Child Neglect PDF

Child Neglect: A Guide for
Prevention, Assessment, and

Intervention
Diane DePanfilis
2006
U.S. Department of Health and Human Services
Administration for Children and Families
Administration on Children, Youth and Families
Childrens Bureau
Office on Child Abuse and Neglect

Table of Contents
PREFACE......................................................................................................................................................1
ACKNOWLEDGMENTS.......................................................................................................................3
1. PURPOSEANDOVERVIEW.......................................................................................................7
2. DEFINITIONANDSCOPEOFNEGLECT...............................................................................9
WhatIsNeglect?.............................................................................................................................9
TypesofNeglect...........................................................................................................................11
SignsofPossibleNeglect...............................................................................................................15
ScopeoftheProblem....................................................................................................................16
3. IMPACTOFNEGLECT.............................................................................................................21
HealthandPhysicalDevelopment................................................................................................22
IntellectualandCognitiveDevelopment.......................................................................................24
Emotional,Psychosocial,andBehavioralDevelopment.................................................................25
4. RISKANDPROTECTIVEFACTORS........................................................................................29
EnvironmentalFactors..................................................................................................................29
FamilyFactors...............................................................................................................................33
ParentorCaregiverFactors...........................................................................................................36
ChildFactors................................................................................................................................39
5. ASSESSMENTOFCHILDNEGLECT......................................................................................43
FrameworkforPractice.................................................................................................................45
Intake...........................................................................................................................................45
InitialAssessmentorInvestigation................................................................................................46
FamilyAssessmentProcess............................................................................................................49
StructuredAssessmentMeasures...................................................................................................52
Child Neglect: A Guide for Prevention, Assessment, and Intervention i

6. CHILDNEGLECTPREVENTIONANDINTERVENTION....................................................55
PrinciplesforEectivePreventionandIntervention......................................................................55
TeoreticalFrameworksandApproaches.......................................................................................57
KeyStepsintheInterventionProcess............................................................................................63
PromisingPracticesforIntervention.............................................................................................68
Conclusion...................................................................................................................................71
ENDNOTES.........................................................................................................................................73
APPENDICES:
APPENDIXAGLOSSARYOFTERMS...................................................................................87
APPENDIXBRESOURCELISTINGSOFSELECTEDNATIONALORGANIZATIONS
CONCERNEDWITHCHILDMALTREATMENT...................................................................93
APPENDIXCSTATETELEPHONENUMBERSFORREPORTINGCHILDABUSE........99
APPENDIXDNEGLECTANDTHECHILDANDFAMILYSERVICESREVIEWS.........101
ii ii Table of Contents

Preface
E
ach day, the safety and well-being of some
children across the Nation are threatened by
child abuse and neglect. Intervening effectively
in the lives of these children and their families is
not the sole responsibility of any single agency or
professional group, but rather is a shared community
concern.
Since the late 1970s, the Child Abuse and Neglect
User Manual Series has provided guidance on
child protection to hundreds of thousands of
interdisciplinary professionals and concerned
community members. The User Manual Series
provides a foundation for understanding child
maltreatment and the roles and responsibilities of
various practitioners in its prevention, identification,
investigation, assessment, and treatment. Through
the years, the manuals have served as valuable
resources for building knowledge, promoting effective
practices, and enhancing community collaboration.
Since the last update of the User Manual Series in
the early 1990s, a number of changes have occurred
that dramatically affect each communitys response
to child maltreatment. This is true particularly in the
area of neglect. Both the field and the community
increasingly recognize the impact of many factors on
neglect, such as poverty, unemployment, and housing,
as well as individual and family characteristics. The
changing landscape reflects increased recognition
of the complexity of issues facing parents and their
children, new legislation, practice innovations,
and system reform efforts. Significant advances
in research have helped shape new directions for
interventions, while ongoing evaluations help us to
know what works.
The Office on Child Abuse and Neglect (OCAN)
within the Childrens Bureau of the Administration
for Children and Families (ACF), U.S. Department
of Health and Human Services (DHHS), has
developed this third edition of the User Manual
Series to reflect the increased knowledge base and
the evolving state of practice. The updated and
new manuals are comprehensive in scope while
succinct in presentation and easy to follow, and
they address trends and concerns relevant to todays
professional.
While the User Manual Series primarily addresses
the issues of child abuse and neglect, this manual
delves deeper into the root causes, symptoms,
and consequences of neglect, as well as the
interdisciplinary ways to prevent both its occurrence
and recurrence. Readers of Child Neglect: A Guide
for Assessment, Prevention, and Intervention also
may be interested in Child Protective Services:
A Guide for Caseworkers, which goes into more
depth on issues such as family assessment and
case planning. They also may have interest in A
Coordinated Response to Child Abuse and Neglect:
The Foundation for Practice, the keystone for the
series, which addresses the definition, scope, causes,
and consequences of child abuse and neglect. It
Child Neglect: A Guide for Prevention, Assessment, and Intervention 1

presents an overview of prevention efforts and the different professional groups and offers guidance
child protection process. Because child protection on how the groups can work together effectively to
is a multidisciplinary effort, The Foundation for protect the safety, permanency, and well-being of
Practice describes the roles and responsibilities of children.
User Manual Series
TismanualalongwiththeentireChild Abuse and Neglect User Manual SeriesisavailablefromChild
WelfareInformationGateway.Forafulllistofavailablemanualsandorderinginformation,contact:
ChildWelfareInformationGateway
1250MarylandAvenue,SW
EighthFloor
Washington,DC20024
Phone:(800)394-3366or(703)385-7565
Fax:(703)385-3206
E-mail:info@childwelfare.gov
Temanualsalsoareavailableonlineathttp://www.childwelfare.gov/pubs/usermanual.cfm.
2 Preface

ACKNOWLEDGMENTS
AUTHOR
DianeDePanlis,Ph.D.,M.S.W.,istheAssociate
DeanforResearchandanAssociateProfessorof
SocialWorkattheUniversityofMaryland,Baltimore,
wheresheteachessocialworkpracticeandchild
welfareresearchcoursesintheMasterofSocialWork
program,aswellasresearchseminarsinthedoctoral
program.SheisalsodirectoroftheInstitutefor
Human Services Policy and codirectoroftheCenter
forFamilies,aninterdisciplinarypartnershipbetween
theschoolsofsocialworkandmedicineandthe
departmentofpediatrics.Overthepast30years,she
hasprovidedchildwelfareservicesatthelocallevelas
acaseworker,supervisor,andadministrator;workedas
aconsultantatthenationallevelconductingprogram
evaluations and providing training and technical
assistancetosocialworkersandotherdisciplines;and
conductedextensivestudiesrelatedtothedeliveryof
child protective services and the prevention of child
maltreatment. She is co-editor of the Handbook on
Child Protection Practiceandisaformerpresidentof
theAmericanProfessionalSocietyontheAbuseof
Children.
CONTRIBUTING AUTHORS
JeannieNewman,M.S.W.,M.I.B.S.,aconsultant
withCaliber,anICFInternationalCompany,has
heldpolicyanddirectpracticepositionsinchild
welfareandfamilyprograms.Shealsohascultivated
an extensive network in various related professional
elds, including domestic violence, fatherhood, and
poverty.SheiscurrentlytheProjectManagerforthe
User Manual Series.
LindsayRitterTaylor,aformerconsultantwith
Caliber, an ICF International Company, worked
onprojectsrelatingtovariouschildwelfareand
juvenilejusticeissues.Shehelpedauthorissuebriefs
highlightingndingsfromtheNational Survey of
Child and Adolescent Well-being,anationalsample
of children who had been abused or neglected.
Additionally, she worked with the Caliber technical
assistanceandevaluationteamsontheImproving
Child Welfare through Systems of Caregrantproject.
MatthewShuman,M.S.W.,aconsultantwithCaliber,
anICFInternationalCompany,hasmorethan8years
experienceinthehumanserviceseld.Hepreviously
workedasananalystintheOceoftheSecretaryof
theDepartmentofHealthandHumanServicesona
variety of child welfare issues, including foster care,
adoption,andchildcare.Healsohasresearchedand
writtenseveralpapersonchildwelfareissues.
Jean Strohl, a consultant with Caliber, an ICF
InternationalCompany,worksasaseniorwriter/
editor.Shehasmorethan15yearsofexperience
in writing about the inuences of family and social
environmentsonsubstanceabuseanditsprevention.

Shealsohascontributedtomanypublicationson
thesubjects of cultural diversity and understanding
the underlying patterns of beliefs and attitudes
characteristicofAmericansandotherculturalgroups
(Hispanic,Asian,MiddleEastern,Russian).
ACKNOWLEDGMENT OF PRIOR EDITION
Tismanualwasoriginallypublishedin1993asChild
Neglect: A Guide for Intervention byJamesGaudin,
Jr., Ph.D. Te prior version and the authors other
research and work informed and contributed to the
developmentofthispublication.
REVIEWERS
JackDenniston,ChildWelfareInformationGateway
HowardDubowitz,Ph.D.,UniversityofMaryland
SchoolofMedicine
JamesM.Gaudin,Jr.,Ph.D.,UniversityofGeorgia
KathyPinto,HowardCounty,Maryland,Department
ofSocialServices
SandraSlappey,ChildWelfareInformationGateway
Sarah Webster,Texas Department of Protective and
RegulatoryServices(retired)
TECHNICAL ADVISORY PANEL
TefollowingweremembersoftheJanuary2001
TechnicalAdvisoryPanel forthe User Manual Series
contract.Teorganizationsidentiedreecteach
membersaliationatthattime.
CarolynAbdullah
FRIENDSNationalResourceCenter
Washington,DC
LienBragg
AmericanPublicHumanServicesAssociation
Washington,DC
Sgt.RichardCage
MontgomeryCountyPoliceDepartment
Wheaton,MD
DianeDePanlis,Ph.D.
UniversityofMarylandatBaltimoreSchoolofSocial
Work
Baltimore,MD
PaulineGrant
FloridaDepartmentofChildrenandFamilies
Jacksonville,FL
JodiHill
ConnecticutDepartmentofChildrenandFamilies
Hartford,CT
RobertOrtega,Ph.D.
UniversityofMichiganSchoolofSocialWork
AnnArbor,MI
NancyRawlings
KentuckyCabinetforFamiliesandChildren
Frankfort,KY
BarrySalovitz
ChildWelfareInstitute/NationalResourceCenter
onChildMaltreatment
Glenmont,NY
SarahWebster
TexasDepartmentofProtectiveandRegulatory
Services
Austin,TX
RonZuskin
UniversityofMarylandatBaltimoreSchoolofSocial
Work
Baltimore,MD
4 Acknowledgments

Te following members subsequently were added to
theTechnicalAdvisoryPanel:
WilliamR.(Reyn)ArcherIII,M.D.
HillandKnowlton,Inc.
Washington,DC
DavidPopenoe,Ph.D.
NationalMarriageProject
Princeton,NJ
BobScholle
IndependentConsultant
Pittsburgh,PA
BradWilcox,Ph.D.
UniversityofVirginia,DepartmentofSociology
Charlottesville,VA
ADDITIONAL ACKNOWLEDGMENTS
TethirdeditionoftheUser Manual Serieswas
developed under the guidance and direction of Irene
Bocella,FederalTaskOrderOcer,andCatherine
Nolan,Director,OceonChildAbuseandNeglect.
AlsoprovidinginputandreviewwereDr.SusanOrr,
AssociateCommissioner,ChildrensBureau,aswell
as Sidonie Squier, Director, and Peter Germanis,
NationalPolicyExpert,ImmediateOceofthe
Director,OceofFamilyAssistance,Administration
forChildrenandFamilies.
TismanualwasdevelopedandproducedbyCaliber,
anICFInternationalCompany,Fairfax, VA,under
ContractNumberHHS-282-98-0025.

CHAPTER 1
Purpose and Overview
C
hildprotectiveservices(CPS),adivisionwithin
State and local social service agencies, is at the
centerofeverycommunityschildprotectioneorts.
Inmostjurisdictions,CPSistheagencymandatedby
lawtoconductaninitialassessmentorinvestigation
ofreportsofchildabuseorneglect.Italsooers
servicestofamiliesandchildrenwhenmaltreatment
hasoccurredorislikelytooccur.
CPS does not work alone. Many community
professionalsincluding law enforcement ocers,
healthcareproviders,mentalhealthprofessionals,
educators,legalandcourtsystempersonnel,and
substitute care providersareinvolved in eortsto
prevent,identify,investigate,andtreatchildabuse
andneglect.Inaddition,community-andfaith-
based organizations, substance abuse treatment
facilities,advocatesforvictimsofdomesticviolence,
extendedfamilymembers,andconcernedcitizens
playimportantrolesinsupportingfamiliesandin
keepingchildrensafefromharm.Typically,CPS
is the lead agency in coordinating the eorts of the
variousdisciplinesworkingtoprotectchildrenandto
educatethecommunityabouttheproblemsofchild
abuseandneglect.
Tisinterdisciplinaryapproachisparticularlyevident
inaddressingthecomplexaspectsofneglect.Other
manualsinthisseries,A Coordinated Response to
Child Abuse and Neglect: Te Foundation for Practice
andChild Protective Services: A Guide for Caseworkers,
provide fundamental information that CPS
professionalsmustknowinordertoperformessential
caseworkfunctions.Tismanual,Child Neglect: A
Guide for Assessment, Prevention, and Intervention,
covers neglects denition, causes, impact, and
preventionandinterventionstrategiesinmoredetail.
Italsobuildsonbothoftheearliermanuals,reiterates
some of their most important points, and addresses
thefollowingtopics:
Denitionandscopeofneglect;
Impactofneglect;
Riskandprotectivefactors;
Assessmentofchildneglect;
Childneglectpreventionandintervention.

CHAPTER 2
Definition and Scope
of Neglect
C
hild neglect is the most common type of
child maltreatment.
1
Unfortunately, neglect
frequently goes unreported and, historically, has
notbeenacknowledgedorpublicizedasgreatlyas
childabuse.Evenprofessionalsoftenhavegiven
less attention to child neglect than to abuse.
2
One
studyfoundthatcaseworkersindicatedthatthey
wereleastlikelytosubstantiatereferralsforneglect.
3
In some respects, it is understandable why violence

against children has commanded more attention
than neglect. Abuse often leaves visible bruises and
scars,whereasthesignsofneglecttendtobeless
visible.However,theeectsofneglectcanbejustas
detrimental. In fact, some studies have shown that
neglect may be more detrimental to childrens early
braindevelopmentthanphysicalorsexualabuse.
4
WHAT IS NEGLECT?
Howneglectisdenedshapestheresponsetoit.
Sincethegoalofdeningneglectistoprotectchildren
and to improve their well-beingnot to blame the
parentsorcaregiversdenitionshelpdetermineifan
incidentorapatternofbehaviorqualiesasneglect,
itsseriousnessorduration,and,mostimportantly,
whetherornotthechildissafe.
5
Denitions of neglect vary among States and across

dierentdisciplines,agencies,andprofessionalgroups
(e.g., child protective services, court systems, health
care providers), as well as among individuals within
these agencies and groups. Te denitions also are
used for dierent purposes within the child welfare
eld.Forexample,amedicaldoctormayviewa
parentasneglectfuliftheparentrepeatedlyforgets
togivehischildaprescribedmedication.Tismay
ormaynotlegallybeconsideredneglect,however,
dependingonthestringencyoftheneglectcriteriaof
manyCPSagencies.
6
DicultyDeningNeglect
Deningneglecthistoricallyhasbeendiculttodo,
leadingtoinconsistenciesinpolicies,practice,and
research.Withoutaconsistentdenitionofneglect,
itisnearlyimpossibletocompareresearchresults.
Tisinconsistencyalsoleadstovariabilityintheway
neglectcasesarehandled.
7
Te debate over a denition of neglect centers on a
lackofconsensusinansweringthesequestions:
Whataretheminimumrequirementsassociated
withcaringforachild?
Whatactionorinactionbyaparentorother
caregiverconstitutesneglectfulbehavior?
Musttheparentsorcaregiversactionorinaction
beintentional?
Whatimpactdoestheactionorinactionhaveon
thehealth,safety,andwell-beingofthechild?

Whatconstitutesfailureorinabilitytoprovide
adequatefood,shelter,protection,orclothing?
Should failure or inability to protect be
included?
Istheactionorinactionaresultofpovertyrather
thanneglect?
8
Additionally,whatisconsideredneglectvariesbased
ontheageandthedevelopmentallevelofthechild,
making it dicult to outline a set of behaviors that
are always considered neglect. For example, leaving
achildunattendedforanhourisconsideredneglect
whenthechildisyoung,butnotwhenthechild
isateenager.Anotherissueisthatmanyneglect
denitions specify that omissions in care may result
eitherinriskofharmorinsignicantharmto
thechild.Whilethe1996reauthorizationofthe
ChildAbusePreventionandTreatmentAct(CAPTA)
(P.L. 104-235) narrowed the denition of child
maltreatmenttocaseswheretherehasbeenactual
harmoranimminentriskofseriousharm,these
termsoftenarenotdenedbylaw,leavingthelocal
CPSagenciestointerpretthem.Tisleadstoalack
ofconsistencyinrespondingtofamilieswhomaybe
challengedtomeetthebasicneedsoftheirchildren.
9
DenitionsofNeglect
CAPTA,reauthorizedagainintheKeepingChildren
andFamiliesSafeActof2003(P.L.108-36),provides
minimumstandardsfordeningchildphysicalabuse,
neglect,andsexualabusethatStatesmustincorporate
intotheirstatutorydenitionsinordertoreceive
Federalfunds.UnderthisAct,childmaltreatment
isdenedas:
Anyrecentactorfailuretoactonthepartof
aparentorcaregiver,whichresultsindeath,
seriousphysicaloremotionalharm,sexualabuse
orexploitation,oranactorfailuretoactwhich
presentsanimminentriskofseriousharm.
10
Achildunderthisdenitiongenerallymeansa
personwhoisundertheageof18orwhoisnotan
emancipatedminor.Incasesofchildsexualabuse,a
childisonewhohasnotattainedtheageof18orthe
agespeciedbythechildprotectionlawoftheState
inwhichthechildresides,whicheverisyounger.
11
Instances of neglect are classied as mild, moderate,

orsevere.
Mildneglectusuallydoesnotwarrantareportto
CPS, but might necessitate a community-based
intervention(e.g.,aparentfailingtoputthechild
inacarsafetyseat).
Moderateneglectoccurswhenlessintrusive
measures, such as community interventions,
have failed or some moderate harm to the
childhasoccurred(e.g.,achildconsistentlyis
inappropriatelydressedfortheweather,such
asbeinginshortsandsandalsinthemiddle
ofwinter).Formoderateneglect,CPSmay
be involved in partnership with community
support.
Severeneglectoccurswhensevereorlong-term
harmhasbeendonetothechild(e.g.,achild
withasthmawhohasnotreceivedappropriate
medicationsoveralongperiodoftimeandis
frequentlyadmittedtothehospital).Inthese
cases,CPSshouldbeandisusuallyinvolved,asis
thelegalsystem.
12
Viewingtheseverityofneglectalongthiscontinuum
helpspractitionersassessthestrengthsandweaknesses
offamiliesandallowsforthepossibilityofproviding
preventive services before neglect actually occurs
orbecomessevere. Tereissomecontroversyover
whether potential harm should be considered
neglect, and, as with the denition of neglect, State
lawsvaryonthisissue.Althoughitisdicultto
assesspotentialharmasneglect,itcanhaveemotional
aswellasphysicalconsequences,suchasdiculty
establishingandmaintainingcurrentrelationshipsor
thoselaterinlife.
13
Teseriousnessoftheneglectisdeterminednot
only by how much harm or risk of harm there is to
thechild,butalsobyhowchronictheneglectis.
10 Definition and Scope of Neglect

Chronicitycanbedenedaspatternsofthesame
actsoromissionsthatextendovertimeorrecurover
time.
14
Anexampleofchronicneglectwouldbe
parents with substance abuse problems who do not
provideforthebasicneedsoftheirchildrenonan
ongoingbasis.Ontheotherhand,caregiversmight
haveminorlapsesincare,whichareseldomthought
of as neglect, such as occasionally forgetting to give
theirchildrentheir antibiotics.
15
However,if those
childrenwerefrequentlymissingdoses,itmaybe
consideredneglect.Somesituationsonlyneedto
occuronceinordertobeconsideredneglect,suchas
leaving an infant unattended in a bathtub. Because
somebehaviorsareconsideredneglectonlyifthey
occur on a frequent basis, it is important to look at
the history of behavior rather than focusing on one
particularincident.
TYPES OF NEGLECT
While neglect may be harder to dene or to detect
than other forms of child maltreatment, child
welfareexpertshavecreatedcommoncategoriesof
neglect, including physical neglect; medical neglect;
inadequatesupervision;environmental,emotional,
andeducationalneglect;andnewbornsaddictedor
exposed to drugs, as well as some newly recognized
formsofneglect.Tefollowingsectionsgivedetailed
informationoneachofthesetypesofneglect.
States denitions of neglect are usually located in mandatory child maltreatment reporting statutes (civil
laws),criminalstatutes,orjuvenilecourtjurisdictionstatues.Formoreinformationaboutreportinglaws,
visittheState Laws on Reporting Child Abuse and Neglect sectionoftheChildWelfareInformationGateway
Websiteathttp://www.childwelfare.gov/laws_policies/state/reporting.cfm.
FrameworkforNeglect
Currenttheoryonmaltreatmentviewsneglectfromasocio-ecologicalperspectiveinwhichmultiplefactors
contributetochildabuseandneglect.
16
Fromthisperspective,oneshouldconsidernotonlytheparentsrole,but
alsothesocietalandenvironmentalvariablescontributingtotheparentsinabilitytoprovideforthebasicneedsofthe
child.
17
Tesocio-ecologicalmodelisvaluablebecauseitrecognizesthesharedresponsibilityamongindividuals,
families,communities,andsociety,therebyenablingamoreconstructiveapproachandtargetinginterventionson
multiplelevels.
18
Examplesoffactorstoconsiderwhenlookingatneglectfromasocio-ecologicalperspectiveare
socialisolationandpoverty.Formoreinformationaboutfactorsrelatedtochildneglect,seeChapter4,Risk and
Protective Factors.
Itisimportanttokeepinmindthatnotallincidentsinwhichapersonfailstoprovideforthebasicneedsfora
childarenecessarilyconsideredneglect.Factorsrelatingtotheparentshealthandwell-being,suchasmentalillness,
substanceabuse,ordomesticviolence,oftencontributetoneglect.Anyinterventionforneglectwillneedtoconsider
thesefactorsaswell.
FederalandStatelawsoftenassumethatitispossibletodetermineclearlywhenparentshavecontroloveromissions
incareandwhentheydonot.Forexample,childrenmaybepoorlyfedbecausetheirparentsarepoorandareunable
toprovidethemwiththeappropriatetypeandamountoffood.Insuchcases,itisimportanttoidentifyfactorsthat
maybecontributingtothisinabilitytoprovide,suchasmentalillness.However,whenafamilyconsistentlyfails
toobtainneededsupportorisunabletouseinformationandassistancethatisavailable,aninterventionmaybe
required.Havingacomprehensiveunderstandingofwhatmaycontributetoneglectcanhelpdetermineappropriate
interventionsthataddressthebasicneedsofthechildandfamilyandalsoenhancesprofessionalsandcommunities
abilitiestodevelopandtouseinterventions,regardlessofCPSinvolvement.
19

PhysicalNeglect
Physicalneglectisoneofthemostwidelyrecognized
forms.Itincludes:
Abandonmentthedesertionofachildwithout
arranging for his reasonable care or supervision.
Usually,achildisconsideredabandonedwhen
notpickedupwithin2days.
Expulsionthe blatant refusal of custody, such
asthepermanentorindeniteexpulsionofachild
fromthehome,withoutadequatelyarrangingfor
hiscarebyothersortherefusaltoacceptcustody
ofareturnedrunaway.
Shuttlingwhenachildisrepeatedlyleftinthe
custodyofothersfordaysorweeksatatime,
possiblyduetotheunwillingnessoftheparentor
thecaregivertomaintaincustody.
Nutritional neglectwhen a child is
undernourished or is repeatedly hungry for
longperiodsoftime,whichcansometimesbe
evidenced by poor growth. Nutritional neglect
oftenisincludedinthecategoryofotherphysical
neglect.
Clothingneglectwhenachildlacksappropriate
clothing,suchasnothavingappropriatelywarm
clothesorshoesinthewinter.
Other physical neglectincludes inadequate
hygieneandformsofrecklessdisregardforthe
childssafetyandwelfare(e.g.,drivingwhile
intoxicatedwiththechild,leavingayoungchild
inacarunattended).
20
MedicalNeglect
Medicalneglectencompassesaparentorguardians
denialofordelayinseekingneededhealthcarefora
childasdescribedbelow:
Denialofhealthcarethefailuretoprovide
ortoallowneededcareasrecommendedbya
competenthealthcareprofessionalforaphysical
injury,illness,medicalcondition,orimpairment.
TeCAPTAamendmentsof1996and2003
containednoFederalrequirementforaparentto
provideanymedicaltreatmentforachildifthat
treatmentisagainsttheparentsreligiousbeliefs.
However, CAPTA also designates that there
is no requirement that aState either nd or be
prohibitedfromndingabuseorneglectincases
whereparentsorlegalguardiansactinaccordance
with their religious beliefs. While CAPTA
stipulatesthatallStatesmustgiveauthorityto
CPS to pursue any legal actions necessary 1) to
ensuremedicalcareortreatmenttopreventorto
remedyseriousharmtoachildor2)toprevent
thewithholdingofmedicallyindicatedtreatment
fromachildwithalife-threateningcondition
(exceptinthecasesofwithholdingtreatment
fromdisabledinfants),alldeterminationswill
be done on a case by case basis within the sole
discretionofeachState.
21
Delayinhealthcarethefailuretoseektimely
andappropriatemedicalcareforaserioushealth
problemthatanyreasonablepersonwouldhave
recognized as needing professional medical
attention.Examplesofadelayinhealthcare
include not getting appropriate preventive
HomelessnessandNeglect
Itisunclearwhetherhomelessnessshouldbeconsideredneglect;someStatesspecicallyomithomelessness
byitselfasneglect.Unstablelivingconditionscanhaveanegativeeectonchildren,andhomeless
childrenaremoreatriskforothertypesofneglectinareassuchashealth,education,andnutrition.
Homelessnessisconsideredneglectwhentheinabilitytoprovideshelteristheresultofmismanagement
ofnancialresourcesorwhenspendingrentresourcesondrugsoralcoholresultsinfrequentevictions.
22

medicalordentalcareforachild,notobtaining
careforasickchild,ornotfollowingmedical
recommendations.Notseekingadequatemental
healthcarealsofallsunderthiscategory.Alackor
delayinhealthcaremayoccurbecausethefamily
doesnothavehealthinsurance.Individualswho
areuninsuredoftenhavecompromisedhealth
because they receive less preventive care, are
diagnosedatmoreadvanceddiseasestages,and,
oncediagnosed,receivelesstherapeuticcare.
23
InadequateSupervision
Inadequatesupervisionencompassesanumberof
behaviors,including:
Lack of appropriate supervision. Some States
specify the amount of time children at dierent
agescanbeleftunsupervised,andtheguidelines
fortheseagesandtimesvary.Inaddition,
all children are dierent, so the amount of
supervision needed may vary by the childs age,
development,orsituation.Itisimportantto
evaluatethematurityofthechild,theaccessibility
ofotheradults,thedurationandfrequencyof
unsupervisedtime,andtheneighborhoodor
environmentwhendeterminingifitisacceptable
toleaveachildunsupervised.
24
Exposure to hazards. Examples of exposure to

in-andout-of-homehazardsinclude:
Safety hazardspoisons, small objects,
electricalwires,stairs,drugparaphernalia;
Smokingsecond-hand smoke, especially
for children with asthma or other lung
problems;
Gunsandotherweaponsgunsthatarekept
inthehousethatareloadedandnotlocked
uporareinreachofchildren;
Unsanitary household conditionsrotting
food, human or animal feces, insect
infestation, or lack of running or clean
water;
Lackofcarsafetyrestraints.
25
Inappropriate caregivers. Another behavior
thatcanfallunderfailuretoprotectisleaving
achildinthecareofsomeonewhoeitheris
unable or should not be trusted to provide care
forachild.Examplesofinappropriatecaregivers
includeayoungchild,aknownchildabuser,or
someonewithasubstanceabuseproblem.
26
Other forms of inadequate supervision.

