7/11/2016 PART 1: HISTORY OF NEGLECT EXAMINATION OF NEGLECT OVERVIEW. What makes it chronic and what can we do about it?

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1 EXAMINATION OF NEGLECT What makes it chronic and what can we do about it? Karin Kline, MSW Cara Kelly, LMSW OVERVIEW Historical Context Scope of the Problem Contextual Considerations Recognizing the Impact Understanding Risk Characteristics of Families Promising Opportunities for Intervention PART 1: HISTORY OF NEGLECT 1

2 DEFINING CHRONIC NEGLECT C H R O N I C N E G L E C T S T A R V E S T H E D E V E L O P I N G M I N D O F S T I M U L AT I O N A N D D E N I E S T H E C H I L D I N F O R M AT I O N A N D I N T E R E S T A B O U T T H E S E L F A N D O T H E R S. One or more needs basic to a child s healthy development are not met The neglect is perpetrated by a parent or caregiver The neglect happens on a recurring or enduring basis (Kaplan et al., 2009) TYPES OF NEGLECT N E G L E C T I S T Y P I F I E D B Y A N O N G O I N G PAT T E R N O F I N A D E Q U AT E C A R E, A N D I S R E A D I LY O B S E R V E D B Y I N D I V I D U A L S I N C L O S E C O N T A C T W I T H T H E C H I L D. Type of Neglect Physical Abandonment Medical Psychological/Emotional Developmental Supervisory Guidance Educational Examples Nutrition, Inadequate Clothing, Hygiene Parents/Caregivers Health Care, Mental Health Treatment Deprivation of Nurturance, Emotional Absence Failure to address developmental needs, Failure to foster normal development Inadequate Supervision, Parental Incapacitation, Entrapment Exposure to illegal activities School Enrollment/Absenteeism (DHHS, 2016) NEGLECT OF NEGLECT D E S P I T E I N C R E A S E D A W A R E N E S S O F C H I L D M A LT R E AT M E N T, N E G L E C T O F T E N I S U N R E P O R T E D A N D M I S U N D E R S T O O D. History of Child Welfare Intervention Political Implications Cultural Considerations Confirmation Difficulties Role of Government to Intervene 2

3 COMMON MISCONCEPTIONS E X I S T I N G R E S E A R C H C H A L L E N G E S T H E C O M M O N M I S C O N C E P T I O N T H AT N E G L E C T I S N O T A S S E R I O U S A S O T H E R F O R M S O F M A LT R E AT M E N T. Substance abuse does not impact children Domestic violence doesn t impact safety unless children get hurt It s okay if the home condition is cluttered or even dirty, but no safety hazards are present Home is not dirty by DCS standards Neglect isn t as harmful to children as physical abuse If I can t see it or measure, it it doesn t exist There are no long -term consequences to children By addressing neglect I am judging a family s lifestyle PART 2: SCOPE OF THE PROBLEM THE DATA ARE CLEAR A R I Z O N A T R E N D S C L E A R LY S H O W A C O N T I N U A L I N C R E A S E I N R E P O R T S R E C E I V E D B Y T H E A R I Z O N A C H I L D A B U S E H O T L I N E, P L A C I N G F U R T H E R S T R A I N O N A R I Z O N A S C H I L D W E L F A R E S Y S T E M. (Children's Action Alliance, 2016 from DCS data) 3

4 THE PROBLEM IS DEEPENING E X I S T I N G R E S E A R C H C H A L L E N G E S T H E C O M M O N M I S C O N C E P T I O N T H AT N E G L E C T I S N O T A S S E R I O U S A S O T H E R F O R M S O F M A LT R E AT M E N T. (Children's Action Alliance, 2016 from DCS data) DIFFERENCES ARE SIGNIFICANT C U M U L AT I V E R E A L I T Y, L A R G E G R O U P D I F F E R E N C E S Over 58,549 reports of maltreatment received in the U.S. in 2014 Other 3.04% Neglect 70.8% Physical Abuse 25.3% Report Rate: 8.6 per 1000 Neglect Rate: 6.1 per 1000 Multi-Type Maltreatment Common Family Characteristics Demographic Predictors Child Welfare Intervention (DHHS, 2015) MEASUREMENT ISSUES IN NEGLECT M E T H O D O L O G I C A L A N D M E A S U R E M E N T I S S U E S A M O N G S T N E G L E C T A L L E G AT I O N S A R E C O M M O N, I N C L U D I N G M I S C L A S S I F I C AT I O N, U N D E R R E P O R T I N G, A N D VA R I A N C E A C R O S S D E F I N I T I O N S. Neglect Misclassification Varying Definitions Severity of Harm Multiple Allegations Multi-System Involvement Underreporting Value Driven Determinations Forecasting the Future 4

