Child Neglect: A Guide for

Prevention, Assessment, and 

Intervention

Diane DePanfilis 

2006

U.S. Department of Health and Human Services

Administration for Children and Families

Administration on Children, Youth and Families

Children’s Bureau

Office on Child Abuse and Neglect

Child Neglect: A Guide for Prevention, Assessment, and Intervention

Table of Contents

Preface.......................................................................................................................................................1

Acknowledgments........................................................................................................................ 3

1. Purpose and Overview........................................................................................................ 7

2. DEFINITION AND SCOPE OF NEGLECT ................................................................................ 9

What Is Neglect?..............................................................................................................................9

Types of Neglect............................................................................................................................11

Signs of Possible Neglect................................................................................................................15

Scope of the Problem.....................................................................................................................16

3. IMPACT OF NEGLECT.............................................................................................................. 21

Health and Physical Development.................................................................................................22

Intellectual and Cognitive Development........................................................................................24

Emotional, Psychosocial, and Behavioral Development..................................................................25

4. RISK AND PROTECTIVE FACTORS......................................................................................... 29

Environmental Factors...................................................................................................................29

Family Factors................................................................................................................................33

Parent or Caregiver Factors............................................................................................................36

Child Factors.................................................................................................................................39

5. ASSESSMENT OF CHILD NEGLECT....................................................................................... 43

Framework for Practice..................................................................................................................45

Intake............................................................................................................................................45

Initial Assessment or Investigation.................................................................................................46

Family Assessment Process.............................................................................................................49

Structured Assessment Measures....................................................................................................52
ii Table of Contents

6. CHILD NEGLECT PREVENTION AND INTERVENTION..................................................... 55

Principles for Effective Prevention and Intervention.......................................................................55

Theoretical Frameworks and Approaches........................................................................................57

Key Steps in the Intervention Process.............................................................................................63

Promising Practices for Intervention..............................................................................................68

Conclusion....................................................................................................................................71

ENDNOTES.......................................................................................................................................... 73

APPENDICES:

 Appendix a—GLOSSARY OF TERMS.................................................................................... 87

 Appendix B—RESOURCE LISTINGS OF SELECTED NATIONAL ORGANIZATIONS 

CONCERNED WITH CHILD MALTREATMENT.................................................................... 93

 Appendix C—STATE TELEPHONE NUMBERS FOR REPORTING CHILD ABUSE......... 99

 Appendix D—NEGLECT AND THE CHILD AND FAMILY SERVICES REVIEWS.......... 101
Child Neglect: A Guide for Prevention, Assessment, and Intervention 

Preface

Each day, the safety and well-being of some children across the Nation are threatened by 

child abuse and neglect. Intervening effectively 

in the lives of these children and their families is 

not the sole responsibility of any single agency or 

professional group, but rather is a shared community 

concern. 

Since the late 1970s, the Child Abuse and Neglect 

User Manual Series has provided guidance on 

child protection to hundreds of thousands of 

interdisciplinary professionals and concerned 

community members. The User Manual Series 

provides a foundation for understanding child 

maltreatment and the roles and responsibilities of 

various practitioners in its prevention, identification, 

investigation, assessment, and treatment. Through 

the years, the manuals have served as valuable 

resources for building knowledge, promoting effective 

practices, and enhancing community collaboration.

Since the last update of the User Manual Series in 

the early 1990s, a number of changes have occurred 

that dramatically affect each community’s response 

to child maltreatment. This is true particularly in the 

area of neglect. Both the field and the community 

increasingly recognize the impact of many factors on 

neglect, such as poverty, unemployment, and housing, 

as well as individual and family characteristics. The 

changing landscape reflects increased recognition 

of the complexity of issues facing parents and their 

children, new legislation, practice innovations, 

and system reform efforts. Significant advances 

in research have helped shape new directions for 

interventions, while ongoing evaluations help us to 

know “what works.”

The Office on Child Abuse and Neglect (OCAN) 

within the Children’s Bureau of the Administration 

for Children and Families (ACF), U.S. Department 

of Health and Human Services (DHHS), has 

developed this third edition of the User Manual 

Series to reflect the increased knowledge base and 

the evolving state of practice. The updated and 

new manuals are comprehensive in scope while 

succinct in presentation and easy to follow, and 

they address trends and concerns relevant to today’s 

professional.

While the User Manual Series primarily addresses 

the issues of child abuse and neglect, this manual 

delves deeper into the root causes, symptoms, 

and consequences of neglect, as well as the 

interdisciplinary ways to prevent both its occurrence 

and recurrence. Readers of Child Neglect: A Guide 

for Assessment, Prevention, and Intervention also 

may be interested in Child Protective Services: 

A Guide for Caseworkers, which goes into more 

depth on issues such as family assessment and 

case planning. They also may have interest in A 

Coordinated Response to Child Abuse and Neglect: 

The Foundation for Practice, the keystone for the 

series, which addresses the definition, scope, causes, 

and consequences of child abuse and neglect. It 
 Preface

presents an overview of prevention efforts and the 

child protection process. Because child protection 

is a multidisciplinary effort, The Foundation for 

Practice describes the roles and responsibilities of 

different professional groups and offers guidance 

on how the groups can work together effectively to 

protect the safety, permanency, and well-being of 

children. 

User Manual Series

This manual—along with the entire Child Abuse and Neglect User Manual Series—is available from Child

Welfare Information Gateway. For a full list of available manuals and ordering information, contact:

Child Welfare Information Gateway

1250 Maryland Avenue, SW

Eighth Floor

Washington, DC 20024

Phone: (800) 394-3366 or (703) 385-7565

Fax: (703) 385-3206

E-mail: info@childwelfare.gov

The manuals also are available online at http://www.childwelfare.gov/pubs/usermanual.cfm.
Child Neglect: A Guide for Prevention, Assessment, and Intervention 

ACKNOWLEDGMENTS

Author

Diane DePanfilis, Ph.D., M.S.W., is the Associate

Dean for Research and an Associate Professor of

Social Work at the University of Maryland, Baltimore,

where she teaches social work practice and child

welfare research courses in the Master of Social Work

program, as well as research seminars in the doctoral

program. She is also director of the Institute for

Human Services Policy and codirector of the Center

for Families, an interdisciplinary partnership between

the schools of social work and medicine and the

department of pediatrics. Over the past 30 years, she

has provided child welfare services at the local level as

a caseworker, supervisor, and administrator; worked as

a consultant at the national level conducting program

evaluations and providing training and technical

assistance to social workers and other disciplines; and

conducted extensive studies related to the delivery of

child protective services and the prevention of child

maltreatment. She is co-editor of the Handbook on 

Child Protection Practice and is a former president of

the American Professional Society on the Abuse of

Children.

Contributing Authors

Jeannie Newman, M.S.W., M.I.B.S., a consultant

with Caliber, an ICF International Company, has

held policy and direct practice positions in child

welfare and family programs. She also has cultivated

an extensive network in various related professional

fields, including domestic violence, fatherhood, and

poverty. She is currently the Project Manager for the

User Manual Series.

Lindsay Ritter Taylor, a former consultant with

Caliber, an ICF International Company, worked

on projects relating to various child welfare and

juvenile justice issues. She helped author issue briefs

highlighting findings from the National Survey of 

Child and Adolescent Well-being, a national sample

of children who had been abused or neglected.

Additionally, she worked with the Caliber technical

assistance and evaluation teams on the Improving 

Child Welfare through Systems of Care grant project.

Matthew Shuman,M.S.W., a consultantwithCaliber,

an ICF International Company, has morethan 8 years

experience in the human services field. He previously

worked as an analyst in the Office of the Secretary of

the Department of Health and Human Services on a

variety of child welfare issues, including foster care,

adoption, and child care. He also has researched and

written several papers on child welfare issues.

Jean Strohl, a consultant with Caliber, an ICF

International Company, works as a senior writer/

editor. She has more than 15 years of experience

in writing about the influences of family and social

environments on substance abuse and its prevention.
 Acknowledgments

She also has contributed to many publications on

the subjects of cultural diversity and understanding

the underlying patterns of beliefs and attitudes

characteristic of Americans and other cultural groups

(Hispanic, Asian, Middle Eastern, Russian). 

Acknowledgment of Prior Edition

This manual was originally published in 1993 as Child 

Neglect: A Guide for Intervention by James Gaudin,

Jr., Ph.D. The prior version and the author’s other

research and work informed and contributed to the

development of this publication.

Reviewers

Jack Denniston, Child Welfare Information Gateway

Howard Dubowitz, Ph.D., University of Maryland

School of Medicine

James M. Gaudin, Jr., Ph.D., University of Georgia

Kathy Pinto, HowardCounty,Maryland,Department

of Social Services

Sandra Slappey, Child Welfare Information Gateway

Sarah Webster, Texas Department of Protective and

Regulatory Services (retired)

Technical Advisory Panel

The following were members of the January 2001

Technical Advisory Panel for the User Manual Series 

contract. The organizations identified reflect each

member’s affiliation at that time. 

Carolyn Abdullah

FRIENDS National Resource Center

Washington, DC

Lien Bragg

American Public Human Services Association

Washington, DC

Sgt. Richard Cage

Montgomery County Police Department

Wheaton, MD

Diane DePanfilis, Ph.D.

University of Maryland at Baltimore School of Social

Work

Baltimore, MD

Pauline Grant

Florida Department of Children and Families

Jacksonville, FL

Jodi Hill

Connecticut Department of Children and Families

Hartford, CT

Robert Ortega, Ph.D.

University of Michigan School of Social Work

Ann Arbor, MI

Nancy Rawlings

Kentucky Cabinet for Families and Children

Frankfort, KY

Barry Salovitz

Child Welfare Institute/National Resource Center

on Child Maltreatment

Glenmont, NY

Sarah Webster

Texas Department of Protective and Regulatory

Services

Austin, TX

Ron Zuskin

University of Maryland at Baltimore School of Social

Work

Baltimore, MD
Child Neglect: A Guide for Prevention, Assessment, and Intervention 

The following members subsequently were added to

the Technical Advisory Panel:

William R. (Reyn) Archer III, M.D.

Hill and Knowlton, Inc.

Washington, DC

David Popenoe, Ph.D.

National Marriage Project

Princeton, NJ

Bob Scholle

Independent Consultant

Pittsburgh, PA

Brad Wilcox, Ph.D.

University of Virginia, Department of Sociology

Charlottesville, VA

Additional Acknowledgments

The third edition of the User Manual Series was

developed under the guidance and direction of Irene

Bocella, Federal Task Order Officer, and Catherine

Nolan, Director, Office on Child Abuse and Neglect.

