Spotlight on child neglect
Spotlight on child neglect
Adam M. Tomison
- What is Child Neglect?
- Definition of Neglect
- Incidence of Neglect
- Characteristics of Child Neglect
- Chronic Neglect Cases
- Effects of Neglect
- The Neglect of Child Neglect
- Case Labelling and the Minimisation of Child Neglect
- When Child Neglect is Minimised
- Redefinition of Physical Abuse Cases as Emotional Abuse or Neglect
It has been contended by a number of authors (for example, Moore 1989; Wolock and Horowitz 1984) that child neglect has long been neglected as a form of maltreatment, and that often it exists merely as an 'add-on' to child abuse.
This paper aims to re-focus attention on neglect by briefly outlining some of the current child neglect issues evident in the research literature. The paper presents the argument that child neglect is minimised via its links with child abuse - in particular, by the perception that child abuse is a more serious societal problem than neglect. An outline is presented of a variety of ways in which neglect is negated, and there is a discussion of the place of neglect in the child protection system, into the next century.
Child neglect became recognised as a societal concern throughout much of the western world during the industrial revolution of the late nineteenth century (Goddard 1988; Lynch 1985; Corby 1987; Swift 1995), with initial concerns for abandoned and physically neglected children resulting in the formation of the first child protection societies and the first child protection legislation.
Child maltreatment was 'discovered' in the early 1960s in the United States by a group of medical professionals led by Henry Kempe who constructed the 'battered child syndrome' as a medical interpretation of what is commonly thought of as physical abuse (Kempe, Silverman, Steele, Droegemuller and Silver 1962). The definition of what constitutes child maltreatment has changed significantly in the last three decades, and now encompasses not only physical abuse but a wide range of behaviours, clinical features and assumptions (Parton 1979), embracing both sexual and emotional abuse.
Child neglect is a form of child maltreatment frequently linked with child abuse, and many authors have actually subsumed 'neglect' under the general term 'abuse' (Wolock and Horowitz 1984), with some arguing that child maltreatment has come to be defined primarily as child abuse (Wolock and Horowitz 1984; Daro 1988). According to Wolock and Horowitz, neglect has been effectively reclassified as a less important social problem, existing merely as an addendum to child abuse. Nelson, Saunders and Landsman (1993:661) stated that 'there has been a lack of attention to families in which child neglect is a significant problem'. According to Hallett and Birchall (1992), cases of neglect and emotional abuse are particularly prone to be being under- registered on official child abuse registers. Daro (1988:32) titled a section in her book: 'Physical neglect: the most forgotten form of maltreatment'.
What is child neglect
The professional child abuse community generally agrees that there are problems in arriving at concrete definitions of the various forms of child abuse and neglect (Giovannoni 1989; Goddard and Carew 1993).
The United States National Research Council (1993:5) noted that: 'Despite vigorous debate over the last two decades, little progress has been made in constructing clear, reliable, valid, and useful definitions of child abuse and neglect. The difficulties in constructing definitions include such factors as lack of social consensus over what forms of parenting are dangerous or unacceptable; uncertainty about whether to define maltreatment based on adult characteristics, adult behaviour, child outcome, environmental context or some combination; conflict over whether standards of endangerment or harm should be used in constructing definitions; and confusion as to whether similar definitions should be used for scientific, legal, and clinical purposes.'
Neglect in particular can be characterised as a continuum of omissions in parental caretaking. By its very nature, this failure to take action is more difficult to describe or detect than are the various acts of commission which categorise child abuse (Drotar 1992). Definitions of neglectful behaviour are dependent upon societal standards of acceptable parenting (Korbin 1980). Thus, the definitions of what constitutes ideal parental behaviour, the threshold for inappropriate parental behaviour, and what are considered to be adequate standards of care, vary across communities (Drotar 1992).
Zigler and Berman (1983) contended that different working definitions of child neglect are required for different purposes. While narrow definitions of neglect are required for legal intervention in order to protect the rights of the family, broad definitions are required when the intention is to focus on at-risk families, and to provide such families with suitable services. Aber and Zigler (1981, as cited by the National Research Council 1993) noted distinctions between a number of approaches to defining child maltreatment (and more specifically child neglect): medico-diagnostic, legal, sociological and research.
