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Child Care in Practice Vol. 17, No. 2, April 2011, pp. 103Á113
Lest We Forget: Remembering the Consequences of Child Neglect A Clarion Call to ‘‘Feisty Advocates’’
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Dominic McSherry
It is widely acknowledged that, across the United Kingdom and the USA, childcare practitioners often struggle with cases of child neglect, because of the difficulties involved in attempting to define the problem at hand, and balancing these cases with others in the caseload that may appear more pressing, such as physical abuse. Consequently, in an attempt to refocus the lens of professional policy and practice, this article will profile a number of research studies that have highlighted the profound developmental deficits that neglect can cause, relative to other forms of child maltreatment, and a range of interventions that have proven to be effective with these types of cases. The article concludes with a discussion of the potential negative impact of the current financial crisis for neglected children. Introduction Social policy in the United States continually understates the consequences of child neglect when constructing legal and social interventions for neglected children. Instead, policy is driven by the more emotionally charged problems of child abuse (Gelles, 1999). Rose and Meezan (1996) found that foster care workers viewed neglect less seriously than Child Protection Service (CPS) workers, and that both of these groups rated neglecting behaviours as being less serious compared with laypersons from the community at large. It was argued that this difference may be explained by the perceived seriousness of child abuse compared with the less obvious harm of neglect. A similar picture has also emerged within the United Kingdom. Several commentators (Minty & Pattinson, 1994; Stevenson, 1996; Stone, 1998) have argued that social workers often underestimate the seriousness of neglect, in spite of the large
Dr Dominic McSherry is Senior Research Fellow at Queen’s University, Belfast. Correspondence to: Dominic McSherry, Queen’s University, Institute of Child Care Research, 6 College Park, Belfast BT7 1LP, UK. Email: dominic.mcsherry@qub.ac.uk ISSN 1357-5279 print/1476-489X online/11/020103-11 # 2011 The Child Care in Practice Group DOI: 10.1080/13575279.2010.541426
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body of evidence that suggests that neglect may lead to major developmental deficits and may increase the risk of the child being injured or even killed. Minty and Pattinson (1994) pointed out that a significant number of child fatalities have been attributed to parental/caregiver neglect, and that professionals had failed to recognise the risk posed to these children, even in cases of severe neglect (see Department of Health, 1991). Research from the Republic of Ireland suggests that social workers are either ‘‘overwhelmed’’ by the enormity of problems presented by neglecting parents, or are ‘‘underwhelmed’’ to the extent where the behaviour of these neglecting parents becomes normalised (Buckley, 2002). The reasons for this ‘‘neglect of neglect’’ have recently been examined by McSherry (2007) and Dubowitz (2007), and appear to be reflective of a range of interrelated issues, such as the difficulties that tend to be associated with defining, substantiating, and prioritising child neglect. These issues, in turn, are related to a widespread deterministic perspective that neglect is an inevitable by-product of families living in poverty, and a tendency to see any positive dimension of a child neglect case as precluding the necessity for intervention, particularly in the context of ever increasing rate of referrals, and the subsequent growing pressure upon social service resources to meet this need (McSherry, Iwaniec, & Larkin, 2004). Given that there appears to be a general misunderstanding or underestimation of the consequences of child neglect by practitioners, both within the United States and the United Kingdom, this article will profile a number of research studies that have highlighted the profound developmental deficits that neglect can cause, relative to other forms of child maltreatment, and a range of interventions that have proven to be effective with these types of cases. This is particularly important given the current world financial crisis, and the acute strains that are being placed upon health and social care budgets both in the United States and the United Kingdom, and the particular concerns that this raises in relation to dealing effectively with child neglect. Cognitive Developmental Problems Over 20 years ago, Egeland, Sroufe, and Erickson (1983) carried out a longitudinal study of 267 motherÁinfant pairs deemed to be at high risk of neglect. They found that children who were neglected had higher performance deficits on a range of tasks at both 42 and 56 months than a control group and even than other maltreated (physically or sexually abused) children. By early school age it was found that the neglected group was exhibiting deficits in cognitive performance, academic achievement, classroom behaviour and social interactions. In further work, Egeland (1991) also found that by the second grade (ages seven to eight) every neglected child was involved in some special educational programme. The neglected children demonstrated greater developmental problems than any other maltreated groups. Similarly, Eckenrode, Laird, and Doris (1993) found that neglected children, when compared with children who had been physically or sexually abused, had the poorest school performance for Grade K (ages three to four) through Grade 12 (ages 15Á16).
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The developmental course of neglected children through school and the possible developmental effects of neglect alone and also neglect in conjunction with abuse were examined by Kendall-Tackett and Eckenrode (1996). They selected a group of 420 maltreated children using the records of the New York State Child Abuse and Maltreatment Register. These included children who had been neglected, physically abused and sexually abused. A comparison group of 420 non-maltreated children was selected from the general population of school children. The two groups were matched on gender, type of school attended, grade in school, residential location and classroom. The maltreated group was further divided into two smaller groups. These were: the ‘‘neglected only’’ group, which incorporated those children who had experienced only neglect and no other form of maltreatment (217 children); and the ‘‘neglect with abuse’’ group, which included those children who had also experienced physical (56 children) and sexual (51 children) abuse. Results demonstrated that neglected children were not performing academically as well as their non-maltreated peers. Furthermore, neglect alone was found to be just as damaging to school performance and number of suspensions as was neglect in combination with physical and sexual abuse. However, it was found that the children who had experienced the combination of abuse and neglect had a higher incidence of disciplinary referrals and grade repetition. A similar study by Kurtz, Gaudin, Wodarski, and Howling (1993) compared the school performance of three groups of school-age children and adolescents. These groups were: neglected (n047), physically abused (n022) and non-maltreated (n070) children. Assessment took place at three intervals with an initial assessment early in the study, followed up after six months and then one year. School performance was assessed in terms of academic achievement, socio-emotional development, adaptive behaviour in functional areas of motor development, personal living skills and community orientation. Five data sources were utilised. These were: teachers, parents, the children themselves, school records and child protective service caseworkers. It was found that both abused and neglected children scored lower than comparisons (nonmaltreated) on overall school performance over time. Both groups of maltreated children had significantly lower scores on the language and mathematics sections of the Iowa Test of Basic Skills than the comparison group. A key finding was that academic deficits were particularly evident with neglected children. For example, when assessed after six months, performance by the neglected children placed them on the 29th percentile for language skills and the 28th percentile for maths skills. Abused children, however, were placed at the 44th and 42nd percentiles and nonmaltreated children at the 67th and 73rd percentiles, respectively. Teacher reports confirmed that neglected children were working and learning at below average levels compared with their peers. One reason for this poor performance may be related to school absence. Kurtz et al. (1993) found that rate of absence for the neglect group was almost five times that of the non-maltreated group. It was also found that neglected children tended not to display any serious behavioural or school adjustment problems in the classroom and did not differ from
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the comparison group on any socio-emotional measure. However, they cautioned that further work is necessary before assuming that neglected children are socioemotionally resilient. They concluded that the unavailable, neglectful parent presents a direct threat to the intellectual development of the child. Low educational aspirations, lack of encouragement for learning, a paucity of language stimulation, non-participation in school activities, and unresponsiveness to the child’s achievements all undermine school success. (p. 588)
De Paul and Arruabarrena (1995), working in Spain, compared 17 physically abused, 24 physically neglected and 25 low-risk comparison children in terms of academic achievement. They found that both physically abused and neglected children presented lower levels of academic performance and adaptive functioning relative to non-maltreated comparisons. However, they found that the neglected children demonstrated the greatest academic delay. English (1998) argued that maltreatment behaviours associated with ongoing neglect typically result not in a discrete injury, but in cumulative harm. Gaudin, Polansky, Kilpatrick, and Shilton (1996) remarked that it is no surprise neglected children suffer academically given that neglect may occur over a long period of time and intellectual development is heavily dependent upon the ongoing quality of parentÁchild interaction. Similarly, Leiter and Johnsen (1994) suggested that neglected children suffer from learning deficits as a result of their parents’ unwillingness to provide a stimulating environment for the child, to read to them, to supervise their homework, or to be involved in their academic life in any way. Psychological Problems The effects of reported neglect and physical abuse on the severity of symptomatology were examined by Gauthier, Stollack, Messe, and Aronoff (1996). Five hundred and twelve (276 female/236 male) undergraduate psychology students from Michigan State University completed questionnaires on their childhood environment and current functioning. It was found that neglect was significantly related to the extent of psychological problems and relational difficulties experienced. Those individuals who were considered to have experienced neglect were increasingly likely to have reported current problems in relation to anxiety, depression, somatisation, paranoia and hostility compared with those who reported physical abuse. These results suggest that neglect (or more specifically memories of such experiences) may be a stronger predictor of certain aspects of psychological dysfunction in adulthood than physical abuse. It was argued that one reason physical neglect may be so harmful to children’s development is because it involves a lack of mutual interaction between the child and caretaker, the attachment relationship, which has been recognised as critical to healthy development for some time (Bowlby, 1969). Similarly, Ney, Fung, and Wickett (1994) found that emotional neglect may be more closely related to the development of psychiatric illness in later life than any other form of maltreatment.