Additionalexamplesofinadequatesupervision
include:
Leavingachildwithanappropriatecaregiver,
butwithoutproperplanningorconsent(e.g.,
notreturningtopickupthechildforseveral
hoursordaysaftertheagreeduponpick-
uptimeornotgivingthecaregiverallthe
necessaryitemstotakecareofthechild);
Leavingthechildwithacaregiverwhoisnot
adequatelysupervisingthechild(e.g.,the
caregiveriswiththechild,butisnotpaying
closeattentiontothechildduetoconstantly
beingdistractedbyotheractivities);
Permittingornotkeepingthechildfrom
engaginginrisky,illegal,orharmfulbehaviors
(e.g.,lettingachildsmokemarijuana).
27
Anothercommonbutcomplexexampleissingle,
working parents who are having diculty arranging
forappropriateback-upchildcarewhentheirregular
childcareprovidersareunavailable.Forexample,
a mother may leave her child home alone when the
child care provider fails to show up. If the mother
doesnotgoto work,she canlose herjoband will
notbeabletotakecareofherchild.However,ifshe
leavesthechildalone,shewillbeguiltyofneglect.It
isimportantthatparentsinsituationssimilartothis
receiveadequatesupportsothattheyarenotforcedto
makethesedicultdecisions.
EnvironmentalNeglect
Someofthecharacteristicsmentionedabovecan
beseenasstemmingfromenvironmentalneglect,
whichischaracterizedbyalackofenvironmental

or neighborhood safety, opportunities, or resources.
Whilechildrenssafetyandprotectionfromhazardsare
majorconcernsforCPS,mostattentionfocusesonthe
conditionsinthehomeandparentalomissionsincare.
A broad view of neglect incorporates environmental
conditionslinkingneighborhoodfactorswithfamily
and individual functioning, especially since the
harmful impact of dangerous neighborhoods on
childrens development, mental health, and child
maltreatmenthasbeendemonstrated.
28
CPSworkers
should be aware of this impact on the family when
assessingthesituationanddevelopingcaseplans.For
example, they can help parents nd alternative play
areasinadrug-infestedneighborhood,ratherthan
havetheirchildrenplayonthestreets.
EmotionalNeglect
Typically,emotionalneglectismorediculttoassess
thanothertypesofneglect,butisthoughttohave
more severe and long-lasting consequences than
physical neglect.
29
It often occurs with other forms
ofneglectorabuse,whichmaybeeasiertoidentify,
andincludes:
Inadequate nurturing or aectionthe
persistent,markedinattentiontothechildsneeds
foraection,emotionalsupport,orattention.
Chronic or extreme spouse abusethe
exposure to chronic or extreme spouse abuse or
otherdomesticviolence.
Permitted drug or alcohol abusethe
encouragementorpermissionbythecaregiverof
drugoralcoholusebythechild.
Other permitted maladaptive behavior
the encouragement or permission of other
maladaptivebehavior(e.g.,chronicdelinquency,
assault)undercircumstanceswheretheparentor
caregiverhasreasontobeawareoftheexistence
andtheseriousnessoftheproblem,butdoesnot
intervene.
Isolationdenyingachildtheabilitytointeract
or to communicate with peers or adults outside
orinsidethehome.
30
EducationalNeglect
AlthoughStatestatutesandpoliciesvary,bothparents
and schools are responsible for meeting certain
requirementsregardingtheeducationofchildren.
Typesofeducationalneglectinclude:
Permitted, chronic truancypermitting
habitualabsenteeismfromschoolaveragingat
least5daysamonthiftheparentorguardianis
informed of the problem and does not attempt
tointervene.
Failuretoenrollorothertruancyfailingto
homeschool,toregister,ortoenrollachildof
mandatoryschoolage,causingthechildtomiss
atleast1monthofschoolwithoutvalidreasons.
Inattention to special education needs
refusingtoalloworfailingtoobtainrecommended
remedial education services or neglecting to
obtainorfollowthroughwithtreatmentfora
childsdiagnosedlearningdisorderorotherspecial
educationneedwithoutreasonablecause.
31
NewbornsAddictedorExposedtoDrugs
As of 2005, 24 States had statutory provisions
requiring the reporting of substance-exposed
newbornstoCPS.
32
Womenwhousedrugsoralcohol
duringpregnancycanputtheirunbornchildrenat
riskformentalandphysicaldisabilities.Tenumber
ofchildrenprenatallyexposedtodrugsortoalcohol
eachyear is between 409,000 and 823,000.
33
One
studyshowedthatdrug-exposednewbornsconstitute
asmanyas72percentofthebabiesabandonedin
hospitals.
34
Anotherstudyfoundthat23percent
of children prenatally exposed to cocaine were later
abused or neglected, compared with 3 percent who
were not prenatally exposed.
35
To address the needs
ofthesechildren,theKeepingChildrenandFamilies

SafeActof2003(P.L.108-36,sec.114(b)(1)(B))
mandated that States include the following in their
CAPTAplans:
(ii)Policiesandprocedures(includingappropriate
referralstochildprotectionservicesystemsandfor
otherappropriateservices)toaddresstheneedsof
infantsbornandidentiedasbeingaectedbyillegal
substanceabuseorwithdrawalsymptomsresulting
fromprenataldrugexposure,includingarequirement
thathealthcareproviders involved inthe delivery or
careofsuchinfantsnotifythechildprotectiveservices
systemoftheoccurrenceofsuchconditionofsuch
infants,exceptthatsuchnoticationshallnotbe
construedto
(I)establishadenitionunderFederallawof
whatconstituteschildabuse;or
(II)requireprosecutionforanyillegalaction.
(iii)Tedevelopmentofaplanofsafecareforthe
infantbornandidentiedasbeingaectedbyillegal
substanceabuseorwithdrawalsymptoms;
(iv)Proceduresfortheimmediatescreening,risk
andsafetyassessment,andpromptinvestigation
ofsuchreports.
SIGNS OF POSSIBLE NEGLECT
Itcanbediculttoobserveasituationandtoknow
forcertainwhetherneglecthasoccurred.Behaviors
andattitudesindicatingthataparentorotheradult
caregivermaybeneglectfulincludeifheorshe:
Appearstobeindierenttothechild;
Seemsapatheticordepressed;
Behavesirrationallyorinabizarremanner;
Abusesalcoholordrugs;
Denies the existence of or blames the child for
thechildsproblemsinschoolorathome;
Sees the child as entirely bad, worthless, or
burdensome;
Looks to the child primarily for care, attention,
orsatisfactionofemotionalneeds.
36
Indicators of neglect are more likely to be visible in
theappearanceorbehaviorofthechild.Mandatory
reportersandconcernedindividualsshouldconsider
reportingpossibleneglectiftheynoticethatachild:
MethamphetamineUseandChildMaltreatment
Inadditiontotheproblemofprenataldruguse,theriseinmethamphetamineabusealsohashada
strongimpactonchildmaltreatment.U.S.AttorneyGeneralAlbertoGonzalesrecentlyproclaimedin
termsofdamagetochildrenandtooursociety,methisnowthemostdangerousdruginAmerica.
37
Childrenwhoseparentsusemethamphetamineareataparticularlyhighriskforabuseandneglect.
Methamphetamineisapowerfullyaddictivedrug,andindividualswhouseitcanexperienceserious
healthandpsychiatricconditions,includingmemoryloss,aggression,violence,psychoticbehavior,and
potentialcoronaryandneurologicaldamage.
38
Tedrugisrelativelyeasytomake,exposingmanychildren
ofmethamphetamineuserstotheadditionalrisksoflivinginornearamethamphetaminelab.In2003,
3,419childreneitherwereresidinginorvisitingamethamphetaminelabthatwasseized,and1,291
childrenwereexposedtotoxicchemicalsintheselabs.
39
Formoreinformationonthisepidemic,goto
http://www.whitehousedrugpolicy.gov/news/press05/meth_factsheet.

Wears soiled clothing or clothing that is
signicantlytoosmallorlargeorisofteninneed
ofrepair;
Seemsinadequatelydressedfortheweather;
Alwaysseemstobehungry;hoards,steals,orbegs
forfood;orcomestoschoolwithlittlefood;
Oftenappearslistlessandtiredwithlittleenergy;
Frequentlyreportscaringforyoungersiblings;
Demonstratespoorhygiene,smellsofurineor
feces,orhasdirtyordecayingteeth;
Seemsemaciatedorhasadistendedstomach
(indicativeofmalnutrition);
Hasunattendedmedicalordentalproblems,such
asinfectedsores;
Statesthatthereisnooneathometoprovide
care.
40
SCOPE OF THE PROBLEM
AccordingtotheNationalChildAbuseandNeglect
DataSystem(NCANDS),in2004,anestimatedthree
millionreferralsweremadetoCPS,representing5.5
millionchildren.Fromthispopulation,approximately
872,000 children were found to be victims of
maltreatment,and64.5percentofthesechildrenwere
neglected.Incomparison,18percentofmaltreated
childrenwerephysicallyabused,10percentwere
sexually abused, and 7 percent were psychologically
maltreated.Additionally,15percentofvictimswere
associatedwithothertypesofmaltreatment,suchas
abandonmentorcongenitaldrugaddiction.Achild
couldbeidentiedasavictimofmorethanonetype
ofmaltreatment.
41
From2000to2004,theratesofneglectwerenearly
stable.In2004,approximately7.4outofevery1,000
children in the general population were reported as
beingneglected.Medicalneglectislistedseparately,
but it also has experienced nearly stable rates,
uctuating between 0.5 children per 1,000 in 2000
and0.3children per1,000 in2004.
42
Exhibit2-1
showsthevictimizationratebymaltreatmenttype
from2000to2004.
However,accordingtotheTirdNationalIncidence
StudyofChildAbuseandNeglect(NIS-3),less
thanone-thirdofchildabuseandneglectcasesare
reportedtoCPS.
43
DatafromNIS-3showthat
theratesofchildneglectmaybeevenhigherthan
notedintheNCANDSdata,with13.1children
per1,000beingneglected.
44
Withinthecategory
ofneglect,physicalneglectwasthemostcommonly
occurringtypeandincludedabandonment;medical
neglect;inadequatenutrition,clothing,orhygiene;
andleavingayoungchildunattendedinamotor
vehicle.
45
Mandatory Reporters
Mandatoryreportersareindividualswhoarerequiredbylawtoreportcasesofsuspectedchildabuseor
neglect.Teycanfacecriminalandcivilliabilityfornotdoingso.Inapproximately18States,anyone
whosuspectschildabuseorneglectisconsideredamandatoryreporter.
46
InmostStates,mandatory
reportersarerequiredtomakeareportimmediatelyuponhavingsuspicionorknowledgeofanabusive
orneglectfulsituation.TisinitialreportmaybemadeorallytoeitherCPSoralawenforcementagency.
Examplesofindividualswhotypicallyarelistedasmandatoryreportersincludephysicians,socialworkers,
educators,mentalhealthprofessionals,childcareproviders,medicalexaminers,andpolice.EveryState
hasstatutesthatspecifyproceduresformandatoryreporterstofollowwhenmakingareportofchild
abuseorneglect.FormoreinformationaboutStatelawsregardingmandatoryreporters,seehttp://www.
childwelfare.gov/laws_policies/state/reporting.cfm.

Exhibit2-1
VictimizationRatesbyMaltreatmentType,20002004
47
2000 2001 2002 2003 2004
R
a
t
e

p
e
r

1
,
0
0
0

C
h
i
l
d
r
e
n

8.0
7.0
6.0
5.0
4.0
3.0
2.0
1.0
0.0
2.4
7.3
0.5
1.2
1.0
2.8
2.3
7.1
0.3
1.2
0.9
3.2
2.3
7.2
0.3
1.2
0.8
3.3
2.3
7.5
0.3
1.2
0.6
3.7
2.1
7.4
0.3
1.2
0.9
3.2
Physi cal Abuse Negl ect Medi cal Sexual Abuse Psychol ogi cal O ther Abuse
Negl ect Mal treatment
Maltreatment Type
SpotlightonChronicNeglect
Oneissueindeningchildneglectinvolvesconsiderationofincidentsofneglectversusapatternof
behaviorthatindicatesneglect.SusanJ.Zuravin,Ph.D.,attheUniversityofMarylandatBaltimore
SchoolofSocialWork,recommendsthatifsomebehaviorsoccurinachronicpattern,theyshouldbe
consideredneglectful.Examplesincludelackofsupervision,inadequatehygiene,andfailuretomeeta
childseducationalneeds.Tissuggeststhatratherthanfocusingonindividualincidentsthatmayor
maynotbeclassiedasneglectful,oneshouldlookatanaccumulationofincidentsthatmaytogether
constituteneglect.
InmostCPSsystems,however,thecriteriaforidentifyingneglectfocusonrecent,distinct,veriable
incidents.Dr.ZuravinnotesthatifCPSfocusesonlyontheimmediateallegationbeforethemandnot
thepatternreectedinmultiplereferrals,thenmanyneglectedchildrenwillcontinuetobeinappropriately
excludedfromtheCPSsystem.
48
Forexample,afamilyexhibitingapatternofbehaviorthatmay
constituteneglectmighthavefrequentCPSreportsofnothavingenoughfoodinthehomeorkeeping
olderchildrenhomefromschooltowatchyoungerchildren.However,sinceeachindividualreportmay
notbeconsideredneglect,thefamilymaynotreceivetheappropriatesupportorbeservedbytheCPS
system.Additionally,manydenitionsofneglectthataddresschronicitydonotidentifywhatitmeans
(e.g.,Whatdoesfrequentreportsofnothavingenoughfoodinthehomemean?Twiceperweek?Twice
permonth?).TismaypreventCPScaseworkersfromconsistentlyapplyingthechildmaltreatmentlaws
inthesecases.
OnestudyfoundthatmanychildrenwhohadbeenreferredtoCPSforneglectdidnotreceiveservices
becausetheircasesdidnotmeetthecriteriaforneglect.Itfound,however,thatallofthesechildrenhad,
infact,sueredseveredevelopmentalconsequences.Inrecognitionofthisissue,theMissouriDivision
ofFamilyServicesassignedoneofitsCPSstaasachronicneglectspecialistanddenedchronicneglect
asapersistentpatternoffamilyfunctioninginwhichthecaregiverhasnotsustainedand/ormetthe
basicneedsofthechildren,whichresultsinharmtothechild.
49
Tefocusherewasontheaccumulation
ofharm.CPSandcommunityagenciesarerecognizingtheimportanceofearlyinterventionand
serviceprovisiontosupportfamiliessothatneglectdoesnotbecomechronicorleadtoothernegative
consequences.
50
Formoreinformationonthistopic,seeActs of Omission: An Overview of Child Neglectat
http://www.childwelfare.gov/pubs/focus/acts.

Recurrence
Recurrenceofchildabuseandneglectremainsavery
seriousproblem.Ithasbeenshownthatsubsequent
referrals of maltreatment are most oftenfor neglect
(and, specically, lack of supervision), regardless
ofthetypeofmaltreatmentintheinitialreferral.
51
Tesendingshighlighttheneedtoscreenforneglect
andtoprovidepreventiveserviceswhereneeded,not
justforthosecasesinitiallyidentiedasneglect.
52
Itis
importanttoknowtheextenttowhichchildrenwho
havebeenincontactwithCPSarevictimsofrepeat
maltreatmentinordertoprotectthemandtoprevent
itsrecurrence.
53
Trough the Child and Family Services Reviews

(CFSRs),whicharearesults-oriented,comprehensive
monitoring system designed to assist States in
improvingoutcomesforthechildrenandfamiliesthey
serve,theChildrensBureausetanationalstandardfor
recurrenceofmaltreatment,whichismeasuredusing
NCANDSdata.TepercentofStatesthatmetthe
national standard increased from 29.4 percent of all
Statesin2000to42.2percentofStatesin2004.
54
(See
AppendixD,Neglect and the Child and Family Services
Reviews,formoreinformationonCFSRndings.)
One study on recurrence that followed families
for5yearsdenedrecurrenceasanyconrmed
reportofphysicalabuse, sexualabuse, or neglecton
any child in the family that occurred at least 1 day
followingtheindexincidentreportdate.
55
Ofthe
43 percent of families in the study that experienced
atleastoneincidentofrecurrenceofmaltreatment
within5yearsoftheoriginalincident,64percentof
themwereclassiedasneglect.Tisstudyalsofound
that52percentoffamilieswhoexperiencedrepeated
maltreatmenthadonlyonerecurrence.Tehighest
probabilityforrecurrencewaswithintherst30days
oftheoriginaloccurrenceofmaltreatment.
56
ChildNeglectFatalities
Anestimated1,490childrendiedfromabuseor
neglectin2004.Tisisarateof2.03deathsper
100,000children,whichiscomparabletotherateof
2.00per100,000childrenin2003.
57
Tedistinctionbetweenchildneglectfatalitiesand
childabusefatalitiesisthatdeathsfromneglectresult
fromafailuretoact,whereasdeathsfromabuseresult
fromaphysicalact.Fatalitiesduetochildneglect
mayoerlessobviouscluesastowhoisresponsible
andhowthedeathoccurredthanfatalitiesdueto
abuse.Deathsduetochildneglect,therefore,often
aremorediculttoinvestigateandprosecute.Tis
also causes diculty in determining the overall
numberoffatalitiesduetochildneglect.Infact,one
studyestimatedthat85percentofchildmaltreatment
fatalitiesarenotrecordedassuchondeathcerticates.
58
OtherstudiesconductedinColoradoandNorth
Carolina estimatedthat50to60percent ofdeaths
duetochildmaltreatmentwerenotrecordedand
thatchildneglectisthemostunder-recordedform
offatalmaltreatment.
59
Dieringdenitionsofchild
homicide, abuse, and neglect, as well as the lack of
thoroughinvestigationsintosomechildfatalities,also
mayberesponsibleforthisunderreporting.
Childneglectfatalitiesusuallyresultfrominadequate
supervision, chronic physical neglect, or medical
neglectandmayresultfromchronicinaction(e.g.,
malnourishment)orfromanacuteincident(e.g.,
anunsupervisedchilddrowninginapool).Te
childs home is the most common place for a child
neglectfatalitytooccur,andthebathroomisthemost
commonroominwhichthedeathoccurs.Often
these children die from drowning or from res that
occurwhiletheyareunsupervised.
60
Otherexamples
ofneglectfatalitiesincludedyingfromfallsfrom
unprotectedwindows,suocation,poisoning,and
notreceivingneededmedicalcare.
Exhibit2-2showsthetypeofmaltreatmentassociated
withchildfatalitiesin2004.
As these statistics in Exhibits 2-1 and 2-2 illustrate,
child neglect is the largest form both of child
maltreatmentandoffatalitiesduetomaltreatment.

Exhibit2-2
FatalitiesbyTypeofMaltreatment,2004
61
36.9
28.3
30.2
0.8
3.9
0% 5% 10% 15% 20% 25% 30% 35% 40%
M
a
l
t
r
e
a
t
m
e
n
t

T
y
p
e

Negl ect Onl y (i ncl udes Medi cal Negl ect Onl y)
Physi cal Abuse Onl y
Mul ti pl e Mal treatment Types
Sexual Abuse Onl y
Psychol ogi cal Mal treatment Onl y, Other Onl y, or
Unknown
Percentage

CHAPTER 3
Impact of Neglect
T
heimpactofneglectonachildmaynotbe
apparentatanearlystageexceptinthemost
extremecases.However,theeectsofneglectare
harmfulandpossiblylong-lastingforthevictims.Its
impactcanbecomemoresevereasachildgrowsolder
andcanencompassmultipleareas,including:
Healthandphysicaldevelopment;
Intellectualandcognitivedevelopment;
Emotionalandpsychologicaldevelopment;
Socialandbehavioraldevelopment.
Althoughtherearefourcategoriesofneglectseects
onanindividual,theyoftenarerelated.Forexample,
if a child experiences neglect that leads to a delayed
developmentofthebrain,thismayleadtocognitive
delaysorpsychologicalproblems,whichmaymanifest
associalandbehavioralproblems.Becauseneglected
childrenoftenexperiencemultipleconsequencesthat
maybetheresultofneglectandrelatedcircumstances
in their lives, it may be dicult to determine if the
impactisrelatedspecicallytotheneglect,iscaused
byanotherfactor,orarisesfromacombinationof
factors.Teimpactofneglectcanvarybasedon:
Techildsage;
Tepresenceandstrengthofprotectivefactors;
Te frequency, duration, and severity of the
neglect;
Te relationship between the child and
caregiver.
62
Te negative impacts of neglect are often associated
with the various outcomes children experience
inthechildwelfaresystem.Forexample,someof
thedevelopmentalandhealthproblemslinkedto
neglectarerelatedtohigherratesofplacementin
out-of-home care, a greater number of out-of-home
placements,longerout-of-homeplacements,anda
decreasedlikelihoodofchildrenresidingwiththeir
parentswhendischargedfromfostercare.
63
Research shows that the rst few years of childrens

livesarecrucialandsensitiveperiodsfordevelopment.
During these years, neural synapses are formed at a
very high rate. After the age of 3, synapses start to
bepruned,andcertainpathwaysthatarenotused
may be discarded. Studies supporting the idea of a
sensitivedevelopmentalperiodshowthatmaltreated
infantssuerfromgreaterdevelopmentaldisabilities
thanthosechildrenwhoweremaltreatedlaterin
childhood.
64
Oneexampleofthisistheabilityto
formattachmentswithonesprimarycaregiver.If
thisprocessisdisruptedearlyinchildrenslives,they
mayhavedicultyforminghealthyrelationships
throughout their lives. Although learning can
happenthroughoutlife,itoftenismoredicultfor
childrenwhoweredeprivedofcertaintypesofearly
stimulation.

Programs,suchasEarlyHeadStartandotherinfancy
and early childhood programs, acknowledge that
therstfewyearsoflifeareextremelysignicantfor
development.(FormoreinformationonEarlyHead
Start,seeChapter6,Child Neglect Prevention and
Intervention.) Child welfare laws and interventions,
however, often do not provide or authorize the
resources necessary to protect children from neglect
duringthesecriticalyears.Unlesschildrenshowclear
physicalsignsofneglect,interventionoftenisunlikely
tobemandated.Tus,formanycasesofemotional
neglect,andespeciallyforyoungchildrenwhocannot
tellothersabouttheneglect,interventionsmayoccur
toolateornotatall.Ifinterventionsnallyoccur,the
childrenmaybepastcriticaldevelopmentalpoints
andcouldsuer from decienciesthroughouttheir
lives.
65
Terefore, it is importantthat professionals
workingwithyoungchildrenbeabletorecognizethe
possiblesignsofneglectinordertointerveneandto
keepchildrenfromsueringfurtherharm.
HEALTH AND PHYSICAL DEVELOPMENT
Studiesshowthatneglectedchildrencanbeatriskfor
many physical problems, including failure to thrive,
severediaperrashandotherskininfections,recurrent
andpersistentminorinfections,malnourishment,and
impairedbraindevelopment.Becauseneglectincludes
medicalneglect,otherhealthproblemscanarisefrom
thefailureoftheparentstoobtainnecessarymedical
carefortheirchildren.Ifchildrendonotreceive
theproperimmunizations,prescribedmedications,
necessary surgeries, or other interventions, there
canbeseriousconsequences,suchasimpairedbrain
developmentorpoorphysicalhealth.Teimpactof
a delay in or lack of treatment might be noticeable
immediatelyormaynotbeapparentforseveral
weeks,months,orevenyears.
66
Forexample,achild
whodoesnotreceiveproperdentalcaremightbeall
right in the short term, but suer from tooth decay
andgumdiseaselaterinlife.Childrenwithdiabetes
maybenewithouttreatmentforashortwhile,but
anextendeddelayintreatmentcouldhaveserious
consequencesandpossiblyresultindeath.
ImpairedBrainDevelopment
Insomecases,childneglecthasbeenassociatedwith
afailureofthebraintoformproperly,whichcan
leadtoimpairedphysical,mental,andemotional
development.Tebrainofachildwhohasbeen
maltreatedmaydevelopinsuchawaythatitis
adaptiveforthechildsnegativeenvironment,butis
maladaptiveforfunctionalorpositiveenvironments.
A maltreated childs brain may adapt for day-to-day
survival,butmaynotallowthechildtodevelopfully
healthycognitiveandsocialskills.
67
Inonestudy,
neglectedchildrenhadthehighestproportionof
later diagnoses of mental retardation, which may be
duetonotgettingthenecessarycareandstimulation
forproperbraindevelopment.Childrenwhoare
neglectedearlyinlifemayremaininastateofhyper-
arousalinwhichtheyareconstantlyanticipating
threats,ortheymayexperiencedissociationwitha
decreasedabilitytobenetfromsocial,emotional,
andcognitiveexperiences.Tobeabletolearn,a
childsbrainneedstobeinastateofattentivecalm,
whichisrareformaltreatedchildren.Ifachildis
unabletolearnnewinformation,thismaycause
some areas of the brain to remain inactive, possibly
resultingindelayedorstuntedbraingrowth.Italso
can impair functioning later in life and may lead to
the child being anxious, acting overly aggressive, or
beingwithdrawn.
68
Children who have experienced global neglect,

denedasneglectinmorethanonecategory,may
have signicantly smaller brains than the norm.
Tiscouldbeindicativeoffewerneuronalpathways
availableforlearningandmayleadthechildrentobe
atanintellectualdisadvantagefortheirentirelives.
69
PoorPhysicalHealth
Tephysicalproblemsassociatedwithneglectmay
startevenbeforeaninfantisborn,suchaswhen
themotherhashadlittleornoprenatalcareor
smoked during pregnancy. Tese children may
be born prematurely and have complications at
birth. Neglected children also can have severe
22 Impact of Neglect

ImpactontheBrainofPrenatalExposuretoAlcoholandDrugs
Exposuretoalcoholanddrugsinuteromaycauseimpairedbraindevelopmentforthefetus.Studies
haveshownthatprenatalexposuretodrugsmayalterthedevelopmentofthecortex,reducethenumber
ofneuronsthatarecreated,andalterthewaychemicalmessengersfunction.Tismayleadtodiculties
withattention,memory,problemsolving,andabstractthinking.However,ndingsaremixedandmay
dependonwhatdrugisabused.Alcoholabusehasbeenfoundtohavesomeofthemostdetrimental
eectsoninfants,includingmentalretardationandneurologicaldecits.Oneproblemwithdetermining
theimpactofsubstanceabuseonafetusisisolatingwhetherthenegativeoutcomesaredirectlyassociated
withthealcoholordrugexposureorwithotherfactors,suchaspoorprenatalcareornutrition,premature
birth,oradverseenvironmentalconditionsafterbirth.
70
physicalinjuries,possiblyduetotheinattentionof
theirparents,suchascentralnervoussystemand
craniofacial injuries, fractures, and severe burns.
Teyalsomaybedirtyandunhygienic,leadingto
evenmorehealthproblems,suchasliceorinfections.
Childrenalsomaybeexposedtotoxinsthatcould
causeanemia,cancer,heartdisease,poorimmune
functioning, and asthma. For example, exposure to
indoorandoutdoorairpollutants,suchasozone,
particulatematter,andsulphurdioxide,cancausethe
development of asthma or increase the frequency or
severityofasthmaattacks.
71
Additionally,children
may have health problems due to a lack of medical
attention for injury or illness, including chronic
healthproblems.Neglectedchildrenmaysuerfrom
dehydrationordiarrheathatcanleadtomoresevere
problemsifunattended.
A medical condition associated with child neglect is
failuretothrive,whichcanbedenedaschildren
whose growth deviates signicantly from the norms
fortheirageandgender.
72
Tisconditiontypically
occursininfantsandtoddlersundertheageof2years.
Failuretothrivecanbemanifestedassignicant
growthdelays,aswellas:
Poormuscletone;
Unhappyorminimalfacialexpressions;
Decreasedvocalizations;
Generalunresponsiveness.
73
Failuretothrivecanbecausedbyorganicornonorganic
factors,butsomedoctorsmaynotmakesuchasharp
distinctionbecausephysicalandbehavioralcauses
oftenappeartogether.Withorganicfailuretothrive,
thechildsdelayedgrowthcanbeattributedtoa
physical cause, usually a condition that inhibits the
childsabilitytotakein,digest,orprocessfood.When
failure to thrive is a result of the parents neglectful
behavior,itisconsiderednonorganic.
Treatmentforfailuretothrivedependsonthecause
ofthedelayedgrowthanddevelopment,aswellas
thechildsage,overallhealth,andmedicalhistory.
For example, delayed growth due to nutritional
factorscanbeaddressedbyeducatingtheparents
onanappropriateandwell-balanceddietforthe
child. Additionally, parental attitudes and behavior
maycontributetoachildsproblemsandneedtobe
examined.Inmanycases,thechildmayneedtobe
hospitalizedinitiallytofocusonimplementationofa
comprehensivemedical,behavioral,andpsychosocial
treatmentplan.
74
Evenwithtreatment,failureto
thrive may have signicantlong-term consequences
forchildren,suchasgrowthretardation,diminished
cognitiveability,mentalretardation,socio-emotional
decits,andpoorimpulsecontrol.
75

