CA NEGLECT1 CHILD NEGLECT * What is Neglect? Types of Neglect What constitutes neglect: Behavior of...

CA NEGLECT 1

CHILD NEGLECT * What is Neglect?

Types of NeglectWhat constitutes neglect: Behavior of Parent or Harm to child?

* How Many Children Are Neglected?Vast Differences between estimatesDifficulty in defining and measuring

Cultural criterionWhere to draw the lineIs failure to protect from observing violence neglect?

* Is there any way to measure neglect aside from the number of injured children discovered?* Most prevalent and least researched form of child maltreatment

* Ways of measuring neglect: CPS, CTS scale, MNS-A and MNS-C

* Consequences of Neglect: IDV study, Maine-NH study

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TYPES OF NEGLECTU.S. Department of Health and Human Services as cited in Barnett:

1. Health care neglect (the refusal to provide physical and mental health care)

2. Personal hygiene neglect (personal care and cleanliness standards are failed to be met)

3. Nutritional neglect (failure to provide a nutritious and quality diet)

4. Neglect of household safety (safety hazards either within the house or surrounding area pose danger to the child)

5. Neglect of household sanitation (housekeeping and cleanliness standards are not met)

6. Inadequate shelter (lack of stable home)

7. Abandonment (physical abandonment)

8. Supervisory neglect (parental supervision lacks to the extent that injury is possible)

9. Educational neglect (parents don’t provide the necessary care and supervision to promote education)

10. Emotional neglect (security, support, and encouragement aren’t provided)

11. Fostering delinquency (the encouragement of illegal behaviors)

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DEFINITION OF NEGLECT

Neglect is behavior by a caregiver that constitutes a failure to act in ways that are presumed by the culture of a society to be necessary to meet the developmental needs of a child and which are the responsibility of a caregiver to provide.

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CONTROVERSIAL ELEMENTS IN THE DEFINITION

“Behavior by a caregiver”

* Essential to avoid confounding the definition and measurement of neglect with either the causes of neglect (such as poverty or motive) or with the effects of neglect such as physical or psychological damage to the child.

* Crucial to measure causes or effects. For example, service providers may often also need data on injury, as this is often prescribed by statute

* Causes and effects must be measured separately from the caregiver behavior that constitutes neglect.

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HARM TO THE CHILD IS NOT IGNORED BY A DEFINITION THAT EXCLUDES HARM

•Actualy facilitates research to investigate the degree of harm associated with deviation from culturally established standards of care.

• Studies of this type• First identifytype and frequency of neglectful behavior, defined as

deviation from cultural standards.• Next investigate the probability and degree of harm associated with

those deviations from cultural standardsExample: standards for appropriate levels of supervision, such as leaving a seven year-old under the daily supervision of a 10 year-old sibling after school until a parent returns from work.

* What percent of such children are harmed? * If harm is included in the definition, there is no way of measuring

that.

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“PRESUMED BY THE CULTURE”

* Except possibly at the extremes when a child is seriously injured or dies, neglect is a culturally constructed phenomenon

* Cultural norms concerning neglect vary from society to society. Within a given society they change over time.

* Laotia, Cambodian, and many other societies: leaving an infant in the daylong care of 7 or 8 year old siblings expected rather

than be considered neglect (Korbin & Spilsbury, 1999).

* Contemporary USA: both the infant and the 7 or 8 year-old caregiver child would be judged as neglected.

* For example, learning to read and write was at one time a privilege of a small minority of children rather than a developmental need that, if not met, constitutes neglect.

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“RESPONSIBILITY OF A CAREGIVER”

• Allows for a division of labor between caregivers.

• If there are two caregivers and only one is expected to provide food, and only one does, the other caregiver has not been neglectful.

• If both are expected to provide food and one does not, that is neglect by the caregiver who fails to provide food.

• This is the case even if the child gets enough to eat from the other caregiver because a primary caregiver has failed to meet the standards of the culture.