5 PART 3: CONTEXTUAL CONSIDERATIONS HOW DID WE GET HERE? C U M U L AT I V E P O L I T I C A L, E C O N O M I C, A N D S O C I A L C H A N G E S H AV E L E D T O A N D E C R E A S E I N AVA I L A B L E S E R V I C E S A N D S U P P O R T S F O R F A M I L I E S I N C R I S I S, A N D A S U B S E Q U E N T I N C R E A S E I N A R I Z O N A S F O S T E R C A R E P O P U L AT I O N. Economic Crisis Decline in Funding for Childcare Subsidies Reductions in System Capacity Increased Need for Supportive Services Child Welfare Services Misaligned with Needs Resource Allocation CONTEXT IS CRITICAL U N D E R S T A N D I N G T H E C O N T E X T I N W H I C H N E G L E C T I S O C C U R R I N G I S C R I T I C A L T O A P P R O P R I AT E LY A S S E S S I N G T H E P R O B L E M, A N D S U B S E Q U E N T I N T E R V E N T I O N Definition Determines the Response Single Incident Shaped by Values, Culture, and the Community Assumptions about Intentions Care Occurs on a Continuum When Does Care Become Neglectful? Policy, Practice & Research Varying Definitions Across Jurisdictions Chronic Neglect 5

6 PART 4: RECOGNIZING THE IMPACT CONSEQUENCES OF CHRONIC NEGLECT R E C O G N I Z I N G T H E S I G N S O F C H R O N I C N E G L E C T C A N A S S I S T I N I D E N T I F Y I N G A P P R O P R I AT E S U P P O R T S A N D R E S O U R C E S F O R F A M I L I E S Impaired Brain Development Attachment Disorders Cognitive Development Emotional Dysregulation Social Self Confidence Social Competence Concerns Perseverance in Problem Solving Empathy and Social Conscience Developmental Delays & Behavioral Concerns Diminished Sense of Safety, Stability, and Well -Being (Hildyard & Wolfe, 2002, Perry 2003) PART 5: UNDERSTANDING RISK 6

7 THEORETICAL UNDERSTANDING T H E E X I S T I N G L I T E R AT U R E O N C H I L D N E G L E C T R E C O G N I Z E S T H I S M U LT I F A C E T E D P R O B L E M R E Q U I R E S A F R A M E W O R K T H AT A D D R E S S E S A L L T H E C O N T R I B U T I N G F A C T O R S F R O M A S Y S T E M S P E R S P E C T I V E UNDERSTANDING RISKS R I S K S A R E O F T E N C U M U L AT I V E A N D F L U I D A S H O U S E H O L D C O M P O S I T I O N S A N D F A M I LY C I R C U M S T A N C E S C H A N G E Powerlessness Limited Nurturing Substance Abuse Mental Health Unemployment Socioeconomic Disadvantage Intergenerational Issues Chaos Chronic Neglect Social Isolation Community Poverty (Loman, 2006, Tanner & Turney, 2003; Wilson & Horner, 2003, Cahn & Nelson, 2009) PART 6: CHARACTERISTICS OF FAMILIES 7

8 PARENTAL INDICATORS R E C O G N I Z I N G P O T E N T I A L I N D I C AT O R S F O R N E G L E C T C A N A L L O W F O R A P P R O P R I AT E C O N N E C T I O N T O S E R V I C E S A N D S U P P O R T S F O R F A M I L I E S Caregiver Limitations Mental Health Concerns (Depression, Irrational or Bizarre Behaviors) Caregiver Substance Abuse (Drug or Alcohol Abuse) Single Parent Household Parental Capacity Indifference Towards the Child Unrealistic Developmental Expectations Views Child as Entirely Bad, Worthless or Burdensome Looks to Child to Fulfil Emotional Needs Denial or Blame of Problems Concerning the Child Large Family Size With First Birth as a Teen (Cahn & Nelson, 2009) CHILD INDICATORS M A N Y I N D I C AT O R S F O R C H I L D N E G L E C T A R E O F T E N O V E R L O O K E D O R M I N I M I Z E D D U E T O A N U N D E R E S T I M AT I O N O F T H E I M PA C T O N T H E C H I L D. Declining School Performance Untreated Medical Concerns or Delay in Treatment Parentification Disorganized or Insecure Attachment Basic Needs not Consistently Met(clothing, nutrition) Low Energy Levels Flat or Depressed Affect Hygiene Lack of S upervision Often Unsupervised or Responsible for Supervising Younger Siblings (Cahn & Nelson, 2009) FAMILY INDICATORS T H E N E E D S O F N E G L E C T F U L F A M I L I E S A R E VA R I E D A N D C O M P L E X, C A L L I N G F O R A N INTERAGENCY APPROACH. Home Environment Dirty, Unsafe Disorganized Unstable, Violent neighborhood Household Members Transient Many adults living in the home Unrelated adults living in the home History of criminal involvement or law enforcement interaction Substance Abusing Household Characteristics Poverty Unemployment Limited Support System Domestic Violence (Cahn & Nelson, 2009) 8