The United States National Incidence Survey of Child Abuse and Neglect cited by the National Center for Child Abuse and Neglect (1988), included four main categories of neglect - educational, emotional, physical, and general or unspecified. Together these covered seventeen different sub-categories. Zuravin (1991) proposed fourteen sub-categories of neglect that were mutually exclusive, and defined neglect in terms of parental behaviours rather than child outcomes. These included: refusal or delay in providing general health, or mental health care (medical neglect); supervisory neglect (inadequate supervision); abandonment or desertion; failure to provide an adequate living environment; failure to ensure adequate personal hygiene; failure to provide adequate nutrition; and educational neglect.
In addition, some researchers (for example, Hegar and Yungman 1989) include an additional category: psychological or emotional neglect. It is generally acknowledged that most abusive or neglectful actions have a detrimental emotional or psychological effect on the child (Department of Health, in press). Where specific acts of emotional harm constitute the sole or main form of abuse, whether by omission or commission, there is agreement that such actions should be defined as emotional abuse (Department of Health and Social Security 1988).
Definition of neglect
For the purposes of this paper, neglect will be broadly defined as 'any serious act of omission or commission which, within the bounds of cultural tradition, constitutes a failure to provide conditions that are essential for the healthy physical and emotional development of a child' (Australian Institute of Health and Welfare 1995).
Incidence of child neglect
It should be acknowledged that which definition of neglect is employed by professionals will have an effect on how the problem is perceived and, in particular, on estimates of its incidence. The pattern of incidence and the outcomes of the various forms of child maltreatment (including neglect) are inadequately known, there being a large gap between prevalences revealed in various surveys, and cases registered by professionals (Birchall 1989). While the former attempts to determine the frequency of neglect in the general population (Birchall 1989), the latter is merely a tally of those cases of child maltreatment which have been referred to child protection services who have, upon investigation, substantiated the abusive concerns.
Thus case registers reveal more about changes in professional perceptions of maltreatment than about real incidence (Birchall 1989).
Although acknowledging the problems in obtaining a reliable estimate of the prevalence of neglect, research from the United States in particular has indicated that neglect is more prevalent than other types of child maltreatment (Wolock and Horowitz 1984; National Center for Child Abuse and Neglect 1988). Depending on the source of the data and sample type, estimates of neglect in the United States have ranged from 30 per cent to 65 per cent of substantiated child maltreatment cases (National Center for Child Abuse and Neglect 1988; Starr, Dubowitz and Bush 1990). In Britain, where neglect is reportedly underestimated (Hallett and Birchall 1992; Minty and Pattinson 1994), estimates have ranged from 7 per cent (child abuse case register figures) to 38 per cent (BBC Childwatch Survey 1986, as cited by Birchall 1989).
The most recent Australian national figures for substantiated child maltreatment indicated that 23 per cent of all substantiated cases were officially labelled by the various state child protection services as child neglect, with the proportion of neglect cases substantiated varying from 16-34 per cent across the states. Cases labelled as physical abuse constituted 29 per cent of all substantiated cases, 25 per cent were labelled as emotional abuse, and 23 per cent were labelled as sexual abuse (Australian Institute of Health and Welfare 1995). There were approximately equal numbers of male and female neglect victims, while the majority of identified maltreating caregivers were women (77 per cent). A significant finding related to the Aboriginal and Torres Strait Islander families. They were particularly over-represented in cases of neglect, with 40 per cent of child maltreatment cases labelled as neglect. Compared with the general population, however, there was a much lower proportion of sexual abuse cases (14 per cent), physical abuse (26 per cent) and emotional abuse cases (20 per cent).
A useful summary of the various types of neglect (and abuse) which occur in communities is provided by the National Center for Child Abuse and Neglect (1988). There are: the cases referred to statutory child protection services; the cases detected by, or which are referred to, other professional agencies with investigative powers (for example, police and health departments) but which are not officially labelled as abusive or neglectful; cases known to be abusive/neglectful by non-investigatory agencies or professionals (for example, schools and hospitals), but which are not officially reported; cases recognised by a layperson but which are not reported; and finally, children who are being abused or neglected, but who are not recognised as such by anyone.