Also providing input and review were Dr. Susan Orr,

Associate Commissioner, Children’s Bureau, as well

as Sidonie Squier, Director, and Peter Germanis,

National Policy Expert, Immediate Office of the

Director, Office of Family Assistance, Administration

for Children and Families.

This manual was developed and produced by Caliber,

an ICF International Company, Fairfax, VA, under

Contract Number HHS-282-98-0025.

Child Neglect: A Guide for Prevention, Assessment, and Intervention 

Chapter 1

Purpose and Overview

Child protective services (CPS), a division within

State and local social service agencies, is at the

center of every community’s child protection efforts.

In most jurisdictions, CPS is the agency mandated by

law to conduct an initial assessment or investigation

of reports of child abuse or neglect. It also offers

services to families and children when maltreatment

has occurred or is likely to occur.

CPS does not work alone. Many community

professionals—including law enforcement officers,

health care providers, mental health professionals,

educators, legal and court system personnel, and

substitute care providers—are involved in efforts to

prevent, identify, investigate, and treat child abuse

and neglect. In addition, community- and faithbased organizations, substance abuse treatment

facilities, advocates for victims of domestic violence,

extended family members, and concerned citizens

play important roles in supporting families and in

keeping children safe from harm. Typically, CPS

is the lead agency in coordinating the efforts of the

various disciplines working to protect children and to

educate the community about the problems of child

abuse and neglect.

This interdisciplinary approach is particularly evident

in addressing the complex aspects of neglect. Other

manuals in this series, A Coordinated Response to 

Child Abuse and Neglect: The Foundation for Practice 

and Child Protective Services: A Guide for Caseworkers,

provide fundamental information that CPS

professionals must know in order to perform essential

casework functions. This manual, Child Neglect: A 

Guide for Assessment, Prevention, and Intervention,

covers neglect’s definition, causes, impact, and

prevention and intervention strategies in more detail.

It also builds on both of the earlier manuals, reiterates

some of their most important points, and addresses

the following topics:

Definition and scope of neglect;

Impact of neglect;

Risk and protective factors;

Assessment of child neglect;

Child neglect prevention and intervention.

•

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•

•

•

Child Neglect: A Guide for Prevention, Assessment, and Intervention 

Child neglect is the most common type of

child maltreatment.1

Unfortunately, neglect

frequently goes unreported and, historically, has

not been acknowledged or publicized as greatly as

child abuse. Even professionals often have given

less attention to child neglect than to abuse.2

One

study found that caseworkers indicated that they

were least likely to substantiate referrals for neglect.3

In some respects, it is understandable why violence

against children has commanded more attention

than neglect. Abuse often leaves visible bruises and

scars, whereas the signs of neglect tend to be less

visible. However, the effects of neglect can be just as

detrimental. In fact, some studies have shown that

neglect may be more detrimental to children’s early

brain development than physical or sexual abuse.4

What Is Neglect? 

How neglect is defined shapes the response to it.

Sincethe goal of defining neglect is to protect children

and to improve their well-being—not to blame the

parents or caregivers—definitions help determineif an

incident or a pattern of behavior qualifies as neglect,

its seriousness or duration, and, most importantly,

whether or not the child is safe.5

Definitions of neglect vary among States and across

different disciplines, agencies, and professional groups

(e.g., child protective services, court systems, health

care providers), as well as among individuals within

these agencies and groups. The definitions also are

used for different purposes within the child welfare

field. For example, a medical doctor may view a

parent as neglectful if the parent repeatedly forgets

to give his child a prescribed medication. This may

or may not legally be considered neglect, however,

depending on the stringency of the neglect criteria of

many CPS agencies.6

Difficulty Defining Neglect

Defining neglect historically has been difficult to do,

leading to inconsistencies in policies, practice, and

research. Without a consistent definition of neglect,

it is nearly impossible to compare research results.

This inconsistency also leads to variability in the way

neglect cases are handled.7

The debate over a definition of neglect centers on a

lack of consensus in answering these questions:

What are the minimum requirements associated

with caring for a child?

What action or inaction by a parent or other

caregiver constitutes neglectful behavior?

Must the parent’s or caregiver’s action or inaction

be intentional?

What impact does the action or inaction have on

the health, safety, and well-being of the child?

•

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Chapter 2

Definition and Scope

of Neglect
 10 Definition and Scope of Neglect

What constitutes “failure or inability to provide”

adequate food, shelter, protection, or clothing?

Should “failure or inability to protect” be

included?

Is the action or inaction a result of poverty rather

than neglect?8

Additionally, what is considered neglect varies based

on the age and the developmental level of the child,

making it difficult to outline a set of behaviors that

are always considered neglect. For example, leaving

a child unattended for an hour is considered neglect

when the child is young, but not when the child

is a teenager. Another issue is that many neglect

definitions specify that omissions in care may result

either in “risk of harm” or in “significant harm” to

the child. While the 1996 reauthorization of the

Child Abuse Prevention and Treatment Act (CAPTA)

(P.L. 104-235) narrowed the definition of child

maltreatment to cases where there has been actual

harm or an imminent risk of serious harm, these

terms often are not defined by law, leaving the local

CPS agencies to interpret them. This leads to a lack

of consistency in responding to families who may be

challenged to meet the basic needs of their children. 9

Definitions of Neglect

CAPTA, reauthorized again in the Keeping Children

and Families Safe Act of 2003 (P.L. 108-36), provides

minimum standards for defining child physical abuse,

neglect, and sexual abuse that States must incorporate

into their statutory definitions in order to receive

Federal funds. Under this Act, child maltreatment

is defined as:

Any recent act or failure to act on the part of

a parent or caregiver, which results in death,

serious physical or emotional harm, sexual abuse

or exploitation, or an act or failure to act which

presents an imminent risk of serious harm.10

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.11

Instances of neglect are classified as mild, moderate,

or severe.

Mild neglect usually does not warrant a report to

CPS, but might necessitate a community-based

intervention (e.g., a parent failing to put the child

in a car safety seat).

Moderate neglect occurs when less intrusive

measures, such as community interventions,

have failed or some moderate harm to the

child has occurred (e.g., a child consistently is

inappropriately dressed for the weather, such

as being in shorts and sandals in the middle

of winter). For moderate neglect, CPS may

be involved in partnership with community

support.

Severe neglect occurs when severe or long-term

harm has been done to the child (e.g., a child

with asthma who has not received appropriate

medications over a long period of time and is

frequently admitted to the hospital). In these

cases, CPS should be and is usually involved, as is

the legal system.12

Viewing the severity of neglect along this continuum

helps practitioners assess the strengths and weaknesses

of families and allows for the possibility of providing

preventive services before neglect actually occurs

or becomes severe. There is some controversy over

whether “potential harm” should be considered

neglect, and, as with the definition of neglect, State

laws vary on this issue. Although it is difficult to

assess potential harm as neglect, it can have emotional

as well as physical consequences, such as difficulty

establishing and maintaining current relationships or

those later in life.13

The seriousness of the neglect is determined not

only by how much harm or risk of harm there is to

the child, but also by how chronic the neglect is.

•

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•
Child Neglect: A Guide for Prevention, Assessment, and Intervention 11

Chronicity can be defined as “patterns of the same

acts or omissions that extend over time or recur over

time.” 14 An example of chronic neglect would be

parents with substance abuse problems who do not

provide for the basic needs of their children on an

ongoing basis. On the other hand, caregivers might

have minor lapses in care, which are seldom thought

of as neglect, such as occasionally forgetting to give

their children their antibiotics.15 However, if those

children were frequently missing doses, it may be

considered neglect. Some situations only need to

occur once in order to be considered neglect, such as

leaving an infant unattended in a bathtub. Because

some behaviors are considered neglect only if they

occur on a frequent basis, it is important to look at

the history of behavior rather than focusing on one

particular incident.

Types of Neglect

While neglect may be harder to define or to detect

than other forms of child maltreatment, child

welfare experts have created common categories of

neglect, including physical neglect; medical neglect;

inadequate supervision; environmental, emotional,

and educational neglect; and newborns addicted or

exposed to drugs, as well as some newly recognized

forms of neglect. The following sections give detailed

information on each of these types of neglect. 

States’ definitions of neglect are usually located in mandatory child maltreatment reporting statutes (civil

laws), criminal statutes, or juvenile court jurisdiction statues. For more information about reporting laws,

visit the State Laws on Reporting Child Abuse and Neglect section of the Child Welfare Information Gateway

Web site at http://www.childwelfare.gov/laws_policies/state/reporting.cfm.

Framework for Neglect

Current theory on maltreatment views neglect from a socio-ecological perspective in which multiple factors

contribute to child abuse and neglect.16 From this perspective, one should consider not only the parent’s role, but

also the societal and environmental variables contributing to the parent’s inability to provide for the basic needs of the

child. 17 The socio-ecological model is valuable because it “recognizes the shared responsibility among individuals,

families, communities, and society, thereby enabling a more constructive approach and targeting interventions on

multiple levels.”18 Examples of factors to consider when looking at neglect from a socio-ecological perspective are

social isolation and poverty. For more information about factors related to child neglect, see Chapter 4, Risk and 

Protective Factors. 

It is important to keep in mind that not all incidents in which a person fails to provide for the basic needs for a

child are necessarily considered neglect. Factors relating to the parent’s health and well-being, such as mental illness,

substance abuse, or domestic violence, often contribute to neglect. Any intervention for neglect will need to consider

these factors as well.

Federal and State laws often assume that it is possible to determine clearly when parents have control over omissions

in care and when they do not. For example, children may be poorly fed because their parents are poor and are unable

to provide them with the appropriate type and amount of food. In such cases, it is important to identify factors that

may be contributing to this inability to provide, such as mental illness. However, when a family consistently fails

to obtain needed support or is unable to use information and assistance that is available, an intervention may be

required. Having a comprehensive understanding of what may contribute to neglect can help determine appropriate

interventions that address the basic needs of the child and family and also enhances professionals’ and communities’

abilities to develop and to use interventions, regardless of CPS involvement.19
 12 Definition and Scope of Neglect

Physical Neglect

Physical neglect is one of the most widely recognized

forms. It includes:

Abandonment—the desertion of a child without

arranging for his reasonable care or supervision.

Usually, a child is considered abandoned when

not picked up within 2 days.

Expulsion—the blatant refusal of custody, such

as the permanent or indefiniteexpulsion of a child

from the home, without adequately arranging for

his care by others or the refusal to accept custody

of a returned runaway.

