Child Neglect: Intervention and Prevention

Neglect is now recognized as leading to significantly poor outcomes for children in the short- and long-term. It is also known to co-exist with other forms of abuse and adversity. At the same time, the child protection system struggles to find an appropriate response to neglect which is often chronic and associated with poverty and material deprivation. (Daniel, Brigid. Child Neglect : Practice Issues for Health and Social Care. London, GBR: Jessica Kingsley Publishers, 2004. Copyright © 2004. Jessica Kingsley Publishers. All rights reserved.)

According to Wallace (2005) Child neglect is defined as "negligent treatment or maltreatment of a child by a parent or caretaker under circumstances indicating harm or threatened harm to the child's health or welfare (p.92)." He warns that it is not as simple and straight forward as the statement may appear; that neglect covers many activities and omissions impacting a child's physical and emotional status (93). This paper will examine possible causes of neglect, as well as prevention and intervention techniques used to control this form of child abuse.

Spencer and Baldwin in Child Neglect: Practice Issues for Health and Social Care (2004) suggests that a holistic approach must be taken when considering the cause of neglect. The cause is often no more on the families than the societies. "Social and economic policy decisions may enhance or impede the ability of parents to undertake the difficult task of child rearing (26)." The authors insist that social responsibility requires attention that it has yet to receive. This is not to say that ending poverty will end neglect, rather that all of the factors increasing vulnerability for the occurrence of neglect must be considered.

A commonly considered cause of child neglect is poverty. Wallace (2005) explains that although poverty can affect a parent's ability to care for a child, that it is still unclear which begets which. The question is does poverty cause child neglect or is it a result of the parent's inability to function. He asserts that the personalistic theories are more reasonably considered. "In this approach, neglect is viewed as being caused by complex maladaptive interactions and /or lack of essential caretaking behaviors that are influenced by the level of parental skill, knowledge deficits, and other stress factors (94)." This is a more holistic approach that considers biopschyosocial elements to the cause.

Intervention is an ever evolving act dating far back. Although not limited to neglect, it is beneficial to reflect on the Mary Ellen Wilson case of 1876. In this case Mary Ellen Wilson had been moved from home to home as a result of her father's death and her mother's inability to escape a spiraling path to poverty. The state, having received care of her, placed her in a home illegally and without proper documents. She was placed with a man, who claimed to be her biological father, and his family. He soon after, died. In the care of this new mother, the tragic abuse and neglect began. She describes, in her court testimony the extent of her neglect:

I have no recollection of ever having been kissed by any one? have never

been kissed by Mamma. I have never been taken on my mamma?s lap and

caressed or petted. I never dared to speak to anybody, because if I did I would get whipped. . . . I do not know for what I was whipped? Mamma never said anything to me when she whipped me. (Copyright © 2005. Oxford University Press, Incorporated. All rights reserved.) (American Humane Association, 2005, 4).

In considering intervention through the eyes of this case and time we find that laws were limited. There were laws concerning "excessive physical discipline." New York had laws protecting neglected children by removing them from their caregivers. Regardless of laws in place, the complexity of Mary Ellen's case made it hard to get the legal system to take notice. Her case was brought to justice and public attention, finally, by persistent private citizens, of which one was Henry Bergh, "a leader of the animal humane movement (American Humane Association, 2005, 4)." This case lead to much needed public coverage, raising awareness and leading to further movements made by child welfare agencies. Furthermore Mary Ellen's abuser was found guilty of felonious assault which landed her with "one year of hard labor in the penitentiary (5.)."

AHA (2005) explains that "the treatment of neglect is often protracted, combining the efforts of many different agencies and professionals (p.149)." Doctors will work with CPS workers to observe continued progress in growth, development, and health. This collaborative effort is necessary and crucial. The "U.S. Department of Health and Human Services (2004) reports that in 2002 there were over twice as many neglect cases as physical and sexual abuse cases (p.149)." Of all the child abuse cases reported for this survey 60.5% of them involved neglect.

Different forms of neglect may require different forms of action. The AHA discussed neglects such as failure to thrive, physical neglect, medical neglect, substance abuse and neglect, and safety neglect (149). Often there is a caloric intake issue that is either organic or non-organic in nature. Another explanation for non-organic failure to thrive is maternal depravation. Intervention for this form of neglect would require an assessment of the entire family. It has been found that infants lacking physical touch "fail to grow and die at a high rate (150)." Another cause may be that the caretaker withdraws as a result of depression, substance abuse or other problems. These are some factors influencing the intervention process. Additional factors to consider are beliefs surrounding diet and intake, as well as socioeconomic barriers. "Although some of these cases are due to lack of money or education and can be solved with financial aid and counseling, it is still imperative that all malnourished children be examined by a medical provider (152)."

Some indicators of physical neglect are failure to provide proper food, shelter, or clothing. Interventions for this type of neglect generally begin with removing the child from the home. This should be combined with therapy and possibly medical treatment such as hormonal therapy if needed. AHA states that it is imperative to address the psychosocial pathology of the child's environment if they are potentially returning to it. With this, court ordered therapy for the caregivers may be a required. "Returning a child to this environment without demonstrated involvement in and improvement with intensive therapy is a risk. Careful monitoring of growth and development and emotional health, whether reunited with the parent in treatment or in foster care, is crucial (p.165)."

