or "psychologically unavailable parenting"
as Erickson and Egeland [1996] refer to emotional neglect). If Reid
et al. (1994) are right in saying that "[i]n effect, neglect
is a residual category composed of all instances of child maltreatment
other than those explicitly defined as sexual, physical and emotional
abuse" (p. 12), then perhaps the reason why so many seemingly
disparate typologies get lumped under the heading of "emotional
neglect" is that it is the
residual form within a residual
category. For example, O. Barnett et al. (1997, p. 112) noted considerable
overlap between definitions of emotional neglect and psychological
maltreatment.
One attempt to define emotional neglect refers to it as
...the passive ignoring of a child's emotional needs; to lack of
attention and of stimulation; and to parental unavailability to
care, to supervise, to guide, to teach, and to protect.... Emotional
neglect more often than not originates from parental unawareness
and ignorance, depressive moods, chaotic life-styles, poverty, lack
of support, and lack of appropriate child-rearing models (often
based on parental childhood experiences), unwittingly impairing
child-development and well-being (Iwaniec, 1995, p. 5). Failure
to Thrive (FTT)
Many terms used in discussions of child maltreatment are either
poorly defined or very fluid. An illustration of the kind of confusion
that can result is reflected in an examination of the research literature
on "failure to thrive" (FTT).
FTT syndrome has been defined as delayed physical growth due to
inadequate emotional care; however, this is difficult to prove empirically
and the definition is not universally accepted (Rose & Meezan,
1993,
pp. 282_283).
18
Child Neglect: Current Definitions and Models
Failure to thrive (FTT) refers to chronic, severe, undernutrition
of an infant. Medical staff may diagnose FTT if the infant's weight
is 20% below the ideal weight for the infant's height. Poor weight
gain over time is another indicator of FTT. Thirty per cent of FTT
cases have an organic cause. Fifty per cent are due to extreme neglect
and dysfunctional mothering, and the rest are caused by errors in
formula preparation or breast-feeding problems (Downs et al., 1996,
p. 188).
The first cases of the "syndrome" were diagnosed in the
1940s among institutionalized infants. It was seen to be the result
of psychosocial deprivation of early childhood development in institutions.
Researchers surmised that infants living in unstimulating homes
must be subject to equivalent disadvantage.
Their task was then to demonstrate that the primary caretaker of
the child with NOFT [Non-organic Failure to Thrive] (invariably
the mother) was not capable of providing an adequate parenting experience
by reason of psychiatric disorder, poverty, or marital and family
discord (Puckering et al., 1995,
p. 574).
FTT appears to be the result of insufficient attachment between
the mother and the baby. Explanations for the lack of bonding
include early deprivation of the mother during her own childhood,
difficulties during the pregnancy or childbirth resulting in prematurity
or congenital defects, acute illness of mother or baby, and stressful
current life events (Mayhall & Norgard, 1983) (Downs et al.,
1996, p. 189).
According to DiLeonardi (1993):
[T]he traditional definition of "failure-to-thrive" has
changed dramatically over the years. In the 1970s, Barbero et al.
(1975) described failure-to-thrive as being diagnosable by a series
of symptoms including weight below the third centile for age with
subsequent weight gain in the presence of appropriate nurturing;
no evidence of systemic disease or abnormality; developmental retardation
with subsequent acceleration when the environment is changed; clinical
signs of maternal deprivation; and presence of significant environmental
psychosocial disruption. It was regarded as a severe and life-threatening
form of neglect in many jurisdictions. Currently, failure-to-thrive
is diagnosed as weight below the fifth centile with no organic reason
and is not regarded as child neglect (Dubowitz, Black, Starr Jr.
and Zuravin, 1993). There are no developmental markers. This change
in definition has increased the number of failure-to-thrive cases
geometrically, since by this
19
Forms of Neglect
definition approximately 5% of all infants and small children fail
to thrive, a substantially higher number than the total number of
all abuse and neglect allegations in the country
(p. Appendix C_2).
Hanson (1993) hypothesized that Non-organic Failure to Thrive (NFTT),
which has no biological origin,
...may be caused by parental inexperience in not knowing how to
feed properly or how much babies eat, or by diluting the formula
for lack of money. NFTT can also be a more deeply rooted problem.
Infants quickly sense the feelings and attitudes of caregivers.
If the parent feels ambivalence or hostility toward the infant,
lacks attachment, or sees the child as too demanding, the infant
may react negatively.... Maternal deprivation has largely been held
accountable for the NFTT syndrome. Family systems proponents suggest
this condition is symptomatic of total family maladaptation, of
family disengagement characterized by distancing and lack of communication
within the total family unit (p. 105).
Others have reached different
conclusions:
However, with the increasing use of well controlled studies,
and the objective measurement of family relationships using instruments
of known psychometric properties, it became clear that within the
syndrome of NOFT [Non-organic Failure to Thrive] not all families
are alike, and parents do not consistently fit into these limited
categories (e.g., Drotar, 1991) (Puckering et al., 1995, p. 573).
FTT cases are believed to result from "psychosocial diseases"
such as physical neglect and psychological maltreatment. "Although
most experts agree that non-organic FTT results from psychosocial
difficulties that reduce caloric intake, the nature of the psychosocial
difficulties has been the subject of considerable debate."
Some see it as a medical condition due to physical child neglect
(inadequate food and nutrition). Others focus on psychological aspects
of FTT, such as isolation and lack of stimulation and view FTT as
a psychological condition. Studies evaluating the differences between
non-organic FTT infants and normally developing infants, for example,
have found that the interactions between FTT children and their
mothers are characterized by deficits in attachment, sensitivity
toward the child, and degree of comfort between mother and child
(O. Barnett et al., 1997, p. 118).
Controversies surrounding non-organic failure-to-thrive children
continue unabated. It is arguable that the assumption
20
Child Neglect: Current Definitions and Models
that FTT is the result only of neglect is unsupported: the condition
may involve negative parental feelings, which are demonstrated by
difficult parent-child interaction, and indeed there may be many other
factors that need to be taken into account including unwanted pregnancy,
insecure attachment, problematic temperamental attribute of the child,
distorted parental perceptions and attitudes, and insufficient support
systems for parents in need (Iwaniec, 1995,
p. 189). Other Forms
Concern with inadequate medical care has evolved from an emphasis
on not providing care to actively refusing care, most often based
on religious conviction (Rose & Meezan, 1993).
Withholding medically indicated treatment from newborn babies with
serious birth defects is another "new" and somewhat controversial
category of neglect, as is prenatal exposure to drugs/alcohol (Gaudin,
1993a, p. 8).
Neglect of the unborn child, or "prenatal neglect," is
another recently identified and controversial
form of neglect. It is generally considered to include actions that
occur during the prenatal period that can potentially harm the unborn
child. In current practice, the focus is on women who abuse drugs
or alcohol during pregnancy. In 1993, the U.S. National Committee
to Prevent Child Abuse found 6,922 infants were reported for prenatal
drug exposure in 1993; 7,469 in 1994 (Wiese and Daro, 1995) (O.
Barnett et al., 1997, p. 113).
There is limited research evidence linking prenatal drug exposure
and negative developmental outcome. Nonetheless, in 1994, 27 states
in the US required the reporting of drug-exposed babies and according
to
O. Barnett et al. (1997), it appears more legal responses are emerging.
There is disagreement over the rights of the unborn versus the rights
of the mother, and punitive responses to substance-abusing pregnant
women have been questioned on practical, constitutional, therapeutic,
and empirical grounds.
Although the problem of prenatal neglect continues to be the focus
of much theoretical discussion and empirical research, solutions
will likely remain elusive for some time (O. Barnett et al., 1997,
p. 113).
21
18
Child Neglect: Current Definitions and Models
Models of Child
Maltreatment
Models of Child
Maltreatment
In an effort to make sense of the complexities surrounding child maltreatment
in general, researchers formulate different conceptual models and
develop assessment tools to help operationalize definitions. Different
models and tools affect how research studies are defined, findings
are interpreted, and meaning is applied. Different models each carry
their own biases; each grew out of different theories about the etiology,
sequelae, and treatment of child abuse and neglect.
Research also has clearly revealed that each perspective, by itself,
is insufficient for accounting for the causes and effects of child
maltreatment. Rather, an integration of approaches seems most warranted.
Consequently, these different viewpoints should not be thought of
as mutually exclusive nor should they be inappropriately or artificially
pitted against one another
(D. Barnett et al., 1993, p. 21).
Some of the main conceptual models that are current in child neglect
research today are outlined below. Medical_Diagnostic
The medical_diagnostic approach to child maltreatment is the oldest
model outlined here. This model has a narrow focus and is limited
primarily to the most severe instances of child maltreatment, such
as those that can be documented by x-rays of children with multiple
fractures
(D. Barnett et al., 1993, p. 18). This approach has resulted in
formulations that emphasize treating a disorder afflicting the parent
(e.g., the battered child syndrome). Psychiatric or psychological
conceptualizations that focus on perpetrator characteristics are
a feature of the research.
[C]urrent knowledge about neglect has been limited almost entirely
to questions about the supposed causes of neglect and effectiveness
of various treatment models. It is, in other words, a highly individualistic
approach, based on a view of neglect as a disease entity in need
of a cure. This approach assumes the continuing need for the current
array of social services and programs. That these programs have
not reduced the scope of the problem
23
Models of Child Maltreatment
over the past hundred years (Nagi, 1977; Rose & Meezan, 1993)
is not addressed (Swift, 1995a, p. 11). Sociological
Sociological models of child maltreatment (e.g., Gelles, Giovannoni
and Becerra) define child maltreatment in terms of a social judgement
of parental acts that are deemed inappropriate by cultural standards
and practices. Sociological models focus on contextual conditions,
such as poverty, that give rise to mal-
treatment.
In accord with the sociological perspective, we propose that the
emphasis in defining child maltreatment should be on the parental
acts that are viewed to be unacceptable or "improper"
by society, because the majority of the population believe that
they place children at risk for physical and emotional harm. We
emphasize parental actions over other variables to define child
maltreatment for a number of reasons (D. Barnett et al., 1993, pp.
22_23). Legal
Legal models of child maltreatment (e.g., Wald) establish clear
guidelines regarding parental actions justifying court action. These
models aim to provide national standards for judicial decisions
about maltreatment. Ecological
Ecological models (e.g., Bronfenbrenner, Belsky, Garbarino, Starr,
Zuravin) place equal emphasis on environmental and familial contributions
to maltreatment. These models maintain that society as a whole shares
responsibility for child protection (D. Barnett et al., 1993, pp.
18_19). Family behaviour is viewed within the larger social context
in which it is embedded.
Current theory emphasizes the ecology of childhood, with multiple
and interacting factors contributing to the occurrence of child
abuse and neglect. In addition to the individual and interpersonal
factors, interactions between parents and children are influenced
by community and society factors, such as the availability of child
care and poverty (Dubowitz et al., 1993, p. 10).
Dubowitz et al. (1993) addressed three issues of ecological context:
parental understanding of the needs of children, the relevance of
cultural or religious beliefs, and the role of poverty. These researchers
noted that parents sometimes need information from professionals
to understand children's needs and that society shares an obligation
for children's care. Some circumstances (e.g., sending children
to school) are parents' responsibility, whereas other situations
require professionals to inform parents (e.g., lead poisoning).