Shuttling—when a child is repeatedly left in the

custody of others for days or weeks at a time,

possibly due to the unwillingness of the parent or

the caregiver to maintain custody.

Nutritional neglect—when a child is

undernourished or is repeatedly hungry for

long periods of time, which can sometimes be

evidenced by poor growth. Nutritional neglect

often is included in the category of “other physical

neglect.”

Clothingneglect—whena childlacks appropriate

clothing, such as not having appropriately warm

clothes or shoes in the winter.

Other physical neglect—includes inadequate

hygiene and forms of reckless disregard for the

child’s safety and welfare (e.g., driving while

intoxicated with the child, leaving a young child

in a car unattended).20

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•

•

•

Medical Neglect

Medical neglect encompasses a parent or guardian’s

denial of or delay in seeking needed health care for a

child as described below:

Denial of health care—the failure to provide

or to allow needed care as recommended by a

competent health care professional for a physical

injury, illness, medical condition, or impairment.

The CAPTA amendments of 1996 and 2003

contained no Federal requirement for a parent to

provide any medical treatment for a child if that

treatment is against the parent’s religious beliefs.

However, CAPTA also designates that there

is no requirement that a State either find or be

prohibited from finding abuse or neglect in cases

where parents or legal guardians act in accordance

with their religious beliefs. While CAPTA

stipulates that all States must give authority to

CPS to pursue any legal actions necessary 1) to

ensure medical care or treatment to prevent or to

remedy serious harm to a child or 2) to prevent

the withholding of medically indicated treatment

from a child with a life-threatening condition

(except in the cases of withholding treatment

from disabled infants), all determinations will

be done on a case by case basis within the sole

discretion of each State.21 

Delay in health care—the failure to seek timely

and appropriate medical care for a serious health

problem that any reasonable person would have

recognized as needing professional medical

attention. Examples of a delay in health care

include not getting appropriate preventive

•

•

Homelessness and Neglect

It is unclear whether homelessness should be considered neglect; some States specifically omit homelessness

by itself as neglect. Unstable living conditions can have a negative effect on children, and homeless

children are more at risk for other types of neglect in areas such as health, education, and nutrition. 

Homelessness is “considered neglect when the inability to provide shelter is the result of mismanagement

of financial resources or when spending rent resources on drugs or alcohol results in frequent evictions.”22 
Child Neglect: A Guide for Prevention, Assessment, and Intervention 13

medical or dental care for a child, not obtaining

care for a sick child, or not following medical

recommendations. Not seeking adequate mental

health care also falls under this category. A lack or

delay in health care may occur because the family

does not have health insurance. Individuals who

are uninsured often have compromised health

because they receive less preventive care, are

diagnosed at more advanced disease stages, and,

once diagnosed, receive less therapeutic care.23 

Inadequate Supervision

Inadequate supervision encompasses a number of

behaviors, including:

Lack of appropriate supervision. Some States

specify the amount of time children at different

ages can be left unsupervised, and the guidelines

for these ages and times vary. In addition,

all children are different, so the amount of

supervision needed may vary by the child’s age,

development, or situation. It is important to

evaluatethe maturity of the child, the accessibility

of other adults, the duration and frequency of

unsupervised time, and the neighborhood or

environment when determining if it is acceptable

to leave a child unsupervised.24 

Exposure to hazards. Examples of exposure to

in- and out-of-home hazards include:

Safety hazards—poisons, small objects,

electrical wires, stairs, drug paraphernalia; 

Smoking—second-hand smoke, especially

for children with asthma or other lung

problems;

Guns and other weapons—guns that are kept

in the house that are loaded and not locked

up or are in reach of children;

Unsanitary household conditions—rotting

food, human or animal feces, insect

infestation, or lack of running or clean

water;

Lack of car safety restraints.25

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Inappropriate caregivers. Another behavior

that can fall under “failure to protect” is leaving

a child in the care of someone who either is

unable or should not be trusted to provide care

for a child. Examples of inappropriate caregivers

include a young child, a known child abuser, or

someone with a substance abuse problem.26

Other forms of inadequate supervision.

Additional examples of inadequate supervision

include:

Leaving a child with an appropriate caregiver,

but without proper planning or consent (e.g.,

not returning to pick up the child for several

hours or days after the agreed upon pickup time or not giving the caregiver all the

necessary items to take care of the child);

Leaving the child with a caregiver who is not

adequately supervising the child (e.g., the

caregiver is with the child, but is not paying

close attention to the child due to constantly

being distracted by other activities);

Permitting or not keeping the child from

engaging in risky, illegal, or harmful behaviors

(e.g., letting a child smoke marijuana).27

Another common but complex example is single,

working parents who are having difficulty arranging

for appropriate back-up child care when their regular

child care providers are unavailable. For example,

a mother may leave her child home alone when the

child care provider fails to show up. If the mother

does not go to work, she can lose her job and will

not be able to take care of her child. However, if she

leaves the child alone, she will be guilty of neglect. It

is important that parents in situations similar to this

receive adequate support so that they are not forced to

make these difficult decisions.

Environmental Neglect

Some of the characteristics mentioned above can

be seen as stemming from environmental neglect,

which is characterized by a lack of environmental

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 14 Definition and Scope of Neglect

or neighborhood safety, opportunities, or resources.

While children’ssafety and protection fromhazards are

major concerns forCPS, most attention focuses on the

conditions in the home and parental omissions in care.

A broad view of neglect incorporates environmental

conditions linking neighborhood factors with family

and individual functioning, especially since the

harmful impact of dangerous neighborhoods on

children’s development, mental health, and child

maltreatment has been demonstrated.28 CPS workers

should be aware of this impact on the family when

assessing the situation and developing case plans. For

example, they can help parents find alternative play

areas in a drug-infested neighborhood, rather than

have their children play on the streets. 

Emotional Neglect

Typically, emotional neglect is more difficult to assess

than other types of neglect, but is thought to have

more severe and long-lasting consequences than

physical neglect.29 It often occurs with other forms

of neglect or abuse, which may be easier to identify,

and includes:

Inadequate nurturing or affection—the

persistent, marked inattention to the child’s needs

for affection, emotional support, or attention.

Chronic or extreme spouse abuse—the

exposure to chronic or extreme spouse abuse or

other domestic violence.

Permitted drug or alcohol abuse—the

encouragement or permission by the caregiver of

drug or alcohol use by the child.

Other permitted maladaptive behavior—

the encouragement or permission of other

maladaptive behavior (e.g., chronic delinquency,

assault) under circumstances where the parent or

caregiver has reason to be aware of the existence

and the seriousness of the problem, but does not

intervene.

•

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•

•

Isolation—denying a child the ability to interact

or to communicate with peers or adults outside

or inside the home.30

Educational Neglect

Although Statestatutes and policies vary, both parents

and schools are responsible for meeting certain

requirements regarding the education of children.

Types of educational neglect include:

Permitted, chronic truancy—permitting

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—failing to

homeschool, to register, or to enroll a child of

mandatory school age, causing the child to miss

at least 1 month of school without valid reasons.

Inattention to special education needs—

refusing to alloworfailing to obtainrecommended

remedial education services or neglecting to

obtain or follow through with treatment for a

child’s diagnosed learning disorder or otherspecial

education need without reasonable cause.31

Newborns Addicted or Exposed to Drugs

As of 2005, 24 States had statutory provisions

requiring the reporting of substance-exposed

newborns to CPS.32 Women who use drugs or alcohol

during pregnancy can put their unborn children at

risk for mental and physical disabilities. The number

of children prenatally exposed to drugs or to alcohol

each year is between 409,000 and 823,000.33 One

study showed that drug-exposed newborns constitute

as many as 72 percent of the babies abandoned in

hospitals.34 Another study found that 23 percent

of children prenatally exposed to cocaine were later

abused or neglected, compared with 3 percent who

were not prenatally exposed.35 To address the needs

of these children, the Keeping Children and Families

•

•

•

•
Child Neglect: A Guide for Prevention, Assessment, and Intervention 15

Safe Act of 2003 (P.L. 108-36, sec. 114(b)(1)(B))

mandated that States include the following in their

CAPTA plans:

(ii) Policies and procedures (including appropriate

referrals to child protection service systems and for

other appropriate services) to address the needs of

infants born and identified as being affected by illegal

substance abuse or withdrawal symptoms resulting

from prenatal drug exposure, including a requirement

that health care providers involved in the delivery or

care of such infants notify the child protective services

system of the occurrence of such condition of such

infants, except that such notification shall not be

construed to—

(I) establish a definition under Federal law of

what constitutes child abuse; or

(II) require prosecution for any illegal action.

(iii) The development of a plan of safe care for the

infant born and identified as being affected by illegal

substance abuse or withdrawal symptoms;

(iv) Procedures for the immediate screening, risk

and safety assessment, and prompt investigation

of such reports.

Signs of Possible Neglect

It can be difficult to observe a situation and to know

for certain whether neglect has occurred. Behaviors

and attitudes indicating that a parent or other adult

caregiver may be neglectful include if he or she:

Appears to be indifferent to the child;

Seems apathetic or depressed;

Behaves irrationally or in a bizarre manner;

Abuses alcohol or drugs;

Denies the existence of or blames the child for

the child’s problems in school or at home;

Sees the child as entirely bad, worthless, or

burdensome;

Looks to the child primarily for care, attention,

or satisfaction of emotional needs.36

Indicators of neglect are more likely to be visible in

the appearance or behavior of the child. Mandatory

reporters and concerned individuals should consider

reporting possible neglect if they notice that a child:

•

•

•

•

•

•

•

Methamphetamine Use and Child Maltreatment

In addition to the problem of prenatal drug use, the rise in methamphetamine abuse also has had a

strong impact on child maltreatment. U.S. Attorney General Alberto Gonzales recently proclaimed “in

terms of damage to children and to our society, meth is now the most dangerous drug in America.” 37

Children whose parents use methamphetamine are at a particularly high risk for abuse and neglect. 

