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A Coordinated Response to Child Abuse and Neglect: The Foundation for Practice
Office on Child Abuse and Neglect, Children's Bureau. Goldman, J., Salus, M. K., Wolcott, D., Kennedy, K. Y.|
|Year Published: 2003|
Chapter Three: What Is Child Maltreatment?
To prevent and respond to child abuse and neglect effectively, there needs to be a common understanding of the definitions of those actions and omissions that constitute child maltreatment. Unfortunately, there is no single, universally applied definition of child abuse and neglect. Over the past several decades, different stakeholders—including State and Federal legislative bodies, agency officials, and researchers—have developed definitions of maltreatment for different purposes. Definitions vary across these groups and within them. For example, legal definitions describing the different forms of child maltreatment for reporting and criminal prosecution purposes are found mainly in State statutes, and definitions vary from State to State. Similarly, agency guidelines for accepting reports, conducting investigations, and providing interventions vary from State to State and sometimes from county to county. In addition, researchers use varying methods to measure and define abuse and neglect, making it difficult to compare findings across studies. Despite the differences, there are commonalities across definitions. This chapter describes sources of definitions in Federal and State laws and summarizes those elements commonly recognized as child maltreatment.
Definitions in Federal Law
The Child Abuse Prevention and Treatment Act (CAPTA) provides minimum standards for defining physical child abuse, child neglect, and sexual abuse that States must incorporate in their statutory definitions to receive Federal funds. Under CAPTA, child abuse and neglect means:
- Any recent act or failure to act on the part of a parent or caretaker that results in death, serious physical or emotional harm, sexual abuse, or exploitation;
- An act or failure to act that presents an imminent risk of serious harm.
The definition of child abuse and neglect refers specifically to parents and other caregivers. A "child" under this definition generally means a person who is under the age of 18 or who is not an emancipated minor. In cases of child sexual abuse, a "child" is one who has not attained the age of 18 or the age specified by the child protection law of the State in which the child resides, whichever is younger.
While CAPTA provides definitions for sexual abuse and the special cases related to withholding or failing to provide medically indicated treatment, it does not provide specific definitions for other types of maltreatment—physical abuse, neglect, or psychological maltreatment.
CAPTA Definition of Sexual Abuse
CAPTA defines "sexual abuse" as:
"[T]he employment, use, persuasion, inducement, enticement, or coercion of any child to engage in, or assist any other person to engage in, any sexually explicit conduct or simulation of such conduct for the purpose of producing a visual depiction of such conduct;"
"[T]he rape, and in cases of caretaker or inter-familial relationships, statutory rape, molestation, prostitution, or other form of sexual exploitation of children, or incest with children."
CAPTA Definition of
Withholding of Medically Indicated Treatment
CAPTA defines the "withholding of medically indicated treatment" as:
"[T]he failure to respond to the infant's life-threatening conditions by providing treatment which, in the treating physician's reasonable medical judgment, will be most likely to be effective in ameliorating or correcting all such conditions."
The term "withholding of medically indicated treatment" does not include the failure to provide treatment (other than appropriate nutrition, hydration, and medication) to an infant when, in the treating physician's reasonable medical judgment:
- The infant is chronically and irreversibly comatose;
- The provision of such treatment would merely prolong dying;
- The provision of such treatment would not be effective in ameliorating or correcting all of the infant's life-threatening conditions;
- The provision of such treatment would otherwise be futile in terms of the survival of the infant;
- The provision of such treatment would be virtually futile in terms of the survival of the infant, and the treatment itself under such circumstances would be inhumane.2
Sources of Definitions in State Law
While the Federal legislation sets minimum definitional standards, each State is responsible for providing its own definition of maltreatment within civil and criminal contexts. The problem of child maltreatment is generally subject to State laws (both statutes and case law) and administrative regulations. Definitions of child abuse and neglect are located primarily in three places within each State's statutory code:
- Mandatory child maltreatment reporting statutes (civil laws) provide definitions of child maltreatment to guide those individuals mandated to identify and report suspected child abuse. These reports activate the child protection process. (See Chapter 9, "What Does the Child Protection Process Look Like?," for more information on mandated reporters and reporting procedures.)
- Criminal statutes define those forms of child maltreatment that are criminally punishable. In most jurisdictions, child maltreatment is criminally punishable when one or more of the following statutory crimes have been committed: homicide, murder, manslaughter, false imprisonment, assault, battery, criminal neglect and abandonment, emotional and physical abuse, child pornography, child prostitution, computer crimes, rape, deviant sexual assault, indecent exposure, child endangerment, and reckless endangerment.
- Juvenile court jurisdiction statutes provide definitions of the circumstances necessary for the court to have jurisdiction over a child alleged to have been abused or neglected. When the child's safety cannot be ensured in the home, these statutes allow the court to take custody of a child and to order specific treatment services for the parents and child.
Together, these legal definitions of child abuse and neglect determine the minimum standards of care and protection for children and serve as important guidelines for professionals regarding those acts and omissions that constitute child maltreatment.
