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Acts of Omission : An Overview of Child Neglect
Bulletin for Professionals

Author(s):  Child Welfare Information Gateway

Year Published:  2001

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You are in section: Table of Contents 1 - How big is the problem? 2 - What is neglect? 3 - Selected issues 4 - What are the characteristics of… 5 - What are the consequences of… 6 - Interventions 7 - Research 8 - Summary and conclusion References Endnotes

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What is Neglect?

This is not an easy question. In general, neglect is an act of omission. It is the failure of a child's primary caretaker to provide adequate food, clothing, shelter, supervision, and medical care. But what is adequate? And is it neglect if the primary caretaker is simply unable to provide for the child's needs, or must the caretaker "willfully" deprive the child? And is it neglect only if the child has suffered harm, or if the child is potentially at harm? And are there other types of deprivation not mentioned above-such as a failure to provide for a child's educational or emotional needs-that also should be classified as neglect? Both legal and research professionals struggle with these questions.

Legal Definitions
The Federal Child Abuse Prevention and Treatment Act (CAPTA) provides minimum standards for definitions. CAPTA states,

"The term 'child abuse and neglect' means, at a minimum, any recent act or failure to act on the part of a parent or caretaker, which results in death, serious physical or emotional harm, sexual abuse or exploitation, or an act or failure to act which presents an imminent risk of serious harm" (42 U.S.C.A. §5106g(2) (West Supp. 1998).

Using this minimum standard as a foundation, each State provides its own definitions for child abuse and neglect. There are three places in State statutes in which abuse and neglect are defined: (1) reporting laws for child maltreatment, (2) criminal codes, and (3) juvenile court statutes (U.S. Department of Health and Human Services, 2000).

A review of State reporting laws reveals that neglect frequently is defined by the States as deprivation of adequate food, clothing, shelter, or medical care (U.S. Department of Health and Human Services, 2000). However, there is great variation among the States in operationalizing their definitions, which contributes to the lack of clarity on a national level. For example, approximately one-fifth of the States do not define neglect separately from abuse. Of those that do define neglect separately, some also define particular types of neglect, such as abandonment or medical neglect. In addition, many States address related issues in their statutes such as parental incapacity (i.e., parent is hospitalized or incarcerated) or injurious environments (i.e., child is exposed to criminal activity in the home). Most States also specify exemptions or issues to be taken into consideration, including religious exemptions for medical neglect and financial considerations for physical neglect (U.S. Department of Health and Human Services, 2000).²

Beyond State reporting laws, various State regulations, policies, and procedures provide guidance for child welfare professionals to determine whether or not neglect has occurred. Various agencies and workers interpret these guidelines as they make decisions about which reports to investigate, and which investigations will result in interventions. Clearly, there is no universal legal or practice definition of child neglect.³

Research Definitions
There is little agreement among researchers regarding a conceptual or operational definition of neglect. Researchers lament this situation because a lack of consensus makes it difficult to compare findings across studies and difficult to apply findings to child welfare professionals' interventions (Black & Dubowitz, 1999; Zuravin, 1991). In addition to using various definitions, researchers also have used a variety of methods to measure neglect, including observations of the home, specific behavioral criteria, medical history, self-report measures, interviews, case record abstractions, and CPS case findings (Black & Dubowitz, 1999; Zuravin, 1999).

One important element of a child neglect definition or classification system is the identification of behaviors or conditions that are considered "neglectful." Some behaviors seem universally classified as neglect by researchers. These include:

• Inadequate nutrition, clothing, or hygiene
• Inadequate medical, dental, or mental health care
• Unsafe environments
• Inadequate supervision, including use of inadequate caretakers
• Abandonment or expulsion from the home (Barnett, Manly & Cicchetti, 1993; Sedlack & Broadhurst, 1996).

However, many behaviors may be categorized differently by different classification systems. Table 1 illustrates this using examples from two widely known classification systems: the Third National Incidence Study of Child Abuse and Neglect (NIS-3) (Sedlack & Broadhurst, 1996) and the Maltreatment Classification System (MCS) developed by Barnett, Manly and Cicchetti (1993).

