Joining Forces

Joining Families

Volume 10, Issue 1 • March 2007

R e a l W o r l d R e s e a r c h f o r F a m i ly A d v o c a c y P r o g r a m s
F e at u r e d I n t e r v i e w

Conceptualization and Measurement of Child Neglect
Interview with Howard Dubowitz, MD. by James E. McCarroll, PhD
Howard Dubowitz, MD
Howard Dubowitz, MD, is Professor of
Pediatrics and the Director of the Center for
Families at the University of Maryland Medical
School in Baltimore, Maryland. He received his
medical training at the University of Cape Town,
South Africa, completed an internship in Israel,a pediatric residency at Boston City Hospital,

In This Issue
The Spring Joining Forces Joining Families (JFJF) newsletter focuses onchild neglect, an issue of importance for the United States Army as well as
for our nation. In the Army, rates of child neglect have risen since 2001. Our
featured interview is with child neglect expert, Howard Dubowitz, MD, Professor of Pediatrics at the University of Maryland Medical School. We review his
recent research on child neglect prevention and intervention and comment on
the implications of his work for reducing child neglect in the Army. Building
Bridges explores statistical concepts related to the measurement of childneglect and describes two types of scales developed for research, clinical, andadministrative purposes. Websites of Interest offers some links to resourceson child neglect including an excellent manual, Child Neglect: Guide for Prevention, Assessment and Intervention, published by the Children’s Bureau, U.S.
Department of Health and Human Services. As always, we welcome your feedback on how JFJF has been or can be helpful inyour outreach to our community that continues to experienceextreme stress and uncertainty.
Conceptualization and Measurement of Child Neglect, An Interview with
Howard Dubowitz, MD.............................................................................. 1
Review of Recent Research: Howard Dubowitz, MD................................... 3
Building Bridges to Research: Defining and Measuring Child Neglect......... 5
Websites of Interest................................................................................... 8

and a fellowship in child abuse and neglect at
Children’s Hospital, Boston. Dr. Dubowitz, whoholds a Master of Science degree in epidemiology from the Harvard School of Public Health,is widely published and renowned for his clinicalwork, teaching, research, and advocacy. Among
his numerous professional honors, he is therecipient of the American Academy of Pediatrics’
Special Achievement Award. Dr. Dubowitz is oneof the principal investigators of the LONGitudinal Studies of Child Abuse and Neglect (LONGSCAN), a 20 year study in its 17th year of data collection (see Runyan et al., 1998, for a descriptionof the Longscan Study)1. A bibliography of studies
from the LONGSCAN is available at http://www.
iprc.unc.edu.
Dr. McCarroll: Based on your international
experiences, training, and practice, what do
we know about child maltreatment acrosscultures?
Dr. Dubowitz: To the best of my knowledge
all cultures have a taboo against child sexual
abuse, although cross-cultural differences doexist. For example, a majority of countries do
not have prohibitions against child pornography. Physical abuse issues are a little trickier.
Even within the state of Maryland there are differences. For example, some people may equate
Continued on page 2
1. Runyan DK, Curtis PA, Hunter WM, BlackMM, Kotch JB, Bangdiwala S, Dubowitz H,
English D, Everson MD, & Lansdverk J. (1998).
LONGSCAN: A consortium for longitudinalstudies of maltreatment and the life courseof children. Aggression and Violent Behavior,
3:275–285.

any hitting of a young child as abuse whileothers accept spanking as appropriate in somecircumstances.

Four major risk
factors for childabuse and neglect are
depression, substanceabuse, domestic
violence, and parental
stress.

Dr. McCarroll: Tell us a little about yourCenter.
Dr. Dubowitz: Our Center is within the
Department of Pediatrics at the University of
Maryland Medical School. We have four main
activities: clinical programs, clinical research,teaching, and advocacy. Our goal is to encourage the development of policies that will help
children and families within the city, the state,
and nationally.
Dr. McCarroll: In your teaching and researchdo you address the intersection of child andadult maltreatment?
Dr. Dubowitz: I generally do raise it as an
issue. I think this is an important intersection.
One of the projects that we are completing
is focused on routine screening for domestic
violence by pediatricians.. There are studies
showing that parents, usually mothers, willreport domestic violence to pediatric and othermedical staff when asked.