Studies investigating the epidemiology of abuse or neglect, or the incidence of specific types of maltreatment frequently rely on summaries of substantiated child abuse and neglect cases collected by child protection services. The National Center for Child Abuse and Neglect estimated that only 40 per cent of child abuse and neglect cases were reported to child protection services in the United States, indicating a substantial under-reporting of the incidence of child abuse and neglect. Hallett and Birchall (1992:179) noted that the '[under- registration] of neglect and emotional abuse is particularly marked '.
Alternatively, researchers may use statistics on the number of cases reported or indicated within the professional community. This practice is also questionable because allegations to child protection services are frequently not substantiated. For example, according to the Australian Institute of Health and Welfare (1995), approximately half of all Australian reports of child maltreatment in 1992-93 were not substantiated. Starr, Dubowitz and Bush (1990) cite United States figures estimating the substantiation rate across a number of large-scale studies to be 40-45 per cent. As for those identified by professionals, but not investigated by protective services at all, the proportion of cases which would be substantiated must, by definition, remain unknown.
However, despite the problems inherent in estimating the incidence of child neglect, it is clear that a significant number of children are neglected each year.
Characteristics of child neglect
Child neglect is commonly associated with low income, larger, multi- problem families, families receiving government benefits, poor housing and living conditions, and low educational and employment levels (Boehm 1964; Daro 1988). Most child abuse and neglect concerns do not occur in isolation. That is, many cases involve a variety of different concerns.
In the United Kingdom, Farmer and Owen (1995) found that in one-third of cases where neglect was the main concern, there were also physical abuse concerns; in one-fifth of physical abuse cases, there were neglect concerns; and in one-quarter of sexual abuse cases there were neglect concerns.
In Australia, Tomison (1994) found that approximately 15 per cent of all neglect cases and 25 per cent of emotional abuse cases involved some form of physically abusive action.
Chronic neglect cases
Within child neglect is a sub-set of cases often defined as 'chronic' neglect cases. These can be characterised in terms of their 'chaotic and unpredictable character' (National Research Council 1993), their long-term involvement with family support and child protection services (Nelson, Saunders and Landsman 1993; Tomison 1994), and a lack of cognitive stimulation and emotional nurturance for the child (Polansky, Gaudin and Kilpatrick 1992, as cited by National Research Council 1993).
The caregivers in such cases often fit the stereotype of the neglecting parent, with a multitude of predictors being identified in the family. Such families often comprise single parents (usually mothers), with financial and/or housing problems, who may have little or no community support, and who are categorised as having some form of parenting problem (Tomison 1994). Many of the caregivers are also described as 'low functioning' - that is, they have some type of mild intellectual disability, or possibly a psychiatric condition (Nelson, Saunders and Landsman 1993).
In the less severe cases of chronic neglect: 'many of the clients were regarded quite warmly by the [child protection] workers, they were usually perceived as very cooperative, but were unable to fully function on their own. Commonly, the protective concerns were minimal for these cases, with most falling well below the criteria for legal intervention. The workers would therefore organise some form of assistance (for example, financial support, family aide visits, parenting skills courses) and end their involvement with the case' (Tomison 1994:73).
The more severe cases could be characterised as facing an enormity of problems, significantly more child abuse and neglect problems, more resource problems, often 'rearing larger families on extremely low incomes' (Nelson, Saunders and Landsman 1993:669).
Daro (1988) argued that interventions with child neglect cases were less likely to succeed, when compared with child abuse. It is contended that this is in part due to a lack of appropriate, intensive, long-term services that can support a neglecting family (Nelson, Saunders and Landsman 1993). The unavailability of family support services is a common theme in child protection services in Britain, the United States and Australia (Hallett and Birchall 1992; Nelson Saunders and Landsman 1993; Tomison 1994; Department of Health, in press). The lack of appropriate services is obviously of greater importance when dealing with the more severe, chronic cases of neglect.
In Tomison's (1994) child abuse case tracking study, the only support services that could be offered to clients were of a short-term nature; when services were terminated, the clients had to cope on their own. They invariably ended up returning voluntarily to child protection services (or were referred by other workers) in order to receive more support. It appeared that this cycle continued on until the caregiver(s) could no longer adequately care for the child, and the family become dysfunctional enough for child protection workers to apply for a supervision or guardianship order. Alternatively, the families could manage to achieve an adequate level of functioning. Tomison (1994) cited worker reports indicating that this was often achieved by the parent becoming part of an informal community/neighbourhood network which could provide ongoing non-professional support.