24
Child Neglect: Current Definitions and Models
However, if reasonable efforts have been made to inform parents about
their children's needs and parents are not responsive, they are not
fulfilling their responsibility and they are contributing to their
child's neglect (p. 19). Developmental_Ecological
Belsky (1993), who has written an excellent review of the scientific
research into the causes of maltreatment, used a "developmental_ecological"
analysis, which underscores the dyadic nature of problematic parenting.
If, as is now widely acknow-
ledged, maltreatment is a transactional by-product of processes
taking place between parent and child in a family and community
context, than studies...that examine "main effects" of
child characteristics are more likely to underestimate the interactive
role that factors like prematurity and handicap play (p. 419).
Belsky noted that the current
research points to a model in which child maltreatment is the result
of a transactional process involving the characteristics of children
and parents, embedded in multiple contexts. Cicchetti and Toth (1995)
concurred:
We believe that a developmental framework holds considerable promise
for helping to unravel
not only the sequelae of maltreatment, but also the processes that
underlie these maladaptive outcomes. Therefore, in accord with a
developmental psychopathology perspective, we approach our review
of the consequences of maltreatment within an organizational framework
that necessitates an examination of adaptation on stage-salient
issues
(p. 546).
In its 1989 publication, Research on Children and Adolescents
with Mental, Behavioral, and Development Disorders, the U.S.
Institute of Medicine noted that a developmental approach should
take into account "the emerging behavioural repertoire, cognitive
and language functions, social and emotional processes, and changes
occurring in anatomical structures and physiological processes of
the brain" throughout the life course (Cicchetti & Toth,
1995,
p. 542).
A developmental psychopathology approach to defining maltreatment
is also proposed by D. Barnett et al. (1993).
Consummate to understanding the multifaceted nature of the causes
and consequence of maltreatment is the recognition of the developmental
aspects of child abuse and neglect. Each of the components involved
in child maltreatment, the environment, the parent, and the child,
are transacting over time....
25
Models of Child Maltreatment
And in this sense, the parental acts that are judged to be unacceptable
by society change as a function of the child's age
(pp. 23_24).
As well as by Cicchetti and Toth (1995):
Finally, in a recent developmental_ecological analysis of the etiology
of child abuse and neglect, Belsky (1993) examines a variety of
contexts of maltreatment, including the contributions of parent
and child characteristics and pro-cesses, parenting and parent_child
interactions, and community, cultural, and evolutionary contexts
of maltreatment. After a careful and thorough analysis of the research
literature, Belsky (1993) concludes that child abuse and neglect
are multiply determined by factors that are operating at various
levels of the ecology. As such, it is impossible to unearth a single
pathway to maltreatment or to consistently identify a factor or
factors that, when present, culminate in an act of maltreatment.
Rather, Belsky's review confirms that maltreatment occurs when stressors
exceed supports and when risks are greater than protective factors
(cf. Belsky, 1980; Cicchetti and Lynch, 1993; Cicchetti and Rizley,
1981). According to Belsky, the fact that research reviews consistently
fail to identify etiological correlates of child maltreatment
confirms the belief that etiological factors result in maltreatment
only in combination with other contributory agents. Therefore, analyses
that focus on "main effects" by comparing maltreated and
comparison groups on a single variable may fail to reveal group
differences because of an inability to elucidate the interplay among
factors. These points are important to keep in mind when evaluating
research on the sequelae of child maltreatment (pp. 545_546). Parent-Focused
Vs. Child-Focused
Another conceptual approach for current research models divides
definitions of child neglect (and more generally, child maltreatment)
into two camps: "parent-focused" and "child-focused."
A widely prevalent framework in the child welfare field focuses
on omissions in caregiver behaviour regarding children. Others are
more concerned with basic needs of children not being met, whatever
the reason (Dubowitz, 1994, p. 558).
Historically, the issue of neglect has been approached from the
perspective of the parents' behaviour toward the child. As a result,
there is relatively little research about the effects of neglect
on children and few treatment interventions that focus on providing
treatment services to the
26
Child Neglect: Current Definitions and Models
child. Rather, the emphasis has been on treating the neglecter.
The newer, child-focused approach is concerned with the effects
of neglectful behaviour on the child.
This perspective arose in
response to the potential abuses inherent in the emphasis on parental
inaction: an overreliance on worker discretion and judgement as
to the meaning and consequences of parental behaviour, placement
of children in outside homes when substantial risk of harm was not
clearly established, and cultural and class bias in the assessment
of risk (Rose & Meezan, 1993, p. 284).
Goldstein, Freud and Solnit defined neglect from the point of view
of harm to the child and placed their emphasis primarily on the
child's psychological well-being. They defined neglect as "a
lack of emotional attachment of the child to the parent based on
the parent's failure to provide the attention a child needs to feel
cared for, nourished, comforted, loved, and stimulated" (Rose
& Meezan, 1993, p. 284).
Among those who have taken the parent-focused approach include
Kadushin, who
...has argued that we must rely on parental behaviour as an indicator
of neglect because the effect of neglect may not always be immediately
visible....
Authors who favour this [broad] perspective have argued that judges
and caseworkers need discretion in determining neglect and that
more specific definitions remove such discretion. It has also been
argued that more specific definitions could not be sensitive to
community standards (Rose & Meezan, 1993, p. 283).
The parent-focused approach, it has been argued, allows workers
to make use of protective services before evidence of harm has been
demonstrated; therefore, a broader and more inclusive definition
of neglect is desirable (Rose & Meezan, 1993,
p. 287).
Dubowitz et al. (1993), on the other hand, stated that the focus
of concern in defining neglect must be on children and their unmet
needs because needs vary according to age and developmental level.
Neglect occurs when basic needs of children are not met, regardless
of cause. Basic needs include adequate shelter, food, health
care, clothing, education, protection, and nurturance (p. 10).
An evaluation of contributory factors is important for planning
appropriate interventions, according to Dubowitz et al. (1993):
Situations where the effect on children is unclear should not be
considered neglect; research
27
Models of Child Maltreatment
is needed to examine the impact on children of conditions that are
thought to be harmful (e.g., latchkey children), despite little or
no supporting evidence
(p. 13).
Narrow definitions, such as those used in legal and child protection
systems, restrict our ability to fully understand neglect, according
to Dubowitz et al., although they are relatively easy to operationalize
and implement. Parental responsibility is implicit in narrow definitions,
they say. Broad definitions may appear to absolve parents of all
responsibility and are often vague and difficult to implement, but
"despite the immense challenges associated with a broad conceptual
definition of neglect, we suggest...that from a child's perspective
this is a more meaningful and useful view" (Dubowitz et al.,
1993, p. 10). Assessment Tools
As previously mentioned, researchers have developed various measures
to assist in assessing the existence of child neglect. Perhaps the
best known of these is the Childhood Level of Living (CLL) Scale,
which grew out of Polansky et al.'s 1967 research of neglectful
mothers in rural Appalachia and was later applied to a study of
low-income families in Philadelphia. The CLL Scale
...was designed to examine specific elements of care along a continuum
from poor to
excellent, in the arenas of physical, emotional, and cognitive care.
This measure, which remains probably the most comprehensive available,
allows for deficits in one area to be compensated for by strengths
in another and for patterns of good as well as poor care to be identified
(Swift, 1995a, p. 69).
Geared predominantly toward maternal carein a majority of
households only the female parent was available for studythe
CLL presents nine descriptive categories, five of which assess physical
care and four the emotional, cognitive, or psychological factors.
Under physical care, consideration is given to such facts as meal
planning, medical care, safety issues, leaving the child alone,
house or shelter adequacy and safety, appropriateness of sleeping
and living conditions, and cleanliness. The psychological assessment
considers the type of stimulation the child is given, the parents'
emotional availability to the child, quality of discipline, the
mother's concern for the child, and her own stability (Hally, Polansky,
and Polansky, 1980) (Hanson, 1993, p. 96).
The CLL is lengthy and detailed (it includes 99 items). Some authors
question the relevance of some of it and the cultural relevance
for
minorities.
28
Child Neglect: Current Definitions and Models
The other most widely used measure of child neglect at the moment
is the Child Well-Being (CWB) Scales (Trocmé, 1996, p. 1456).
According to Trocmé, the CWB Scales are the currently preferred
measure but the scales were not specifically developed for neglect
and some criticize its conceptualization of child well-being as being
vague.
Trocmé has developed the Ontario Child Neglect Index (CNI).
The CNI was designed to be short, easy to administer and "accurately
reflect child welfare practice within the framework of Ontario's
child welfare laws" (Trocmé, 1996, p. 145).
The Child Neglect Index is designed to provide child welfare practitioners
and researchers with a validated and easy-to-use instrument that
specifies type and severity of neglect. Field testing shows that
the validity and reliability of this one-page index compare favourably
with the Child Well-Being Scales. Although the Child Neglect Index
was designed within the context of Ontario's child welfare laws,
the instrument and the structured expert-based method used to develop
it can be easily applied to other jurisdictions (Trocmé,
1996, p. 145).
The CNI reflects Ontario's 1984 Child and Family Services Act,
which defines neglect in terms of the different forms of physical
or emotional harm that affect neglected
children. This focus on evidence of harm or risk of harm marks an
important conceptual shift in practice in Ontario, according to
Trocmé. The shift is not as inclusive as the positions of
Wald or Dubowitz who argued that neglect occurs when basic needs
are not met, regardless of the cause. Instead, the legislation restricts
the definition of neglect to situations in which harm to the child
is associated with parental failure to "care or provide for"
a child and excludes neglect attributed to other caregivers, such
as school personnel or society at large as in cases of child poverty
(Trocmé, 1996, p. 146).
Although in principle legislation should guide intervention, in
practice this is not always the case. Given that only 10% of child
protection cases are brought to court (Trocmé et al., 1994)
practitioners exercise considerable discretion in deciding which
situations should be targeted for service. The clinical factors
considered by workers in making intervention decisions in child
neglect cases may be quite different for cases that do not proceed
to court. Workers involved in the field test raised this issue;
they felt that the CNI was less sensitive to mild forms of child
neglect. Although they recognized that the CNI reflected the legislation,
they also believed that the legislation sets limits that fail to
consider some families that require preventive
29
Models of Child Maltreatment
intervention. The stringent "evidence of harm or substantial
risk of harm" criterion excludes families that are considered
at risk of neglecting their children even though no specific harm
can be documented (Trocmé, 1996,
p. 151).
A copy of the Ontario CNI is included in Appendix A of this report.
Other assessment tools are used and adapted for research and practice.
Another tool of note is the Strange Situation Procedure, which is
used for assessing the quality of parent_infant attachment.
This assessment procedure, used most often when the child is 1
or 2 years of age, has been demonstrated to be a valid and reliable
measure of the infant's adaptation within the context of the infant_caregiver
relationship and it is predictive of the child's subsequent behaviour
in a variety of situations (Erickson & Egeland, 1996, pp. 10_11).
30
Child Neglect: Current Definitions and Models
Causes/Risk Factors
Causes/Risk Factors
It should be noted from the outset that there is no single cause of
child maltreatment. One Canadian study (cited by Palacio-Quintin and
Éthier, 1993) of the risk factors associated with child maltreatment
in Montréal identified four "best predictors" of
child maltreatment:
family revenue below poverty line
mother sole financial provider
mother's first pregnancy occurs before the age of 21
four or more children in family
This study reported that 100% of negligent families and 84% of
abusive families lived below the poverty line (Palacio-Quintin &
Éthier, 1993, p. 156).