Joining Forces
Joining Families
Editor-in-chief
James E. McCarroll, Ph.D.
Email: jmccarroll@usuhs.mil
EditorJohn H. Newby, MSW, Ph.D.
Email: jnewby@usuhs.mil
Joining Forces Joining Families
is a publication of the Community and Family Support Center and the Family
Violence and Trauma Projectof the Center for the Study ofTraumatic Stress, part of the
Department of Psychiatry,
Uniformed Services University of the Health Sciences,
Bethesda, Maryland 208144799. Phone: 301-295-2470.

 • Joining Forces/Joining Families

Editorial Advisor
LTC Mary Dooley-Bernard, MSW
Family Advocacy Program Manager
Headquarters, Department of theArmy
E-mail: Mary.Dooley-			
Bernard@cfsc.army.mil
Editorial Consultants
David M. Benedek, M.D., LTC, MC, USA
Associate Professor and Scientist
Center for the Study of Traumatic Stress
Uniformed Services University of the
Health Sciences
dbenedek@usuhs.mil
Nancy T. Vineburgh, M.A.
Director, Office of Public Education
and Preparedness
Center for the Study of Traumatic Stress
Email: nvineburgh@usuhs.mil

Dr. McCarroll: What is the best way to screen
for child or adult maltreatment?
Dr. Dubowitz: I recommend using a screening instrument. Screening cannot and must not
be limited to visual examination. So much getsmissed when you depend only on gross examination, such as the woman with the black eye.
Abuse is a problem that is often well masked.
Dr. McCarroll: Would you say the same thing
about child abuse? Would you rely on ascreening instrument as opposed to a visual
examination or verbal report?
Dr. Dubowitz: I think the difficult question is what instrument to use. If there weresomething practical it would be quite attractive. However, this has been elusive. As partof a project called SEEC – a safe environment
for every child –we included two questions
that seem to be important. They were part of aone-page questionnaire that parents completed
while waiting for the child’s appointment. (1)“Have you been concerned that your child may
have been sexually abused?” and (2) “Have you
felt the need to hit your child?” These questions
have shown some predictive value. The big
problem is that of response bias in the direction of social desirability and how does one
circumvent it. [Editor’s note: Social desirability
is presenting oneself in an overly favorable light.]
In a current study that we are conducting with
about 85–90 pediatricians in private practice,
we are targeting risk factors such as depression,
substance abuse, domestic violence and parental stress as the four big contributors to childabuse and neglect.
Dr. McCarroll: Your earlier papers emphasize
the ecological model as developed byBrofenbrenner (1979) and Belsky (1980). Do
you still teach this as a way of conceptualizing
how children are affected by their world?
[Editor’s note: The ecological model is a theory
emphasizing the multiple interacting factors that
contribute to child abuse and neglect.]
Dr. Dubowitz: Yes, it is a major focus. It is
important for professionals, when these cases
evoke feelings of pain, anger, and dismay, torecognize that neglectful parents are not simply
evil people. Where these models can be helpful is to caution us not to excuse the behavior,
but to understand that there are underpinnings
to some of these problems. I often will suggestthat pediatricians think of abuse and neglect
Continued on p. 7
March 2007

L i t e r at u r e R e v i e w

A Review of Recent Research of Howard Dubowitz, MDJames E. McCarroll, Ph.D. and Robert J. Ursano, M.D.
Three basic needsof children are for
emotional support andaffection, protection
from family conflict,and from community
violence.

