Chapter 1

The Maltreatment of

Children Then and Now

Early Views of Children  Initially children were the property of their parents who

could decide their life, death, or discipline.  Infanticides in ancient world was not an uncommon practice.

Infanticide is a term referring to the killing an infant within a year of birth, typically carried out by the parents of the child.

 Children were placed in Farm labor in feudal societies

 Matters of Discipline  Corporal punishment

 Sexual exploitation of children  Female children were often bartered and abused in convents,

while pederasty for boys were a common practice.

 Pederasty in ancient Greece was a socially acknowledged romantic relationship between an adult male and a younger male usually in his teens.

 Awareness, not until 1500’s

Early Views of Children  Contradictions in Victorian era

 Strict moral code

 Yet rampant pornography and child prostitution

 Child Labor  During Industrial Revolution  Slavery in the southern state  Child Labor during industrial revolution and slavery in the

southern states. Indenture was a popular form of child labor in the early United States. Indenture also provided an opportunity for children to be abused. Indenture was a term used to refer to a to a person being bonded as an apprentice or laborer.

 Child Labor in America: Industrial Revolution: https://youtu.be/j-fbnS6sSZA

Growing Concerns &

Awareness

 Settlement Houses (late 1880’s) – provided

refuge from child labor, mostly for white

children

 African American children were

neglected by child welfare system

 Native American children were removed

from home and sent to boarding schools

to assimilate them into the White culture

Early Attempts  1838. Dickens wrote Oliver Twist & campaigned for child

protection. Dickens was a British writer who wrote an autobiographical book Oliver Twist and brought the issue of child abuse to public attention.

 1875. Mary Ellen Wilson: first child removed from her home due to abuse. The case of Mary Ellen, the first child removed from her home due to abuse, gave rise to a myriad of reforms, such formation of Society for the Prevention of Cruelty to Children (SPCC) in 1875 and The Child Welfare League of American in 1920.  The Stranger who Cared: The Story of Etta Wheeler & Mary Ellen

Wilson: https://youtu.be/GG3OI2JwaYY

 1875. Society for the Prevention of Cruelty to Children (SPC C) was founded

 1920. Child Welfare League of America

Early Attempts  1935. Social Security Act: established Aid for

Dependent Children (ADC)

 1962. Dr. C. Henry Kempe published “The Battered- Child Syndrome” in the Journal of the American Medical Association. The coining of the term “the battered Child Syndrome” by C. Henry Kempe was a result of the discoveries of abuse made by Caffey and his colleagues when they noticed unexplained breaks on x-rays. The use of this term furthered both research and treatment efforts.

 1972. The National Center for the Prevention of Child Abuse and Neglect was established.

Further Efforts on Behalf of

Children  1974. The Child Abuse Prevention Act

 Mandated reporting

 Funds for research

 1978. The Indian Child Welfare Act  Terminated the practice of removing children from their

parents and tribes

 1993. Family Preservation and Support Services Act

 Several pieces of federal legislation have had an impact on intervention with abused and neglected children. The Child Abuse Prevention Act (1974), The Indian Child Welfare Act (1978) and Family Preservation and Support Services Act (1993).

Emerging Influences  Adverse Childhood Experiences (ACE) Study

 Significant correlation between child abuse and household dysfunction  Ted Talk on How childhood trauma affects health across a lifetime

| Dr. Nadine Burke Harris: https://youtu.be/95ovIJ3dsNk

 Psychological Trauma Theory  Neurological findings: insight into the causes of behavioral

and psychological problems correlated with childhood maltreatment

 Emerging theoretical influences include Adverse Childhood Experiences Study (ACE) and Psychological Trauma Theory. Studies have found significant correlation between child abuse and household dysfunctions.

Child Protection Services Now  From ‘taking kids away’ to Family Rehabilitation

 Trauma-informed intervention & treatment

 The search for risk assessment tools

 The development of child abuse registers

 The formation of multidisciplinary child protection teams

 Child Protection Services (CPS) has become more involved in solidifying risk assessment criteria, advocating for child protection teams, and offering more family centered services, following the model of Family Rehabilitation.

