1. CA NEGLECT1 CHILD NEGLECT * What is Neglect? Types of Neglect What constitutes neglect: Behavior of Parent or Harm to child? * How Many Children Are Neglected? Vast Differences between estimates Difficulty in defining and measuring Cultural criterion Where to draw the line Is 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

2. CA NEGLECT2 TYPES OF NEGLECT U.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)

3. CA NEGLECT3 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.

4. CA NEGLECT4 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.

5. CA NEGLECT5 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 standards Example: 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.

6. CA NEGLECT6 “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.

7. CA NEGLECT7 “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.

8. CA NEGLECT8 PREVALENCE OF NEGLECT DIFFERENCES IN RATES FROM THREE SOURCES RATENUMBER PER 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 270.018,865,000 Cases known to professionals is double Cases uncovered by 1995 survey of parents is 37 times greater WHAT COULD EXPLAIN THESE DIFFERENCES?

9. CA NEGLECT9 WHAT COULD EXPLAIN THESE DIFFERENCES? MOST CASES NOT REPORTED Even human service professionals do not report all (perhaps half of cases they know about) DIFFERENT CRITERIA FOR JUDGING A CASE TO BE NEGLECT National Survey of parents used parents behavior CPS 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

10. CA NEGLECT10 HOW CAN NEGLECT BE MEASURED ASIDE 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 Scale Form A – Adolescent Report and Adult Recall Form AS – Short form as part of the PRP Form CR – Computer Administered For children 6-12 Form PR – Parent Self Report

11. CA NEGLECT11 WHY HAVING OTHER MEASURES IS MPORTANT Cases known to CPS are the tip of the iceberg Provides more complete estimate of prevalence But 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

12. CA NEGLECT12 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 2136.0 when you thought some adult should be with him/her NC. Were not able to make sure your child got 110 1375.5 the food he/she needed NE. Were so drunk or high that you had a 33 5.92.3 Problem taking care of your child ND. Were not able to make sure your child got to 4 122.0 a doctor or hospital when he/she needed it. NB. Were so caught up with problems that you 2 114.6 were not able to show or tell your child that you loved him/her Neglect Scale (= sum of the 5 items) 270 3066.9__________ Chronicity is the mean number of times each act was reported among the subset of parents who reported at least one occurrence. THE CTS NEGLECT SCALE

13. CA NEGLECT13 MULTIDIMENSIONAL NEGLECT SCALE SHORT 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 Needs My parents made sure I went to school (R) My parents did not care if I got into trouble in school Emotional needs My parents helped me when I had problems (R) My parents did not comfort me when I was upset Physical needs My parents gave me enough clothes to keep me warm (R) My parents did not keep me clean (R) = REVERSED ITEMS RELIABILITY COEFFICIENT (ALPHA =.71)

14. CA NEGLECT14 Table 3: Percent Reporting One or More Forms of Each Type of Neglect, by Gender 7,500 Students in 14 Countries

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16. CA NEGLECT16 Table 5a: Neglect Total Scores in Rank Order by Site, by Gender

17. CA NEGLECT17 Figure 1: Interaction Effect of Gender and Site for Total Neglect

18. CA NEGLECT18 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

19. CA NEGLECT19 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

20. CA NEGLECT20 Is this… Emotional Neglect Sample Item Cont.

21. CA NEGLECT21 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 Which girl is most like you? Cognitive Neglect Sample Item

22. CA NEGLECT22 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)

23. CA NEGLECT23 Which boy is most like you? 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)

24. CA NEGLECT24 Hasn’t left alone for a couple of days without grown-ups

25. CA NEGLECT25 Which boy is most like you? 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

26. CA NEGLECT26 Sees grown-ups in the house hitting each other

27. CA NEGLECT27 Which girl is most like you? Some girls are unhappy a lot of the time Other girls are pretty happy a lot of the time Depression Sample Item

28. CA NEGLECT28 Is this… Depression Sample Item Cont.

29. CA NEGLECT29 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

30. CA NEGLECT30 % Child Behavioral Problems by MNS-CR Median Split Scores

31. CA NEGLECT31 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

32. CA NEGLECT32 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

33. CA NEGLECT33 SUMMARY ESTIMATES OF NEGLECT VARY WIDELY Mainly 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

34. CA NEGLECT34 End for Soc 697

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38. CA NEGLECT38 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