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Fatality Obviously, the worst consequence of all is when neglect results in the child’s death. Lung and Daro (1996) carried out a survey of 26 states in the United States that specify the type of maltreatment associated with child fatalities. They found between 1993 and 1995 that 37% of maltreatment-related child fatalities were caused by neglect, with 48% caused by abuse, and 15% resulting from a combination of both neglect and abuse. Furthermore, the NCPA (1998) reported that 1185 child deaths related to child abuse and neglect were confirmed by CPS agencies, with 44% of these resulting from neglect. Given that research has indicated that the damage neglect can inflict upon children is often underestimated at both the levels of policy and practice, the preceding studies are an important reminder of the potentially devastating developmental consequences for children of being raised in a neglectful family. This, in turn, highlights the need for effective intervention and prevention in these cases. Intervention and Prevention The complexity of child neglect, with its many forms and its intergenerational pervasiveness, suggests that a comprehensive and multifaceted approach to prevention may be required. Gaudin (1993) pointed out that in order to change a pattern of neglect it is important to address the causes rather than the symptoms. It was also suggested that understanding the interaction of stressful life events, lack of environmental support, and deficits in personal resources should be the first step towards developing an intervention plan. Black and Dubowitz (1999) argued that investigations of the causes and consequences of child neglect ought to be theory-driven. It was suggested that single-factor, atheoretical investigations are highly unlikely to contribute to our understanding of the complex factors that have been associated with the causes and consequences of child neglect. Burke, Chandy, Dannerbeck, and Watt (1998) noted that, due to the difficulty that has been experienced when attempting to establish the causes of neglect, no comprehensive systemic theories have been developed and tested across studies to understand the pattern of neglectful behaviour. Consequently, they constructed a conceptual model of neglectful behaviour that views neglect as a parental behaviour that is related to a number of factors in the parenting environment, and which traces parental behaviour to its impact on the well-being of the child. They argued that neglect constitutes ‘‘deficits or omissions in the parental role performance related to inadequate use of the parental environment that result in a serious threat to or observable decline in the well-being of the child’’ (Burke et al., 1998, p. 394). Burke et al. (1998) defined the parental environment at both the individual and family levels. At the individual level, it was noted that a number of studies have shown neglectful parents often exhibit low levels of socialisation, high levels of boredom and depression, and high rates of substance abuse (Albert & Barth, 1996; US Department of Health and Human Services, 1998; Zuravin, 1988). At the family level,
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it was observed that there appears to be an increased risk of neglect if the family is single rather than dual parent, with an 87% greater likelihood of neglect occurring within single parent families (US Department of Health and Human Services, 1998). On the basis of the research evidence, Burke et al. (1998) developed a model of child neglect, with three clusters of factors in the parental environment affecting parental ability to create and maintain an environment conducive to child well-being. These are: . A parental skills cluster that incorporates factors directly related to the knowledge and skills that the parents need to perform care functions for their children. . A social support cluster that deals with issues such as feelings, perceptions and relationships and the way these may have a bearing upon the occurrence of child neglect. . A resource management cluster that focuses upon the parental relationship with the outside world and address the functional capacity of parents to utilise their environment. A number of comprehensive intervention schemes have been initiated to prevent the occurrence or re-occurrence of child neglect. Over 20 years ago, Lutzker, Frame, and Rice (1982) developed an eco-behavioural approach to treating child neglect, named Project 12-ways. The project provided 15 different services, to abusive and neglectful families in rural Southern Illinois, which were based upon individual or family needs. These included: parentÁchild training, stress reduction, assertiveness training, substance abuse treatment, and assistance finding employment. Wiehe (1996) argued that evaluative research has established the effectiveness of Project 12-ways. It was noted that the programme has been found to break into families’ intergenerational cycle of neglect, thereby preventing a continuation of this pattern of child maltreatment. Wiehe suggested that, although the programme was very costly, these costs ought to be considered reasonable given the programme’s positive impact upon the behaviour of neglecting parents. According to Ethier, Couture, Lacharite, and Gagnier (2000), one of the fundamental problems in child neglect intervention is that many of the programmes directed at reducing neglect have tended to focus on a single form of problematic parental behaviour. They carried out a study, which evaluated and compared the short-term effects of two types of intervention that were applied to families at high risk of neglect. The study was developed from the Personal Family and Community Help Programme (PFCHP) (Palacio-Quinton, Ethier, Jourdan-Ionescu, & Lacharite, 1994): an intervention programme that addressed multiple dimensions of child neglect. This programme had two aims: first, to reduce maltreating behaviours and enhance parental competencies; and second, to reduce debilitating conditions such as social isolation, parental stress, depression and relational problems, thus making the family environment more receptive to appropriate parental behaviours. The programme was initially designed for maltreating families in general but was adapted by Ethier et al. (2000) to specifically address families at risk of neglect.
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There were four main aspects to the PFCHP programme: . Home visiting family assistance, which was aimed at improving integration of the target family within the social environment. . Group meetings for parents, which focused upon relational and parental competency. . Stimulating the child through educational activities so as to enhance their language, cognition and social skills. . Individual counselling offered to each family by their social worker. This was intended to complement other aspects of the programme and was provided on demand. The clinical team involved in implementing the PFCHP programme included a social worker, the parents, a group counsellor and two members of the research team. The team formulated and coordinated individualised objectives. Team meetings were held every two weeks and the whole programme lasted 18 months. Ethier et al. (2000) compared the PFCHP program (n 015) with a more conventional treatment scheme provided by social services in a typical Quebec Local Community Services Centre (LCSC) setting (n 014). Unlike the PFCHP approach, which is multidimensional, LCSC assistance is more concerned with psychosocial intervention and is aimed at improving parental skills and the parentÁchild relationship along with making referrals to appropriate community services. For the most part, meetings with the social worker occurred every two weeks. In the study sample of those using LCSC assistance, intervention lasted between 12 and 20 months with a mean of 16.3 months. All families were recruited through a LCSC. Three criteria for inclusion in the study were; the presence of at least four risk factors; the family not having been the subject of a previous investigation by the Youth Protection Services; and at least one child under the age of six. From the quantitative analyses that were carried out, it was found that both types of intervention were equally associated with improved family situations. Regardless of whether the programme was eco-systemic or psychosocial, parents were making demonstrable progress after 24 months. For example, parental stress, level of depression and potential for child abuse and neglect had all decreased. Furthermore, satisfaction with the social network had significantly improved. However, despite these advances, parents still remained vulnerable, for although parental stress did decrease significantly, it still remained at a high level. The results also indicated that there was a marked variance between the two types of intervention programmes in relation to the social support network. The PFCHP participants did not seek as much help from professionals or their children, relying more upon friends and members of their family. In contrast, LCSC participants were turning to their children for support. The danger of this type of role reversal is that the parent’s expectations may reach far beyond the child’s capacity for support, thus creating risk of abuse and neglect through parental frustration at the child’s inability to provide support and the increasing emotional stress placed upon the child. Results also suggested that both types of intervention were equally effective in reducing the
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risk of child neglect, but the PFCHP programme was more effective at improving the mother’s relationship with her environment. Results also suggested that the mothers in the PFCHP group were more involved in their children’s activities and were better at applying discipline. They also seemed to be doing better in terms of their marital relationships, social networks and self-improvement. For example, it was found that mothers in the PFCHP group were more likely to terminate an abusive relationship and were also more likely to go back to work or school. Yuan and Struckman-Johnson (1991) looked at the family preservation services offered through eight demonstration projects in California and found that they were less successful with chronically neglecting families than with other forms of maltreatment. They observed that out-of-home placement occurred with 27% of the neglected families, in spite of the services that were provided, whereas the same could only be said for 12% of the children who were at risk of placement for other reasons. Despite these findings, Olds and Kitzman (1993) argued that intensive and comprehensive home visitation prevention programmes are effective in improving the behaviour of parents at risk of inflicting abuse and neglect, improving the home environment and reducing child behavioural difficulties. There is also some evidence that the benefits resulting from home visitation programs are durable. Olds et al. (1997) carried out a long-term follow-up of a relatively intense nurse visitation programme and found that, over a 15-year period, comparison mothers were nearly twice as likely to be reported for child abuse or neglect than the high-risk mothers who participated in the programme. More recently, Olds (2006) commented that longer-term outcomes are best for the most deprived and at-risk families. A ‘‘nurseÁfamily partnership’’ model, based on that developed by Olds, is being implemented and evaluated across 10 English Primary Care Trusts, and the early indicators from the families involved are positive (Barnes et al., 2008; Barnes, Ball, Meadows, Belsky, & FNP Implementation Research Team, 2009). English (1999) argued that community-based support services may be the most appropriate intervention for lower-risk, non-chronic neglect situations, given that neglect appears more to do with inadequate parenting skills and knowledge and other caregiver deficits. The suggestion is that in-home specialists, such as home health nurses who can model parenting skills, may be more effective than the types of services routinely offered by CPS workers. However, high-risk cases of neglect, such as the presence of substance abuse or domestic violence may be more appropriately addressed by the more intrusive CPS, which can invoke legal intervention to protect the child if necessary. Conclusion This review has been written as a call against complacency. As has been the case for the last number of decades in the United States, approximately two-thirds of families in the child protection system are there due to neglect (US Department of Health and Human Services, 2006). Across the United Kingdom (Northern Ireland, Scotland, England, and Wales), levels are lower at between 45 and 50% (Data Unit