ImpactofMalnutritiononChildren
Malnutrition,especiallyearlyinachildslife,hasbeenshowntoleadtostuntedbraingrowthandtoslower
passageofelectricalsignalsinthebrain.Malnutritionalsocanresultincognitive,social,andbehavioral
decits.
76
Irondeciency,themostcommonformofmalnutritionintheUnitedStates,canleadtothe
followingproblems:
Cognitiveandmotordelays;
Anxiety;
Depression;
Socialproblems;
Problemswithattention.
77
INTELLECTUAL AND COGNITIVE DEVELOPMENT

Researchshowsthatneglectedchildrenaremore
likely to have cognitive decits and severe academic
and developmental delays when compared with
non-neglectedchildren.Whenneglectedchildren
enter school, they may suer from both intellectual
and social disadvantages that cause them to become
frustrated and fall behind.
78
One study found that
individualsat28yearsofagewhosueredfrom
childhoodneglectscoredloweronIQandreading
abilitytests,whencontrollingforage,sex,race,and
socialclass,thanpeople whowere notneglected as
children.
79
Otherstudieshavefoundthat,although
bothabusedandneglectedchildrenexhibitedlanguage
delaysordisorders,theproblemsweremoresevere
for neglected children.
80
Furthermore, neglected
childrenhavethegreatestdelaysinexpressiveand
receptive language when compared with abused
andnonmaltreatedchildren.
81
Whencomparedto
physicallyabusedchildren,neglectedchildrenhave
academicdicultiesthataremoreseriousandshow
signsofgreatercognitiveandsocio-emotionaldelays
ImpactofNeglectonAcademicPerformance
Neglectcannegativelyaectachildsacademicperformance.Studieshavefoundthat:
Childrenplacedinout-of-homecarebecauseofabuseorneglecthavebelow-averagelevelsof
cognitivecapacity,languagedevelopment,andacademicachievement.
Neglectedchildrendemonstratedanotabledeclineinacademicperformanceuponenteringjunior
highschool.
ChildrenwhowerephysicallyneglectedwerefoundtohavesignicantlylowerIQscoresat24and
36monthsandthelowestscoresonstandardizedtestsofintellectualfunctioningandacademic
achievementinkindergartenwhencomparedwithchildrenwhohadexperiencedeitherno
maltreatmentorotherformsofmaltreatment.
Neglectedchildren,whencomparedwithnonmaltreatedchildren,scoredloweronmeasuresof
overallschoolperformanceandtestsoflanguage,reading,andmathskills.
Neglectedboys,butnotgirls,werefoundtohavelowerfull-scaleIQscoresthanphysicallyabused
andnonmaltreatedchildren.
82

atayoungerage.Teseacademicdicultiesmaylead
tomorereferralsforspecialeducationservices.
83
Terearealsolanguageproblemsassociatedwith
neglect. In order for babies to learn language, they
need to hear numerous repetitions of sounds before
theycanbeginmakingsoundsandeventuallysaying
wordsandsentences.Languagedevelopmentmay
be delayed if the parent or other caregiver does not
providethenecessaryverbalinteractionwiththe
child.
EMOTIONAL, PSYCHOSOCIAL, AND BEHAVIORAL
DEVELOPMENT
Neglectcanhaveastrongimpacton,andleadto
problemsin,achildsemotional,psychosocial,and
behavioraldevelopment.Aswithothereectsalready
mentioned, these may be evident immediately after
themaltreatmentornotmanifestthemselvesuntil
many months or years later. Exhibit 3-1 is a listing
ofemotional,psychosocial,andbehavioralproblems
associatedwithneglect.
EmotionalandPsychosocialConsequences
All types of neglect, and emotional neglect in
particular, can have serious psychosocial and
emotionalconsequencesforchildren.Someofthe
short-termemotionalimpactsofneglect,suchasfear,
isolation,andaninabilitytotrust,canleadtolifelong
emotionalandpsychologicalproblems,suchaslow
self-esteem.
84
Amajorcomponent of emotionaland psychosocial

developmentisattachment.Childrenwhohave
experiencedneglecthavebeenfoundtodemonstrate
higherfrequenciesofinsecure,anxious,andavoidant
attachments with their primary caregivers than
nonmaltreated children.
85
In fact, studies have
demonstratedthat70to 100 percentof maltreated
infants form insecure attachments with their
caregivers.
86
Often,emotionallyneglectedchildren
have learned from their relationships with their
primarycaregiversthattheywillnotbeabletohave
theirneedsmetbyothers.Tismaycauseachildnot
totrytosolicitwarmthorhelpfromothers.Tis
behavior may in turn cause teachers or peers not to
oerhelporsupport,thusreinforcingthenegative
expectationsoftheneglectedchild.
87
Onemitigating
factor, however, may be having an emotionally
supportiveadult,eitherwithinoroutsideofthe
family, such as a grandparent or a teacher, available
duringchildhood.Anothermitigatingfactormaybe
havingaloving,acceptingspouseorclosefriendlater
inlife.
88
Neglectedchildrenwhoareunabletoformsecure
attachmentswiththeirprimarycaregiversmay:
Become more mistrustful of others and may be
lesswillingtolearnfromadults.
Havedicultyunderstandingtheemotionsof
others,regulatingtheirownemotions,orforming
andmaintainingrelationshipswithothers.
Havealimitedabilitytofeelremorseorempathy,
whichmaymeanthattheycouldhurtothers
withoutfeelingtheiractionswerewrong.
Demonstratealackofcondenceorsocialskills
thatcouldhinderthemfrombeingsuccessfulin
school,work,andrelationships.
Demonstrateimpairedsocialcognition,which
isonesawarenessofoneselfinrelationtoothers
andanawarenessofothersemotions.Impaired
socialcognitioncanleadapersontoviewmany
socialinteractionsasstressful.
89

Exhibit3-1
NeglectandEmotional,Psychosocial,andBehavioralProblems
Neglectedchildren,evenwhenolder,maydisplayavarietyofemotional,psychosocial,andbehavioral
problemswhichmayvarydependingontheageofthechild.Someoftheseinclude:
Displayinganinabilitytocontrolemotionsorimpulses,usuallycharacterizedbyfrequentoutbursts;
Beingquietandsubmissive;
Havingdicultylearninginschoolandgettingalongwithsiblingsorclassmates;
Experiencingunusualeatingorsleepingbehaviors;
Attemptingtoprovokeghtsorsolicitsexualinteractions;
Actingsociallyoremotionallyinappropriatefortheirage;
Beingunresponsivetoaection;
Displayingapathy;
Beinglessexible,persistent,andenthusiasticthannon-neglectedchildren;
Demonstratinghelplessnessunderstress;
Havingfewerinteractionswithpeersthannon-neglectedchildren;
Displayingpoorcopingskills;
Actinghighlydependent;
Actinglethargicandlackluster;
Displayingself-abusivebehavior(e.g.,suicideattemptsorcuttingthemselves);
Exhibitingpanicordissociativedisorders,attention-decit/hyperactivitydisorder,orpost-traumatic
stressdisorder;
Sueringfromdepression,anxiety,orlowself-esteem;
Exhibitingjuveniledelinquentbehaviororengaginginadultcriminalactivities;
Engaginginsexualactivitiesleadingtoteenpregnancyorfatherhood;
Havinglowacademicachievement;
Abusingalcoholordrugs.
90

SocietalConsequences
Societypaysformanyoftheconsequencesofneglect.Terearelargemonetarycostsformaintaining
childwelfaresystems,judicialsystems,lawenforcement,specialeducationprograms,andphysicaland
mentalhealthsystemsthatareneededtorespondtoandtotreatvictimsofchildneglectandtheirfamilies.
Manyindirectsocietalconsequencesalsoexist,suchasincreasedjuveniledelinquency,adultcriminal
activity,mentalillness,substanceabuse,anddomesticviolence.Teremaybealossofproductivitydue
tounemploymentandunderemploymentassociatedwithneglect.Additionally,supportingchildrenwho
havedevelopmentaldelaysbecauseofmalnutritionoftenismuchmorecostlythanprovidingadequate
nutritionandcaretopoorwomenandchildren.
91
BehavioralConsequences
Neglected children may suer from particular
behavioral problems throughout life. Research
shows thatchildren whoare exposed topoorfamily
managementpracticesareatagreaterriskofdeveloping
conductdisordersandofparticipatingindelinquent
behavior.
92
Neglectedchildrenalsomaybeatrisk
forrepeatingtheneglectfulbehavior with their own
children.Researchalsoshowsthatneglectedchildren
donotnecessarilyperceivetheirupbringingtobe
abnormalordysfunctionalandmaymodeltheirown
parenting behavioronthebehavioroftheir parents.
Onestudyestimatesthatapproximatelyone-thirdof
neglectedchildrenwillmaltreattheirownchildren.
93
EarlyPreventionandIntervention
Teincidenceofneglectandtheharmitdoestochildrencanbereducedormitigatedthroughearly
preventionandinterventionprograms.Althoughtheeectivenessoftheseprogramshasnotbeenstudied
adequately,theyaremosteectivewhentheyarecomprehensiveandlong-term.
94
Withtheeectsof
neglectbeingespeciallydamagingduringinfancy,italsoisimportanttoworkwithfamiliesasearlyas
possibleevenbeforethebabyisborn.
95
Twopromisingearlypreventionandinterventionprograms
aretheOldsmodelandProjectSTEEP(StepsTowardEective,EnjoyableParenting).TeOldsmodel
utilizesintensivenursehomevisitingduringpregnancyandthroughage2ofthechild.Teprogramhad
positiveeectsonparentingattitudesandbehaviorandonreportsofchildmaltreatment.
96
ProjectSTEEP
includeshomevisitationandgroupsupportandeducationforexpectantmothersandseekstoenhance
mother-infantrelationships.Intheinitialimplementationofthisprogram,mothersintheexperimental
groupdemonstratedabetterunderstandingofchilddevelopment,betterlifemanagementskills,fewer
depressivesymptoms,fewerrepeatpregnancieswithin2yearsofthebirthoftheirbaby,andgreater
sensitivitytotheirchildscuesandsignals.
97

CHAPTER 4
Risk and
Protective Factors
N
eglectoccurstochildrenofallraces,socio-
economicclasses,religions,familystructures,
and communities. However, there are some factors
thatappeartomakechildrenmoreorlesslikelytobe
neglected.Havingoneormoreriskfactorsdoesnot
necessarilymeanthatachildwillbeneglected;families
andchildrenreacttopersonalandsocietalfactors
dierently.Buttheyarewarningsigns,nevertheless.
One or two major risk factors for neglect may have
littleeectonachildsdevelopment,buthaving
threeormoreriskfactorsexponentiallyincreasesthe
potential for developmental problems. Risk factors
maybecumulativesothatthemoreriskfactorsa
child or family is exposed to over the course of the
childsdevelopment,thegreaterthepotentialfor
problems to arise.
98
Te risk and protective factors
inachildorfamilyslifealsomayinteractwitheach
other.Exhibit4-1providesaconceptualmodelofthe
interplayofvariousriskandprotectivefactorsrelated
tochildneglect.
Aninstanceofpossibleneglectmayberelatedtoone
ormorecontributingfactors.Forexample,ifachildis
exposedtoleadpaintinthehome,theremaybemany
contributingfactorstotheneglect.Teparentmay
beunwillingorunabletomovetoahomewherelead
paint is not present, the landlord may be unwilling
toremovetheleadpaintfromthewalls,thecitymay
nothaveanadequateleadabatementprogram,orthe
communitymaynothaveplacedenoughemphasis
onmakingsurethatlow-incomehousingissafe.
99
Tecaseworkerwouldneedtoassessthesituationto
determineifthisisacaseofneglectbytheparent.
Child welfare professionalsand others who interact
regularlywithchildrenandfamiliesshouldbeableto
recognizeriskfactorssothattheycanidentifysituations
whereneglectislikelyanddeterminethemosteective
interventions.Tischapterhighlightsseveraltypesof
riskandprotectivefactorsenvironmental,family,
parentorcaregiver,andchildforneglect.
ENVIRONMENTAL FACTORS
Neglectfulfamiliesdonotexistinavacuum;numerous
environmentalfactorscancontributetochildneglect.
Some of these include poverty, community and
society characteristics, and access to social supports.
Tesefactorsmaybeinterrelated(e.g.,families who
arepooroftenliveinhigh-riskorunsafecommunities
orlacksocialsupports).
Poverty
Televelofchildwell-beinginaStateisstrongly
associatedwithitsrateofchildpoverty.
100
While
childpovertyhasdeclinedoverthepastdecade,it
currentlystandsat17.6percent.
101
Comparedto
othertypesofchildmaltreatment,neglectismore
directly associated with poverty.
102
Of course, most
poorpeopledonotneglectorotherwisemaltreattheir

Exhibit4-1
ConceptualModelofChildNeglect
103
30 Risk and Protective Factors

children,butpoverty,whencombinedwithother
riskfactors,suchassubstanceabuse,socialisolation,
nancialuncertainty,continualfamilychaos,ora
lack of available transportation and aordable child
carecanputachildatgreaterriskforneglect.
104
Anotherstudyfoundthatwithinaneconomically
disadvantagedsample,particularaspectsofpoverty
aremorestronglycorrelatedwithphysicalneglect
reportsthanothers.
105
Forexample,theperception
bythecaregiverofeconomichardshipwaspositively
correlatedwithchildneglect,evenmorethanactual
variationsinhouseholdincomes.Terefore,self-
reports of economic hardship may be an important
signal for engaging in interventions with families to
preventsubsequentneglect.Incontrast,employment
hadaninverserelationshiptoreportsofphysical
neglect.Nodierenceexistedbetweenincomegroups
forratesoffatalinjuryoremotionalneglect.
106
It is important to note that many poor families are

well adjusted and competent; they have healthy
marriagesanddonotexpresstheirstressinviolentor
otherwise hurtful ways. Many children who live in
povertyareabletoperformwellinschool,aresocially
well-adjusted,donotengageinillegalactivities,and
arenotpoorasadults.Tesechildrenmayhave
protective factors, such as aectionate parents, high
self-esteem,orarolemodel,thathelpthemtoachieve
thesepositiveoutcomes.
107
AsdiscussedinChapter2,Denition and Scope of

Neglect,manyStatesincludeanexceptionforpoverty
intheirdenitionsofneglect.Tereisusuallya
distinction between a caregivers inability to provide
theneededcarebasedonthelackofnancialresources
andacaregiversknowingreluctanceorrefusalto
providecare,eventhoughtheinitialeectonthe
childisthesame.
108
Forexample,afamilymaynotbe
abletoaordfoodfortheirchildren;therefore,their
childrensbasicnutritionalneedswillnotbemet.If
theparentsdonotknowaboutfoodassistance,they
wouldnotbeconsideredneglectful,butiftheyhave
beentoldaboutafoodassistanceprogramandfailed
touseit,theymaybeguiltyofneglect.
CommunityCharacteristics
Childrenwholiveindangerousneighborhoodshave
beenfoundtobeathigherriskforneglectthan
childreninsaferneighborhoods.Onestudysuggests
a relationship between unsafe or dangerous housing
conditionsandtheadequacyofchildrensphysical
needs being met in the areas of nutrition, clothing,
andpersonalhygiene.
109
Tesecommunitiesalsoare
associatedwithlesssocialcontactorsupport,whichis
anotherriskfactorforneglect.
110
Othercharacteristics
ofthesedistressedneighborhoodsincludehighlevels
oftruancy,lowacademicachievement,highjuvenile
arrestrates,andhighteenbirthrates.Whenstressful
livingconditionscontinueovertime,familiesinthese
neighborhoodsaremorelikelytobereportedtochild
protectiveservices(CPS)forchildneglect.
111
Childrenlivinginunsafeneighborhoodsmaybe
exposed to hazards in the neighborhood or in their
houseorapartmentthatmayleadtoincidentsof
neglect.
112
For example, if a family lives in a house
withleadpaintorinaneighborhoodwithahigh
prevalenceofdrugabuse,childrenmaybeexposed
to these hazards, leading to neglect allegations.
Conversely, children living in safe communities and
neighborhoods are less likely to be exposed to these
typesofhazardsandmaybemorelikelytohave
neighborsandothercommunitymemberswhoare
abletooerstructureandmonitoring.Furthermore,
communitieswithaordablechildcareandgood
publictransportationcancontributetotheability
ofparentsandothercaregiverstocarefortheir
children.
113
Neighborhoodorcommunityfactors
thatcanplayaroleinchildneglectinclude:
Teaccessibilityofhealthcare,socialservices,
andaordablechildcare;
Acceptance of violence or neglect in the
community;
Narrowlegaldenitionsofneglect(e.g.,lawsthat
donotincludechronicityofincidents);

Politicalorreligiousviewsthatdiscourageany
outsideinterventionwithfamilies,nomatterhow
detrimental the neglect may be on the children
(e.g.,cults,suchastheFamilyofGod,that
promote isolation from the community, remove
childrenfromtheirmothersatbirth,andprevent
anyvisiblemeansofsupport).
114
SocialSupport
Familieswithhealthysupportnetworkshavemore
accesstomodelsofsuitableparentalbehavior.In
addition,theyhavemorefriends,family,orneighbors
whomaybewillingtoactasalternativecaregiversor
toprovideadditionalsupportornurturancetoboth
theparentandthechild.Impoverishedcommunities
often lack positive informal and formal support
systemsforfamilies.
115
Socialsupportcantakemany
forms,including:
Emotionalsupport;
Tangiblesupport;
Decision-makingorproblem-solvingassistance;
Supportrelatedtoself-esteem;
Socialcompanionship.
116
Socialsupportisprovidedby:
Relatives;
Neighbors;
Friends;
Schools;
Employers;
Healthandmentalhealthserviceagencies;
Religiousinstitutions;
Recreationalprograms;
After-schoolprogramsandsports;
Othercommunitygroupsandorganizations.
117
Studiesonsocialisolationandchildneglecthave
comparedparentswhomaltreattheirchildrenwith
parentswhodonot.Tesestudiesfoundthatparents
whomaltreattheirchildren:
Reportmoreisolationandloneliness;
Reportlesssocialsupport;
Havesmallersocialnetworks;
Receivelesssocialandemotionalsupportfrom
theirsocialnetworks;
Havefewercontactswithothersintheirsocial
networks;
Perceive the support they receive as less positive
thannon-neglectingparents;
Maybemorelikelytodistrustavailablesocial
support;
May perceive, rightly or wrongly, that their
neighborhoods are less friendly and their
neighborslesshelpful.
118
Socialsupportisimportantnotonlyforparentsbut
alsoforchildren.Socialsupportsoerchildrenboth
emotionalandphysicalresourcesthatmayeither
protectthemfromneglectorhelpthemtoachieve
betteroutcomesiftheyhavebeenneglected.However,
childrenmaynotbeawareofsomeofthetherapeutic
aid, social services, or school supports that are
availabletothem withouttheassistance of someone
withintheirsocial network.Supportive adultsmay
be able to serve as substitute attachment gures if a
childsparentsorothercaretakersareunabletoll
thisrole.Researchshowsthatthepresenceofoneor
more positive and signicant individuals in a childs
lifemayactasabueragainstnegativeoutcomesdue
tochildabuseorneglect.Supportiveadultsmaybe
abletolookoutforchildrenandpossiblyprotect
themfromneglect.Forachildwhoisinanout-of-
homeplacement,apositiverelationshipwithafoster
parentmightserveasaprotectivefactor.
119

FAMILY FACTORS
Severalfamilycharacteristicsareassociatedwithhigher
ratesofneglect.Somelifesituations,suchasmarital
problems, domestic violence, single parenthood,
unemployment, and nancial stress, can increase
thelikelihoodthatneglectwilloccur.Although
thesecharacteristicsmaynotcausemaltreatment,
theyarepossibleriskfactorsforneglect.Some
familycharacteristicsthatmayleadtoneglectcan
becategorizedascommunicationandinteraction
patterns,familycomposition,domesticviolence,and
familystress.
CommunicationandInteractionPatterns
Characteristicsoffamiliesthataremorelikelyto
have positive outcomes include cohesion; emotional
supportforoneanother;andparentsorcaregivers
whoarewarm,involvedwiththeirchildren,andrm
andconsistentintheirdisciplinemethods.Families
thatsharesimilarbeliefs,rituals,orvaluesinsuch
mattersasnancialmanagementandtheuseofleisure
timealsoappeartooersomeprotection.Havinga
strongfamilialsenseofcultureandspiritualityalso
helps.
120
Inaddition,afathersinvolvement,support,
andconnectionwithhischildrenhavealsobeen
associatedwithmorepositivechildoutcomes.
121
Even
ifparentsarenotabletoprovideapositivefamily
environment,otherrelatives(suchasoldersiblingsor
grandparents)maybeabletostepinandprovidethis
forthechildren.
122
Neglectfulfamilies,however,oftenhaveproblems
communicating and interacting in positive or
appropriateways.Tesefamiliesaremorechaotic,
expressfewerpositiveemotions,andhavelessempathy
and openness. Additionally, they are more likely to
lackemotionalcloseness,negotiationskills,anda
willingness to take responsibility for their actions.
123
ReligiosityandSocialSupport
Involvementinfaithcommunitieshasbeenshowntohavemanypositiveeectsforfamilies.Families
withaccesstoahelpfulcommunityofpeoplereceivesignicantsocial,nancial,emotional,andphysical
support.Parentswhoareconnectedwithareligiouscommunitymayexperiencehigherlevelsofsocial
supportthemselvesandmayaordtheirchildrengreateropportunitiesforsuchsupportthandoparents
whodonotparticipate.Aconsistentempiricalndingisthatadultswhoarepartofareligiouscommunity
arelesssociallyisolatedthanareotheradults.
124
Suchsupportenhancescopingmechanismsandprovides
parentswithadierentperspectivewhichhelpsthemdealwithstressanddiculties.
125
Agrowingbodyof
researchhighlightstheroleofreligionandspiritualityinhelpingparentscopewithsickoremotionallyor
behaviorallydisturbedchildren.
126
Religiosityhasbeenfoundinseveralstudiestobepositivelycorrelatedwithfamilycohesivenessandless
incidenceofinterparentalconict.
127
Parentalreligiosityhasbeenlinkedtogreaterinvolvement,warmth
andpositivityinparent-childrelationships.
128
Religiousnessispositivelycorrelatedwithanauthoritative
parentingstyle,whichischaracterizedbygreaterrespect,warmthandaection,aswellasclearly-
communicatedandwell-denedrulesforchildren.
129
Additionally,manyreligionshaveproscriptions
againstexcessivedrugandalcoholuse.Eachofthesecharacteristicspromotesahealthyfamily
environment.
130
Formoreinformation,gototheWhiteHouseOceofFaith-BasedandCommunityInitiativesathttp://
www.whitehouse.gov/government/fbci/.

Inneglectfulfamilies,theremaybelessengagement
betweentheparentandthechildandmorenegative
interactionsthaninnon-neglectfulfamilies.Parents
whomaltreattheirchildrenoftenarelesssupportive,
aectionate,playful,orresponsivethanparentswho
donotmaltreattheirchildren.
131
FamilyComposition
Singleparenthoodisassociatedwithhigherincidences
ofneglect.Onestudyfoundthatbeinginasingle-
parent household increased the risk of child neglect
by87percent.
132
Manyfactorsmayaccountfor
this.Tereislesstimetoaccomplishthetasksof
thehousehold,includingmonitoringandspending
timewithchildrenandearningsucientmoney
whenthereisonlyoneparentorcaregiver.Single
parentsoftenhavetoworkoutsidethehome,which
mightmeantheyarenotalwaysavailabletosupervise
their children. Single-parent families are also more
likelytoliveinpovertythantwo-parenthouseholds.
Accordingtooneanalysisofthechildpovertyrateby
familytype,thepovertyratein2003was:
7.6 percent for children living with married
parents;
34.0percentforchildrenlivingwithasingle
parent;
21.5percentofchildrenlivingwithco-habiting
parents.
133
Ofcourse,neglectalsooccursinmarried,two-parent
households,especiallyifthereisahighlevelofmarital
discord.
134
Tepresenceoffathersinfamiliesoftenhasbeenleft
outoftheresearchonchildneglect.Tismaybe
becausefatherstypicallyarenotseenastheperson
primarily responsible for providing for the needs of
thechildren,orbecausemanymothersaresingle
parentsorprimarycaregiversoraretypicallymore
accessibletoresearchers.
135
However,researchon
fathersshowsthatthepresenceofapositivefather
orfatherguredecreasesthelikelihoodofneglectin
the home.
136
Having a father in the household not
only may provide children and the mother with an
additionalsourceofemotionalsupport,butitalso
mayprovidethefamilywithmoremoneyandother
resources. Comparedtotheirpeerslivingwithboth
parents,childreninsingle-parenthomeshad:
87 percent greater risk of being harmed by
physicalneglect;
165 percent greater risk of experiencing notable
physicalneglect;
74percentgreaterriskofsueringfromemotional
neglect;
120percentgreaterriskofexperiencingsome
typeofmaltreatmentoverall.
137
Formoreinformationontheroleoffathers,seeTe
Importance of Fathers in the Healthy Development
in Children at http://www.childwelfare.gov/
pubs/usermanual.cfm. For more information on
theDepartmentofHealthandHumanServices,
AdministrationforChildrenandFamilysHealthy
MarriageInitiative,visithttp://www.acf.hhs.gov/
healthymarriage/.
DomesticViolence
Children living in a home where domestic violence
ispresentareatagreaterriskofbeingneglected.
Onestudyfoundthatin35percentofneglectcases,
domestic violence had occurred in the home.
138
Caregiverswhoarevictimsofdomesticviolencemay
beabusedtothepointofbeingunableorunwilling
tokeeptheirabusersfromalsoabusingthechildren.
Tistypeofneglectisoftenreferredtoasfailureor
inability to protect the child from harm. In some
cases, abused caregivers are afraid to defend the
childrenintheircarebecausedoingsomightput
thecaregiversorchildrenslivesindangerorprovoke
more abuse. Whether or not caregivers are charged

EectsofWitnessingDomesticViolenceonChildren
Inmanyfamiliesaectedbydomesticviolence,theparentsbelievethattheirchildrenarenotwitnessing
theincidents,butreportsfromchildrenshowthatbetween80and90percentareawareoftheabuse
andcanprovidedetailedaccountsofit.
139
Childrenwhowitnessdomesticviolenceoftensuerharmful
consequences.Teextentoftheharmpossiblydependsuponthechildsage,developmentalstage,gender,
androleinthefamily.Someresearchsuggeststhatexposuretodomesticviolenceincreasesthelikelihood
thatchildrenwillengageindelinquentandcriminalbehaviorsasteenagersandadultsandwillhave
problemswithviolenceinfuturerelationships.
140
Otherstudies,however,donotshowthesenegative
eects.Withincreasingrecognitionoftheeectexposuretodomesticviolencecanhaveonchildren,
manyCPSagenciesconsideritaformofemotionalabuse.Formoreinformation,seeChild Protection in
Families Experiencing Domestic Violence athttp://www.childwelfare.gov/pubs/usermanual.cfm.
withfailureorinabilitytoprotectoftendependson
whether the caregivers knew or should have known
thattheirchildrenwerebeingabused.
141
Studiesshowthatin30to60percentofhomes
withidentiedcasesofdomesticviolenceorchild
maltreatment,itislikelythatbothtypesofabuse
exist.
142
Insomecommunities,childwelfareagencies
and domestic violence service providers have started
workingtogethertondwaystosupportbothadult
victims and their children.
143
An example of this is
Te Greenbook Demonstration Initiative.TeFamily
Violence Department of the National Council
of Juvenile and Family Court Judges convened
leadingfamilycourtjudgesandexpertsonchild
maltreatment and domestic violence. Tis, in
turn,ledtotheFederaldemonstrationinitiative,
ajointeortbetweenseveralagenciesintheU.S.
DepartmentofHealthandHumanServicesandthe
U.S.DepartmentofJustice.Preliminaryresultsfrom
thisprojectincludeincreasedroutinescreeningfor
domesticviolencebyCPScaseworkersandincreased
routinescreeningforchildmaltreatmentbydomestic
violenceserviceproviders.Additionalchangesin
CPSpoliciesandpracticesincludeincreasedinter-
agencycooperation,regulartrainingonthedynamics
ofdomesticviolence,andsharingresourceswith
domesticviolenceorganizations.
144
FamilyStress
Neglectfulfamiliesoftenhaveexperiencedstressful
life events due to nancial diculties, substance
abuse problems, housing problems, illness, or
other challenges. Families that are coping with
such problems may not have the time or emotional
capacity to provide for the basic needs of their
childrenortoparticipateininterventions.Neglectful
familiesoftenreportmoreday-to-daystressthannon-
neglectfulfamilies.Inaddition,particularlystressful
life events (such as the loss of a job or the death of
afamilymember)mayexacerbatecharacteristicsin
thefamily,suchashostility,anxiety,ordepression,
whichmayincreaselevelsoffamilyconictandchild
maltreatment.
145
Whenassessingafamily,itmaybehelpfulfora
CPSworkertoclassifystressesintothefollowing
categories:
Chronic environmental stressbackground
stressthatisbasedintheenvironmentandsocial
structure,includingdangeroushousing,indigent
neighborhoods,andchronicunemployment;
Lifeeventsstressfuleventsandlifetransitions,
includingajobloss,thedeathofalovedone,or
aneviction;
FormoreonTeGreenbookInitiative,goto
http://www.thegreenbook.info/init.htm.