Methamphetamine is a powerfully addictive drug, and individuals who use it can experience serious

health and psychiatric conditions, including memory loss, aggression, violence, psychotic behavior, and

potential coronary and neurological damage.38 The drug is relatively easy to make, exposing many children

of methamphetamine users to the additional risks of living in or near a methamphetamine lab. In 2003,

3,419 children either were residing in or visiting a methamphetamine lab that was seized, and 1,291

children were exposed to toxic chemicals in these labs.39 For more information on this epidemic, go to

http://www.whitehousedrugpolicy.gov/news/press05/meth_factsheet.
 16 Definition and Scope of Neglect

Wears soiled clothing or clothing that is

significantly too small or large or is often in need

of repair;

Seems inadequately dressed for the weather;

Always seems to be hungry; hoards, steals, or begs

for food; or comes to school with little food;

Often appears listless and tired with little energy;

Frequently reports caring for younger siblings;

Demonstrates poor hygiene, smells of urine or

feces, or has dirty or decaying teeth;

Seems emaciated or has a distended stomach

(indicative of malnutrition);

Has unattended medical or dental problems, such

as infected sores;

States that there is no one at home to provide

care.40

Scope of the Problem

According to the National Child Abuse and Neglect

Data System (NCANDS), in 2004, an estimated three

million referrals were made to CPS, representing 5.5

millionchildren. Fromthispopulation, approximately

872,000 children were found to be victims of

•

•

•

•

•

•

•

•

•

maltreatment, and 64.5 percent of these children were

neglected. In comparison, 18 percent of maltreated

children were physically abused, 10 percent were

sexually abused, and 7 percent were psychologically

maltreated. Additionally, 15 percent of victims were

associated with “other” types of maltreatment, such as

abandonment or congenital drug addiction. A child

could be identified as a victim of more than one type

of maltreatment.41

From 2000 to 2004, the rates of neglect were nearly

stable. In 2004, approximately 7.4 out of every 1,000

children in the general population were reported as

being neglected. Medical neglect is listed separately,

but it also has experienced nearly stable rates,

fluctuating between 0.5 children per 1,000 in 2000

and 0.3 children per 1,000 in 2004.42 Exhibit 2-1

shows the victimization rate by maltreatment type

from 2000 to 2004.

However, according to the Third National Incidence

Study of Child Abuse and Neglect (NIS-3), less

than one-third of child abuse and neglect cases are

reported to CPS.43 Data from NIS-3 show that

the rates of child neglect may be even higher than

noted in the NCANDS data, with 13.1 children

per 1,000 being neglected.44 Within the category

of neglect, physical neglect was the most commonly

occurring type and included abandonment; medical

neglect; inadequate nutrition, clothing, or hygiene;

and leaving a young child unattended in a motor

vehicle.45

Mandatory Reporters

Mandatory reporters are individuals who are required by law to report cases of suspected child abuse or

neglect. They can face criminal and civil liability for not doing so. In approximately 18 States, anyone

who suspects child abuse or neglect is considered a mandatory reporter.46 In most States, mandatory

reporters are required to make a report immediately upon having suspicion or knowledge of an abusive

or neglectful situation. This initial report may be made orally to either CPS or a law enforcement agency. 

Examples of individuals who typically are listed as mandatory reporters include physicians, social workers,

educators, mental health professionals, child care providers, medical examiners, and police. Every State

has statutes that specify procedures for mandatory reporters to follow when making a report of child

abuse or neglect. For more information about State laws regarding mandatory reporters, see http://www.

childwelfare.gov/laws_policies/state/reporting.cfm.
Child Neglect: A Guide for Prevention, Assessment, and Intervention 17

Exhibit 2-1

Victimization Rates by Maltreatment Type, 2000–200447

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, Ph.D., at 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. 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. 

In most CPS systems, however, the criteria for identifying neglect focus on recent, distinct, verifiable

incidents. Dr. Zuravin notes that “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.” 48 For example, a family exhibiting a pattern of behavior that may

constitute neglect might have frequent CPS reports of not having enough food in the home or keeping

older children home from school to watch younger children. However, since each individual report may

not be considered neglect, the family may not receive the appropriate support or be served by the CPS

system. Additionally, many definitions of neglect that address chronicity do not identify what it means

(e.g., What does “frequent reports of not having enough food in the home” mean? Twice per week? Twice

per month?). This may prevent CPS caseworkers from consistently applying the child maltreatment laws

in these cases. 

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 neglect. It 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 assigned one of its CPS staff as a chronic neglect specialist and defined 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.”49 The focus here was on the accumulation

of harm. CPS and community agencies 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.50 For more information on this topic, see Acts of Omission: An Overview of Child Neglect at

http://www.childwelfare.gov/pubs/focus/acts.

2.4

7.3

0.5

1.2 1.0

2.8

2.3

7.1

0.3

1.2 0.9

3.2

2.3

7.2

0.3

1.2

0.8

3.3

2.3

7.5

0.3

1.2

0.6

3.7

2.1

7.4

0.3

1.2 0.9

3.2

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

Physical Abuse Neglect Medical

Neglect

Sexual Abuse Psychological

Maltreatment 

O ther Abuse

Maltreatment Type

Rate per 1,000 Children

2000 2001 2002 2003 2004
 18 Definition and Scope of Neglect

Recurrence

Recurrence of child abuse and neglect remains a very

serious problem. It has been shown that subsequent

referrals of maltreatment are most often for neglect

(and, specifically, lack of supervision), regardless

of the type of maltreatment in the initial referral.51

These findings highlight the need to screen for neglect

and to provide preventive services where needed, not

just for those cases initially identified as neglect.52 It is

important to know the extent to which children who

have been in contact with CPS are victims of repeat

maltreatment in order to protect them and to prevent

its recurrence.53

Through the Child and Family Services Reviews

(CFSRs), which are a results-oriented, comprehensive

monitoring system designed to assist States in

improving outcomes for the children and families they

serve, the Children’s Bureau set a national standard for

recurrence of maltreatment, which is measured using

NCANDS data. The percent of States that met the

national standard increased from 29.4 percent of all

States in 2000 to 42.2 percent of States in 2004.54 (See

Appendix D, Neglect and the Child and Family Services 

Reviews, for more information on CFSR findings.)

One study on recurrence that followed families

for 5 years defined recurrence as “any confirmed

report of physical abuse, sexual abuse, or neglect on

any child in the family that occurred at least 1 day

following the index incident report date.” 55 Of the

43 percent of families in the study that experienced

at least one incident of recurrence of maltreatment

within 5 years of the original incident, 64 percent of

them were classified as neglect. This study also found

that 52 percent of families who experienced repeated

maltreatment had only one recurrence. The highest

probability for recurrence was within the first 30 days

of the original occurrence of maltreatment.56 

Child Neglect Fatalities

An estimated 1,490 children died from abuse or

neglect in 2004. This is a rate of 2.03 deaths per

100,000 children, which is comparable to the rate of

2.00 per 100,000 children in 2003. 57 

The distinction between child neglect fatalities and

child abuse fatalities is that deaths from neglect result

from a failure to act, whereas deaths from abuse result

from a physical act. Fatalities due to child neglect

may offer less obvious clues as to who is responsible

and how the death occurred than fatalities due to

abuse. Deaths due to child neglect, therefore, often

are more difficult to investigate and prosecute. This

also causes difficulty in determining the overall

number of fatalities due to child neglect. In fact, one

study estimated that 85 percent of child maltreatment

fatalities arenotrecorded assuch ondeath certificates.58

Other studies conducted in Colorado and North

Carolina estimated that 50 to 60 percent of deaths

due to child maltreatment were not recorded and

that child neglect is the most under-recorded form

of fatal maltreatment.59 Differing definitions of child

homicide, abuse, and neglect, as well as the lack of

thorough investigations into some child fatalities, also

may be responsible for this underreporting.

Child neglect fatalities usually result from inadequate

supervision, chronic physical neglect, or medical

neglect and may result from chronic inaction (e.g.,

malnourishment) or from an acute incident (e.g.,

an unsupervised child drowning in a pool). The

child’s home is the most common place for a child

neglect fatality to occur, and the bathroom is the most

common room in which the death occurs. Often

these children die from drowning or from fires that

occur while they are unsupervised.60 Other examples

of neglect fatalities include dying from falls from

unprotected windows, suffocation, poisoning, and

not receiving needed medical care. 

Exhibit 2-2 shows thetype of maltreatment associated

with child fatalities in 2004. 

As these statistics in Exhibits 2-1 and 2-2 illustrate,

child neglect is the largest form both of child

maltreatment and of fatalities due to maltreatment. 
Child Neglect: A Guide for Prevention, Assessment, and Intervention 19

Exhibit 2-2

Fatalities by Type of Maltreatment, 200461

36.9

28.3

30.2

0.8

3.9

0% 5% 10% 15% 20% 25% 30% 35% 40%

Neglect O nly (includes Medical Neglect O nly) 

Physical Abuse O nly

Multiple Maltreatment Types

Sexual Abuse O nly

Psychological Maltreatment O nly, O ther O nly, or

Unknown

Maltreatment Type 

Percentage

Child Neglect: A Guide for Prevention, Assessment, and Intervention 21

The impact of neglect on a child may not be

apparent at an early stage except in the most

extreme cases. However, the effects of neglect are

harmful and possibly long-lasting for the victims. Its

impact can become more severe as a child grows older

and can encompass multiple areas, including:

Health and physical development;

Intellectual and cognitive development;

Emotional and psychological development;

Social and behavioral development.

Although there are four categories of neglect’s effects

on an individual, they often are related. For example,

if a child experiences neglect that leads to a delayed

development of the brain, this may lead to cognitive

delays or psychological problems, which may manifest

as social and behavioral problems. Because neglected

children often experience multiple consequences that

may be the result of neglect and related circumstances

in their lives, it may be difficult to determine if the

impact is related specifically to the neglect, is caused

by another factor, or arises from a combination of

factors. The impact of neglect can vary based on:

The child’s age;

The presence and strength of protective factors;

The frequency, duration, and severity of the

neglect;

•

•

•

•

•

•

•

The relationship between the child and

caregiver.62

The negative impacts of neglect are often associated

with the various outcomes children experience

in the child welfare system. For example, some of

the developmental and health problems linked to

neglect are related to higher rates of placement in

out-of-home care, a greater number of out-of-home

placements, longer out-of-home placements, and a

decreased likelihood of children residing with their

parents when discharged from foster care.63 

Research shows that the first few years of children’s

lives are crucial and sensitive periods for development.

During these years, neural synapses are formed at a

very high rate. After the age of 3, synapses start to

be “pruned,” and certain pathways that are not used

may be discarded. Studies supporting the idea of a

sensitive developmental period show that maltreated

infants suffer from greater developmental disabilities

than those children who were maltreated later in

childhood.64 One example of this is the ability to

form attachments with one’s primary caregiver. If

this process is disrupted early in children’s lives, they

may have difficulty forming healthy relationships

throughout their lives. Although learning can

happen throughout life, it often is more difficult for

children who were deprived of certain types of early

stimulation. 

