SHEDDING LOVE AND LIGHT ON THE ELEPHANT IN THE ROOM: Intervening in Child Neglect

1. SHEDDING LOVE AND LIGHT ON THEELEPHANT IN THE ROOM:Intervening in Child Neglect Rose Monteiro, LCSWAdjunct ProfessorUSC Graduate School of Social Work

2. A Little History In 1628, Massachusetts Stubborn Child Act • Rebellious, disobedient children could be put to death

3. A Little History 1850 – 1875 Charles Loring Brace, sent children into the country side on Orphan Trains to live with families. Children were removed from city slums living with immigrant parents. He believed that clean air, food, clothing, shelter were important to child development.

4. A Little History, cont’d In 1874, “Mary Ellen” • Eight year old girl beaten by caretaker. SPCA took matter to court as “Children are part of the Animal Kingdom” • SPCC — est. 1875

5. A Little History, cont’d 1875 Henry Birgh helped found the New York Society for Prevention of Cruelty to Children because so many children were being brought to the Society for Prevention of Cruelty to Animals. Late 1800’s first home visits made by friendly visitors (women) volunteers. Later became paid professional forerunners of the profession of social work.

6. A Little History, cont’d 1912 Children’s Bureau established. First federal agency that represented the interests of children. As a result of the Children’s Bureau many public and private social service organizations were established.

7. A Little History, cont’d In 1959, Declaration of the Rights of the Child adopted by the United Nations 10 principles. • Principal 8 – The child shall in all circumstances be among the first to receive protection and relief. • Principle 9 – (abridged) The child shall be protected against all forms of neglect, cruelty, and exploitation. He shall not be the subject of traffic, in any form. • Principal 10 – (abridged) The child shall be protected from practices which may foster racial, religious, and other forms of discrimination. He shall be brought up in the spirit of understanding, tolerance, friendship among peoples, peace, and universal brotherhood. http://www.un.org/cyberschoolbus/humanrights/resources/plainchild.asp

8. A Little History, cont’d • In 1963, California enacted its first mandated child abuse reporting laws, requiring physicians to report physical abuse

9. A Little History, cont’d • 1970 Federal Legislation on Permanency to eliminate foster care drift. This is a shift from child rescue foster placement to permanency with reunification as the first priority for the child.

10. A Little History, cont’d • ? Name shift from Department of Children Services to Department of Children and Family Services.

11. A Little History, cont’d • 1970 California law passed mandated reporting of suspected child abuse by citizens and professionals: case loads increased dramatically creating system overload.

12. A Little History, cont’d 1980 Public Law 96-272 The Adoption Assistance Act passed to assure a permanent home for children. Permanent alternative for those who cannot return home.

13. A Little History, cont’d 1987 Senate Bill (S.B. 243) code change to include concept of specific “harm and substantial risk, which must be proven in order for protective services to intervene.” Change in philosophy from “concern for what might be good for child to issue of “specificity,” “minimal standard of care.”

14. A Little History, cont’d Tulare Co. Data 2007 23,290 people lived below the poverty level. Substantiated cases: July 1,2007- June 30, 2008 there were: • 57 severe neglect • 513 general neglect • 29 cases of emotional abuse • 3216 substantiated referrals combined severe neglect, emotional abuse, and general neglect.

15. A Little History, cont’d Substantiated cases: June 1, 2008 – July 30, 2009 there were: • 46 severe neglect • 600 general neglect • 54 cases of emotional abuse • 699 substantiated referrals combined severe neglect, emotional abuse, and general neglect.

16. A Little History, cont’d • Culture of violence • Culture of poverty • Drug culture • Materialistic culture • Media and technology culture • Internet chat rooms • Pornography • Acculturation • Culture Clash

17. “We worry about what a child will become tomorrow, yet we forget that he is someone today.”~Stacia TauscherAbuse violates moral standards

18. “What a child doesn’t receive he can seldom later give.”  ~P.D. James, Time to Be in Earnest

19. “Children’s talent to endure stems from their ignorance of alternatives.”  ~Maya Angelou, I Know Why the Caged Bird Sings

20. Definitions General Neglect: Willful or negligent failure of a parent or guardian to provide the child with adequate food, clothing, shelter, medical care, or supervision

21. Definitions, cont’d Severe Neglect: Minor will suffer sever and serious physical harm or illness as a result of parent or guardian failure to provide adequate care and supervision Example: failure to thrive

22. Subtypes of Neglect Physical Neglect • Failure to protect from harm and danger • Child’s basic physical needs, food, clothing, shelter not met Data from Third National Incidence Study indicates that of all subtypes of maltreatment, physical neglect is most clearly associated with poverty.

23. Subtypes of Neglect, cont’d Emotional Neglect • Passive or passive aggressive. • Inattentive to the child’s emotional needs. • Nurturing or emotional well-being.

24. Subtypes of Neglect, cont’d Medical Neglect • Caregiver failure to provide prescribed medical treatment including: Failure to have children get proper immunizations. Prescribed medication. Recommended surgery. Other interventions in case of serious disease or injury. (This particular area can clash with parents’ freedom of religion and choice.)

25. Subtypes of Neglect, cont’d Mental Health Neglect • Refusal to comply with recommended corrective or other procedures (My child isn’t crazy.) (I won’t give my child all those drugs.)

26. Subtypes of Neglect, cont’d Educational Neglect • Caregiver failure to comply with state requirements for school attendance.

