Understanding child neglect

CFCA Paper No. 20 – April 2014

Responses to neglect

Neglect is a failure to provide minimally acceptable care. Cultural and contextual circumstances influence such perceptions of acceptable care. In families where care is shared across other adults or older children, an assessment must consider this. It is also important to consider the context of what is available in terms of housing options for families who are unable to access better resources because of economics and/or discrimination (Gaudin et al., 1996). Similarly, families may not access transportation, education, health or other services due to remoteness or a lack of those services - any assessment should consider whether parents have access to services and if so, choose not to access them. The assessment should also consider what other informal services and support, as well as more formal services, the family can access.

However, one of the difficulties in a child protection response to neglect is that often there is no specific incident that reaches a threshold. Instead, neglect is characterised by low or inconsistent levels of care over long periods of time. From a child protection worker perspective there is often difficulty in establishing who is responsible for the neglect occurring - whether it is due to parental omission, a lack of access to services, or environmental conditions (McSherry, 2007). Additionally, harm is cumulative and until statutory authorities recognise this in their thresholds for intervention, neglect may not be investigated or substantiated. Neglect is typically a sustained pattern of events, or "failures" that individually might not warrant a statutory response (Bromfield, Gillingham, & Higgins, 2007). This means that the risks are unrecognised and therefore unreported. Even for those children who come to the attention of child protection systems, the response is not straightforward.

Child protection systems were originally designed to respond to reports of serious and immediate harm, particularly sexual abuse and serious physical abuse. The increasing volume of reports has resulted in a need for systems to respond to what appears to be the most serious cases first (McSherry, 2007). An unintended consequence of these policies is that neglect tends to be given a lower priority until there is a specific incident that must be responded to (Stone, 1998).

While there are procedural frameworks (e.g., structured decision-making tools and software) to assist caseworkers to identify and substantiate neglect, they are often subjective in nature. Workers often have to rely on cultural and personal biases and their own personal judgement of what "good enough" parenting looks like. Initially caseworkers may be reluctant to characterise these families as neglectful when they are already disadvantaged by poverty. Interventions often require ongoing, long-term involvement with the child protection system (Jonson-Reid et al., 2013). As they continue to work with the family, the social worker is "drawn in" to the situation the family faces. In effect, their perception changes and they minimise the situation as compared to how they would perceive similar circumstances if the family were a new case (Tanner & Turney, 2003).

Tanner and Turney (2003) described why caseworkers find it a challenge to work with families of neglected children:

  • It is difficult to decide at what threshold a situation requires intervention. Making a decision when parenting is not "good enough" is subjective. Social workers may not want to label a family as neglectful when they are already disadvantaged by poverty, or the "rule of optimism" may discourage them from defining a situation as neglectful.
  • Neglect often occurs over a long period of time and may not have a specific event that triggers a response.
  • Case workers dealing with a family who is experiencing low level neglect and hopelessness over a long period of time may become used to that level of care and stop seeing the seriousness or deterioration of the situation.
  • The long-term, chronic nature of neglect contributes to a "defensive practice", where case workers rely on routinised responses that they've employed for long periods of time. This also means that case workers become "acclimatised" to the family situation and so thresholds where they do respond also increase.
  • Historically, caseworkers have relied on some learning but a largely intuitive, rather than evidence based, response. Where research exists, it may not be well disseminated or implemented (though this is slowly changing).

For the most part, the child protection response occurs at the individual level. For many families the response required extends beyond that to community and societal needs and those complex needs require long-term commitment and intervention and often go beyond the responsibility or capacity of anyone agency or government department.

Intervention

A response to neglect is well suited to an ecological framework where the child is not seen in isolation, but within the context of parent, family, community, and society. Once a child is identified as being "at risk", a comprehensive assessment is required to clarify family needs. There is no one-size-fits-all approach in relation to child neglect and it is likely that the response will not be a specific single intervention but a number of approaches based on detailed assessment of family needs and difficulties (Trocmé et al., 2013). Treatment for neglectful families may be focused on individual caregivers and children, family groups, or aimed at circumstances of poverty, isolation, and disadvantage (Tanner & Turney, 2003).