Officially such cases could be seen as a 'success' by child protection bureaucracies, given that an appropriate investigation was conducted, the case appeared suitable for a community-based case plan, the worker had allocated the appropriate services, and the case had been referred on. The reality is that the 'quick fixes' which were the only options available to workers, generally provided no more than a respite for both the client and child protection staff - hence the chronic, cyclical nature of the cases. The workers managing the cases reported feeling frustrated by the lack of long-term services and the inability to use some existing services more than once because of resource demands (for example, family aides) (Tomison 1994).
It seems a tragedy that long-term services which could cater for the ongoing needs of these clients do not presently exist (Nelson, Saunders and Landsman 1993; Department of Health, in press). It could be argued that the client is actually better off under a statutory child protection order, at least then services are provided for longer period than would be the case if the family was engaged voluntarily (Tomison 1994).
Effects of neglect
Research directly investigating the consequences of child neglect is sparse (Herrenkohl 1990). Wolock and Horowitz (1994) point to this scarcity of research as a further indicator of the overshadowing of neglect by abuse.
Many neglected children present as suffering from medical conditions, failure to thrive, or malnutrition, which in their severe forms may be life- threatening (Drotar 1992). Studies of the psychological effects of neglect on children are limited by methodological problems (Lamphear 1986). However, 'taken together, available studies underscore the vulnerability for risk experienced by neglected . . . children and the need for prevention' (Drotar 1992:119).
What research there is supports the contention that neglect produces long- term detrimental effects in children, particularly in cases of chronic neglect. Polansky, one of the few researchers who has focused on child neglect (as cited by Herrenkohl 1990), provided evidence that the cognitive development of neglected children is more retarded than that of non-neglected children. In an examination of the long-term effects of neglect, Oates (1986) found that cases of 'non-organic failure to thrive' were significantly lower in social maturity, language development and verbal ability. Oates's findings also indicated that the neglected children had more personality abnormalities.
The neglect of child neglect
Historically there has been a lack of attention paid to families in which neglect was a significant problem (Wolock and Horowitz 1984; Hallett and Birchall 1992; Nelson, Saunders and Landsman 1993; Minty and Pattinson 1994). What has led to this neglect of child neglect?
A variety of explanations have been postulated in order to determine why neglect has become a mere addendum to child abuse. Minty and Pattinson (1994:734) noted that in order to establish neglect, evidence had to be collected 'in a systematic way over a period, rather than at one point in time' in order to prove that the child was suffering significant harm or was likely to suffer significant harm.
Contrast this with incidents of physical or sexual abuse, where investigations are concerned with establishing the occurrence of specific instances of abuse. As Drotar (1992) noted, by its very nature the failure to take action is more difficult to describe or detect than are the various acts of commission which categorise child abuse. Perhaps then, the nebulous nature of neglect cases have led to a focus on the seemingly more clear-cut cases of child abuse.
Moore (1989) suggested that the neglect of child neglect occurs because such cases do not contain enough 'drama' to provide the necessary 'superordinate goal' to the interagency child protection system, and also because it is intrinsically expensive in terms of both staff emotional energy and agency resources.
As mentioned previously, in the United Kingdom it was apparent that child protection workers were not registering the bulk of neglect cases on the child abuse register. Birchall (1989) suggested that the lack of registration may be due to a professional inability to define adequately cases for registration, an organisational appraisal that the child protection system cannot absorb the volume of neglect cases, or that it reflects a growing recognition that neglect is strongly linked to poverty and cannot be helped by the child abuse case register.
With regard to the latter point, Wolock and Horowitz (1984) contended that neglect may be accorded less importance because of its link to poverty. Thus neglect is seen to reflect the low priority accorded to alleviating poverty. Patti (1976, as cited by Wolock and Horowitz 1984:7) speculated that the magnitude of the child neglect problem has been evaded by the United States Congress because of its close links with poverty, a problem which would raise 'the potential cost of possible public alternatives beyond what congressional leaders considered politically feasible'.
Minty and Pattinson (1994) contended that social workers have intrinsically negative perceptions of the probability of effecting lasting change with neglecting families. In support of this view, Daro (1988) found that in only 40 per cent of neglecting families did interventions produce lasting change, which compared unfavourably with the success rate in interventions with cases of physical or sexual abuse. Daro noted that child neglect remained the most resistant to current prevention and treatment initiatives.