39. CA NEGLECT39 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

40. CA NEGLECT40 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

41. CA NEGLECT41 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

42. CA NEGLECT42 Maltreatment Types in Clinical Sample Number & % 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 Types57 (40%)

43. CA NEGLECT43 Total MNS-CR Scores by Sample: Age 6-9 Significance, * p = <.01 *

44. CA NEGLECT44 MNS-CR Scores by Sample: Age 6-9 Neglect DomainClinical Sample (N = 81) Cmty. Sample (N = 30) Emotional1.831.07 Cognitive1.651.17 Supervision1.880.69** Physical2.831.63 Abandonment0.160* Failure to Protect0.880.73 Alcohol0.230* Child’s Appraisal2.743.15 Depression2.862.31 ** p <.01, * p <.05

45. CA NEGLECT45 Total MNS-CR Scores by Sample: Age 10-15

46. CA NEGLECT46 MNS-CR Scores by Sample: Age 10-15 Neglect DomainClinical Sample (N = 81) Cmty. Sample (N = 30) Emotional2.261.94 Cognitive1.580.80 Supervision2.041.18 Physical1.581.20 Abandonment0.160.13 Failure to Protect0.660.69 Alcohol0.090.0 Child’s Appraisal1.941.91 Depression2.612.43

47. CA NEGLECT47 MNS-CR Scores by Neglect: Age 6-9 Yes (N = 20) No (N = 54) Neglect Total8.148.24 Emotional1.662.00 Cognitive1.401.56 Supervision1.761.99 Physical3.222.56 * Abandonment0.100.13 Alcohol0.250.23 Failure to Protect0.451.05 General Appraisal2.77 Depression3.442.63*

48. CA NEGLECT48 MNS-CR Scores by Psych. Abuse: Age 6-9 Yes (N = 20) No (N = 54) Neglect Total6.079.00 Emotional1.052.22 Cognitive1.161.65 Supervision1.602.05 Physical2.212.94 Abandonment0.050.15 Alcohol0.300.21 Failure to Protect0.610.99 General Appraisal2.612.82 Depression2.073.10

49. CA NEGLECT49 MNS-CR Scores by Neglect: Age 10-15 Yes (N = 17) No (N = 47) Neglect Total8.206.15 Emotional2.521.80 Cognitive1.731.28 Supervision1.941.98 Physical1.891.09 Abandonment0.120.0 Alcohol0.060.10 Failure to Protect0.490.55 General Appraisal2.261.72 Depression2.402.69

50. CA NEGLECT50 MNS-CR Scores by Psych. Abuse: Age 10-15 Yes (N = 21) No (N = 37) Neglect Total10.124.84 Emotional3.111.39 Cognitive2.131.00 Supervision3.161.16 Physical1.631.16 Abandonment0.100.0 Alcohol0.240.0 Failure to Protect0.970.28 General Appraisal1.811.92 Depression3.352.13

51. CA NEGLECT51 MNS-CR Scores by Past CPS Involvement

52. CA NEGLECT52 MNS-CR Scores by Current CPS Involvement (Open Case)

53. CA NEGLECT53 PPVT Standard Scores by Presenting Maltreatment Type PPVT Standard Score Age 6-9Age 10-15 Neglect Concerns Yes88.37**87.87** No100.31100.74 Physical Abuse Concerns Yes92.1795.33 No98.7998.00 Sexual Abuse Concerns Yes99.64**99.58* No89.6790.80 Psych. Abuse Concerns Yes94.8095.43 No98.0298.19 * p <.05, ** p <.01

54. CA NEGLECT54 Table 1: Comparison of Neglect Estimated

55. CA NEGLECT55 Table 2: Reliability of Neglect

56. CA NEGLECT56 Reliability Summary for MNS-CR Scores ScaleNumber of Items Alpha Age 6-9Age 10-15 Neglect Total36.78.91 Emotional7.55.79 Cognitive5.30.59 Supervision8.29.73 Physical13.45.72 Abandonment2-.02N/A Alcohol Use2-.07N/A Failure to Protect3-.04.35 General Appraisal6.50.45 Depression6.68.78