In their review of child neglect treatment, Lacharité, Ethier, and Couture (1996) found that there was an urgent need to identify effective treatments for neglect. Their study found that "resilient peer" treatment and imaginative play training produced positive effects for neglected children.

However, responding to neglect must be more than simply treating the child's presenting symptoms (See Box 1 for an alternative perspective on intervention). Particularly in the case where neglect is due to poor parenting practice or poor family functioning, practitioners must also ensure that the neglect stops (See Box 2 for intervention guidelines). This may involve advocating for access to resources that provide social and financial assistance on behalf of their clients as well as addressing the issues within the family (Lacharité et al., 1996). For example, poverty and neglect are closely aligned but child protection workers are not often able to provide sufficient and broad ranging family support needed to ameliorate the impact of poverty on child neglect (Dufour et al., 2008). Other research has gone so far as to question the usefulness of family preservation and reunification services where the families are not assisted to find stable, adequate housing (Brayden et al., 1992).

Box 1: An alternative perspective on intervention

Crittenden (1999) has proposed three forms of neglect (described below) as a classification to help caseworkers understand the cause of neglect and frame a response accordingly. She proposed that there are failures on behalf of the parents/caregivers to establish enduring and productive relationships with their children because of interpersonal problems and that a positive outcome for families is reliant on addressing these underlying problems.

Disorganised neglect

This form of neglect is characterised by families who have multiple problems and are always in a state of responding to another "bushfire". Typically the parent or caregiver is keen to have "help" to respond to whatever the current crisis is - whether it be a child suspended from school or a phone bill that hasn't been paid and so the service is about to be cut off.

These families are motivated by emotional responses, feelings and affect. The more intense the feeling a problem generates, the more immediate the response. For example, children who are frequently fighting with each other will generate a response while the phone bill will be set aside to respond to when things are calmer. This type of parenting creates unpredictable responses for the child; parents respond sensitively if there is nothing else going on, respond angrily if they are trying to deal with another situation, or ignore the child if the child isn't demanding enough. This unpredictable parenting style teaches children to exaggerate their emotions to emphasise the drama, and they won't listen or compromise which just compounds the chaotic environment.

Working with these families is a challenge. Caseworker responses are organised cognitively with predictable consequences for behaviours and actions - but the family only responds and engages affectively (from an emotional perspective). The response must initially provide comfort and reassurance to the parent/caregiver then create a structured, predictable environment where the caseworker always provides accurate information about behaviours and outcomes. Maintaining support for the family after they begin to change their behaviour and become more competent is critical, allowing them to move into independence as they are ready, not withdrawing services to promote independence. Throughout all of this the caseworker should be teaching the parent to use cognitive information to respond to their children's needs and to regulate that response with emotions.

Emotional neglect

In contrast to disorganised neglect, emotional neglect is characterised by prioritising cognitive responses rather than emotion/affect. Usually physical and psychological neglect are associated with poverty but in emotional neglect, Crittenden described parents who are often able to provide materially, but not emotionally for their children. These parents are unable to experience affect and so focus on predictable outcomes, leading to an emphasis on education, performance, and learning rules for behaviour. Households where this is the case are likely to have numerous rules and the children seem more mature, independent, neater, and more diligent in completing their homework than other children. These household characteristics can lead to high levels of functioning at school and work so families may have a financial advantage and are therefore less likely to be identified as neglectful. Typically, the parents/caregivers provide material objects like expensive clothes and toys to demonstrate their love and affection, the children may attend expensive schools and may be engaged in multiple after school activities.

As children in these homes develop, they are punished for expression of negative emotions. They learn to inhibit these feelings and eventually block even the awareness of the missing responses. They may appear falsely cheerful. Conversely if the parents are depressed, their responses may be non-existent and the child learns to respond to parent needs.

There are two responses to these families described in Crittenden's work. For the families that are superficially successful and cheerful she recommends additional research to better understand the consequences of these behaviours and develop policy responses accordingly.