27. Subtypes of Neglect, cont’d Emotional Neglect • Most extreme, non organic failure to thrive. At almost two years of age, neglected children lacked enthusiasm, were easily frustrated, displayed considerable anger and were non- compliant. Emotional neglect is seen to have more profound effect on children than physical neglect and other forms of child maltreatment.

28. “Particular” Child Child Abuse & Neglect “Potential” Parent Crisis

29. Neglectful Families Profile • Fewer resources • Larger families • Children older • Mothers have less education • Less employment experience • Poverty • Among mothers who were neglectful or abused when they were children, 40% maltreated their children in early years and additional 30% provided borderline care. • Among mothers who were neglected as children, 7 out of 9 maltreated their own children and most of these cased were neglect. • Chronic, more physical health problems

30. Neglectful Families Profile, cont’d • History of chronic mental illness and depression • More inappropriate expectations of their children • Lack of knowledge about parenting and child development

31. Newly Neglectful Families Profile • Centered on inability to manage recent crisis effectively • Problems with drugs • Feelings of social isolation • Loneliness • Confused thinking • Feelings of dread Symptoms correlate to anxiety and depression Mothers who repeated the cycle had higher scores on a measure of disassociation.

32. Psychoneurobiology of Brain Development • Maternal separation or neglect can profoundly affect the brain’s biochemistry, with lifelong consequences for growth and mental ability. • Scientists have known for decades that maternal deprivation in infancy can mark children for life with serious behavioral problems, leaving them withdrawn, apathetic, slow to learn and prone to chronic illness. • Children raised without being regularly hugged, caressed or stroked – deprived of the physical reassurance of normal family attention – have abnormally high levels of stress hormones.

33. Psychoneurobiology of Brain Development, cont’d • The children who had the highest levels of cortisol also had the lowest scores on tests of mental motor ability. • The relationship between parental care, the neurobiology of touch and the chemistry of stress lies at the heart of the new insights on how a newborn brain takes shape. • One of the critical aspects of maternal behavior is the tactile contact between mother and infants. “Neglect Harms Infants’ Brains,” Society for Neuroscience. 10/27/1997

34. Attachment Theory John Bowlby and Mary Aimsworth • Working Models • Consistency and Predictability • Attachment Styles Secure Insecure Anxious Ambivalent Avoidant – detached Aggressive

35. Understanding Change / Crisis Change Models / Triggers V Crisis Danger or Opportunity

36. Four Factors that Broke the Cycle • Presence of a loving supportive adult during their childhood gave them a different view of themselves and others. • A supportive partner at the time they became parents. • Therapeutic intervention that enabled mothers to come to some resolution of their early issues and achieve greater emotional stability and maturity. • The mother’s integration of the maltreating experiences into a coherent view of self.

37. Interventions / Systems • Agency • Case Management (Crisis Intervention) • Coordination • Collaboration • Client case conference / case planning

38. InterventionsThe Non-Voluntary Client Helper Roles and Tasks • Empathy • Listen to client story • Share legal mandate and description of neglect • Helper needs to be consistent and predictable • Emphasis on client strengths • Never work harder than the client (teach client to fish)

39. InterventionsThe Non-Voluntary Client, cont’d Helper Roles and Tasks, cont’d Do not support clients being victims. Point out choice and consequences. • Revise any notion you have about fast change. • Observe what people do, not what they say. • Advocacy

40. Interventions, cont’d Solution Focused • Goals – What would you love to have happen as a result of your being mandated to see a representative of Children Services? • The situations (behavior) when are the times that the situation doesn’t happen? • Let’s review what your options are. Miracle Question Do you ever wish for a miracle? Do you wish for magic to happen? So if you went to sleep tonight and you woke up the next morning and the problem was solved, what would be different?

41. Interventions, cont’d Scaling Questions On a scale of 1-10, 1 being not serious, 10 being very serious, how would you rate the problem? How would your children rate the problem? How would your neighbors, department rate the problem? What number would you choose that would satisfy you and the department that the problem was solved or improving? What would it take to keep the solution in place?

42. Interventions, cont’d Appropriate intervention must be tailored to the type of neglect and the outcome of the assessment process. Chronic multiproblem neglectful families require more sustained intervention with multiple services. When neglect is primarily a result of individual and family factors, intervention is different than when it is a matter of environment or community conditions. Neglectful mothers who fit the Polansky typology of the apathy-futility syndrome must be treated differently than those whose neglect is a result of recent unemployment or lack of parental support systems.

43. PreventionPositive Parenting Project STEEP 1990-1992 found that expectant parents were more open to supportive therapeutic services prior to the birth of their first child. This was because they were not yet parents and did not feel that their child rearing practices were being judged. • Health care providers in obstetrics, prenatal, and pediatric settings are in an excellent position to identify potentially neglectful families. (Egeland, B. & Erickson, M.F. (1990). Rising Above the Past: Strategies for Helping New Mothers Break the Cycle of Abuse and Neglect. Zero to Three. 11(21, 29-35)

44. PreventionPositive Parenting, cont’d Intervention research suggests that chronic neglectful families need comprehensive services that are relatively long term. Analysis of 34 prevention studies pointed to individualization as the key to success. Factors include: • Age • Gender of child • Stage of family development • Race/ethnicity • Age and education of parent • Strength based

45. Resources and Referrals • Drug treatment • Psychotherapy, counseling, mediation • Regional Center for Developmental Disabilities • Food stamps, medical • Social Security / medicine • Housing • Child care • Education / Training • Support group / bereavement • Positive parenting • Family Planning

46. Care for the Care Giver