Case labelling and the minimisation of child neglect
The tendency of workers sometimes to minimise abusive or neglectful concerns has been discussed in the child maltreatment literature since the early 1980s (Dingwall, Eekelaar and Murray 1983; Department of Health 1991; Goddard and Hiller 1992; Tomison 1994).
In 1983, Dingwall, Eekelaar and Murray investigated professional decision making in an English child protection system. They developed the 'rule of optimism' to explain how health and social workers were screening or filtering out many of the cases with which they were involved. These researchers asserted that under the 'rule of optimism' workers applied a heuristic or routine method of practice which was used to reduce, minimise, or remove the concerns for the child's welfare or safety. This was done via the workers applying overly positive interpretations to the cases they were assessing.
Dingwall, Eekelaar and Murray provided two methods or techniques which they contended were used by workers to alleviate concerns for the child, minimising the severity of the abuse and the level of protective intervention applied to the case.
The first technique was referred to as 'cultural relativism', which was an agency-level justification allowing some deviant behaviour to be justified by labelling it as a cultural practice. That is, under the assumption that all cultures are equally valid, abuse is written off as an act required of a culture (for example, an extreme version of this would be the traditional practice of genital mutilation). Deviant 'cultural' acts become excusable, with members of one culture having no right to criticise other cultures by the application of their own standards of judgement. When 'cultural relativism' is applied, acts of child abuse and neglect become 'not abusive or neglectful, but positive attempts to comply with alternative standards that would allow them to be recognised as appropriate parental behaviour' (Dingwall, Eekelaar and Murray 1983:82).
The second method used under a 'rule of optimism' was called 'Natural Love'. Dingwall and colleagues suggested that there is a general assumption in society that parents love their children. Faced with this norm, workers were seen to interpret all evidence of child abuse under the assumption of 'natural love', a positive assumption about the nature of the parent-child relationship of such power that the worker's task of finding incontrovertible proof of child maltreatment becomes extremely difficult.
When this assumption is combined with cultural relativism to form the 'rule of optimism', it is clear that workers are given a highly versatile approach to interpreting parental deviance, leading to a drop in the identification of cases as abusive or neglectful in nature. This tendency to minimise abuse is further strengthened by the pressure on workers to avoid an incorrect classification of cases as abuse, due to the rather grave consequences which can result for the family (Department of Health 1991).
Thus workers operate in a culture which looks for overwhelming evidence of abuse before action is taken, yet have relatively limited powers of surveillance with which to gather such evidence. This becomes more critical in cases of suspected neglect which, as stated previously, are more difficult to describe or detect than are the various acts of commission which categorise child abuse (Drotar 1992).
As well, such investigations which are completed take place in an environment suffering from inadequate funding - that is, workers and agencies are expected to protect children effectively while the child protection system is under-resourced (Willis, Holden and Rosenberg 1992). Economic pressures may also provide a partial explanation for the minimisation of abusive concerns, or an inability of child protection workers to deal with less serious abusive concerns.
Dingwall, Eekelaar and Murray (1983) suggested that the 'rule of optimism' was only discounted when parents refused to cooperate with workers and rejected help (a 'failure to cooperate'), or when there was a 'failure of containment' where a number of workers became involved with the case and the pressure for protective action became too great.
While the 'rule of optimism' of Dingwall and colleagues has relevance to the identification and management of neglect cases, there are other forms of 'minimisation' (such as economic rationalisation) which may be employed by workers in the study sample. Tomison (1994) and Goddard and Hiller (1993) noted that abuse may be minimised via the failure of professionals to refer cases (or delays in referring) to child protection services, the misapplication of official case labels, the minimisation of the abusive or neglectful concerns, the severity of the abuse, or the risk to the child of further abuse/neglect. Abuse could also be minimised by the decision of child protection services not to take legal action to protect the child.
It has been argued (Department of Health, in press) that neglect and emotional abuse cases were most likely to be rejected at each 'threshold' or case management decision taken by child protection workers during a protective investigation. Birchall (1989) suggested that the lack of registration may be due to: a professional inability to define adequately cases for registration; an organisational appraisal that the child protection system cannot absorb the volume of neglect cases; or that it reflects a growing recognition that neglect is strongly linked to poverty and is something that cannot be remedied by the child abuse case register. It was therefore contended that neglect cases were being screened out of the child protection system (Hallett and Birchall 1992).