9 PART 7: PROMISING OPPORTUNITIES FOR INTERVENTION TURNING INFORMATION INTO ACTION W H E N O N E F O R M O F N E G L E C T I S I D E N T I F I E D W I T H I N A F A M I LY S Y S T E M, T H E I M PA C T C A N B E F A R - R E A C H I N G. F U R T H E R A S S E S S M E N T I S N E C E S S A R Y T O U N D E R S T A N D T H E VA R I O U S I M PA C T S O F N E G L E C T O N T H E C H I L D, A N D I D E N T I F Y T H E R O O T C A U S E Nature of Neglect (Type, Severity, Chronicity) Family s Understanding of the Neglect Risk Factors Contributing to the neglect Protective Factors Buffering the Impact of Neglect What Problems need Further Assessment? Living Situation: Safety and Stability Support System Community Involvement/Social Isolation (Johnson 2009, DePanfilis, 2006, Jones and Gutta, 2003) INTERVENTION PLANNING T H E R E I S A G R O W I N G C O N S E N S U S A M O N G R E S E A R C H E R S A N D P O L I C Y - M A K E R S T H AT A C A R E F U L LY C O O R D I N AT E D, C O M P R E H E N S I V E S E R V I C E S Y S T E M H O L D S T H E G R E AT E S T P R O M I S E F O R I M P R O V I N G T H E L I F E C H A N C E S O F V U L N E R A B L E C H I L D R E N Concrete Needs Children s Basic Needs Form Helping Alliances Readiness to Change Outcome Driven Service Plans Community Outreach Empower Families Cultural Competence Tailored Interventions 9

10 PLANNING FOR CHANGE C H R O N I C N E G L E C T I N T E R V E N T I O N S H AV E G R E AT P O T E N T I A L T O R E D U C E O C C U R R E N C E T H R O U G H A D D R E S S I N G R I S K F A C T O R S W I T H I N I N D I V I D U A L PA R E N T S, T H E I R I M M E D I AT E C O N T E X T, A N D T H E B R O A D E R S O C I E T A L S Y S T E M Building a Trusting Relationship with the Entire Family Tailored Interventions Goals that are Specific, Measureable, Achievable, and Related to Outcomes Plan for Longer Intervention Planning Ecological Approach Interventions which Focus on Skill Building Make More Frequent/Intensive Visits over a Longer Time (Child Welfare Information Gateway, 2016) CONCRETE SUPPORTS C O N N E C T I N G F A M I L I E S T O R E S O U R C E S AVA I L A B L E I N T H E C O M M U N I T Y T O A D D R E S S F A M I LY- S P E C I F I C N E E D S S U C H A S C H I L D C A R E, R E S P I T E, A N D H O U S I N G W I L L H E L P F A M I L I E S M E E T T H E I R B A S I C N E E D S A N D A L L O W PA R E N T S T O T E N D T O PA R E N T I N G. Everyday Actions: Meet Concrete (Survival Needs) First Help Families to Develop Skills and Tools they need to Identify their Needs and Connect to Supports Assist Families in Digging Deeper to Understand Root Causes Respond Immediately When Families are in Crisis Provide Information and Connections to Services in the C ommunity Assist Families in Connecting to Resources Empower Families to Identify Additional Resources Assist in Building Life and Problem Solving Skills around Time and Money, Household Management, and Family Planning (Child Welfare Information Gateway, 2016) PARENTAL RESILIENCE E M P O W E R I N G F A M I L I E S T O S E E K H E L P A N D T A K E S T E P S T O C O M B AT S T R E S S I S PA R T O F B U I L D I N G B O T H R E S I L I E N C E A N D H O P E. PA R T N E R I N G W I T H F A M I L I E S I N C L U D E S H E L P I N G A L L F A M I LY M E M B E R S T R A N S L AT E T H E I R C O N C E R N S I N T O S O L U T I O N S. Everyday Actions: Assist Parents in Understanding How their Ability to Cope with Stress may Impact their Parenting Behaviors and their Child s Development Empower Families to Seek Help and Take Steps to Combat Stress Partner with Families to Translate Existing Concerns into Specific Needs that can be Discussed and Resolved Facilitate the Modeling of Coping Behaviors by Parents in the Home Model Problem-Solving Skills Support Families in Strengthening their Communication Skills (Child Welfare Information Gateway, 2016) 10