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Wales, 2009; DCSF, 2009; DHSSPS, 2009; Scottish Government, 2009), but still high relative to physical, sexual, and emotional abuse. In essence, these figures refer to tens of thousands of children, year on year. The studies highlighted in this review have re-illustrated the detrimental impact upon children who experience parental neglect, particularly in terms of its impact upon the development of cognitive functioning, which inhibits positive school performance, and which is so critical for future life opportunities for these children and their own children. But it is not a pessimistic perspective. The range of interventions specified illustrate that these problems are not insurmountable, and that comprehensive support and monitoring programmes can be very effective at improving the quality of the parenting of neglecting (or high-risk) parents, and the quality of life of their children. However, these interventions are by nature expensive, and we are living in increasingly challenging financial times. Across the United Kingdom, the current financial crisis is placing enormous strain upon governmental health and social care budgets, belts are being tightened, and the assumption is that similar processes are occurring in the United States. This type of fiscally pressurised scenario presents as ominous for children experiencing parental neglect, as experience has shown time and time again that, when push comes to shove, child protection agencies will prioritise abuse to the detriment of neglect (English, 1998). How might these challenges be overcome? Dubowitz (2007, p. 606) comments that in order to address the ‘‘neglect of neglect’’, ‘‘there is a need for feisty advocates for systemic changes in priorities, policies, and programs to better support families and to help ensure children’s basic needs are met’’. Clearly, there is potential for the current financial crisis to exacerbate the ‘‘neglect of neglect’’. Consequently, ‘‘feisty advocates’’ are desperately required within social service departments, at all levels, within governmental and non-governmental organisations, and within the academic community. People who are prepared to lobby and argue the case for neglected children, who can present an informed perspective on the necessity to ensure that sufficient resources are directed at the prevention of child neglect, for example through general and targeted community support programmes, and the provision of intensive supports for children who have experienced parental neglect, particularly in terms of addressing deficits in cognitive development. This review is a stark reminder to us all that there are tens of thousands of good reasons to start getting feisty. References
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Black, M.M., & Dubowitz, H. (1999). Child neglect: Research recommendations and future directions. In H. Dubowitz (Ed.), Neglected children: Research, practice and policy (pp. 261Á 277). Thousand Oaks, CA: Sage Publications. Bowlby, J. (1969). Attachment and loss. New York: Basic Books. Buckley, H. (2002). Child protection and welfare: Innovations and interventions. Dublin: Institute of Public Administration. Burke, J., Chandy, J., Dannerbeck, A., & Watt, J.W. (1998). The parental environment cluster model of child neglect: An integrative conceptual model. Child Welfare, 77(4), 389Á405. Data Unit Wales. (2009). Child protection statistics. Gwion: Data Unit Wales Dissemination Tool. DCSF. (2009). Referrals, assessment, and children and young people who are the subject of a child protection plan, England*year ending 31st March 2009. London: Department for Children, Schools and Families. Department of Health. (1991). Child abuse: A study of inquiry reports 1980Á1989. London: HMSO. De Paul, J., & Arruabarrena, M.I. (1995). Behaviour problems in school-aged physically abused and neglected children in Spain. Child Abuse and Neglect, 19(4), 409Á418. DHSSPS. (2009). Children order statistical bulletin 2008. Belfast: Northern Ireland, Department ´´ ´ ´ of Health, Social Services, and Public Safety. An Roinn Slainte, Seirbhısı Soisialta agus ´ ´ ´ Sabhailteachta Poiblı. Dubowitz, H. (2007). Understanding and addressing the ‘‘neglect of neglect’’: Digging into the molehill. Child Abuse and Neglect, 31(6), 603Á606. Eckenrode, J., Laird, M., & Doris, J. (1993). School performance and disciplinary problems among abused and neglected children. Developmental Psychology, 29, 53Á62. Egeland, B. (1991). A longitudinal study of high-risk families: Issues and findings. In R.H. Starr & D.A. Wolfe (Eds.), The effects of child abuse and neglect: Issues and research (pp. 33Á56). New York: Guilford. Egeland, B., Sroufe, L.A., & Erickson, M. (1983). The developmental consequences of different patterns of maltreatment. Child Abuse and Neglect, 7, 459Á469. English, D.J. (1998). The extent and consequences of child maltreatment. The Future of Children, 8(1), 31Á53. English, D.J. (1999). Evaluation and risk assessment of child neglect in public child protection services. In H. Dubowitz (Ed.), Neglected children: Research, practice and policy (pp. 191Á 210). Thousand Oaks, CA: Sage Publications. Ethier, L.S., Couture, G., Lacharite, C., & Gagnier, J. (2000). Impact of a multidimensional intervention programme applied to families at risk for child neglect. Child Abuse Review, 9(19), 19Á36. Gaudin, J.M. (1993). Child neglect: A guide for intervention (pp. 1Á92). Washington, DC: US Department of Health and Human Services, The Clearinghouse on Child Abuse and Neglect Information. Gaudin, J.M., Polansky, N.A., Kilpatrick, A.C., & Shilton, P. (1996). Family functioning in neglectful families. Child Abuse and Neglect, 20(4), 363Á377. Gauthier, L., Stollak, G., Messe, L., & Aronoff, J. (1996). Recall of childhood neglect and physical abuse as differential predictors of current psychological functioning. Child Abuse and Neglect, 20(7), 549Á559. Gelles, R.J. (1999). Policy issues in child neglect. In H. Dubowitz (Ed.), Neglected children: Research, practice and policy (pp. 278Á298). Thousand Oaks, CA: Sage Publications. Kendall-Tackett, K.A., & Eckenrode, J. (1996). The effects of neglect on academic achievement and disciplinary problems: A developmental perspective. Child Abuse and Neglect, 20(3), 161Á 169. Kurtz, P.D., Gaudin, J.M., Wodarski, J.S., & Howing, P.T. (1993). Maltreatment and the school-aged child: School performance consequences. Child Abuse and Neglect, 17, 581Á589. Leiter, J., & Johnsen, M.C. (1994). Child maltreatment and school performance. American Journal of Education, 102, 154Á189.
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Lung, C.T. & Daro, D. (1996). Current trends in child abuse reporting and fatalities: The results of the 1995 annual fifty state survey (Working Paper No. 808). Chicago, IL: National Committee to Prevent Child Abuse. Lutzker, J., Frame, R., & Rice, J. (1982). Project 12-ways: An eco-behavioural approach to the treatment and prevention of child abuse and neglect. Education and Treatment of Children, 5, 141Á155. McSherry, D. (2007). Understanding and addressing the ‘‘neglect of neglect’’: Why are we making a mole-hill out of a mountain? Child Abuse and Neglect, 31(6), 607Á614. McSherry, D., Iwaniec, D., & Larkin, E. (2004). Counting the costs: The Children (Northern Ireland) Order 1995, social work, and the courts (Research report). Belfast: Institute of Child Care Research, Queen’s University. Minty, B., & Pattinson, G. (1994). The nature of child neglect. British Journal of Social Work, 24, 733Á747. NCPA. (1998). Abuse and neglect statistics. Chicago: National Committee to prevent Child Abuse. Ney, P.G., Fung, T., & Wickett, A.R. (1994). The worst combinations of child abuse and neglect. Child Abuse and Neglect, 18, 705Á714. Olds, D.L. (2006). The nurseÁfamily partnership: An evidence-based preventive intervention. Infant Mental Health Journal, 27(1), 5Á25. Olds, D.L., & Kitzman, H. (1993). Review of research on home visiting for pregnant women and parents of young children. The Future of Children, 3, 53Á92. Olds, D.L., Eckenrode, J., Henderson, C.R., Kitzman, H., Powers, J., Cole, R., & . . . Luckey, D. (1997). Long-term effects of home visitation on maternal life course and child abuse and neglect. Journal of the American Medical Association, 278, 637Á643. Palacio-Quinton, E., Ethier, L.S., Jourdan-Ionescu, C., & Lacharite, C. (1994). L’intervention aupres des families negligentes. In J.P. Pourtois (Ed.), Enfance Maltraitee (pp. 173Á212). Bruxelles: De Boek. Rose, S.J., & Meezan, W. (1996). Variations in perceptions of child neglect. Child Welfare, 75(2), 139Á160. Scottish Government. (2009). Child protection statistics 2008/9. Edinburgh: National Statistics. Stevenson, O. (1996). Emotional abuse and neglect: a time for reappraisal. Children and Family Social Work, 1, 13Á18. Stone, B. (1998). Child neglect: Practitioners’ perspectives. Child Abuse Review, 7, 87Á96. US Department of Health and Human Services. (1998). Child abuse and neglect state statutes series. In Crimes: Religious exemption to criminal child abuse and neglect (Vol. 37, pp. 1Á9). Washington, DC: National Centre for Prosecution of Child Abuse. US Department of Health and Human Services, Administration on Children, Youth and Families. (2006). Child maltreatment*2004. Washington, DC: US Government Printing Office. Wiehe, V.R. (1996). Working with child abuse and neglect: A primer. Thousand Oaks, CA: Sage Publications. Yuan, Y.T., & Struckman-Johnson, D.L. (1991). Placement outcomes for neglected children with prior placements in family preservation programs. In K. Wells & D.E. Bigel (Eds.), Family preservation services: Research and evaluation (pp. 92Á118). Newbury Park, CA: Sage Publications. Zuravin, S.J. (1988). Child abuse, child neglect, and maternal depression: Is there a connection? In Research symposium on child neglect (pp. D-23Á48). Washington, DC: National Center on Child Abuse and Neglect.