Children of the families where there is role reversal, and the child has become the "parent", have more serious needs and are also more likely to be noticed because of the caregiver/parent incompetence. She recommends keeping the child at home with the parents if possible (unless the child is in serious danger of harm). This is to avoid issues of separation for the child and the additional stress of them having to learn to re-engage with new people. Services should be offered at home to teach caregivers/parents to seek support from people other than their children and to teach them how to engage with their children emotionally. This is particularly important that children don't feel further abandoned as the caregiver/parent learns to rely on others.

Depressive neglect

Depressive neglect is the more typical picture of neglect, according to Crittenden. These families appear withdrawn and dull, with little interest or understanding of why there is a need for intervention. The caregivers/parents struggle with cooperating and changing because they are unable to understand their child's needs even after careful explanation. Furthermore, they doubt that anything will change the current situation.

The development of children in these families is inhibited because the parent does not respond to their cues; the contact is infrequent and lacks affectionate play or soothing. Eventually, the child quits seeking attention and begins to withdraw. While this can occur at any stage of development, it is most serious when it occurs to an infant because they then have no recollection of a world where their needs were responded to and met. These children shut off their feelings and don't reach out. This means that they don't focus on the hurt, which results in depression that can be more profound than other forms of depression because there are no associated feelings of anger, hurt, or abandonment.

Interventions need to focus on families learning that behaviours cause predictable and meaningful outcomes. Caregivers and parents must be taught that children need stimulus and taught how to engage with appropriate expressions of affect, like smiles and laughter.

Box 2: Intervention guidelines for consideration

  • As the majority of parents want to do the right thing by their children, start by identifying strengths that can be reinforced and built upon.
  • Respect and build on cultural strengths such as respected elders or role models that can affirm religious and spiritual values and beliefs.
  • Don't rely on assumptions and generalisations. Respect the uniqueness of every family and respond accordingly.
  • Maintain a balance between supportive counselling, enabling the family to access services and setting reasonable and achievable goals that lead to increasingly independent functioning. Empower independence through reinforcement and praise.
  • Legal action should be a last resort after all efforts to work cooperatively have been exhausted.
  • Intervention plans must include advocacy to access and mobilise formal and informal services. When outside resources assist the family to meet their identified requirements, family feelings of hopelessness, resistance, and distrust will be minimised.

Adapted from: Gaudin, 1993, p. 39.

Differential response to neglect

A differential response to child protection provides scope for more than one type of response. This may also be known as "alternative response" or "dual track". Differential responses recognise that different child protection concerns may require different responses. There are various models of differential response but all recognise that in some circumstances a traditional, statutory child protection investigation and response is required. For other cases, the differential response allows organisations to refer their concerns about child wellbeing to support agencies that can provide family support as required - these supports may not take the form of a child protection response (e.g., provision of housing or financial support).

A differential response operates from a partnership model as opposed to the more adversarial approach seen in some statutory child protection responses - where families are "investigated" and "reports substantiated". In a differential response model, the focus shifts from a perspective of blame to one of "how can we work with the realities you face and ensure the safety and wellbeing of your children" (Council of Australian Governments [COAG], 2009, p. 22). The aim of the response then shifts to one of a timely response, rather than on investigation and substantiation of harm.

In most European countries child protection concerns are addressed by family welfare agencies. These agencies can provide services to families and children without first having to determine that the maltreatment has been substantiated. There has been a shift toward this differential response in some Australian and North American jurisdictions, but for the most part, reports are first made to a child protection organisation and then referred from there to family services after being investigated and failing to meet the substantiation threshold. A number of these reports, particularly those of neglect, may be dealt with at a family support level and referred up to child protection - serving to provide services to families in need, but also to reduce some of the load on the child protection services (Shusterman, Hollinshead, Fluke, & Yuen, 2005).