When child neglect is minimised
Minty and Pattinson (1994) asserted that British social workers frequently underestimate the seriousness of neglect, in spite of the evidence indicating that neglect could lead to poorer psychological development, and may increase the risk of the child being injured or killed. They noted that a significant proportion of child deaths have been attributed to parental/caregiver neglect, and that professionals had failed to recognise adequately the risk to the child posed by the more severe cases of neglect - a contention ably supported in the death inquiry literature (Community Services Victoria 1991; Department of Health 1991; Fogarty 1993; Wolock and Horowitz 1994).
Minty and Pattinson's (1994) contention that social workers have at times inappropriately allowed seriously neglected children to suffer from ongoing neglect, and allowed them to remain at-risk in the home of 'inadequate' parents, is supported by, amongst other findings, a series of Victorian child death inquiries released in 1994 by Health and Community Services Victoria. A common finding in seven child death cases was that the child had died of neglect while residing in the care of their parent(s), despite the involvement of the state child protection service in the cases (Fogarty 1993). The victims were generally very young, born prematurely and/or drug dependent. The parent was often a substance abuser, or appeared to lead a 'chaotic' lifestyle. Despite these stressors, the victim had remained in the family, and despite being subject to court-directed supervision, died a number of months into the supervision order.
Fogarty reported that it was apparent that the workers involved in some of the cases had focused on the rights of the parent to the detriment of the rights of the child. Thus, the parent was given numerous opportunities to improve the family situation, and to care for the child adequately, while the worker's expectation appeared to be that the child protection service's supervision, along with the provision of a variety of community services, would enable the child to survive.
This issue highlights the difficulty that workers must face. Do they err on the side of optimism and attempt to remedy the situation while the child remains in the home? Or do they remove the child more frequently, in order to safeguard against further, more severe, incidences of neglect? This is a classic representation of the crux of child protection work: when to remove the child? It could perhaps be argued that this decision is made more difficult by having to assess neglectful actions (or, rather, inaction) instead of the discrete acts of child abuse (Drotar 1992).
'If they are over-cautious and take children away from their families they are pilloried for doing so. If they do not take such action and . . . something terrible happens to the child, then likewise they are pilloried.' (The Cleveland Inquiry 1987:85, as cited in Department of Health 1991)
Redefinition of physical abuse cases as emotional abuse of neglect
A number of reasons have been put forward as to why neglect has sometimes been screened out of the child protection system. As already mentioned, child abuse and neglect concerns do not occur in isolation (Farmer and Owen 1995), and in the previous section it was noted that workers were often reported to be minimising the serious of child neglect.
Recent research in Australia (Goddard and Hiller 1992; Tomison 1995) has indicated that there is another way that some workers appear to be using the official case labels to misclassify cases. It is contended that when dealing with cases involving both abusive and neglectful concerns, workers sometimes minimise the abuse and mislabel cases as neglect. It is argued that this misclassification occurs because neglect cases are generally dealt with by the provision of family support services, whereas abuse cases, particularly sexual and physical abuse cases, are likely to require more stringent protective intervention. Thus, the perceived lesser severity of neglect may in fact be used by some workers to minimise child abuse and the level of protective intervention required.
In a large-scale case tracking study, Tomison (1994) conducted an analysis of the constituent elements of suspected child abuse cases in comparison with the official labels applied to the cases. The cases were re-coded into the four main categories of abuse in the following order of priority - sexual abuse, physical abuse, neglect, emotional abuse. Thus a case of sexual, physical and emotional abuse became a sexual abuse case; a case of physical abuse, neglect and child at risk became physical abuse; and so on. The classification system was used on the assumption that it approximated the weighting given to different types of child abuse by the various professionals involved in child protection case management. Using this system, physically abusive actions should not, on the whole, have occurred in cases defined as emotional abuse or neglect.
However, as previously mentioned, Tomison found that 15 per cent of cases labelled as neglect and 25 per cent of cases labelled as emotional abuse involved some form of physically abusive action. How then can the sizeable proportion of such cases incorporating physical abuse be explained?