•

Chapter 3

Impact of Neglect
 22 Impact of Neglect

Programs, such as Early Head Start and other infancy

and early childhood programs, acknowledge that

the first few years of life are extremely significant for

development. (For more information on Early Head

Start, see Chapter 6, Child Neglect Prevention and 

Intervention.) Child welfare laws and interventions,

however, often do not provide or authorize the

resources necessary to protect children from neglect

during these critical years. Unless children show clear

physical signs of neglect, intervention often is unlikely

to be mandated. Thus, for many cases of emotional

neglect, and especially for young children who cannot

tell others about the neglect, interventions may occur

too late or not at all. If interventions finally occur, the

children may be past critical developmental points

and could suffer from deficiencies throughout their

lives.65 Therefore, it is important that professionals

working with young children be able to recognize the

possible signs of neglect in order to intervene and to

keep children from suffering further harm.

Health and Physical Development

Studies show that neglected children can be at risk for

many physical problems, including failure to thrive,

severe diaper rash and other skin infections, recurrent

and persistent minor infections, malnourishment, and

impaired brain development. Because neglectincludes

medical neglect, other health problems can arise from

the failure of the parents to obtain necessary medical

care for their children. If children do not receive

the proper immunizations, prescribed medications,

necessary surgeries, or other interventions, there

can be serious consequences, such as impaired brain

development or poor physical health. The impact of

a delay in or lack of treatment might be noticeable

immediately or may not be apparent for several

weeks, months, or even years.66 For example, a child

who does not receive proper dental care might be all

right in the short term, but suffer from tooth decay

and gum disease later in life. Children with diabetes

may be fine without treatment for a short while, but

an extended delay in treatment could have serious

consequences and possibly result in death. 

Impaired Brain Development

In some cases, child neglect has been associated with

a failure of the brain to form properly, which can

lead to impaired physical, mental, and emotional

development. The brain of a child who has been

maltreated may develop in such a way that it is

adaptive for the child’s negative environment, but is

maladaptive for functional or positive environments.

A maltreated child’s brain may adapt for day-to-day

survival, but may not allow the child to develop fully

healthy cognitive and social skills.67 In one study,

neglected children had the highest proportion of

later diagnoses of mental retardation, which may be

due to not getting the necessary care and stimulation

for proper brain development. Children who are

neglected early in life may remain in a state of “hyperarousal” in which they are constantly anticipating

threats, or they may experience dissociation with a

decreased ability to benefit from social, emotional,

and cognitive experiences. To be able to learn, a

child’s brain needs to be in a state of “attentive calm,”

which is rare for maltreated children. If a child is

unable to learn new information, this may cause

some areas of the brain to remain inactive, possibly

resulting in delayed or stunted brain growth. It also

can impair functioning later in life and may lead to

the child being anxious, acting overly aggressive, or

being withdrawn.68 

Children who have experienced global neglect,

defined as neglect in more than one category, may

have significantly smaller brains than the norm.

This could be indicative of fewer neuronal pathways

available for learning and may lead the children to be

at an intellectual disadvantage for their entire lives.69

Poor Physical Health 

The physical problems associated with neglect may

start even before an infant is born, such as when

the mother has had little or no prenatal care or

smoked during pregnancy. These children may

be born prematurely and have complications at

birth. Neglected children also can have severe
Child Neglect: A Guide for Prevention, Assessment, and Intervention 23

physical injuries, possibly due to the inattention of

their parents, such as central nervous system and

craniofacial injuries, fractures, and severe burns.

They also may be dirty and unhygienic, leading to

even more health problems, such as lice or infections.

Children also may be exposed to toxins that could

cause anemia, cancer, heart disease, poor immune

functioning, and asthma. For example, exposure to

indoor and outdoor air pollutants, such as ozone,

particulate matter, and sulphur dioxide, can cause the

development of asthma or increase the frequency or

severity of asthma attacks.71 Additionally, children

may have health problems due to a lack of medical

attention for injury or illness, including chronic

health problems. Neglected children may suffer from

dehydration or diarrhea that can lead to more severe

problems if unattended. 

A medical condition associated with child neglect is

“failure to thrive,” which can be defined as “children

whose growth deviates significantly from the norms

for their age and gender.”72 This condition typically

occurs in infants and toddlers under the age of 2 years.

Failure to thrive can be manifested as significant

growth delays, as well as:

Poor muscle tone;

Unhappy or minimal facial expressions;

Decreased vocalizations;

General unresponsiveness.73

•

•

•

•

Failuretothrive canbe causedbyorganicornonorganic

factors, but some doctors may not make such a sharp

distinction because physical and behavioral causes

often appear together. With organic failure to thrive,

the child’s delayed growth can be attributed to a

physical cause, usually a condition that inhibits the

child’s ability to takein, digest, or process food. When

failure to thrive is a result of the parent’s neglectful

behavior, it is considered nonorganic. 

Treatment for failure to thrive depends on the cause

of the delayed growth and development, as well as

the child’s age, overall health, and medical history.

For example, delayed growth due to nutritional

factors can be addressed by educating the parents

on an appropriate and well-balanced diet for the

child. Additionally, parental attitudes and behavior

may contribute to a child’s problems and need to be

examined. In many cases, the child may need to be

hospitalized initially to focus on implementation of a

comprehensive medical, behavioral, and psychosocial

treatment plan.74 Even with treatment, failure to

thrive may have significant long-term consequences

for children, such as growth retardation, diminished

cognitive ability, mental retardation, socio-emotional

deficits, and poor impulse control.75 

Impact on the Brain of Prenatal Exposure to Alcohol and Drugs

Exposure to alcohol and drugs in utero may cause impaired brain development for the fetus. Studies

have shown that prenatal exposure to drugs may alter the development of the cortex, reduce the number

of neurons that are created, and alter the way chemical messengers function. This may lead to difficulties

with attention, memory, problem solving, and abstract thinking. However, findings are mixed and may

depend on what drug is abused. Alcohol abuse has been found to have some of the most detrimental

effects on infants, including mental retardation and neurological deficits. One problem with determining

the impact of substance abuse on a fetus is isolating whether the negative outcomes are directly associated

with the alcohol or drug exposure or with other factors, such as poor prenatal care or nutrition, premature

birth, or adverse environmental conditions after birth.70 
 24 Impact of Neglect

Intellectual and Cognitive Development

Research shows that neglected children are more

likely to have cognitive deficits and severe academic

and developmental delays when compared with

non-neglected children. When neglected children

enter school, they may suffer from both intellectual

and social disadvantages that cause them to become

frustrated and fall behind.78 One study found that

individuals at 28 years of age who suffered from

childhood neglect scored lower on IQ and reading

ability tests, when controlling for age, sex, race, and

social class, than people who were not neglected as

children.79 Other studies have found that, although

both abused and neglected children exhibited language

delays or disorders, the problems were more severe

for neglected children.80 Furthermore, neglected

children have the greatest delays in expressive and

receptive language when compared with abused

and nonmaltreated children.81 When compared to

physically abused children, neglected children have

academic difficulties that are more serious and show

signs of greater cognitive and socio-emotional delays

Impact of Malnutrition on Children

Malnutrition, especially early in a child’s life, has been shown to lead to stunted brain growth and to slower

passage of electrical signals in the brain. Malnutrition also can result in cognitive, social, and behavioral

deficits.76 Iron deficiency, the most common form of malnutrition in the United States, can lead to the

following problems:

Cognitive and motor delays;

Anxiety;

Depression;

Social problems;

Problems with attention.77

•

•

•

•

•

Impact of Neglect on Academic Performance

Neglect can negatively affect a child’s academic performance. Studies have found that:

Children placed in out-of-home care because of abuse or neglect have below-average levels of

cognitive capacity, language development, and academic achievement.

Neglected children demonstrated a notable decline in academic performance upon entering junior

high school.

Children who were physically neglected were found to have significantly lower IQ scores at 24 and

36 months and the lowest scores on standardized tests of intellectual functioning and academic

achievement in kindergarten when compared with children who had experienced either no

maltreatment or other forms of maltreatment.

Neglected children, when compared with nonmaltreated children, scored lower on measures of

overall school performance and tests of language, reading, and math skills.

Neglected boys, but not girls, were found to have lower full-scale IQ scores than physically abused

and nonmaltreated children. 82

•

•

•

•

•
Child Neglect: A Guide for Prevention, Assessment, and Intervention 25

at a younger age. These academic difficulties may lead

to more referrals for special education services.83 

There are also language problems associated with

neglect. In order for babies to learn language, they

need to hear numerous repetitions of sounds before

they can begin making sounds and eventually saying

words and sentences. Language development may

be delayed if the parent or other caregiver does not

provide the necessary verbal interaction with the

child. 

Emotional, Psychosocial, and Behavioral

Development

Neglect can have a strong impact on, and lead to

problems in, a child’s emotional, psychosocial, and

behavioral development. As with other effects already

mentioned, these may be evident immediately after

the maltreatment or not manifest themselves until

many months or years later. Exhibit 3-1 is a listing

of emotional, psychosocial, and behavioral problems

associated with neglect.

Emotional and Psychosocial Consequences

All types of neglect, and emotional neglect in

particular, can have serious psychosocial and

emotional consequences for children. Some of the

short-term emotional impacts of neglect, such as fear,

isolation, and an inability to trust, can lead to lifelong

emotional and psychological problems, such as low

self-esteem.84 

A major component of emotional and psychosocial

development is attachment. Children who have

experienced neglect have been found to demonstrate

higher frequencies of insecure, anxious, and avoidant

attachments with their primary caregivers than

nonmaltreated children.85 In fact, studies have

demonstrated that 70 to 100 percent of maltreated

infants form insecure attachments with their

caregivers.86 Often, emotionally neglected children

have learned from their relationships with their

primary caregivers that they will not be able to have

their needs met by others. This may cause a child not

to try to solicit warmth or help from others. This

behavior may in turn cause teachers or peers not to

offer help or support, thus reinforcing the negative

expectations of the neglected child.87 One mitigating

factor, however, may be having an emotionally

supportive adult, either within or outside of the

family, such as a grandparent or a teacher, available

during childhood. Another mitigating factor may be

having a loving, accepting spouse or close friend later

in life.88 

Neglected children who are unable to form secure

attachments with their primary caregivers may:

Become more mistrustful of others and may be

less willing to learn from adults. 

Have difficulty understanding the emotions of

others, regulating their own emotions, or forming

and maintaining relationships with others.

Have a limited ability to feel remorse or empathy,

which may mean that they could hurt others

without feeling their actions were wrong.

