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Home > Child Neglect: A Guide for Prevention, Assessment, and Intervention > Risk and Protective Factors
Child Neglect: A Guide for Prevention, Assessment and Intervention.
Chapter 4 Neglect occurs to children of all races, socio-economic classes, religions, family structures, and communities. However, there are some factors that appear to make children more or less likely to be neglected. Having one or more risk factors does not necessarily mean that a child will be neglected; families and children react to personal and societal factors differently. But they are warning signs, nevertheless. One or two major risk factors for neglect may have little effect on a child's development, but having three or more risk factors exponentially increases the potential for developmental problems. Risk factors may be cumulative so that the more risk factors a child or family is exposed to over the course of the child's development, the greater the potential for problems to arise.98 The risk and protective factors in a child or family's life also may interact with each other. Exhibit 4-1 provides a conceptual model of the interplay of various risk and protective factors related to child neglect. An instance of possible neglect may be related to one or more contributing factors. For example, if a child is exposed to lead paint in the home, there may be many contributing factors to the neglect. The parent may be unwilling or unable to move to a home where lead paint is not present, the landlord may be unwilling to remove the lead paint from the walls, the city may not have an adequate lead abatement program, or the community may not have placed enough emphasis on making sure that low-income housing is safe.99 The caseworker would need to assess the situation to determine if this is a case of neglect by the parent. Child welfare professionals and others who interact regularly with children and families should be able to recognize risk factors so that they can identify situations where neglect is likely and determine the most effective interventions. This chapter highlights several types of risk and protective factors—environmental, family, parent or caregiver, and child—for neglect. Environmental Factors Neglectful families do not exist in a vacuum; numerous environmental factors can contribute to child neglect. Some of these include poverty, community and society characteristics, and access to social supports. These factors may be interrelated (e.g., families who are poor often live in high-risk or unsafe communities or lack social supports).
Poverty The level of child well-being in a State is strongly associated with its rate of child poverty.100 While child poverty has declined over the past decade, it currently stands at 17.6 percent.101 Compared to other types of child maltreatment, neglect is more directly associated with poverty.102 Of course, most poor people do not neglect or otherwise maltreat their children, but poverty, when combined with other risk factors, such as substance abuse, social isolation, financial uncertainty, continual family chaos, or a lack of available transportation and affordable child care can put a child at greater risk for neglect.104 Another study found that within an economically disadvantaged sample, particular aspects of poverty are more strongly correlated with physical neglect reports than others.105 For example, the perception by the caregiver of economic hardship was positively correlated with child neglect, even more than actual variations in household incomes. Therefore, self-reports of economic hardship may be an important signal for engaging in interventions with families to prevent subsequent neglect. In contrast, employment had an inverse relationship to reports of physical neglect. No difference existed between income groups for rates of fatal injury or emotional neglect.106 It is important to note that many poor families are well adjusted and competent; they have healthy marriages and do not express their stress in violent or otherwise hurtful ways. Many children who live in poverty are able to perform well in school, are socially well-adjusted, do not engage in illegal activities, and are not poor as adults. These children may have protective factors, such as affectionate parents, high self-esteem, or a role model, that help them to achieve these positive outcomes.107 As discussed in Chapter 2, Definition and Scope of Neglect, many States include an exception for poverty in their definitions of neglect. There is usually a distinction between a caregiver's inability to provide the needed care based on the lack of financial resources and a caregiver's knowing reluctance or refusal to provide care, even though the initial effect on the child is the same.108 For example, a family may not be able to afford food for their children; therefore, their children's basic nutritional needs will not be met. If the parents do not know about food assistance, they would not be considered neglectful, but if they have been told about a food assistance program and failed to use it, they may be guilty of neglect. Community Characteristics Children who live in dangerous neighborhoods have been found to be at higher risk for neglect than children in safer neighborhoods. One study suggests a relationship between unsafe or dangerous housing