What determines whether maltreatment will take place is the balance
of stressors and supports. When parents' stressors are stronger
than the mitigating factors, maltreatment occurs. Current research
reflects this understanding and etiological studies seek to identify
"contributing rather than determining agents" (Belsky,
1993, p. 418).
Belsky noted that
...there is no shortage of causal agents that are invoked to explain
the occurrence of physical child abuse and neglect. Some of the
factors are historical (e.g., socie-tal attitudes toward family
privacy) and some are contemporaneous (e.g., poverty); some are
cultural (e.g., tolerance of violence) and some are situational
(e.g., crying episode); and some are attributes of parents (e.g.,
hostile personality) and some of children (e.g., difficult temperament)
(Belsky, 1993, p. 413). Limitations of the Research
Etiological studies of child maltreatment have been criticized
for a number of shortcomings in their scientific approach. Biased
sampling, small samples, poorly matched control groups, and vagueness
about severity and chronicity characterize many etiological studies
of child maltreatment, according to Belsky (1993).
For the most part, studies of the etiology of child maltreatment
lack precise a priori predictions
31
Causes/Risk Factors
and thus are little more than empirical fishing expeditions in which
controls for statistical tests are rarely if ever implemented (Belsky,
1993, p. 414).
Belsky was careful to note that researchers are well aware of the
methodological difficulties but they are not easy to address and,
indeed, many research problems are
"fundamental to the study of child maltreatment."
Because there is no single cause of the physical abuse and neglect
of children, and because these forms of maltreatment arise as a
result of a transactional process involving characteristics of parents,
children, and the multiple contexts in which they are embedded,
the search for "main effects" invariably yields sporadic
findings.... As Bronfenbrenner (1979) so astutely noted, in the
ecology of human developmentand thus in the etiology of child
maltreatment"the principal main effects are likely to
be interactions" (p. 38) (Belsky, 1993, p. 414).
Contributing to the difficulties associated with studying child
abuse and neglect is the fact that researchers tend to base their
studies on families that have come to the attention of child protection
agencies and that have been labelled by the agencies as neglectful
or abusive. It is hard to say how reliable these labels are in
practice; many times, definitions are applied "after much negotiation
and consultation with the family, judicial authorities, and others"
(Belsky, 1993, p. 413). This reliance on "labels" of child
protection services is noteworthy:
Across the various subtypes of maltreatment, [Knudsen's] most consistent
finding was the absence of clear criteria for defining maltreatment
and systematizing the investigation and substantiation process.
Consequently, cases frequently were decided upon in an idio-
syncratic fashion guided primarily by the beliefs and practices
of the individual case workers (D. Barnett et al., 1993, p. 26).
Nonetheless, research is conducted and reviewers point to improvements
over time in how the work is conducted and reported. To present
the research information on the causes of child neglect, we will
borrow a framework from Polansky, who suggested that all causes
of maltreatment can be grouped within three theories:
Personalisticattributing poor child
care to individual differences among parental personalities, particularly
their character structures.
Economicemphasizing the role of material deprivation
and poverty.
32
Child Neglect: Current Definitions and Models
Ecologicalviewing a family's behaviour as responsive
to the larger social context in which it is embedded (1981,
p. 21) (Hanson, 1993, p. 102). Personalistic Causes: Gender
Most research to date on the causes of child neglect focuses on
the personality characteristics of neglecting mothers. The reason
for the focus on mothers, as opposed to mothers and fathers, is
a subject of debate. Belsky's 1993 review noted that "virtually
all the research evidence examined here deals with mistreatment
of children by mothers. This should not imply anything other than
that mothers more often care for children than do fathers and thus
have been subject to more intensive investigations" (Belsky,
1993,
p. 414).
Swift, however, has a different
interpretation:
The discourse of neglect has long since established mothers as
the "crucial variable" in neglect (Polansky et al., 1972),
and this belief is echoed explicitly or implicitly by almost everyone
writing about child neglect. The study of child neglect is in effect
the study of mothers who "fail" (Swift, 1995a, p. 101).
Indeed, our society assigns prime responsibility for rearing children
to women and the research reflects that.
However, Swift (1995a) noted that the research obscures the fact
that it is analyzing mothers and mothering because the literature
frequently uses the terms "parents" and "parenting."
In fact, mother as the "crucial variable" is the main
theme in most writing about neglect. Role rejection (Kadushin, 1967),
lack of nurturing knowledge (Jones and McNeely, 1980), immaturity
of the mother (Young, 1964; Katz, 1971), and the poor nurturing
of the mother herself (Hall et al., 1982) all appear as variations
on this theme. While many researchers are concerned with establishing
the main causal variables of neglect, they also contribute to the
definition of the problem by framing it in personal and intrafamilial
terms (Swift, 1995a, p. 89).
As Swift went on to note, the "failure to provide care and
in fact the complete abandonment of children by their fathers generally
produces no comment at all" in case workers' files.
In cases of neglect, fathers are usually not mentioned if they
are not living in the home. If they are living at home, files seldom
comment on the quality, quantity, or frequency of their financial
input. Clearly, these files are not about fathers, but about mothers
and the responsibilities they are supposed to carry out (Swift,
1995a, pp. 104_105).
33
Causes/Risk Factors
The veritable dearth of research on neglectful fathers is puzzling.
Even though more mothers are responsible for meeting the needs of
children than fathers, 1988 American Association for Protecting Children
(AAPC) statistics on reported cases of neglect found males were reported
to be the primary perpetrators in 30% of the cases (O. Barnett et
al., 1997, p. 128).
Until relatively recently, researchers have tended to have little
comment on the tendency to mislabel "mothering" as "parenting"
and to overlook the role of the father in cases of child neglect.
One notable exception is research by Palacio-Quintin & Éthier
(1993):
It is unacceptable for mothers to be held solely responsible for
neglect and the only parent implicated in CPS investigations. Fathers
have a direct influence on their children as well as indirect, in
supporting the mother, emotionally and financially, in nurturing
the child.... Neglectful parenting has to be seen in the context
of the whole family, including the father. This relieves the mother
of sole responsibility for the neglect but also to expand [sic]
the available family resources. It is essential to convince workers
of the fact that two parents are responsible for their children
and focusing on the two increases the chance of successful intervention
(pp. 157_161). Personalistic Causes: Mental/Psychological
The etiological research is far from clear about the individual
characteristics of neglectful mothers.
Even though it is likely that reviewers of the relevant literature
draw different conclusions regarding the role of personality and
psychological resources more generally as a result of their varying
theoretical orientations, they are certainly assisted by the inconsistency
that is apparent in the database (Belsky, 1993, p. 417).
Despite these inconsistencies, many researchers have drawn conclusions
about the personality characteristics of neglectful parents:
Neglectful parents are largely children themselves. Their infantile
personalities seem to be largely the result of their own unmet childhood
needs. They are isolated, have difficulty maintaining relationships,
are verbally inaccessible, and lack the knowledge, judgement, and
maturation [sic] to adequately parent their children. From their
studies of neglectful mothers, Polansky and colleagues identified
five types of personalities: the apathetic-futile, the impulse-ridden,
the woman in reactive-depression, the mentally retarded, and the
psychotic (Hanson, 1993, p. 120).
34
Child Neglect: Current Definitions and Models
Research on characteristics of neglectful mothers found
depression (Downey & Coyne, 1990; Kinard, 1982), anxiety (Egeland
et al., 1980), immaturity (Polansky, Ammons & Gaudin, 1985), intellectual
and problem-solving deficits (Crittenden, 1988; Hansen et al., 1989;
Martin & Walkers 1982) (Palacio-Quintin & Éthier 1993,
p. 157).
[M]altreating parents often are characterized by a lack of understanding
of the emotional complexity of human relationships, especially
the parent_child relationship. They have difficulty seeing things
from the child's perspective or understanding behaviour in terms
of the child's developmental level and the context or situation.
Maltreating parents tend to think in global, all-or-nothing terms
rather than see the shades of grey that more realistically capture
human behaviour (Erickson & Egeland, 1996,
p. 13).
Compared to abusive and
non-abusive/non-neglectful parents, neglectful parents exhibit poor
problem-solving skills, intellectual deficits, and inappropriate
development expectations for their children (O. Barnett, 1997, p.
116).
Information-processing deficits among neglectful parents appear
to be
worthy of further research. As Toth underlined:
[T]he effect of poor quality caregiving and traumatic experiences
on biological processes can provide important insight into the role
of experience in altering the course of neurobiological growth (Cicchetti,
1993; Cicchetti & Tucker, 1994) (Toth, 1995, p. 561).
Crittenden (1993) looked at cognitive theory on information processing
and identified four states at which parents could fail to respond
to signs by their children. She theorized that parents might fail
to respond to stimuli indicative of children's need for care because
they "a) did not perceive the signal, b) interpreted the signal
as
not requiring a parental response,
c) knew that a response was needed but did not have a response available,
or d) selected a response but failed to implement it" (p. 27).
Crittenden also noted that each distinct failure to respond represents
a different type of neglect, associated with different types of
parental developmental history and each requiring different kinds
of interventions.
Greene et al. (1995) looked at two case studies involving mentally
retarded parents with children placed in care due to abuse and neglect.
They noted that "there is growing evidence that competence
of parents with mental retardation (and developmental disability)
can be improved
35
Causes/Risk Factors
with training" (p. 417) and over time, the right intervention
services are provided.
Additional research may be helpful in considering assessment and
intervention strategies to facilitate such decisions. For example,
perhaps the prospects of the parent assuming full-time parenting
responsibility should be questioned very early, and different intervention
strategies should be attempted if the incremental custody of the
children is made contingent upon the parent's completion of child
care tasks but does not effect sustained and generalized changes
in child care practice (p. 433).
Belsky (1993) noted that more recent studies "seem more consistent
in linking negative emotional states and traits with maltreatment
and...the literature on depression (without regard to maltreatment)
consistently highlights linkages between this state-trait and intrusive,
hostile and rejecting care, as well as detached and unresponsive
parenting" (p. 417).
One recent study looked at both psychological and social factors
of maltreating parents but did not find a link between neglect and
depression. Age, socio-economic status, social support, education,
household size, and gender, as well as psychiatric disorders including
substance abuse and depression, were examined. In order to overcome
the limitations
imposed by reliance on officially reported neglect cases that occurred
in the past, Chaffin et al. (1996) used data from the National Institute
for Mental Health's Epidemiologic Catchment Area survey. This study
followed 7,103 parents who did not self-report physical abuse or
neglect of their children in the first wave of the survey but who
self-reported physical abuse or neglect identified at Wave II. Physical
abuse and neglect were found to have distinct sets of risk factors,
with minimal overlap between the groups. Social and demographic
variables were found to be limited predictors of maltreatment, while
substance abuse disorders were strongly associated with the onset
of both abuse and neglect. Depression was found to be a strong risk
factor for physical abuse (Chaffin et al., 1996, p. 191).