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References: Albert, V.N., & Barth, R.P. (1996). Predicting growth in child abuse and neglect reports in urban, suburban and rural counties. Social Services Review, 70, 58Á82. Barnes, J.B., Ball, M., Meadows, P., McLeish, J., Belsky, J., & FNP Implementation Research Team (2008). NurseÁfamily partnership programme: First year pilot sites implementation in England. Pregnancy and the post-partum period. London: DCSF. Barnes, J.B., Ball, M., Meadows, P., Belsky, J., & FNP Implementation Research Team (2009). NurseÁ family partnership programme: Second year pilot sites implementation in England. The infancy period. London: DCSF. 112 D. McSherry Black, M.M., & Dubowitz, H. (1999). Child neglect: Research recommendations and future directions. In H. Dubowitz (Ed.), Neglected children: Research, practice and policy (pp. 261Á 277). Thousand Oaks, CA: Sage Publications. Bowlby, J. (1969). Attachment and loss. New York: Basic Books. Buckley, H. (2002). Child protection and welfare: Innovations and interventions. Dublin: Institute of Public Administration. Burke, J., Chandy, J., Dannerbeck, A., & Watt, J.W. (1998). The parental environment cluster model of child neglect: An integrative conceptual model. Child Welfare, 77(4), 389Á405. Data Unit Wales. (2009). Child protection statistics. Gwion: Data Unit Wales Dissemination Tool. DCSF. (2009). Referrals, assessment, and children and young people who are the subject of a child protection plan, England*year ending 31st March 2009. London: Department for Children, Schools and Families. Department of Health. (1991). Child abuse: A study of inquiry reports 1980Á1989. London: HMSO. De Paul, J., & Arruabarrena, M.I. (1995). Behaviour problems in school-aged physically abused and neglected children in Spain. Child Abuse and Neglect, 19(4), 409Á418. DHSSPS. (2009). Children order statistical bulletin 2008. Belfast: Northern Ireland, Department ´´ ´ ´ of Health, Social Services, and Public Safety. An Roinn Slainte, Seirbhısı Soisialta agus ´ ´ ´ Sabhailteachta Poiblı. Dubowitz, H. (2007). Understanding and addressing the ‘‘neglect of neglect’’: Digging into the molehill. Child Abuse and Neglect, 31(6), 603Á606. Eckenrode, J., Laird, M., & Doris, J. (1993). School performance and disciplinary problems among abused and neglected children. Developmental Psychology, 29, 53Á62. Egeland, B. (1991). A longitudinal study of high-risk families: Issues and findings. In R.H. Starr & D.A. Wolfe (Eds.), The effects of child abuse and neglect: Issues and research (pp. 33Á56). New York: Guilford. Egeland, B., Sroufe, L.A., & Erickson, M. (1983). The developmental consequences of different patterns of maltreatment. Child Abuse and Neglect, 7, 459Á469. English, D.J. (1998). The extent and consequences of child maltreatment. The Future of Children, 8(1), 31Á53. English, D.J. (1999). Evaluation and risk assessment of child neglect in public child protection services. In H. Dubowitz (Ed.), Neglected children: Research, practice and policy (pp. 191Á 210). Thousand Oaks, CA: Sage Publications. Ethier, L.S., Couture, G., Lacharite, C., & Gagnier, J. (2000). Impact of a multidimensional intervention programme applied to families at risk for child neglect. Child Abuse Review, 9(19), 19Á36. Gaudin, J.M. (1993). Child neglect: A guide for intervention (pp. 1Á92). Washington, DC: US Department of Health and Human Services, The Clearinghouse on Child Abuse and Neglect Information. Gaudin, J.M., Polansky, N.A., Kilpatrick, A.C., & Shilton, P. (1996). Family functioning in neglectful families. Child Abuse and Neglect, 20(4), 363Á377. Gauthier, L., Stollak, G., Messe, L., & Aronoff, J. (1996). Recall of childhood neglect and physical abuse as differential predictors of current psychological functioning. Child Abuse and Neglect, 20(7), 549Á559. Gelles, R.J. (1999). Policy issues in child neglect. In H. Dubowitz (Ed.), Neglected children: Research, practice and policy (pp. 278Á298). Thousand Oaks, CA: Sage Publications. Kendall-Tackett, K.A., & Eckenrode, J. (1996). The effects of neglect on academic achievement and disciplinary problems: A developmental perspective. Child Abuse and Neglect, 20(3), 161Á 169. Kurtz, P.D., Gaudin, J.M., Wodarski, J.S., & Howing, P.T. (1993). Maltreatment and the school-aged child: School performance consequences. Child Abuse and Neglect, 17, 581Á589. Leiter, J., & Johnsen, M.C. (1994). Child maltreatment and school performance. American Journal of Education, 102, 154Á189. Child Care in Practice 113 Lung, C.T. & Daro, D. (1996). Current trends in child abuse reporting and fatalities: The results of the 1995 annual fifty state survey (Working Paper No. 808). Chicago, IL: National Committee to Prevent Child Abuse. Lutzker, J., Frame, R., & Rice, J. (1982). Project 12-ways: An eco-behavioural approach to the treatment and prevention of child abuse and neglect. Education and Treatment of Children, 5, 141Á155. McSherry, D. (2007). Understanding and addressing the ‘‘neglect of neglect’’: Why are we making a mole-hill out of a mountain? Child Abuse and Neglect, 31(6), 607Á614. McSherry, D., Iwaniec, D., & Larkin, E. (2004). Counting the costs: The Children (Northern Ireland) Order 1995, social work, and the courts (Research report). Belfast: Institute of Child Care Research, Queen’s University. Minty, B., & Pattinson, G. (1994). The nature of child neglect. British Journal of Social Work, 24, 733Á747. NCPA. (1998). Abuse and neglect statistics. Chicago: National Committee to prevent Child Abuse. Ney, P.G., Fung, T., & Wickett, A.R. (1994). The worst combinations of child abuse and neglect. Child Abuse and Neglect, 18, 705Á714. Olds, D.L. (2006). The nurseÁfamily partnership: An evidence-based preventive intervention. Infant Mental Health Journal, 27(1), 5Á25. Olds, D.L., & Kitzman, H. (1993). Review of research on home visiting for pregnant women and parents of young children. The Future of Children, 3, 53Á92. Olds, D.L., Eckenrode, J., Henderson, C.R., Kitzman, H., Powers, J., Cole, R., & . . . Luckey, D. (1997). Long-term effects of home visitation on maternal life course and child abuse and neglect. Journal of the American Medical Association, 278, 637Á643. Palacio-Quinton, E., Ethier, L.S., Jourdan-Ionescu, C., & Lacharite, C. (1994). L’intervention aupres des families negligentes. In J.P. Pourtois (Ed.), Enfance Maltraitee (pp. 173Á212). Bruxelles: De Boek. Rose, S.J., & Meezan, W. (1996). Variations in perceptions of child neglect. Child Welfare, 75(2), 139Á160. Scottish Government. (2009). Child protection statistics 2008/9. Edinburgh: National Statistics. Stevenson, O. (1996). Emotional abuse and neglect: a time for reappraisal. Children and Family Social Work, 1, 13Á18. Stone, B. (1998). Child neglect: Practitioners’ perspectives. Child Abuse Review, 7, 87Á96. US Department of Health and Human Services. (1998). Child abuse and neglect state statutes series. In Crimes: Religious exemption to criminal child abuse and neglect (Vol. 37, pp. 1Á9). Washington, DC: National Centre for Prosecution of Child Abuse. US Department of Health and Human Services, Administration on Children, Youth and Families. (2006). Child maltreatment*2004. Washington, DC: US Government Printing Office. Wiehe, V.R. (1996). Working with child abuse and neglect: A primer. Thousand Oaks, CA: Sage Publications. Yuan, Y.T., & Struckman-Johnson, D.L. (1991). Placement outcomes for neglected children with prior placements in family preservation programs. In K. Wells & D.E. Bigel (Eds.), Family preservation services: Research and evaluation (pp. 92Á118). Newbury Park, CA: Sage Publications. Zuravin, S.J. (1988). Child abuse, child neglect, and maternal depression: Is there a connection? In Research symposium on child neglect (pp. D-23Á48). Washington, DC: National Center on Child Abuse and Neglect. Copyright of Child Care in Practice is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder 's express written permission. However, users may print, download, or email articles for individual use.