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PREVALENCE OF NEGLECTDIFFERENCES IN RATES FROM THREE SOURCES

RATE NUMBERPER 1,000 OF CHILDREN

Cases reported to Child Protective Services, 1998 7.2 504,000 53% of all cases reported to CPS

National Incidence Study of cases known to human 15.9 1,004,00 service professionals

(random sample of 28 counties)

National Survey of 1,000 parents, 1995 270.0 18,865,000

Cases known to professionals is doubleCases uncovered by 1995 survey of parents is 37 times greater

WHAT COULD EXPLAIN THESE DIFFERENCES?

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WHAT COULD EXPLAIN THESE DIFFERENCES?

MOST CASES NOT REPORTEDEven human service professionals do not report all (perhaps half

of cases they know about)

DIFFERENT CRITERIA FOR JUDGING A CASE TO BE NEGLECTNational Survey of parents used parents behaviorCPS and human service professionals tend to use injury to the

child Most neglect does not result in a visible injury. The most

frequent injury is psychological and it is rarely observable

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HOW CAN NEGLECT BE MEASUREDASIDE FROM REPORTS TO CPS?

Surveys Of Service Providers – the least useful approach

Epidemiological Surveys = studies of a general population

The CTS Neglect Scale

The Multimensional Neglect ScaleForm A – Adolescent Report and Adult RecallForm AS – Short form as part of the PRPForm CR – Computer Administered For children 6-12Form PR – Parent Self Report

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WHY HAVING OTHER MEASURES IS MPORTANT

Cases known to CPS are the tip of the icebergProvides more complete estimate of prevalenceBut the criteria are not necessarily the same

A means of testing the effectiveness of prevention and treatment programs

More adequate data on CPS cases, especially cases with other presenting problems

Research that will provide the better understanding of the causes neglect needed to develop "primary prevention" programs

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NATIONAL SURVEY OF 1,000 PARENTS(Straus et al, 1995)

Prevalence Past Yr Scale and Items Year Ever Chron NA. Had to leave your child home alone, even 195 213 6.0 when you thought some adult should be with him/herNC. Were not able to make sure your child got 110 137 5.5 the food he/she neededNE. Were so drunk or high that you had a 33 5.9 2.3 Problem taking care of your childND. Were not able to make sure your child got to 4 12 2.0 a doctor or hospital when he/she needed it.NB. Were so caught up with problems that you 2 11 4.6 were not able to show or tell your child that you loved him/her

Neglect Scale (= sum of the 5 items) 270 306 6.9__________ Chronicity is the mean number of times each act was reported amongthe subset of parents who reported at least one occurrence.

THE CTS NEGLECT SCALE

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MULTIDIMENSIONAL NEGLECT SCALESHORT FORM (Form MNS-AS)

Cognitive needs

My parents helped me with homework if I needed help (R)My parents did not help me to do my best in school

Educational NeedsMy parents made sure I went to school (R)My parents did not care if I got into trouble in school

Emotional needsMy parents helped me when I had problems (R)My parents did not comfort me when I was upset

Physical needsMy parents gave me enough clothes to keep me warm (R)My parents did not keep me clean

(R) = REVERSED ITEMS

RELIABILITY COEFFICIENT (ALPHA = .71)

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Table 3: Percent Reporting One or More Forms of Each Type of Neglect, by Gender

Total Males Females Chi Square

1+ forms 50.50% 56.20% 47.80% 55.27***

2+ forms 24.50% 28.70% 22.60%

1+ forms 29.80% 34.40% 27.70% 34.66***

2+ forms 5.30% 5.60% 5.10%

1+ forms 22.30% 25.50% 20.90% 29.90***

2+ forms 5.60% 5.20% 5.70%

1+ forms 19.80% 23.20% 18.30% 23.42***

2+ forms 1.20% 1.40% 1.10%

1+ forms 11.80% 14.40% 10.70% 27.93***

2+ forms 0.70% 1.30% 0.50%

Neglect Scale

Physical

Educational

Emotional

Cognitive

Total

7,500 Students in 14 Countries

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Table 3. Number of Neglectful Behaviors Experienced by Students

