10: Chronic Neglect and Accumulation of Harm
Chapter 10 Overview
This chapter provides recommended practice for providing services to children and families at risk of or experiencing chronic neglect and accumulation of harm.
Chronic Neglect, as defined by American Humane, is an ongoing, serious pattern of deprivation of a child’s basic physical, developmental, and/or emotional needs by a parent or caregiver resulting in accumulation of harm to the child.
Chronic neglect cases, where families are repeatedly reported with minimal sustainable change resulting from multiple interventions, are very challenging for the traditional practice of a child protection agency. A holistic approach to chronic child neglect is best practice and each child in the home must be considered regardless of which child is listed as the "victim" child. What distinguishes chronic neglect from situational neglect or sporadic neglect is the ineffectiveness of working with chronic families in a typical, problem-solving way. A lack of protective capacities in these families is often an indicator of underlying, serious parental impairments such as substance abuse, mental illness, or low cognitive functioning. There are a significant number of families for whom this approach is effective, as all neglect is not chronic neglect. However, with chronically neglectful families, this approach is not sufficient.
The primary expected outcomes for implementation of chronic neglect policy are as follows:
- This policy will help staff to better identify, assess, and provide and/or refer the family to goal-oriented, long term, supportive services for chronic neglect.
- Designated staff will be knowledgeable about the dynamics of chronic neglect and accumulation of harm, including safety factors, comprehensive assessments, development and monitoring of outcome oriented (specific and individualized) treatment plans, intervention decision making and coordination of intervention techniques.
- County office staff will utilize a multi-disciplinary team approach that will provide community support in an effort to prevent, reduce, and remedy chronic neglect.
- Staff will more effectively document the need for removal of the child due to accumulation of harm, if necessary. Staff will be able to determine when to terminate Division intervention by more comprehensively assessing and documenting a family’s ability to sustain, over time, necessary behavioral changes.
Staff will be knowledgeable of the Framework for Safety Decision-Making model considering the safety threat in the home, protective capacities of the parents and child vulnerability when making a safety decision.
Accumulation Of Harm
Accumulation of harm can have long term effect on the child’s overall physical, mental, or emotional development. The concept of accumulation of harm is important in identifying and developing treatment strategies with families who are experiencing chronic neglect, as well as any other pattern of abuse/neglect. When assessing the immediate safety and future risk of a child’s condition, Division staff must be aware of the heightened risk to children when caretakers show a repeated pattern of failing to meet the child’s physical, medical, educational and emotional needs.
In most Child Protective systems the criteria for identifying neglect focuses on recent, distinct, verifiable incidents. This is also called "incident based" focus. Instead of focusing on individual incidents as they occur, one should look at an "accumulation of experience", or the cumulative effect on children of repeated incidents, when determining whether neglect exists.
Indicators Of Chronic Neglect
The Children’s Service Worker should be aware of the presence of chronic neglect indicators, which may indicate that the child(ren) is affected by an accumulation of harm. The continuous or prolonged nature of these indicators will show the chronicity of neglect in a family. The indicators listed below should aid the worker in identifying accumulation of harm and child safety issues, as they relate to the occurrence of chronic neglect.
- Prior History of Child Abuse & Neglect Reports and/or Referrals
- Type of Maltreatment-neglect, more likely
- Age of Child-younger, more likely
- Number of Children in the Home-more children, more likely
- Family Income-lower, more likely
- Parental Substance Abuse or Untreated Mental Illness
- Child Vulnerability/disability
Suggested Strategies For Assessment And Service Delivery In Chronic Neglect
- Ensure family interventions have enough time to work by engaging the family at the earliest opportunity.
- Be vigilant about racial bias.
- Parental support systems, both formal and informal, should be assessed
- Consideration should be given to the family heritage of neglect. It is important to utilize the genogram, when assessing the accumulation of harm and patterns of behavior that may have been learned from the neglectful parent’s family of origin
- The Children’s Service Worker should consider the family’s need for long-term support. Although the traditional family-centered model is built around the principle of short-term intervention, the treatment of chronic neglect most often requires long-term support. This does not mean that the Division must have open Family-Centered Services. A long-term community support plan may better serve a specific family’s needs.
- Children’s Service Workers should use the practice of empowerment and advocacy in working with families. This involves strengthening the family’s own control and involvement in their lives and their communities.
- The team approach should be utilized. This approach will focus on assessment, treatment, and evaluation of family progress so that families receive comprehensive services.
Reassessment In Chronic Neglect
Reassessment will be an ongoing process due to the long-term nature and intensity involved in chronic neglect. During the assessment process, the multi-disciplinary team can serve to assist the Children’s Service Worker in evaluation of the family’s progress and by continuing to hold staffings after the initial team meeting.
Termination Of Family-Centered Services In Chronic Neglect
There are special considerations for termination of Family-Centered Services in chronic neglect. There should be a plan in place for continued support by a designated community resource or natural helper after the Division’s services to the family have been terminated. In some cases, the caretakers may make behavioral changes in a short period of time that result in a safe environment for the child. However, these behavioral changes must be shown to be sustained over time. The multi-disciplinary team and direct supervisor will be key in assessing the family’s ability to sustain behavioral changes.