Demonstrate a lack of confidence or social skills

that could hinder them from being successful in

school, work, and relationships.

Demonstrate impaired social cognition, which

is one’s awareness of oneself in relation to others

and an awareness of other’s emotions. Impaired

social cognition can lead a person to view many

social interactions as stressful.89

•

•

•

•

•
 26 Impact of Neglect

Exhibit 3-1

Neglect and Emotional, Psychosocial, and Behavioral Problems

Neglected children, even when older, may display a variety of emotional, psychosocial, and behavioral

problems which may vary depending on the age of the child. Some of these include:

Displaying an inability to control emotions or impulses, usually characterized by frequent outbursts;

Being quiet and submissive;

Having difficulty learning in school and getting along with siblings or classmates;

Experiencing unusual eating or sleeping behaviors;

Attempting to provoke fights or solicit sexual interactions;

Acting socially or emotionally inappropriate for their age;

Being unresponsive to affection;

Displaying apathy;

Being less flexible, persistent, and enthusiastic than non-neglected children;

Demonstrating helplessness under stress;

Having fewer interactions with peers than non-neglected children;

Displaying poor coping skills;

Acting highly dependent;

Acting lethargic and lackluster;

Displaying self-abusive behavior (e.g., suicide attempts or cutting themselves);

Exhibiting panic or dissociative disorders, attention-deficit/hyperactivity disorder, or post-traumatic

stress disorder;

Suffering from depression, anxiety, or low self-esteem;

Exhibiting juvenile delinquent behavior or engaging in adult criminal activities;

Engaging in sexual activities leading to teen pregnancy or fatherhood;

Having low academic achievement;

Abusing alcohol or drugs. 90

•

•

•

•

•

•

•

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Child Neglect: A Guide for Prevention, Assessment, and Intervention 27

Behavioral Consequences

Neglected children may suffer from particular

behavioral problems throughout life. Research

shows that children who are exposed to poor family

managementpractices are at a greaterriskofdeveloping

conduct disorders and of participating in delinquent

behavior.92 Neglected children also may be at risk

for repeating the neglectful behavior with their own

children. Research also shows that neglected children

do not necessarily perceive their upbringing to be

abnormal or dysfunctional and may model their own

parenting behavior on the behavior of their parents.

One study estimates that approximately one-third of

neglected children will maltreat their own children.93

Societal Consequences

Society pays for many of the consequences of neglect. There are large monetary costs for maintaining

child welfare systems, judicial systems, law enforcement, special education programs, and physical and

mental health systems that are needed to respond to and to treat victims of child neglect and their families. 

Many indirect societal consequences also exist, such as increased juvenile delinquency, adult criminal

activity, mental illness, substance abuse, and domestic violence. There may be a loss of productivity due

to unemployment and underemployment associated with neglect. Additionally, supporting children who

have developmental delays because of malnutrition often is much more costly than providing adequate

nutrition and care to poor women and children.91

Early Prevention and Intervention

The incidence of neglect and the harm it does to children can be reduced or mitigated through early

prevention and intervention programs. Although the effectiveness of these programs has not been studied

adequately, they are most effective when they are comprehensive and long-term.94 With the effects of

neglect being especially damaging during infancy, it also is important to work with families as early as

possible—even before the baby is born.95 Two promising early prevention and intervention programs

are the Olds model and Project STEEP (Steps Toward Effective, Enjoyable Parenting). The Olds model

utilizes intensive nurse home visiting during pregnancy and through age 2 of the child. The program had

positive effects on parenting attitudes and behavior and on reports of child maltreatment.96 Project STEEP

includes home visitation and group support and education for expectant mothers and seeks to enhance

mother-infant relationships. In the initial implementation of this program, mothers in the experimental

group demonstrated a better understanding of child development, better life management skills, fewer

depressive symptoms, fewer repeat pregnancies within 2 years of the birth of their baby, and greater

sensitivity to their child’s cues and signals.97

Child Neglect: A Guide for Prevention, Assessment, and Intervention 29

Neglect occurs to children of all races, socioeconomic classes, religions, family structures,

and communities. However, there are some factors

that appear to make children more or less likely to be

neglected. Having one or more risk factors does not

necessarily mean that a childwill be neglected; families

and children react to personal and societal factors

differently. But they are warning signs, nevertheless.

One or two major risk factors for neglect may have

little effect on a child’s development, but having

three or more risk factors exponentially increases the

potential for developmental problems. Risk factors

may be cumulative so that the more risk factors a

child or family is exposed to over the course of the

child’s development, the greater the potential for

problems to arise.98 The risk and protective factors

in a child or family’s life also may interact with each

other. Exhibit 4-1 provides a conceptual model of the

interplay of various risk and protective factors related

to child neglect.

An instance of possible neglect may be related to one

or more contributing factors. Forexample, if a child is

exposed to lead paint in the home, there may be many

contributing factors to the neglect. The parent may

be unwilling or unable to move to a home where lead

paint is not present, the landlord may be unwilling

to remove the lead paint from the walls, the city may

not have an adequate lead abatement program, or the

community may not have placed enough emphasis

on making sure that low-income housing is safe.99

The caseworker would need to assess the situation to

determine if this is a case of neglect by the parent.

Child welfare professionals and others who interact

regularly with children and families should be able to

recognizeriskfactorssothatthey canidentify situations

where neglectislikely and determinethemosteffective

interventions. This chapter highlights several types of

risk and protective factors—environmental, family,

parent or caregiver, and child—for neglect.

Environmental Factors

Neglectfulfamilies do notexistin a vacuum; numerous

environmental factors can contribute to child neglect.

Some of these include poverty, community and

society characteristics, and access to social supports.

These factors may be interrelated (e.g., families who

are poor often live in high-risk or unsafe communities

or lack social supports).

Poverty

The level of child well-being in a State is strongly

associated with its rate of child poverty.100 While

child poverty has declined over the past decade, it

currently stands at 17.6 percent.101 Compared to

other types of child maltreatment, neglect is more

directly associated with poverty.102 Of course, most

poor people do not neglect or otherwise maltreat their

Chapter 4

Risk and 

Protective Factors
 30 Risk and Protective Factors

Exhibit 4-1

Conceptual Model of Child Neglect103
Child Neglect: A Guide for Prevention, Assessment, and Intervention 31

children, but poverty, when combined with other

risk factors, such as substance abuse, social isolation,

financial uncertainty, continual family chaos, or a

lack of available transportation and affordable child

care can put a child at greater risk for neglect.104

Another study found that within an economically

disadvantaged sample, particular aspects of poverty

are more strongly correlated with physical neglect

reports than others. 105 For example, the perception

by the caregiver of economic hardship was positively

correlated with child neglect, even more than actual

variations in household incomes. Therefore, selfreports of economic hardship may be an important

signal for engaging in interventions with families to

prevent subsequent neglect. In contrast, employment

had an inverse relationship to reports of physical

neglect. No differenceexisted between income groups

for rates of fatal injury or emotional neglect.106 

It is important to note that many poor families are

well adjusted and competent; they have healthy

marriages and do not express their stress in violent or

otherwise hurtful ways. Many children who live in

poverty are able to perform well in school, are socially

well-adjusted, do not engage in illegal activities, and

are not poor as adults. These children may have

protective factors, such as affectionate parents, high

self-esteem, or a role model, that help them to achieve

these positive outcomes.107

As discussed in Chapter 2, Definition and Scope of 

Neglect, many States include an exception for poverty

in their definitions of neglect. There is usually a

distinction between a caregiver’s inability to provide

the needed care based on thelack of financial resources

and a caregiver’s knowing reluctance or refusal to

provide care, even though the initial effect on the

child is the same.108 For example, a family may not be

able to afford food for their children; therefore, their

children’s basic nutritional needs will not be met. If

the parents do not know about food assistance, they

would not be considered neglectful, but if they have

been told about a food assistance program and failed

to use it, they may be guilty of neglect. 

Community Characteristics

Children who live in dangerous neighborhoods have

been found to be at higher risk for neglect than

children in safer neighborhoods. One study suggests

a relationship between unsafe or dangerous housing

conditions and the adequacy of children’s physical

needs being met in the areas of nutrition, clothing,

and personal hygiene.109 These communities also are

associated with less social contact or support, which is

another risk factor for neglect.110 Other characteristics

of these distressed neighborhoods include high levels

of truancy, low academic achievement, high juvenile

arrest rates, and high teen birth rates. When stressful

living conditions continue over time, families in these

neighborhoods are more likely to be reported to child

protective services (CPS) for child neglect.111

Children living in unsafe neighborhoods may be

exposed to hazards in the neighborhood or in their

house or apartment that may lead to incidents of

neglect.112 For example, if a family lives in a house

with lead paint or in a neighborhood with a high

prevalence of drug abuse, children may be exposed

to these hazards, leading to neglect allegations.

Conversely, children living in safe communities and

neighborhoods are less likely to be exposed to these

types of hazards and may be more likely to have

neighbors and other community members who are

able to offer structure and monitoring. Furthermore,

communities with affordable child care and good

public transportation can contribute to the ability

of parents and other caregivers to care for their

children.113 Neighborhood or community factors

that can play a role in child neglect include:

The accessibility of health care, social services,

and affordable child care;

Acceptance of violence or neglect in the

community;

Narrow legal definitions of neglect (e.g., laws that

do not include chronicity of incidents);

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 32 Risk and Protective Factors

Political or religious views that discourage any

outsideintervention with families, no matter how

detrimental the neglect may be on the children

(e.g., cults, such as the Family of God, that

promote isolation from the community, remove

children from their mothers at birth, and prevent

any visible means of support).114 

Social Support

Families with healthy support networks have more

access to models of suitable parental behavior. In

addition, they have more friends, family, or neighbors

who may be willing to act as alternative caregivers or

to provide additional support or nurturance to both

the parent and the child. Impoverished communities

often lack positive informal and formal support

systems for families.115 Social support can take many

forms, including:

Emotional support;

Tangible support;

Decision-making or problem-solving assistance;

Support related to self-esteem;

Social companionship.116 

Social support is provided by:

Relatives;

Neighbors;

Friends;

Schools;

Employers;

Health and mental health service agencies;

Religious institutions;

Recreational programs;

After-school programs and sports;

Other community groups and organizations.117

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Studies on social isolation and child neglect have

compared parents who maltreat their children with

parents who do not. These studies found that parents

who maltreat their children:

Report more isolation and loneliness;

Report less social support;

Have smaller social networks;

Receive less social and emotional support from

their social networks;

Have fewer contacts with others in their social

networks;

Perceive the support they receive as less positive

than non-neglecting parents;

May be more likely to distrust available social

support;

May perceive, rightly or wrongly, that their

neighborhoods are less friendly and their

neighbors less helpful.118

Social support is important not only for parents but

also for children. Social supports offer children both

emotional and physical resources that may either

protect them from neglect or help them to achieve

better outcomesif they have been neglected. However,

children may not be aware of some of the therapeutic

aid, social services, or school supports that are

available to them without the assistance of someone

within their social network. Supportive adults may

be able to serve as substitute attachment figures if a

child’s parents or other caretakers are unable to fill

this role. Research shows that the presence of one or

more positive and significant individuals in a child’s

life may act as a buffer against negative outcomes due

to child abuse or neglect. Supportive adults may be

able to look out for children and possibly protect

them from neglect. For a child who is in an out-ofhome placement, a positive relationship with a foster

parent might serve as a protective factor.119

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Child Neglect: A Guide for Prevention, Assessment, and Intervention 33

Family Factors

Severalfamily characteristics are associatedwith higher

rates of neglect. Some life situations, such as marital

problems, domestic violence, single parenthood,

unemployment, and financial stress, can increase

the likelihood that neglect will occur. Although

these characteristics may not cause maltreatment,

they are possible risk factors for neglect. Some

family characteristics that may lead to neglect can

be categorized as communication and interaction

patterns, family composition, domestic violence, and

family stress.