Lest We Forget: Remembering the Consequences of Child Neglect A Clarion Call to ‘‘Feisty Advocates’’
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Dominic McSherry
It is widely acknowledged that, across the United Kingdom and the USA, childcare practitioners often struggle with cases of child neglect, because of the difficulties involved in attempting to define the problem at hand, and balancing these cases with others in the caseload that may appear more pressing, such as physical abuse. Consequently, in an attempt to refocus the lens of professional policy and practice, this article will profile a number of research studies that have highlighted the profound developmental deficits that neglect can cause, relative to other forms of child maltreatment, and a range of interventions that have proven to be effective with these types of cases. The article concludes with a discussion of the potential negative impact of the current financial crisis for neglected children. Introduction Social policy in the United States continually understates the consequences of child neglect when constructing legal and social interventions for neglected children. Instead, policy is driven by the more emotionally charged problems of child abuse (Gelles, 1999). Rose and Meezan (1996) found that foster care workers viewed neglect less seriously than Child Protection Service (CPS) workers, and that both of these groups rated neglecting behaviours as being less serious compared with laypersons from the community at large. It was argued that this difference may be explained by the perceived seriousness of child abuse compared with the less obvious harm of neglect. A similar picture has also emerged within the United Kingdom. Several commentators (Minty & Pattinson, 1994; Stevenson, 1996; Stone, 1998) have argued that social workers often underestimate the seriousness of neglect, in spite of the large
Dr Dominic McSherry is Senior Research Fellow at Queen’s University, Belfast. Correspondence to: Dominic McSherry, Queen’s University, Institute of Child Care Research, 6 College Park, Belfast BT7 1LP, UK. Email: dominic.mcsherry@qub.ac.uk ISSN 1357-5279 print/1476-489X online/11/020103-11 # 2011 The Child Care in Practice Group DOI: 10.1080/13575279.2010.541426
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body of evidence that suggests that neglect may lead to major developmental deficits and may increase the risk of the child being injured or even killed. Minty and Pattinson (1994) pointed out that a significant number of child fatalities have been attributed to parental/caregiver neglect, and that professionals had failed to recognise the risk posed to these children, even in cases of severe neglect (see Department of Health, 1991). Research from the Republic of Ireland suggests that social workers are either ‘‘overwhelmed’’ by the enormity of problems presented by neglecting parents, or are ‘‘underwhelmed’’ to the extent where the behaviour of these neglecting parents becomes normalised (Buckley, 2002). The reasons for this ‘‘neglect of neglect’’ have recently been examined by McSherry (2007) and Dubowitz (2007), and appear to be reflective of a range of interrelated issues, such as the difficulties that tend to be associated with defining, substantiating, and prioritising child neglect. These issues, in turn, are related to a widespread deterministic perspective that neglect is an inevitable by-product of families living in poverty, and a tendency to see any positive dimension of a child neglect case as precluding the necessity for intervention, particularly in the context of ever increasing rate of referrals, and the subsequent growing pressure upon social service resources to meet this need (McSherry, Iwaniec, & Larkin, 2004). Given that there appears to be a general misunderstanding or underestimation of the consequences of child neglect by practitioners, both within the United States and the United Kingdom, this article will profile a number of research studies that have highlighted the profound developmental deficits that neglect can cause, relative to other forms of child maltreatment, and a range of interventions that have proven to be effective with these types of cases. This is particularly important given the current world financial crisis, and the acute strains that are being placed upon health and social care budgets both in the United States and the United Kingdom, and the particular concerns that this raises in relation to dealing effectively with child neglect. Cognitive Developmental Problems Over 20 years ago, Egeland, Sroufe, and Erickson (1983) carried out a longitudinal study of 267 motherÁinfant pairs deemed to be at high risk of neglect. They found that children who were neglected had higher performance deficits on a range of tasks at both 42 and 56 months than a control group and even than other maltreated (physically or sexually abused) children. By early school age it was found that the neglected group was exhibiting deficits in cognitive performance, academic achievement, classroom behaviour and social interactions. In further work, Egeland (1991) also found that by the second grade (ages seven to eight) every neglected child was involved in some special educational programme. The neglected children demonstrated greater developmental problems than any other maltreated groups. Similarly, Eckenrode, Laird, and Doris (1993) found that neglected children, when compared with children who had been physically or sexually abused, had the poorest school performance for Grade K (ages three to four) through Grade 12 (ages 15Á16).
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The developmental course of neglected children through school and the possible developmental effects of neglect alone and also neglect in conjunction with abuse were examined by Kendall-Tackett and Eckenrode (1996). They selected a group of 420 maltreated children using the records of the New York State Child Abuse and Maltreatment Register. These included children who had been neglected, physically abused and sexually abused. A comparison group of 420 non-maltreated children was selected from the general population of school children. The two groups were matched on gender, type of school attended, grade in school, residential location and classroom. The maltreated group was further divided into two smaller groups. These were: the ‘‘neglected only’’ group, which incorporated those children who had experienced only neglect and no other form of maltreatment (217 children); and the ‘‘neglect with abuse’’ group, which included those children who had also experienced physical (56 children) and sexual (51 children) abuse. Results demonstrated that neglected children were not performing academically as well as their non-maltreated peers. Furthermore, neglect alone was found to be just as damaging to school performance and number of suspensions as was neglect in combination with physical and sexual abuse. However, it was found that the children who had experienced the combination of abuse and neglect had a higher incidence of disciplinary referrals and grade repetition. A similar study by Kurtz, Gaudin, Wodarski, and Howling (1993) compared the school performance of three groups of school-age children and adolescents. These groups were: neglected (n047), physically abused (n022) and non-maltreated (n070) children. Assessment took place at three intervals with an initial assessment early in the study, followed up after six months and then one year. School performance was assessed in terms of academic achievement, socio-emotional development, adaptive behaviour in functional areas of motor development, personal living skills and community orientation. Five data sources were utilised. These were: teachers, parents, the children themselves, school records and child protective service caseworkers. It was found that both abused and neglected children scored lower than comparisons (nonmaltreated) on overall school performance over time. Both groups of maltreated children had significantly lower scores on the language and mathematics sections of the Iowa Test of Basic Skills than the comparison group. A key finding was that academic deficits were particularly evident with neglected children. For example, when assessed after six months, performance by the neglected children placed them on the 29th percentile for language skills and the 28th percentile for maths skills. Abused children, however, were placed at the 44th and 42nd percentiles and nonmaltreated children at the 67th and 73rd percentiles, respectively. Teacher reports confirmed that neglected children were working and learning at below average levels compared with their peers. One reason for this poor performance may be related to school absence. Kurtz et al. (1993) found that rate of absence for the neglect group was almost five times that of the non-maltreated group. It was also found that neglected children tended not to display any serious behavioural or school adjustment problems in the classroom and did not differ from
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the comparison group on any socio-emotional measure. However, they cautioned that further work is necessary before assuming that neglected children are socioemotionally resilient. They concluded that the unavailable, neglectful parent presents a direct threat to the intellectual development of the child. Low educational aspirations, lack of encouragement for learning, a paucity of language stimulation, non-participation in school activities, and unresponsiveness to the child’s achievements all undermine school success. (p. 588)
De Paul and Arruabarrena (1995), working in Spain, compared 17 physically abused, 24 physically neglected and 25 low-risk comparison children in terms of academic achievement. They found that both physically abused and neglected children presented lower levels of academic performance and adaptive functioning relative to non-maltreated comparisons. However, they found that the neglected children demonstrated the greatest academic delay. English (1998) argued that maltreatment behaviours associated with ongoing neglect typically result not in a discrete injury, but in cumulative harm. Gaudin, Polansky, Kilpatrick, and Shilton (1996) remarked that it is no surprise neglected children suffer academically given that neglect may occur over a long period of time and intellectual development is heavily dependent upon the ongoing quality of parentÁchild interaction. Similarly, Leiter and Johnsen (1994) suggested that neglected children suffer from learning deficits as a result of their parents’ unwillingness to provide a stimulating environment for the child, to read to them, to supervise their homework, or to be involved in their academic life in any way. Psychological Problems The effects of reported neglect and physical abuse on the severity of symptomatology were examined by Gauthier, Stollack, Messe, and Aronoff (1996). Five hundred and twelve (276 female/236 male) undergraduate psychology students from Michigan State University completed questionnaires on their childhood environment and current functioning. It was found that neglect was significantly related to the extent of psychological problems and relational difficulties experienced. Those individuals who were considered to have experienced neglect were increasingly likely to have reported current problems in relation to anxiety, depression, somatisation, paranoia and hostility compared with those who reported physical abuse. These results suggest that neglect (or more specifically memories of such experiences) may be a stronger predictor of certain aspects of psychological dysfunction in adulthood than physical abuse. It was argued that one reason physical neglect may be so harmful to children’s development is because it involves a lack of mutual interaction between the child and caretaker, the attachment relationship, which has been recognised as critical to healthy development for some time (Bowlby, 1969). Similarly, Ney, Fung, and Wickett (1994) found that emotional neglect may be more closely related to the development of psychiatric illness in later life than any other form of maltreatment.