Although the Children’s Service Worker and family may agree that behaviorally specific goals have been met during the first treatment period, the worker should develop, with the team’s input, a system of continued support for the family.
Contact with the family by individuals or agencies actively involved in supporting the family is recommended. Contacts by CD and other supports should be routine enough to identify as soon as possible any indication that the family may be regressing. As long as CD continues to be involved, the focus should not only be "monitoring" the family, but on an active program that includes ongoing assessment, education, role modeling, support, and empowerment for the family. Utilizing a team approach to decision making for CD closure of services should result in the most effective method of identifying that the family has the ability to sustain necessary behavioral changes.
A plan of continued support for the family at termination of Family-Centered Services is crucial. Before closure of services, the Children’s Service Worker must explore with the family the family’s own system of "monitoring" themselves. It is necessary that the family can identify and determine for themselves when help may again be needed. Is the family able to identify the behaviors that led to neglect/abuse and recognize when they may be slipping back into these behaviors? The family should feel comfortable in asking for assistance from CD or other resources, if their situation begins to regress.
In situations involving children that have been identified as having developmental delays, insufficient growth rate, malnourishment, or other physical problems associated with neglect, staff should continually evaluate the child’s growth, weight gain, and development. This growth must be documented by a medical professional who is following the child. A medical professional involved with the family and participating as a team member is of vital importance.
If the juvenile court is involved, the court will also be a key component in the evaluation of the family’s behavioral increments of change and subsequent recommendation for termination of court jurisdiction and termination of Family-Centered Services.
Staff should consider and utilize in teamwork the following factors when assessing for termination of services:
- There has been a reduction in risk that has been sustained over time;
- There has been a significant improvement in parental behaviors that have been sustained over time;
- There is clear and documentable indication that bonding and attachment is occurring between the parent and child;
- There is at least one caretaker in the home that does not exhibit any sign of depression, drug/alcohol abuse, or other disability preventing proper care of the child(ren) and has a safety plan for the child in the event another caretaker who is experiencing these problems is in the home;
- The home is free of problems such as lack of utilities, structural damage, filth/debris, and safety hazards and these conditions have been alleviated and improvement is sustained over time; and
- The family can verbalize an awareness of the behaviors that led to neglect and can recognize in themselves when these behaviors are occurring and can demonstrate a willingness to ask for help, if needed.
When Out-Of-Home Care Is The Plan
While in-home services are the preferable intervention in child protective services, removal of children from their homes must remain a viable alternative for all forms of maltreatment, including chronic neglect. The criteria involved in the decision-making process for recommending a child be removed from his/her home will require intensive information gathering based on the aforementioned indicators of chronic neglect. A referral to Intensive In-Home Services should be considered when children are at imminent risk of removal.
Criteria For Referral To Juvenile Court For Protective Custody In Chronic Neglect
Existing policy in regard to recommendation to the court for protective custody of children provides factors to consider in regard to decision-making.
These factors provide detailed, relevant, and useful guidelines for assisting in the judgment for removal of a child. In addition to these guidelines, when assessing the need for removal in cases of chronic neglect, staff should consider the following factors. Taken alone, each of these factors should not be grounds for removal of a child. However, staff should be aware that the presence of two or more of these factors, persisting without improvement, may have long-term impact on the family, resulting in a need for placement of the children out of their home. Staff should also take into consideration what reasonable efforts have been accomplished in order to alleviate these factors and whether all resources, such as Intensive In-Home Services, have been provided to the family:
- Family has children that for any reason are particularly vulnerable and unable to protect self, such as very young children, children with developmental disabilities, etc.;
- No utilities and no access to essential utilities, especially when weather conditions are a determinant factor;
- Filth, debris and/or unsanitary conditions (that have resulted in or have strong potential to produce negative outcomes for the child) and can't be cleaned up in one day and no alternative housing is immediately available;
- Structural damage dangerous to children and there are no parental efforts to safeguard children from potential hazards;
- Absence of food and drink, especially sufficient fluids, and there are no resources to obtain such or no ability/effort on the part of the caretaker to access resources;
- Continued substance abuse, domestic violence, untreated depression, or any other incapacitating condition on the part of the caretaker that results in the caretaker’s inability to provide for the safety of the child(ren) and the child(ren) cannot provide for or protect self;
- Child has received medical evaluation in which there is evidence of malnutrition, dehydration, lack of sleep, child is not growing normally, child is failure to thrive, child is not gaining weight, child is losing weight, etc. and this is due to lack of parenting;
- There appears to be no bonding or attachment between the parent and the child (no indication or observation that parent hugs, nurtures, holds, or comforts the child/parent views child in predominately negative way); and
- Repeated unsustained effort on the part of the caretaker to rectify any of the above factors.