conditions and the adequacy of children's physical needs being met in the areas of nutrition, clothing, and personal hygiene.109 These communities also are associated with less social contact or support, which is another risk factor for neglect.110 Other characteristics of these distressed neighborhoods include high levels of truancy, low academic achievement, high juvenile arrest rates, and high teen birth rates. When stressful living conditions continue over time, families in these neighborhoods are more likely to be reported to child protective services (CPS) for child neglect.111 Children living in unsafe neighborhoods may be exposed to hazards in the neighborhood or in their house or apartment that may lead to incidents of neglect.112 For example, if a family lives in a house with lead paint or in a neighborhood with a high prevalence of drug abuse, children may be exposed to these hazards, leading to neglect allegations. Conversely, children living in safe communities and neighborhoods are less likely to be exposed to these types of hazards and may be more likely to have neighbors and other community members who are able to offer structure and monitoring. Furthermore, communities with affordable child care and good public transportation can contribute to the ability of parents and other caregivers to care for their children.113 Neighborhood or community factors that can play a role in child neglect include:
Social Support Families with healthy support networks have more access to models of suitable parental behavior. In addition, they have more friends, family, or neighbors who may be willing to act as alternative caregivers or to provide additional support or nurturance to both the parent and the child. Impoverished communities often lack positive informal and formal support systems for families.115 Social support can take many forms, including:
Social support is provided by:
Studies on social isolation and child neglect have compared parents who maltreat their children with parents who do not. These studies found that parents who maltreat their children:
Social support is important not only for parents but also for children. Social supports offer children both emotional and physical resources that may either protect them from neglect or help them to achieve better outcomes if they have been neglected. However, children may not be aware of some of the therapeutic aid, social services, or school supports that are available to them without the assistance of someone within their social network. Supportive adults may be able to serve as substitute attachment figures if a child's parents or other caretakers are unable to fill this role. Research shows that the presence of one or more positive and significant individuals in a child's life may act as a buffer against negative outcomes due to child abuse or neglect. Supportive adults may be able to look out for children and possibly protect them from neglect. For a child who is in an out-of-home placement, a positive relationship with a foster parent might serve as a protective factor.119 Family Factors Several family characteristics are associated with higher rates of neglect. Some life situations, such as marital problems, domestic violence, single parenthood, unemployment, and financial stress, can increase the likelihood that neglect will occur. Although these characteristics may not cause maltreatment, they are possible risk factors for neglect. Some family characteristics that may lead to neglect can be categorized as communication and interaction patterns, family composition, domestic violence, and family stress. Communication and Interaction Patterns Characteristics of families that are more likely to have positive outcomes include cohesion; emotional support for one another; and parents or caregivers who are warm, involved with their children, and firm and consistent in their discipline methods. Families that share similar beliefs, rituals, or values in such matters as financial management and the use of leisure time also appear to offer some protection. Having a strong familial sense of culture and spirituality also helps.120 In addition, a father's involvement, support, and connection with his children have also been associated with more positive child outcomes.121 Even if parents are not able to provide a positive family environment, other relatives (such as older siblings or grandparents) may be able to step in and provide this for the children.122 Neglectful families, however, often have problems communicating and interacting in positive or appropriate ways. These families are more chaotic, express fewer positive emotions, and have less empathy and openness. Additionally, they are more likely to lack emotional closeness, negotiation skills, and a willingness to take responsibility for their actions.123
In neglectful families, there may be less engagement between the parent and the child and more negative interactions than in non-neglectful families. Parents who maltreat their children often are less supportive, affectionate, playful, or responsive than parents who do not maltreat their children.131 Family Composition Single parenthood is associated with higher incidences of neglect. One study found that being in a single-parent household increased the risk of child neglect by 87 percent.132 Many factors may account for this. There is less time to accomplish the tasks of the household, including monitoring and spending time with children and earning sufficient money when there is only one parent or caregiver. Single parents often have to work outside the home, which might mean they are not always available to supervise their children. Single-parent families are also more likely to live in poverty than two-parent households. According to one analysis of the child poverty rate by family type, the poverty rate in 2003 was:
Of course, neglect also occurs in married, two-parent households, especially if there is a high level of marital discord.134 The presence of fathers in families often has been left out of the research on child neglect. This may be because fathers typically are not seen as the person primarily responsible for providing for the needs of the children, or because many mothers are single parents or primary caregivers or are typically more accessible to researchers.135 However, research on fathers shows that the presence of a positive father or father figure decreases the likelihood of neglect in the home.136 Having a father in the household not only may provide children and the mother with an additional source of emotional support, but it also may provide the family with more money and other resources. Compared to their peers living with both parents, children in single-parent homes had:
Domestic Violence Children living in a home where domestic violence is present are at a greater risk of being neglected. One study found that in 35 percent of neglect cases, domestic violence had occurred in the home.138 Caregivers who are victims of domestic violence may be abused to the point of being unable or unwilling to keep their abusers from also abusing the children. This type of neglect is often referred to as "failure or inability to protect the child from harm." In some cases, abused caregivers are afraid to defend the children in their care because doing so might put the caregiver's or children's lives in danger or provoke more abuse. Whether or not caregivers are charged with "failure or inability to protect" often depends on whether the caregivers knew or should have known that their children were being abused.141
Studies show that in 30 to 60 percent of homes with identified cases of domestic violence or child maltreatment, it is likely that both types of abuse exist.142 In some communities, child welfare agencies and domestic violence service providers have started working together to find ways to support both adult victims and their children.143 An example of this is The Greenbook Demonstration Initiative. The Family Violence Department of the National Council of Juvenile and Family Court Judges convened leading family court judges and experts on child maltreatment and domestic violence. This, in turn, led to the Federal demonstration initiative, a joint effort between several agencies in the U.S. Department of Health and Human Services and the U.S. Department of Justice. Preliminary results from this project include increased routine screening for domestic violence by CPS caseworkers and increased routine screening for child maltreatment by domestic violence service providers. Additional changes in CPS policies and practices include increased inter-agency cooperation, regular training on the dynamics of domestic violence, and sharing resources with domestic violence organizations.144
Family Stress Neglectful families often have experienced stressful life events due to financial difficulties, substance abuse problems, housing problems, illness, or other challenges. Families that are coping with such problems may not have the time or emotional capacity to provide for the basic needs of their children or to participate in interventions. Neglectful families often report more day-to-day stress than non-neglectful families. In addition, particularly stressful life events (such as the loss of a job or the death of a family member) may exacerbate characteristics in the family, such as hostility, anxiety, or depression, which may increase levels of family conflict and child maltreatment.145 When assessing a family, it may be helpful for a CPS worker to classify stresses into the following categories:
Parent or Caregiver Factors Some parental or caregiver characteristics associated with child neglect include problematic childhoods, developmental histories, or personality factors; physical and mental health problems; substance abuse issues; and poor parenting or problem-solving skills. As with all risk factors, the presence of one or more of these factors does not mean that a parent or caregiver will be neglectful, but these are characteristics that are present more often in neglectful parents. Assessment of these factors is useful for targeting prevention and intervention services to address the challenges faced by at-risk and neglectful families. The roles and characteristics of the mother and father should be taken into account when determining a child's risk for neglect. Parent's Childhood, Developmental History, and Personality Factors The way parents were reared can greatly affect the way they rear their own children. People who did not have their needs met by a parent when they were children may not know how to meet the needs of their own children. Some studies have found that neglectful parents are more likely to