Who Were Neglected, By Gender* Number of Behaviors

Total

Males

Females

1 51.4% 49.0% 52.7% 2 24.3% 24.1% 24.4% 3 12.8% 14.2% 12.0% 4 6.8% 7.8% 6.3% 5 2.9% 3.3% 2.8% 6 1.2% 1.4% 1.1% 7 0.5% 0.2% 0.6% 8 0.0% 0.0% 0.0%

Mean 1.91 1.97 1.88 SD 1.22 1.23 1.22

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Table 5a: Neglect Total Scores in Rank Order by Site, by Gender

Rank

1 KOR-PUSAN 93.9 KOR-PUSAN 95.0 KOR-PUSAN 28.1 KOR-PUSAN 41.2

2 HKG-HONGKONG 86.2 HKG-HONGKONG 78.9 HKG-HONGKONG 25.3 HKG-HONGKONG 30.8

3 BEL-LEUVEN 73.3 BEL-LEUVEN 64.0 USA-TX NCDCHS 24.3 CAN-LONDON 20.3

4 MEX-JUAREZ 70.2 MEX-JUAREZ 61.8 CAN-WINNIPEG 23.5 USA-MISSISSP 16.3

5 NDL-AMSTRDAM 69.4 ISR-EMEKZYRL 59.3 CAN-LONDON 22.7 USA-TX-MEX 15.5

6 PRT-BRAGA 69.1 CHE-GERMAN 56.9 MEX-JUAREZ 21.3 USA-LOUISIAN 13.9

7 IND-PUNE 65.6 PRT-BRAGA 54.5 USA-TX-N MEX 20.2 MEX-JUAREZ 13.5

8 BRA-SAOPAULO 65.1 NDL-AMSTRDAM 53.6 BRA-SAOPAULO 19.1 ISR-EMEKZYRL 12.9

9 ISR-EMEKZYRL 64.0 BRA-SAOPAULO 53.2 USA-MISSISSP 17.9 CAN-HAMILTON 12.0

10 CAN-HAMILTON 61.9 USA-MISSISSP 52.9 USA-LOUISIAN 17.6 CAN-WINNIPEG 11.2

11 USA-TX-N MEX 58.1 USA-TX-MEX 52.2 USA-CINCINN 17.5 USA-TX-N MEX 10.5

12 USA-UTAH 56.9 CAN-HAMILTON 49.6 ISR-EMEKZYRL 17.4 BRA-SAOPAULO 10.4

13 USA-LOUISIAN 56.8 USA-TX NCDCHS 48.4 USA-UTAH 16.7 IND-PUNE 9.8

14 USA-TX-MEX 56.3 USA-LOUISIAN 48.1 BEL-LEUVEN 16.4 NDL-AMSTRDAM 9.6

15 CAN-MONTREAL 54.8 IND-PUNE 48.1 AUS-MAGILL 14.6 CHE-GERMAN 9.5

16 USA-TX NCDCHS 54.1 CHE-FRENCH 46.6 CHE-FRENCH 13.7 USA-TX NCDCHS 9.5

17 USA-MISSISSP 53.6 CAN-MONTREAL 45.7 USA-NH 2 12.8 AUS-MAGILL 9.4

18 CAN-WINNIPEG 52.9 CAN-LONDON 45.6 CAN-MONTREAL 12.3 CAN-MONTREAL 9.4

19 USA-CINCINN 52.6 CAN-WINNIPEG 42.2 NDL-AMSTRDAM 12.2 PRT-BRAGA 9.1

20 CAN-LONDON 51.5 USA-UTAH 42.0 PRT-BRAGA 12.2 BEL-LEUVEN 8.8

21 CHE-FRENCH 50.5 USA-TX-N MEX 42.0 CAN-HAMILTON 11.9 NZL-CHRISTCH 8.7

22 CHE-GERMAN 48.4 AUS-MAGILL 41.4 IND-PUNE 11.5 USA-CINCINN 7.7

23 AUS-MAGILL 42.7 USA-CINCINN 40.5 USA-TX-MEX 10.1 USA-UTAH 7.6

24 USA-NH 2 40.4 NZL-CHRISTCH 33.7 NZL-CHRISTCH 10.0 CHE-FRENCH 6.2

25 NZL-CHRISTCH 40.0 USA-NH 2 27.8 CHE-GERMAN 6.3 USA-NH 2 4.7

26 USA-NH 1 24.7 USA-NH 1 17.8 USA-NH 1 5.2 USA-NH 1 2.4

NHT1 (% 3 or more)NHT1 (% 1 or more)