One possible explanation may be that the physical abuse elements of the emotional abuse and neglect cases may have been found to be unsubstantiated, in which case the workers involved may have labelled the case in terms of the substantiated abuse (that is, emotional abuse or neglect) expunging the unproven concerns. Additionally, workers may have chosen to focus on the more salient abuse - that which appeared to be of greater importance. Thus, given that physical abuse concerns identified throughout Tomison's study were of relatively mild severity, it may have been appropriate to focus on other aspects of the case.
However, it could also be argued that for these cases the workers' (conscious or unconscious) omission of any major reference to physical abuse while officially labelling their cases emotional abuse or neglect, constituted a minimisation of the physically abusive concerns. Such a practice of minimisation would result in the adoption of potentially inadequate child protection, given that the caseplan would be tailored for a scenario which ignored specific aspects of the case. Thus the omission of physically abusive concerns via the misclassification of cases as neglect or emotional abuse may lead to less than adequate case management.
Surprisingly, support for this position comes from the Victorian child protection services, which produced a report concluding that child protection workers were in fact misapplying the label 'emotional abuse' to cases; this was perceived in some cases to result in a minimisation of the concerns (Dwyer 1991). The report had been commissioned in response to the finding that almost half of all substantiated cases in Victoria in 1987-88 where labelled as emotional abuse.
Neglect cases, and chronic neglect cases in particular, are reportedly the most difficult cases with which to achieve a positive outcome (Daro 1988). By the time they have become child protection cases, they often require significant resources in order to alleviate the family's dysfunction and protect the child from further neglect. Nelson, Saunders and Landsman (1993) provided evidence implicating extreme poverty in neglecting families, and particularly with chronically neglecting families. They also acknowledged the need for intensive, comprehensive, long-term interventions as part of the solution to chronic neglect. Yet Daro (1988:198) also noted that 'jointly expanding our treatment and prevention efforts is a more cost-effective practice and policy path to pursue than simply dealing with the growing number of victims'.
Child abuse prevention is usually categorised into primary, secondary or tertiary prevention. Primary prevention can be characterised as attempts to influence community attitudes to child maltreatment - that is, community education. Primary prevention strategies also take the form of personal safety programs. Secondary prevention is aimed at support programs for 'at-risk' populations, such as families with substance-abusing caregivers. Tertiary prevention is managed by the various state child protection services, and is directed at preventing the re-abuse of children (James 1994a).
Previous National Child Protection Clearing House Issues Papers and Newsletters have detailed the types of primary and secondary prevention programs currently operating in Australia and overseas (James 1994a, 1994b, 1994c). Without replicating that information, it is worth re-considering the secondary child maltreatment prevention programs which directly affect the management of child neglect cases. These programs can be broadly defined as parenting/family skills and family support programs (James 1994c). Parenting and family skills programs are focused on the child's parents, and are predominantly concerned with reducing the likelihood of physical and emotional abuse and neglect. Family support services provide home visitation services and respite care for 'at-risk' families.
Throughout this paper, it has been noted that the effective management of child neglect cases requires ongoing interventions, whether it be in terms of detecting and identifying neglecting families, or the alleviation of the concerns once the cases are 'known' (Nelson, Saunders and Landsman 1993). Home visitation services have been found to be very effective in both roles. Drotar (1992) stated that the prevention of (chronic or acute) neglect must involve the early recognition of neglect, the alleviation of the child's symptoms and acute problems, and attention to factors that contribute to psychological risk - maladaptive parental behaviour and the extended family's interference.
Home visitation services, whether they be home visitors, which operate in the United Kingdom child protection system, infant welfare nurses, family aides or volunteer family support personnel, are well placed to monitor the family over time. Where resources allow, they are also able to support and educate parents in situ, and are much more likely to detect problematic changes in family functioning (Drotar 1992; Tomison 1994).
In the past decade in Britain, Australia and the United States resources have been channelled into further refining the investigatory role of child protection services (Department of Health, in press) to the detriment of family support and maltreatment prevention services (Willis, Holden and Rosenberg 1992; Tomison 1994). As a consequence of the economic depression of the 1980s, the approach of many governments to child protection has been the abolition, or cutting back, of many of the services which had been conducting home visits, offering respite care, or other forms of family support (Goddard and Carew 1993).
