Meeting the
Challenge of
Chronic Neglect
Washington State CASA Conference
Spokane, Washington
October 21, 2013
Chronic neglect and chronic maltreatment (i.e.,
the combination of chronic neglect with physical
abuse and/ or sexual abuse) is arguably the
most difficult challenge facing public child
welfare systems in the U.S.
Child welfare systems in the
U.S. were not designed to cope
with this challenge
NCANDS Statistics
In recent NCANDS reports, almost 80% of
substantiated victims were found to
be neglected; and in some states, 90 to 100%
of children in substantiated cases were
neglected.
Two child welfare scholars, Jane Waldfogel and
Isabel Wolock, have provided strong evidence
that high child poverty rates in English speaking
countries lead to child protection systems in
which neglect reports far outnumber reports of
other types of child maltreatment.
POC Study
A 2009 Partners for Our Children (POC) study
found that almost half of families with open
child welfare cases had annual incomes of less
than $10,000 per year; and one-fifth of families
had no source of income and were not living
with a person making more than $20,000 per
year.
Substance Abuse
Mental Health
Poverty
Trauma/Violence
RECIPE FOR CHRONIC NEGLECT
AND CHRONIC MALTREATMENT
Combine a high child poverty rate and a
high rate of severe long term poverty
ADD
Extreme Income Inequality
MIX WITH
Early onset mood disorders (depression,
PTSD) often resulting from early trauma
TOP OFF WITH
Substance abuse and/or family violence
Other factors may contribute to this
recipe
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Porous social safety net
High rate of poor single parent families
Racial bias
Ambivalent confused social attitudes
regarding neglect
• Extreme cognitive impairments of parents
Chronic neglect and chronic maltreatment are
an extreme form of family breakdown. The legal
scholar and child welfare expert, Michael Wald,
has estimated that about one-fifth of low income
families engage in marginal to poor parenting
practices.
In far less affluent societies, family breakdown
may result in large numbers of young school
age children living on the streets.
Fortunately, not all neglect is chronic
neglect
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Situational Neglect
Sporadic Neglect
Chronic Neglect
Chronic Maltreatment
The type of child abuse and neglect in the initial report
is not a reliable predictor of types of subsequent reports
(Loman, 2006)
There are two main dynamics in chronic
neglect and chronic maltreatment: (a) the
erosion or collapse of social norms around
parenting and (b) the loss of self
efficacy associated with depression and
demoralization.
Depression and Demoralization
Severe depression has a strong cognitive
element, i.e., hopelessness/helplessness,
which I refer to as demoralization.
Indicators of Demoralization
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Poor self care
Lack of concern with physical environment
Apathy in the face of threat
Cannot “regroup” in the face of adversity
Accepts demeaning behavior and attributions
Unresponsive to offers of help
Hopeless/helpless
Factors Which Sustain Morale in Difficult
Circumstances
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Past success with overcoming adversity
Strong sense of identity
Good health
Affiliation with a religious community
Social support/encouragement
Hope
A sense of meaning and purpose
Taking pleasure in small things
An ability to ask for help and give help
Strong self-esteem
Anger
Material resources
The Practice Challenge
What does it take to engage hopeless/helpless
parents in services or in therapeutic activities?
Young children in chronically neglecting and
chronically maltreating families may be in
physical danger from time to time; young
children are more likely to die in neglect
related “accidents” than from physical abuse.
In practice, it is often difficult for professionals
to agree whether a child’s death was neglect
related or solely an accident.
Nevertheless, the main harms to children
resulting from chronic neglect and chronic
maltreatment are emotional and
developmental; and these harms are
cumulative.
Blank face video
Chronic Neglect Makes Children More
Vulnerable
Severe and chronic neglect in early
childhood compromises young children’s
immune systems.
Dysregulation
Physiological dysregulation lays the foundation
for emotional dysregulation.
Serve and Response
Normal brain development in young children
depends on predictable “serve and
response” interactions between babies and
toddlers and their caregivers.
Effects of chronic neglect/chronic maltreatment
on children’s development, emotional well being
and mental health
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Compromises immune system
Attachment
Cognitive development/language delay
Affect regulation
Social self confidence, social competence
Perseverance in problem solving
Empathy/conscience
Conduct disorders/delinquency
Young children living in chronically
neglecting or chronically maltreating families
need to be in high quality or therapeutic
child care programs.
Effective interventions with many of these
families will be lengthy and expensive; child
welfare policy and practice should emphasize
prevention and early intervention.
A Design Change
Public agencies, in collaboration with other
state and community agencies, need to
develop a structured approach to the
assessment of multi – problem families.
Family Support Teams
Ideally, chronically neglecting and chronically
maltreating families would be served by 4 to 5
person family support teams that include
substance abuse, mental health, child welfare
and a parent advocate.
Four Main Types of Services for
Neglecting Families
• Poverty-related services
• Parenting programs and other programs
designed to teach skills
• Substance abuse and/or mental health
treatment and DV services
• Long term case management services for
chronically, mentally ill or developmentally
disabled parents
Sequencing?
There is no research based right answer to the
question of how best to sequence services to
chronically neglecting multi-problem families.
However, there is general agreement that
complex service plans must be sequenced to
be effective.
Promising Practices
In the past 10-15 years, several promising
practices have been developed for working with
substance abusing parents, many of whom
have had their children removed due to neglect.
These practices include: use of family
treatment drug courts, peer mentors, parent
advocates (e.g., PCAP), Pregnant and
Parenting Women treatment programs and
transitional housing programs.
An Economic Future
Some fraction of parents in recovery can
benefit from educational or job training
programs.
Community Empowerment
Community empowerment programs have been
used to lower rates of neglect reports and rates
of out-of-home care. These programs utilize a
combination of social norming and
comprehensive family supports.