have been maltreated as children.148 Neglectful mothers were three times more likely to have been sexually abused than mothers who do not neglect their children.149 However, the majority of individuals who are maltreated as children do not maltreat their own children. In addition, there are individuals who were not abused or neglected as children who maltreat their children. It remains unclear why some previously maltreated people abuse and neglect their children while others do not.150 Two other childhood factors that have been found to be associated with future neglect are running away from home and having been placed in foster care, which usually indicate a troubled childhood that can negatively affect one's ability to take care of one's own children.151 Growing up in unstable, hostile, non-nurturing homes can lead to unstable personalities when the children become adults, which can lead to stressful marriages and abusive parenting practices with their own children.152 Children also may be at greater risk of harm if their parents are not aware of the neglect, deny that neglect took place, downplay their role in the neglect, or are unwilling to do anything to make sure the neglect does not recur. One study found that the most common response given by mothers for supervisory neglect was that there was nothing wrong with their behavior.153 Some parental developmental and personality characteristics that can be considered protective factors include having secure attachments, stable relationships with their own parents, good coping skills, social competence, and reconciliation with their own history (if any) of childhood maltreatment.154 For example, parents who were maltreated as children may be less likely to maltreat their own children if they are able to resolve their internal conflicts and pain related to their history of maltreatment and if they have a healthy, intact, supportive, and nonabusive relationship with their parents. Marital or parenting programs may provide parents with guidance about challenges to expect after the birth of their first child, in rearing children, and in understanding common gender differences in children. These classes may act as protective factors by strengthening the family's knowledge and bonds.155 Parenting and Problem-solving Skills Parents need to have the cognitive resources to care adequately for a child. They also need certain educational abilities, such as literacy, to be able to care properly for their child (e.g., to read prescription labels on their child's medication). Studies have found links between child neglect and parents' poor problem-solving skills, poor parenting skills, and inadequate knowledge of childhood development.156 Parents who are unaware of the developmental and cognitive abilities of children at different ages may have unrealistic expectations and be more likely to neglect their children. For example, a parent might expect that a 4-year old child can be left alone for the evening because of unrealistic expectations of the child's abilities. Studies also have found that parents who are inconsistent with discipline or use harsh or excessive punishment can be at risk for neglecting their children.157 As would be expected, having parents who are engaged with their children and involved in their activities and education acts as a protective factor.158 Substance Abuse Reported rates of substance abuse by maltreating parents vary; neglect, however, has the strongest association with substance abuse among all forms of maltreatment. One study found that children whose parents abused alcohol and other drugs were more than four times more likely to be neglected than children whose parents did not.159 According to one study of CPS caseworkers, 65 percent of maltreated children who had parents with substance abuse problems were maltreated while the parent was intoxicated. Also, the substance most likely to be abused by maltreating parents is alcohol (alone or in combination with an illicit drug).160 Substance abuse also may be related to the recurrence of neglect. Studies have found that caregivers with substance abuse problems are more likely to neglect their children continually and to be re-referred to CPS than caregivers who do not abuse substances.161 Substance abuse also has been linked with as many as two thirds of child maltreatment fatalities.162 This strong relationship between parental substance abuse and neglect exists because substance abuse impairs one's mental functioning and can affect decision-making. Parents who are abusing substances often cannot make appropriate decisions, such as preventing a young child from going out alone late at night or supervising their children adequately. They also often put their own needs ahead of the needs of the child, such as spending money on drugs rather than on food for the child. Substance abuse often co-occurs with other problems, which makes it difficult to assess its impact on child maltreatment. Parental substance abuse is likely to co-occur with the following problems that also are associated with child maltreatment:
Because substance abuse often occurs along with many other risk factors, it may be difficult for professionals to prioritize which services should be provided to families; therefore, intervention programs for parents who abuse substances should focus on multiple factors.