Much of Dr. Dubowitz’s work has focusedmaltreatment. Two articles on child neglect
on child neglect, a complex social problem.
provide very clear and useful language and apChild neglect accounts for the largest numproaches for providers of health care. The firstber of cases and highest rates of any kind of(Dubowitz, Giardino & Gustavson, 2000) demaltreatment in the U.S. civilian society and in scribes manifestations of child neglect, provides
the Army. Recent data also indicate that childprinciples for assessment and management ofneglect in the U.S. Army has
neglect and suggests thatrisen during recent deploycaregivers focus on chilPrograms emphasizing
ments.
dren’s basic needs rather
parenting efficacy could playChild neglect has beenthan on the omissions ofdifficult to define, both inparenting. The second
a valuable role in enhancing
research and in practice.
article (Dubowitz, 2002)
the involvement and parenting
Some communities havedescribes the importancemore concern for physicalof preventing child abuseskills of fathers.
aspects of child care whileand neglect, identifies
others may focus more on
risk and protective factors
psychological issues. However, there is overall
for child maltreatment, and provides guidance
general agreement on the circumstances thaton screening, brief assessment, and initial manare harmful to children (Dubowitz, Klockneragement of child maltreatment.
Starr, & Black, 1998). Part of the discussion of
One of the important issues that Dr.
child neglect is whether to categorize subtypes
Dubowitz has emphasized in his research andand, if so, how. In a study of the relationships
teaching is the association between fatherof three major subtypes of neglect (physical,
involvement and child neglect. In a 2000 study,
psychological, and environmental), Dubowitz,
Dubowitz and colleagues found that the mere
Pitts, and Black (2004) found modest correlapresence of a father did not significantly influtions among the neglect subtypes indicatingence the degree of neglect of the child, but thesome degree of overlap, while still suggesting
nature of his involvement did. Fathers who felt
somewhat unique factors in each.
more effective as parents were less likely to neA recent conceptual model of child neglect
glect their children. Less neglect was associatedat ages 4–6 (Dubowitz et al., 2005) identified
with fathers’ longer duration of involvement,
12 children’s needs, and conceptualized neglect more involvement with household tasks, andas occurring when these basic needs are not ad- less involvement in child care (Dubowitz, Black,equately met. This study related child needs toKerr, Starr, & Harrington, 2000). The investigalongitudinal measures of child maltreatment.
tors thought that the sense of parenting efficacy
Three basic needs were derived: emotional sup- might represent parenting skills and suggested
port/affection, protection from family conflict, that caregivers could play a valuable role inand protection from community violence. The
enhancing the involvement and parenting skills
model then assessed whether these three conof fathers.
structs were related to children’s adjustment at
In a very recent article, Dr. Dubowitz
age 8. Low perceived support from the mother(Dubowitz, 2006) commented on two studwas associated with child behavior problems.
ies on child neglect (Coohey, 2006; Pittman
Exposure to family conflict and children’s& Buckley, 2006), reviewed the significant
sense of experiencing little early affection wereresearch on fathers and child maltreatment,
associated with both child behavior problems
and described the current need to understandand with social problems. The investigators
the roles of fathers in child rearing and childconcluded that conceptualizing neglect as themaltreatment. Coohey found several predicfailure to meet children’s needs could help
tors of recidivism among fathers who abusedbuild our understanding of child neglect.
their children: (1) father unemployed, (2)An important part of Dr. Dubowitz’s work
not the biological father of all the children in
is educating health care professionals on familyContinued on p. 4

http://www.centerforthestudyoftraumaticstress.org

Joining Forces/Joining Families • Review of Dubowitz Research, from page 3

Dubowitz suggeststhat caregivers focus
on children’s basic
needs rather thanon omissions ofparenting.

the family, (3) denying responsibility for his
behavior, (4) having previously maltreateda younger child, and (5) seriously injured achild. Dubowitz noted that an important clinical implication of Coohey’s work was getting
fathers to acknowledge their own responsibility, which has implications for both prevention
and intervention.
Dubowitz noted that Pittman and Buckley’s study of 2,841 offenders treated in the U.S.
Air Force Family Advocacy Program foundmany similarities and few differences between
mothers and fathers of neglected children.
The mothers reported more distress and more
problems outside the family, while fathers reported more rigid expectations of children andless family cohesion. Taking into account suchdifferences may help tailor treatment interventions to address specific problems that differ
for mothers and fathers.
Finally, Dr. Dubowitz has performed
community research on the effectiveness ofstrategies to prevent child neglect. The program, Family Connections, was a demonstration project of a prevention strategy assessed in
154 families who received the intervention for
3 months or 9 months (DePanfilis & Dubowitz, 2005). The outcomes of the program
were protective factors (parenting attitudes,
parenting sense of competence, family functioning, and social support), key risk factors
for neglect (caregiver depressive symptoms,
parenting stress, and everyday stress), childsafety (physical and psychological care of thechild), and child behavior (caregiver reports ofchild internalizing and externalizing behavior).
Internalizing behavior included somatic complaints and withdrawn, anxious, or depressive
behavior. Externalizing behavior was measured
as delinquency or aggressiveness. The interven-

