Neglected Children: Research, Practice, and Policy
Child neglect is the most common type of child maltreatment. Substantial evidence indicates that the morbidity and mortality associated with neglect are significant, with enormous costs to the children involved and to society. Yet there is no major text focused exclusively on child neglect. Neglected Children presents a comprehensive and critical portrait of the phenomenon of neglect, based on theory, research and clinical practice experience. The editor and the contributing authors present a rich, interdisciplinary conceptualization with a broad view of neglect, moving far beyond the current child welfare focus on parental omissions in care. This broader view is essential to seriously addressing the complex and pervasive underpinnings of neglect.
- Front Matter
- Back Matter
- Subject Index
- Chapter 1: Child Neglect: The Family with a Hole in the Middle
- Chapter 2: Child Neglect: A Review of Definitions and Measurement Research
- Chapter 3: Child Neglect: Causes and Contributors
- Chapter 4: Cultural Competence and Child Neglect
- Chapter 5: Child Neglect: Short-Term and Long-Term Outcomes
- Chapter 6: Neglect of Children's Health Care
- Chapter 7: Prenatal Alcohol and Drug Use and Risk for Child Maltreatment: A Timely Approach to Intervention
- Chapter 8: Fatal Child Neglect
- Chapter 9: The Prevention of Child Neglect
- Chapter 10: Evaluation and Risk Assessment of Child Neglect in Public Child Protection Services
- Chapter 11: Intervening with Families When Children are Neglected
- Chapter 12: Are Battered Women Bad Mothers? Rethinking the Termination of Abused Women's Parental Rights for Failure to Protect
- Chapter 13: Child Neglect: Research Recommendations and Future Directions
- Chapter 14: Policy Issues in Child Neglect
Dedicated to my gentle and loving father, Nathan Paul Dubowitz (1923–1980).
Copyright © 1999 by Sage Publications, Inc.
All rights reserved. No part of this book may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the publisher.
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Library of Congress Cataloging-in-Publication Data
Neglected children: Research, practice, and policy / edited by Howard Dubowitz.
Includes bibliographical references and index.
ISBN 0-7619-0853-6 (cloth: alk. paper)
ISBN 0-7619-1842-6 (pbk.: alk. paper)
1. Child abuse—United States. 2. Abused children—Services for—United States. 3. Social work with children—United States. I. Dubowitz, Howard.
HV6626.52 N44 1999
99 00 01 02 03 10 9 8 7 6 5 4 3 2 1
Acquiring Editor: C. Terry Hendrix
Production Editor: Diana E. Axelsen
Editorial Assistant: Nevair Kabakian
Book Designer: Lynn Miyata
Typesetter: Christina M. Hill
Cover Designer: Michelle Lee
“The neglect of neglect” has almost become a cliché, and like many other clichés, there is ample justification for the phrase. Abuse, particularly sexual abuse, has evoked an intense response from the media, the public, and professionals. Neglect has attracted far less attention. Journals and conferences pertaining to child maltreatment have had relatively little on neglect. At the same time, it has been clear that neglect is distressingly prevalent and that the effect on children can be immense. The importance of child neglect as a major clinical and social issue is not in question.
Despite not getting its due attention, a great deal has been learned about child neglect. Because cases involving neglect constitute more than half of cases reported to child protective services, the child welfare system and practitioners in several disciplines have had enormous experience addressing neglect. There has also been increasing research on neglect, particularly supported by the National Center on Child Abuse and Neglect (now, the Office on Child Abuse and Neglect). The main goal of this book is to synthesize our knowledge of child neglect in one text, in a way that will be valuable for clinicians, researchers, and policymakers. Obviously, much remains to be learned, but here is an opportunity to examine the state of our knowledge and, sometimes, the “state of the art.” I hope this book will in some small way help enhance efforts to protect children and support families and provide a foundation for further developing the [Page viii]knowledge base and new theory, programs, and policies related to the neglect of children.
It is inevitable that an edited volume will include divergent views; this book is no exception. This offers an accurate reflection of our field, and I have resisted the temptation to present a single or my perspective. The lack of consensus on a definition and causal pathways of neglect, for example, poses challenges for clinicians and researchers. The link between child neglect and political and ideological values makes it likely that certain differences will continue. At the same time, substantial overlap in views and interpretations of the research exists; I believe that the differences are not as huge as they may appear.