Child protective services (CPS) workers use statutory definitions of child maltreatment to determine whether maltreatment has occurred and when intervention into family life is necessary. For particular localities within a State, local CPS policies and procedures, based on statutes and regulations, further define different types of maltreatment and the conditions under which intervention and services are warranted.
To review a summary of reporting laws, visit the State Statutes section of Child Welfare Information Gateway website at www.childwelfare.gov/systemwide/laws_policies/index.cfm.
General Definitions by Type of Maltreatment
There are four commonly recognized forms of child abuse or maltreatment:
There is great variation from State to State regarding the details and specificity of child abuse definitions, but it is still possible to identify commonalities among each different type of child maltreatment. These commonalities, in part, reflect societal views of parental actions that are seen as improper or unacceptable because they place children at a risk of physical and emotional harm.
Generally, physical abuse is characterized by physical injury, such as bruises and fractures that result from:
- Hitting with a hand, stick, strap, or other object
Although an injury resulting from physical abuse is not accidental, the parent or caregiver may not have intended to hurt the child. The injury may have resulted from severe discipline, including injurious spanking, or physical punishment that is inappropriate to the child's age or condition. The injury may be the result of a single episode or of repeated episodes and can range in severity from minor marks and bruising to death.
Some cultural practices are generally not defined as physical abuse, but may result in physically hurting children. For example:
- "Coining" or cao gio—a practice to treat illness by rubbing the body forcefully with a coin or other hard object.
- Moxabustion—an Asian folkloric remedy that burns the skin.
As Howard Dubowitz, a leading researcher in the field, explains: "While cultural practices are generally respected, if the injury or harm is significant, professionals typically work with parents to discourage harmful behavior and suggest preferable alternatives."3
Child sexual abuse generally refers to sexual acts, sexually motivated behaviors involving children, or sexual exploitation of children.4 Child sexual abuse includes a wide range of behaviors, such as:
- Oral, anal, or genital penile penetration;
- Anal or genital digital or other penetration;
- Genital contact with no intrusion;
- Fondling of a child's breasts or buttocks;
- Indecent exposure;
- Inadequate or inappropriate supervision of a child's voluntary sexual activities;
- Use of a child in prostitution, pornography, Internet crimes, or other sexually exploitative activities.
Sexual abuse includes both touching offenses (fondling or sexual intercourse) and nontouching offenses (exposing a child to pornographic materials) and can involve varying degrees of violence and emotional trauma. The most commonly reported cases involve incest—sexual abuse occurring among family members, including those in biological families, adoptive families, and step-families.5 Incest most often occurs within a father-daughter relationship; however, mother-son, father-son, and sibling-sibling incest also occurs. Sexual abuse is also sometimes committed by other relatives or caretakers, such as aunts, uncles, grandparents, cousins, or the boyfriend or girlfriend of a parent.
Child neglect, the most common form of child maltreatment, is generally characterized by omissions in care resulting in significant harm or risk of significant harm. Neglect is frequently defined in terms of a failure to provide for the child's basic needs—deprivation of adequate food, clothing, shelter, supervision, or medical care. Neglect laws often exclude circumstances in which a child's needs are not met because of poverty or an inability to provide. In addition, many States establish religious exemptions for parents who choose not to seek medical care for their children due to religious beliefs that may prohibit medical intervention.
The Department of Health and Human Services' Third National Incidence Study of Child Abuse and Neglect (NIS-3)6 is the single most comprehensive source of information about the current incidence of child maltreatment in the United States. NIS-3 worked with researchers and practitioners to define physical, educational, and emotional neglect in a succinct and clear manner, as described below.
- Refusal of health care—the failure to provide or allow needed care in accordance with recommendations of a competent health care professional for a physical injury, illness, medical condition, or impairment.
- Delay in health care—the failure to seek timely and appropriate medical care for a serious health problem that any reasonable layman would have recognized as needing professional medical attention.
- Abandonment—the desertion of a child without arranging for reasonable care and supervision.
- Expulsion—other blatant refusals of custody, such as permanent or indefinite expulsion of a child from the home without adequate arrangement for care by others or refusal to accept custody of a returned runaway.
- Inadequate supervision—leaving a child unsupervised or inadequately supervised for extended periods of time or allowing the child to remain away from home overnight without the parent or caretaker knowing or attempting to determine the child's whereabouts.
- Other physical neglect—includes inadequate nutrition, clothing, or hygiene; conspicuous inattention to avoidable hazards in the home; and other forms of reckless disregard of the child's safety and welfare (e.g., driving with the child while intoxicated, leaving a young child in a car unattended).
- Permitted chronic truancy—habitual absenteeism from school averaging at least 5 days a month if the parent or guardian is informed of the problem and does not attempt to intervene.
- Failure to enroll or other truancy—failure to register or enroll a child of mandatory school age, causing the child to miss at least 1 month of school; or a pattern of keeping a school-aged child home without valid reasons.
- Inattention to special education need—refusal to allow or failure to obtain recommended remedial education services or neglect in obtaining or following through with treatment for a child's diagnosed learning disorder or other special education need without reasonable cause.