Research possibilities involving neglect:n prevalence of subtypes
n targeting neglect prevention programs for the mostprevalent subtypes

n degree of overlap of subtypes and other forms of child 		maltreatment

n child neglect and domestic violencen the meaning of children’s experiences of neglect andthe risk of harm • Joining Forces/Joining Families

tion aimed to improve protective factors, diminish risk factors, and thereby improve childsafety and behavior. Interestingly, the 9 monthprogram had few advantages over the 3 monthprogram. This finding reinforces the need forresearch on the optimal length of intervention
for community-based programs.
There are many implications of Dr.
Dubowitz’s work for the Army Family Advocacy Program as well as suggestions for further
research. Among the research and program
development opportunities within the Armycommunity are to: (1) determine the types andprevalence of subtypes of neglect; (2) clarify
the degree of overlap of neglect subtypes withother types of neglect and with other types ofchild maltreatment, and domestic violence;(3) develop neglect prevention programs targeting the subtypes of neglect and the highest
risk families; and (4) understand the meaning
and implications of children’s experiences ofneglect and risk for harm.
Dr. Dubowitz’s work in the field of childneglect can help educate and inform the Armycommunity. In the current context of rapid,
long, and repeated military deployments, it isoften hard for parents to balance all the needsof the active duty member(s) and the children.
Further understanding of child neglect in ourown community can protect our nation’s children and strengthen the Army family.

References:
Coohey C. (2006). Physically abusive fathers
and risk assessment. Child Abuse & Neglect,
30:467–480.
DePanfilis D. & Dubowitz H. (2005). Family
Connections: A program for preventing childneglect. Child Maltreatment, 10:108–123.
Dubowitz H. (2002). Preventing child neglect
and physical abuse: A role for pediatricians.
Pediatrics in Review, 23:191–196.
Dubowitz H. (2006). Where’s Dad? A need tounderstand father’s role in child maltreatment. Child Abuse & Neglect, 30:461–465.
Dubowitz H, Black MM, Kerr MA, Starr RH,& Harrington D. (2000). Fathers and childneglect. Archives of Pediatric and Adolescent
Medicine, 154:135–141.
Dubowitz H, Giardino A, & Gustavson E. (2000).
Child neglect: Guidance for pediatricians.
Pediatrics in Review, 21:111–116.

Continued on p. 6
March 2007

Building Bridges to Research: 				Defining and Measuring Child Neglect
James E. McCarroll, Ph.D. and Robert J. Ursano, M.D.
Reliability refers to
the consistency of ameasurement.