Mental Health Certain mental health problems in parents have been associated with child neglect, although research results vary on this connection. For example, some studies have found that, when controlling for social variables and substance abuse, neglect and depression are not associated.164 Other studies have shown a link between child neglect and serious or postpartum depression. For example, mothers suffering from postpartum depression are less responsive and sensitive toward their infants and may be disengaged or withdrawn.165 Of course, numerous mental illnesses can affect an individual's ability to care for a child properly. As with any condition, mental illness occurs along a continuum of severity. Other Parental Factors Other parental factors that may be associated with child neglect include:
Research on young parents has focused mostly on teenage mothers. Low parental education may also be associated with neglect, and young mothers may be less likely to attain a high level of education, thus limiting their work prospects and leading to financial stress. Other risk factors for neglect associated with young mothers include substance abuse, inadequate knowledge of childhood development, and poor parenting skills.167 Because a lack of employment is related to so many other risk factors for child neglect, it is not surprising that both maternal and paternal lack of employment are associated with higher rates of child neglect. Parents who have committed a crime also may be more likely to neglect their children.168 Again, this may be because criminal activity is linked to other risk factors, such as substance abuse and poverty. Parents' prior involvement with CPS has been linked to subsequent reports of neglect. These parents may be discouraged, less likely to think that their situation will change, less willing to receive services, or less motivated to change. However, families who have been involved with CPS and had positive experiences may be more motivated and open to receiving services.169 It is important that young parents, both mothers and fathers, obtain the support they need so that they can adequately attend to the needs of their children. Child Factors Any child can be the victim of neglect, but some characteristics appear to be more highly represented among maltreated children, including being under the age of 3, having certain behavioral problems, and having special needs. Age In 2004, children from birth to age 3 had the highest rate of reported maltreatment (16.1 per 1,000 children).170 Research also shows that children under the age of 3 are most at risk for neglect, with rates decreasing as the age of the child increases.171 Temperament and Behavior A child's temperament and behavior may be associated with child neglect. Children with an irritable temperament and who have difficulty being soothed may be more at risk for being neglected than other children, since having a difficult temperament may strain the parent-child relationship. One study found that a difficult child temperament (as perceived by the mother) was specifically associated with emotional neglect.172 Neglected children also often demonstrate a distinct set of behaviors including being passive, nonassertive, or withdrawn.173 It is unclear whether children develop these behavior problems because they are neglected or if they are neglected because they have behavior problems. When considering the relationship between behavior problems and neglect, a CPS worker should assess whether the neglected child actually has more behavior problems or if the neglectful parent merely believes that the child has more behavior problems. Behavior problems can be categorized as either internalizing or externalizing. Internalizing behavior is a behavior or a feeling that is directed inward, such as depression. Such children may be overlooked because they rarely act out. Externalizing behavior is characterized by outward expressions of behaviors and feelings that are easily observable, such as being aggressive. These children often receive more attention than those who internalize because their behavior is often disruptive to others.174 Exhibit 4-2 lists indicators of internalizing and externalizing behavior problems.
Special Needs While the link between children with special needs and neglect is unclear, some studies have found higher rates of child abuse and neglect among children with disabilities. One study found such children to be 1.7 times more likely to be maltreated than children without disabilities.175 Another study, however, failed to find increased levels of maltreatment among a sample of children with moderate to severe retardation.177 Children with special needs, such as those with physical or developmental challenges, may be more at risk for maltreatment because:
An alternate explanation for higher rates of maltreatment among children with special needs is that parents of children with special needs have more frequent contact with an array of professionals and thus may be under greater scrutiny.179 In any case, these parents may need more support and encouragement to help them provide for the needs of their children. For children with special needs, having a strong and secure attachment to their primary caregivers, in turn, may moderate the negative effects of the disability and provide protection from neglect.180 Other Child Characteristics Other child characteristics associated with neglect include:
Children who are premature or have low birth weights may be at risk for neglect because their parents may be confused, anxious, or feel helpless, which may make it harder for them to relate to the baby. These parents also may have fewer or less positive interactions with the infant, restricting the formation of positive attachments.182 Some child characteristics that appear to be protective factors against neglect include:
Recently there has been a shift toward a strengths-based focus with a greater emphasis on resilience and protective factors and a movement away from focusing solely on risk factors, particularly for preventing neglect and its recurrence. The belief is that prevention strategies are most effective when they involve building up a family's strengths. However, research suggests that solely focusing on building up protective factors, while not resolving some of the risk factors, may not be a particularly effective strategy. Intervention strategies should address both risk and protective factors to provide the most help to families.184
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