StressandtheImmigrantCommunity
Stressalsomaybeaparticularlyrelevantproblemforimmigrants.Somecommonadditionalstressorsthey
faceinclude:
Languagediculties;
Separationfromfamilyandfriends;
Healthproblems;
Financialproblems;
Dicultyndingandkeepingajob;
Homesicknessandisolation;
Fearofdeportation;
Conictingculturalnormsforchild-rearing.
146
Dailyhasslesminorstressesthatarepresentin
day-to-day life, such as being stuck in trac or
problemsatwork;
Role strainstress caused by ones inability
to ll a particular role. For example, a stay-at-
homefathermayexperiencerolestrainduetothe
expectationsofmainstreamsocietythatfathers
mustalwaysparticipateintheworkforce.
147
PARENT OR CAREGIVER FACTORS

Some parental or caregiver characteristics associated
withchildneglectincludeproblematicchildhoods,
developmental histories, or personality factors;
physicalandmentalhealthproblems;substanceabuse
issues;andpoorparentingorproblem-solvingskills.
Aswithallriskfactors,thepresenceofoneormoreof
thesefactorsdoesnotmeanthataparentorcaregiver
willbeneglectful,butthesearecharacteristicsthatare
presentmoreofteninneglectfulparents.Assessment
ofthesefactorsisusefulfortargetingpreventionand
intervention services to address the challenges faced
byat-riskandneglectfulfamilies.Terolesand
characteristicsofthemotherandfathershouldbe
takenintoaccountwhendeterminingachildsrisk
forneglect.
ParentsChildhood,DevelopmentalHistory,
andPersonalityFactors
Tewayparentswererearedcangreatlyaecttheway
theyreartheirownchildren.Peoplewhodidnothave
theirneedsmetbyaparentwhentheywerechildren
may not know how to meet the needs of their own
children.Somestudieshavefoundthatneglectful
parentsaremorelikelytohavebeenmaltreatedas
children.
148
Neglectfulmotherswerethreetimes
morelikelytohavebeensexuallyabusedthanmothers
who do not neglect their children.
149
However, the
majorityofindividualswhoaremaltreatedaschildren
donotmaltreattheirownchildren.Inaddition,there
areindividualswhowerenotabusedorneglected
as children who maltreat their children. It remains
unclearwhysomepreviouslymaltreatedpeopleabuse
andneglecttheirchildrenwhileothersdonot.
150
Twootherchildhoodfactorsthathavebeenfoundto
beassociatedwithfutureneglectarerunningaway
fromhomeandhavingbeenplacedinfostercare,
whichusuallyindicateatroubledchildhoodthatcan
negativelyaectonesabilitytotakecareofonesown
children.
151
Growingupinunstable,hostile,non-
nurturinghomescanleadtounstablepersonalities
whenthechildrenbecomeadults,whichcanleadto

stressfulmarriagesandabusiveparentingpractices
withtheirownchildren.
152
Childrenalsomaybeatgreaterriskofharmiftheir
parentsarenotawareoftheneglect,denythatneglect
tookplace,downplaytheirroleintheneglect,orare
unwilling to do anything to make sure the neglect
doesnotrecur.Onestudyfoundthatthemost
commonresponsegivenbymothersforsupervisory
neglectwasthattherewasnothingwrongwiththeir
behavior.
153
expectthata4-yearoldchildcanbeleftalonefor
theeveningbecauseofunrealisticexpectationsof
thechildsabilities.Studiesalsohavefoundthat
parentswhoareinconsistentwithdisciplineoruse
harshorexcessivepunishmentcanbeatriskfor
neglectingtheirchildren.
157
As would beexpected,
having parents who are engaged with their children
andinvolvedintheiractivitiesandeducationactsasa
protectivefactor.
158
SubstanceAbuse
Some parental developmental and personality
characteristics that can be considered protective
factorsincludehavingsecureattachments,stable
relationshipswiththeirownparents,goodcoping
skills,socialcompetence,andreconciliationwiththeir
ownhistory(ifany)ofchildhoodmaltreatment.
154
Forexample,parentswhoweremaltreatedaschildren
maybelesslikelytomaltreattheirownchildrenifthey
are able to resolve their internal conicts and pain
related to their history of maltreatment and if they
haveahealthy,intact,supportive,andnonabusive
relationshipwiththeirparents.Maritalorparenting
programsmayprovideparentswithguidanceabout
challengestoexpectafterthebirthoftheirrstchild,
in rearing children, and in understanding common
genderdierencesinchildren.Teseclassesmayact
asprotectivefactorsbystrengtheningthefamilys
knowledgeandbonds.
155
ParentingandProblem-solvingSkills
Parentsneedtohavethecognitiveresourcesto
care adequately for a child. Tey also need certain
educationalabilities,suchas literacy,tobeableto
careproperlyfortheirchild(e.g.,toreadprescription
labelsontheirchildsmedication).Studieshave
foundlinksbetweenchildneglectandparentspoor
problem-solvingskills,poorparentingskills,and
inadequateknowledgeofchildhooddevelopment.
156
Parents whoareunawareofthedevelopmentaland
cognitive abilities of children at dierent ages may
have unrealistic expectations and be more likely to
neglecttheirchildren.Forexample,aparentmight
Reportedratesofsubstanceabusebymaltreating
parentsvary;neglect,however,hasthestrongest
associationwithsubstanceabuseamongallforms
ofmaltreatment.Onestudyfoundthatchildren
whoseparentsabusedalcoholandotherdrugswere
morethanfourtimesmorelikelytobeneglected
thanchildrenwhoseparentsdidnot.
159
According
toonestudyofCPScaseworkers,65percentof
maltreatedchildrenwhohadparentswithsubstance
abuseproblemsweremaltreatedwhiletheparentwas
intoxicated.Also,thesubstancemostlikelytobe
abusedbymaltreatingparentsisalcohol(aloneorin
combinationwithanillicitdrug).
160
Substanceabusealsomayberelatedtotherecurrence
of neglect. Studies have found that caregivers with
substance abuse problems are more likely to neglect
theirchildrencontinuallyandtobere-referredto
CPSthancaregiverswhodonotabusesubstances.
161
Substanceabusealsohasbeenlinkedwithasmanyas
twothirdsofchildmaltreatmentfatalities.
162
Tis strongrelationshipbetween parentalsubstance

abuseandneglectexistsbecausesubstanceabuse
impairs ones mental functioning and can aect
decision-making.Parentswhoareabusingsubstances
oftencannotmakeappropriatedecisions,suchas
preventingayoungchildfromgoingoutalonelateat
nightorsupervisingtheirchildrenadequately.Tey
alsooftenputtheirownneedsaheadoftheneedsof
thechild, suchasspending money ondrugsrather
thanonfoodforthechild.

Substanceabuseoftenco-occurswithotherproblems,
whichmakesitdiculttoassessitsimpactonchild
maltreatment. Parentalsubstanceabuse islikelyto
co-occurwiththefollowingproblemsthatalsoare
associatedwithchildmaltreatment:
Lackofknowledgeaboutchilddevelopment;
Poorproblem-solvingandsocialskills;
Lowmaternalaection;
Poorattachmentrelationships;
Poorattentiontotheneedsofaninfant;
Disinterestinspendingtimewithoneschildren;
Inconsistentdisciplinarypractices;
Socialisolation;
Mentalhealthproblems,especiallydepression;
Angertowardoralackofattentiontoones
children;
Dicultymaintainingemployment;
Engagementincriminalbehavior;
Failuretoprovideappropriatelyfortheneeds
oftheirchildren(clothing,food,medicalcare,
hygiene,andemotionalattention).
163
Becausesubstanceabuseoftenoccursalongwithmany
otherriskfactors,itmaybedicultforprofessionals
toprioritizewhichservicesshouldbeprovidedto
families;therefore,interventionprogramsforparents
who abuse substances should focus on multiple
factors.
For more information on substance abuse in
families, see Protecting Children in Families
with Substance Abuse Problems at http://www.
childwelfare.gov/pubs/usermanual.cfm.
MentalHealth
Certainmentalhealthproblemsinparentshavebeen
associatedwithchildneglect,althoughresearchresults
varyonthisconnection.Forexample,somestudies
havefoundthat,whencontrollingforsocialvariables
and substance abuse, neglect and depression are not
associated.
164
Otherstudieshaveshownalinkbetween
child neglect and serious or postpartum depression.
Forexample,motherssueringfrompostpartum
depressionarelessresponsiveandsensitivetoward
theirinfantsandmaybedisengagedorwithdrawn.
165
Ofcourse,numerousmentalillnessescanaectan
individualsabilitytocareforachildproperly.As
withanycondition,mentalillnessoccursalonga
continuumofseverity.
OtherParentalFactors
Otherparentalfactorsthatmaybeassociatedwith
childneglectinclude:
Age;
Education;
Gender;
Employment;
Criminalactivity;
PriorinvolvementwithCPS.
166
Researchonyoungparentshasfocusedmostlyon
teenage mothers. Low parental education may also
be associated with neglect, and young mothers may
belesslikelytoattainahighlevelofeducation,thus
limitingtheirworkprospectsandleadingtonancial
stress.Otherriskfactorsforneglectassociatedwith
young mothers include substance abuse, inadequate
knowledge of childhood development, and poor
parentingskills.
167
Because a lack of employment is related to so many

otherriskfactorsforchildneglect,itisnotsurprising
thatbothmaternalandpaternallackofemployment

areassociatedwithhigherratesofchildneglect.
Parentswhohavecommittedacrimealsomaybe
more likely to neglect their children.
168
Again, this
maybebecausecriminalactivityislinkedtoother
riskfactors,suchassubstanceabuseandpoverty.
ParentspriorinvolvementwithCPShasbeenlinked
tosubsequentreportsofneglect.Teseparentsmay
bediscouraged,lesslikelytothinkthattheirsituation
willchange,lesswillingtoreceiveservices,orless
motivatedtochange.However,familieswhohave
beeninvolvedwithCPSandhadpositiveexperiences
may be more motivated and open to receiving
services.
169
It is important that young parents, both
mothersandfathers,obtainthesupporttheyneedso
thattheycanadequatelyattendtotheneedsoftheir
children.
CHILD FACTORS
Anychildcanbethevictimofneglect,butsome
characteristics appear to be more highly represented
amongmaltreatedchildren,includingbeingunder
theageof3,havingcertainbehavioralproblems,and
havingspecialneeds.
Age
In2004,childrenfrombirthtoage3hadthehighest
rate of reported maltreatment (16.1 per 1,000
children).
170
Researchalsoshowsthatchildrenunder
the age of 3 are most at risk for neglect, with rates
decreasingastheageofthechildincreases.
171
TemperamentandBehavior
Achildstemperamentandbehaviormaybeassociated
with child neglect. Children with an irritable
temperamentandwhohavedicultybeingsoothed
may be more at risk for being neglected than other
children,sincehavingadiculttemperamentmay
straintheparent-childrelationship.Onestudyfound
thatadicultchildtemperament(asperceivedbythe
mother)wasspecicallyassociatedwithemotional
neglect.
172
Neglectedchildrenalsooftendemonstrateadistinct
setofbehaviorsincludingbeingpassive,nonassertive,
orwithdrawn.
173
Itisunclearwhetherchildrendevelop
thesebehaviorproblemsbecausetheyareneglected
or iftheyareneglectedbecausetheyhavebehavior
problems.Whenconsideringtherelationshipbetween
behaviorproblemsandneglect,aCPSworkershould
assess whether the neglected child actually has more
behaviorproblemsoriftheneglectfulparentmerely
believesthatthechildhasmorebehaviorproblems.
Behavior problems can be categorized as either
internalizingorexternalizing.Internalizingbehavior
isabehaviororafeelingthatisdirectedinward,such
asdepression.Suchchildrenmaybeoverlooked
becausetheyrarelyactout.Externalizingbehavior
is characterized by outward expressions of behaviors
and feelings that are easily observable, such as
being aggressive. Tese children often receive more
attentionthanthosewhointernalizebecausetheir
behavior is often disruptive to others.
174
Exhibit 4-
2listsindicatorsofinternalizingandexternalizing
behaviorproblems.
SpecialNeeds
While the link between children with special needs
andneglectisunclear,somestudieshavefoundhigher
ratesofchildabuseandneglectamongchildrenwith
disabilities.Onestudyfoundsuchchildrentobe
1.7timesmorelikelytobemaltreatedthanchildren
without disabilities.
175
Another study, however,
failed to nd increased levels of maltreatment
40
Exhibit4-2
InternalizedandExternalizedBehaviorProblems
Childrencanexhibitdicultiesorproblemsresultingfrommaltreatmentinavarietyofways,including
theirbehavior.Childrenmayfocustheirnegativefeelingsinternallyorexternally.Maltreatmentmay
causeinternalizedbehaviors,suchas:
Agitation;
Nightmares;
Avoidanceofcertainactivitiesorpeople;
Dicultyfallingasleeporstayingasleep;
Sleepingtoomuch;
Dicultyconcentrating;
Hypervigilance;
Irritability;
Becomingeasilyfatigued;
Poorappetiteorovereating;
Lowself-esteem;
Feelingsofhopelessness.
Teabovesymptoms,ifexperiencedpersistentlyorifmanyofthemareexperiencedallatonce,shouldbe
causeforconcern.Maltreatmentalsomaycauseexternalizedbehaviors,including:
Dicultypayingattention;
Notlisteningwhenspokento;
Dicultyorganizingtasksandactivities;
Beingeasilydistracted;
Beingforgetful;
Bedwetting;
Excessivetalking;
Dicultyawaitingtheirturn;
Bullyingorthreateningothers;
Beingphysicallycrueltopeopleoranimals;
Playingwithorstartingres;
Stealing;
Destroyingproperty.
Itisimportanttokeepthechildsageanddevelopmentallevelinmindwhenassessingachildforthese
symptoms.Forexample,bedwettingbya13-yearoldwouldcausemoreconcernthanbedwettingbya2-
yearold.Ifachildsinternalizedorexternalizedbehaviorsinterferewithhisnormalfunctioningorifhis
behaviorchangesdramatically,thenthechildshouldbereferredforfurtherassessment.
176
Risk and Protective Factors

amongasampleofchildrenwithmoderatetosevere
retardation.
177
Children with special needs, such as those with

physicalordevelopmentalchallenges,maybemoreat
riskformaltreatmentbecause:
Teir parents become overwhelmed with
tryingtotakecareofthemandmayrespond
withirritability,inconsistentcare,orpunitive
discipline;
Childrenmaybeunresponsiveorhavelimited
abilitytorespond,interact,orshowasmuch
aectionasparentsexpect,therebydisrupting
parent-childattachments;
Society tends to devalue individuals with
disabilities.
178
An alternate explanation for higher rates of

maltreatmentamongchildrenwithspecialneedsis
thatparentsofchildrenwithspecialneedshavemore
frequentcontactwithanarrayofprofessionalsand
thusmaybeundergreaterscrutiny.
179
Inanycase,these
parentsmayneedmoresupportandencouragement
tohelpthemprovidefortheneedsoftheirchildren.
Forchildrenwithspecialneeds,havingastrongand
secureattachmenttotheirprimarycaregivers,inturn,
maymoderatethenegativeeectsofthedisability
andprovideprotectionfromneglect.
180
OtherChildCharacteristics
Otherchildcharacteristicsassociatedwithneglect
include:
Beingbornprematurely,withalowbirthweight,
orwithbirthanomalies;
Beingexposedtotoxinsinutero;
Experiencingchildhoodtrauma;
Havinganantisocialpeergroup,suchasbeinga
gangmember.
181
Childrenwhoareprematureorhavelowbirthweights
maybeatriskforneglectbecausetheirparentsmaybe
confused,anxious,orfeelhelpless,whichmaymakeit
harderforthemtorelatetothebaby.Teseparents
alsomayhavefewerorlesspositiveinteractions
withtheinfant,restrictingtheformationofpositive
attachments.
182
Somechildcharacteristicsthatappeartobeprotective
factorsagainstneglectinclude:
Goodhealth;
Ahistoryofadequatedevelopment;
Above-averageintelligence;
Hobbiesandinterests;
Humor;
Apositiveself-concept;
Goodpeerrelationships;
Aneasytemperament;
Apositivedisposition;
Anactivecopingstyle;
Goodsocialskills;
An internal locus of control (believing ones
behaviorandlifeexperiencesaretheresultof
personaldecisionsandeorts);
Alackofself-blame;
A balance between seeking help and
autonomy.
183
Recentlytherehasbeenashifttowardastrengths-
basedfocuswithagreateremphasisonresilience
andprotectivefactorsandamovementawayfrom
focusing solely on risk factors, particularly for
preventing neglect and its recurrence. Te belief is
thatpreventionstrategiesaremosteectivewhenthey
involvebuildingupafamilysstrengths.However,
researchsuggeststhatsolelyfocusingonbuilding
upprotectivefactors,whilenotresolvingsomeof
theriskfactors,maynotbeaparticularlyeective
strategy.Interventionstrategiesshouldaddressboth
risk and protective factors to provide the most help
tofamilies.
184

Resilience
Resiliencecanbedenedastheabilitytothrive,mature,andincreasecompetenceinthefaceofadverse
circumstances.
185
Somechildrenwhoareneglectedareablenotonlytosurvivetheneglect,butalsoto
achievepositiveoutcomesdespiteit.Whatsetsthesechildrenapartmaybeagreaternumberofprotective
factorsrelatedtoeitherthemselves,theirparents,ortheirenvironment.Oneimportantndingfrom
researchisthatresiliencycanbedevelopedatanypointinlife.Forexample,teenagerswhoexhibit
learningorbehaviorproblemsmaybecomewell-functioning,productiveadultsbythetimetheyare
30.
186
Resilienceisthoughttostemfromordinaryhumanprocesses,suchasparenting,thinkingskills,
motivation,ritualsoffamilyandculture,andotherbasicsystemsthatfosterhumanadaptationand
development.Teseordinaryprocessesshouldberecognized,promoted,andsupportedsothattheywork
wellandcanhelpchildren.
187
Troughoutthischapter,manyprotectivefactorshavebeenmentioned.Tesefactorsmaynotonlymake
achildlesslikelytobeneglected,butalsomaymitigatetheeectsofneglectonachild.Teprobability
thataneglectedchildwillberesilientincreaseswhenthereareenoughprotectivefactorstocounteractrisk
factors.
188
Justassomeriskfactorsareassociatedwithoneanother(e.g.,povertyandlivinginanunsafe
neighborhood),thesameistrueofprotectivefactors.Forexample,beingpartofamentoringprogramor
havingparentswhosupportachildseducationmayleadtogreatereducationalachievementsforachild.
189

CHAPTER 5
Assessment of
Child Neglect
C
hildprotectiveservices(CPS)isresponsiblefor
receivingandevaluatingreportsofsuspected
childabuseandneglect,determiningifthereported
informationmeetsstatutoryandagencyguidelines
forchildmaltreatment,andjudgingtheurgency
with which the agency must respond to the report.
Inaddition,CPSprovidesthepublic,aswellas
individuals who report allegations of child abuse or
neglect(frequentlyreferredtoasreporters),with
information aboutState statutes, agency guidelines,
andtherolesandresponsibilitiesofCPS.
Afterreceivingareport,CPSconductsaninitial
assessmentorinvestigation,whichmayincludethe
following:
A determination of whether the report of child
maltreatmentissubstantiated.
Asafetyassessmenttodetermineifthechilds
immediatesafetyisaconcern.Ifitis,CPS
develops a safety plan with interventions to
ensurethechildsprotectionwhilekeepingthe
childwithinthefamilyorwithfamilymembers
(e.g.,kinshipcareorsubsidizedguardianship),if
atallpossibleandappropriate.
Ariskassessmenttodetermineifthereisariskof
futuremaltreatmentandthelevelofthatrisk.
Aserviceorcaseplan,ifcontinuingagency
services,isneededtoaddressanyeectsofchild
maltreatmentandtoreducetheriskoffuture
maltreatment.
190
Duringtheinitialassessmentorinvestigation,CPS
mustdeterminewhetherchildabuseorneglectoccurred
andcanbesubstantiatedandwhethertoconduct
an evaluationto determine the risk ofmaltreatment
occurring in the future. Te initial assessment
identiestheriskandsafetyfactorsofconcerninthe
family.Tefamilyassessment:
Considerstherelationshipbetweenthestrengths
andtherisks;
Identieswhatmustchangeinorderto:
Keepchildrensafe;
Reducetheriskof(future)neglect;
Increasepermanency;
Enhancechildandfamilywell-being.
Consequently, while the initial assessment identies
problems, the family assessment promotes an
understandingoftheproblemsandbecomesthe
basisforthepreventionandintervention,orthe
caseplan.
191
Exhibit5-1presentsanoverviewofthe
typicalCPSprocess.

Exhibit5-1
OverviewofChildProtectiveServicesProcess
44 Assessment of Child Neglect

FRAMEWORK FOR PRACTICE
Practitionersgenerallyagreethatastrengths-based,
child-centered, family-focused, and culturally
responsive framework for prevention, assessment,
andinterventionofchildneglectandotherforms
ofmaltreatmentwillpromotethebestoutcomesfor
children and families.
192
Tis integrative framework
forpracticebuildsuponvemainperspectives:
Anecologicalperspective,whichconceptualizes
humanbehaviorandsocialfunctioningwithin
anenvironmentalcontext.Individual,family,
community,societal,andculturalfactorsinteract
to inuence how people behave. Child neglect
andotherformsofmaltreatmentareviewed
astheconsequenceoftheinterplaybetweena
complexsetofriskandprotectivefactorsateach
oftheselevels.
Astrengths-basedperspective,whichrefersto
practice methods and strategies that draw upon
thebalanceofstrengthsandtheneedsofchildren,
families, and communities. Strengths-based
practiceinvolvesashiftfromadecitapproach,
whichemphasizes problems, to a more positive
partnershipwiththefamily.Teassessment
focusesonthestrengthsrelatedtoindividual
familymembers,thefamilyasaunit,andthe
broaderneighborhoodandenvironment.
Adevelopmentalperspective,whichrefersto
understandinganindividualsandfamilysgrowth
anddevelopmentfromalifespanperspective.It
examines individuals and families interacting
withtheirenvironmentsoverthecourseoftime
andtailorsinterventionsbasedonthespecic
developmental needs of each child and the
family.
A permanency planning orientation, which
holdsthatallchildrenhavearighttoapermanent
home.Practitionersfocusonsafelymaintaining
childrenintheirownhomeswhenpossibleor,if
necessary, placing them permanently with other
families.Interventionsincludeasetofgoal-
directed activities designed to help children live
insafefamilieswhooerasenseofbelongingand
legal,lifetimefamilyties.
A culturally competent perspective, which
requires practitioners to understand the
perspectiveofclientsorpeerswhomaycome
from culturally diverse backgrounds and to
adapttheirpracticeaccordingly.Basiccultural
competence is achieved when organizations
and practitioners accept and respect dierences,
engageinanongoingculturalself-assessment,
expandtheirdiversityknowledgeandskills,and
adaptservicemodelstotthetargetpopulations,
culture,situation,andperceivedneeds.
193
Teintegrationoftheseperspectivesprovidesastrong
frameworkforacomprehensiveassessmentofthe
presenceandseverityofneglectinfamilieswhocome
totheattentionofthechildwelfaresystem.
INTAKE
Whenareferralismadeto CPS,adecision is made
whetheritshouldbescreenedinorscreenedout
forinvestigationorassessment.Foracasetobe
screenedin,thereusuallyhastobeaspecicallegation
ofmaltreatmentoranimminentthreatordangerto
thechild.Casesthatarescreenedinthenreceive
an initial assessment or investigation. Families may
be referred to CPS multiple times without having a
referralscreenedinbecauseeachincidentinquestion
maynotmeettheStateorlocalstandardsforneglect
thatareusedbytheparticularCPSagency.Incases
ofneglectwherenoactualinjuryoccurred,itoftenis
dicultforaCPScaseworkertodetermineifachild
is atrisk ofbeing harmedor howgreat theriskis;
therefore,thesecasesmaybescreenedout.
194
Many CPS agencies only screen in the most serious

cases.Consequently,casesinwhichitisreportedthat
achildmaybeatriskforneglect(e.g.,achildlivingin
adirtyhousewithuseddrugneedlesontheoor),but
actuallyhasnotbeenharmed,maygouninvestigated.