Defining and measuring child neglect is
er reliability is the degree of agreement between
challenging. Sound empirically based assesspersons judging candidates for a job. Validity,
ments are needed. This article provides someon the other hand, is a different concept. There
examples of neglect definitions and measures
are several types of validity. In general, validitythat have been developed for research andindicates the degree to which you are measuring
clinical use. The examples illustrate the types
the concept or behavior that you are attemptingof measures used. Increased knowledge ofto measure. Concurrent validity is the degree
measures of neglect can aid
of agreement of a new
the Army Family Advocacy
measure, say a test, with
Validity indicates the degree toProgram in its mission.
one that has already been
Straus and Kantor
validated. Predictive vawhich you are measuring the(2005) suggest a definilidity is a measure of how
concept or behavior that you
tion of neglect, provide
well a test predicts someare attempting to measure
a conceptual analysis of
criterion. For example, inthat definition, and idenmaltreatment research, wetify principles, criteria andwould like to have a meaproblems in creating measures of neglect. Their sure with high predictive validity for recidivism.
definition highlights the neglectful behaviors ofThat is, it would accurately and with high proba caregiver that constitute failures to meet theability predict recidivism risk. High predictive
developmental needs of a child. Thus, neglect is validity is generally required for clinical use.
conceptualized as failure to meet needs in conInternal consistency reliability is anothertrast to inflicting harm. Its causes and motives
psychometric measurement property. In deare also different.
veloping their measures, Kantor et al. (2004)
Kantor and Straus, at the Family Research
included a clinical sample of 144 children, ages
Laboratory at the University of New Hamp6–15 and a comparison sample of 87 children.
shire, have developed a number of measures of The full version of the MNBS-CR had highchild neglect. One of these is the Multidimeninternal consistency reliability among both thesional Neglectful Behavior Scale-Child Reportyounger (alpha=.66) and older children (al(MNBS-CR) (Kantor et al., 2004). It measures
pha=.94) with neglect concerns. Alpha is a meafour primary domains of neglectful behavior:
sure of the internal consistency of a scale. Inemotional, cognitive, supervision and physicalternal consistency measures the extent to which
neglect. Good psychometric properties werescale items correlate with each other. The higher
demonstrated in their validation samples.
the value of alpha, the more the items measure
The term psychometric properties refers
the same idea and the higher is the internal
to measures that have been obtained in theconsistency. Scores above 0.60 indicate reasondevelopment of an instrument. Generally, atable internal reliability. For more informationa minimum, these include measures of relion scales and measures, see http://www2.chass.
ability and validity. Reliability and validity arencsu.edu/garson/PA765/standard.htm.
two basic concepts in test development andCorrelations among the MNBS-CR submeasurement. There are many types of bothscales ranged from moderate to high indicating
reliability and validity. In general, reliability
overlap between the subscales. Correlationalrefers to the consistency of a measurement.
analyses between the total neglect scores andTest-retest reliability is the degree of agreement child outcomes provide some support for conachieved when a measure is given on two difstruct validity of the MNBS-CR. In addition,
ferent occasions. For example, if intelligence isanalyses of the relationship between MNBS-CR
measured on two separate occasions under thereports and caretaker reports were conducted
same circumstances, the results should be very
to address construct and predictive validity.
similar. Inter-rater reliability is a measure of the (The MNBS-CR scales should be used only with
degree of agreement of two or more persons
permission of Straus and Kantor. Contact the
rating the same event. An example of inter-ratContinued on p. 6

http://www.centerforthestudyoftraumaticstress.org

Joining Forces/Joining Families • Building Bridges to Research, from page 5

Concurrent validity is thedegree of agreement of
a new measure with one
that has already beenvalidated.

authors at: http://www.unh.edu/frl/unpubpap.
htm.)
Another instrument that focuses upon
the measurement of child neglect is the Child
Neglect Index (CNI) (Trocme, 1996). It was
designed as a substantiation tool for childwelfare practitioners and researchers to easily
measure the type and severity of child neglect. Trocme’s definition of neglect is basedon criteria used by child welfare workers and,accordingly, reflects a more legal than clinicalapproach. In contrast to Straus and Kantor’s
conceptualization of neglect, the CNI defines
neglect in terms of the different forms of physical or emotional harm that is seen in neglectedchildren.
The CNI is a single page instrument including the following six scales: supervision,
nutrition, clothing and hygiene, physical healthcare, mental health care and developmental/
educational care. For all scales an inadequate orneglect rating requires evidence of impairment
or harm or exposure to situations that could
cause harm.
The CNI was field tested in a large welfare
agency on 127 consecutive intake investigations. Two scales, psychological care and developmental care, were correlated above .50. Testretest reliability was assessed by the completionof the CNI by the intake workers twice within
two weeks. Test-retest reliability scores foreach scale were acceptable, with a range from.83 (developmental/educational care) to .91(supervision). Interrater reliability scores on
individual scales ranged from .69 to .95 with amean of .79. Validity and reliability of the CNI

compare favorably to longer and more detailed
measures of child neglect.
Straus and Kantor (2005) give additional
helpful information on the conceptualizationand measurement of neglect in a recent article.
They discuss neglect definitions, principles andcriteria for the measurement of neglect separately from harm, various measures of neglectful behavior and their psychometric properties,
and implications for research and practice.
Although there are differences in the measurement of child neglect, there continues to be an
ongoing need for interventions and supportive
services for neglected children and neglectfulparents. Enhancing our knowledge and understanding of measurement characteristics associated with the study of child neglect should
significantly contribute to this important task.

