Session Six: The Impact of Neglect, Physical,
Emotional, & Sexual Abuse on Permanency
This session will review the negative impact of
neglect and abuse (physical, emotional, and
sexual) on children, youth, and families.
Students will compare normative childhood
development and its tasks with childhood
development clouded by abuse, neglect, and the
trauma associated with those conditions. The
class will learn about the role of
psychopharmacological interventions and the
healing power of relationships.
Session Six Competencies
Knows and understands the impact of
abuse/neglect; substance abuse; domestic violence;
mental illness and poverty of families and
communities on children, youth and families
affected by the child welfare system.
Session Six Objectives
Explain the State’s legal definition of physical abuse, sexual
abuse, neglect, dependency and endangerment.
Describe the physical, emotional, and behavioral indicators
of physical abuse, neglect and sexual abuse in child victims
and their families.
Describe the unique interpersonal and family dynamics
typically associated with physical and sexual abuse, neglect,
and emotional maltreatment.
Identify risk and protective factors in family functioning.
Child Neglect - Definition
The inability or unwillingness of a parent, guardian
or custodian of a child to provide that child with
supervision, food, clothing, shelter or medical care
if that inability or unwillingness causes unreasonable
risk of harm to the child's health or welfare, except if
the inability of a parent, guardian or custodian to
provide services to meet the needs of a child with a
disability or chronic illness is solely the result of the
unavailability of reasonable services.
Child Neglect - Definition
Permitting a child to enter or remain in any
structure or vehicle in which volatile, toxic or
flammable chemicals are found or equipment is
possessed by any person for the purposes of
manufacturing a dangerous drug.
Child Neglect - Definition
A determination by a health professional that a
newborn infant was exposed prenatally to a drug or
substance and that this exposure was not the result
of a medical treatment administered to the mother
or the newborn infant by a health professional.
This subdivision does not expand a health professional’s
duty to report neglect based on prenatal exposure
to a drug or substance.
Child Neglect - Definition
The determination by the health professional shall
be based on one or more of the following:
 Clinical indicators in the prenatal period including
maternal and newborn presentation.
 History of substance use or abuse.
 Medical history.
 Results of a toxicology or other laboratory test on the
mother or the newborn infant.
Child Neglect - Definition
 Diagnosis by a health professional of an infant
under one year of age with clinical findings
consistent with fetal alcohol syndrome or fetal
alcohol effects.
 Deliberate exposure of a child by a parent,
guardian or custodian to sexual conduct or to
sexual contact, oral sexual contact or sexual
intercourse or explicit sexual materials.
Child Neglect - Definition
Any of the following acts committed by the child’s
parent, guardian or custodian with reckless
disregard as to whether the child is physically
present:
 Sexual contact
 Oral sexual contact
 Sexual intercourse
 Bestiality
Child Neglect
Impact on Permanency
Defining neglect historically has been difficult to do,
leading to inconsistencies in policies, practice and
research.
Without a consistent definition of neglect, it is nearly
impossible to compare research results.
This inconsistency also leads.to.variability.in.the.way.
Neglect cases are handled.
Child Neglect
Impact on Permanency
The debate over a definition of neglect centers on a
lack of consensus in answering these questions:
• What are the minimum requirements associated
with caring for a child?
• What action or inaction by a parent or other
caregiver constitutes neglectful behavior?
Child Neglect
Impact on Permanency
• Must the parent’s or caregiver’s action or inaction
be intentional?
• What impact does the action or inaction have on
the health, safety, and well-being of the child?
• What consititutes failure or inability to provide,
food, shelter, protetcion or clothing?
Child Neglect
Impact on Permanency
• Should failure to thrive be included?
• Is action or inaction the result of poverty rather
than neglect?