The range of topics covered in this book should be of broad interest to professionals in the field of child maltreatment. Clearly, neglect often co-occurs with other forms of child maltreatment. It is hoped that clinicians, researchers, and policymakers will find useful guidance in these pages. Ultimately, neglected children and their families should benefit.Acknowledgments
There are many people who have contributed to my interest and development in the field of child maltreatment; I feel very fortunate to have had such terrific colleagues. Robert Reece and Eli Newberger were early role models introducing me to this area of pediatrics in the early 1980s. The faculty and fellows at the Family Development Program at Boston's Children's Hospital taught me the value and pleasure of interdisciplinary collaboration. Maureen Black, Diane DePanfilis, Donna Harrington, Wayne Holden, Charles Shubin, Raymond Starr, and Susan Zuravin, all at the University of Maryland, have helped make work in this difficult area stimulating and rewarding.
I am also grateful to my colleagues in the Longitudinal Study on Child Abuse and Neglect and the American Professional Society on the Abuse of Children; I have learned so much from them. Terry Hendrix at Sage has been an enthusiastic supporter of this project, and Jan Roberts has been a whiz with word processing challenges. I want to thank the authors who contributed to this book. Life is not dull for any of them, and these chapters required a great deal. Behind the scene, my wife, Diana, and children, Nikki and Andy, have been an important source of support and inspiration.
About the Contributors[Page 315]
Maureen M. Black, Ph.D., is Professor in the Department of Pediatrics at the University of Maryland School of Medicine and Director of the Growth and Nutrition Clinic, a multidisciplinary, family-focused clinic for children with failure to thrive. She is a fellow of the American Psychological Association, president of the Society of Pediatric Psychology, and a past president of the Division of Child, Youth, and Family Services of the APA. Her clinical and research interests involve nutritional and family-focused interventions with children and families from low-income urban communities to promote growth and development, follow-up of children exposed to substances prenatally, and evaluation of multigenerational programs to promote adolescent development and parenting skills among adolescent mothers and fathers.
Barbara L. Bonner, Ph.D., is a clinical child psychologist and Director of the Center on Child Abuse and Neglect in the Department of Pediatrics at the University of Oklahoma. Her research interests include child abuse-related fatalities, children and adolescents with inappropriate or illegal sexual behavior, and the effectiveness of family preservation and family support programs. She recently completed a 5-year treatment outcome study funded by the National Center on Child Abuse and Neglect on children with sexual behavior problems. She is past president of the American Professional Society on the Abuse of Children (APSAC) and is treasurer of the International Society for the Prevention of Child Abuse and Neglect (ISPCAN). She serves on the Editorial Boards of Child Maltreatment, Journal of Pediatric Psychology, and Child Abuse and Neglect, and she has published many articles on child maltreatment.
Ira J. Chasnoff, M.D., is President of the Children's Research Triangle and Professor of Pediatrics at the University of Illinois College of Medicine in Chicago. He is one of the nation's leading researchers in the field of maternal drug use during pregnancy and the effects on the newborn infant and child. His research projects include a study of the long-term cognitive, behavioral, and educational developmental [Page 316]effects of prenatal exposure to alcohol, cocaine, and other drugs; the effects on birth outcome of prenatal treatment and counseling for pregnant drug abusers; and the effectiveness of both outpatient and residential treatment programs for pregnant drug abusers. He is the author of four books and numerous articles on the effects of drug use on pregnancy and on the long-term cognitive, behavioral, and learning outcomes of prenatally exposed children. His most recent book, Understanding the Drug-Exposed Child, has been cited as an important addition to the literature on helping children at risk of educational failure.
Cyleste C. Collins is a research assistant at the Family Life Development Center at Cornell University in Ithaca, New York.
Patricia McKinsey Crittenden, Ph.D., M.Ed., M.A., is a consultant on social ecology and development, University of Virginia, Family Relations Institute. Her primary interest is developmental psychopathology. Her work with maltreating mothers and children and later administering a family support center for at-risk families in a housing project is central to her understanding of both child neglect and the process by which early exposure to threatening conditions affects later psychological and interpersonal functioning. She has published empirical research on the functioning of maltreating families and contributed to the development of theory regarding developmental psychopathology. Currently, she teaches, in universities and health organizations around the world, research and clinical assessment methods tied to dynamic-maturational theory of the development of interpersonal strategies for protecting the self and one's children.
Sheila M. Crow, M.A., is Assistant Director of the Center on Child Abuse and Neglect and Director of the Center's Administrative Programs in the Department of Pediatrics at the University of Oklahoma Health Sciences Center. She also serves as the Administrator of the Oklahoma Child Death Review Board. Her primary research interest is in child fatalities, with a focus on child maltreatment-related deaths. She is past co-chair of the American Professional Society on the Abuse of Children's (APSAC) Child Fatality Task Force and is editor of The Link, the official newsletter of the International Society for the Prevention of Child Abuse and Neglect (ISPCAN). She has published reports on child fatalities and child maltreatment-related disabilities.