References
Straus MA & Kantor GK. (2005). Definition andmeasurement of neglectful behavior: someprinciples and guidelines. Child Abuse & Neglect, 29:19–29.
Kantor GK, Holt MK, Mebert CJ, Straus MA,
Drach KM, Ricci LR, MacAllum CA, & Brown
W. (2004). Development and preliminary
psychometric properties of the Multidimensioonal Neglectful Behavior Scale—Child
Report. Child Maltreatment, 9:409–428.
Trocme N. (1996). Development and preliminary
evaluation of the Ontario Child Neglect Index.
Child Maltreatment, 1:145–155.

Review of Dubowitz Research, from page 4

Three major subtypesof child neglect arephysical, psychological,
and environmental.

Dubowitz H, Klockner A, Starr RH, & Black M.
(1998). Community and professional definitions of child neglect. Child Maltreatment,
3:235–243.
Dubowitz H, Newton RR, Litrownik AJ, Lewis
T, Briggs EC, Thompson R, English D, Lee
L, & Freerick MM. (2005). Examination ofa conceptual model of child neglect. Child
Maltreatment, 10:173–189.

 • Joining Forces/Joining Families

Dubowitz H, Pitts SC, & Black MM. (2004).
Measurement of three major subtypes ofchild neglect. Child Maltreatment, 9:344–356.
Pittman JF & Buckley RR (2006). Comparing
maltreating fathers and mothers in terms of
personal distress, interpersonal functioning and perceptions of family climate. Child
Abuse & Neglect, 30:481–496.

March 2007

Dr. Dubowitz Interview, from page 2

as symptoms. That seems to help take someof the edge off of angry feelings and helps us
realize the importance of the family, cultural,and community issues that contribute to thesituation.
Parents, most of thetime, would like forlife to be good fortheir children. The
big question is tounderstand what getsin the way of goodintentions.

Dr. McCarroll: It sounds like this approach
could be helpful to parents as well as tophysicians.
Dr. Dubowitz: I am always careful whenpresenting the model to not let parents off thehook. It is walking a bit of a tightrope. I do saythat parents have the primary responsibility toprotect and nurture their children. The clichéthat it takes a village is, however, actually kindof true.
Dr. McCarroll: The high rates of neglect in
the U.S. civilian community and the Army
are of concern. In many publications one
reads about subtypes of neglect, but mostjurisdictions do not publish data on subtypes.
What is the value of categorizing neglect
into subtypes? Would this help to target
interventions?
Dr. Dubowitz: Again, there is quite a bit ofvariation across states. Very often, states have
two, three or four subtypes. One of them isoften called failure to provide. This includes thephysical aspects of childcare such as food andhousing, clothing, and, sometimes, health care.
The second main subtype that is often used islapses in supervision. Some also have educational neglect, but generally it is the physical aspectsof children exposed to hazards and concerns
about supervision that states are most concerned about.
Dr. McCarroll: Do you think the subtypes areprimarily for researchers? Are clinicians
interested in using such categorization?
Dr. Dubowitz: I think that this is not aquestion just for researchers. These different
subtypes are, in fact, different. To lump together, for example, the child who has inadequate
nutrition with a child who is abandoned does
not make much sense. The circumstances arequite different. One could argue that for theindividual clinician, even having subtypes is
too crude. I say this as a clinician. For example,
the criminal law on abandonment in one state
requires that about 15 or 20 different contextual variables need to be taken into account.
In the instance of a child left alone, contextual

