Child neglect: Definition and identification of youth's experiences in official reports of maltreatment

Abstract

Objective

The purpose of this study was to describe the nature of neglect in child welfare clients, to describe these experiences, to examine its typologies, and to understand how different types of neglect co-occurred with each other and with other types of maltreatment.

Methods

Case record abstraction was conducted on the child welfare case records of an urban, ethnically-diverse sample of youths (n = 303) identified as maltreated by a very large public child welfare agency. We utilized the Maltreatment Case Record Abstraction Instrument (MCRAI) which was based on the work of Barnett et al. (1993) as modified by English and LONGSCAN (1997). Thirteen items of parental behavior deemed neglectful were coded and organized into 5 subtypes of neglect (care neglect, environmental neglect, medical neglect, educational neglect, supervisory neglect).

Results

Neglect was present in 71.0% of the sample as compared to the 41.0% classified as neglected by CPS records. Neglect was accompanied by other types of maltreatment in 95% of the cases. Children who were neglected had more reports of maltreatment and experienced a greater number of different types of maltreatment than those who were maltreated, but not neglected. The most common type of neglect was supervisory neglect (72.5%) followed by environmental neglect (61.6%). With the exception of medical neglect, all types of neglect were significantly correlated with each other.

Conclusions

The abstraction resulted in rich data showing that under a one-word label of neglect, the nature of neglect that the youngsters actually experienced was quite diverse and heterogeneous in its phenomenology. Furthermore, neglect is pervasive for children in the child welfare system and official classifications underestimate its occurrence. Neglect does not happen in isolation; children who are reported as neglected are likely to experience other forms of maltreatment.

Practice implications

Official classifications should not be used in determining interventions for children and families. Interventions for neglected youngsters should be individualized to address the complexity of children's experiences.

Introduction

Child neglect is the most common type of maltreatment in the USA. Recent data indicate that of the over 794,000 substantiated victims of child maltreatment in 2007, 59.0% of them were victims of neglect (US Department of Health and Human Services, 2009). In spite of neglect being the most common type of maltreatment, much less is known about it than other types of maltreatment. Research has been weighted toward the study of sexual abuse with physical abuse having a smaller but growing representation (Mayer, Lavergne, Tourigny, & Wright, 2007).

There are many reasons for this “neglect of neglect” as it has often been called (Dubowitz, 2007, Wolock and Horowitz, 1984) but among them are the consistent difficulties related to definition. Research has often relied on the legal definition of neglect which may vary by jurisdiction. The Child Abuse Prevention and Treatment Act as amended by the Keeping Children and Families Safe Act of 2003 defines child abuse and neglect as “at a minimum, any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation or an act or failure to act which presents an imminent risk of serious harm” (US Department of Health and Human Services, 2003). Only sexual abuse and “withholding of medically indicated treatment” are defined in the statute leaving the definition of neglect (as well as physical abuse and emotional abuse) up to the individual states. In California, the site of the current study, neglect is defined by the failure of a parent or caretaker to provide for a child's needs. The results of the failure are what determine the designation of neglect. A case is considered general neglect if no physical injury results and severe neglect when the child's health is endangered (Legislative Analysts Office, 1996). In contrast, the neighboring state of Arizona considers caretaking omissions as neglect only when it causes substantial risk of harm to the child (US Department of Health and Human Services, 2009). Thus a parent could be identified as having neglected her child in California while not meeting the Arizona definition. Medical neglect and educational neglect are specified in most states, although the exact definition differs. Abandonment of a child is an explicit category in some states while in others it is categorized under neglect (US Department of Health and Human Services, 2009). Similarly, the age that a child may be left alone varies by jurisdictions meaning that a parent's actions could be defined by one state as lack of supervision but not in another. Thus the official definitions do not tell us much about a child's actual experience.

Also complicating the issue of neglect is that unlike physical and sexual abuse where overt acts are committed against a child, neglect is most often the omission of caretaking behavior that a child needs for healthy development. There is less societal agreement on whether these caretaking omissions rise to the level of severity that would require child welfare authorities to intrude in the life of a family. In addition, cultural expectations help determine expectations of appropriate parenting leading to different definitions of what is neglectful behavior (Elliott & Urquiza, 2006). The high correlation between poverty and neglect adds another complication which many believe implicates society as well as parents in the maltreatment of children (Drake and Pandey, 1996, Polansky, 1985).

If researchers and practitioners are to understand the consequences of neglect on children's development, there will need to be much more specificity about the concept of neglect and the different experiences that constitute neglect. Very dissimilar experiences are categorized as neglect. For example, if a mother leaves a child home alone while she is working to earn enough money to adequately feed her children, she will be guilty of neglect, just as a mother who lives in a dirty rat infested home without sufficient food for the children. Clearly, the two experiences are very different and likely to have very different outcomes for the child.

Experts in the field of child maltreatment have tried to deal with this problem by developing categories of neglect that group children's experiences into broader subtypes. Dubowitz, Pitts, and Black (2004) suggested three subtypes of neglect: physical, psychological, and environmental. Slack, Holl, Altenbernd, McDaniel, and Stevens (2003) also postulate three subtypes of neglect: physical, mental health, and cognitive, however their subtypes are somewhat different than Dubowitz's. Emotional, cognitive, supervision, and physical neglect are the subtypes proposed by Kaufman Kantor et al. (2004). Knutson, DeGarmo, and Reid (2004) articulated denial of care neglect and supervisory neglect noting that medical neglect was often categorized under denial of care neglect and educational neglect, which they classified under supervisory neglect, was seldom the focus of CPS investigations. Later, they expanded what they now called care neglect to include what others have called environmental neglect (Knutson, DeGarmo, Koeppl, & Reid, 2005). Erickson and Egeland (2002) propose 5 types: physical neglect, emotional neglect, medical neglect, mental health neglect, and educational neglect. While there are similarities among the subtypes, there is still not consensus on what these subtypes should be. Some have included the subtypes of mental health neglect, psychological neglect, and emotional neglect under psychological maltreatment or emotional abuse (Brassard and Donovan, 2006, Trickett et al., 2009).

A number of researchers have tried to deal with these issues by more clearly explicating categories of maltreatment by gathering data about children's reports from official records and developing categories based on those reports. One of the most important of these is Barnett, Manly, and Cicchetti's (1993) work that categorized maltreatment reports by subtype, severity, and developmental period. The Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) research team modified this system in their work to include more specificity about subtype and severity (English and LONGSCAN, 1997, English et al., 2005). The types in their definition schema are physical abuse, sexual abuse, physical neglect, emotional maltreatment, and moral/legal/educational maltreatment. Under neglect, they included failure to provide (i.e., food, clothing, shelter, medical care) and lack of supervision (i.e., inadequate supervision, failing to ensure that a child is engaged in safe activities). The purpose of this paper was to use the Barnett et al. (1993) system as modified by English and LONGSCAN (1997) as well as the Knutson et al. (2005) schema to describe the nature of the reports of neglect in a sample of urban maltreated children. Specifically our questions were:

• What percentage of this sample is classified as neglected at the time of referral to our study? Are males and females and members of different ethnic groups equally likely to be neglected?

• When the full case records of these youth are examined, what percentage of this sample is identified as neglected? Are males and females and members of different ethnic groups equally likely to be neglected?

• In this sample, what is the nature of these neglectful experiences? What is the frequency of occurrence of the different subtypes? What are the relationships among the subtypes? What is the co-occurrence of the different subtypes of neglect with other types of maltreatment (e.g., physical, sexual, emotional abuse)?