Male Female Male Female

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Figure 1: Interaction Effect of Gender and Site for Total Neglect

0.70

0.90

1.10

1.30

1.50

1.70

1.90

2.10

2.30

Male Female

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Multidimensional Neglect Scale-Child Report (MNS-CR)

Glenda Kaufman Kantor, Ph.D., Murray A. Straus, Ph.D., & Melissa Holt, Ph.D,

Family Research Laboratory, University of New Hampshire

Lawrence Ricci, M.D. & Kerry Drach, Psy.D.

Spurwink Clinic, Portland Maine

•FOR CHILDREN 6-9 AND 10-15•COMPUTER ADMINISTERD -- SOUND AND TOUCH SCREEN•WARM-UP PICTURES DONE WITH RESEARCER•COMPUTER GAME HALF WAY THROUGH

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This girl’s father doesn’t make her feel better when

she is sad or scared

This girl’s father makes her feel better when she is sad

or scared

Which girl is most like you?

Emotional Neglect Sample Item

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Is this…

Emotional Neglect Sample Item Cont.

A little Sort of A lot Really a lot like you like you like you like you

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This girl’s mother does not talk to her about what she is

learning in school

This girl’s mother talks to her about what she is

learning in school


Cognitive Neglect Sample Item

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Which boy is most like you?

This boy’s mother doesn’t know where he’s playing

outdoors

This boy’s mother knows where he’s playing

outdoors

Supervision Neglect Sample Item(age 6-9)

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This boy’s father does not find out where he is going after

school

This boy’s father finds out where he is going after

school

Supervision Neglect Sample Item(age 10-15)

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Hasn’t left alone for a couple of days without grown-ups

CA NEGLECT 25


This boy’s mother makes sure he takes a bath

This boy’s mother does not make sure he takes a bath

Physical Neglect Sample Item

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Sees grown-ups in the house hitting each other

CA NEGLECT 27


Some girls are unhappy a lot of the time

Other girls are pretty happy a lot of the time

Depression Sample Item

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Is this…

Depression Sample Item Cont.

A little Sort of A lot Really a lot like you like you like you like you

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Sample Characteristics

• Clinical Sample• N = 143• 57% 6-9 years of age• 43% 10-15 yrs. of age• 59% female• 41% male• 6% non-white

• Community Sample• N = 45• 67% 6-9 years of age• 33% 10-15 yrs. of age• 53% female• 47% male• 38% non-white

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% Child Behavioral Problems by MNS-CR Median Split Scores

19%

30%25%

37%

0%

5%

10%

15%

20%

25%

30%

35%

40%

6-9 year olds 10-15 year olds

Below Median

Above Median

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Relations of Neglect to Depression and PPVT Standard Scores: Age 6-9

• Child Depression• Neglect Total (r = .54**)• Emotional Neglect (r = .40**)• Cognitive Neglect (r = .40**)• Supervision Neglect (r = .41**)• Physical Neglect (r = .45**)• Parental Alcohol Use (r = .50**)• Child’s Appraisal of Neglect (r = .53**)

• PPVT Standard Scores• MNS-CR Total Score (r = -.26*)• Physical Neglect (r = -.36**)• Neglect Maltreatment Group (r = -.38**)

* p = .05, ** p = .01

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Relations of Neglect to Depression and PPVT Standard Scores: Age 10-15

• Child Depression• Neglect Total (r = .35*)• Emotional Neglect (r = .37**)• Cognitive Neglect (r = .33*)• Supervision Neglect (r = .49**)• Failure to Protect (r = .58**)• Parental Alcohol Use (r = .32**)

• PPVT Standard Scores• Child’s Appraisal of Neglect (r = -.30*)• Neglect Maltreatment Group (r = -.50**)