Family support services carrying out an 'early detection' role had previously had some success in identifying families at risk before family dysfunction reached a level requiring protective intervention (Olds, Henderson, Chamberlin and Tatelbaum 1986; Olds, Henderson, Tatelbaum and Chamberlin 1986). They were then able to divert/refer families to the most appropriate support and often alleviated the family situation without the necessity of child protection services' involvement (National Research Council 1993; Tomison 1994).
Presently, the majority of existing family support services are over-loaded, and unable to offer early detection, or maltreatment prevention services to voluntary (non-statutory) clients and/or those families who actively seek help prior to the development of abusive or neglectful concerns. The result is that these cases often re-enter the system as substantiated child abuse or neglect. Only then are the families able to get some form of assistance, albeit often only of a short-term nature (Tomison 1994).
Apart from the social costs of inadequate management of child abuse and neglect cases, it is also important to note that it is actually cheaper in the long term to prevent maltreatment, to alleviate family problems before the dysfunction is seen to require protective intervention (James 1994b). There are signs, however, that governments are beginning to reframe thinking on child abuse and neglect, and to move to a more balanced, family support/child protection system similar to that espoused by Daro (1988) above.
In 1991 it was announced by the Prime Minister that an Australian National Child Protection Council would be established with the mandate to prevent child abuse and neglect. Primarily the Council's focus is on primary and secondary child abuse and neglect prevention. The Council has representatives from each State and Territory and the community, and reports to the Commonwealth Minister for Family Services. As a consequence of this initiative, there has been a commitment from State and Federal governments to work together cooperatively to attempt to address the problem of child maltreatment proactively.
In Britain, there is growing acknowledgement of a need to consider abusive incidents within a context of 'general need within which there may be protection issues' (Department of Health, in press:23). In a similar vein to Daro's (1988) contention that there should be a balance between child protection and maltreatment prevention, professional debate in Britain is focusing more on the provision of extensive family support services to families as a means to redress the balance of child protection, family support and child welfare. Little (1995:18) noted that research has effectively used the idea of 'thresholds to distinguish between abuse and non-abuse, and whether or not to intervene'.
In the last few years the number of referrals coming into the child protection system has skyrocketed in Australia and overseas (Australian Institute of Health and Welfare 1995; Little 1995). Yet the increase in reporting has not been supported by an adequate increase in the child protection and family support services necessary to deal adequately with the high volume of cases (Clark 1995; Department of Health, in press). The result is that the 'threshold' for intervention has moved upwards (Little 1995) and fewer children are meeting the criteria for child protection case management.
Little (1995) reported that in Britain, a new focus on child protection outcomes research and the perspectives of the child and family has led to a change in focus from seeing cases in purely child protection terms, to a position where the abusive actions are considered within the context in which they have occurred.
In Australia, the National Child Protection Council is helping to lead the way forward in terms of shaping debate on the most appropriate means of preventing child maltreatment (James 1994a). It is also apparent that state child protection services are re-evaluating their role in the child welfare network (Clark 1995). For example, the New South Wales Department of Community Services is 'moving towards classifying some of the calls about families as "concern for a child" or "calls for assistance" rather than neglect or abuse; changing the terminology is the beginning of changing practice and thinking' (Shier, personal communication 1995). Already, there is a burgeoning primary and secondary child abuse prevention industry in Australia and overseas (James 1994b, 1994c).
It remains to be seen how the concept of family support will be integrated into the child welfare system in the next decade. It could be argued that child abuse and neglect case management is to some extent reverting to a 1970s style of child protection system, with family support agencies holding a more powerful position and being more able to influence child maltreatment case management. Given the need for intensive support for the effective management of neglect cases in particular (Nelson, Saunders and Landsman 1993), a family support focus should result in a system better able to resource neglecting families.
This Issues Paper has attempted to re-focus attention on the apparent neglect of child neglect, and is by no means an exhaustive review of the many facets of neglecting families, neglected children or the responses of welfare systems. As Swift (1995) notes, the neglect of children has been a societal concern for over one hundred years. It is possibly an indictment of our society that we seem to have made little progress in eradicating the problem.
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This paper aims to provide a broad overview of child neglect, one of the most common forms of maltreatment.
In this paper, we look at the issues facing those responsible for ensuring the safety and wellbeing of children in the context of parental separati
Review of theoretical constructs relating to child abuse prevention, health promotion strategies and the development of healthy communities.
This paper presents an analysis of a range of issues, as they relate to the prevention of, and response to, sexual abuse of children in OOHC.