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Fatality Obviously, the worst consequence of all is when neglect results in the child’s death. Lung and Daro (1996) carried out a survey of 26 states in the United States that specify the type of maltreatment associated with child fatalities. They found between 1993 and 1995 that 37% of maltreatment-related child fatalities were caused by neglect, with 48% caused by abuse, and 15% resulting from a combination of both neglect and abuse. Furthermore, the NCPA (1998) reported that 1185 child deaths related to child abuse and neglect were confirmed by CPS agencies, with 44% of these resulting from neglect. Given that research has indicated that the damage neglect can inflict upon children is often underestimated at both the levels of policy and practice, the preceding studies are an important reminder of the potentially devastating developmental consequences for children of being raised in a neglectful family. This, in turn, highlights the need for effective intervention and prevention in these cases. Intervention and Prevention The complexity of child neglect, with its many forms and its intergenerational pervasiveness, suggests that a comprehensive and multifaceted approach to prevention may be required. Gaudin (1993) pointed out that in order to change a pattern of neglect it is important to address the causes rather than the symptoms. It was also suggested that understanding the interaction of stressful life events, lack of environmental support, and deficits in personal resources should be the first step towards developing an intervention plan. Black and Dubowitz (1999) argued that investigations of the causes and consequences of child neglect ought to be theory-driven. It was suggested that single-factor, atheoretical investigations are highly unlikely to contribute to our understanding of the complex factors that have been associated with the causes and consequences of child neglect. Burke, Chandy, Dannerbeck, and Watt (1998) noted that, due to the difficulty that has been experienced when attempting to establish the causes of neglect, no comprehensive systemic theories have been developed and tested across studies to understand the pattern of neglectful behaviour. Consequently, they constructed a conceptual model of neglectful behaviour that views neglect as a parental behaviour that is related to a number of factors in the parenting environment, and which traces parental behaviour to its impact on the well-being of the child. They argued that neglect constitutes ‘‘deficits or omissions in the parental role performance related to inadequate use of the parental environment that result in a serious threat to or observable decline in the well-being of the child’’ (Burke et al., 1998, p. 394). Burke et al. (1998) defined the parental environment at both the individual and family levels. At the individual level, it was noted that a number of studies have shown neglectful parents often exhibit low levels of socialisation, high levels of boredom and depression, and high rates of substance abuse (Albert & Barth, 1996; US Department of Health and Human Services, 1998; Zuravin, 1988). At the family level,
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it was observed that there appears to be an increased risk of neglect if the family is single rather than dual parent, with an 87% greater likelihood of neglect occurring within single parent families (US Department of Health and Human Services, 1998). On the basis of the research evidence, Burke et al. (1998) developed a model of child neglect, with three clusters of factors in the parental environment affecting parental ability to create and maintain an environment conducive to child well-being. These are: . A parental skills cluster that incorporates factors directly related to the knowledge and skills that the parents need to perform care functions for their children. . A social support cluster that deals with issues such as feelings, perceptions and relationships and the way these may have a bearing upon the occurrence of child neglect. . A resource management cluster that focuses upon the parental relationship with the outside world and address the functional capacity of parents to utilise their environment. A number of comprehensive intervention schemes have been initiated to prevent the occurrence or re-occurrence of child neglect. Over 20 years ago, Lutzker, Frame, and Rice (1982) developed an eco-behavioural approach to treating child neglect, named Project 12-ways. The project provided 15 different services, to abusive and neglectful families in rural Southern Illinois, which were based upon individual or family needs. These included: parentÁchild training, stress reduction, assertiveness training, substance abuse treatment, and assistance finding employment. Wiehe (1996) argued that evaluative research has established the effectiveness of Project 12-ways. It was noted that the programme has been found to break into families’ intergenerational cycle of neglect, thereby preventing a continuation of this pattern of child maltreatment. Wiehe suggested that, although the programme was very costly, these costs ought to be considered reasonable given the programme’s positive impact upon the behaviour of neglecting parents. According to Ethier, Couture, Lacharite, and Gagnier (2000), one of the fundamental problems in child neglect intervention is that many of the programmes directed at reducing neglect have tended to focus on a single form of problematic parental behaviour. They carried out a study, which evaluated and compared the short-term effects of two types of intervention that were applied to families at high risk of neglect. The study was developed from the Personal Family and Community Help Programme (PFCHP) (Palacio-Quinton, Ethier, Jourdan-Ionescu, & Lacharite, 1994): an intervention programme that addressed multiple dimensions of child neglect. This programme had two aims: first, to reduce maltreating behaviours and enhance parental competencies; and second, to reduce debilitating conditions such as social isolation, parental stress, depression and relational problems, thus making the family environment more receptive to appropriate parental behaviours. The programme was initially designed for maltreating families in general but was adapted by Ethier et al. (2000) to specifically address families at risk of neglect.
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There were four main aspects to the PFCHP programme: . Home visiting family assistance, which was aimed at improving integration of the target family within the social environment. . Group meetings for parents, which focused upon relational and parental competency. . Stimulating the child through educational activities so as to enhance their language, cognition and social skills. . Individual counselling offered to each family by their social worker. This was intended to complement other aspects of the programme and was provided on demand. The clinical team involved in implementing the PFCHP programme included a social worker, the parents, a group counsellor and two members of the research team. The team formulated and coordinated individualised objectives. Team meetings were held every two weeks and the whole programme lasted 18 months. Ethier et al. (2000) compared the PFCHP program (n 015) with a more conventional treatment scheme provided by social services in a typical Quebec Local Community Services Centre (LCSC) setting (n 014). Unlike the PFCHP approach, which is multidimensional, LCSC assistance is more concerned with psychosocial intervention and is aimed at improving parental skills and the parentÁchild relationship along with making referrals to appropriate community services. For the most part, meetings with the social worker occurred every two weeks. In the study sample of those using LCSC assistance, intervention lasted between 12 and 20 months with a mean of 16.3 months. All families were recruited through a LCSC. Three criteria for inclusion in the study were; the presence of at least four risk factors; the family not having been the subject of a previous investigation by the Youth Protection Services; and at least one child under the age of six. From the quantitative analyses that were carried out, it was found that both types of intervention were equally associated with improved family situations. Regardless of whether the programme was eco-systemic or psychosocial, parents were making demonstrable progress after 24 months. For example, parental stress, level of depression and potential for child abuse and neglect had all decreased. Furthermore, satisfaction with the social network had significantly improved. However, despite these advances, parents still remained vulnerable, for although parental stress did decrease significantly, it still remained at a high level. The results also indicated that there was a marked variance between the two types of intervention programmes in relation to the social support network. The PFCHP participants did not seek as much help from professionals or their children, relying more upon friends and members of their family. In contrast, LCSC participants were turning to their children for support. The danger of this type of role reversal is that the parent’s expectations may reach far beyond the child’s capacity for support, thus creating risk of abuse and neglect through parental frustration at the child’s inability to provide support and the increasing emotional stress placed upon the child. Results also suggested that both types of intervention were equally effective in reducing the
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risk of child neglect, but the PFCHP programme was more effective at improving the mother’s relationship with her environment. Results also suggested that the mothers in the PFCHP group were more involved in their children’s activities and were better at applying discipline. They also seemed to be doing better in terms of their marital relationships, social networks and self-improvement. For example, it was found that mothers in the PFCHP group were more likely to terminate an abusive relationship and were also more likely to go back to work or school. Yuan and Struckman-Johnson (1991) looked at the family preservation services offered through eight demonstration projects in California and found that they were less successful with chronically neglecting families than with other forms of maltreatment. They observed that out-of-home placement occurred with 27% of the neglected families, in spite of the services that were provided, whereas the same could only be said for 12% of the children who were at risk of placement for other reasons. Despite these findings, Olds and Kitzman (1993) argued that intensive and comprehensive home visitation prevention programmes are effective in improving the behaviour of parents at risk of inflicting abuse and neglect, improving the home environment and reducing child behavioural difficulties. There is also some evidence that the benefits resulting from home visitation programs are durable. Olds et al. (1997) carried out a long-term follow-up of a relatively intense nurse visitation programme and found that, over a 15-year period, comparison mothers were nearly twice as likely to be reported for child abuse or neglect than the high-risk mothers who participated in the programme. More recently, Olds (2006) commented that longer-term outcomes are best for the most deprived and at-risk families. A ‘‘nurseÁfamily partnership’’ model, based on that developed by Olds, is being implemented and evaluated across 10 English Primary Care Trusts, and the early indicators from the families involved are positive (Barnes et al., 2008; Barnes, Ball, Meadows, Belsky, & FNP Implementation Research Team, 2009). English (1999) argued that community-based support services may be the most appropriate intervention for lower-risk, non-chronic neglect situations, given that neglect appears more to do with inadequate parenting skills and knowledge and other caregiver deficits. The suggestion is that in-home specialists, such as home health nurses who can model parenting skills, may be more effective than the types of services routinely offered by CPS workers. However, high-risk cases of neglect, such as the presence of substance abuse or domestic violence may be more appropriately addressed by the more intrusive CPS, which can invoke legal intervention to protect the child if necessary. Conclusion This review has been written as a call against complacency. As has been the case for the last number of decades in the United States, approximately two-thirds of families in the child protection system are there due to neglect (US Department of Health and Human Services, 2006). Across the United Kingdom (Northern Ireland, Scotland, England, and Wales), levels are lower at between 45 and 50% (Data Unit
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Wales, 2009; DCSF, 2009; DHSSPS, 2009; Scottish Government, 2009), but still high relative to physical, sexual, and emotional abuse. In essence, these figures refer to tens of thousands of children, year on year. The studies highlighted in this review have re-illustrated the detrimental impact upon children who experience parental neglect, particularly in terms of its impact upon the development of cognitive functioning, which inhibits positive school performance, and which is so critical for future life opportunities for these children and their own children. But it is not a pessimistic perspective. The range of interventions specified illustrate that these problems are not insurmountable, and that comprehensive support and monitoring programmes can be very effective at improving the quality of the parenting of neglecting (or high-risk) parents, and the quality of life of their children. However, these interventions are by nature expensive, and we are living in increasingly challenging financial times. Across the United Kingdom, the current financial crisis is placing enormous strain upon governmental health and social care budgets, belts are being tightened, and the assumption is that similar processes are occurring in the United States. This type of fiscally pressurised scenario presents as ominous for children experiencing parental neglect, as experience has shown time and time again that, when push comes to shove, child protection agencies will prioritise abuse to the detriment of neglect (English, 1998). How might these challenges be overcome? Dubowitz (2007, p. 606) comments that in order to address the ‘‘neglect of neglect’’, ‘‘there is a need for feisty advocates for systemic changes in priorities, policies, and programs to better support families and to help ensure children’s basic needs are met’’. Clearly, there is potential for the current financial crisis to exacerbate the ‘‘neglect of neglect’’. Consequently, ‘‘feisty advocates’’ are desperately required within social service departments, at all levels, within governmental and non-governmental organisations, and within the academic community. People who are prepared to lobby and argue the case for neglected children, who can present an informed perspective on the necessity to ensure that sufficient resources are directed at the prevention of child neglect, for example through general and targeted community support programmes, and the provision of intensive supports for children who have experienced parental neglect, particularly in terms of addressing deficits in cognitive development. This review is a stark reminder to us all that there are tens of thousands of good reasons to start getting feisty. References
Albert, V.N., & Barth, R.P. (1996). Predicting growth in child abuse and neglect reports in urban, suburban and rural counties. Social Services Review, 70, 58Á82. Barnes, J.B., Ball, M., Meadows, P., McLeish, J., Belsky, J., & FNP Implementation Research Team (2008). NurseÁfamily partnership programme: First year pilot sites implementation in England. Pregnancy and the post-partum period. London: DCSF. Barnes, J.B., Ball, M., Meadows, P., Belsky, J., & FNP Implementation Research Team (2009). NurseÁ family partnership programme: Second year pilot sites implementation in England. The infancy period. London: DCSF.