Child Neglect
Impact on Permanency
Neglected children, even when older, may display a variety of
emotional, psychosocial, and behavioral problems which may vary
depending on the age of the child
Some of these include:
• Displaying an inability to control emotions or impulses, usually
characterized by frequent outbursts;
•
• Being quiet and submissive;
Child Neglect
Impact on Permanency
• Having difficulty learning in school and getting along with siblings
or classmates;
• Experiencing unusual eating or sleeping behaviors;
• Attempting to provoke fights or solicit sexual interactions;
• Acting socially or emotionally inappropriate for their age;
• Being unresponsive to affection;
• Displaying apathy;
• Abusing alcohol or drugs
Child Neglect
Impact on Permanency
• Being less flexible, persistent, and enthusiastic than non-neglected children;
• Demonstrating helplessness under stress;
• Having fewer interactions with peers than non-neglected children;
• Displaying poor coping skills;
• Acting highly dependent;
• Acting lethargic and lack luster;
• Displaying self-abusive behavior (eg,suicide attempts or cutting themselves);
Child Neglect
Impact on Permanency
• Exhibiting panic or dissociative disorders, attention-
deficit/hyperactivity disorder, or post-traumatic stress disorder;
• Suffering from depression, anxiety, or low self-esteem;
• Exhibiting juvenile delinquent behavior or engaging in adult
criminal activities;
• Engaging in sexual activities leading to teen pregnancy or
fatherhood;
• Having low academic achievement;
Child Neglect
Family Factors
Several family characteristics are associated with higher rates
of neglect.
Some life situations, such as:
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Marital Problems,
Domestic Violence,
Single Parenthood,
Unemployment,
Financial Stress
All can increase the likelihood that neglect will occur.
Child Neglect
Family Factors
Although these characteristics may not cause maltreatment,
they are possible risk factors for neglect
Some family characteristics that may lead to neglect can be
categorized as:
• Communication and Interaction Patterns,
 Family composition,
 Domestic Violence
 Family Stress
Severity of Child Neglect
Mild Neglect
Usually does not warrant a report to CPS, but might necessitate a
community-based intervention( eg, a parent failing to put the child in a
car safety seat)
Moderate Neglect
Occurs when less intrusive measures, such as community interventions,
have failed or some moderate harm to the child has occurred (eg, a child
consistently is inappropriately dressed for the weather, such as being in
shorts and sandals in the middle of winter) For moderate neglect, CPS
may be involved in partnership with community support
Severe Neglect
Occurs when severe or long-term harm has been done to the child (eg, a
child
with asthma who has not received appropriate medications over a long
period of time and is frequently admitted to the hospital) In these cases,
CPS should be and is usually involved, as is the legal system
Types Child Neglect
Physical
Medical
Inadequate Supervision
Environmental
Educational
Emotional
Newborns Addicted or Exposed to Substances
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Child Abuse - Definition
Physical, sexual or emotional maltreatment or
neglect of a child or children. In the United States,
the Centers for Disease Control and Prevention
(CDC) and the Department for Children and
Families (DCF) define child maltreatment as any act
or series of acts of commission or omission by a
parent or other caregiver that results in harm,
potential for harm, or threat of harm to a child.
Child Abuse - Definition
Child abuse can occur in a child's home, or in the
organizations, schools or communities the child
interacts with. There are three major categories of
child abuse: physical abuse, emotional abuse, and
sexual abuse.
Child Abuse - Physical
Non-accidental physical injury (ranging from minor
bruises to severe fractures or death) as a result of
punching, beating, kicking, biting, shaking,
throwing, stabbing, choking, hitting (with a hand,
stick, strap, or other object), burning, or otherwise
harming a child, that is inflicted by a parent,
caregiver, or other person who has responsibility for
the child, regardless the intention.
BRUISES, CUTS, WELTS, OR SCRATCHES
BRUISES
CUTS
WELTS
SCRATCHES
*Discolored but
not broken
*Contusions
*Old- yellow,
green, or brown
*New- red,
purple, or blue
*Fade–from
outer edges
inward
*Minor
opening,
incision or
break caused
by external
agent
*Elevation of
the skin
caused by lash
or blow;
*Usually a belt,
electrical cord
or wire hanger;
*Skin is not
broken
*Thin, shallow
opening, mark
or break in the
skin;
*Usually from
a sharp object
or fingernails
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Child Abuse - Emotional
A pattern of behavior that impairs a child’s
emotional development or sense of self-worth. This
may include constant criticism, threats, or rejection,
as well as withholding love, support, or guidance. It
is often difficult to prove, and therefore, child
protective services may not be able to intervene
without evidence of harm or mental injury to the
child. Emotional abuse is almost always present when
other types of maltreatment are identified.