Diane DePanfilis, Ph.D., M.S.W., is Assistant Professor at the University of Maryland School of Social Work. With more than 25 years of experience in the child welfare field as a caseworker, supervisor, program manager, national trainer, consultant, and researcher, she is a frequent consultant to child welfare agencies. She is currently principal investigator of a demonstration project funded by the National Center on Child Abuse and Neglect that is providing early intervention to families at risk of neglect and is coediting Child Protection Practice Handbook (Sage Publications, forthcoming). Recent research and publications relate to child maltreatment recurrences; CPS risk assessment and decision making; the relationship between adolescent parenting and child maltreatment; intergenerational transmission [Page 317]of child maltreatment; the role of social support in preventing neglect; and family-focused, outcome-based intervention to reduce risk of neglect. She is currently president of the National Board of Directors of the American Professional Society on the Abuse of Children.
Howard Dubowitz, M.D., M.S., is Professor of Pediatrics at the University of Maryland School of Medicine and Director of the Child Protection Program at the University of Maryland Medical System. He is Chair of the Child Maltreatment Committee of the American Academy of Pediatrics, Maryland Chapter, and he is on the Executive Committee of the American Professional Society on the Abuse of Children (APSAC). His clinical work has included all forms of child maltreatment with a special interest in neglect. His research has been in the areas of child neglect, sexual and physical abuse, kinship care, physician training in child abuse, and the prevention of child maltreatment. He has been actively involved in child advocacy at the state and national levels, and he chairs the Legislative Committee of APSAC. He has presented at numerous local, regional, national and international conferences, and he has published widely in the field of child abuse and neglect.
Diana J. English, M.S.W., Ph.D., is affiliated with the Department of Social and Health Services at the University of Washington, Seattle, and is the director of a public child welfare research center located in a public child welfare agency. Her research interests include risk assessment in child protection, factors that influence child protective services decision making, the long-term effects of child maltreatment on children's growth and development, and the effectiveness of public service interventions.
James Garbarino, Ph.D., is Co-Director of the Family Life Development Center and Professor of Human Development at Cornell University. He served as President of the Erikson Institute for Advanced Study in Child Development from 1985–1994. Garbarino is author or editor of seventeen books, including Understanding Abusive Families (second edition, 1992); The Psychologically Battered Child (1986); What Children Can Tell Us (1989); Children in Danger: Coping With the Consequences of Community Violence (1993); and Raising Children in Socially Toxic Environment (1995). He has served as a scientific expert witness in criminal and civil cases involving issues of violence and children. The National Conference on Child Abuse and Neglect honored Garbarino in 1985 with its first C. Henry Kempe Award, in recognition of his efforts on behalf of abused and neglected children. In 1994, the American Psychological Association's Division on Child, Youth, and Family Services presented him with its Nicholas Hobbs Award. Also in 1994, he received the Dale Richmond Award from the American Academy of Pediatrics Section on Behavioral and Developmental Pediatrics.
James M. Gaudin, Jr., Ph.D, is Professor at the University of Georgia School of Social Work. He has been principal investigator for research on child neglect and incarcerated mothers and their children over the past 17 years. His research has been funded by the U.S. Department of Health and Human Services, National [Page 318]Center on Child Abuse and Neglect, University of Georgia Research Foundation, and private foundations. He is author of 30 articles in refereed journals, two books, and three book chapters. He authored Child Neglect: A Guide for Professional Helpers, one of the User Manual Series published by the National Center on Child Abuse and Neglect. He is recognized nationally and internationally as one of the leading researchers in child abuse and neglect, and has given workshops on child neglect to professional groups throughout the southeastern United States. He has more than 25 years of experience as a clinical practitioner, supervisor, administrator, program developer, teacher, and researcher in the field of family and child welfare.
Richard J. Gelles, Ph.D, holds the Joanne and Raymond Welsh Chair of Child Welfare and Family Violence in the School of Social Work at the University of Pennsylvania. His book The Violent Home was the first systematic investigation of family violence and continues to be highly influential. He is the author or coauthor of 23 books and more than 100 articles and chapters on family violence. His latest books are The Book of David: How Preserving Families Can Cost Children's Lives (1996) and Intimate Violence in Families, Third Edition (Sage, 1997). He is a member of the National Academy of Science panel on “Assessing Family Violence Interventions.” He is also vice president for publications for the National Council on Family Relations. He edited the journal Teaching Sociology from 1973 to 1981 and received the American Sociological Association, Section on Undergraduate Education, “Outstanding Contributions to Teaching Award” in 1979. He has presented lectures to policy-making groups and media groups, including The Today Show, CBS Morning News, Good Morning America, The Oprah Winfrey Show, Dateline, and All Things Considered. In 1984, Esquire named him as one of the men and women who are “changing America.”