 In 2012, New Jersey's Division of Youth and Family Services (DYFS) was officially renamed the Division of Child Protection and Permanency (DCP&P) as way to more precisely define the agency's core mission of providing safety, permanency, and well-being for New Jersey’s most vulnerable children and families.

Chapter 4

The Neglect of Children

Definition and Impact of Neglect • Neglect: an act of omission related to parental deficits

• Physical neglect: non-organic failure to thrive, abandonment, failure to meet basic physical needs

• Inadequate supervision • Medical neglect, educational neglect, emotional neglect, mental

health neglect • Stimulation neglect, language neglect, gross/fine motor neglect • Environmental neglect

• Neglect is the most common form of Child abuse • In the U.S., neglect accounts for 78% of all child maltreatment cases,

far more than physical abuse (17%), sexual abuse (9%), and psychological abuse (8%) combined.

• Video – In Brief: The Science of Neglect – https://youtu.be/bF3j5UVCSCA

• Video – Still Face Experiment: Dr. Edward Tronic – https://youtu.be/apzXGEbZht0

4 Types of Unresponsive Care

Impacts of Neglect of Child Development

The absence of responsive relationships poses a serious threat to a child’s development and well-being. • Sensing threat activates biological stress response systems, and excessive

activation of those systems can have a toxic effect on developing brain circuitry. When the lack of responsiveness persists, the adverse effects of toxic stress can compound the lost opportunities for development associated with limited or ineffective interaction. This complex impact of neglect on the developing brain underscores why it is so harmful in the earliest years of life. It also demonstrates why effective early interventions are likely to pay significant dividends in better long-term outcomes in educational achievement, lifelong health, and successful parenting of the next generation.

Chronic neglect is associated with a wider range of damage than active abuse, but it receives less attention in policy and practice. • Science tells us that young children who experience significantly limited

caregiver responsiveness may sustain a range of adverse physical and mental health consequences that actually produce more widespread developmental impairments than overt physical abuse. These can include cognitive delays, stunting of physical growth, impairments in executive function and self- regulation skills, and disruptions of the body’s stress response.

Brain Scan of two Infants

• In the well-developed brain on the left, rich areas of red and orange depicting high activity; on the right, a few lobes of orange in a sea of black empty space where there should be active tissue.

• The deprived brain was that of a Romanian orphan in the 1990s. Rarely held or snuggled, much less removed from her crib, this poor child’s brain never had the kind of stimulation it required to grow appropriately.

The Measurement of Neglect: Child Neglect Index (CNI) • Supervision

• Extent to which parent anticipates risky situations and intervenes to protect child in an age-appropriate manner; knowledge of child’s whereabouts

• Physical Care

• Adequate nutrition with regular meals; Hygiene: child is clean and adequately clothed

• Health Care

• Provides basic medical needs, responds to child’s emotional needs; ensures developmental and educational needs are met

Risk Factors for Neglect:

• Environmental factors:

• Poverty

• Community characteristics: lack of resources

• Access to social supports

• Ecological factors:

• run-down neighborhoods

• systemic oppression

• Parenting factors:

• Difficulties in processing information & affect

• Substance abuse

Neglect & Risk Factors/Protective Factors

Symptoms & Effects of Neglect: Infancy/Early Childhood • Non-organic failure to thrive syndrome:

• Falls below the fifth percentile in weight

• Eats little, lacks interest in environment, shows developmental lag

• Psychosocial dwarfism:

• Behavioral problems around food and sleep

• Hyperactivity

• Extreme fatigue.

Symptoms & Effects of Neglect: Young Children • Presence of Pediculosis (lice)

• Poor motor skills

• Language delays

• Lack of medical care: routine and urgent care; immunizations

• Academic problems: difficulty with advanced conceptualizations and complicated instructions

• Impaired socialization

• Impulsiveness

Brain Scan of two Toddlers

Studies on children in a variety of settings show that severe deprivation or neglect: • Disrupts the ways in which children’s brains

develop and process information, increasing the risk for attentional, emotional, cognitive, and behavioral disorders.

• Alters the development of biological stress- response systems, leading to greater risk for anxiety, depression, cardiovascular problems, and other chronic health impairments later in life.