Medical neglect is the result of denying pertinent medical care to a child in need. These parents are far more protected by their rights to refuse treatment than any other form of neglect. Additionally these cases often become a matter of perception. But in cases that test medical ethics in upholding the best interest of the child, often the parents can be persuaded. The intervention used in cases where they can not be persuaded is court. An appeal regarding the risk and benefits are used to persuade the courts to intervene. (AHA, 2005).

Substance Abuse and neglect is responsible for some shocking statistics. "Recent studies have identified parental substance abuse as occurring in 40% to 60% of the cases of child maltreatment (AHA, 2005, 166)." Interventions for this form of neglect vary in nature as they can begin during pregnancy. "Prenatal screening for substance abuse can be useful to identify high-risk pregnancies and offer close care and support to the pregnant mother (168)." Drug treatment is also offered to the mothers. Intervention for families of substance abuse can be delicate. Often these families come with a cluster of other problems needing to be addressed. Unfortunately any continued use of substances can undermine any form of treatment offered. This requires then that the children be protected and removed should the caregiver refuse or not cooperate with the required treatment services. Additional interventions for all forms of neglect, offered by Macdonald (2004), are directed at the caregiver. They include home visits, cognitive-behavioral programs, family therapy, and social network interventions (279-287).

Safety neglect is the act of an injury as a result of "gross lack of supervision". Leaving poisonous or dangerous objects at the reach of a child as well as repeated dog bites often are indicative of this form of neglect. This is often a series of repeated dangers and not to be confused with an accidental situation. Interventions may include CPS support, parental education, and financial assistance in safety proofing a home.

We might consider that if Mary Ellen Wilson had received preventative services following the loss of her parents, she may have experienced life a little more pleasantly. However the intervention can often become a moment for prevention. This case exemplifies the success of such moments. Mary Ellen's first concerned citizen was Etta Wheeler. This is actually who brought Mary Ellen to Mr. Bergh's attention. Etta Wheelers continued involvement with Mary Ellen could be speculated as driving her future success. Etta intervened when Mary Ellen was placed in a group home and advocated for her to be put into the custody of Etta's own mother. Mary Ellen grew to have two biological children and a foster child. Two of them became teachers and the third a business women. Her "children and grandchildren described her as gentle and not much of a disciplinarian (American Humane Association, 5)."

Spencer and Baldwin (2004) urge that it is important to incorporate what is known about the child and caretaker dynamics into strategies combating the problem of neglect. As mentioned earlier these authors believe in taking a holistic approach to understanding neglect. With that one might consider the benefits of taking that same approach in preventative services. Including the entire community in increasing awareness and offerings of parental support is a good plan. Coulton and Korbin (2007) state that "Adverse child outcomes tend to be concentrated in neighborhoods with constellations of adverse conditions and risk factors (abstract)." Consequently holistic approaches should be considered at a family level too. It is important to consider the biopschyosocial factors that can result in vulnerability for the occurrence of neglect. Social and neighborhood supports should consider all of these factors when organizing preventative services. Intervention should happen at all levels to assure optimal support.

In conclusion, the cause of neglect can be the consequence of various factors resulting in a vulnerability to such occurrences. One commonly explored factor is socioeconomic status, though it is yet to be proven whether or not poverty is a cause of neglect. It is certain though that it can strain the ability of the parents to provide and increases stress level without bias of coping skills. Interventions generally require a collaborative effort but can vary in action depending on the type of neglect assessed. Preventative services are slim, but it is certain that they should take place at a family as well as a community level. Familial support is a dire component in decreasing the likelihood of child neglect. Just as our current President of the United said in regards to National Child Abuse Prevention, it is important to take an active role, as a citizen, in creating a safe and caring community that protects our Nations Children from abuse and neglect.

References

American Humane Association. Understanding the Medical Diagnosis of Child Maltreatment : A Guide For Nonmedical Professionals. Cary, NC, USA: Oxford University Press, Incorporated, 2005. p 5. Copyright © 2004. Jessica Kingsley Publishers. All rights reserved. Retrieved on November 2007 from http://site.ebrary.com/lib/empire/Doc?id=10091848&ppg=24

Coulton , Claudia J, and E Korbin, Jill. (2007). Indicators of child well-being through a neighborhood lens. Social Indicators Research, 84(3), 349-361. Retrieved November 22, 2007, from ABI/INFORM Global database. (Document ID: 1372610201).

George W. Bush (2004). National Child Abuse Prevention. FDCH Regulatory Intelligence Database; WHITE HOUSE, 202-456-7150 Retrieved on November 22, 2007 from http://library.esc.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=buh&AN=32W2371984259&site=ehost-live

Spencer and Baldwin from taken from Taylor, Julie and Brigid, Daniel (2005). Child neglect practice issues for health and social care / London ; Philadelphia : Jessica Kingsley Publishers, c2004. Retrieved on November 22, 2007 from http://site.ebrary.com/lib/empire/Doc?id=10082344&ppg=26

Wallace, Harvey (2005). Family Violence: Legal, Medical, and Social Perspective, 4th Edition. Pearson Education, Inc