Of the psychiatric disorders studied, substance abuse disorders
appear to be the most common and among the most powerfully associated
with maltreatment.... Depression was found to be more uniquely associated
with physical abuse rather than neglect once social factors and
substance abuse are statistically controlled.... This suggests that
the relationship between depression and
neglect may not be direct, as it appears to be for abuse, but may
be mediated by substance abuse, which is a common complication of
depression. The association of neglect with
36
Child Neglect: Current Definitions and Models
[Obsessive-Compulsive Disorder] was unanticipated and presents something
of a puzzle, especially given that the relationship persists when
controlling for substance abuse (Chaffin et al., 1996, p. 200).
These results contrast with a
Canadian study that found that "Mothers who neglect their children
tend to exhibit higher rates of depression compared to non-neglectful
mothers. Neglectful mothers also experience a high degree of stress"
(Éthier, Lacharité, & Couture, 1995) (Wiehe, 1996,
p. 50). Personalistic Causes: Substance Abuse
Research into parental drug use and neglect is very preliminary,
although it appears to be an area of growing research interest.
Research to date has been limited by vague definitions of "substance
abuse." Nonetheless, DiLeonardi hypothesized that children
of substance abusing mothers are more likely to be neglected than
abused and are more likely to suffer several subtypes of neglect
(NCCAN Chronic Neglect Symposium
proceedings, p. Appendix C_1).
Gaudin (1993a) also reported a link between substance abuse and
neglect:
Abuse of alcohol or drugs is often present in cases of child neglect.
Recent reports from urban CPS [child protection services] agencies
indicate that substance abuse is a factor in a
growing percentage of child neglect cases. Estimates range from
a low of less than 24% [Martin and Walters, 1982] to 80 to 90% of
all child maltreatment reports [National Committee for the Prevention
of Child Abuse, 1989]. An earlier study found that 52% of the children
removed from their homes for severe child abuse or neglect had at
least one parent with a history of alcoholism [Famularo, 1986].
A study of women served in a Chicago alcoholism treatment program
reported that 65 to 75% of the women were neglectful toward their
children. The epidemic of cocaine addiction in urban inner-city
areas has resulted in large increases in the numbers of neglect
reports.... In spite of these associations, there is yet insufficient
data to conclude that substance abuse causes neglect, but it is
an increasingly significant contributing factor (p. 15). Personalistic
Causes: The Child
Newer models of child maltreatment make an effort to consider the
dyadic nature of parenting and the role of parent_child interactions.
Findings of these studies indicate:
Younger children appear more likely to experience maltreatment
for a variety of reasons. One is that physical force is more often
used against them (Straus, Gelles, & Steinmetz, 1980). Another
is
37
Causes/Risk Factors
that they spend more time with their caregivers and are more physically
and psychologically dependent on them. A third reason is that they
are simply more susceptible to injury (Belsky, 1993, p. 419).
There is not a great deal of research into the child's interactions
with the neglecting parent, although it would appear that there
is much to be learned in this area. (See, for example, recent findings
related to non-organic FTT syndrome, discussed in the section on
Effects.) The preliminary conclusions that have been drawn about
the role of the child in neglect can be summarized as
follows:
In summary, although I am inclined to draw the conclusion that
parents play a larger role in the etiologic equation than do children
with respect to the developmental-psychological context of maltreatment,
there is no disputing the fact that children inadvertently contribute
too (Belsky, 1993, p. 420).
Erickson & Egeland (1996) added to this hypothesis:
Although few would dispute that some children are more difficult
to care for than others, there is strong evidence from observational
studies that
child characteristics alone do not account for maltreatment. Research
taking a transactional view of parent_child
relationships demonstrates the power of parental sensitivity and
responsiveness in overcoming the child's difficulty (p. 14).
Using information collected by agencies receiving official reports
of neglect, O. Barnett et al. (1997, p. 115) reported the following
statistics:
The average age of neglected children is six years. Several
sources indicate that the risk for neglect generally declines with
age and the seriousness of injuries are more common for younger
children.
According to the National Center on Child Abuse and Neglect
(NCCAN) in 1994, 51% of reported child neglect victims are under
five years of age and 34% of those reports are for children under
one year of age.
Few gender differences are associated with neglect. NCCAN
indicated that 52% of reported cases were males and 48% were females.
Studies attempting to determine racial differences in rates
of child neglect are fraught with methodological difficulties and,
as a result, should be interpreted cautiously.
According to 1988 statistics, 63% of child neglect reports
involved Caucasian children, 20% involved African-American children
and 12% involved Hispanic children. Because census data indicate
that 12.4%
38
Child Neglect: Current Definitions and Models
of the population are African- American and less than 3.5% are Hispanic,
the risk of neglect appears to be higher
for African-American and Hispanic children. The significance of this
pattern, however, is unclear because race is
also associated with socio-economic status. The Cycle Theory: Intergenerational
Transmission of Maltreatment
A model of child maltreatment that appears to be waning in popularity
is the "cycle theory" of intergenera-tional transmission.
The theory, which was prominent in the 1960s and 1970s, is simple:
neglectful (and abusive) parents maltreat their children because
the parents themselves were neglected (abused) as children. "Closely
related to the `intergene-rational continuity of abuse' are theories
of maternal bonding and child development" (Swift, 1995a,
p. 96).
Psychological immaturity, characterized as "infantile personality,"
"impulse ridden," or "apathy-futility syndrome"
by Polansky, Chalmers, Williams, and Buttenwieser (1981) or lack
of "psychological complexity" by Pianta, Egeland, and
Erickson (1989) is a personality characteristic of
many neglectful mothers that is often related to their failure to
receive nurturing as children (Gaudin, 1993b, p. 69).
During the 1970s, two clinicians at the forefront of inquiry into
the etiology and sequelae of child maltreatment observed that "the
most constant fact [concerning child abusers] is that parents themselves
were nearly always abused or battered or neglected as children"
(Fontana, 1973, p. 74) and that "we see an unbroken line in
the repetition of parental abuse from childhood into the adult years"
(Steele, 1976, p. 15). More than 15 years after these comments were
made, there are few in the scientific community who would embrace
such remarks (Belsky, 1993, p. 415).
Massé explained that the cycle theory of child maltreatment
is attractive and appeals to common sense but existing evidence
of cause and effect is limited. A 1987 review by Kaufman and Zigler
estimated that only 25% to 35% of victims of extreme physical abuse,
sexual abuse, or neglect abuse their own children. Similarly, in
1989, Widom found 1.1% of adults abused as children abuse or neglect
their children, compared with 1.0% of the control group. Massé
suggested that the effects of placement on a child may be more serious
(Massé, 1994).
39
Causes/Risk Factors
Belsky (1993) pointed out that "most scholars are all too aware
of the inherent limitations of the available database" on the
cycle theory
(p. 415). For one thing, he said, there has been an excessive reliance
on retrospective reports of perpetrators labelled as maltreaters.
O. Barnett et al. (1997) noted that few studies of the intergenerational
transmission of child maltreatment have looked specifically at child
neglect and that there are contradictory results from the few that
have. For example, a study by Éthier compared childhood histories
of physically abusive mothers to neglectful mothers and found neglectful
mothers more likely to have been victims of neglect, both physical
and emotional. Conversely, a study by Zuravin and DiBlasio of teenage
mothers found that neglectful mothers were no more likely to be
abused or neglected than non-neglecting mothers but the neglecting
mothers were more likely to have been sexually abused (p.129).
Swift questioned the ideological character of the cycle idea theory.
The suggestion that mothers are unable to provide care primarily
because they did not receive adequate care from their mothers
supplies a satisfactory explanation for poor care, but "our
attention is simultaneously drawn away from the social and economic
context in which all these mothers have been doing their work"
(Swift, 1995a, p. 99).
Another Canadian researcher shares Swift's concern. Massé
noted that the cycle of violence theory masks the cycle of poverty
and deprivation. He says that researchers should ask what risks
are associated with the cycle of violence and maltreatment and what
protective factors help parents to break the cycle of abuse (Massé,
1994, p. 248).
Belsky, however, pointed to "a few well-designed, prospective
studies [that] clearly document a linkage between a reported history
of childhood maltreatment and the perpetration of maltreatment."
He hypothesized that certain maltreating individuals who report
no history of maltreatment simply may not "recollect their
troubled childhoods." It may be "that aggressive, antisocial
behaviour is learned in childhood and [is] simply expressed in adulthood
in the parenting role" (Belsky, 1993, p. 415). Further, parents'
philosophy of discipline may be a factor in intergenerational transmission.
It "seems plausible that abusive and neglectful childhoods
may promote hostile personalities" (p. 415).
A study by Caliso and Milner found that women who broke the intergenerational
cycle of transmission tended to be married to supportive and nurturant
men. Belsky added that some studies suggest that physical attractiveness
may be a mitigating factor in how children and women are treated.
"Far more needs to be understood about who obtains the
40
Child Neglect: Current Definitions and Models
social-emotional support that seems so important, if not critical,
for disrupting the intergenerational transmission process" (Belsky,
1993, pp. 416_417). Economic Causes: Poverty
The link between poverty and child neglect is clear. However, the
meaning of this link is the cause of considerable debate. Data from
the NIS-2 indicated that, of all subtypes of maltreatment, physical
neglect is most clearly associated with poverty and Aid to Families
with Dependent Children (AFDC) status (Erickson & Egeland, 1996,
p. 14). Crittenden found that abusive parents have a higher level
of revenue, social status and education than neglectful families
(Palacio-Quintin & Éthier, 1993, p. 156).
In Canada, it has been estimated by child welfare agencies that
between 66% and 75% of children in care come from poor families.
One study of the cases served by a Toronto Children's Aid Society
found 85% had incomes below the Statistics Canada low-income cut-off
and a further 11% were economically vulnerable. At least half of
the children in care come from single-parent families, yet single
parents constitute about 13% of the families in Canada (Callahan,
1993, p. 182).
Rates of neglect are higher in
families characterized by very low income, unemployment, and
dependence on social assistance
(O. Barnett et al., 1997, p. 115).
SES [socio-economic status], in fact, is a stronger predictor of
child neglect than physical abuse.... In addition, approximately
51% of the children reported for neglect reside in single-female-headed
households, and approximately 42% of the primary caretakers are
unemployed (O. Barnett, 1997, p. 115).
Although child maltreatment permeates all socio-economic levels
in our society, most maltreating parents are poor and welfare dependent.
Simply stated, economic hardship and limited resources have long
been linked with the occurrence of child abuse and neglect.... Nonetheless,
it should be noted that the majority of families living below the
poverty level provide adequate care to their children (D. Barnett
et al., 1993, p. 15).
There are notable cases of neglect and abuse occurring in well-off
families but there is reason to believe that the social and cultural
resources of these families allow them to better hide their circumstances
from child protection agencies. It is therefore possible that hidden
neglect is equally distributed among social classes (Palacio-Quintin
& Éthier, 1993, p. 156).
41
Causes/Risk Factors
Although status, income level, and cultural heritage do not necessarily
determine whether or not a family is neglectful, these factors may
correlate with the likelihood of being defined and reported as neglectful.
The chances for this more affluent White family being reported to
a protective agency are probably quite slim. The status or authority
of the parents in the community is one deterrent. Poor or minority
families, on the other hand, are more likely to come to the attention
of the social service system. Therefore, this chapter deals with the
families more likely to be reportedthose with lower incomes
and with fewer resources (Hanson, 1993, p. 102).