112 D. McSherry
Black, M.M., & Dubowitz, H. (1999). Child neglect: Research recommendations and future directions. In H. Dubowitz (Ed.), Neglected children: Research, practice and policy (pp. 261Á 277). Thousand Oaks, CA: Sage Publications. Bowlby, J. (1969). Attachment and loss. New York: Basic Books. Buckley, H. (2002). Child protection and welfare: Innovations and interventions. Dublin: Institute of Public Administration. Burke, J., Chandy, J., Dannerbeck, A., & Watt, J.W. (1998). The parental environment cluster model of child neglect: An integrative conceptual model. Child Welfare, 77(4), 389Á405. Data Unit Wales. (2009). Child protection statistics. Gwion: Data Unit Wales Dissemination Tool. DCSF. (2009). Referrals, assessment, and children and young people who are the subject of a child protection plan, England*year ending 31st March 2009. London: Department for Children, Schools and Families. Department of Health. (1991). Child abuse: A study of inquiry reports 1980Á1989. London: HMSO. De Paul, J., & Arruabarrena, M.I. (1995). Behaviour problems in school-aged physically abused and neglected children in Spain. Child Abuse and Neglect, 19(4), 409Á418. DHSSPS. (2009). Children order statistical bulletin 2008. Belfast: Northern Ireland, Department ´´ ´ ´ of Health, Social Services, and Public Safety. An Roinn Slainte, Seirbhısı Soisialta agus ´ ´ ´ Sabhailteachta Poiblı. Dubowitz, H. (2007). Understanding and addressing the ‘‘neglect of neglect’’: Digging into the molehill. Child Abuse and Neglect, 31(6), 603Á606. Eckenrode, J., Laird, M., & Doris, J. (1993). School performance and disciplinary problems among abused and neglected children. Developmental Psychology, 29, 53Á62. Egeland, B. (1991). A longitudinal study of high-risk families: Issues and findings. In R.H. Starr & D.A. Wolfe (Eds.), The effects of child abuse and neglect: Issues and research (pp. 33Á56). New York: Guilford. Egeland, B., Sroufe, L.A., & Erickson, M. (1983). The developmental consequences of different patterns of maltreatment. Child Abuse and Neglect, 7, 459Á469. English, D.J. (1998). The extent and consequences of child maltreatment. The Future of Children, 8(1), 31Á53. English, D.J. (1999). Evaluation and risk assessment of child neglect in public child protection services. In H. Dubowitz (Ed.), Neglected children: Research, practice and policy (pp. 191Á 210). Thousand Oaks, CA: Sage Publications. Ethier, L.S., Couture, G., Lacharite, C., & Gagnier, J. (2000). Impact of a multidimensional intervention programme applied to families at risk for child neglect. Child Abuse Review, 9(19), 19Á36. Gaudin, J.M. (1993). Child neglect: A guide for intervention (pp. 1Á92). Washington, DC: US Department of Health and Human Services, The Clearinghouse on Child Abuse and Neglect Information. Gaudin, J.M., Polansky, N.A., Kilpatrick, A.C., & Shilton, P. (1996). Family functioning in neglectful families. Child Abuse and Neglect, 20(4), 363Á377. Gauthier, L., Stollak, G., Messe, L., & Aronoff, J. (1996). Recall of childhood neglect and physical abuse as differential predictors of current psychological functioning. Child Abuse and Neglect, 20(7), 549Á559. Gelles, R.J. (1999). Policy issues in child neglect. In H. Dubowitz (Ed.), Neglected children: Research, practice and policy (pp. 278Á298). Thousand Oaks, CA: Sage Publications. Kendall-Tackett, K.A., & Eckenrode, J. (1996). The effects of neglect on academic achievement and disciplinary problems: A developmental perspective. Child Abuse and Neglect, 20(3), 161Á 169. Kurtz, P.D., Gaudin, J.M., Wodarski, J.S., & Howing, P.T. (1993). Maltreatment and the school-aged child: School performance consequences. Child Abuse and Neglect, 17, 581Á589. Leiter, J., & Johnsen, M.C. (1994). Child maltreatment and school performance. American Journal of Education, 102, 154Á189.
Child Care in Practice 113
Lung, C.T. & Daro, D. (1996). Current trends in child abuse reporting and fatalities: The results of the 1995 annual fifty state survey (Working Paper No. 808). Chicago, IL: National Committee to Prevent Child Abuse. Lutzker, J., Frame, R., & Rice, J. (1982). Project 12-ways: An eco-behavioural approach to the treatment and prevention of child abuse and neglect. Education and Treatment of Children, 5, 141Á155. McSherry, D. (2007). Understanding and addressing the ‘‘neglect of neglect’’: Why are we making a mole-hill out of a mountain? Child Abuse and Neglect, 31(6), 607Á614. McSherry, D., Iwaniec, D., & Larkin, E. (2004). Counting the costs: The Children (Northern Ireland) Order 1995, social work, and the courts (Research report). Belfast: Institute of Child Care Research, Queen’s University. Minty, B., & Pattinson, G. (1994). The nature of child neglect. British Journal of Social Work, 24, 733Á747. NCPA. (1998). Abuse and neglect statistics. Chicago: National Committee to prevent Child Abuse. Ney, P.G., Fung, T., & Wickett, A.R. (1994). The worst combinations of child abuse and neglect. Child Abuse and Neglect, 18, 705Á714. Olds, D.L. (2006). The nurseÁfamily partnership: An evidence-based preventive intervention. Infant Mental Health Journal, 27(1), 5Á25. Olds, D.L., & Kitzman, H. (1993). Review of research on home visiting for pregnant women and parents of young children. The Future of Children, 3, 53Á92. Olds, D.L., Eckenrode, J., Henderson, C.R., Kitzman, H., Powers, J., Cole, R., & . . . Luckey, D. (1997). Long-term effects of home visitation on maternal life course and child abuse and neglect. Journal of the American Medical Association, 278, 637Á643. Palacio-Quinton, E., Ethier, L.S., Jourdan-Ionescu, C., & Lacharite, C. (1994). L’intervention aupres des families negligentes. In J.P. Pourtois (Ed.), Enfance Maltraitee (pp. 173Á212). Bruxelles: De Boek. Rose, S.J., & Meezan, W. (1996). Variations in perceptions of child neglect. Child Welfare, 75(2), 139Á160. Scottish Government. (2009). Child protection statistics 2008/9. Edinburgh: National Statistics. Stevenson, O. (1996). Emotional abuse and neglect: a time for reappraisal. Children and Family Social Work, 1, 13Á18. Stone, B. (1998). Child neglect: Practitioners’ perspectives. Child Abuse Review, 7, 87Á96. US Department of Health and Human Services. (1998). Child abuse and neglect state statutes series. In Crimes: Religious exemption to criminal child abuse and neglect (Vol. 37, pp. 1Á9). Washington, DC: National Centre for Prosecution of Child Abuse. US Department of Health and Human Services, Administration on Children, Youth and Families. (2006). Child maltreatment*2004. Washington, DC: US Government Printing Office. Wiehe, V.R. (1996). Working with child abuse and neglect: A primer. Thousand Oaks, CA: Sage Publications. Yuan, Y.T., & Struckman-Johnson, D.L. (1991). Placement outcomes for neglected children with prior placements in family preservation programs. In K. Wells & D.E. Bigel (Eds.), Family preservation services: Research and evaluation (pp. 92Á118). Newbury Park, CA: Sage Publications. Zuravin, S.J. (1988). Child abuse, child neglect, and maternal depression: Is there a connection? In Research symposium on child neglect (pp. D-23Á48). Washington, DC: National Center on Child Abuse and Neglect.