• Correlates with significant risk for emotional and interpersonal difficulties, including high levels of negativity, poor impulse control, and personality disorders, as well as low levels of enthusiasm, confidence, and assertiveness.

• Is associated with significant risk for learning difficulties and poor school achievement, including deficits in executive function and attention regulation, low IQ scores, poor reading skills, and low rates of high school graduation.

Parents Who Neglect Children

• Apathetic

• appears to have given up on life

• negative, withdrawn

• Impulsive

• low tolerance

• seeks immediate gratification

• Reactive-depressive

• unable to cope with some stressors

• (i.e. birth of a child, partner leaving)

• Parents with mental Illness

Substance-Abusing Families

• Parents under the influence of drugs or alcohol can physically, sexually, or emotionally abuse their children.

• They are not fully available to provide adequate parenting.

• Prenatal Abuse:

• Fetal Alcohol Spectrum Disorder

• Neonatal Abstinence Syndrome

• HIV infection

Plight of the Parent and the Social Worker • Is the neglectful parent the adversary?

• The neglectful parent is still the whole world to the child

• The child sees the condemnation of their parents as a rejection of themselves.

• Solution is not simple: the cycle must be broken.

• Removal of the children?

• ‘Parenting’ of the parents!

C A S E M A N A G E M E N T A N D T R E A T M E N T O F P H Y S I C A L A B U S E A N D N E G L E C T

CHAPTER 13

CASE MANAGEMENT

• Case management: the ongoing work with families

to

• set & review goals/outcomes

• make plans to achieve those goals

• identify & select needed services

• collaborate with servicer providers

• monitor progress

• provide emotional support

• maintain records

• prepare documentation and reports

CAUTIONS FOR CASE WORKERS

• counter-transference: the worker’s reaction to the

client (feelings, attitudes, thoughts and behaviors),

which is brought about by the helper’s own past life

experiences

• must become aware of it so that helper’s own actions do

not negatively influence the service being provided.

• Confidentiality may need to be broken if the client

threatens or attempt suicide, threatens to kill

another, of abuse/neglect a child: must be

reported.

POTENTIAL TREATMENT SERVICES

• Therapy: art; cognitive processing; trauma-focused

play, integrative-eclectic, cognitive-behavioral;

parent-child interaction, & intensive family

preservation.

• Education: early childhood program, resilient peer

training intervention, parent-child education for

physically abusive parents

• Care: eye movement desensitization and

reprocessing (EMDR); therapeutic foster care;

parents anonymous, Inc.; family preservation

services

PROVIDING TREATMENT: CLIENT RESPONSE

• Engaging families in treatment can be difficult:

• showing difficulty in trusting others

• exhibit personality disorder, intolerant of a lengthy treatment

process

• have communication/cultural misunderstandings

• Treatment can provoke loyalty conflicts in children.

• Families are not always eligible for treatment by

appropriate agencies.

• Resources to treat may be limited.

WHO PROVIDES TREATMENT & HOW LONG?

• Family preservation agencies, often with the aid of

grans and independent of child protective services,

provide a full range of treatment services.

• The duration of treatment: specific guidelines

measure when families are ready for termination:

parents must demonstrate the following:

• be more aware of their own needs and how to get them

met

• be able to reach out for help in the future

• be able to communicate more effectively

• feel more positively toward their children

TREATMENT OF NEGLECTFUL FAMILIES

• Neglectful families may be especially resistant to treatment and necessitate family-centered services. • In-Home Family-Centered Services: intensive, short-term,

family-based services; voluntary, crisis prevention services to promote healthy functioning

• Shared Family Care: out-of-home care in which host caregivers and the parent(s) care for the children simultaneously; skills building model promotes parental responsibility and resource development

• The goal to help the family to function & improve their parenting skills so that the family can remain together.

TREATMENT OF PHYSICALLY ABUSIVE FAMILIES

• The primary goal of treatment with physically

abusive family is for the battering to cease and the

parents to develop coping skills for the future.

• Treatment for the child

• attending to the medical problem resulting from the abuse

• providing a safer environment

• attending to the psychological scars from the abuse.