Callahan (1993) captured the link between neglect and poverty,
as well as the potential to apply different meanings to this link:
One of the most troubling aspects of child welfare is this separation
between poverty and child care. The relationship between these two
factors is so self-evident it seems amazing that child welfare services
do not make it front and centre in their business. But they do not.
Instead, child welfare researchers and policy-makers have accepted
poverty as the context for the work and within that context have
set about to develop other responses. A recent
and widely acclaimed study illustrates this phenomenon (Polansky,
Gaudin, & Kilpatrick, 1992). A Maternal Characteristic Scale
[MCS] was applied to poor neglecting mothers and poor non-neglecting
mothers, almost half Afro-American. The scale was successful in
distinguishing between the two groups on their ability to relate,
their impulse control, their confidence, and their verbal accessibility.
Examples of such behaviour include "answers with single words,"
"hard to consider new ways," and "can laugh at herself."
The authors suggest that the scale can be used by social workers
to distinguish non-neglecting and neglecting mothers, and
conclude:
The MCS emphasizes unresolved schizoid elements and associated
problems with forming relationships, communicating, internalizing
controls, perceiving reality, self-observation, and empathy. At
the level of character traits, we speak of the Apathy-Futility Syndrome
and the Impulse-Ridden Character.... Review of specific behaviours
calls attention to rigidity, withdrawal, flatness of affect, and
lack of empathy
(pp. 278_279).
It would be equally possible to come to vastly different conclu
42
Child Neglect: Current Definitions and Models
sions. The behaviour of the others could be viewed as behaviour typical
of powerless people rather than of psychologically inadequate ones.
The reasons why some poor mothers and not others exhibited these behaviours
could be explained also in terms of powerlessness. The neglecting
mothers were rated by child protection workers who had already identified
these women as needing assistance. The control group was rated by
headstart workers who had made no judgements about the mothers. As
the neglecting group was involved in the child welfare system already,
the fact alone could have made their behaviour even more typical of
powerless people. The whole study could have been reframed to look
at poverty, powerlessness, and the child welfare system. Instead,
it ignored poverty and attempted to differentiate between mothers'
capacity to manage in the face of it (Callahan, 1993, p. 186).
Dubowitz (1994) also commented on this point:
It is also possible that some professionals may harbour, wittingly
or unwittingly, a less sympathetic view toward the poor (Piven &
Cloward, 1971). Low-income families may be held largely accountable
for their circumstances and profes
sionals may be reluctant to become involved in financial issues.
This approach may also stem from professional blinders leading to
a narrow view of one's professional role (e.g., provide psychotherapy
to the mother). Pelton's (1978) classic paper on "the myth
of classlessness" describes the professional and political
interests served by falsely disconnecting child abuse and neglect
from poverty
(p. 558).
Dubowitz (1994) argued for a broader conceptual definition of neglect,
in which "poverty is clearly a major contributor, if not a
form of neglect
per se" (p. 557).
Of the different types of maltreatment, neglect is most strongly
connected with poverty. One study found that the most severe neglect
was among the poorest of the poor (Giovannoni & Billingsley,
1970). Indeed, many of the manifestations of physical neglect (e.g.,
inadequate clothing, exposure to environmental hazards, poor hygiene)
may be primarily due to poverty (Dubowitz, 1994, p. 557).
Swift (1995a) also suggested that poverty is a form of neglect:
[I]t is also well established in discourse that neglect is a phenomenon
of poor populations. Pelton (1981), for instance, has convincingly
argued against the idea that maltreatment of
43
Causes/Risk Factors
children is a "classless" phenomenon. Horowitz and Wolock
(1981), like Polansky, studied low-income populations to discover
why some poor people are better parents than others. Unlike Polansky
they find that poverty is the primary causal factor. Neglecting parents,
they say, are the "poorest of the poor," and their 1980
study confirms these findings. Hutchinson (1990) confirms that the
argument continues on into the 1990s. One of its permutations is the
interactionist approach, which suggests that maltreatment of children
is an outcome of the interaction between personal and situational
factors, including poverty (Garbarino, 1978). Cohen (1992, p. 217)
reminds us again of the confusion workers face in distinguishing between
poverty and neglect: "Many believe that children are permanently
damaged at least to some degree by the mere fact of growing
up in a home of abject poverty." Whatever the approach, virtually
all authors concur that poverty is a factor almost invariably associated
with child neglect (p. 89).
Swift (1995a) argued that child neglect "is a concept through
which more powerful groups maintain their
dominant position over particular vulnerable and marginalized groups"
(p. 34).
Categories of deviance such as neglect also work in more subtle
ways. For instance, they produce a group of scapegoats, giving us
somebody to blame when society is not working well. They also provide
legitimation for designated authorities to enter into the private
affairs of individuals and families (Swift, 1995a, p. 12).
Others question the cause and effect relationship:
Poverty has been linked by many researchers to neglect. The samples
used, however, may have been biased because low-income, limited-resource
families, during their quest for public assistance, tend to come
into contact with maltreatment reporting agencies more frequently
than families with higher levels of resources. What these studies
may be doing is studying the behaviour of social welfare agencies
involved in reporting child maltreatment cases. This may or may
not have relevance for understanding the behaviour of the parents
and children involved in neglectful situations (Albert & Barth,
1996) (Burke et al., 1998, p. 396).
44
Child Neglect: Current Definitions and Models
Environmental Causes: Multiple Pathways
More recent risk and causal models of child maltreatment have increasingly
emphasized sociological factors that combine through multiple pathways
to result in physical abuse or neglect (Chaffin et al., 1996, p.
191).
Major environmental factors (which are not specific to neglect
but appear to be "robust" in regard to maltreatment in
general) include:
violence in the marital
relationship,
parental unemployment,
general disorganization, and
the availability of a helpful, supportive social network,
perhaps especially among single parents who lack intimate emotional
support
(Erickson & Egeland, 1996,
p. 14).
Gaudin et al. (1993, p. 598) studied 102 neglectful families and
103 non-neglectful families, selected from US AFDC fund recipients.
"Neglect and control groups were composed of predominantly
low-income, single-parent, AFDC-recipient families; 60% of each
group were African-American, the rest were White (including one
Hispanic family in each group)." Their analysis of a wide range
of demographic factors found significant differences in only two
factors: the primary care providers in the neglectful families had
less
education (an average of grade 10 compared to grade 12 for the control
group) and more children (3.16 vs. 2.56). Environmental Causes:
Social Isolation
Social isolation is a factor that is increasingly linked to neglecting
mothers. However, definitional problems also plague this construct
and the meaning of the term seems to have changed over time.
In the 1960s, social isolation referred to a relatively narrow
concept: the state of being socially integrated or embedded within
the large community, based primarily on the number of contacts with
formal organizations. Its current usage, however, reflects a broad
set of findings taken from studies examining
a) the structural characteristics
of the parent's informal or formal network (i.e., number of contacts
with network members), b) the parent's perception that there is
adequate or available support, or c) whether the parent actually
received supportive resources in the past (Coohey, 1996, p. 243).
Jones (1996) noted that "[p]ractitioners appear to use the
concept to incorporate everything from the restricted network of
social contacts of an
impoverished, lonely, single parent through to social isolation
due to anti-social, hostile, argumentative behaviour, which has
led to relative
isolation" (p. 239).
45
Causes/Risk Factors
DiLeonardi (1993) stated: "Social isolation is manifested in
part as lack of trust of persons outside the family. Child welfare
workers are seen as the enemy, as persons whose function is to remove
children from the home" (p. 558).
A second difficulty in drawing conclusions about the relationship
among components of the social isolation construct and child maltreatment
can be attributed to differences between samples. "Inattention
to socio-economic status or income is particularly problematic in
the study of maltreaters and social networks, because they are over-represented
in the lower classes or in communities with the highest poverty
rates. Lower-income parents are likely to have lower-income members
in their social networks which, in turn, is likely to affect the
objective availability and flow of some resources to and from parents.
Fewer actual resources, in turn, are likely to affect the perception
that support is available or adequate. Moreover, lower income or
socio-economic status has been found to be related to some structural
properties, such as smaller networks; smaller networks tend to provide
fewer resources, especially for women" (Coohey, 1996, p. 243).
Belsky maintained that social support has been linked with physical
and psychological well-being and has been conceptualized as a stress
buffer. "There is an abundance of evidence linking social isolation
and
limited social ties with elevated risk of child abuse and neglect"
(Belsky, 1993, p. 422).
Éthier, Palacio-Quintin,
Jourdan-Ionescu, Lacharité and Couture compared negligent
and violent mothers and found that when faced with difficulties,
negligent mothers used their personal supports (spouse, children,
parents, siblings) less than violent mothers (Palacio-Quintin &
Éthier, 1993, p. 158). Polansky found neglecting mothers
less involved in informal helping networks and described themselves
as more lonely (O. Barnett et al., 1997, p. 128).
Results of a study by Gaudin et al. (1993) "confirm and shed
further light upon previously reported associations between neglectful
parenting and the loneliness and social isolation of the parents.
The significant correlations between self-reported loneliness and
measures of social-network support confirm that neglectful parents
not only report less support from neighbours, friends, and relatives
but also feel more lonely and isolated" (p. 603).
Polansky has focused on psychosocial factors at the level of the
individual and family. Across a series of studies, he and his colleagues
have documented how isolation from social supports and extended
family relationships plays a large role in the difficulties that
neglecting parents have in
46
Child Neglect: Current Definitions and Models
performing parental functions. Social isolation can lead to loneliness
and depression in the parent, which results in both a lack of attention
to the needs of the child and further isolation from supports in the
family and friendship network. This can result in the "apathy-futility"
syndrome in which the neglecting parent increasingly feels that there
is no point in attempting to solve the difficulties in the family
(Polansky et al., 1981; Polansky et al., 1985a, 1985b) (Burke et al.,
1998,
p. 395).
Social isolation and loneliness have been attributed by some to
transience, although Belsky noted "the very real possibility
that isolation and lack of social support is, at least in part,
something that maltreating parents actively, even if inadvertently,
contribute to, rather than something that simply happens to them"
(Seagull, 1987) (Belsky, 1993, p. 422).
On the other hand, Coohey (1996), added:
Still we do not know why the structural properties of neglectful
mothers' networks differ in the first place.... One factor that
is often overlooked in treating child neglect is the neglectful
mother's educational background and IQ level. Both Polansky and
colleagues (1981) and Crittenden (1985) have found mental retardation
to be a
factor in child neglect; Crittenden found that 72% of the neglectful
mothers were retarded versus 5% of the physically abusive mothers
(p. 251).
To summarize, neglectful mothers had fewer members in their networks,
had fewer total contacts, had less contact with the members they
did have, perceived their members to be less supportive, and received
fewer instrumental and emotional resources from their network members
compared to mothers who did not abuse their children. Thus, the
neglectful mother's perception of support was consistent with the
actual receipt of fewer resources. If any particular type of maltreater
ought to be labelled "socially isolated," neglectful mothers
clearly had the most deficient social connections
(p. 250). Environmental Factors: Culture
Cultural attitudes and practices are seen by many to have an effect
on child neglect and other forms of maltreatment.
In sum, then, although most child maltreatment takes place in the
family and thus "behind closed doors," this immediate
and even developmental context of maltreatment itself needs to be
contextualized.