* p = .05, ** p = .01

CA NEGLECT 33

SUMMARY

ESTIMATES OF NEGLECT VARY WIDELYMainly because they measure different phenomena

Parent behavior versus injury

INFORMATION ABOUT NEGLECT THAT DOES NOT COME TO THE ATTENTION OF CPS IS NEEDED BECAUSE CPS CASES ARE A SMALL FRACTION OF THE ACTUAL NUMBER OF CASES

THE ABOVE STATEMENT IS TRUE ONLY IF ONE MEASURES NEGLECT BY PARENT BEHAVIOR

IT IS POSSIBLE TO MEASURE NEGLECT IN THE GENERAL POPULATION

USE OF ONE OF THESE MEASURES IN THE INTERNATIONAL DATING VIOLENCE STUDY SHOWS THAT NEGLECT OCCURS WORLD-WIDE

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End for Soc 697

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Neglect History Total INDA%>2TOTAL

50454035302520151050

Assa

ult s

ever

e by

self

30%

25%

20%

15%

10%

5%

0%

CA NEGLECT 37

Neglect History Total INDA%>2TOTAL

454035302520151050

Assa

ult t

otal

by

self

50%

40%

30%

20%

10%

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Central Aims of the Study

• Develop a standardized instrument to measure neglect

• Estimate the prevalence of different types of neglect in a community sample

• Describe characteristics of neglectful families in community and clinical samples

• Describe the relationship of neglect to child behavior problems & family characteristics

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ACASI

• Audio enhanced version of the Computer Assisted Self-Administered Interview

• Uses an audio system and touch screen to interview child

• Scale version adapted by age and gender of the child and gender of the primary caretaker

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Child Self Report Neglect Scale

• Measures cognitive, emotional, supervision, and physical neglect

• Includes subscales on: Child Endangerment: exposure to parental conflict & violence, abandonment, and parental alcohol abuse;

• Includes subscale on child’s general feelings or appraisals of each domain

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Eligibility• Inclusionary Criteria- 6-15 yrs old

• Lived in foster care < 6 months (age 6-9)• Lived in foster care < 1 year (age 10-15)

• Exclusionary Criteria- • Visually impaired • Hearing impaired• No spoken language ability• Non-English speaking • Formal diagnosis of mental retardation• Deemed “not interviewable” by clinician

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Maltreatment Types in Clinical SampleNumber & % in

Group

(Total N = 143)

Overall Types

Neglect

Physical abuse

Sexual abuse

Emotional/Psychological abuse

41 (29%)

39 (27%)

104 (73%)

44 (31%)

“Pure” Categories (Participants with only one designated abuse type)

Neglect

Physical abuse

Sexual abuse

Emotional/Psychological abuse

86 (60%)

8 (5.6%)

2 (1.4 %)

74 (51.7%)

2 (1.4%)

Multiple Abuse Types 57 (40%)

CA NEGLECT 43

Total MNS-CR Scores by Sample: Age 6-9

4.56

8.35

0

2

4

6

8

10

Community Sample Clinical Sample

Neglect Total

Significance, * p = <.01

*

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MNS-CR Scores by Sample: Age 6-9Neglect Domain Clinical Sample

(N = 81)

Cmty. Sample

(N = 30)

Emotional 1.83 1.07

Cognitive 1.65 1.17

Supervision 1.88 0.69**

Physical 2.83 1.63

Abandonment 0.16 0*

Failure to Protect 0.88 0.73

Alcohol 0.23 0*

Child’s Appraisal 2.74 3.15

Depression 2.86 2.31

** p < .01, * p < .05

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Total MNS-CR Scores by Sample: Age 10-15

5.26

7.62

0

2

4

6

8

Community Sample Clinical Sample

Neglect Total

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MNS-CR Scores by Sample: Age 10-15Neglect Domain Clinical Sample

(N = 81)

Cmty. Sample

(N = 30)