• TF-CBT: trauma-focused cognitive behavioral therapy

TREATMENT FOR THE PHYSICALLY ABUSED CHILD

• Psychological Services:

• Trauma-focused cognitive behavioural therapy (TF-CBT)

• Therapies to help with self-concept & affect

• Remedial Services:

• Motor skills, cognitive development, & individualized

education plan (IEP)

• Socialization Services:

• Aggressiveness leads to cycle of poor peer relations

TREATMENT OF THE PARENTS & SIBLINGS

• Abusive parents also need to be treated for their

own traumatic pasts, in developing better

relationships with their children and in learning more

effective parenting skills, including appropriate

disciplinary techniques.

• Parent-child interaction therapy (PCIT)

• parent–child relationships

• parenting skills

• Alternatives for families cognitive-behavioral

therapy (AF-CBT)

• targets violent/abusive behaviors

Chapter 10

Intervention: Reporting, Investigation, and Assessment

Culturally Sensitive Intervention: Cultural Competence Defined • Culture: goes beyond race and ethnicity, including religious

identification, gender identity/expression, & sexual orientation.

• Cultural Competence: “a heightened consciousness of how culturally diverse populations experience their uniqueness and deal with their differences and similarities within a larger social context” (NASW, 2015, p.10)

Culturally Sensitive Intervention: Putting Cultural Competence into Practice

• Determine family’s level of acculturation and the reason for their immigration

• Assess how the family views a social worker’s power

• Understand how the family views itself, and their sense of family cohesion

• Acknowledge varying communication styles

• Learn about culture, but do not over-generalize

• Consult with bilingual and bicultural staff

• Know how one’s (helping professional’s) own values interface with the client’s

Understanding the Intervention Process: Reporting • Mandated reporters: individuals who, in their professional

relationship with the child and family, may encounter child maltreatment.

• State laws specify repointing agency, reportable conditions, responsibility of mandated reporters, and the investigation process

• Although anonymous reports may be accepted, they are not preferred since they do not allow for follow-up questions

Understanding the Intervention Process: Child Protection Teams • Child Protection Teams (CPT): comprised of staff from

different disciplines

• Ex) School-based CPT include an administrator, a guidance counselor, school nurse, and one or two teachers.

• Suspicions of child maltreatment are brought to CPT.

• If CPT agrees with the report, then the child protection agency is notified.

• CPTs are effective in medical facilities & churches.

Understanding the Intervention Process: Investigation & Assessment

• Intake worker meets with the child & his/her family to assess risk, protective factors, and impact of disclosure on stability of the family

• If the report is substantiated, the worker identifies goals and strategies for the family

• If unsubstantiated, the case is referred or closed

• Treatment planning and services begins

• Must evaluate the family’s progress and revise service plan as necessary

Understanding the Intervention Process: Family Reactions & Home Visiting

• The family is in a state of crisis, disequilibrium, when disclosure takes place, experiencing fear: fear of authority, fear of having the child removed, the fear of helplessness.

• Responses (defense mechanisms) to fear: denial, projection, blaming the system, antagonism towards social services, or withdrawal.

• Workers must evaluate the family’s strengths too.

• Home visitation allows assessment, but also requires additional sensitivity and interviewing skills.

Assessing Risk and Protective Factors • Is the child at risk from abuse or neglect, and to what degree?

• What is causing the problem?

• What are the strengths or protective factors that could be built on with services to alleviate the problem?

• Is the home a safe environment or must the child be placed?

• Essential information: parental history and family functioning, parent’s view of child, & environmental factors and supports

Interviewing for Assessment

• Ask questions designed to assess the potential risk of the home situation and the capacity of the parents to cope with child rearing.

• Use non-leading questions; avoid blaming; recognize the client’s feelings

• Interview the child in a nonthreatening setting; adjust to child’s developmental level and language preferences, including names of body parts; allow for stories, metaphors, and drawings

Handling Emergencies

• Emergencies: imminent danger to the child, child abandonment, or if the parents are not cooperating.

• Require an immediate decision on whether to involve the court system, remove the child from home, or both; need assessment to determine who should have custody of the children and the impact that this will have on the children.