- Inadequate nurturing or affection—marked inattention to the child's needs for affection, emotional support, or attention.
- Chronic or extreme spouse abuse—exposure to chronic or extreme spouse abuse or other domestic violence in the child's presence.
- Permitted drug or alcohol abuse—encouragement or permitting of drug or alcohol use by the child.
- Permitted other maladaptive behavior—encouragement or permitting of other maladaptive behavior (e.g., chronic delinquency, severe assault) under circumstances where the parent or caregiver has reason to be aware of the existence and seriousness of the problem but does not intervene.
- Refusal of psychological care—refusal to allow needed and available treatment for a child's emotional or behavioral impairment or problem in accordance with a competent professional recommendation.
- Delay in psychological care—failure to seek or provide needed treatment for a child's emotional or behavioral impairment or problem that any reasonable layman would have recognized as needing professional, psychological attention (e.g., suicide attempt).
Spotlight on Chronic Neglect
One issue in defining child neglect involves consideration of "incidents" of neglect versus a pattern of behavior that indicates neglect. Susan J. Zuravin, from the University of Maryland at Baltimore School of Social Work, recommends that if some behaviors occur in a "chronic pattern," they should be considered neglectful.7 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."8 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.
One study 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. It also found, however, that all of these children had, in fact, suffered severe developmental consequences . 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." The focus here is on the "accumulation of harm." CPS and community agencies across the country are recognizing the importance of early intervention and service provision to support families so that neglect does not become chronic or lead to other negative consequences.9
Psychological maltreatment—also known as emotional abuse and neglect—refers to "a repeated pattern of caregiver behavior or extreme incident(s) that convey to children that they are worthless, flawed, unloved, unwanted, endangered, or only of value in meeting another's needs."10 Summarizing research and expert opinion, Stuart N. Hart, Ph.D., and Marla R. Brassard, Ph.D., present six categories of psychological maltreatment:
- Spurning (e.g., belittling, hostile rejecting, ridiculing);
- Terrorizing (e.g., threatening violence against a child, placing a child in a recognizably dangerous situation);
- Isolating (e.g., confining the child, placing unreasonable limitations on the child's freedom of movement, restricting the child from social interactions);
- Exploiting or corrupting (e.g., modeling antisocial behavior such as criminal activities, encouraging prostitution, permitting substance abuse);
- Denying emotional responsiveness (e.g., ignoring the child's attempts to interact, failing to express affection);
- Mental health, medical, and educational neglect (e.g., refusing to allow or failing to provide treatment for serious mental health or medical problems, ignoring the need for services for serious educational needs).11
To warrant intervention, psychological maltreatment must be sustained and repetitive. For less severe acts, such as habitual scapegoating or belittling, demonstrable harm to the child is often required for CPS to intervene.
Psychological maltreatment is the most difficult form of child maltreatment to identify. In part, the difficulty in detection occurs because the effects of psychological maltreatment, such as lags in development, learning problems, and speech disorders, are often evident in both children who have experienced and those who have not experienced maltreatment. Additionally, the effects of psychological maltreatment may only become evident in later developmental stages of the child's life.
Although any of the forms of child maltreatment may be found alone, they often occur in combination. Psychological maltreatment is almost always present when other forms are identified.
Case Examples Of Maltreatment
Physical AbuseDuring a violent fight between her mother and her mother's boyfriend, 8-year-old Kerry called 911. She told the operator that her mother's boyfriend always hit her mommy when he came home drunk. In addition, Kerry said she was worried about her 5-year-old brother, Aaron, because he tried to help their mom and the boyfriend punched him in the face. As a result, Aaron fell, hit his head on the coffee table, and had not moved since. The operator heard yelling in the background and the mother screaming, "Get off the phone!" When the police and paramedics arrived, Aaron was unconscious and the mother had numerous bruises on her face.
Child NeglectRobert and Carlotta are the parents of a 9-month-old son named Ruiz. Robert and Carlotta used various drugs together until Robert was arrested and sent to prison for distributing cocaine. Since Robert's arrest, Carlotta has been living with different relatives and friends. Recently, she left her son with her sister who also has a history of drug use. Her sister then went to a local bar and left Ruiz unattended. After hearing the baby boy cry for over an hour, the neighbors called the police. When Carlotta arrived to pick up Ruiz, the police and the CPS worker were also there. It appeared that she had been using drugs.
Sexual AbuseJody, age 11, said that she was asleep in her bedroom and that her father came in and took off his robe and underwear. She stated that he got into bed with her and pulled up her nightgown and put his private part on her private part. She stated that he pushed hard and it hurt. Jody said that the same thing had happened before while her mother was at work. Jody stated that she told her mother, but her father insisted that she was telling a lie.
Psychological AbuseJackie is a 7-year-old girl who lives with her mother. Jackie's mother often screams at her, calls her degrading names, and threatens to kill her when Jackie misbehaves. Jackie doesn't talk in class anymore, doesn't have any friends in her neighborhood, and has lost a lot of weight.
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