E. Wayne Holden, Ph.D., is employed by Macro International Inc. as principal investigator of the national evaluation of the Comprehensive Community Mental Health Services for Children and Their Families program, sponsored by the Substance Abuse and Mental Health Services Administration. He was a faculty member in the Department of Pediatrics at the University of Maryland School of Medicine from 1988 to 1998. He has published extensively in the area of children's mental health and specifically in the area of child maltreatment.
Jill E. Korbin, Ph.D., is Professor of Anthropology at Case Western Reserve University. She received the 1986 Margaret Mead Award from the American Anthropological Association, served as a Society for Research in Child Development Congressional Science Fellow in 1985–86 in the offices of Senator Bill Bradley, and was a Scholar-in-Residence at the Kempe National Center in 1977–78. She has published numerous articles on culture and child maltreatment, including her edited book, Child Abuse and Neglect: Cross-Cultural Perspectives (1981). She has conducted research on women incarcerated for fatal child maltreatment, on child and elder maltreatment in Ohio, on the impact of neighborhood factors on child maltreatment in Cleveland, and on health and childrearing among Ohio's Amish population.
[Page 319]Mary Beth Logue, Ph.D., is a pediatric psychologist and Assistant Professor in the Department of Pediatrics at the University of Oklahoma Health Sciences Center. Her research interests include physical symptom presentations of psychological disorders, ethical decision making by health professionals, and other topics related to child maltreatment. Her clinical practice includes working with medically ill children in both inpatient and outpatient settings, as well as children and families with a variety of problems. She is a member of the Child Protection Committee at Children's Hospital of Oklahoma, the American Psychological Association, Oklahoma Psychological Association, and the American Professional Society on the Abuse of Children (APSAC).
Lee Ann Lowder, J.D., is an attorney who supervises appeals for the Office of the Cook County Public Guardian. The office represents 43,000 abused and neglected children in the juvenile court in Chicago. About 85% of the parents of the Public Guardian's child clients have substance abuse problems. The Illinois Department of Children and Family Services has a policy of referring women whose newborns test positive for cocaine and other illegal substances to drug treatment programs. A woman's first cocaine baby is rarely brought to the attention of the court. Consequently, the most common new case in Cook County juvenile court is brought on behalf of the second or third cocaine baby born to a mother, and the mother's older children.
Thomas D. Lyon, J.D., Ph.D., is Associate Professor of Law at the University of Southern California Law School. He worked as an attorney for the Children's Services Division of the Los Angeles County Counsel's Office from 1987 to 1995, representing the Department of Children's Services in dependency proceedings alleging child abuse and neglect. His dissertation was named the outstanding dissertation in developmental psychology by the American Psychological Association in 1995. He is associate editor for legal issues for the Advisor, a publication of the American Professional Society on the Abuse of Children (APSAC), and he is also on APSAC's board of directors. His work has appeared in Child Development, Contemporary Psychology, Cornell Law Review, Pacific Law Journal, Harvard Women's Law Journal, and Psychology, Public Policy, and Law.
Laura Nabors, Ph.D., is on the faculty of the Division of Child and Adolescent Psychiatry at the University of Maryland School of Medicine. She completed a postdoctoral fellowship at the Frank Porter Graham Child Development Center at the University of North Carolina at Chapel Hill. Her research interests include examining risk and resilience factors and their influence on the lives of children and families; conducting program evaluation and quality improvement activities in children's mental health services; increasing knowledge about the impact of abuse, neglect, and violence on children and the prevention of these problems; and ways in which to improve educational opportunities for and the social development of young children with special needs.
[Page 320]James C. Spilsbury, M.P.H., is a doctoral student in the Department of Anthropology at Case Western Reserve University. He has worked in international health projects in sub-Saharan Africa and Haiti for eight years. He has developed an interest in the anthropology of childhood and is currently conducting his dissertation research on inner-city children's perceptions of safety and danger in Cleveland, Ohio.
Susan J. Zuravin, Ph.D., M.S.W., is Associate Professor at the University of Maryland School of Social Work. Her primary research focus is child welfare. She has received funding from the National Center on Child Abuse and Neglect to conduct studies both on the etiology and sequelae of child abuse and neglect and on the characteristics and outcomes of the public foster care system. Published papers from these studies have examined the relationship between maternal depression and both child physical abuse and neglect, the ecological correlates of child maltreatment, the childbearing and contracepting patterns of maltreating families, the intergenerational transmission of child maltreatment, and various long-term sequelae of child sexual abuse.