ProvidingServicestoAt-riskFamilieswithUnsubstantiatedCases
SomeStateshavefoundcreativewaystoprovideservicestofamilieswithunsubstantiatedcasesof
maltreatment.Tefollowingareafewexamples:
Createathirddispositionalcategory.SomeStatesoerathirdcategoryforcasesinadditionto
substantiatedandunsubstantiated,suchasinconclusiveorunabletodetermine.Tisallowsat-risk
familiestoreceivesomesupportiveservicesthattheymightnothaveaccesstootherwise.
Employanalternativeresponsemodel.Inthesemodels,whicharesometimescalleddualtrack,
multipleresponse,orexibleresponsemodels,casesaredividedintolow-riskandhigh-riskcategories
duringintake.Casesthatarelow-riskfollowaservice-orientedtrack,whilecasesthatarehigh-riskfollow
theregularinvestigativetrack.Agencystathencanfocusmostoftheirtimeoninvestigatinghigh-risk
cases,andvoluntaryservicescanbeoeredtolow-riskcases.
Usevolunteers.Inmanycasesthataredeemedlow-risk,well-trainedvolunteerscouldadequatelyprovide
servicestofamilies.Anadditionalbenetofusingvolunteersisthattheymayseemlessthreateningor
stigmatizingthanCPScaseworkers.Althoughtrainingandresourcesforvolunteersmaybecostlyatrst,
theuseofvolunteersoftenprovestobecost-eectiveinthelongrun.
195
Unfortunately,somechildrenandfamilieswhocould
benetfromservicesarenotreceivingthemeitherdue
tobeingscreenedoutortohavinganunsubstantiated
case.Inaddition,familieswhohaveunsubstantiated
incidences of neglect and do not receive services are
likelytobereferredlaterforincidencesthataremore
serious.Receivingevenoneformofservicemay
reduce the likelihood that a neglectful family would
be re-referred. For the safety and well-being of the
child,itwouldbemorebenecialforthesefamiliesto
receiveservicestopreventneglectfromoccurring.
196
INITIAL ASSESSMENT OR INVESTIGATION

Determiningwhetherchildneglecthasoccurredis
basedontheanswerstotwoprimaryquestions:Do
theconditionsorcircumstancesindicatethatachilds
basicneedsareunmet?andWhatharmorthreatof
harmmayhaveresulted?Answeringthesequestions
requiressucientinformationtoassessthedegreeto
which omissions in care have resulted in signicant
harm or signicant risk of harm. CPS caseworkers
alsomustmaketheirdeterminationofwhetherneglect
hasoccurredbasedonStateorlocalstatutes.Unlike
theotherformsofmaltreatment,thisdetermination
may not be reached by examining one incident; the
decisionoftenrequiresconsideringpatternsofcare
over time. Te analysis should focus on examining
howthechildsbasicneedsaremetandonidentifying
situationsthatmayindicatespecicomissionsincare
thathaveresultedinharmortheriskofharmtothe
child.
197
Communityserviceprovidersandothersintheeld
haveexpressedconcernthatCPSagenciesscreenout
many neglect cases during investigations because
circumstanceshavenotyetmettheCPSthresholdfor
neglect.Bythetimethesefamiliesatriskforneglect
areservedbyCPS,theyoftenhaveacuteandchronic
needsthatrequirelong-terminterventionandaremore
likelytoexperiencerecurrencesofchildmaltreatment
thanabusivefamilies.
198
Teseconditionspointto
theneedforeectivewaystotargetandserveat-
riskfamiliesassoonastheyareidentiedwithrisks
that could lead to child neglect. When conducting
aninitialassessmentorinvestigation,acaseworker
shouldnotewhetherachildhasunmetphysicaland
medicalneedsandifthereisalackofsupervision.

UnmetPhysicalandMedicalNeeds
Armativeanswerstoanyofthefollowingquestions
mayindicatethatachildsphysicalormedicalneeds
possiblyareunmet:
Havetheparentsorcaregiversfailedtoprovidethe
childwithneededcareforaphysicalinjury,acute
illness,physicaldisability,orchroniccondition?
Have the parents or caregivers failed to provide
thechildwithregularandamplemealsthatmeet
basicnutritionalrequirementsorhavetheparents
or caregivers failed to provide the necessary
rehabilitativediettoachildwithparticularhealth
problems?
Havetheparentsorcaregiversfailedtoattend
to the cleanliness of the childs hair, skin, teeth,
andclothes?Itisdiculttodeterminethe
dierencebetweenmarginalhygieneandneglect.
Caseworkers should consider the chronicity,
extent,andnatureofthecondition,aswellasthe
impactonthechild.
Doesthechildhaveinappropriateclothingfor
theweather?Caseworkersshouldconsiderthe
natureandextentoftheconditionsandthe
potentialconsequencesto thechild.Teyalso
musttakeintoaccountdiverseculturalvalues
regardingclothing.
Doesthehomehaveobviouslyhazardousphysical
conditions(exposedwiringoreasilyaccessible
toxicsubstances)orunsanitaryconditions(feces-
ortrash-coveredooringorfurniture)?
Does the child experience unstable living
conditions (frequent changes of residence or
evictionsduetothecaretakersmentalillness,
substanceabuse,orextremepoverty)?
Dotheparentsorcaregiversfailtoarrangefora
safesubstitutecaregiverforthechild?
Havetheparentsorcaregiversabandonedthe
child without arranging for reasonable care and
supervision?
199
Home accidents pose a signicant risk to young
children and often occur because of a lack of
supervision.Morethan90percentofallfatalitiesand
injuriesto children younger than 5 yearsof agecan
be attributed to accidents within the home.
200
Since
almost all accidents are preventable, an evaluation of
hazardoushomeconditionsisessentialtoensurea
safe environment for children. Te Home Accident
PreventionInventoryisausefultoolforahousehold
safetyassessment.Insituationswhereanoccurrenceis
clearlydeterminedtobeanaccident,involvementwith
CPSisminimalornonexistent.Resourcesinmost
communitiescanhelpthesefamilies.Aparenting
class,informationalpamphlet,instructionalvideo,and
other educational materials can help parents identify
andremovehazardsorplacethemoutofreach.
201
Exhibit5-2listscommonhomeaccidenthazards.
Practitionersshouldbasetheirassessmentsonrelevant
theoryandresearchandconsiderpossibleunderlying
causesofinadequatecare.Whatwouldexplainavery
dirtyhouse?Istheparentinpoorphysicalhealth?Is
heorsheoverwhelmedbytoomanyyoungchildren?
Is the parent depressed and unable to respond,
uncertain about what is needed, or resentful toward
the child? Assessing the detailed circumstances and
behaviorswithinthewidestpossiblecontextwillhelp
ensureasuccessfulinterventionplan.
202
LackofSupervision
WhileStatestatutesvary,mostCPSprofessionals
agree that children underthe ageof 8 whoare left
alonefor anysubstantialamountoftimearebeing
neglected.
203
Indeterminingwhetherneglecthas
occurred,thefollowingissuesshouldbeconsidered:
Te childs age, physical condition, mental
abilities, coping capacity, maturity, competence,
knowledge regarding how to respond to an
emergency,andfeelingsaboutbeingalone.

Exhibit5-2
TeHomeAccidentPreventionInventory
204
PoisonbySolidsandLiquids
Medicines
Detergentsandcleaners
Polishesandwaxes
Alcoholicbeverages
Beautyproducts
Insecticidesandpesticides
Paintsandstains
Solventsandthinners
Gluesandadhesives
Petroleumproducts
Fertilizersandherbicides
Poisonoushouseplants
FireandElectricalHazards
Combustibles
Fireplaceswithoutscreens
Outletsorswitches(withoutplates)
SuocationbyObjects
Plasticbags
Criborblindcords
Ingestiblesmallobjects
SharpandDangerousObjects
Firearms
Kitchenknivesandutensils
FallingHazards
Balconies
Steps
Windows
DrowningHazards
Bathtubsandsinks
Buckets
Pools
Tetypeanddegreeofindirectadultsupervision.
Forexample,isthereanadultwhoisregularly
checkinginonthechild?
Telengthoftimeandfrequencywithwhichthe
childisleftalone.Isthechildbeingleftaloneall
day,everyday?Isheorsheleftaloneallnight?
Te safety of the childs environment,
neighborhood,andhome.
205
DistinguishingRiskandSafetyAssessments
Assessingriskdiersfromassessingsafety.Arisk
assessment isthecollectionofinformationtodetermine
the degree to which a child is likely to be abused or
neglectedinthefuture.Asafety assessment involvesthe
identicationandevaluationoftheimminentriskof
harmregardingthespecicvulnerabilityofachild.
206
Dependingonwheretheyfallonacontinuumof
severityandchronicity,factorsaretypicallyrelevant
tobothriskandsafetyassessments.Caseworkers
shouldworkwithfamiliestodevelopaneectiveand
accomplishablesafetyplan.Tisisusuallyanin-home
orout-of-homeservicestrategycreatedaftertheinitial
assessment or investigation that specically addresses
andmanagesriskofharm.
207
Inaddition,riskand
safetyassessmentsshouldbeongoingthroughoutthe
lifeofthecase,notjustduringtheinitialassessment.
Exhibit5-3listssomeofthetypesofinformation
collectedinriskandsafetyassessments.

Exhibit5-3
RiskandSafetyAssessmentInformation
208
NeglectandOtherMaltreatment Child
Caregiveractionsandbehaviorsresponsiblefor
theneglect
Durationandfrequencyoftheneglect
(chronicityofneglect)
Physicalandemotionalmanifestationsinthe
child(severityofneglect)
Caregiversattitudetowardthechilds
conditionandtheassessmentprocess
Caregiversexplanationoftheeventsand
eectsofthemaltreatment
Developmentallevel
Physicalandpsychologicalhealth
Currentfunctioning
Childsexplanationofeventsandeects,if
possibleandappropriate
FamilyFunctioning ParentsandCaregivers
Powerandissuesofcontrolwithinthefamily
Interactionsandconnectionswithothersoutside
thefamily
Qualityofrelationships
Problem-solvingability
Currentfunctioning
Relationshipsoutsidethehome
Financialsituation
FAMILY ASSESSMENT PROCESS

Tefamilyassessmentisacomprehensiveprocessfor
identifying,considering,andweighingfactorsthat
aectthechildssafety,permanency,andwell-being.
It is designed to gain a greater understanding about
thestrengths,needs,andresourcesofthefamily.Te
assessmentshouldbeconductedinpartnershipwith
thefamilytohelpparentsorcaregiversrecognize
and remedy conditions so that children can be safe
andtheriskofneglectcanbereduced.Family
assessmentsmustbeindividualizedandtailoredto
theuniquestrengthsandneedsofeachfamily.When
possibleandappropriate,thisassessmentalsoshould
be undertaken through family decision-making
meetingsandothermeansdesignedtoinvolvethe
extendedfamilyandsupportnetwork.
209
ConducttheInitialAssessment
Intheinitialinformation-gatheringpartoftheprocess,
thecaseworkershouldaskthefollowingquestionsto
informtheassessment:
Whataretheriskfactorsandtheneedsofthe
familythataectsafety,permanency,andwell-
being?
Whataretheresultsofneglectthataectsafety,
permanency,andwell-being?
Whataretheindividualandfamilystrengths?

Whatdothefamilymembersperceiveastheir
needsandstrengths?
Whatmustchangeinorderfortheeectsof
neglecttobeaddressedandtheriskofneglectand
othermaltreatmenttobereducedoreliminated?
Whatistheparentorcaregiverslevelofreadiness,
motivation,andcapacityforchangetoensure
safety,permanency,andfamilywell-being?
210
CPS caseworkers need sensitive interviewing and

analytic skills to engage the family in a partnership,
togatherandorganizetheinformation,toanalyze
andinterpretthemeaningoftheinformation,andto
draw accurate conclusions based on the assessment.
Toaccomplishthepurposesofthefamilyassessment,
caseworkersshould:
Reviewtheinitialassessmentorinvestigation
information;
Begintodevelopafamilyassessmentplan;
Conductthefamilyassessmentbyinterviewingall
membersofthehouseholdandotherindividuals
the family identies as having an interest in the
safetyandwell-beingofthechild;
Consultwithotherprofessionalsasappropriate;
Developasafetyplan,ifnecessary;
Analyzeinformationandmakedecisions.
211
ReviewtheInitialAssessmentorInvestigation
Information
Basedontheinformationobtainedintheinitial
assessmentorinvestigation,thecaseworkershould
develop a list of issues to address during the family
assessment process. Te following questions are
examplesofareasthatthecaseworkertypicallywill
wanttoexamine:
Whatwasthenatureoftheneglect(type,severity,
chronicity)?
What was the familys understanding of the
neglect?
Whichriskfactorsidentiedduringtheinitial
assessmentorinvestigationaremostinuential?
What is the childs current living situation with
regardtosafetyandstability?
Wasasafetyplandeveloped?Whathasbeenthe
familysresponsetothisplan?
Whatiscurrentlyknownabouttheparentor
caregivers history? Are there clues that suggest
that further information about the past will
helpexplaintheparentorcaregiverscurrent
functioning?
Whatisknownaboutthefamilyssocialsupport
network?Whoelseissupportingthefamily?
Whowillbeavailableonanongoingbasisforthe
familytorelyon?Whatweaklinkagesmightbe
strengthenedtooermoresupport?
Are there any behavioral symptoms observed in
thechild?Howhasthechildfunctionedinschool
and in social relationships? Who else may have
informationaboutanybehavioraloremotional
concerns?
Haveproblemsbeenidentiedthatmayneed
further examination or evaluation (drug or
alcoholproblems,domesticviolence,psychiatric
orpsychologicalproblems,healthneeds)?
Whatadditionalinformationaboutthefamily
willhelpprovideanunderstandingoftherisk
andprotectivefactorsrelatedtothepotentialof
continuedneglect?
212
DevelopaFamilyAssessmentPlan
Basedontheareasidentiedthroughthereview,
the caseworkershouldconsiderthefollowing when
developingaplanforhowthefamilyassessment
processwilloccur:

Whenwilltherstmeetingbeheldwiththe
family?
Howoftenwillmeetingswiththefamilyoccur?
Wherewillmeetingsbeheld?
Willtheservicesofotherprofessionalsbeneeded
(for psychological tests or alcohol or other drug
abuseassessments)?
Whowillbeinvolvedineachmeeting?Arethere
otherpersons(friends,extendedfamily,other
professionals) who have critical information
abouttheneedsofthisfamily?Howwilltheybe
involvedintheprocess?
What reports may be available to provide
informationaboutaparticularfamilymemberor
thefamilyasasystem(fromschoolorhealthcare
providers)?
Whenwilltheinformationbeanalyzedanda
familyassessmentsummarycompleted?
How will the caseworker share this information
withthefamily?
213
ConducttheFamilyAssessment
Oncetheplanfortheassessmenthasbeenestablished,
thecaseworkerconductsinterviewswiththechild
andfamilytodeterminetheirtreatmentneeds.Tree
typesofmeetingsareusuallyheld:
Meeting with the family. If possible, and if it
issafeforallfamilymembers,thecaseworker
should:
Meetwiththeentirefamilyinanintroductory
sessiontobeginthefamilyassessment;
Attempt to gain an initial understanding of
thefamilysperceptionofitscurrentsituation
andoftheagency;
Bespecicwiththefamilyaboutthepurposes
ofthefamilyassessment;
Addressmutuallyidentiedproblemsthat
increasetheriskoffuturechildneglect.
Togainabetterunderstandingoffamilydynamics,
at least one assessment meeting beyond the
introductorysessionshouldbeconductedwith
theentirefamilytoobserveandassesstheirroles
andinteractions.
Meetings with individual family members.
Meetings with individual family members,
includingthechildren,shouldbeheld,ifpossible.
Tey are not interrogations; the caseworker
is trying to understand the person and the
situationbetter.Tecaseworkershouldattempt
toobtainfamilymembersperceptionsabout
family strengths and how they can be enhanced
toreducetheriskofneglect.Ininterviewswith
the children, the emphasis will likely be on
understandingmoreaboutanyeectsofneglect.
Ininterviewswiththeparents,theemphasisison
tryingtouncoverthecausesforthebehaviorsand
conditionsthatpresentrisk,aswellastoobtain
theparentsperceptionsoftheirproblems.
Meetingwiththeparentsorcaregivers.When
workingwithfamilieswithmorethanoneadult
caregiver,thecaseworkershouldarrangetohold
atleastoneofthemeetingswithalltheadults
together,ifitispossibleandsafeforthem.During
thisinterview,thecaseworkershouldobserve
and evaluate the nature of the communication;
consideranddiscussparentingissues,aswellasthe
healthandqualityoftheirrelationship;andseek
eachadultsperceptionofthe problems, current
situation,andfamily.Tecaseworkershouldbe
alertto signs that could indicate the possibility
of spouse abuse and avoid placing any adult in
a situation that could increase the risk of harm,
suchasreferringtopreviouslydisclosedsensitive
information.Asappropriateorifrequested,
thecaseworkeralsomayprovidereferralsfor
additionalresourcesorservices,suchasacontact
for the local domestic violence victims advocate
orshelter,toclients.
214

FatherInvolvementandtheChildandFamilyServicesReviews
Te1994amendmentstotheSocialSecurityActmandatedthedevelopmentofregulationstoreview
Stateschildandfamilyservices.Inresponse,theChildrensBureaudevelopedandimplementedtheChild
andFamilyServicesReviews(CFSRs),aresults-oriented,comprehensivemonitoringsystemdesignedto
assistStatesinimprovingoutcomesforthechildrenandfamiliestheyserve.AsnotedintheCFSRs,a
commonchallengewithrespecttochildwell-beingwasalackoffatherinvolvementincaseplanning.Te
ndingsshowthatchildwelfaresystemswereoftennotmakingadequateeortstoestablishcontactwith
fathers,evenwhenfatherswereinvolvedwiththefamily.Additionally,agencieswerelesslikelytoassess
theneedsoffathers,tosearchforpaternalrelativesaspossibleplacementsorforotherinvolvement,or
toprovidefatherswithservicesthantheywerewithmothers.
215
Also,ifthemotherwasnotcontacted,
thenthefatherwasalsonotlikelytobecontacted.Ingeneral,childwelfareagenciesrecognizethislack
ofinvolvementandareworkingtoaddresstheissueprimarilythroughinitiatingchangesinpolicies,
protocols,andpracticeguidelines.
ConsultOtherProfessionals
WhiletheCPScaseworkerhasprimaryresponsibility
for conducting the family assessment, other
communityprovidersfrequentlymaybecalledupon
to assist when there is a specic client condition or
behaviorthatmayrequireadditionalprofessional
assessment.Forexample:
Techildorparentexhibitsanundiagnosed
physical health problem or the childs behaviors
oremotionsdonotappeartobeage-appropriate
(hyperactivity,excessivesadnessandwithdrawal,
chronicnightmares,orbedwetting);
Teparentexhibitsbehaviorsoremotionsthat
do not appear to be controlled, such as violent
outbursts, extreme lethargy, depression, or
frequentmoodswings;
Te child or parent appears to have a chemical
dependency.
216
Agoodwaytojudgewhetheroutsidereferralsare
neededistoreviewthegatheredinformationandto
assesswhethersignicantquestionsstillexistabout
therisksandstrengthsinthisfamily.Sometimesother
providerscontributetotheassessmentprocessbecause
oftheirroleasadvocatesforthechild.Forexample,if
thejuvenileorfamilycourtisinvolved,thechildmay
haveaGuardianadLitem(GAL)orcourt-appointed
specialadvocate(CASA)whoadvisesthecourton
needed services based on interviews conducted with
thechildandfamilymembers.
217
AnalyzeInformationandMakeDecisions
Toindividualizetheresponsetoaparticularchildand
family,thecaseworkeridentiesthecriticalriskfactors
byexaminingtheinformationintermsofcause,
nature,extent,eects,strengths,andthefamilys
perceptionoftheneglect.Tecaseworkerandfamily
thenshouldidentifythenecessarychanges,translate
themintodesiredoutcomes,andmatchtheoutcomes
withthecorrectinterventiontoincreasesafety,well-
being,andpermanencyforthechildren.
218
STRUCTURED ASSESSMENT MEASURES

Eachsourceofdataregardingachildsneglectmay
provide dierent ndings. Research has pointed
tosomeofthelimitationsofCPScaserecordsand
caseworkers as sources of information for neglect
denitions.
219
Useofstandardizedassessmentmeasureswillincrease
thevalidityandreliabilityofassessments.Tese
measures attempt to establish the minimal parenting

CulturalCompetenceinAssessment
Byincreasingtheirknowledgeabouttheculture,beliefs,andchild-rearingpracticesoftheirclients,CPS
caseworkerscanincreasetheirawarenessandappreciationofculturaldierenceswhileacceptingthatsome
culturalpracticesmaybeharmfultothechild.Recognitionofdierencesamongrelatedculturalgroupswill
helpguardagainstmisplacedassumptionsabouttheriskandprotectivefactorsinthechildsenvironment.
Forexample,theculturalvalues,beliefs,andpracticeswithintheLatinoculturearenotnecessarilythesame
forMexicanAmericans,CubanAmericans,andPuertoRicanAmericans.
Parentalmotivescannotsimplybecategorizedasintentionalorunintentional,butalsomustbeconsidered
inaculturalcontext.Forexample,immigrantparentssometimesdonotusecarseatsbecausetheybelieve
theirbabieswillfeelabandonedifnotheldintheirparentsarms.Nevertheless,thelawrequirestheuseof
carseatstoprotectchildrenfrompotentialharm.
220
Indecidingwhetheraculturalpracticeispotentiallyharmfultoachild,thefollowingquestionscanfostera
culturallysensitiveconsiderationoftheissueofneglect:
Whatexactlyisthepractice?
Isitsafe?
Isactualorpotentialharminvolved?
Isthereasignicantlybetteroption?
Aretherepotentiallyharmfulimplicationsofdeviatingfromtheculturalpractice?
Havethechildsbasicneedsnotbeenmet?
Isitagainstthelaw?
221
standards,which,ifnotmet,constituteevidenceof
neglect. Te focus on minimal adequacy stems from
theculturesconcernaboutinterveninginmatters
ofindividualandfamilyautonomy.Teconcept
ofminimallyadequateparentingimpliesthatthere
may be dimensions of parenting or child care which
are essential, that prociency in parenting falls along
a continuum of each dimension, and that parenting
adequacybeginstobequestionableatsomepointsor
withinsomerangeofthatcontinuum.
222
Dimensions
that may be more dicult to quantify along a
continuum would include adequacy of aection and
emotionalsupport.Otherdimensionsusuallyare
easiertoquantify,suchasmoneymanagementand
providingsucientfood,shelter,andclothingforthe
child.
Anassessmenttoolthatshowspromisefordetermining
the possible existence of neglect is the Neglect Scale,
an easy-to-administer, retrospective, self-report
measurethatcanbeadministeredtodiverseclient
populations.
223
Otherstandardizedclinicalassessment
measures include observational measures (Family
AssessmentForm,ChildWell-beingScales,Home
ObservationforMeasureoftheEnvironment)and
self-reportmeasures(FamilyFunctioningStyleScale,
FamilyNeedsScale,SupportFunctionsScale).

Formoreinformationonassessment,seeA Coordinated Response to Child Abuse and Neglect: Te Foundation
for Practice andChild Protective Services: A Guide for Caseworkersathttp://www.childwelfare.gov/pubs/
usermanual.cfm.
Formoreinformationontheseinstruments,see:
NeglectScale:http://pubpages.unh.edu/~mas2/NS7A.htm
FamilyAssessmentForm:http://www.srpublications.com/socialwork/Family-Assessment-Form.htm
ChildWell-beingScales,HomeObservationforMeasureoftheEnvironment:http://www.family.
umaryland.edu
FamilyFunctioningStyleScale:http://www.childwelfare.gov/preventing/programs/whatworks/
familyconnections.cfm
FamilyNeedsScale:http://www.clas.uiuc.edu/special/evaltools/cl00950.html
SupportFunctionsScale:http://www.acf.hhs.gov/programs/opre/ehs/perf_measures/reports/
resources_measuring/res_meas_phiu.html.

CHAPTER 6
Child Neglect Prevention
and Intervention
T
hegoaloftheinitialpreventionorintervention
shouldbetoaddresssafetyandotheremergency
needsandtoincreasethecaregiversreadinessfor
change-orientedpracticesorbehaviors.Bythetime
familiesexperiencingneglectcometotheattention
of CPS agencies, they often have acute and chronic
needsthatrequirelong-termintervention.Tese
familiesaresignicantlymorelikelytoexperience
recurrenceofchildneglectthanabusivefamilies.In
someCPSagencies,familiesexperiencingneglectare
givenlessprioritythanthosedealingwithphysicalor
sexualabuse,eventhoughtheirriskofrecurrencemay
beparticularlyhigh.
224
Eectivewaysmustbefoundtotargetandserve
theseat-riskfamiliesassoonastheyareidentiedto
minimize risksthat could leadtochildneglect and
abuse.Tischapterdiscussestheprinciplescomprising
thefoundationofpreventionandintervention,their
theoreticalframework,andkeystepsinimplementing
their practice. Examples of successful interventions
arealsopresented.
PRINCIPLES FOR EFFECTIVE PREVENTION AND
INTERVENTION
Eortstargetingsingleriskfactorsmaybeaseective
inpreventingneglectanditsrecurrenceasprograms
that are individualized and oer multiple services.
225
Eitherway,servicesmustbebasedonprinciples
thatempowerfamilies,builduponstrengths,and
respectculturaldiversity.Tefollowingaresome
TeImportanceofReceivingServicesatanEarlyAge
Programsthatpromoteapositiveandresponsiveparent-childrelationshiparedesirableaspreventionand
interventionstrategies.Optimally,parentscanbeassistedwhentheirchildrenareveryyoungandthefamilies
arenotyetpresentingseriouschildbehaviorproblems.Chancesforbetterparent-infantrelationshipsare
improved,andthelikelihoodofchildneglectisdiminished.
226
Teintensityofinterventionsrequiredfor
children to catch up is expensive and unlikely to be available. For children of families living in poverty,
thesupportneededforproperdevelopmentoftenexceedswhattheirparentscanprovide.Tesechildren
may benet from quality child care or preschool settings, such as Head Start, a component not typically
consideredinmostinterventionsforneglectedchildren.Tesecenter-basedprogramscanoertheparent
respitefromchildcareandteachthechildcommunicationandproblem-solvingskillsthatmaybuerthe
childfromsomeeectsofneglect.
227

basicprinciplesforpractitionerswhointervenewith
familieswhenchildrensbasicneedsareunmet:
Haveanecological-developmentalframework.As
discussedinChapter5,Assessment of Child Neglect,
neglectmaybeviewedwithinasystemofriskand
protective factors interacting at multiple levels,
includingthe individual,the family system, and the
largersocialsystem.Tobemosteective,intervention
shouldbedirectedatthesemultiplelevels,depending
onthespecicneedsofthefamily.Examplesinclude
aordablechildcare,educationandemployment
opportunities,low-incomehousing,andlarge-scale
drugpreventionandtreatmentinitiatives.
Understand the importance of outreach and
community.Becausefamiliesexperiencingneglect
tend to be poor,sociallyisolated,and lackingaccess
toresources,interventionsmustincludeaggressive
outreachandbedesignedtomobilizeconcreteformal
andinformalhelpingresources.Sincein-oce,one-
to-one counseling by professionals often has proven
tobeineectivewithfamiliesexperiencingneglect,
servicesprovidedinthehomeandwithin thelocal
communityareessentialtounderstandthefamilyinits
dailyenvironment.Itmustbeacollaborativeprocess
betweenthefamilyandcommunityinwhichpeople
planandcarry out goals togetherfor strengthening
theirneighborhood.
228
Carry out a comprehensive family assessment.

