7.4 Factors That Lead to Child Abuse and Neglect in Out-of-Home Care Settings

The facility itself can play a significant role in contributing to the abuse/neglect of children. Some key issues in deciding a facility's involvement and culpability in an incident of abuse/neglect include: whether the facility has made provisions for staff training; has the facility provided staff, and when appropriate, children and their families, with the facility’s written policies, procedures and practices. The worker should review all written policies, procedures and practices which are applicable to the incident being investigated and which relate to the following:

Description of the facility's treatment program and population served;
Current service plan for the child, the involvement of each person responsible for service delivery, including child care staff, and the mechanisms for evaluating and updating service plans;
Rights of children and their families;
A grievance reporting system when children and their families feel their rights have been violated;
Expectations of children and their families;
Discipline of children;
Problem management, physical restraint, time out and isolation;
Staffing patterns/coverage requirements which include action plans for staff absences, emergencies, planned or respite breaks from children and integration and assignment of new employees, especially child care staff;
Staff job descriptions, staff behavioral guidelines/expectations, staff evaluations, possible corrective or disciplinary actions for staff and staff grievance procedures;
Staff orientation and their ongoing training plan;
Supervision of all levels of staff, including chain of command for the institution according to the table of organization;
Required written/oral reports and their time frames;
Medical care, routine and emergency, for children;
Safekeeping, transporting and dispensing medications;
Use of psychotropic medications;
Reporting and maintenance system for hazardous conditions on grounds, in buildings or with equipment, including vehicles.

7.4.1 Common Situations Which May Lead to Out-of-Home Care Abuse

The following are some common day-to-day situations which, when handled inappropriately, may lead to abuse:

Staff are not given training on how to control a child who is verbally or physically aggressive;
Staff are not provided with training and instruction on how to break up fights between children;
Staff are not provided with training on how to redirect a child who refuses to follow instructions;
The facility fails to provide the type of program that is needed for the population they serve;
A facility provides no means for staff, who have a heated interchange with a child, to remove themselves from the situation in order to regain self-control.

7.4.2 Common Situations Which May Lead to Out-of-Home Care Sexual Maltreatment

The following are some common day-to-day situations which, when handled inappropriately, may lead to sexual maltreatment of a child by staff:

There are no policies or procedures provided by the facility regarding a staff member removing a child from his/her living unit;
When a facility does not provide adequate supervision to children during sleeping hours.

7.4.3 Common Situations Which May Lead to Out-of-Home Care Neglect

The following are some common day-to-day situations in an institution which, when handled inappropriately, may lead to neglect:

The facility's staffing patterns and coverage requires persons to work long shifts;
The facility does not make provisions for supervision of child care staff on a unit and as a result, staff sleep, are under the influence of drugs/alcohol, or are engaged in other activities outside their work assignments while on the job;
When facility lacks clear guidelines on the safekeeping of medication or the dispensing of medication and as a result, there is misuse of medication by children;
When staff do not supervise children, ignore or fail to remedy a problem;
When staff are not trained on how to handle a medical emergency.

7.4.4 Written Policies and Practices of the Institution

These play a significant role in determining the investigative conclusion of a child abuse/neglect report and should be reviewed by the worker. The administration’s failure to develop and/or follow written policy and procedures may result in a finding that the administration is responsible for the incident and should be named as the perpetrator. If appropriate written policy and procedure had been developed and followed by the administration, but the staff member failed to follow it, only the staff member may be named as the perpetrator.

7.4.5 Physical Structure

The design and layout of the facility can increase the likelihood of abuse/neglect of a child by staff or other residents and the worker should try to determine the location where the alleged abuse/neglect occurred. By observing the physical structure of the facility, the worker should be able to develop an understanding of how the abuse/neglect may have occurred.

The sleeping quarters of the residents can be some distance from the staff's room making it difficult to hear a disturbance or a child crying out for help. Good practice requires staff to make tours of all resident rooms during the night.

Design and layout not only includes an awareness of physical location of rooms, but also includes accessibility to either staff or phones when an emergency exists. When observing the location where the incident was to have occurred, the worker should look at where telephones are located and should determine how far away was another staff person, who could have been able to assist other staff or children.

The worker should also look at what objects are in the room where the incident took place (i.e., dangerous or sharp objects, or furniture in the room that blocks staff or child residents view of what is going on in the room).