47
Causes/Risk Factors
Cultural attitudes, values, and practices, as well as the
economic circumstances of a society and its cultural history, play
an important role in the etiology of child maltreatment. Even though
they are not in any sense an immediate or proximate cause of child
abuse and neglect, they create a fertile soil in which these disturbing
practices can grow and even flourish (Belsky, 1993, p. 423).
Despite the growing tendency to cite cultural issues as important
to child welfare practice, there is little research in this area.
But as Garbarino and Ebata (1983) have observed, cultural and ethnic
differences have received a treatment that might best be described
as benign neglect. Moreover, serious problems reduce the confidence
that can be placed in any conclusions that might be drawn from the
few relevant studies (Belsky, 1993, p. 427).
48
Child Neglect: Current Definitions and Models
Effects of Neglect
Effects of Neglect
As has been noted, most of the research into child neglect has focused
on neglectful mothers, rather than on children. O. Barnett et al.
(1997) reported that there is relatively little research on the effects
of child neglect on children's functioning and that the studies that
do exist are marred by methodological problems. However,
[c]ollectively, these studies have consistently uncovered several
problems associated with child neglect including social difficulties,
intellectual deficits, emotional and behavioural problems, and physical
consequences (O. Barnett et al., 1997, p. 116).
In reviewing studies investigating the effects of child neglect
on children's development, Crouch and Milner (1993) reported that
"studies exploring child neglect victim effects focus on child
`maltreatment' groups for which inclusion criteria tend to be broad"
(p. 50). Further, the lack of consensus on subtypes of neglect cause
difficulties in establishing definitions for research purposes;
the recruitment of subjects for studies often relies solely on social
service
agencies; samples are often small and poorly controlled; studies
tend to rely on retrospective self-reports or child protection reports;
and child neglect measures are often not standardized, so replication
of studies and the interpretation of results becomes difficult (p.
50).
Egeland and Sroufe, in a longitudinal study of four maltreatment
groups of mothers, stated that a significantly higher proportion
of neglected children were anxiously attached (e.g., overly dependent,
clingy, prone to crying) at 12 and 18 months, compared to children
in the control group (O. Barnett et al., 1997, p. 116).
Becker et al. (1995) summarized recent research into the effects
of neglect on children and reported that some studies have found
that neglected children display more behaviour problems than non-abused
children, such as apathy, passivity and less flexibility, persistence
and enthusiasm. They noted that
Hoffman-Plotkin and Twentyman found significant cognitive deficits
when comparing neglected and non-
neglected preschoolers and Wodarski found severe academic delays
among neglected children (pp. 29_30).
49
Effects of Neglect
Another description of the effects of neglect on children is presented
by Erikson and Egeland (1996):
Hoffman-Plotkin and Twentyman (1984) reported that abused children
were more aggressive than either neglected or nonmaltreated children,
but the neglected children interacted less with peers than either
abused or nonmaltreated children. Similarly, Crittenden (1985 and
1989) found that abused children were described as having difficult
temperaments, became angry under stress and exhibited mild developmental
delays. Neglected children, on the other hand, were passive, tended
toward helplessness under stress, and showed significant development
delays. In a review of studies from 1975 to 1992, Katz (1992) found
that both abused and neglected children had language delays or disorders,
but the problems of neglected children were more severe (p. 9).
A longitudinal study of developmental outcomes for physically abused
and neglected children revealed that physically neglected preschoolers
presented "the least positive and most negative affect"
of all types of maltreated children. Hoffman-Plotkin and Twentyman
found that neglected preschoolers engaged in the least number of
peer interactions when compared to physically abused and control
subjects. Allen and Oliver
found that neglect alone predicted both poor auditory comprehension
and poor verbal ability, even after controlling for the effects
of sex and socio-economic status (Becker et al., 1995, p. 30).
In one of the few studies involving adolescents, Henggeler, McKee,
and Bourduin (1989) examined the relation between neglect and delinquency
in 48 male adolescents divided into three groups: neglected-delinquent,
delinquent, and control. Results indicated that delinquents from
neglectful and nonneglectful families experience similar behavioural
and family communication problems, suggesting that neglect itself
was not a primary determinant. However, because the criterion for
neglect was protective services involvement, it is possible that
many of the nonneglectful families were in fact neglectful (Becker
et al., 1995, p. 30).
Hanson (1993) reported that children who have been neglected demonstrate
retarded growth, poor motor and language development, flat affect,
indications of malnutrition, unattended medical problems, and an
inability to conceptualize. Hanson also suggested the intergenerational
transmission of neglect in that older children "often seek
early emancipation and may begin the cycle all over again"
(p. 120).
50
Child Neglect: Current Definitions and Models
McCurdy and Daro (1994) explained that nearly half of the fatalities
attributed to child maltreatment in the United States result from
neglect.
Many of these are young children left alone, dying in house fires.
A follow-up study of different forms of maltreatment found the worse
outcomes associated with neglect (Rivera & Widom, 1992). Several
studies have identified other serious and long-term effects of child
neglect, including failure to thrive, cognitive deficits, poor social
skills, and increased criminal behaviour (Egeland, Sroufe, &
Erickson, 1983; Fox, Lond, & Langlos, 1988; Rivera & Widom,
1992) (Dubowitz, 1994, pp. 556_557).
Neglected children, if they survive physically, often fail to develop
the confidence, concentration, and social skills that would enable
them to succeed in school and in relationships. The behaviour they
bring to the classroom sets them up for a continuing cycle of failure
and disappointment unless something happens to make a difference.
Even the most subtle kinds of emotional neglect have a dramatic
effect on children's development, especially during the early years
of life.... [A]ttachment theory provides a useful framework for
understanding the impact of neglect. This theory proposes that the
infant's relationships with primary caregivers are the prototypes
for subsequent relationships.... For example, the child whose mother
fails to respond to his or her signals will eventually shut down,
no longer seeking or accepting contact with her.... Then, when the
child enters the new social world of school, those old expectancies
and behaviours continue to play out in regard to learning, peer
relationships, and response to teachers (Erickson & Egeland,
1996, p. 15).
The Minnesota Mother-Child Project is a longitudinal study
that was designed to follow the development of a sample of 267 children
born to first-time mothers identified as being at risk for parenting
problems due to poverty, youth, low education, lack of support,
and unstable life circumstances. Findings led Erickson and Egeland
(1996) to conclude that emotional neglect seems to be the most serious
form of maltreatment, in terms of the consequences.
In many ways, our study shows the consequences of emotional neglect
(or what we call psychologically unavailable parenting) to be even
more profound than physical neglect and the other types of maltreatment.
Nearly all of the children in this group were anxiously attached,
with the majority of those classified as anxious-avoidant. In each
of the
51
Effects of Neglect
assessments at 24 and 42 months, they displayed anger, noncompliance,
lack of persistence, and little positive
affect.... Although the maltreatment they experienced was the most
subtle of all groups, the consequences for the children were the most
striking (p. 12).
52
Child Neglect: Current Definitions and Models
Prevention and
Treatment
Prevention and
Treatment
Research literature "does not yet determine which intervention
targets are either most likely to prevent or remediate child maltreatment
or which are most easily or effectively modified" (Belsky, 1993,
p. 413). Researchers have proposed few interventions unique to child
neglect and "available studies suffer from a variety of methodological
limitations, including single-subject research design, exceedingly
small sample sizes, non-standardized assessment methods, and biased
samples. In addition, most intervention programs directed at neglect
include services for parents, with few direct services for children"
(O. Barnett et al., 1997, p. 130).
Although the effectiveness of intervention with neglecting families
has not been studied adequately, limited evidence suggests that
interventions are successful with no more than 50% of families.
The most effective interventions are comprehensive and relatively
long term (Gaudin, 1993) (Erickson & Egeland, 1996,
p. 16).
Cohn and Daro also warned of
disappointing results.
Reviews of clinical intervention programs and federally funded
demonstration projects reflect relatively poor outcomes (e.g., 30%
success rate) and a high reoccurrence of maltreating behaviours
(e.g., 66%) in neglectful parents and caregivers. These authors
suggested that positive findings were associated with skill-training
groups (i.e., home management and social skills focus), parent education
and support groups, family counselling, home-based counselling to
remediate daily living skills deficits, and the use of lay counsellors.
In contrast, programs lasting less than 6 months, with more traditional
emphasis on parent-focused interventions and casework, were associated
with the poorest outcomes (Becker et al., 1995, p. 37).
Daro (1988) reviewed 19 NCCAN [National Center on Child Abuse and
Neglect]
demonstration programs from 1978 to 1982 and found that "in
only 53% of the neglectful families was there improvement in the
family's overall level of functioning, and 70% were judged likely
to recidivate after
53
Prevention and Treatment
case closing. In 66% of the neglectful families there were additional
reports of neglect while intervention was in progress." She concluded
that regardless of the type of intervention, the severity of the families'
problems was the most powerful predictor of outcome. The presence
of alcohol and drug problems consistently correlated with less successful
outcomes (Gaudin, 1993b, p. 73).
Working with neglectful families appears to be a difficult job.
Research by Bath indicated that those who have already neglected
are one of the most difficult populations to reach through current
service models (Rose & Meezan, 1993, p. 287). Some authors attribute
this to the nature of the client population:
A major difficulty in serving [chronically neglectful] families
is the emotionally draining effect that the apathy of neglectful
families may have on professionals. The hopelessness and helplessness
of these families make it extremely difficult for workers to initiate
and follow through on plans that might alleviate the families' situation
(DiLeonardi, 1993,
p. 559).
To date, most clinical interventions have focused on treating the
neglecting mother, rather than the neglected child.
As is typical of the abuse and neglect literature, the empirical
studies that are available (e.g., Dawson, de Armas, McGrath &
Kelly, 1986; Gaudin, Wodarski, Arkinson & Avery, 1991; Lutzker,
1990; Lutzker & Newman, 1986; Lutzker & Rice, 1984) have
focused the major intervention on parents rather than on children....
The majority of the clinical and empirical information on treatment
programs for neglected children focuses solely on infants and preschool-age
children (Becker et al., 1995, p. 30).
Swift (1995a) viewed this focus in the following terms:
It is important to notice that while the children's needs warrant
our entry into the private home, it is the needs of the mother rather
than the children that become the focus of intervention. The role
of the state is to produce and enforce care for children through
the family, which usually means through the mother. It is the
need for a change in mother that provides the justification for
intervention, and it further explains the kinds of interventions
that child welfare systems typically offer. Mothers are presented
as having deficit needs; they have not themselves been nurtured
adequately. This explanation is what Fraser describes as "needs
interpretation," a function
54
Child Neglect: Current Definitions and Models
through which personnel "translate [clients'] experienced situations
and life-problems into administrable needs" (1989,
p. 154). In this process, other possible needs are closed off not
only as legitimate but even as specifiable (pp. 113_114).
The few programs directed at
children have tended to provide
therapeutic day care, which appears
to be effective in addressing some of the deficits associated with
neglect.
[M]ost of the treatment programs available to address the needs
of neglected children involve therapeutic day-care programs (e.g.,
Culp et al., 1987; Culp et al., 1991).... Overall, therapeutic day-care
programs have resulted in significant developmental gains in preschoolers.
However, limited information on long-term treatment success is available,
and adaptations of this approach for older children is non-existent
(Becker et al., 1995, p. 30).