Communication and Interaction Patterns

Characteristics of families that are more likely to

have positive outcomes include cohesion; emotional

support for one another; and parents or caregivers

who are warm, involved with their children, and firm

and consistent in their discipline methods. Families

that share similar beliefs, rituals, or values in such

matters as financial management and the use of leisure

time also appear to offer some protection. Having a

strong familial sense of culture and spirituality also

helps.120 In addition, a father’s involvement, support,

and connection with his children have also been

associated with more positive child outcomes.121 Even

if parents are not able to provide a positive family

environment, other relatives (such as older siblings or

grandparents) may be able to step in and provide this

for the children.122

Neglectful families, however, often have problems

communicating and interacting in positive or

appropriate ways. These families are more chaotic,

expressfewer positiveemotions, and havelessempathy

and openness. Additionally, they are more likely to

lack emotional closeness, negotiation skills, and a

willingness to take responsibility for their actions.123

Religiosity and Social Support

Involvement in faith communities has been shown to have many positive effects for families.Families

with access to a helpful community of people receive significant social, financial, emotional, and physical

support.Parents who are connected with a religious community may experience higher levels of social

support themselves and may afford their children greater opportunities for such support than do parents

who do not participate.A consistent empirical finding is that adults who are part of a religious community

are less socially isolated than are other adults.124

Such support enhances coping mechanisms and provides

parents with a different perspective which helps them deal with stress and difficulties.125 A growing body of

research highlights the role of religion and spirituality in helping parents cope with sick or emotionally or

behaviorally disturbed children.126

Religiosity has been found in several studies to be positively correlated with family cohesiveness and less

incidence of interparental conflict.127 Parental religiosity has been linked to greater involvement, warmth

and positivity in parent-child relationships.128 Religiousness is positively correlated with an authoritative

parenting style, which is characterized by greater respect, warmth and affection, as well as clearlycommunicated and well-defined rules for children.129 Additionally, many religions have proscriptions

against excessive drug and alcohol use.Each of these characteristics promotes a healthy family

environment.130

For more information, go to the White House Office of Faith-Based and Community Initiatives at http://

www.whitehouse.gov/government/fbci/.
 34 Risk and Protective Factors

In neglectful families, there may be less engagement

between the parent and the child and more negative

interactions than in non-neglectful families. Parents

who maltreat their children often are less supportive,

affectionate, playful, or responsive than parents who

do not maltreat their children.131

Family Composition

Single parenthood is associated with higher incidences

of neglect. One study found that being in a singleparent household increased the risk of child neglect

by 87 percent.132 Many factors may account for

this. There is less time to accomplish the tasks of

the household, including monitoring and spending

time with children and earning sufficient money

when there is only one parent or caregiver. Single

parents often have to work outside the home, which

might mean they are not always available to supervise

their children. Single-parent families are also more

likely to live in poverty than two-parent households.

According to one analysis of the child poverty rate by

family type, the poverty rate in 2003 was:

7.6 percent for children living with married

parents;

34.0 percent for children living with a single

parent;

21.5 percent of children living with co-habiting

parents.133

Of course, neglect also occurs in married, two-parent

households, especially if there is a high level of marital

discord.134 

The presence of fathers in families often has been left

out of the research on child neglect. This may be

because fathers typically are not seen as the person

primarily responsible for providing for the needs of

the children, or because many mothers are single

parents or primary caregivers or are typically more

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accessible to researchers.135 However, research on

fathers shows that the presence of a positive father

or father figure decreases the likelihood of neglect in

the home.136 Having a father in the household not

only may provide children and the mother with an

additional source of emotional support, but it also

may provide the family with more money and other

resources. Compared to their peers living with both

parents, children in single-parent homes had:

87 percent greater risk of being harmed by

physical neglect;

165 percent greater risk of experiencing notable

physical neglect;

74 percent greaterrisk ofsuffering fromemotional

neglect;

120 percent greater risk of experiencing some

type of maltreatment overall.137

Domestic Violence

Children living in a home where domestic violence

is present are at a greater risk of being neglected.

One study found that in 35 percent of neglect cases,

domestic violence had occurred in the home.138

Caregivers who are victims of domestic violence may

be abused to the point of being unable or unwilling

to keep their abusers from also abusing the children.

This type of neglect is often referred to as “failure or

inability to protect the child from harm.” In some

cases, abused caregivers are afraid to defend the

children in their care because doing so might put

the caregiver’s or children’s lives in danger or provoke

more abuse. Whether or not caregivers are charged

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For moreinformation on therole of fathers, see The 

Importance of Fathers in the Healthy Development 

in Children at http://www.childwelfare.gov/

pubs/usermanual.cfm. For more information on

the Department of Health and Human Services,

Administration for Children and Family’s Healthy

Marriage Initiative, visit http://www.acf.hhs.gov/

healthymarriage/.
Child Neglect: A Guide for Prevention, Assessment, and Intervention 35

with “failure or inability to protect” often depends on

whether the caregivers knew or should have known

that their children were being abused.141 

Studies show that in 30 to 60 percent of homes

with identified cases of domestic violence or child

maltreatment, it is likely that both types of abuse

exist.142 In some communities, child welfare agencies

and domestic violence service providers have started

working together to find ways to support both adult

victims and their children.143 An example of this is

The Greenbook Demonstration Initiative. The Family

Violence Department of the National Council

of Juvenile and Family Court Judges convened

leading family court judges and experts on child

maltreatment and domestic violence. This, in

turn, led to the Federal demonstration initiative,

a joint effort between several agencies in the U.S.

Department of Health and Human Services and the

U.S. Department of Justice. Preliminary results from

this project include increased routine screening for

domestic violence by CPS caseworkers and increased

routine screening for child maltreatment by domestic

violence service providers. Additional changes in

CPS policies and practices include increased interagency cooperation, regular training on the dynamics

of domestic violence, and sharing resources with

domestic violence organizations. 144

Family Stress

Neglectful families often have experienced stressful

life events due to financial difficulties, substance

abuse problems, housing problems, illness, or

other challenges. Families that are coping with

such problems may not have the time or emotional

capacity to provide for the basic needs of their

children or to participate in interventions. Neglectful

families often report more day-to-day stress than nonneglectful families. In addition, particularly stressful

life events (such as the loss of a job or the death of

a family member) may exacerbate characteristics in

the family, such as hostility, anxiety, or depression,

which may increase levels of family conflict and child

maltreatment.145

When assessing a family, it may be helpful for a

CPS worker to classify stresses into the following

categories:

Chronic environmental stress—background

stress that is based in the environment and social

structure, including dangerous housing, indigent

neighborhoods, and chronic unemployment;

Life events—stressful events and life transitions,

including a job loss, the death of a loved one, or

an eviction;

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For more on The Greenbook Initiative, go to

http://www.thegreenbook.info/init.htm.

Effects of Witnessing Domestic Violence on Children

In many families affected by domestic violence, the parents believe that their children are not witnessing

the incidents, but reports from children show that between 80 and 90 percent are aware of the abuse

and can provide detailed accounts of it.139 Children who witness domestic violence often suffer harmful

consequences. The extent of the harm possibly depends upon the child’s age, developmental stage, gender,

and role in the family. Some research suggests that exposure to domestic violence increases the likelihood

that children will engage in delinquent and criminal behaviors as teenagers and adults and will have

problems with violence in future relationships.140 Other studies, however, do not show these negative

effects. With increasing recognition of the effect exposure to domestic violence can have on children,

many CPS agencies consider it a form of emotional abuse. For more information, see Child Protection in 

Families Experiencing Domestic Violence at http://www.childwelfare.gov/pubs/usermanual.cfm.
 36 Risk and Protective Factors

Daily hassles—minor stresses that are present in

day-to-day life, such as being stuck in traffic or

problems at work;

Role strain—stress caused by one’s inability

to fill a particular role. For example, a stay-athome father may experience role strain due to the

expectations of mainstream society that fathers

must always participate in the workforce.147 

Parent or Caregiver Factors

Some parental or caregiver characteristics associated

with child neglect include problematic childhoods,

developmental histories, or personality factors;

physical and mental health problems; substance abuse

issues; and poor parenting or problem-solving skills.

As with all risk factors, the presence of one or more of

these factors does not mean that a parent or caregiver

will be neglectful, but these are characteristics that are

present more often in neglectful parents. Assessment

of these factors is useful for targeting prevention and

intervention services to address the challenges faced

by at-risk and neglectful families. The roles and

characteristics of the mother and father should be

taken into account when determining a child’s risk

for neglect.