Caseworkers should conduct an assessment to
determine the type of neglect that has occurred and
itscontributingcauses(e.g.,thechildsparenthas
asubstanceabuseproblemorthechildlivesina
dangerousneighborhood).Wheneverpossible,the
caseworkershouldincludeotherserviceprovidersin
theassessment.Acomprehensiveassessmentcanbe
madeusingstandardizedclinicalmeasuresofriskand
protectivefactors,aswellasbyassessingparenting
attitudes,knowledge,and skills.
229
(See Chapter 5,
Assessment of Child Neglect,formoreinformation.)
Establish a helping alliance and partnership
withthefamily.Tisisoneofthemostimportant
principlesforeectiveintervention.Itmaybea
challenge,however,becausemanycaregiverswith
neglectproblemstendtohavedicultyformingand
sustaining interpersonal relationships. By attending
tothecommunicationstylesoffamilymembers,the
caseworkerismorelikelytoengagethefamilyinan
activepartnership,therebyhelpingthefamilydevelop
communication skills and build more sustaining
relationshipswithothers.
230
Utilizeanempowerment-basedpractice.Teaching
familieshowtomanagethemultiplestressesand
conditions of their lives eectively empowers family
members to solve their own problems and to avoid
dependenceonthesocialservicesystem.Teroleof
the helper becomes one of partner, guide, mediator,
advocate,andcoach.
231
Emphasize family strengths. A strengths-based
orientationaddressesproblems,helpsbuildona
familysexistingcompetencies,andpromoteshealthy
functioning of the family system. Te intervention
enables caregivers to meet the needs of family
memberswhothenwillbebetterabletohavethe
time,energy,andresourcesforenhancingthewell-
beingofthefamily.
232
Developculturalcompetence.Riskandprotective
factorsforchildneglectmaydieraccordingto
raceandethnicity.Becauseminorityfamiliesare
disproportionatelyrepresentedinthechildwelfare
systemandneglectcasesrepresentmorethanone-
halfofthecaseloadofchildwelfareagencies,itis
imperativetoincreasetheculturalcompetenceof
service providers. Cultural competency requires
acceptanceofandrespectfordierences,diversity
ofknowledgeandskills,andadaptationofservices
totthetargetpopulationsculture,situation,and
perceivedneeds.
233
Ensure developmental appropriateness.
Practitioners must consider the developmental
needs of the children, the caregivers, and the family
asasystemintheirassessmentsandintervention
strategies.Childrenwhosephysicalandemotional
needshavebeenneglectedoftenwillsuersignicant
developmentaldelays.Ifthecaregiversareadolescents,
56 Child Neglect Prevention and Intervention

they may have diculty assuming parental roles
and responsibilities. Te family system also may be
stressedwhenthefamilyincludescaregiversacross
generations.
234
THEORETICAL FRAMEWORKS AND APPROACHES
Teprecedingprinciplesofneglectpreventionsuggest
thatwhenriskfactorsarepresent,communitygroups
orotheragenciescanassistfamiliestoreduceriskand
tostrengthenprotectivefactors,therebypreventing
futureincidencesofchildneglect.Eectiveprograms
focus on developing basic problem-solving skills,
providingforthefamilysconcreteneeds,teaching
behavior management strategies, and addressing
environmental factors.
235
Specic interventions
shouldbematchedtoaddressthemostpressing
needsofeachindividualfamilymemberandtotarget
individualizedfamilyoutcomes.
Withinasinglecaseofneglect,multipleapproaches
andmodelsmaybeemployeddependingonthe
family members, the circumstances surrounding the
neglect,andlocalandagencypracticestandards.
Additionally,theseapproachesandmodelsarenot
mutuallyexclusive;thestrategiesemployedineach
approachormodelmayoverlap.
DierentialResponseStrategies
Relianceonanauthoritative,investigativeresponseis
notappropriateformanyfamilies,butthisisoftenthe
onlymeansofentryintothechildwelfaresystemof
services.Traditionalservicesoftenhavebeencriticized
asbeingtooinvasiveandfocusedonsevereproblems
whilenotprovidingenoughservicestochildrenat
lowormoderateriskofmaltreatment.
236
Inresponse
tothisconcern,someStateshaveimplementeda
dierentialresponsesysteminwhichonlyfamilieswith
themostseriousmaltreatmentorthoseatthehighest
riskaresubjecttoamandatoryCPSinvestigation.
Otherfamilieswithlessseriousmaltreatmentand
whoareassessedatlowormoderateriskreceivea
voluntaryfamilyassessmentandapreventiveservices-
orientedresponse.Insteadofaninvestigationthat
concentratesondeterminingwhethermaltreatment
has already occurred, the assessment focuses on
whatmighthappeninthefutureandonwhattypes
of interventions will best meet the needs of specic
families.
Exhibit6-1listsappropriateresponsestofamilies
whoareassessedbypractitionersasbeingatmild,
moderate,orsevereriskforexperiencingneglect,
aswellastheindividualsresponsibleforproviding
services.
Tis dual-track or multiple-response approach
providesgreaterexibilitytoresponddierentially,
consideringthechildrenssafety,thedegreeofrisk
present,andthefamilysneedforsupportservices.
For example, in cases of severe abuse and neglect or
ofcriminaloensesagainstchildren,aninvestigation
willcommence.Inlessseriouscaseswherethe
family may benet from community services, a
comprehensiveassessmentwillbeconductedsothat
thefamilysstrengthsandneedscanbematchedwith
theappropriatecommunityservices.Statesthat
haveimplementeddierentialresponsesystemshave
shownthatamajorityofcasescanbehandledsafely
throughanapproachthatemphasizesservicedelivery
andvoluntaryfamilyparticipation,aswellasthefact-
ndingoftraditionalCPSinvestigations.
237
Child-centeredStrategies
Tefocusofchild-centeredstrategiesisonproviding
childrenatriskof,oralreadyexperiencing,neglect
withnecessaryservicestoensuretheirsafetyand
to provide them with the skills and support to
overcomemaltreatmentsuccessfully.Child-centered
interventions include pediatric care, mentoring,
orbehavioralandmentalhealthtreatment.For
youngerchildren,preschoolinterventions,suchas
parent-child educational play and Early Head Start,
maybeconsidered.Programsfosteringanopenand
educationalclimatearehelpfulformiddle-school
childrenandcanhelpthemenhanceself-control,

Exhibit6-1
PossibleResponsestoFamilies
238
TypesofCases ResponsesSuggested OrganizationsResponsible
MildRisk Earlyintervention,familysupport,formal
orinformalservices,parenteducation,
housingassistance,communityneighborhood
advocacy.
Communityprograms
ModerateRisk Appropriateformalservices,coordinated
familysupport,safetyplans,community
supportservices.
CPSandcommunityprograms
SevereRisk Intensivefamilypreservationorreunication
services,childremoval,court-orderedservices,
fostercare,adoption,criminalprosecution.
CPSandlawenforcement
develop communication and problem-solvingskills,
andlearnhowtoresistnegativesocialinuences.
239
Parent-centeredStrategies
Tefocusofparent-centeredstrategiesisonenabling
caregivers to meet the needs of all family members,
includingthemselves,inabalancedway,providing
parentswiththeresourcestoensurethesafetyandwell-
beingofthefamily.Strategiesfocusontheenduring
andunderlyingprotectivefactors,alongwiththerisks,
tooptimizeamatchofinterventions.Examplesthat
show promise in improving parenting skills and the
parent-childrelationshipincludeparentingeducation
programs,suchasParents as Teacher andParents and
Children Together (P.A.C.T.),andtreatmentprograms
that address problems such as depression, substance
abuse,anddomesticviolence.
240
Formoreonparent-centeredandotherstrategies,
seeEmerging Practices in the Prevention of Child
Abuse and Neglectathttp://www.childwelfare.
gov/preventing/programs/whatworks/report/.
Family-centeredStrategies
Family-centeredstrategiesinvolveparents,children,
andothermembersofthefamilysystem,where
appropriate. Coordination of multiple service
providers,aswellasfaith-andcommunity-based
organizations,maybeneededtosupportafamilys
variousneeds.Family-centeredstrategiesfocuson
enhancingparentingskillsandhelpingfamiliesrecover
fromneglect.CPScaseworkersworkwiththefamily
bytrainingparentsinbehavioralandsocialskills,
settingshort-termgoalswithclearlydenedaction
steps,providingin-hometeachingandskillstraining
to parents to improve parent-child interactions, and
teachinghomemanagementskills.
Neglectfulfamiliesoftenshowhighratesofrecidivism.
In-homeinstructionisoftenthebeststrategyto
preventrecurrenceandisalsoasuccessfulstrategy
forworkingwithfamiliesatriskforneglect.Parents
tendtorespondpositivelytothemorepersonalized,
outreach nature of the home-visitor approach.
241
Whileprovidingin-homeinstruction,caseworkers
can teach behaviors that encourage attachment,
appropriate feeding and child care practices, infant-

toddler stimulation, successful money management,
andpropernutrition.Providinginformationrelated
to child development characteristics and capabilities
isan important element ofmanyin-homeservices.
When possible, training should be providedduring
subsequentpregnanciesforhigh-riskfamiliesand
duringthepostpartumperiod.
242
UtilizationofConcreteResources
Telackofconcreteresourcesandthestressof
povertythatcomefromlivinginneglectedandunsafe
neighborhoods are risk factors for neglect. Helping
familiesaccessconcreteresourcesisoftenessential
before they can deal with other factors in their lives
thatmayaectthecareoftheirchildren.Examples
ofconcreteresourcesincludehousing;emergency
nancial,food,andenergyassistance;aordableand
qualitychildcare;transportation;homemanagement
assistance; and free or low-cost medical care. Tese
resourcesareneededtohelpfamiliesmovebeyond
meresurvivaltooptimalfunctioning.
243
UtilizationofSocialSupports
As discussed in Chapter 4, Risk and Protective
Factors,parentswhoexperienceloneliness,lacksocial
support,andaresociallyisolatedmaybemoreprone
toneglectingtheirchildrenthanfamilieswho have
astrongnetworkofsocialsupports.Buildingsocial
supportscanserveasameansofstresspreventionas
wellasastressbuer.Beinginthecompanyofothers
canenhanceself-esteem,provideasenseofbelonging,
improveaccessto healthyrolemodels,and provide
incentivestocomplywithsocialnorms.
244
Socialsupportinterventionsincludeanyactivitiesor
programs that address social isolation, loneliness, or
otherdecitsinthesocialnetworkoffamilies.Social
supportsprovidethefollowing:
Emotional support through armation,
compassion,andempathy;
Feedback,advice,encouragement,andguidance
in coping with demands such as managing
emotionalstressandchildrearing;
Access to information, services, and material
resourcesandassistance(neighborsandfriends
mayprovideadviceaboutschoolsandchildcare
ordonateneededitems,suchasclothingoracar
seat);
Assistanceinlearningnewjobskills,making
homerepairs,managinghouseholdneeds,and
creating nancial plans using an informal social
networkofneighbors,friends,andworkplace
colleagues.
245
Researchsuggeststhatsocialsupportinterventions,
incombinationwithcaseworkandcasemanagement
services,areeectiveinimprovingthefunctioningof
neglectfulfamilies.
246
Socialsupportinterventions
must be managed carefully to maximize the
advantagesofthesupportwhileminimizingpotential
disadvantages.Excessivesocialsupportmaynotonly
foster dependency in the recipient, but also increase
feelingsofindebtednessortheneedtoreciprocate.
Sometimes those oering emotional support nd it
diculttochallengetherecipientsbehavior(e.g.,
substanceabuse).
247
ItiscrucialforCPS,aswell
ascommunity-andfaith-basedgroups,toprovide
assistancetothesupportnetworkoftroubledfamilies
to prevent their exhaustion and burnout. Working
inteamsonhomevisitationshasbeeneectivein
supportingthesupporters,whileorganizingmutual
supportgroupsmayprovidemuchneededassistance
fortheinformalsupportnetwork.
248
UtilizationofCommunityServices
Bothinformalandformalprovisionofcommunity
services can help reduce family stresses that can
contribute to child abuse and neglect. To be
eective, social support needs to be integrated with
communityservices,suchassocialskillstraining,
home-based family interventions, emergency
assistance, parenting education, intensive therapy,

and, in some cases, substance abuse treatment.
CPStypicallyistheleadagencyincoordinating
communicationbetweenvariouspartiesandservices
withinthecommunity.Otherprofessionalsinvolved
incommunitypreventionandinterventioneorts
include law enforcement, educators, early child
careproviders,healthcareproviders,mentalhealth
professionals,legalandjudicialsystemprofessionals,
substitute care providers, the faith community,
communityorganizations,supportservicesproviders,
andotherconcernedcitizens.Integrationofthese
servicesystemsandproviderswillhelpensurethat
families can be supported appropriately across their
developmentallifespan.
249
Assistanceprogramsaremostlikelytosucceedwhen
theyprovideanarrayofbenetstothegeneral
population so that recipients are not stigmatized by
identicationwiththeprogram.Ifthisisnotpossible,
assistancecanbeincorporatedintoprogramsthat
targetawide-rangingpopulation.Contractingwith
community-basedservicescanhelpmeettheneedsof
childrenandfamilieswithintheirownneighborhood,
reducingtheamountoftimeandburdenonfamilies
who otherwise may need to travel long distances to
receivesuchservices.Community-basedprograms
alsoattempttodothefollowing:
Preventtheaccumulationofriskfactors;
Focusonresilienceandadaptation;
Facilitateactiveinvolvementofparents,children,
andothers;
Ensuresucientservicestoat-riskpopulations;
Providetimely,careful,andexpertevaluation,
assessment,andfollow-upservices;
Build safe environments to permit families
to establish structure, routines, rituals, and
organization.
250
Examplesofcommunityservicestrategiesinclude:
Public assistance programs oering job
training,subsidizedchildcare,andnutritional
support(e.g.,theSpecialSupplementalNutrition
Program for Women, Infants, and Children
[WIC]program).
Schools providing social support through
programs,suchasHeadStart,thatincorporate
parental involvement into early childhood
education,orafter-schoolprogramsthatprovide
socialandeducationalassistance,peercounseling,
andtutoringaswellassocialsupporttochildren
withspecialneeds.
Faith-basedandcommunityorganizationsand
recreationalgroupsoeringavarietyofservices
toassisthigh-riskfamilies,includingcommunity
food pantries, clothing, soup kitchens, and
recreationalandrelatedactivities.
In-home assistance in which formal helpers
providefamilieswiththeopportunitytoconsider
eachpersonsviewpointonfamilyproblemsand
thedevelopmentofnewmodesofinteraction.
251
Formoredetailedinformationontherolesand
responsibilitiesofvariousserviceproviderswithin
thecommunity,seeA Coordinated Response to Child
Abuse and Neglect: Te Foundation for Practice at
http://www.childwelfare.gov/pubs/usermanual.
cfm.
Cognitive-behavioralInterventions
Cognitive-behavioral interventions use behavior
modicationtechniquesinindividualtherapysessions
withcaregiverswhohaveneglected.Teyinclude:
Verbal instructionproviding information
aboutappropriatechildcare;
Social skillstrainingdemonstrating methods
formanagingchildcaretasks;
Stress managementteaching relaxation
techniquesorcognitivecopingskills;

HelpingFamiliesAcceptAssistancetoMeetTeirNeeds
Familiesatriskofchildneglectandinneedofsupportaremostlikelytoregardassistancepositivelywhen
they:
Haveopportunitiestoreciprocate(orarerequiredtorepay)theaidtheyreceive;
Acceptassistancebecausetheyperceivetheneedforhelpratherthanbecauseofexternaljudgmentsof
inadequacyorincompetence;
Perceivethebenefactorsintentionsasacombinationofaltruismandself-interest(i.e.,thebenefactor
hasagenuineinterestinthefamily,butalsoispaidorprovidedotherbenetsforhelping);
Believethattheassistancecomeslargelyfromanimpersonalsource(e.g.,agency,organization);
Regardtheirneedforassistanceasexternallyinstigated(e.g.,joblayo)ratherthanasstemmingfrom
personalinadequacies;
Receiveassistanceincircumstancesthatreducestigma(e.g.,benetswidelysharedbycommunity
members);
Obtainaidinawaythatdoesnotinvadeprivacyorlimitautonomy.
252
Cognitive restructuringreplacing self-

defeatingthoughtswithbeliefsandbehaviors
thatleadtoimprovedfunctioning.
Tesetechniquesareespeciallyusefulwithneglectful
familiesiftheytargetboththeenvironmentand
the individual. For example, Project STEEP (Steps
TowardEective,EnjoyableParenting),whichwas
developed atthe University ofMinnesota,isan
intensive,individual,in-homecounselingandgroup
interventionprogramthatseekstochangenegativeself-
perceptions and to break the intergenerational cycle
ofmaltreatment.(FormoreinformationonProject
STEEP, go to http://education.umn.edu/ICD/
harriscenter/STEEPinfo.htm.)ProjectSafeCareuses
anecobehavioralapproachandreportsimprovements
innutrition,homecleanliness,personalhygiene,and
identifyingandreportingchildrensillnesses.
253
(For
moreinformationaboutProjectSafeCare,visithttp://
www.friendsnrc.org/downloads/05ConfPres/
Fidelity.pdf or http://www.cdc.gov/ncipc/pub-
res/parenting/ChildMalT-Brieng.pdf.)
Te following examples are cognitive-behavioral
methodsforaddressing child neglectthat havebeen
showntoimprovehomesafety,aectiveskillsforthe
parents,andinfantdevelopmentstimulation.
Homesafety.Hazardousphysicalenvironments
increaseachildsriskofinjuryfromaccidentsand
fromhighlystressedparentswhomaybecome
physicallyabusivewhiletryingtopreventachild
frominjuringhimorherselffromahousehold
hazard. A safety assessment can be followed by
personalizedtrainingandeducationalactivities.
Tese activities may include audiovisual
presentationsofhowtoresolvesafetyhazards,use
ofself-feedback stickers,and printed guidelines
(e.g.,theproperuseofsafetyplatesandelectrical
tape).
Aective skills training. Parents learn positive
waysofinteractingwiththeirchildren,including
developing the ability to provide corresponding
physicalandverbalmessages,assuminganequal
positionofheightwiththechild,andactively
initiating positive, nurturing physical contact
withthechild.
Stimulating infant development. Teaching
parentshowtonurtureinfantscanreducethe

riskofdevelopmentaloremotionaldiculties
withtheirbabies.Stimulationactivitiesinclude
frequentuseofaectionatewordsandchild-
parentinteractiveplay.
254
SystemsofCare
InterventionswithSpecialPopulations
CPSandotherorganizationsthatprovideneglect
prevention and intervention services serve many
specialpopulations,includingfamiliesofcolorand
parentswithintellectualdisabilities.
A Systems of Care approach is a collaborative eort
onthepartofserviceagenciestosupportchildrenand
familieswithcomplexneedsinanintegratedmanner.
SystemsofCareenablecross-agencycoordination
of services regardless of where or how children and
familiesenterthesystem.Agenciesworkstrategically,
inpartnershipwithfamiliesandotherformaland
informalsupportsystemsandcanaddressneglect
basedonafamilysuniqueneeds.Tisapproachhas
beenacatalystforchangingthewaypublicagencies
organize,purchase,andprovideservices.Ithasbeen
appliedacrosstheUnitedStatesinvariouswaysat
themacrolevel(throughpublicpolicyandsystem
change)andatthemicrolevel(inthewayservice
providersdirectlyinteractwithchildrenandfamilies
inneed ofassistance).Todo soeectively,agencies
participatinginSystemsofCaremust:
Agree on common goals, values, and principles
thatwillguidetheireorts;
Developasharedinfrastructuretocoordinate
eorts toward the common goals of safety,
permanency,andwell-being;
Workwithinthatinfrastructuretoensurethe
availabilityofanarrayofhigh-quality,community-
basedservicestosupportfamiliesandchildren
safelyintheirhomesandcommunities.
255
Foradditionalinformationandtocommunicate
withotherprofessionalsabouttheSystemsof
Careapproach,visithttp://www.childwelfare.
gov/systemwide/service_array/soc/.
Servingfamiliesofcolorthroughcommunity-
basedservices.Inresponsetoconcernsabout
theover-representationofminoritychildrenin
thechildwelfaresystem,theChildrensBureau
sponsoredanexploratory,qualitativestudyof
thechildwelfaresystemsresponsetochildren
ofcolor,specically, African-American children.
Testudyidentiedstrategiesthatchildwelfare
agencies were using or should use to meet
the needs of minority children and families.
By providing prevention services within the
neighborhoodorlocalcommunitytosupport
familiesbeforetheycometotheattentionof
the system, it is hoped that fewer minority
childrenwouldenterthesystemintherstplace.
Establishingstrongconnectionswithminority
communitiesandengagingcommunityleaders
may help child welfare agencies collaborate
moreeectivelyandshareresourceswithlocal
agenciesandorganizations.Tiswillhopefully
empowercommunitiestondsolutionstotheir
ownproblemsandbuildaninternalsupport
system.
256
Formoreinformationonminoritychildreninthe
childwelfaresystem,seeChildren of Color in the
Child Welfare System: Perspectives from the Child
Welfare Community athttp://www.childwelfare.
gov/pubs/otherpubs/children/index.cfm.
Supporting parents with intellectual
disabilities.Parentswithintellectualdisabilities
often are identied as being at risk for physical
and psychological neglect of their children.
Expandedservicesareneededtoenhancethe
eectsofparenteducationtoimproveparental
competenciesandtoreducetheriskofchild
neglectanddevelopmentalorbehaviorproblems.

Behavioral, performance-based teaching
strategies often work well with this population.
Practitioners should receive training on the
impactofintellectualdisabilitiesonadultsaswell
asbehavioralskillstraining.Tesetechniques
includesimpleinstructions,taskanalysis,pictorial
prompts,modeling,feedback,role-playing,and
positivereinforcement.
Tese same techniques also are eective in
teaching parenting skills to parents without
intellectualdisabilities.Researchhasshownthat
therateofchildremovaldroppedconsiderably
followinginterventionsthatincreasedparents
child care skills. Furthermore, in-home services
forat-riskchildrenthatimproveparentingskills
andknowledgeofchilddevelopmentmaybe
more feasible and cost-eective than placing
children in specialized preschools.
257
Exhibit 6-
1summarizesvariousinterventionsthatcanbe
usedwithneglectedchildrenandtheirfamilies.
KEY STEPS IN THE INTERVENTION PROCESS
Regardless of which intervention approaches and
models are implemented, certain steps are necessary
Exhibit6-1
InterventionsforNeglectCases
258
Concrete
Support
SocialSupport Developmental
Cognitiveand
Behavioral
Individual FamilySystem
Housing
assistance
Emergency
nancial,
food,orother
assistance
Transportation
Clothing,
household
items
Availabilityor
accessibility
tocommunity
resources
Hands-on
assistanceto
increasesafety
andsanitation
ofhome(home
management
aids)
Freeorlow-cost
medicalcare
Availableand
aordable
qualitychild
care
Individual
socialsupport
(parentaide,
volunteer)
Connections
tofaith-based
activities
Mentor
involvement
Socialsupport
groups
Developmentof
neighborhood
childcareand
respitecare
services
Neighborhood-
centered
activities
Social
networking
Recreation
programs
Cultural
festivalsand
otheractivities
Terapeuticchild
care
Individual
assistancewith
developmental
skills(e.g.,
parenting)
Homevisits
withfocuson
developmental
needsoffamily
members
Peergroups
(oftenatschools)
gearedto
developmental
tasks
Mentors
toprovide
nurturing,
cultural
enrichment,
recreation,and
rolemodeling
Socialskills
training
Communication
skillsbuilding
Teachingofhome
management,
parent-child
interaction,meal
preparation,and
otherlifeskills
Individualor
grouptherapeutic
counseling
(e.g.,regarding
childhood
history)
Parenting
education
Employment
counselingand
training
Financial
management
counseling
Problem-solving
skillstraining
In-and
out-patient
counseling
and
detoxication
forsubstance
abuse
12-Step
programs
Mentalhealth
in-patientand
out-patient
counseling
Crisis
intervention
Stress
management
Playtherapy
Home-based,
family-centered
counseling
regardingfamily
functioning,
communication
skills,home
management,
androlesand
responsibilities
Center-based
familytherapy
Enhancing
familystrengths
Building
nurturing
behaviors
Reningfamily
dynamicsand
patterns

tomakethemappropriatefortheneedsofthechild
andfamily,including:
Buildingarelationshipwiththefamily;
Developingcaseandsafetyplans;
Establishingclear,concretegoals;
Targetingoutcomes;
Trackingfamilyprogress;
Analyzingandevaluatingfamilyprogress.
BuildingaRelationshipwiththeFamily
Establishinggoodrapportwitheachfamilymember
will help the caseworker understand the family
dynamicsaswellasbuildtrustinthecollaborative
processbetweenthecaseworker,family,andother
providers. When families believe their feelings and
concernshavebeenheard,respected,andconsidered,
theyaremorelikely tobe engagedintheplanning
andactionsnecessarytochangethebehaviorsand
conditionsthatcontributetoneglect.CPScaseworkers
alsoshouldbepreparedfortheoftenemotionally
draining eect that the apathy of neglectful families
mayhaveonprofessionals,volunteers,andcommunity
paraprofessionals.
259
DevelopingCaseandSafetyPlans
Interventions should be structured to increase
protectivefactorsortodecreaseriskfactorsidentied
in the family assessment process. Tat information
canbeusedtotailortheinterventiontofacilitate
changesthefamilymustmaketomeetachildsbasic
needs,toeliminatetherisksofchildneglect,andto
developasafetyplan,ifneeded.Flexibilityiscritical
indesigningcaseplanssothattheyareresponsiveto
thefamilyschangingneedsandresources.
TecaseplanthataCPScaseworkerdevelopswitha
familyisitsroadmaptosuccessfulintervention.Te
purposesofcaseplanningareto:
Identifystrategieswiththefamilythataddress
theeectsofneglect;
Provideaclearandspecicguideforchanging
behaviorsandconditionsthatinuencerisk;
Establishabenchmarktomeasureclientprogress
forachievingoutcomes.
260
EstablishingClear,ConcreteGoals
In setting the goals of the intervention, family
members and their informal support networks
shouldbeinvolvedindevelopingplanstomaximize
thechancesforimprovingfamilyfunctioningand
reducingtheriskofneglect.Providingconcrete,
measurable,andachievablegoalswithcontinuous
positivefeedbackwillhelpfamilies accomplish their
individualizedoutcomesandgoals.Goalsshould
indicatepositivebehaviorsorconditionsthatwill
result from the change and not concentrate only on
reducingnegativebehaviors.
Oncegoalsareidentied,thenextstepistobreak
themdownintosmall,incrementaltasks.Tesetasks
describewhatthechildren,family,caseworker,and
otherserviceproviderswilldoandidentifytimeframes
foraccomplishingeachtask.Familiesshouldbeable
tounderstandwhatisexpectedofthemandwhat
theycanexpectfromthecaseworkerandotherservice
providers.Caseworkersshouldattempttoanticipate
potentialobstaclestotaskperformanceandtodevise
strategiesforovercomingthem.
261
TargetingOutcomes
Outcomes should be targeted so that both the risks
andtheeectsofneglectarereducedduetochanges
inthebehaviorsorconditionsthatcontributedto
it.Outcomesshouldaddressissuesrelatedtofour
areasthechild,theparentsorothercaregivers,
thefamilysystem,andtheenvironmentandbe
designed to contribute to the achievement of safety,
permanency,andfamilywell-being.
262

GoalsShouldBeSMART
SpecicTefamilyshouldknowexactlywhathastobedone.
MeasurableGoalsshouldbemeasurable,clear,andunderstandablesoeveryoneknowswhentheyhave
beenachieved.
AchievableTefamilyshouldbeabletoaccomplishthegoalsinadesignatedtimeperiodgiventhe
resourcesthatareaccessibleandavailabletosupportchange.
RealisticTefamilyshouldhaveinputandagreementindevelopingfeasiblegoals.
TimelimitedTimeframesforgoalaccomplishmentshouldbedeterminedbasedonanunderstandingof
thefamilysrisks,strengths,andabilityandmotivationtochange.Teavailabilityandlevelofservicesalso
mayaecttimeframes.
263
Child outcomes. Outcomes for children focus
onchangesinbehavior,development,mental
health,physicalhealth,peerrelationships,and
education.Examplesofdesiredoutcomeswould
beimprovedbehaviorcontrol(asevidencedby
managing angry impulses) or developmental
appropriatenessandadjustmentinallareasof
functioning(asevidencedbyanimprovementin
thechildsphysicaldevelopmentwithintherange
ofthechronologicalage).
Parentorcaregiveroutcomes.Outcomesfor
parentsorcaregiverscanfocusonmanyareas,
such as mental health functioning, problem-
solving ability, impulse control, substance abuse
treatment,andparentingskills.Asampledesired
outcomewouldbeimprovedchildmanagement
skills, such as establishing and consistently
following through with rules and limits for
children.
Familyoutcomes.Teseoutcomesfocusonissues
suchasrolesandboundaries,communication
patterns,andthelevelofsocialsupportreceived.
Asampledesiredoutcomewouldbeenhanced
family maintenance and safety (as evidenced by
the ability to meet family members basic needs
forfood,clothing,shelter,andsupervision).
Environmental outcomes. Tese outcomes
focusonfactorssuchassocialisolation,housing
issues,orneighborhoodsafety.Asampledesired
outcomewouldbeutilizingsocialsupports.
264
Exhibit6-2providessomeexampleslinkingidentied
problemstopossibleoutcomes.

