1. CHRONIC NEGLECT : TRIPLE JEOPARDY Johanna Watson Kate Furst Sharon Burke NSW Centre for Parenting and Research

2. CHILD NEGLECT Definition Neglect is considered to have occurred Neglect is considered to have occurred when a child’s basic developmental needs when a child’s basic developmental needs have not been met (Dubowitz, 2004). have not been met (Dubowitz, 2004).

3. PREVALENCE Neglect is the most common category of substantiated maltreatment in:  the United States - 61% (USDHHS, 2005)  Canada – 40% (Trocmé et al., 2001)  the United Kingdom – 42% (DfES, 2004). In Australia it is the second most common after emotional abuse Australia – 28% (AIHW, 2006).

4. RATES REFLECT DEFINITION In the US, Canada and the UK over the past decade neglect has been the fastest growing category of maltreatment. This increase in rates may in part reflect the broadening of the definition to include compromised developmental well-being.

5. NEGLECT IS HARMFUL Chronic neglect may carry more damaging long-term consequences than isolated incidences of physical abuse (Sullivan, 2000). Half of maltreatment fatalities are attributable to childhood neglect (Sullivan, 2000; NSW Ombudsman, 2005).

6. WHY TRIPLE JEOPARDY? Children are: Neglected by their parents Compared with other maltreatment neglected children also receive comparatively little attention from: Service providers Researchers.

7. AVOIDED BY RESEARCHERS? Of 3,888 articles published on child abuse and neglect over a five year period, only 57 were specifically about neglect. A striking number of pages devoted to the difficulties of defining neglect.

8. AVOIDED BY RESEARCHERS? DEFINITIONAL ISSUES It is very difficult to research a concept until it has been empirically defined. What are basic developmental needs? – –neglect is not a unitary concept eg supervisory, physical, emotional, educational and medical neglect are measured differently. – –Acts of omission difficult to measure eg how much lack of nurturing has to occur to be emotionally neglectful.

9. AVOIDED BY RESEARCHERS? DEFINITIONAL ISSUES (cont..) Concept of neglect socially and culturally dependent. Is it neglect if: –An 11 year old is unsupervised at home (Cawson, et al., 2000)? –An 8 year old looks after a toddler unsupervised ( Laos and Cambodia - Straus & Kantor, 2005)? Does neglect have to be intended? –Parent has developmental delay - 72% ( Connell- Carrick, 2003).

10. AVOIDED BY RESEARCHERS? DEFINITIONAL ISSUES (cont..) Does it have to be persistent? Does it have to be persistent? To what extent might outside circumstances mitigate (eg high correlation with poverty)? To what extent might outside circumstances mitigate (eg high correlation with poverty)?.

11. DEFINITION Neglect occurs when a child’s basic needs, as defined by current social and cultural norms, are not met by those responsible. If basic needs are not met children are still neglected regardless of the reason. Neglecting families may be difficult to engage in research.

12. OVERLOOKED BY SERVICES? Despite overseas experience that neglect is the hardest type of maltreatment to substantiate, in NSW neglect was substantiated at a higher rate than physical abuse. Service providers are likely to respond quickly to clear incidences of serious neglect (eg young children at home alone).

13. OVERLOOKED BY SERVICES? Children in families where the neglect is classified as low level but it is chronic are less likely to come to the attention of service providers (US and Canada). Family reasons – Characteristics of the parents Overwhelmed mothers do not take children to services - eg to GPs and Baby Health Centres. – Characteristics of the child Withdrawn children are easily overlooked. Withdrawn children are easily overlooked.

14. OVERLOOKED BY SERVICES? Service provider reasons Each incident may seem trivial - not a concerning enough ‘trigger event’ (Tanner and Turney, 2003). Reported events may be given low priority, those whose safety is at immediate risk receive priority response (Little, 1995).

15. OVERLOOKED BY SERVICES? Case drift - when involved with the family for a long time, the level of dirt and lack of care may seem ‘normal’ for that family. Focus on supporting parents - become involved with supporting the parents, especially if struggling, and lose focus on the child.

16. OVERLOOKED BY SERVICES? Cultural relativism - being overly mindful of the influence of culture. Court evidence - it is more difficult to persuade the court system that a child is at risk of harm from neglect that if the maltreatment were physical or sexual (Sheehan, 2006).

17. OVERLOOKED BY SERVICES? Neglect known to be difficult - it is the most resistant to treatment initiatives producing lasting change in only 40% of neglecting families (Salmelainen, 1996). Grave consequences to the family so workers try to avoid incorrect classification (Dept of Health, 1995).

18. RESEARCH IN AUSTRALIA Little is known about the picture of neglect in Australia. In the US particularly the welfare system is very different with a 5 year lifetime limit on welfare (Berry, Charleson & Dawson, 2003). Higher rate in the US may be associated with neglect through its strong link to poverty.

19. PROPOSED STUDY PROPOSED STUDY STUDY HAS THREE COMPONENTS Component 1 - Definitional Component 2 - Assessment Component 3 - Intervention

20. PROPOSED STUDY Component 1 - Definition Aims to: –identify the criteria to categorise neglect –identify criteria relating to severity and chronicity of neglect –identify social and familial risk and protective factors associated with substantiated neglect.

21. PROPOSED STUDY Method –Identify criteria used in decision-making process through focus groups representing: differing levels of expertise differing levels of expertise different stages of the assessment process. different stages of the assessment process. –identify risk and protective factors related to severity and chronicity of neglect through: 500 case files of substantiated maltreatment comparing with LSAC data. comparing with LSAC data. –design a template to ‘guide’ decision-making that takes risk factors, severity and chronicity into account.

22. PROPOSED STUDY Component 2 - Assessment Examine the psychometric properties and usefulness of this ‘guide’ in assisting with decision-making. Component 3 - Intervention Examine the effectiveness of parent vs child focussed interventions as a function of severity and chronicity of neglect.

23. FURTHER INFORMATION Literature review can be found at: http://www.community.nsw.gov.au/documents/research_child_neglect.pdf DoCS research site: www.community.nsw.gov.au/html/news_publications/research.htm