http://www.centerforthestudyoftraumaticstress.org

variables might be the age of the child, the timeof day, how long is the child left alone, are theutilities functioning in the house, is there foodin the house, does the child know how to reacha parent? In cases of failure to thrive, contextual
variables also make a huge difference. Clinicians, even sometimes without even using theterminology, recognize this variability and try
to probe the specific circumstances. By doing
so they are paying attention to the differences
across and even within subtypes.
From an administrative standpoint, I cansee how, for example, child protective services
might lump these different categories into failure to provide. For researchers as well there isa need to clarify the meaning of these different
experiences for children. Also, there is substantial overlap between the subtypes.
In the LONGSCAN, for example, with1,300–1,400 children, in a subsample of children who have experienced lapses in supervision, it gets pretty tricky because many ofthese children have experienced other types ofneglect or other forms of maltreatment as well.
[Editor’s note: See the Dr. Dubowitz’s biography
for a reference that describes the LONGSCAN.]
But I should also give another perspective.
There are differences and subtypes of neglect,
but ultimately these are symptoms of parents
having difficulty meeting their children’s basic
needs. From a conceptual standpoint does itreally matter? If one looks at the underlying
parental, family, and community dynamics thatare underpinning these manifestations, are they
likely to be so different? Therein lies a conceptual argument for lumping rather than dividing. So, I think the answer is that it depends
specifically on the question. If it is a matter ofbroader public policy then some of these differences might seem unnecessarily nuanced. On
the other hand, if it’s trying to understand thespecifics around the feeding of young children
then the issue of that specific subtype might bequite important.
Dr. McCarroll: You mentioned in one of yourarticles that various risk factors such as
substance abuse, depression, non-biologicalparents, and others, have low predictive value
for neglect.
Dr. Dubowitz: I hope I have not been dismissive of risk factors because we need a variety
of strategies. Even if a particular risk factor has
a low predictive value, I think when you start
combining them the predictive power gets betContinued on p. 8
Joining Forces/Joining Families • Dr. Dubowitz Interview, from page 7

ter. This gets back to definitional issues. Both domestic violence
and maternal depression are strong risk factors for child abuse.
If one is looking at only parental age, then the connection is
weaker.
Dr. McCarroll: What are the underpinnings of risk factors? Is
this the question of what lies behind the parents’ failure toadequately take into account their children’s needs?
Dr. Dubowitz: For a long time it has been convenient topoint and wag a finger at a guilty parent, but I think one mighttake a broader epidemiological view, a public health perspective
saying, “Wait a moment.” You know, if we are in a society thatsays on the one hand says we love children and at the same time
one in four girls and maybe one in ten boys are sexually abused,

I think it behooves us to take this broader perspective of what
are the contributors that are underpinning these facts.
I have stubbornly held on to the view that most parents
most of the time would like for things to be good for theirchildren. So the big question as we try and put a dent in thisproblem is to better understand what gets in the way of, hopefully, good intentions.

References
Belsky J. (1980). Child maltreatment: An ecological integration.
American Psychologist, 35:320–335.
Bronfenbrenner U. (1979). Toward an experimental ecology ofhuman development. American Psychologist, 52:513–531.

Websites of Interest on Child Neglect
The National Child Information Gateway http://www.
childwelfare.gov is composed of the National Clearinghouseon Child Abuse and Neglect and the National Adoption
Information Clearinghouse. This site includes many valuable resource links including state statues on child abuse andneglect search, publications search, and a section on topics
of interest in child abuse and neglect.
A recent (2006) manual entitled Child Neglect: Guide
for Prevention, Assessment and Intervention is available
from http://www.childwelfare.gov online. This publication
is a comprehensive document published by the Children’s
Bureau, U.S. Department of Health and Human Services,
and authored by Diana DePanfilis, University of Maryland
School of Social Work, Baltimore, MD. This manual provides extensive information on neglect that can be used for
educational or academic purposes as well as prevention,assessment, and intervention. This is a valuable documentthat should be in every Family Advocacy Program and Social
Work Service library.
There are many websites offered by privately fundedgroups and individuals. For example, the National Exchange
Club Foundation, Toledo, Ohio, focuses on preventing childmaltreatment http://www.preventchildabuse.com. They
work directly with parents through parent aides and have anationwide network of nearly 100 centers to provide support
for families at-risk. Their page on neglect presents definitions of four subtypes (physical, educational, emotional, andmedical neglect) and has additional information on fetal
alcohol syndrome and shaken baby syndrome, and a list of
their resource centers.

 • Joining Forces/Joining Families

March 2007