Exhibit6-2
MatchingRiskstoOutcomes
265
Risk or Problem Desired Client Outcomes
Condemnedhousing(noheatorrunningwater,
childrendiagnosedwithleadpoisoning,safety
hazardsforyoungchildren)
Householdsafety
Financialmanagementskills
Problem-solvingskills
Actingoutbehavior(refusingtolisten,throwing
tempertantrums,ghtswithpeers)
Behavioralcontrol
Socialskills
Impulsecontrol
Communicationproblemsorconicts(domestic
violence,parent-childconict)
Conictmanagementskills
Decision-makingskills
Impulsecontrol
Familyfunctioning
Frequentmoves(inandoutofplacement,
numerousschools,numerouscaregivers)
Financialmanagement
Problem-solvingskills
Parentaladdiction Recoveryfromaddiction
Inappropriatelyharshparenting,inappropriate
expectationsofchildren
Parentingknowledge
Emotionalcontrol
Fearofexpressingfeelings,verballyabusive,not
recognizingfeelingsofothers
Communicationskills
Empathy
Lackofsocialsupports Supportivelinkageswithsourcesofformaland
informalsupport
Formoreonoutcomesandinterventions,seeChild Protective Services: A Guide for Caseworkers athttp://

www.childwelfare.gov/pubs/usermanual.cfm.

TrackingFamilyProgress
Determining the extent and nature of a familys
progress is central to CPS intervention. Monitoring
changeshouldbeginassoonastheinterventionis
implementedandcontinuethroughoutthelifeofa
case until the targeted outcomes have been achieved.
Caseworkersshouldevaluatefamilyprogressregularly
byfollowingthesesteps:
Reviewthecaseplan.Outcomes,goals,and
tasksmustbewrittensothattheycanbeused
to determine progress toward reducing risk and
treatingtheeectsofmaltreatment.
Collectandorganizeinformationonfamily
progress.Oncethecaseplanisestablished,each
contactwiththechildrenandfamilyshouldfocus
on assessingtheprogressbeing madetoachieve
establishedoutcomesandtoreassesssafety.
Collectinformationfromallserviceproviders.
Referralstoserviceprovidersshouldclearlyspecify
thenumber,frequency,andmethodsofreports
expected.Tecaseworkeralsomustcommunicate
clearlyanyexpectationsforreportingconcerns,
observablechanges,andfamilyprogress.Itisthe
caseworkersresponsibilitytoensurethesubmission
ofthesereportsandtorequestmeetingswiththe
serviceproviders,ifindicated.
Engage the child and family in reviewing
progress.Usingthecaseplanasaframework
forcommunication,thecaseworkershouldmeet
withthefamilytoreviewprogressjointly.Family
membersshouldbeaskedabouttheirperceptions
ofprogress.
Measure family progress. Change is measured
duringtheevaluationoffamilyprogressontwo
levels. Te most critical riskfactors(identied
duringthefamilyassessment)shouldbereassessed.
Tesecondlevelofmeasurementevaluatesthe
extenttowhichspecicoutcomeshavebeen
accomplished by the family, caseworker, and
serviceproviders.
Document family progress. Torough
documentationallowsthecaseworkertomeasure
familyprogressbetweentheinitialassessment
andthecurrentevaluation.Tisdocumentation
providesthebasisforcasedecisions.
266
AnalyzingandEvaluatingFamilyProgress
Once the information has been collected, the
caseworker should analyze it to help determine
progressandtodecideonfurtheractions.Te
evaluationofafamilysprogressshouldaddressthe
followingissues:
Isthechildsafe?Havetheprotectivefactors,
strengths, or safety factors changed, thereby
warrantingthedevelopmentofasafetyplanora
changeinanexistingsafetyplan?
What changes have occurred in the factors
contributingtotheriskofneglect?
What progress has been made toward achieving
thecasegoalsandoutcomes?
Howeectivehavetheservicesbeeninachieving
theoutcomesandgoals?Specicquestionsthat
shouldbeconsideredare:
Haveservicesbeenprovidedinatimely
manner?
Hasthefamilyparticipatedinservicesas
scheduled?
Hastheserviceproviderdevelopedrapport
withthefamily?
Isthereaneedtoaltertheplanofservice
basedonchangesinthefamily?
Whatisthecurrentlevelofriskinthefamily?
Havetheriskfactorsbeenreducedsuciently
sothattheparentsorcaregiverscanprotecttheir
childrenandmeettheirdevelopmentalneeds,
allowingthecasetobeclosed?

Forchildreninout-of-homecare,isreunication
likelyintherequiredtimeframe,orisanalternate
permanencyplanneeded?
267
PROMISING PRACTICES FOR INTERVENTION

Severalprogramshaveshownpromiseinproviding
eectiveinterventionsforreducingtherisksand
eectsofchildneglect.
While listed in a U.S. Department of Health
and Human Services publication, a program or
organizations inclusion does not in any way connote
its endorsement.
FamilyConnectionsProgram
FamilyConnectionsinBaltimore,Maryland,was
designatedbytheChildrensBureauastheonly
nominatedchildmaltreatmentpreventionprogram
proven eective by a rigorous evaluation (see
Emerging Practices in the Prevention of Child Abuse and
Neglectathttp://www.childwelfare.gov/preventing/
programs/whatworks/report).FamilyConnections
targets families with children between the ages of 5
and11whoareconsideredtobeatriskforchildabuse
and neglect, but have no current CPS involvement.
Te program promotes the safety and well-being of
children and families by identifying and developing
formalandinformalsupportstoaddresseachfamilys
individualneedsandtobuilduponitsstrengths.Sta
membersworkwithfamiliesonproblem-solving,
positive disciplinary methods, coping strategies,
developmental social supports and community
connections,andopportunitiesforpositivefamily
interactionsthroughcommunityactivities.
FormoreinformationonFamilyConnections,visit
http://www.family.umaryland.edu/community
_services/fc.htm.
Evaluationresultsshowedthatchildrenin90percent
oftheat-riskfamiliesintheprogramservedin2000
2001werenotsuspectedofbeingabusedorneglected.
Otheroutcomesincluded:
Adecreaseinriskfactorsandanincreasein
protectivefactorsforneglect;
An increase in social support for caregivers,
caregiver satisfaction with parenting, and
appropriate parenting attitudes among
caregivers;
Adecreaseincaregiverstress,druguse,and
depressivesymptoms;
Adecreaseinchildbehavioralproblems.
268
Nurse-FamilyPartnership
Nurse-FamilyPartnership(NFP)isaprenataland
earlyinfancyprojectthatoriginatedinElmira,New
York and has been replicated in other cities. NFP
is one of the most well-known, evidence-based
programsaddressingchildneglect.Teprogram
incorporatedrandomizedclinicaltrialsevaluatingthe
ecacyofintensive,nursehome-visitationduring
pregnancyandtherst2yearsofachildslife.Initial
outcomesandanalysesofa15-yearfollow-upof
familieswhoreceivedhomevisitationsindicatedthat,
incomparisontothecontrolfamilies,therewasa48
percentreductioninchildmaltreatmentanda59
percentreductioninarrests.Otherprogrambenets
includedbetterprenatalhealthandimprovedschool
readiness.
269
Although this study did not specically target

neglect,theNFPprojectdocumentedthatproviding
professionalsupportindiculttransitionperiods
for high-risk families is an eective strategy for
developing family strengths and preventing negative
outcomes. Becauseoftheencouragingndings,the
OceofJuvenileJusticeandDelinquencyPrevention
oftheU.S.DepartmentofJusticemadeNFPpartof
itsWeedandSeedInitiative.In1999,theNational
CenterforChildren,FamiliesandCommunitieswas

establishedtodisseminatetheprogramnationwide.
Currently, more than 700 nurses participate in
NFPprogramswithmorethan13,000familiesin
approximately250counties.
270
Formoreinformation
onNFP,visithttp://www.nursefamilypartnerhip.
org.
ParentEmpowermentProgram
In1996,theChildProtectionCenteroftheDivision
of Community Pediatrics at Monteore Medical
Center in New York City initiated the Parent
EmpowermentProgram,asocialsupporteducational
interventiontargetedtosociallyisolatedandresource-
poorteenmothersintheSouthBronx.Teprogram
includeda6-monthparentinggroupthatfocused
onaccessingmedicalservicesandbuildingasocial
supportsystem.Practicesconsideredeectiveinthis
programincludedhomevisitationthathelpedbuild
rapportbetweencliniciansandtheyoungwomen,
aexibleparentingskillscurriculumthatcouldbe
modiedtomeetthepressingneedsofprogram
participants,andtheprovisionofimmediatemedical
andmentalhealthservices.
271
Formoreinformation
on the Parent Empowerment Program, visithttp://
montekids.org/programs/cpc.
ProjectSafeCare
From an ecobehavioral perspective, child neglect
isbestaddressedwithinthecontextofthefamily
environment. Project SafeCare has been tested
extensively to determine the key components of
eectiveinterventionwithparentsatriskofchild
maltreatment.Teprogramisamodiedversionof
themodel,Project12-Ways.Whereastheoriginal
projectcontained12areasofintervention,Project
SafeCare focuses on three areas that are particularly
relevant to neglect and young parents: home safety,
infant and child health care, and bonding and
stimulation.
Temodel,whichinvolves15weeksofintervention
with5weeksconcentratingoneacharea,isconducted
on a one-on-one basis with social workers or nurses
whooftenusevideos.Parentsaregiveninstructions,
viewmodelingofvariousskillsandactivities,and
practice these skills with feedback from an in-home
counselor.Sincechildneglectoftenisassociatedwith
dangerousoruncleanconditionsathome,parentsare
taughtaboutsafetyhazards,cleanliness,andcreating
asafeandcleanenvironmentforinfantsandchildren,
includingtheuseoflatchesandlocks.Teyalsoare
taughtspecictasks,suchasrecognizingwhenachild
isill,seekingemergencytreatment,callingthedoctor,
andself-treatinganillness.ProjectSafeCarealso
trainsparentstoincreasepositiveinteractionswith
theirinfantsorchildrenbylearningskillstostructure
activitiesandtoplanstimulatingplay,interactions,
anddailylivingactivities(e.g.,bathinganddressing).
Programevaluationdatahaveconsistentlyshown
that families served by Project SafeCare are at lower
riskforrecidivismduringandaftertreatmentthan
matched comparison families who also are involved
withCPSagenciesandwhoreceiveservicesother
than Project SafeCare.
272
For more information on
ProjectSafeCare,visithttp://www.cdc.gov/ncipc/
pub-res/parenting/ChildMalT-Brieng.pdf.
HeadStart,EarlyHeadStart,andtheEarlyHead
Start/ChildWelfareServicesInitiative
Head Start (HS) is designed to foster healthy
development in low-income children. Program
granteesanddelegateagenciesdeliverarangeof
services that are responsive and appropriate to each
childsandtoeachfamilysheritageandexperienceand
thatencompassesallaspectsofachildsdevelopment
andlearning.FormoreinformationaboutHeadStart,
visit http://www2.acf.dhhs.gov/programs/hsb.
EarlyHeadStart(EHS)promoteshealthyprenatal
outcomes, enhances the development of infants and
toddlers,andpromoteshealthyfamilyfunctioning.
For more information about Early Head Start, visit
theEarlyHeadStartNationalResourceCenterat
http://ehsnrc.org/.
Te Early Head Start/Child Welfare Services (EHS/
CWS)initiativeprovidesauniqueopportunityfor

a select group of EHS grantees, in partnership with
theirlocalCPS,todemonstratehowtoservechildren
inthechildwelfaresystembestusingtheEarlyHead
Startmodel.TeEHS/CWSinitiativewasestablished
throughapartnershipbetweentheHeadStartBureau
andtheChildrensBureau.TegoalofEHS/CWSis
to expand the service network in local communities
sothatitmeetstheneedsofthisuniquepopulation.
EHS/CSWtargetpopulationsvaryfromsitetosite.
Somegranteesserveinfantsandtoddlers,whileothers
may target only infants or only toddlers. Programs
mayalsochoosetofocusonchildreninthechild
welfaresystemwhoremainathome,butreceive
ongoingservices,childrenwhowereremovedfrom
thehomeandplacedinout-of-homecare,orchildren
inthechildwelfaresystembecausetheyareat-riskfor
abuseorneglect.Inaddition,programsmaychoose
tofocusonchildrenwhoseparentshavecertain
problems,suchasbeingincarceratedorbeingina
substanceabuserecoveryprogram.
Althougheachgranteeisdevelopingitsuniquetheory
ofchangeandalocallydesignedevaluation,most
EHS/CWSprojectsareaddressingoutcomeobjectives
thatincludesafety,permanency,andwell-beingfor
children.Manyofthegranteesalsohavedeveloped
evaluationplanstomeasureintermediateoutcomes
thatareexpectedtooccurpriortotheselonger-term
outcomes. Tese include improved parenting skills,
parent-childinteractions,andcopingstrategiesfor
dealingwithstress.
Whileeachofthegranteesisexpectedtoconduct
its own local evaluation and is being provided with
evaluation technical assistance, as necessary, the
Childrens Bureau is sponsoring an independent
evaluation of the initiative as well. For more
informationabouttheEHS/CWSinitiative,visit
http://www.ehsnrc.org/highlights/childwelfare.
htm.
LegalInterventionwithNeglectfulFamilies
Teinvolvementoflawenforcementandthecourtsoccurslessfrequentlywithneglectfulfamiliesthanin
casesofphysicalandsexualabuseand,therefore,isnotalwaysakeystep.Moreoften,theconfrontation
thatcomesfromtheneglectreportandtheCPSinvestigationissucienttomovethefamilytoward
neededchange.
273
Legalinterventionissometimesnecessary,however,toensurethesafetyoftheneglected
childandtobringabouttheneededchangesinthefamily.Formalconfrontationincourtofthefamilys
failuretomeetminimallyadequatestandardsofcaremaycreatethetensionnecessarytomovethefamily
towardprovidingadequatecareforthechildren.
CPScaseworkersmustbalanceanocial,authoritativestancewithahelperrole,whichrequiresthe
caseworkertoincorporatetheuseofconfrontationandchallengingskillswithempathyandsupportive
help.Aneglectfulfamilymustunderstandthatthecareofitschildisunacceptable,yetstillbeencouraged
bythecaseworkersreadinesstohelpthemimprove.
Inextremecasesofchildneglect,whenpersistentinterventioneortshavefailedtobringabouta
minimallyadequatelevelofcare,andthefamilysresponseoerslittlehopeofprovidingadequatecare,
courtactiontoterminateparentalrightsisnecessarytofreethechildforadoptionorotherpermanent
placement.TerminationproceedingsincourtrequiretheCPSorfostercarecaseworkertobeprepared
withfactualobservations,writtendocumentation,andwitnesses,ifavailable,toconvincethecourtofthe
wisdomandjusticeofthisaction.Tepresumptioninmostjuvenileandfamilycourtsisinfavorofthe
rightsofthebiologicalparent.Convincingevidencemustbepresentedtoprovethatparentalcareisless
thanminimallyadequate,likelytoremainso,andthatadoptionistheleastdetrimentalalternativeforthe
child.
274

CONCLUSION
Althoughchildneglectisthemostcommontype
of maltreatment,itscauses,eects,prevention,and
treatmentoftenarenotasprominentlydiscussedand
exploredasarethoseforphysicalorsexualabuse.
Neglect,likeothertypesofmaltreatment,hasmany
contributingfactorsattheindividual,familial,and
community levels. Te complexities of neglect
presentdicultiesnotonlyforanoverburdened
childwelfaresystem,butalsoforcommunity-and
faith-based programs, researchers, legislators, and
otherserviceproviders.Itiskey,therefore,thatthese
groupsworkcollaborativelytodeveloppromising
andeectivepracticesforpreventingneglectandfor
mitigatingitseectsonchildrenandsociety.Part
ofthisprocessisprovidingindividuals,families,and
communities with the knowledge, resources, and
servicestodealwiththechallengesassociatedwith
neglect.Childwelfareagenciescanonlyprovidea
partofthesolution.Neglectmustbeviewednotonly
asanindividualorafamilyproblem,butalsoasa
communityissuerequiringacommunityresponse.

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86 Endnotes

APPENDIX A
Glossary of Terms
AdjudicatoryHearingsheldbythejuvenileand
family court to determine whether a child has been
maltreatedorwhetheranotherlegalbasisexistsfor
theStatetointervenetoprotectthechild.
AdoptionandSafeFamiliesAct(ASFA)signed
intolawNovember1997anddesignedtoimprove
thesafetyofchildren,topromoteadoptionandother
permanent homes for children who need them, and
to support families. Te law requires CPS agencies
toprovidemoretimelyandfocusedassessmentand
interventionservicestothechildrenandfamiliesthat
areservedwithintheCPSsystem.
CASAcourt-appointedspecialadvocates(usually
volunteers) who serve to ensure that the needs
andinterestsofachildinchildprotectionjudicial
proceedingsarefullyprotected.
CaseClosuretheprocessofendingtherelationship
betweentheCPSworker andthefamilythat often
involvesamutualassessmentofprogress.Optimally,
casesareclosedwhenfamilieshaveachievedtheir
goalsandtheriskofmaltreatmenthasbeenreduced
oreliminated.
CasePlanthecaseworkdocumentthatoutlinesthe
outcomes,goals,andtasksnecessarytobeachievedin
ordertoreducetheriskofmaltreatment.
Case Planning the stage of the CPS case process
wheretheCPScaseworkerdevelopsacaseplanwith
thefamilymembers.
CaseworkerCompetencydemonstratedprofessional
behaviorsbasedontheknowledge,skills,personal
qualities,andvaluesapersonholds.
CentralRegistryacentralizeddatabasecontaining
information on all substantiated/founded reports
ofchildmaltreatmentinaselectedarea(typicallya
State).
Child Abuse Prevention and Treatment Act
(CAPTA)seeKeepingChildrenandFamiliesSafe
Act.
ChildProtectiveServices(CPS)thedesignated
socialservicesagency(inmostStates)toreceive
reports,investigate,andprovideinterventionand
treatment services to children and families in which
childmaltreatmenthasoccurred.Frequently,this
agencyislocatedwithinlargerpublicsocialservice
agencies,suchasDepartmentsofSocialServices.
Concurrent Planning identies alternative forms
ofpermanencybyaddressingbothreunicationor
legalpermanencywithanewparentorcaregiverif
reunicationeortsfail.
CulturalCompetenceasetofattitudes,behaviors,
and policies that integrates knowledge about groups
ofpeopleintopracticesandstandardstoenhancethe
qualityofservicestoallculturalgroupsbeingserved.
DierentialResponseanareaofCPSreformthat
oers greater exibility in responding to allegations

ofabuseandneglect.Alsoreferredtoasdualtrack
ormulti-trackresponse,itpermitsCPSagenciesto
responddierentiallytochildrensneedsforsafety,
thedegreeofriskpresent,andthefamilysneedsfor
servicesandsupport.Seedualtrack.
Dispositional Hearings held by the juvenile and
familycourttodeterminethelegalresolutionof
casesafteradjudication,suchaswhetherplacementof
thechildinout-of-homecareisnecessary,andwhat
services the children and family will need to reduce
theriskofmaltreatmentandtoaddresstheeectsof
maltreatment.
DualTracktermreectingnewCPSresponse
systems that typically combine a nonadversarial
service-basedassessmenttrackforcaseswherechildren
arenotatimmediateriskwithatraditionalCPS
investigativetrackforcaseswherechildrenareunsafe
oratgreaterriskformaltreatment.Seedierential
response.
EvaluationofFamilyProgressthestageofthe
CPScaseprocesswheretheCPScaseworkermeasures
changesinfamilybehaviorsandconditions(risk
factors), monitors risk elimination or reduction,
assessesstrengths,anddeterminescaseclosure.
FamilyAssessmentthestageofthechildprotection
process when the CPS caseworker, community
treatmentprovider,andthefamilyreachamutual
understandingregardingthebehaviorsandconditions
that must change to reduce or eliminate the risk of
maltreatment,themostcriticaltreatmentneedsthat
mustbeaddressed,andthestrengthsonwhichto
build.
FamilyGroupConferencingafamilymeeting
modelusedbyCPSagenciestooptimizefamily
strengthsintheplanningprocess.Tismodelbrings
thefamily,extendedfamily,andothersimportant
inthefamilyslife(e.g.,friends,clergy,neighbors)
togethertomakedecisionsregardinghowbestto
ensuresafetyofthefamilymembers.
FamilyUnityModelafamilymeetingmodelused
byCPSagenciestooptimizefamilystrengthsinthe
planningprocess.TismodelissimilartotheFamily
GroupConferencingmodel.
FullDisclosureCPSinformationtothefamily
regardingthestepsintheinterventionprocess,the
requirementsofCPS,theexpectationsofthefamily,
theconsequencesifthefamilydoesnotfulllthe
expectations,andtherightsoftheparentstoensure
thatthefamilycompletelyunderstandstheprocess.
GuardianadLitemalawyerorlaypersonwho
representsachildinjuvenileorfamilycourt.Usually
this person considers the best interest of the child
and may perform a variety of roles, including those
ofindependentinvestigator,advocate,advisor,and
guardianforthechild.Alaypersonwhoservesinthis
roleissometimesknownasacourt-appointedspecial
advocateorCASA.
Home Visitation Programsprevention programs
that oer a variety of family-focused services to
pregnant mothers and families with new babies.
Activitiesfrequentlyencompassstructuredvisitsto
thefamilyshomeandmayaddresspositiveparenting
practices, nonviolent discipline techniques, child
development,maternalandchildhealth,available
services,andadvocacy.
Immunityestablishedinallchildabuselawsto
protectreportersfromcivillawsuitsandcriminal
prosecutionresultingfromlingareportofchild
abuseandneglect.
Initial Assessment or Investigation the stage
of the CPS case processwheretheCPS caseworker
determinesthevalidityofthechildmaltreatment
report, assesses the risk of maltreatment, determines
ifthechildissafe,developsasafetyplanifneededto
assurethechildsprotection,anddeterminesservices
needed.
IntakethestageoftheCPScaseprocesswherethe
CPScaseworkerscreensandacceptsreportsofchild
maltreatment.
Interview Protocol a structured format to ensure
thatallfamilymembersareseeninaplannedstrategy,
88 Appendix AGlossary of Terms

that community providers collaborate, and that
informationgatheringisthorough.
JuvenileandFamilyCourtsestablishedinmost
States to resolve conict and to otherwise intervene
inthelivesoffamiliesinamannerthatpromotesthe
bestinterest ofchildren. Tesecourts specializein
areassuchaschildmaltreatment,domesticviolence,
juvenile delinquency, divorce, child custody, and
childsupport.
KeepingChildrenandFamiliesSafeActTe
KeepingChildrenandFamiliesSafeActof2003
(P.L.108-36)includedthereauthorizationofthe
ChildAbusePreventionandTreatmentAct(CAPTA)
in itsTitleI,Sec. 111. CAPTAprovidesminimum
standardsfordeningchildphysicalabuseandneglect
andsexualabusethatStatesmustincorporateinto
theirstatutorydenitionsinordertoreceiveFederal
funds.CAPTAdeneschildabuseandneglectasat
a minimum, any recent act or failure to act on the
partofaparentorcaretaker,whichresultsindeath,
serious physical or emotional harm, sexual abuse or
exploitation,oranactorfailuretoactwhichpresents
animminentriskofseriousharm.
KinshipCareformalorinformalchildplacement
bythejuvenilecourtandchildwelfareagencyinthe
homeofachildsrelative.
Liaisonthedesignationofapersonwithinan
organizationwhohasresponsibilityforfacilitating
communication, collaboration, and coordination
betweenagenciesinvolvedinthechildprotection
system.
Mandated Reporter individuals required by
Statestatutestoreportsuspectedchildabuseand
neglecttotheproperauthorities(usuallyCPSorlaw
enforcementagencies).Mandatedreporterstypically
includeprofessionals,suchaseducatorsandother
school personnel, health care and mental health
professionals,socialworkers,childcareproviders,and
lawenforcementocers.SomeStatesidentifyall
citizensasmandatedreporters.
Multidisciplinary Team established between
agenciesandprofessionalswithinthechildprotection
systemtodiscusscasesofchildabuseandneglect
and to aid in decisions at various stages of the CPS
caseprocess.Teseteamsmayalsobedesignatedby
dierentnames,includingchildprotectionteams,
interdisciplinaryteams,orcaseconsultationteams.
Neglect the failure to provide for the childs basic
needs. Neglect can be physical, educational, or
emotional.Physical neglectcanincludenotproviding
adequatefoodorclothing,appropriatemedicalcare,
supervision,orproperweatherprotection(heator
coats).Educational neglectincludesfailuretoprovide
appropriateschooling, special educationalneeds,or
allowing excessive truancies. Psychological neglect
includesthelackofanyemotionalsupportandlove,
chronic inattention to the child, exposure to spouse
abuse,ordrugandalcoholabuse.
Out-of-HomeCarechildcare,fostercare,or
residentialcareprovidedbypersons,organizations,
andinstitutions tochildrenwho areplacedoutside
their families, usually under the jurisdiction of
juvenileorfamilycourt.
Parens PatriaeDoctrineoriginatinginfeudal
England,adoctrinethatvestsintheStatearightof
guardianship of minors. Tis concept has gradually
evolvedintotheprinciplethatthecommunity,in
additiontotheparent,hasastronginterestinthecare
andnurturingofchildren.Schools,juvenilecourts,
and socialservice agencies allderive their authority
from the States power to ensure the protection and
rightsofchildrenasauniqueclass.
ParentorCaretakerpersonresponsibleforthecare
ofthechild.
PhysicalAbusetheinictingofanonaccidental
physicalinjuryuponachild.Tismayinclude,
burning,hitting,punching,shaking,kicking,beating,
orotherwiseharmingachild.Itmay,however,
havebeentheresultofover-disciplineorphysical
punishmentthatisinappropriatetothechildsage.

