Identifying Early Indicators and Potential Points of Intervention in Cases of Chronic Neglect

Background:  Although the most prevalent form of maltreatment, child neglect remains an under-researched area.  Chronic neglect is of particular concern, as it may represent a disproportionate burden on Child Protective Services (CPS) systems as indicated in one study – 20% of all cases accounted for almost half of all costs (Loman, 2006). Chronic neglect differs from single-incident neglect in terms of frequency of reports and the complexity of stressors and family dynamics. The impact of chronic neglect is not well understood, but research demonstrates negative effects on children’s mental health and socio-emotional wellbeing (Perry & Pollard, 1998). The aim of this study is to leverage an in-depth examination of case records to deepen understanding of early indicators, risk factors, and best practices for these vulnerable families.

Methods:  This mixed-methods study included detailed analysis of case records for families that had experienced chronic or time-limited neglect in an urban county in a northeastern state (N=49).  The sample was randomly selected from recent cases with five or more screened-in reports that included allegations of neglect.  Analysis included descriptive demographic data of the families in the sample, number and types of allegations of the reports, and presence of risk factors that were identified in the standardized risk and safety assessment tools, and noted in progress notes. Qualitative data analysis of the case record review focused on agency and worker practices and contextual factors.

Results:  The resulting sample was diverse (47.4% African American, 44.7% Caucasian, 2.6% Native American, 5.3% mixed or other; 13.2% Hispanic of any race).  Mother’s age at first report ranged from 18 to 40 years old (M=27) with an average of 4.3 children. The majority of families (68%) had only one or two allegations on their first report, of which 58% were substantiated. The most common risk factors present in these cases included: children dealing with emotional/behavioral issues (89%), parental substance abuse (85%), domestic violence (79%), and parental mental health concerns (76%). Almost all families (92%) in this sample had significant financial stressors and/or were living in poverty.  Findings of the qualitative analysis of worker practices included the following: a lack of early and accurate identification of the presence of domestic violence, parental substance abuse and/or mental illness, and child behavioral or educational issues; inconsistent use of standardized risk and safety assessment protocols; and lack of follow-up/referral to appropriate services prior to case closing.

Implications: This detailed examination of chronic neglect provides novel insights into the conditions faced by these families, and this unique exploration of agency and worker practices adds to the understanding of how CPS may best serve these families. Key implications for practice  include the need for comprehensive assessment of the strengths and needs of the parents and all children within the family; more effective and consistent use of standardized risk and safety assessment tools; and better recognition of past patterns of neglect, which requires good case documentation procedures. The findings also support more cross-system collaboration to address complex contributive factors such as extreme poverty and educational neglect.