Research has shown that a differential response to neglect is more likely to break the cycle between poverty and neglect than a statutory system (Straus & Kantor, 2005). However, it is important to note that for the cycle to be broken, concrete services must be available in the form of financial assistance for food, rent, childcare, and health needs, for example (Straus & Kantor, 2005). One cost-benefit evaluation of a trial of differential response to child neglect, where the aim was to avoid a recurrence of neglect, found that the mean cost per family was $398 less than traditional statutory child protection approach (Straus & Kantor, 2005, p. 24).

Different types of neglect require different responses. For example, low cost housing may assist some families but for others, mental health assessment and treatment or access to drug and alcohol services are required. A summary of the literature suggests examples of community services that may assist neglectful families include:

  • emergency financial assistance;
  • low cost housing;
  • emergency food bank;
  • clothing banks;
  • transportation;
  • recreation programs;
  • mental health assessment and treatment;
  • temporary foster or respite care;
  • budget/credit counselling;
  • job training and employment assistance;
  • parenting support/skills training; and
  • low cost child care.

In some cases, a tertiary child protection response is still required to address issues of neglect and the appropriate response will vary according to the severity of maltreatment, number of previous reports, child age, and the willingness of parents to participate (Lonne, Harries, & Lantz, 2012).

The role of community

Research has identified that child wellbeing is part of a complex interplay of factors. Child development is related to family and peer relationships and the environments and settings where the interplay of these factors all occur (Bronfenbrenner, 1977). Bronfenbrenner's framework demonstrates that child wellbeing is contingent on collaboration between agencies, case workers, paraprofessionals, service provider, communities, families, and individuals.

The community where the child lives plays a significant role in the health of children and families (Lohoar et al., 2013). Community organisations can contribute to risk or safety if they are characterised by individuals who engage in violent behaviour, drug abuse, or are associated with high levels of unemployment or poverty compared to those where individuals are caring, nurturing, and supportive (Scott, 2013).

A child protection response that builds on community strengths (Lohoar et al., 2013) and encourages all members of a community to be engaged and responsible for each other, and participate in providing services to each other on an informal basis has the capacity to improve the overall wellbeing of children and families who live in that community and reduce child maltreatment (Kimbrough-Melton & Campbell, 2008).5

National Framework for Protecting Australia's Children 2009-2020

The National Framework for Protecting Australia's Children 2009-2020 has adopted a public health approach for keeping children safe. Under the Framework the focus moves from one of responding only to children who meet the legislative definition of a child at risk of serious harm to one of promoting the safety and wellbeing of all Australian children (COAG, 2009). It recognises that child protection concerns extend to agencies and organisations beyond the traditional tertiary child protection system. The public health model ensures that support is available for families of neglected children at primary, secondary, and tertiary support levels (see Box 3 for examples of programs at each level). The Framework encourages involvement of services other than the tertiary child protection system in consideration of wellbeing of all children, thereby minimising the likelihood that neglected children will require tertiary intervention (that of the formal state child protection agencies). The public health model is particularly suited to neglect as it also allows the capacity to address underlying issues associated with neglect, such as poverty, and promotes a government-wide approach to dealing with child protection rather than relying solely on a statutory child protection response to families who neglect their children.

Box 3: Public health responses to child protection concerns*

Primary prevention services

These services are available to all children, examples include:

  • education campaigns, such as those encouraging parents to read to your children;
  • universal health care;
  • immunisation; and
  • public education system.

Secondary prevention and support services

These services are designed to support children at risk of neglect, examples include:

  • income support;
  • housing assistance; and
  • nurse home visiting services.

Tertiary response

These services respond to the needs of children who are or have been neglected, examples include:

  • counselling services;
  • care and protection orders;
  • foster care; and
  • alcohol and drug services for parents who neglect their children.

* Not all programs sit neatly in one level or another. For example, alcohol and drug services may be a tertiary response to families where children are neglected, but it may also be provided at a secondary prevention level where parents who engage in substance misuse are at risk of neglecting their children but are currently providing "good enough" care.

 

Footnote

5 For more information on community capacity building responses to child protection see: Applying Community Capacity-Building Approaches to Child Welfare Practice and Policy.