ProtectiveFactorsstrengthsandresourcesthat
appear to mediate or serve as a buer against risk
factorsthatcontributetovulnerabilitytomaltreatment
or against the negative eects of maltreatment
experiences.
Protocolaninteragencyagreementthatdelineates
jointrolesandresponsibilitiesbyestablishingcriteria
andproceduresforworkingtogetheroncasesofchild
abuseandneglect.
PsychologicalMaltreatmentapatternofcaregiver
behaviororextremeincidentsthatconveytochildren
that they are worthless, awed, unloved, unwanted,
endangered,oronlyofvaluetomeetinganothers
needs. Tis can include parents or caretakers using
extremeorbizarreformsofpunishmentorthreatening
or terrorizing a child. Te term psychological
maltreatment is also known as emotional abuse or
neglect,verbalabuse,ormentalabuse.
ResponseTimeadeterminationmadebyCPS
andlawenforcementregardingtheimmediacyofthe
responseneededtoareportofchildabuseorneglect.
Review Hearings held by the juvenile and family
courttoreviewdispositions(usuallyevery6months)
andtodeterminetheneedtomaintainplacementin
out-of-homecareorcourtjurisdictionofachild.
Riskthelikelihoodthatachildwillbemaltreated
inthefuture.
Risk Assessment to assess and measure the
likelihoodthatachildwillbemaltreatedinthefuture,
frequentlythroughtheuseofchecklists,matrices,
scales,andothermethodsofmeasurement.
Risk Factors behaviors and conditions present in
thechild,parent,orfamilythatwilllikelycontribute
tochildmaltreatmentoccurringinthefuture.
Safetyabsenceofanimminentorimmediatethreat
ofmoderate-to-seriousharmtothechild.
Safety Assessment a part of the CPS case process
inwhichavailableinformationisanalyzedtoidentify
whetherachildisinimmediatedangerofmoderate
orseriousharm.
SafetyPlanacaseworkdocumentdevelopedwhenit
isdeterminedthatthechildisinimminentorpotential
riskofseriousharm.Inthesafetyplan,thecaseworker
targetsthefactorsthatarecausingorcontributingto
the risk of imminent serious harm to the child, and
identies,alongwiththefamily,theinterventionsthat
willcontrolthesafetyfactorsandassurethechilds
protection.
SecondaryPreventionactivitiestargetedtoprevent
breakdownsanddysfunctionamongfamilieswho
havebeenidentiedasbeingatriskforabuseand
neglect.
Service Agreement the casework document
developedbetweentheCPScaseworkerandthefamily
thatoutlinesthetasksnecessarytoachievegoalsand
outcomesnecessaryforriskreduction.
Service Provision the stage of the CPS casework
processwhenCPSandotherserviceprovidersprovide
specicservicesgearedtowardthereductionofriskof
maltreatment.
SexualAbuseinappropriateadolescentoradult
sexualbehaviorwithachild.Itincludesfondling
a childs genitals, making the child fondle the
adultsgenitals,intercourse,incest,rape,sodomy,
exhibitionism,sexualexploitation,orexposureto
pornography.Tobeconsideredchildabuse,theseacts
havetobecommittedbyapersonresponsibleforthe
careofachild(forexampleababy-sitter,aparent,
oradaycareprovider)orrelatedtothechild.Ifa
stranger commits these acts, it would be considered
sexualassaultandhandledsolelybethepoliceand
criminalcourts.
Substantiated an investigation disposition
concludingthattheallegationofmaltreatmentorrisk
of maltreatment was supported or founded by State
laworStatepolicy.ACPSdeterminationmeansthat
credibleevidenceexiststhatchildabuseorneglecthas
occurred.
90 Appendix AGlossary of Terms

Treatmentthestageofthechildprotectioncase
processwhenspecicservicesareprovidedbyCPS
andotherproviderstoreducetheriskofmaltreatment,
supportfamiliesinmeetingcasegoals,andaddress
theeectsofmaltreatment.
Unsubstantiated (not substantiated) an
investigationdispositionthatdeterminesthatthereis
not sucient evidence under State law or policy to
concludethatthechildhasbeenmaltreatedoratrisk
of maltreatment. A CPS determination means that
credible evidence does not exist that child abuse or
neglecthasoccurred.

APPENDIX B
Resource Listings of
Selected National
Organizations Concerned
with Child Maltreatment
Listed below are several representatives of the many
nationalorganizationsandgroupsdealingwithvarious
aspectsofchildmaltreatment.Pleasevisithttp://
www.childwelfare.gov/pubs/usermanual.cfm to
viewamorecomprehensivelistofresourcesandvisit
http://www.childwelfare.gov/organizations/index.
cfmtoviewanorganizationdatabase.Inclusionon
thislistisforinformationpurposesanddoesnot
constituteanendorsementbytheOceonChild
AbuseandNeglectortheChildrensBureau.
CHILD WELFARE ORGANIZATIONS
AmericanHumaneAssociation(AHA)
ChildrensDivision
address: 63InvernessDr.,East
Englewood,CO80112-5117
phone: (800)227-4645
(303)792-9900
fax: (303)792-5333
e-mail: children@americanhumane.org
Website: www.americanhumane.org
Conductsresearch,analysis,andtrainingtohelp
publicandprivateagenciesrespondtochild
maltreatment.
AmericanProfessionalSocietyontheAbuseof
Children(APSAC)
address:

phone:

fax:
e-mail:
Website:
P.O.Box30669
Charleston,SC29417
(843)764-2905
(877)40A-PSAC
(803)753-9823
tricia-williams@ouhsc.edu
www.apsac.org
Providesprofessionaleducation,promotesresearch
toinformeectivepractice,andaddressespublic
policyissues.Professionalmembershiporganization.
AmericanPublicHumanServicesAssociation
(APHSA)
address:

phone:
fax:
Website:
810FirstSt.,NE,Suite500
Washington,DC20002-4267
(202)682-0100
(202)289-6555
www.aphsa.org
Addressesprogramandpolicyissuesrelated
totheadministrationanddeliveryofpublicly
fundedhumanservices.Professionalmembership
organization.

AVANCEFamilySupportandEducationProgram
address: 118N.Medina
SanAntonio,TX78207
phone: (210)270-4630
fax: (210)270-4612
Website: www.avance.org
Operatesanationaltrainingcentertoshareand
disseminateinformation,material,andcurriculato
serviceprovidersandpolicy-makersinterestedin
supportinghigh-riskHispanicfamilies.
ChildWelfareLeagueofAmerica(CWLA)
address: 440FirstSt.,NW
TirdFloor
Washington,DC20001-2085
phone: (202)638-2952
fax: (202)638-4004
Website: www.cwla.org
Providestraining,consultation,andtechnical
assistancetochildwelfareprofessionalsandagencies
whileeducatingthepublicaboutemergingissues
aectingchildren.
NationalBlackChildDevelopmentInstitute
address: 110115thSt.,NW
Suite900
Washington,DC20005
phone: (202)833-2220
fax: (202)833-8222
e-mail: moreinfo@nbcdi.org
Website: www.nbcdi.org
Operatesprogramsandsponsorsanationaltraining
conferencethroughHowardUniversitytoimprove
andprotectthewell-beingofAfrican-American
children.
NationalChildrensAdvocacyCenter(NCAC)
address: 210PrattAve
HuntsvilleAL35801
phone: (256)533-KIDS
fax: (256)534-6883
Website: http://www.nationalcac.org
Providesprevention,intervention,andtreatment
servicestophysicallyandsexuallyabusedchildren
andtheirfamilieswithinachild-focusedteam
approach.
NationalIndianChildWelfareAssociation
(NICWA)
address: 5100SWMacadamAve.,
Suite300
Portland,OR97239
phone: (503)222-4044
fax: (503)222-4007
e-mail: info@nicwa.org
Website: www.nicwa.org
Disseminatesinformationandprovidestechnical
assistanceonIndianchildwelfareissues.Supports
communitydevelopmentandadvocacyeortsto
facilitatetribalresponsestotheneedsoffamiliesand
children.
94 Appendix BResource Listings of Selected National Organizations Concerned
Adoption and Safe Families Act to ensure the safety
and well-being of children while meeting the needs
of families.
National Child Welfare Resource Center on Legal
and Judicial Issues
address: ABA Center on Children and
the Law
740 15th St., NW
Washington, DC 20005-1019
phone: (800) 285-2221 (Service Center)
(202) 662-1720
fax: (202) 662-1755
e-mail: ctrchildlaw@abanet.org
Web site: www.abanet.org/child
Promotes improvement of laws and policies aecting
children and provides education in child-related law.

NATIONAL RESOURCE CENTERS (NRCS)
National Child Welfare Resource Center for
Family-Centered Practice
address: Learning Systems Group
1150 Connecticut Ave., NW,
Suite 1100
phone:
fax:
e-mail:
Washington, DC 20036
(202) 638-7922
(202) 742-5394
info@cwresource.org
Helps child welfare agencies and Tribes use family-
centered practice to implement the tenets of the
Adoption and Safe Families Act to ensure the safety
and well-being of children while meeting the needs
of families.
National Child Welfare Resource Center on Legal
and Judicial Issues
address: ABA Center on Children and
the Law
740 15th St., NW
Washington, DC 20005-1019
phone: (800) 285-2221 (Service Center)
(202) 662-1720
fax: (202) 662-1755
e-mail: ctrchildlaw@abanet.org
Web site: www.abanet.org/child
Promotes improvement of laws and policies aecting
children and provides education in child-related law.
National Resource Center for Child Protective
Services
address: 925 #4 Sixth Street NW
Albuquerque, New Mexico 87102
phone: (505) 345-2444
fax: (505) 345-2626
e-mail: theresa.costello@
actionchildprotection.org
Web site: http://www.nrccps.org
Focuses on building State, local, and Tribal
capacity through training and technical assistance
in CPS, including meeting Federal requirements,
strengthening programs, eligibility for the CAPTA
grant, support to State Liaison Ocers, and
collaboration with other NRCs.
National Resource Center for Family-Centered
Practice and Permanency Planning
address: National Resource Center for
Family-Centered Practice and
Permanency Planning
Hunter College School of
Social Work
129 East 79th Street
New York, NY 10021
phone: (212) 452-7053
fax: (212) 452-7475
Web site: http://www.hunter.cuny.edu/
socwork/nrcfcpp/
Provides training and technical assistance and
information services to help States through all
stages of the CFSRs, emphasizing family-centered
principles and practices and helping States build
knowledge of foster care issues. Partners with the
Child Welfare League of America and the National
Indian Child Welfare Association to provide
training, technical assistance, and information
services.

NationalResourceCenteronDomesticViolence:
ChildProtectionandCustody
address: FamilyViolenceDepartment
NationalCouncilofJuvenile
andFamilyCourtJudges
P.O.Box8970
Reno,NV89507
phone: (800)527-3223
fax: (775)784-6160
e-mail: fvdinfo@ncjfcj.org
Website: http://www.ncjfcj.org/dept/
fvd/res_center
Promotesimprovedcourtresponsestofamily
violencethroughdemonstrationprograms,
professionaltraining,technicalassistance,national
conferences,andpublications.
PREVENTION ORGANIZATIONS
NationalAllianceofChildrensTrustand
PreventionFunds
address: 571230thAve.NE
Seattle,WA98105
phone: 206-526-1221
fax: 206-526-0220
e-mail: trafael@juno.com
Website: www.ctfalliance.org
AssistsStatechildrenstrustandpreventionfundsto
strengthenfamiliesandprotectchildrenfromharm.
PreventChildAbuseAmerica
address: 200SouthMichiganAve.
17thFloor
Chicago,IL60604-2404
phone: (800)835-2671(orders)
(312)663-3520
fax: (312)939-8962
e-mail: mailbox@preventchildabuse.org
Website: www.preventchildabuse.org
Conductspreventionactivitiessuchaspublic
awarenesscampaigns,advocacy,networking,
research,andpublishing,andprovidesinformation
andstatisticsonchildabuse.
COMMUNITY PARTNERS
TeCenterforFaith-BasedandCommunity
Initiatives
e-mail: CFBCI@hhs.gov
Website: www.hhs.gov/faith/
Welcomestheparticipationoffaith-basedand
community-basedorganizationsasvaluedand
essentialpartnerswiththeU.S.Departmentof
HealthandHumanServices.Fundinggoestofaith-
basedorganizationsthroughHeadStart,programs
forrefugeeresettlement,runawayandhomeless
youth,independentliving,childcare,childsupport
enforcement,andchildwelfare.
FamilySupportAmerica
(formerlyFamilyResourceCoalitionofAmerica)
address: 205WestRandolphStreet
Suite2222
Chicago,IL60606
phone: (312)338-0900
fax: (312)338-1522
e-mail: info@familysupportamerica.org
Website: www.familysupportamerica.org
Workstostrengthenandempowerfamiliesand
communitiessothattheycanfostertheoptimal
developmentofchildren,youth,andadultfamily
members.
NationalExchangeClubFoundationforthe
PreventionofChildAbuse
address: 3050CentralAve.
Toledo,OH43606-1700
phone: (800)924-2643
(419)535-3232
fax: (419)535-1989
e-mail: info@preventchildabuse.com
Website: www.nationalexchangeclub.com
Conductslocalcampaignsintheghtagainstchild
abusebyprovidingeducation,intervention,and
supporttofamiliesaectedbychildmaltreatment.
96 Appendix BResource Listings of Selected National Organizations Concerned

NationalFatherhoodInitiative
address: 101LakeForestBlvd.
Suite360
Gaithersburg,MD20877
phone: (301)948-0599
fax: (301)948-4325
Website: www.fatherhood.org
Workstoimprovethewell-beingofchildrenby
increasingtheproportionofchildrengrowingup
withinvolved,responsible,andcommittedfathers.
FOR THE GENERAL PUBLIC
ChildhelpUSA
address: 15757North78thSt.
Scottsdale,AZ85260
phone: (800)4-A-CHILD
(800)2-A-CHILD(TDDline)
(480)922-8212
fax: (480)922-7061
e-mail: help@childhelpusa.org
Website: www.childhelpusa.org
Providescrisiscounselingtoadultsurvivorsand
childvictimsofchildabuse,oenders,andparents,
andoperatesanationalhotline.
NationalCenterforMissingandExploited
Children(NCMEC)
address: CharlesB.WangInternational
ChildrensBuilding
699PrinceSt.
Alexandria,VA22314-3175
phone: (800)843-5678
(703)274-3900
fax: (703)274-2220
Website: www.missingkids.com
Providesassistancetoparents,children,law
enforcement,schools,andthecommunityin
recoveringmissingchildrenandraisingpublic
awarenessaboutwaystohelppreventchild
abduction,molestation,andsexualexploitation.
ParentsAnonymous
address: 675WestFoothillBlvd.,Suite220
Claremont,CA91711
phone: (909)621-6184
fax: (909)625-6304
e-mail: Parentsanonymous@
parentsanonymous.org
Website: www.parentsanonymous.org
Leadsmutualsupportgroupstohelpparentsprovide
nurturingenvironmentsfortheirfamilies.
FOR MORE INFORMATION
ChildWelfareInformationGateway
address: 1250MarylandAvenue,SW
EighthFloor
Washington,DC20024
phone: (800)394-3366
(703)385-7565
fax: (703)385-3206
e-mail: info@childwelfare.gov
Website: http://www.childwelfare.gov/
Collects,stores,catalogs,anddisseminates
informationonallaspectsofchildmaltreatment
andchildwelfaretohelpbuildthecapacityof
professionalsintheeld.AserviceoftheChildrens
Bureau.

APPENDIX C
State Telephone
Numbers for Reporting
Child Abuse
EachStatedesignatesspecic agenciestoreceive Statewherethechildisallegedlybeingabusedfor
and investigate reports of suspected child abuse and mostofthefollowingnumberstobevalid.
neglect.Typically,thisresponsibilityiscarriedoutby
ForStatesnotlisted,orwhenthereportingparty
childprotectiveservices(CPS)withinaDepartment
residesinadierentStatefromthechild,pleasecall
ofSocialServices,DepartmentofHumanResources,
Childhelp,800-4-A-Child(800-422-4453),oryour
orDivisionofFamilyandChildrenServices.Insome
localCPSagency.Statesmayoccasionallychangethe
States,policedepartmentsalsomayreceivereportsof
telephone numbers listed below. To view the most
childabuseorneglect.
currentcontactinformation,includingStateWeb
Many States have local or toll-free telephone addresses,visithttp://www.childwelfare.gov/pubs/
numbers,listedbelow,forreportingsuspectedabuse. reslist/rl_dsp.cfm?rs_id=5&rate_chno=11-11172.
Tereportingpartymustbecallingfromthesame
Alabama(AL) Delaware(DE) Indiana(IN)
334-242-9500 800-292-9582 800-800-5556
Alaska(AK) DistrictofColumbia(DC) Iowa(IA)
800-478-4444 202-671-SAFE(7233) 800-362-2178
Arizona(AZ) Florida(FL) Kansas(KS)
888-SOS-CHILD 800-96-ABUSE 800-922-5330
(888-767-2445) (800-962-2873)
Kentucky(KY)
Arkansas(AR) Hawaii(HI) 800-752-6200
800-482-5964 808-832-5300
Maine(ME)
Colorado(CO) Idaho(ID) 800-452-1999
303-866-5932 800-926-2588 800-963-9490(TTY)
Connecticut(CT) Illinois(IL) Massachusetts(MA)
800-842-2288 800-252-2873 800-792-5200
800-624-5518(TDD) 217-524-2606

Mississippi(MS)
800-222-8000
601-359-4991
Missouri(MO)
800-392-3738
573-751-3448
Montana(MT)
866-820-KIDS(5437)
Nebraska(NE)
800-652-1999
Nevada(NV)
800-992-5757
775-684-4400
NewHampshire(NH)
800-894-5533
603-271-6556
NewJersey(NJ)
877-652-2873
800-835-5510(TDD/TTY))
NewMexico(NM)
800-797-3260
505-841-6100
NewYork(NY)
800-342-3720
518-474-8740
800-369-2437(TDD)
Oklahoma(OK)
800-522-3511
Pennsylvania(PA)
800-932-0313
PuertoRico(PR)
800-981-8333
787-749-1333
RhodeIsland(RI)
800-RI-CHILD
(800-742-4453)
SouthCarolina(SC)
803-898-7318
SouthDakota(SD)
605-773-3227
Tennessee(TN)
877-237-0004
Texas(TX)
800-252-5400
512-834-3784
Utah(UT)
800-678-9399
Vermont(VT)
800-649-5285(afterhours)
Virginia(VA)
800-552-7096
804-786-8536
Washington(WA)
866-END-HARM
(866-363-4276)
800-562-5624(afterhours)
800-624-6186(TTY)
WestVirginia(WV)
800-352-6513
100 Appendix CState Telephone Numbers for Reporting Child Abuse

APPENDIX D
Neglect and the Child and
Family Services Reviews
AsaresultoftheSocialSecurityAmendmentsof1994,theU.S.DepartmentofHealthandHumanServices
developedandimplementedtheChildandFamilyServicesReview(CFSR),aresults-oriented,comprehensive
monitoringsystemdesignedtoassistStatesinimprovingoutcomesforchildrenandfamilieswhocomeinto
contactwiththeNationspublicchildwelfaresystems.AsofJune2005,alltheStates(andPuertoRicoand
theDistrictofColumbia)hadcompletedthersttwophasesstatewideassessmentandonsitereview-and
were engaged actively in the third, or Program Improvement Plan (PIP), phase. Several States have already
completedtheirPIPs.
1
BecausetheCFSRprocessisdesignedtopromotecontinuousqualityimprovement,all
Statesthatarenotinsubstantialconformityintheinitialreviewbeginafullreview2yearsaftertheapproval
oftheirPIPs.
Te purpose of the CFSRs is to enhance the goals of childrens safety, permanency, and well-being. Seven
outcomes, measured by 23 indicators or items, related to these three goals are assessed in the CFSR. Te
sevenoutcomesare:
SafetyOutcome1Childrenarerstandforemostprotectedfromabuseandneglect.
SafetyOutcome2Childrenaresafelymaintainedintheirhomeswhenpossible.
PermanencyOutcome1Childrenhavepermanencyandstabilityintheirlivingsituations.
PermanencyOutcome2Tecontinuityoffamilyrelationshipsandconnectionsispreserved.
Well-beingOutcome1Familieshaveenhancedcapacitytoprovideforchildrensneeds.
Well-beingOutcome2Childrenreceiveservicestomeettheireducationalneeds.
Well-beingOutcome3Childrenreceiveservicestomeettheirphysicalandmentalhealthneeds.
AsdiscussedthroughoutChild Neglect: A Guide for Prevention, Assessment, and Intervention,therearemyriad
challengesfacing familiesexperiencingneglect. ManyStatesalso experienced challengesintheireorts to
ensurethesafety,permanency,andwell-beingofchildrenwhoencounterthechildwelfaresystem.Toidentify
1
U.S.DepartmentofHealthandHumanServices,AdministrationforChildren,Youth,andFamilies(ACYF).(2005).Child and
Family Services Review Update[On-line].Available:http://www.acf.hhs.gov/programs/cb/cwrp/geninfo/cfsr_updates/jun05.htm.

these challenges, a content analysis was conducted on the CFSR nal reports for the 35 States participating
inaCFSRfromFY2002toFY2004.(StatesparticipatinginaCFSRinFY2001werenotincludedinthis
analysisbecausethenalreportsforthatyeardidnotusethesameformatforcontentrequirementsasreportsin
subsequentyears.)Tecontentanalysisfocusedonidentifyingchallengesthatwerecommonacrossthe35States
forspecicindicators.Achallengewasconsideredacommonchallengeifitwasrelevanttoapproximately
one-thirdofthe35participatingStates(or12States).
Withanemphasisonneglect,thefollowingtableexaminessomeofthechallengestoachievingseveralofthe
safety,permanency,andwell-beingoutcomesassociatedwiththeissuesdiscussedinthismanual.
CommonChallengesIdentiedwithRespecttoCFSRSafety,Permanency,andWell-beingIndicators
andNumberofStatesforWhichConcernsWereRelevantFY20022004
2
SafetyIndicators CommonChallenges
#(%)of
States
N=35
Timelinessof
investigations
Reportsthatarenotdesignatedhighpriorityoremergencyare
not being routinely investigated in accordance with established
timeframes.
12(34)
Repeatmaltreatment Maltreatmentallegationsonfamilieswithopenchildwelfarecases
arenotbeingreportedasnewallegations,andthereforethereis
noformalassessmentofthevalidityoftheallegation.
16(46)
Servicestofamiliesto
protectchildrenintheir
homesandprevent
removal
Agencyriskandsafetyassessmentsoftenarenotsuciently
comprehensive to capture underlying family issues, such as
substanceabuse,mentalillness,anddomesticviolence,thatmay
contributetomaltreatment.
22(63)
Teagencyisnotconsistentinprovidingservicestoensure
childrenssafetywhiletheyremainintheirownhomes(either
priortoorafterreunication).
18(51)
Riskofharmtochild Teagencyisnotconsistentinprovidingsucientservicesto
addressriskofharmtochildren,particularlyinthein-home
servicescases.
22(63)
Teagencydoesnotconsistentlymonitorfamiliestoassessservice
participationandchangesinriskfactors.
20(57)
2
U.S.DepartmentofHealthandHumanServices(ACYF).(2005).General ndings from the federal child and family services review
[On-line].Available:http://www.acf.hhs.gov/programs/cb/cwrp/results/statendings/genndings04/ch1.htm.
102 Appendix DNeglect and the Child and Family Services Reviews

PermanencyIndicators CommonChallenges
#(%)of
States
N=35
Re-entry Teagencydoesnothavesucientand/oradequatepost-
reunicationservices.
13(37)
Stabilityoffostercare
placements
Emergency shelters frequently are used for initial placements
andastemporaryplacementsafteradisruptionoccurs,even
foryoungchildren.
18(51)
Tere is a scarcity of appropriate placement options for
childrenwithdevelopmentaldisabilitiesorwithseverebehavior
problems.
19(54)
Teagencydoesnotconsistentlyprovideservicestofoster
parentstopreventplacementdisruptions.
21(60)
Tereislittlematchingofplacements.Placementstendtobe
basedonavailabilityratherthanonappropriateness.
21(60)
Permanencygoalforchild A case goal of long-term foster care often is established
withoutthoroughconsiderationoftheoptionsofadoptionor
guardianship.
15(43)
Concurrent planning eorts are not being implemented on a
consistentbasiswhenappropriate.
26(74)
Tegoalofreunicationoftenismaintainedfortoolonga
periodoftimebeforereconsideration.
24(69)
Teagencyisnotlingforterminationofparentalrights(TPR)
inatimelymannerandreasonsfornotlingarenotprovided
inthecaseles.
12(34)
Reunication,
guardianship,and
permanentplacement
withrelatives
Teagencyisnotconsistentinitseortstoprovidetheservices
toparentsorensureparentsaccesstotheservicesnecessaryfor
reunication.
18(51)
Adoption Teagencyisnotconsistentwithregardtoconductingadoption
home studies or completing adoption-related paperwork in a
timelymanner.
17(49)
TeappealsprocessforTPRdecisionsisextremelylengthy. 12(34)
Visitingwithparentsand
siblings
Te agency is not consistent in its eorts to ensure sucient
visitationamongsiblingsinfostercare.
18(51)
Preservingconnections Teagencyisnotconsistentinitseortstoensurethat
childrens connections to extended family are being preserved
whilechildrenareinfostercare.
19(54)
Relativeplacement Teagencyisnotconsistentwithregardtoseekingpaternal
relativesaspotentialplacementresourcesforchildrenentering
fostercare.

Well-beingIndicators CommonChallenges
#(%)
ofStates
N=35
Needsandservicesof
child,parents,foster
parents
Teagencyisnotconsistentinprovidingappropriateservicesto
meettheidentiedneedsofchildrenandparents.
31(89)
Teagencyisnotconsistentinconductingadequateassessments
todeterminetheneedsofchildren,parents,andfosterparents.
30(86)
Teagencyisnotconsistentinprovidingservicestosupport
fosterparentsorrelativecaretakers.
20(57)
Childandfamily
involvementincase
planning
Fathersarenotsucientlyinvolvedincaseplanning. 35(100)
Children,whoareofanappropriateage,arenotsuciently
involvedincaseplanning.
35(100)
Mothersarenotsucientlyinvolvedincaseplanning. 35(100)
Workersvisitwith
children
Tefrequencyofface-to-facecontactsbetweenworkersand
childrenisnotconsistentlysucienttoensurechildrenssafety
andwell-being.
27(77)
Whenestablishingface-to-facecontactswithchildren,workers
arenotconsistentlyfocusingonissuespertinenttocaseplanning
andachievinggoals.
14(40)
Workersvisitwithparents Tefrequencyofface-to-facecontactsbetweenworkersand
parents is not consistently sucient to ensure childrens safety
andpromoteattainmentofcasegoals.
34(97)
Teagencydoesnotmakeconcertedeortstoestablishcontact
with fathers, even when fathers are involved in their childrens
lives.
13(37)
Whenestablishingface-to-facecontactswithparents,workersare
notconsistentlyfocusingonissuespertainingtocaseplanning
andachievingcasegoals.
14(40)
Educational needs of the
child
Manychildreninfostercareexperiencemultipleschoolchanges
asaresultofplacementchanges.
20(57)
Teagencyisnotconsistentinprovidingservicestomeet
childrensneedswithrespecttoidentiededucation-related
problems.
18(51)
Physicalhealthofthe
child
Tenumberofdentists/doctorsintheStatewillingtoaccept
Medicaidisnotsucienttomeettheneed.
27(77)
Teagencyisnotconsistentinprovidingchildrenwithpreventive
healthanddentalservices.
14(40
Teagencyisnotconsistentinconductingadequate,timely
healthassessments.
13(37
Mentalhealthofthechild
Tereisalackofmentalhealthservicesforchildren. 25(71)
Teagencyisnotconsistentinconductingmentalhealth
assessments.
24(69)
Additional information on the CFSRs is available at: http://www.acf.hhs.gov/programs/cb/cwrp/
results.htm.
Appendix DNeglect and the Child and Family Services Reviews 104

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Child Neglect: A Guide for

Prevention, Assessment, and

In some respects, it is understandable why violence

Denitions of neglect vary among States and across

Instances of neglect are classied as mild, moderate,

Child Neglect: A Guide for Prevention, Assessment, and Intervention 11

12 Definition and Scope of Neglect

Exposure to hazards. Examples of exposure to

Other forms of inadequate supervision.

Trough the Child and Family Services Reviews

Research shows that the rst few years of childrens

Children who have experienced global neglect,

Child Neglect: A Guide for Prevention, Assessment, and Intervention 23

INTELLECTUAL AND COGNITIVE DEVELOPMENT

Amajorcomponent of emotionaland psychosocial

Child Neglect: A Guide for Prevention, Assessment, and Intervention 27

It is important to note that many poor families are

AsdiscussedinChapter2,Denition and Scope of

PARENT OR CAREGIVER FACTORS

Tis strongrelationshipbetween parentalsubstance

Because a lack of employment is related to so many

Children with special needs, such as those with

An alternate explanation for higher rates of

Child Neglect: A Guide for Prevention, Assessment, and Intervention 41

Many CPS agencies only screen in the most serious

INITIAL ASSESSMENT OR INVESTIGATION

FAMILY ASSESSMENT PROCESS

CPS caseworkers need sensitive interviewing and

STRUCTURED ASSESSMENT MEASURES

54 Assessment of Child Neglect

Carry out a comprehensive family assessment.

Cognitive restructuringreplacing self-

Child Neglect: A Guide for Prevention, Assessment, and Intervention 63

64 Child Neglect Prevention and Intervention

Formoreonoutcomesandinterventions,seeChild Protective Services: A Guide for Caseworkers athttp://

PROMISING PRACTICES FOR INTERVENTION

Although this study did not specically target

70 Child Neglect Prevention and Intervention

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