Becker et al. (1995) concluded that more empirical studies on the
treatment of neglected children are
needed and that "[f]uture research should address the needs
of older children and adolescents, utilize
standardized measures, separate neglect from other forms of abuse,
and measure outcome through recidivism data as well as the children's
long-
term academic performance and psychological adjustment" (p.
30).
Early interventions are seen to be important:
Because neglect is particularly damaging in infancy, it is important
to work with families as early in the infant's life as possibleor,
preferably, even before the baby is born (Erickson & Egeland,
1996, p. 16).
Multiple interventions are also seen as important:
The best news, in fact, is that because of the "discovery"
that child maltreatment is multiply determined, no "magic bullet"
must be identified and targeted before intervention efforts can
be initiated.... Although the multidetermined nature of child maltreatment
suggests that there are many targets to focus prevention and remediation
efforts, it simultaneously alerts psychologists to the fact that
directing efforts at any single target is not likely to be particularly
successful (Belsky, 1993, p. 428).
Coohey (1996) also recommended a variety of interventions, beginning
with the following:
[T]he premise that personal social networks are the major avenue
by which parents receive most of the resources that were included
in this study. Thus, it is not reasonable to assume that individual
practitioners can provide a permanent or adequate source of, for
example, emotional support to
55
Prevention and Treatment
neglectful mothers. Instead, it does seem reasonable that our interventions
target mothers who have an insufficient level of resources, engage
the mother's important network members who can provide support to
her, assist a mother in developing new relationships with persons
outside her network, and simultaneously, work toward increasing institutional
resources such as adequate education and employment for low-income
parents (p. 252).
Evaluation studies of multi-service interventions have demonstrated
some positive results.
The NCCAN, for example, has recently funded a series of multi-service
projects directed at chronically neglectful families. Evaluations
of these projects have indicated that a combination of parenting
groups, intensive in-home counselling, and supportive interventions
(e.g., parapro-fessional aides) has been effective in improving
neglectful parenting practices.... Two recent studies suggest, however,
that outcomes for neglecting families are less positive than for
abusive families or families of delinquents (O. Barnett et al.,
1997, p. 131).
Dubowitz et al. (1993) echoed the call for varied interventions
tailored to the individual situation (p. 10). Cicchetti and Toth
(1995) emphasized developmental appropriateness:
In examining the needs of maltreating families, it becomes clear
that the integration and coordination of services are critical if
intervention is to be effective. The more unified and comprehensive
the interventions that are available within an individual treatment
centre, the greater the likelihood that splintered services will
be avoided.... Most basically, the survival needs of the family
for food, clothing, and shelter must be met before the family members
can be engaged in more complex psychological and behavioural change.
The clinician working with the family must be responsive to establishing
a trusting relationship with both parents and children. Clinical
interventions need to be sensitive to critical stage-salient issues
of the child, and interventions with parents and children should
focus on those issues.... Intervention with maltreating families
also must be sensitive to variations in family organization, structure,
roles, and patterns of relating that are influenced by cultural,
racial, and ethnic differences (p. 555).
Interventions require clear treatment goals:
To formulate appropriate interventions with neglectful families
it is critical to distinguish between inadequate supervision that
is related to the parent's
56
Child Neglect: Current Definitions and Models
impulsive behaviour, depression, alcoholism or other dysfunctional
behaviour and that which is related to a parent's lack of knowledge
and understanding of age appropriate expectations for a toddler (Azar,
Robinson, Hekimian & Twentyman, 1984; Herrenkohl, Herrenkohl &
Egold, 1983). For example, neglect that is related to a parent's mental
retardation requires intensive, in-home, behavioural instruction to
remedy knowledge and skills deficits (Lutzker, 1990) (Gaudin, 1993b,
p. 69).
Some authors have recognized the importance of preventive strategies.
Nevertheless, because the demographic data clearly indicate that
poverty and early and extensive childbearing provide fertile soil
in which child maltreatment can grow, it is difficult to imagine
that major strides can be made in the battle to prevent, much less
remediate, child maltreatment so long as impoverished women, particularly
those who are young, are rearing multiple and closely spaced offspring
on their own, without sufficient social supports, or both. This
observation suggests that fertility planning, education, employment,
and economic assistance will be required.... (Belsky, 1993, p. 428).
Palacio-Quintin and Éthier (1993) suggested economic and
social policies to address child neglect in Canada, such as reducing
poverty, improving housing, job opportunities and early intervention.
New psychosocial models of early intervention are needed (p. 162).
Tracy et al. (1993) noted that:
The three major family stress factors that affect families ser-viced
by child welfare agencies in this study were substance abuse, economic
difficulties, and poor living conditions. These factors represent
large social-environmental problems that are generally outside the
control or auspice of the child welfare system. This finding is
significant in light of the fact that the major thrust of service
delivery was counselling and therapeutic services (p. 26).
Belsky (1993) also acknowledged the importance of income supports
and improved housing for poor families.
As stated repeatedly, poverty is a major contributing factor to
child maltreatment. Thus it seems likely that guaranteed minimal
incomes, child allowances, and housing benefits would reduce the
risk of maltreatment (p. 429).
Gaudin (1993b) proposed a number of elements for designing interventions,
such as mobilizing concrete formal
57
Prevention and Treatment
and informal helping resources to address family poverty. He stated
that treatment goals must include the nurturing of the neglecting
parents in order to enhance their self-esteem and self-efficacy. Intervention
with neglectful parents requires that workers "parent the parent."
Gaudin also recommended that interventions "begin where the client
is;" assume that parents want to improve the quality of care
for their children and reinforce the parents' hidden strengths. Set
realistic and achievable treatment goals, exercise legal authority
if necessary to overcome any initial denial or apathy and ensure that
treatment lasts at least 12 months (p. 70).
Broadening the focus of treatment is an area that appears promising.
Multi-service interventions and those that included all family members,
rather than focused on the principal care provider, were more successful
with neglectful families, according to Daro (Gaudin, 1993b, p. 77).
Group methods also appear successful, as do intensive, weekly, in-home
casework counselling focusing on concrete problem solving.
Researchers also note that "empowerment" can be effective
in helping neglectful families, although the term appears to be
open to some interpretation. Empowerment can be conceptualized as
a philosophy, as a paradigm, as a process, as a partnership, as
a performance, and as a percep
tion, according to Landsman (NCCAN, 1997b, p. 18). Empowerment-based
practice entails
exchanges between clients and professionals, or between
help-seekers and help-givers;
partnership and mutual respect among all parties involved;
a proactive or strength-based stance toward individuals
and families based on the assumption that people are capable of
acting competently and of enhancing their competence; and
a cognitive componentto gain a sense of self-efficacy,
clients must attribute changes to their own activities or actions.
Several authors have suggested that life-skills training has been
effective.
Project 12-Ways is one of the most carefully documented and successful
programs for neglectful parents reported in the research literature.
The program uses in-home behavioural training to teach neglectful
parents grocery-shopping and menu-planning skills, skills to remedy
specific safety hazards and improve the cleanliness in the home,
and identification of children's illness symptoms. Parents and children
were taught specific skills using the
58
Child Neglect: Current Definitions and Models
behaviour techniques of modelling, coaching, and positive reinforcement
to remedy specific skill deficits and environmental conditions (Barone
et al.) (Gaudin, 1993b, p. 74).
Interventions providing direct service to children appear to help
remedy some of the effects of neglect, according to Daro, but there
is little reliable empirical evidence of this. Her review indicated
that therapeutic child care programs providing cognitive stimulation,
cultural enrichment, and motor and social skill development have
a significant impact on the child's ability to function (Gaudin,
1993b, pp. 83_84).
NCCAN, a part of the U.S. Department of Health and Human Services,
funded six demonstration projects to help neglectful families in
1988. Family empowerment, group work, and paraprofessionals or volunteers
were used to some extent by all of the projects. All of the families
served had an income lower than the poverty level. The Childhood
Level of Living (CLL) Scale was used to assess families before and
after
intake. Services lasted an average of 18 months (range three months
to over two years).
Many families showed improvement in the areas of family socialization
or activities, household cleanliness, and appropriate child discipline
(p. 561). Overall the project families scored at a mean of 64% of
the CLL norms for minimum adequate parenting, which increased to
an average of 82% minimum adequacy at the end (DeLeonardi &
Johnson, 1993) (DiLeonardi, 1993, pp. 557_562).
Neglect is often embedded in a larger pattern of dysfunction and,
in many cases, environmental chaos, making it difficult or impossible
to separate the impact of neglect from other environmental influences....
[I]ntervention efforts most likely will need to address the entire
matrix of home and family variables that support or impede children's
development (Erickson & Egeland, 1996, p. 10).
59
18
Child Neglect: Current Definitions and Models
Conclusion
Conclusion
As has been noted, the issues concerning child neglect are complex.
Debates about its definition, causes, effects, and interventions are
not expected to be resolved in the short term. Research is tied to
child welfare practice, which continues to be scrutinized by the public
and professionals in Canada and the United States.
As Swift (1995a) has indicated, the usual focus of child welfare
personnel is, by legal necessity, on the culpability of the parent.
One reason neglect files are so distressing to read is that we
see in them the dreadful conditions children endure during the lengthy
period the state requires to establish evidence against their parents.
Children are condemned to live like this not only because their
parents are unable or unwilling to do better, but also because the
only helping tool society has provided itself is to find parents
guilty. While scholars debate the desirable definitional breadth
of neglect, the actual standard of care enforced through the present
system is desperately lowsurely well
below any minimum standard scholars would care to commit to paper
(p. 87).
A conceptual shift is required, according to some authors. In light
of what she calls "a hundred years of failure to either save
children or change mothers," Swift recommended a radical rethinking
of the child welfare system, with many shifts in funding, organization,
and orientation so that service providers can become concerned with
the welfare of children rather than with protective practices. She
welcomed fellow Canadian Marilyn Callahan's "recentand
courageoussuggestion that neglect be eliminated as a child
welfare category" altogether.
The ideological baggage neglect carries with it, the overly legalized
system developed to make determinations of neglect, the paltry resources
associated with it, and the abject failure of its use in improving
life for clientschildren and parents alikeall argue
for a radical change in direction. Workers who now spend much of
their time policing families might actually be able to provide service,
were resources to be
61
Conclusion
diverted, as Callahan suggests, into a system designed explicitly
to improve the welfare of Canadian children.... In Canada, we are
accustomed to incremental change. But perhaps in some cases, we should
simply admit failure and begin again. Neglect, for me, is one such
case (Swift, 1995a,
pp. 193_194).
Indeed, Callahan's "courageous" suggestion appears to
make good sense:
In [separating child apprehension from voluntary services to families],
several models could be explored. In any model, the so-called crime
of neglect should simply disappear from the child welfare statutes.
Instead, child welfare statutes could be reframed to define the
caring services to be provided and the circumstances under which
they will be provided. If chronic neglect is primarily a matter
of poverty, frequently the poverty of disadvantaged women, then
it should be dealt with as a resource issue rather than a personal,
individual problem. If situational neglect occurs, such as the abandonment
of children, then such problems can be dealt with by providing care
and resources to children, locating parents, and helping them make
plans for their children. Proving them unfit to care for their children
in either case is irrelevant, as it wastes court time and damages
parent_child relationships. Voluntary care orders would remain.