Copyright of Child Care in Practice is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder 's express written permission. However, users may print, download, or email articles for individual use.
References: Albert, V.N., & Barth, R.P. (1996). Predicting growth in child abuse and neglect reports in urban, suburban and rural counties. Social Services Review, 70, 58Á82. Barnes, J.B., Ball, M., Meadows, P., McLeish, J., Belsky, J., & FNP Implementation Research Team (2008). NurseÁfamily partnership programme: First year pilot sites implementation in England. Pregnancy and the post-partum period. London: DCSF. Barnes, J.B., Ball, M., Meadows, P., Belsky, J., & FNP Implementation Research Team (2009). NurseÁ family partnership programme: Second year pilot sites implementation in England. The infancy period. London: DCSF. 112 D. McSherry Black, M.M., & Dubowitz, H. (1999). Child neglect: Research recommendations and future directions. In H. Dubowitz (Ed.), Neglected children: Research, practice and policy (pp. 261Á 277). Thousand Oaks, CA: Sage Publications. Bowlby, J. (1969). Attachment and loss. New York: Basic Books. Buckley, H. (2002). Child protection and welfare: Innovations and interventions. Dublin: Institute of Public Administration. Burke, J., Chandy, J., Dannerbeck, A., & Watt, J.W. (1998). The parental environment cluster model of child neglect: An integrative conceptual model. Child Welfare, 77(4), 389Á405. Data Unit Wales. (2009). Child protection statistics. Gwion: Data Unit Wales Dissemination Tool. DCSF. (2009). Referrals, assessment, and children and young people who are the subject of a child protection plan, England*year ending 31st March 2009. London: Department for Children, Schools and Families. Department of Health. (1991). Child abuse: A study of inquiry reports 1980Á1989. London: HMSO. De Paul, J., & Arruabarrena, M.I. (1995). Behaviour problems in school-aged physically abused and neglected children in Spain. Child Abuse and Neglect, 19(4), 409Á418. DHSSPS. (2009). Children order statistical bulletin 2008. Belfast: Northern Ireland, Department ´´ ´ ´ of Health, Social Services, and Public Safety. An Roinn Slainte, Seirbhısı Soisialta agus ´ ´ ´ Sabhailteachta Poiblı. Dubowitz, H. (2007). Understanding and addressing the ‘‘neglect of neglect’’: Digging into the molehill. Child Abuse and Neglect, 31(6), 603Á606. Eckenrode, J., Laird, M., & Doris, J. (1993). School performance and disciplinary problems among abused and neglected children. Developmental Psychology, 29, 53Á62. Egeland, B. (1991). A longitudinal study of high-risk families: Issues and findings. In R.H. Starr & D.A. Wolfe (Eds.), The effects of child abuse and neglect: Issues and research (pp. 33Á56). New York: Guilford. Egeland, B., Sroufe, L.A., & Erickson, M. (1983). The developmental consequences of different patterns of maltreatment. Child Abuse and Neglect, 7, 459Á469. English, D.J. (1998). The extent and consequences of child maltreatment. The Future of Children, 8(1), 31Á53. English, D.J. (1999). Evaluation and risk assessment of child neglect in public child protection services. In H. Dubowitz (Ed.), Neglected children: Research, practice and policy (pp. 191Á 210). Thousand Oaks, CA: Sage Publications. Ethier, L.S., Couture, G., Lacharite, C., & Gagnier, J. (2000). Impact of a multidimensional intervention programme applied to families at risk for child neglect. Child Abuse Review, 9(19), 19Á36. Gaudin, J.M. (1993). Child neglect: A guide for intervention (pp. 1Á92). Washington, DC: US Department of Health and Human Services, The Clearinghouse on Child Abuse and Neglect Information. Gaudin, J.M., Polansky, N.A., Kilpatrick, A.C., & Shilton, P. (1996). Family functioning in neglectful families. Child Abuse and Neglect, 20(4), 363Á377. Gauthier, L., Stollak, G., Messe, L., & Aronoff, J. (1996). Recall of childhood neglect and physical abuse as differential predictors of current psychological functioning. Child Abuse and Neglect, 20(7), 549Á559. Gelles, R.J. (1999). Policy issues in child neglect. In H. Dubowitz (Ed.), Neglected children: Research, practice and policy (pp. 278Á298). Thousand Oaks, CA: Sage Publications. Kendall-Tackett, K.A., & Eckenrode, J. (1996). The effects of neglect on academic achievement and disciplinary problems: A developmental perspective. Child Abuse and Neglect, 20(3), 161Á 169. Kurtz, P.D., Gaudin, J.M., Wodarski, J.S., & Howing, P.T. (1993). Maltreatment and the school-aged child: School performance consequences. Child Abuse and Neglect, 17, 581Á589. Leiter, J., & Johnsen, M.C. (1994). Child maltreatment and school performance. American Journal of Education, 102, 154Á189. Child Care in Practice 113 Lung, C.T. & Daro, D. (1996). Current trends in child abuse reporting and fatalities: The results of the 1995 annual fifty state survey (Working Paper No. 808). Chicago, IL: National Committee to Prevent Child Abuse. Lutzker, J., Frame, R., & Rice, J. (1982). Project 12-ways: An eco-behavioural approach to the treatment and prevention of child abuse and neglect. Education and Treatment of Children, 5, 141Á155. McSherry, D. (2007). Understanding and addressing the ‘‘neglect of neglect’’: Why are we making a mole-hill out of a mountain? Child Abuse and Neglect, 31(6), 607Á614. McSherry, D., Iwaniec, D., & Larkin, E. (2004). Counting the costs: The Children (Northern Ireland) Order 1995, social work, and the courts (Research report). Belfast: Institute of Child Care Research, Queen’s University. Minty, B., & Pattinson, G. (1994). The nature of child neglect. British Journal of Social Work, 24, 733Á747. NCPA. (1998). Abuse and neglect statistics. Chicago: National Committee to prevent Child Abuse. Ney, P.G., Fung, T., & Wickett, A.R. (1994). The worst combinations of child abuse and neglect. Child Abuse and Neglect, 18, 705Á714. Olds, D.L. (2006). The nurseÁfamily partnership: An evidence-based preventive intervention. Infant Mental Health Journal, 27(1), 5Á25. Olds, D.L., & Kitzman, H. (1993). Review of research on home visiting for pregnant women and parents of young children. The Future of Children, 3, 53Á92. Olds, D.L., Eckenrode, J., Henderson, C.R., Kitzman, H., Powers, J., Cole, R., & . . . Luckey, D. (1997). Long-term effects of home visitation on maternal life course and child abuse and neglect. Journal of the American Medical Association, 278, 637Á643. Palacio-Quinton, E., Ethier, L.S., Jourdan-Ionescu, C., & Lacharite, C. (1994). L’intervention aupres des families negligentes. In J.P. Pourtois (Ed.), Enfance Maltraitee (pp. 173Á212). Bruxelles: De Boek. Rose, S.J., & Meezan, W. (1996). Variations in perceptions of child neglect. Child Welfare, 75(2), 139Á160. Scottish Government. (2009). Child protection statistics 2008/9. Edinburgh: National Statistics. Stevenson, O. (1996). Emotional abuse and neglect: a time for reappraisal. Children and Family Social Work, 1, 13Á18. Stone, B. (1998). Child neglect: Practitioners’ perspectives. Child Abuse Review, 7, 87Á96. US Department of Health and Human Services. (1998). Child abuse and neglect state statutes series. In Crimes: Religious exemption to criminal child abuse and neglect (Vol. 37, pp. 1Á9). Washington, DC: National Centre for Prosecution of Child Abuse. US Department of Health and Human Services, Administration on Children, Youth and Families. (2006). Child maltreatment*2004. Washington, DC: US Government Printing Office. Wiehe, V.R. (1996). Working with child abuse and neglect: A primer. Thousand Oaks, CA: Sage Publications. Yuan, Y.T., & Struckman-Johnson, D.L. (1991). Placement outcomes for neglected children with prior placements in family preservation programs. In K. Wells & D.E. Bigel (Eds.), Family preservation services: Research and evaluation (pp. 92Á118). Newbury Park, CA: Sage Publications. Zuravin, S.J. (1988). Child abuse, child neglect, and maternal depression: Is there a connection? In Research symposium on child neglect (pp. D-23Á48). Washington, DC: National Center on Child Abuse and Neglect. Copyright of Child Care in Practice is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder 's express written permission. However, users may print, download, or email articles for individual use.
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