Emotional 2.26 1.94

Cognitive 1.58 0.80

Supervision 2.04 1.18

Physical 1.58 1.20

Abandonment 0.16 0.13


Alcohol 0.09 0.0

Child’s Appraisal 1.94 1.91


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MNS-CR Scores by Neglect: Age 6-9

Yes

(N = 20)

No

(N = 54)

Neglect Total 8.14 8.24

Emotional 1.66 2.00

Cognitive 1.40 1.56


Physical 3.22 2.56*


Alcohol 0.25 0.23


General Appraisal 2.77 2.77

Depression 3.44 2.63*

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MNS-CR Scores by Psych. Abuse: Age 6-9

Yes

(N = 20)

No

(N = 54)


Emotional 1.05 2.22

Cognitive 1.16 1.65


Physical 2.21 2.94


Alcohol 0.30 0.21




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MNS-CR Scores by Neglect: Age 10-15

Yes

(N = 17)

No

(N = 47)


Emotional 2.52 1.80

Cognitive 1.73 1.28


Physical 1.89 1.09


Alcohol 0.06 0.10




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MNS-CR Scores by Psych. Abuse: Age 10-15

Yes

(N = 21)

No

(N = 37)


Emotional 3.11 1.39

Cognitive 2.13 1.00


Physical 1.63 1.16


Alcohol 0.24 0.0




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MNS-CR Scores by Past CPS Involvement

5.76

8.8

2.54

6.74

0

1

2

3

4

5

6

7

8

9


Never Involved

Ever Involved

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MNS-CR Scores by Current CPS Involvement (Open Case)

6.82

10.51

5.166.49

0

2

4

6

8

10

12


Currently No OpenCase

Current Open Case

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PPVT Standard Scores by Presenting Maltreatment Type

PPVT Standard Score

Age 6-9 Age 10-15

Neglect Concerns

Yes 88.37** 87.87**

No 100.31 100.74

Physical Abuse Concerns

Yes 92.17 95.33

No 98.79 98.00

Sexual Abuse Concerns

Yes 99.64** 99.58*

No 89.67 90.80

Psych. Abuse Concerns

Yes 94.80 95.43

No 98.02 98.19* p < .05, ** p < .01

CA NEGLECT 54

Authors Sample Case Source Neglect Type Prevalence Rate

Gallup Organization, 1995

Randomly selected US households

Perpetrators interviewed Total Neglect 27.00%

Cawson, P., et al., 2000

Randomly selected 18-24 year old UK residents

Victims interviewed Physical Neglect 6.00%

Christensen, E., 1996

Health Nurses in Denmark

Total known cases of victimization Passive Neglect 4.00%

Department of Families, 2002

Department of Families in Queensland, Australia

Officially reported cases of victimization Total Neglect 3.00%

U.S. Department of Health and Human Services, 1999

Child Protective Services and DHHS in US

Officially reported cases of victimization Passive Neglect 0.60%

National Clearinghouse on Child Abuse and Neglect, 1999

Child Protective Services in US

Total known cases of victimization Total Neglect 0.60%

Total Neglect 1.30%

Educational 0.60%

Physical 0.50%

Emotional 0.30%Sedlak, A. J., et al., 1996

Human Service Professionals in US

Total known cases of victimization

Table 1: Comparison of Neglect Estimated

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File Version Alpha Standardized

Individual level file Original 0.71 0.71

Individual level file DA 0.58 0.58

Aggregate file DA 0.63 0.76

Aggregate file D 0.90 0.91

Aggregate file Pooled 0.59 0.70

Table 2: Reliability of Neglect

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Reliability Summary for MNS-CR Scores

Scale Number of Items

Alpha

Age 6-9 Age 10-15

Neglect Total 36 .78 .91

Emotional 7 .55 .79

Cognitive 5 .30 .59

Supervision 8 .29 .73

Physical 13 .45 .72

Abandonment 2 -.02 N/A

Alcohol Use 2 -.07 N/A

Failure to Protect 3 -.04 .35

General Appraisal 6 .50 .45

Depression 6 .68 .78

CA NEGLECT1 CHILD NEGLECT * What is Neglect? Types of Neglect What constitutes neglect: Behavior of...

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