11 SOCIAL CONNECTIONS I D E N T I F Y I N G W AY S T O H E L P PA R E N T S E X PA N D T H E I R S O C I A L N E T W O R K S A N D B U I L D A B R O A D E R B A S E O F PA R E N T I N G S U P P O R T I S C R U C I A L. PA R E N T S W I T H S T R O N G S O C I A L N E T W O R K S O F F A M I LY, F R I E N D S, A N D N E I G H B O R S H AV E B E T T E R S U P P O R T I N T I M E S O F S T R E S S. Everyday Actions: Help Families to Value, Build, Sustain, and Use Social Connections Assist Families in Identifying ways in which past issues/behaviors/concerns have impacted their social connections Facilitate mutual peer support Promote engagement in the community and participation in community activities Help strengthen support networks with positive peers Connect families with informal networks in the community (Child Welfare Information Gateway, 2016) PARENTING SKILL DEVELOPMENT I N F O R M AT I O N A B O U T W H AT T O A N T I C I PAT E A S C H I L D R E N D E V E L O P, A N D S T R AT E G I E S F O R E F F E C T I V E PA R E N T I N G W I L L H E L P PA R E N T S L E A R N W H AT T O L O O K F O R A S T H E I R C H I L D R E N D E V E L O P, A N D A S S I S T T H E M I N R E A C H I N G T H E I R F U L L P O T E N T I A L. Everyday Actions: Model Developmentally Appropriate Interactions with Children Provide Information and Resources on Parenting and Child Development Assist Families in Identifying Ways in Which They Can Promote Their Child s Development in Multiple Areas Encourage Parents to Observe, Ask Questions, Explore Parenting Issues and Try Out New Strategies Empower Families to Engage in On -going Follow -up With Their Child s Medical Providers and Develop Relationships with Professionals in the Child s Life Provide Information on Keeping Children Safe Address Parenting Issues From a Strength-Based Perspective (Child Welfare Information Gateway, 2016) SOCIAL & EMOTIONAL COMPETENCE W H E N PA R E N T S A N D C H I L D R E N H AV E S T R O N G, W A R M F E E L I N G S F O R O N E A N O T H E R, T H E Y D E V E L O P T R U S T T H AT T H E I R PA R E N T S W I L L P R O V I D E W H AT T H E Y N E E D T O T H R I V E, I N C L U D I N G L O V E, A C C E P T A N C E, P O S I T I V E G U I D A N C E, A N D P R O T E C T I O N. Everyday Actions: Assist Parents in Recognizing Their Own Needs, as Well as the Needs of their Children Help Parents Foster their Child s Social -Emotional Development Assist Parents in Developing Secure Attachments with their Children Model Nurturing Care to Children Include children s social and emotional development activities in programming Help children develop a positive cultural identity and interact in a diverse society Respond proactively when social or emotional development needs extra support Promote self-care and teaming (Child Welfare Information Gateway, 2016) 11

12 QUESTIONS? Contact Information for Presenters: Karin Kline: Cara Kelly: REFERENCES Bronfenbrenner, U. ( ). The ecology of human development: Experiments b y natu re and design. Harvard University Press. Do ugl as, E. ( ). Case, ser v i ce and fami l y characteri stics o f ho useho lds that experience a child maltreatment fatality i n the United States. Child Ab u se Review, 2 2 (1 ), Lo uwers, E., Ko r fage, I., Af fo urtit, M., De Ko ning, H., & Mo l l, H. ( ). Faci l itators and barriers to screening fo r child abuse i n the emergency depar tment. BMC Pediatrics, 1 2 (1 ). Sidebotham, P., Bi u, T., & Go l dsworthy, L. ( ). Child protectio n procedures i n emergency depar tments. Emergency medicine jou rnal:emj, 24 (1 2 ), Stif fman, M., Schnitzer, P., Adam, P., Kruse, R. & Ewi gman, B. ( ). Ho usehold co mposition and risk o f fatal child maltreatment. Pediatrics, 10 9 (4 ), United States Depar tment o f Health and Human Ser v i ces (DHHS). ( ). AFCARS (2 2 ). Washingto n, DC: U.S. Depar tment o f Health and Human Ser v i ces, Children s Bureau. Retrieved from 12