In any event, neglect could remain within the Criminal Code for
those difficult cases where serious neglect occurs yet help is refused
(Callahan, 1993, p. 205).
Other authors have come to similar conclusions. One important shift
in focus appears to be a need to start addressing child neglect
prevention:
In our opinion, one of the major directions for both practice and
research in the area of child neglect is the implementation and
careful evaluation of programs designed to prevent neglect.... We
concur with Aber and his colleagues that programs must be designed,
targeted, and evaluated within a clearly articulated theory on the
development of maltreated children and the factors that lead to
and perpetuate maltreatment. We believe that attachment theory provides
a good place to begin (Erickson & Egeland, 1996, p. 16).
For those who take a less radical approach to change, a number
of recommendations have been made to improve the research base.
Cicchetti and Toth's (1995) recommendations include the following:
consider definitional issues,
expand cultural and ethnic sensitivity,
62
Child Neglect: Current Definitions and Models
conduct more longitudinal research,
elucidate the development processes contributing to adaptation
and maladaptation,
conduct research on the whole family,
address the effects of
co-occurring risk factors,
measure the psychological and biological correlates of functioning
in maltreated children,
further articulate the links between child maltreatment
and psychopathology,
expand public educational efforts, and
disseminate knowledge to legislators and policy
advocates.
The current research points to the seriousness of the effects of
neglect on children and the limits and deficiencies of prevention
and treatment efforts. As Douglas Barnett et al. (1993) summarized:
[S]cientists have been successful in increasing our knowledge of
child maltreatment, but our nation has been comparatively unsuccessful
in benefiting from this progress (p. 44).
Child neglect's strong link with poverty cannot be overlooked.
Hewlett's (1993) examination of child neglect in wealthy, industrialized
nations points to a number of broad economic and political factors
that affect child neglect. Her analysis suggested that child neglect
is not a phenomenon that will disappear on its own in the near future.
Hewlett points to shrinking wages in Anglo-American economies since
the mid-1970s, the increased number of two-income families, longer
work weeks, stresses on parents, the high number of absentee fathers
(in the United States, one quarter of children under 18 are growing
up without fathers10 million as a result of divorce and 5
million as a result of out-of-wedlock births), and low support payments
to mothers
(pp. 5_13).
One question that researchers in Canada must continue to ask is
how relevant American child neglect research is to the Canadian
situation. Does Canada, with lower levels of abject family poverty
than the United States, have a lighter societal burden related to
child neglect? Do our social programs mitigate the occurrence of
child neglect compared with our neighbours to the south? Does the
American crack cocaine epidemic foreshadow increasing drug abuse
in Canada?
Trocmé et al.'s (1994) research concerning child maltreatment
investigations in Ontario suggested that neglect does represent
a lower proportion of child maltreatment cases, compared with US
statistics. Maltreatment investigations conducted in Ontario in
1993 (46,683) showed that
19,352 (41.4%) involved suspected physical abuse,
11,846 (25.3%) involved suspected sexual abuse,
63
Conclusion
13,933 (29.8%) involved suspected neglect, and
4,727 (10%) involved suspected emotional maltreatment.
Maltreatment was substantiated in 27% of these cases, suspected
in 30% and unfounded in 42% (p. iii).
In comparison, the US NIS-3 (1993) found a total of 2,815,600
reported maltreatment cases of which
614,100 (21.8%) were cases of physical abuse,
300,200 (10.6%) were cases of sexual abuse,
532,200 (18.9%) were cases of emotional abuse,
1,335,100 (47.4%) were cases of physical neglect, and
585,100 (20.7%) were cases of emotional neglect.
Canadian programs and interventions may also have a mitigating
factor on child neglect. A number of longitudinal studies currently
under way (e.g., Better Beginnings, Better Futures) may shed
some light on child neglect research and interventions in this country.
Other programs that may have an effect include the
Community Action Program for Children (CAPC) initiatives. These
are community-based programs funded by Health Canada that are designed
to improve the health and well-being of children six years of age
or younger, as well as their families, who are in difficult situa
tions. The ongoing evaluation of the effects of these programs may
also increase the knowledge base concerning effective interventions.
Other Canadian programs that should be examined in light of child
neglect research include the various Headstart programs across the
country, Babies' Best Start in Ontario, home visiting programs,
and enriched, early childhood programs.
Diverse research from a variety of disciplines and fields continues
to broaden our understanding of child maltreatment issues. There
is new information about infant brain development that should be
examined for relevance with regard to prevention for children. As
each new piece of information about social and human development
helps to fill in the pieces of some long-standing puzzles, they
also result in new puzzles and concepts that help us to question
assumptions and re-visit existing models and theories.
Broad, basic questions posed by Swift and other researchers have
not yet been addressed in a systematic way across Canada. Some of
these questions relate to the basic direction of child welfare work
in Canada. There is much policy and research work yet to be done
regarding child neglect in particular and child welfare in general,
beyond the current emphasis on child death reviews and the narrower
focus on "child safety."
It is important that we continue to question the historical biases,
social ideologies, and political expediency
64
Child Neglect: Current Definitions and Models
that hinders efforts to improve the well-being of children who are
at risk of harm. If real improvements are to be made on behalf of
children, it is clear that the economic situation of young families
must be addressed, in conjunction with prevention and early intervention
programs that make a demonstrated, long-lasting improvement in the
lives of children.
65
18
Child Neglect: Current Definitions and Models
Appendix A: Child Neglect Index
Appendix A: Child Neglect Index
20
0
15
5
Child's Name:
File Number:
Worker's Name: Date :
0_2
13_16
6_12
3_5
Age
Supervision
The two factors to be considered in assessing level of supervision
are avoidability (i.e., extent to which a caretaker can be expected
to anticipate and prevent) and severity of harm, or potential harm.
Three specific types of harm that may result from failure to supervise:
physical harm, sexual molestation, criminal activity/child under
13.
Unknown/Does Not Apply
1. Adequateprovisions made to ensure child's safety; caretaker
knows child's whereabouts and activities; clear limits set on activities.
2. Inconsistentchild is occasionally exposed to situation
that could cause moderate harm (e.g., young school-aged child occasionally
left alone, parents do not monitor whereabouts of adolescent who
occasionally comes home late in the evening).
3. Inadequatechild is often exposed to situations that could
cause moderate harm, or there is a slight possibility that the child
could suffer serious harm (e.g., young school-aged child often left
unsupervised, or infant occasionally left alone while sleeping).
4. Seriously Inadequatechild is often exposed to situations
that could cause serious harm (e.g., abandonment, home used as "crack
house" and drugs left within reach of child, child often left
to wander in dangerous neighbourhood, toddler often exposed to hazardous
situations).
s/o
0
25
50
60
67
Appendix A: Child Neglect Index
Physical Care
Physical harm or substantial risk of physical harm due to the caretaker's
failure to care and provide for the child adequately.
Food/Nutrition
Unknown/Does Not Apply
1. Regular and nutritional meals provided.
2. Meals irregular and often not prepared, but child's functioning
is not impared.
3. Meals irregular and often not prepared; child's functioning
is impaired (e.g., child is hungry and has difficulty concentrating
in class).
4. Inadequate food providedthere is a substantial risk that
the child will suffer from malnutrition (e.g., infant given diluted
formula).
5. Child displays clinical symptoms of malnutrition; medical attention
and/or rehabilitative diet required (e.g., weight loss, anemia,
dehydration, etc.).
Clothing & Hygiene
Unknown/Does Not Apply
1. Child is clean and adequately clothed.
2. Inadequate clothing or hygiene, but this does not appear to
affect child's functioning.
3. Inadequate clothing or hygiene limits child's functioning (e.g.,
unable to go outdoors because of lack of clothing, isolated by peers
because of hygiene or appearance).
4. Inadequate clothing or hygiene likely to cause illness requiring
medical treatment (e.g., infestation of head lice).
5. Illness requiring medical treatment due to inadequate clothing
or hygiene (e.g., serious infection due to poor diaper care, intestinal
disorder).
s/o
0
20
40
50
60
s/o
0
20
40
50
60
68
Child Neglect: Current Definitions and Models
Provision of Health Care
"Treatment not provided" includes refusing or being unavailable
or unable to consent to treatment. The extent to which harm could
be avoided should be considered in terms of three factors: (a) whether
a reasonable layman would recognize that a problem needs professional
attention; or (b) whether a professional has recommended services
or treatment; or (c) availability and/or effectiveness of treatment
or services (e.g., the questionable effectiveness of services for
chronic teen manners).
Physical Health Care
Unknown/Does Not Apply
1. Basic medical care provided.
2. Preventive medical care not provided (e.g., no regular checkups).
3. Medical care not provided for injury or illness causing avoidable
distress.
4. Medical care not provided for injury or illness causing avoidable
distress and interfering with child's functioning (e.g., chronic
absence from school due to untreated illness).
5. Medical care not provided for injury or illness, which could
lead to permanent impairment or death (e.g., infant vomiting or
diarrhea leading to dehydration).
Mental Health Care CFSA
Unknown/Does Not Apply
1. Parents anticipate and respond to child's emotional needs.
2. Inconsistent response to emotional distress (e.g., responds
only to crisis situations).
3. Services or treatment not provided in response to emotional
distress; child at substantial risk of severe emotional or behavioural
problems (anxiety, depression, withdrawal, self-destructive or aggressive
behaviour, child under 13 engaging in criminal activity).
4. Services or treatment not provided in response to emotional
distress, child experiencing severe emotional or behavioural
problems.
s/o
0
20
45
50
60
s/o
0
20
50
60
69
Appendix A: Child Neglect Index
Developmental and Educational Care
Unknown/Does Not Apply
1. Child's developmental and educational needs are met.
2. Child's developmental and educational needs are inconsistently
met (e.g., limited infant stimulation, child could benefit from
remedial help in one or two subjects, child having academic difficulties
due to poor school attendance).
3. Services or treatment are not provided in response to identified
learning or developmental problems (e.g., learning disability diagnosed
but caretakers refuse remedial help).
4. Child has suffered or will suffer serious/permanent delay due
to inattention to developmental/educational needs (e.g., Non-organic
Failure to Thrive identified but caretakers refuse remedial help).
For further information contact Nico Trocmé (416_978_5718;
nico.trocme@utoronto.ca), Bell Canada Child Welfare Research Unit,
Faculty of Social Work, University of Toronto.
s/o
0
20
50
60
70
Child Neglect: Current Definitions and Models
Appendix B: List of Acronyms
Appendix B: List of Acronyms
AAPC
American Association for Protecting Children
AFDC
Aid to Families with Dependent Children (USA)
CAPC
Community Action Program for Children
CLL
Childhood Level of Living
CNI
Child Neglect Index (Ontario)
CPS
Child Protection Services
CWB
Child Well-Being
DHHS
Department of Health and Human Services (USA)
FTT
Failure to Thrive
MCS
Maternal Characteristic Scale
NCCAN
National Center on Child Abuse and Neglect (USA)
NIS
National Incidence Study for National Incidence and Prevalence
of Child Abuse and Neglect Study (USA). These studies are conducted
periodically and are differentiated by NIS_1, NIS_2, NIS_3, etc.
NOFT
Non-organic Failure to Thrive (Also referred to as NFTT)
SES
Socio-economic Status (USA)
71
Child Neglect: Current Definitions and Models
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