Life Time Consequences of
Maltreatment
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School achievement and drop out rates
Employment
Long-term medical effects
Criminal behavior
Substance abuse
Relationship dysfunction
Partner violence
Promiscuity/prostitution and high risk sexual
behaviors
 Teen pregnancy
Life Time Consequences of
Maltreatment
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Sexual victimization as an adult
Panic and anxiety disorders
Depression
Serious mental illness
Bipolar disorder
Suicidal behavior
Personality disorders
Homelessness
Victimization of others
Resilience
ACE Study
Life Time Consequences of Maltreatment
Children living in adverse circumstances with known
family/caregiver risk factors are at higher risk for adverse outcomes,
and maltreatment compounds the negative outcomes.
• Maltreatment reports appear more likely in households where
mothers are depressed, complain of somatic symptoms, consume
alcohol, participate in public income support programs, care for
more than one dependent child, have not graduated from high
school, or were separated from their own mothers by age 14.
• In general, families with low levels of social support have a higher
risk of a maltreatment report.
ACE Study
Life Time Consequences of Maltreatment
• Most children who were victimized were victims of more
than one type of maltreatment.
• CPS classification of general neglect was the best predictor
of child behavior problems and poor socialization.
• Type of abuse, severity, chronicity, and age of onset impact
social, emotional, and behavioral problems. For example,
child neglect in the first two years of life appears to be a
more important precursor of childhood aggression than
either later neglect or physical abuse at any age
ACE Study
Life Time Consequences of Maltreatment
• It is important to know about the pattern of a
child’s maltreatment experience over and above a
simple count of substantiations or allegations. Both
the extent and the continuity of a child’s
maltreatment predict social, emotional, and
behavioral outcomes.
• The link between intimate partner violence and
child maltreatment is very strong.
Child Abuse - Sexual
Activities by a parent or caregiver such as fondling a
child’s genitals, penetration, incest, rape, sodomy,
indecent exposure, and exploitation through
prostitution or the production of pornographic
materials.
Child Abuse - Sexual
Federal Statute
Child sexual abuse is defined in Federal law by the
Child Abuse Prevention and Treatment Act, CAPTA
(42 U.S.C. sec. 5106g(4)).
Child Abuse - Sexual
It is defined by CAPTA as “the employment, use,
persuasion, inducement, enticement, or coercion of
any child to engage in, or assist any other person to
engage in , any sexually explicit conduct or
simulation of such conduct for the purpose of
producing a visual depiction of such conduct; or the
rape, and in cases of caretaker or inter-familial
relationships, statutory rape, molestation, prostitution,
or other form of sexual exploitation of children, or
incest with children.”
Child Abuse - Sexual
Louisiana Definition - Sexual Abuse/Exploitation
Citation: Ch. Code art. 603
The term 'abuse' includes any one of the following acts
that seriously endanger the physical, mental, or emotional
health of the child:
 The involvement of the child in any sexual act with a parent
or any other person
 The aiding or toleration by the parent or caregiver of the
child's sexual involvement with any other person
 The aiding or toleration by the parent of the child's
involvement in pornographic displays
Child Abuse - Sexual
 Any other involvement of a child in sexual activity
constituting a crime under the laws of the State
 'Child pornography' means visual depiction of a child
engaged in actual or simulated sexual intercourse,
deviate sexual intercourse, sexual bestiality,
masturbation, sadomasochistic abuse, or lewd
exhibition of the genitals.
 A 'crime against a child' includes rape, sexual battery,
incest, carnal knowledge of a juvenile, indecent
behavior with a juvenile, pornography involving
juveniles, a crime against nature, or molestation of a
juvenile.
Child Abuse - Sexual
Consider the possibility of sexual abuse when the
child shows these signs:
1. Has difficulty walking or sitting
2. Suddenly refuses to change for gym or to
participate in physical activities
3. Reports nightmares or bedwetting
4. Experiences a sudden change in appetite
Child Abuse - Sexual
5. Demonstrates bizarre, sophisticated, or unusual
sexual knowledge or behavior
6. Becomes pregnant or contracts a venereal disease,
particularly if under age 14
7. Runs away
8. Reports sexual abuse by a parent or another adult
caregiver
9. Attaches very quickly to strangers or new adults in
their environment
Child Abuse - Sexual
Consider the possibility of sexual abuse when the
parent or other adult caregiver is:
1. Unduly protective of the child or severely limits
the child’s contact with other children, especially
of the opposite sex
2. Secretive and isolated
3. Jealous or controlling with family members
Child Abuse - Sexual
Standardized measures completed either by the
child or the caregiver are:
 Child Sexual Behavior Inventory (CSBI)- caregiver
 Child Behavior Checklist (CBCL) - caregiver
 Trauma Symptom Checklist for Children (TSCC) –
child (age 8 and older)
 Trauma Symptom Checklist for Young Children
(TSCYC) - caregiver
Child Abuse - Sexual
 In general children do not falsely assert they have been
sexually abused.