In addition to identifying behaviors that are considered neglectful, there are other considerations regarding a definition of neglect. These include:

• Should there be evidence of harm, or does neglect include endangerment of a child's health or welfare?
• Should the caretaker's intent to harm be a consideration?

Many researchers, including Zuravin (1991), propose that endangering a child's health or welfare should be included in any definition of neglect, and that a caretaker's intent to harm or culpability should not be a consideration.

These differences highlight the challenges posed in comparing findings across studies that have used varying definitions of neglect. For example, when examining the rates of child neglect over time, a change in the numbers may not solely represent an actual increase or decrease in the number of children affected, but may partially be accounted for by a change in the definition.

Recognizing these difficulties, Federal agencies have been leading efforts to develop clear research definitions and a measurement tool to collect data on child maltreatment.

Throughout the 1990s, Congress mandated a number of Federal agencies to increase their focus on the problem of child abuse and neglect. The National Institutes of Health (NIH) created the Federal Child Abuse and Neglect Working Group (co-chaired by the National Institute on Mental Health and the National Institute for Child Health and Human Development [NICHD]).⁴ The Working Group began work in 1998 to develop clear classification systems and operational definitions for all types of child maltreatment, including child neglect, that can be used by researchers and also overlap with existing legal and clinical definitions. The Working Group is continuing to pursue this effort.⁵

In 1994, the Federal Interagency Task Force on Child Abuse and Neglect⁶ challenged its Research Committee to address definitional issues confronting the child abuse and neglect research community nationally. The committee had representatives from several DHHS agencies (e.g., NIH, Centers for Disease Control, Substance Abuse and Mental Health Services Administration) and from other departments (e.g., Defense, Education, Interior, and Justice). The efforts of this group focused on developing a data collection system that could be used by researchers to define and identify all types of child abuse and neglect. By 1999, these efforts resulted in an instrument entitled the Child Maltreatment Log.⁷ This instrument is being field tested in two 17-month pilot projects that were initiated in September 2000. Once the results of the pilots are analyzed, the instrument will be revised and disseminated for use by the research community.

The goals of these projects are to offer researchers a common definition and measurement tool so that the findings of various studies can be compared and the studies can be replicated, both of which contribute to a stronger knowledge base. In the field of child neglect, many researchers and policy makers consider this to be an important step in building our knowledge about the problem, the factors associated with it, and how to address it.

Spotlight on Chronic Neglect
One issue in defining child neglect involves consideration of "incidents" of neglect versus a pattern of behavior that indicates neglect. Zuravin (1991) recommends that some behaviors should present a "chronic pattern" to be considered neglectful. Examples include lack of supervision, inadequate hygiene, and failure to meet a child's educational needs. This suggests that rather than focusing on individual incidents that may or may not be classified as "neglectful," one should look at an accumulation of incidents that may together constitute neglect. "If CPS focuses only on the immediate allegation before them and not the pattern reflected in multiple referrals, then many neglected children will continue to be inappropriately excluded from the CPS system" (English, 1999). For example, a family exhibiting a pattern of behavior that may constitute neglect might include frequent reports of not having enough food in the home or keeping older children home from school to watch younger children. In most CPS systems, however, the criteria for identifying neglect focuses on recent, discrete, verifiable incidents.

In recognition of this issue, the Missouri Division of Family Services (n.d.) has assigned one of its CPS staff as a "Chronic Neglect Specialist." This office defines chronic neglect as "… a persistent pattern of family functioning in which the caregiver has not sustained and/or met the basic needs of the children which results in harm to the child" (p. 3). The focus here is what Dr. Patricia Schene calls "accumulation of harm." She states that 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. A study conducted by Egeland (1988) found that many children who had been referred to CPS for neglect did not receive services because their cases did not meet the criteria for "incidents" of neglect. However, he found that all of these children had, in fact, suffered severe developmental consequences.

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You are in section: Table of Contents 1 - How big is the problem? 2 - What is neglect? 3 - Selected issues 4 - What are the characteristics of… 5 - What are the consequences of… 6 - Interventions 7 - Research 8 - Summary and conclusion References Endnotes

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Updated on July 3, 2008