 They are unlikely to have an interest in making a
false allegation.
 Being a victim of sexual abuse is associated with
shame, stigma, and stressful interventions like talking
to the police, having to be involved in a forensic
interview, being removed from the home, and having
to testify in court.
Child Abuse - Sexual
Criteria to look for in a true allegation:
- Description of an explicit sexual act.
- Not just he/she hurt me, touched me.
- A description of the sexual abuse that reflects a
child’s perspective.
Child Abuse - Sexual
- Details about the abuse:
 Such as what the offender’s penis looked like
 Where the penis went
 What the abuse felt like
 How long the sexual act went on
 Whether anything came out of the penis
 If so, what color it was or what it tasted like
 What happened to the stuff that came out of the
penis.
Child Abuse - Sexual
- Details about the context of the sexual abuse:
 Where it happened--in a house, apartment,
trailer, etc., what room, where in the room, a
description of the room.
 When (within the child’s time sense) it
happened.
 Where other people were.
Child Abuse - Sexual
- Other details about the context of the sexual abuse:
 What the offender said to get the child involved.
 Whether the offender said anything about
telling or not telling.
 What clothing was worn and taken off.
Child Abuse - Sexual
Research tells us that:
 Almost every report of sexual abuse leads
to a counter-concern that the allegation
might be false.
 Failure to report actual sexual abuse is a
much larger problem than falsely
reporting sexual abuse.
Child Abuse - Sexual
 Between one-fourth and one-third of children deny
sexual abuse during forensic interviews.
 Populations where there are other indicators of sexual
abuse have higher rates of non-disclosure.
 Research indicates that more than half of children with
Sexually Transmitted Infections do not disclosure sexual
abuse when asked.
 Research indicates that a half to a third of children for
whom there was video evidence of sexual abuse did not
disclose when interviewed.
Child Abuse - Sexual
Research tells us that:
 Most false reports come from adults, not children
 Most false reports are misinterpretations.
 Calculated false allegations of sexual abuse are rare.
 Research indicates they are more likely to be made
by non-custodial parents than custodial parents.
Child Abuse - Sexual
CHILD WELFARE WORKERS’ RESPONSIBILITIES:
Inform foster/adoptive parents about the abuse history
and behavior problems of each child on your caseload.
Help the family develop the rules.
Help the family decide on an appropriate sexual abuse
prevention training.
Child Abuse - Sexual
Facilitate family meetings as indicated.
Ask the foster/adoptive parents to make notes from
each family meeting.
Review the notes and monitor family meetings.
Assure the treatment the child receives is evidencebased.
Child Abuse - Sexual
ADVICE FOR CHILD WELFARE WORKERS:
 Don’t just refer the child to “counseling”.
 Child welfare workers need to be sure the
treatment provided to children on their caseloads
is evidence-based and trauma informed treatment
for sexual abuse.
Child Abuse - Sexual
 Children in care do not live in a vacuum; their
caregivers must be involved in their treatment.
 Caregivers need counseling, too; parenting
sexually abused children is very, very challenging.
 Seek out therapists who provide individual
treatment for children and caregivers and family
sessions
Child Abuse - Sexual
What Can You Do?
 PROTECT YOUR CHILDREN
 SUPPORT CHILD ABUSE VICTIMS
 TEACH OTHERS ABOUT CHILD ABUSE
 REPORT, REPORT, REPORT
Child Abuse - Sexual
The effects of sexual abuse extend far beyond
childhood. Sexual abuse robs children of
Their childhood and creates a loss of trust,
feelings of guilt and self-abusive behavior.
Child Abuse - Sexual
It can lead to antisocial behavior, depression,
identity confusion, loss of self-esteem and
other serious emotional problems.
Child Abuse - Sexual
It can also lead to difficulty with intimate
relationships later in life. The sexual
victimization of children is ethically and
morally wrong.
Child Sexual Abuse
Impact on Permanency
It can also lead to difficulty with intimate
relationships later in life. The sexual
victimization of children is ethically and
morally wrong.