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Parent’s Childhood, Developmental History,

and Personality Factors

The way parents were reared can greatly affect the way

they rear their own children. People who did not have

their needs met by a parent when they were children

may not know how to meet the needs of their own

children. Some studies have found that neglectful

parents are more likely to have been maltreated as

children.148 Neglectful mothers were three times

morelikely to have been sexually abused than mothers

who do not neglect their children.149 However, the

majority of individuals who are maltreated as children

do not maltreat their own children. In addition, there

are individuals who were not abused or neglected

as children who maltreat their children. It remains

unclear why some previously maltreated people abuse

and neglect their children while others do not.150

Two other childhood factors that have been found to

be associated with future neglect are running away

from home and having been placed in foster care,

which usually indicate a troubled childhood that can

negatively affect one’s ability to take care of one’s own

children.151 Growing up in unstable, hostile, nonnurturing homes can lead to unstable personalities

when the children become adults, which can lead to

Stress and the Immigrant Community

Stress also may be a particularly relevant problem for immigrants. Some common additional stressors they

face include:

Language difficulties;

Separation from family and friends;

Health problems;

Financial problems;

Difficulty finding and keeping a job;

Homesickness and isolation;

Fear of deportation;

Conflicting cultural norms for child-rearing.146

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Child Neglect: A Guide for Prevention, Assessment, and Intervention 37

stressful marriages and abusive parenting practices

with their own children.152 

Children also may be at greater risk of harm if their

parents are not aware of the neglect, deny that neglect

took place, downplay their role in the neglect, or are

unwilling to do anything to make sure the neglect

does not recur. One study found that the most

common response given by mothers for supervisory

neglect was that there was nothing wrong with their

behavior.153 

Some parental developmental and personality

characteristics that can be considered protective

factors include having secure attachments, stable

relationships with their own parents, good coping

skills,social competence, and reconciliationwith their

own history (if any) of childhood maltreatment.154

Forexample, parents who were maltreated as children

may belesslikely tomaltreattheir own children ifthey

are able to resolve their internal conflicts and pain

related to their history of maltreatment and if they

have a healthy, intact, supportive, and nonabusive

relationship with their parents. Marital or parenting

programs may provide parents with guidance about

challenges to expect after the birth of their first child,

in rearing children, and in understanding common

gender differences in children. These classes may act

as protective factors by strengthening the family’s

knowledge and bonds.155

Parenting and Problem-solving Skills

Parents need to have the cognitive resources to

care adequately for a child. They also need certain

educational abilities, such as literacy, to be able to

care properly for their child (e.g., to read prescription

labels on their child’s medication). Studies have

found links between child neglect and parents’ poor

problem-solving skills, poor parenting skills, and

inadequate knowledge of childhood development.156

Parents who are unaware of the developmental and

cognitive abilities of children at different ages may

have unrealistic expectations and be more likely to

neglect their children. For example, a parent might

expect that a 4-year old child can be left alone for

the evening because of unrealistic expectations of

the child’s abilities. Studies also have found that

parents who are inconsistent with discipline or use

harsh or excessive punishment can be at risk for

neglecting their children.157 As would be expected,

having parents who are engaged with their children

and involved in their activities and education acts as a

protective factor.158

Substance Abuse

Reported rates of substance abuse by maltreating

parents vary; neglect, however, has the strongest

association with substance abuse among all forms

of maltreatment. One study found that children

whose parents abused alcohol and other drugs were

more than four times more likely to be neglected

than children whose parents did not.159 According

to one study of CPS caseworkers, 65 percent of

maltreated children who had parents with substance

abuse problems were maltreated while the parent was

intoxicated. Also, the substance most likely to be

abused by maltreating parents is alcohol (alone or in

combination with an illicit drug).160

Substance abuse also may be related to the recurrence

of neglect. Studies have found that caregivers with

substance abuse problems are more likely to neglect

their children continually and to be re-referred to

CPS than caregivers who do not abuse substances.161

Substance abuse also has been linked with as many as

two thirds of child maltreatment fatalities.162

This strong relationship between parental substance

abuse and neglect exists because substance abuse

impairs one’s mental functioning and can affect

decision-making. Parents who are abusing substances

often cannot make appropriate decisions, such as

preventing a young child from going out alone late at

night or supervising their children adequately. They

also often put their own needs ahead of the needs of

the child, such as spending money on drugs rather

than on food for the child.
 38 Risk and Protective Factors

Substance abuse often co-occurs with other problems,

which makes it difficult to assess its impact on child

maltreatment. Parental substance abuse is likely to

co-occur with the following problems that also are

associated with child maltreatment:

Lack of knowledge about child development;

Poor problem-solving and social skills;

Low maternal affection;

Poor attachment relationships;

Poor attention to the needs of an infant;

Disinterest in spending time with one’s children;

Inconsistent disciplinary practices;

Social isolation;

Mental health problems, especially depression;

Anger toward or a lack of attention to one’s

children;

Difficulty maintaining employment;

Engagement in criminal behavior;

Failure to provide appropriately for the needs

of their children (clothing, food, medical care,

hygiene, and emotional attention).163

Becausesubstance abuse often occurs alongwith many

other risk factors, it may be difficult for professionals

to prioritize which services should be provided to

families; therefore, intervention programs for parents

who abuse substances should focus on multiple

factors.

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Mental Health

Certain mental health problems in parents have been

associated with child neglect, although research results

vary on this connection. For example, some studies

have found that, when controlling for social variables

and substance abuse, neglect and depression are not

associated.164 Otherstudies haveshown a link between

child neglect and serious or postpartum depression.

For example, mothers suffering from postpartum

depression are less responsive and sensitive toward

their infants and may be disengaged or withdrawn.165

Of course, numerous mental illnesses can affect an

individual’s ability to care for a child properly. As

with any condition, mental illness occurs along a

continuum of severity. 

Other Parental Factors

Other parental factors that may be associated with

child neglect include:

Age;

Education;

Gender;

Employment;

Criminal activity;

Prior involvement with CPS.166

Research on young parents has focused mostly on

teenage mothers. Low parental education may also

be associated with neglect, and young mothers may

be less likely to attain a high level of education, thus

limiting their work prospects and leading to financial

stress. Other risk factors for neglect associated with

young mothers include substance abuse, inadequate

knowledge of childhood development, and poor

parenting skills.167 

Because a lack of employment is related to so many

other risk factors for child neglect, it is not surprising

that both maternal and paternal lack of employment

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For more information on substance abuse in

families, see Protecting Children in Families 

with Substance Abuse Problems at http://www.

childwelfare.gov/pubs/usermanual.cfm.
Child Neglect: A Guide for Prevention, Assessment, and Intervention 39

are associated with higher rates of child neglect.

Parents who have committed a crime also may be

more likely to neglect their children.168 Again, this

may be because criminal activity is linked to other

risk factors, such as substance abuse and poverty.

Parents’ prior involvement with CPS has been linked

to subsequent reports of neglect. These parents may

be discouraged, less likely to think that their situation

will change, less willing to receive services, or less

motivated to change. However, families who have

been involved with CPS and had positive experiences

may be more motivated and open to receiving

services.169 It is important that young parents, both

mothers and fathers, obtain the support they need so

that they can adequately attend to the needs of their

children.

Child Factors

Any child can be the victim of neglect, but some

characteristics appear to be more highly represented

among maltreated children, including being under

the age of 3, having certain behavioral problems, and

having special needs.

Age

In 2004, children from birth to age 3 had the highest

rate of reported maltreatment (16.1 per 1,000

children). 170 Research also shows that children under

the age of 3 are most at risk for neglect, with rates

decreasing as the age of the child increases.171

Temperament and Behavior

A child’s temperament and behavior may be associated

with child neglect. Children with an irritable

temperament and who have difficulty being soothed

may be more at risk for being neglected than other

children, since having a difficult temperament may

strain the parent-child relationship. One study found

that a difficult child temperament (as perceived by the

mother) was specifically associated with emotional

neglect.172 

Neglected children also often demonstrate a distinct

set of behaviors including being passive, nonassertive,

orwithdrawn.173 Itis unclearwhether children develop

these behavior problems because they are neglected

or if they are neglected because they have behavior

problems. When considering therelationship between

behavior problems and neglect, a CPS worker should

assess whether the neglected child actually has more

behavior problems or if the neglectful parent merely

believes that the child has more behavior problems.

Behavior problems can be categorized as either

internalizing or externalizing. Internalizing behavior

is a behavior or a feeling that is directed inward, such

as depression. Such children may be overlooked

because they rarely act out. Externalizing behavior

is characterized by outward expressions of behaviors

and feelings that are easily observable, such as

being aggressive. These children often receive more

attention than those who internalize because their

behavior is often disruptive to others.174 Exhibit 4-

2 lists indicators of internalizing and externalizing

behavior problems.

Special Needs

While the link between children with special needs

and neglect is unclear, somestudies havefound higher

rates of child abuse and neglect among children with

disabilities. One study found such children to be

1.7 times more likely to be maltreated than children

without disabilities.175 Another study, however,

failed to find increased levels of maltreatment
 40 Risk and Protective Factors

Exhibit 4-2

Internalized and Externalized Behavior Problems

Children can exhibit difficulties or problems resulting from maltreatment in a variety of ways, including

their behavior. Children may focus their negative feelings internally or externally. Maltreatment may

cause internalized behaviors, such as:

Agitation;

Nightmares;

Avoidance of certain activities or people;

Difficulty falling asleep or staying asleep;

Sleeping too much;

Difficulty concentrating;

Hypervigilance;

Irritability;

Becoming easily fatigued;

Poor appetite or overeating;

Low self-esteem;

Feelings of hopelessness.

The above symptoms, if experienced persistently or if many of them are experienced all at once, should be

cause for concern. Maltreatment also may cause externalized behaviors, including:

Difficulty paying attention;

Not listening when spoken to;

Difficulty organizing tasks and activities;

Being easily distracted;

Being forgetful;

Bedwetting;

Excessive talking;

Difficulty awaiting their turn;

Bullying or threatening others;

Being physically cruel to people or animals;

Playing with or starting fires;

Stealing;

Destroying property.

It is important to keep the child’s age and developmental level in mind when assessing a child for these

symptoms. For example, bedwetting by a 13-year old would cause more concern than bedwetting by a 2-

year old. If a child’s internalized or externalized behaviors interfere with his normal functioning or if his

behavior changes dramatically, then the child should be referred for further assessment.176

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Child Neglect: A Guide for Prevention, Assessment, and Intervention 41

among a sample of children with moderate to severe

retardation.177 

Children with special needs, such as those with

physical or developmental challenges, may be more at

risk for maltreatment because:

Their parents become overwhelmed with

trying to take care of them and may respond

with irritability, inconsistent care, or punitive

discipline; 

Children may be unresponsive or have limited

ability to respond, interact, or show as much

affection as parents expect, thereby disrupting

parent-child attachments;

Society tends to devalue individuals with

disabilities.178

An alternate explanation for higher rates of

maltreatment among children with special needs is

that parents of children with special needs have more

frequent contact with an array of professionals and

thusmay be under greaterscrutiny.179 In any case,these

parents may need more support and encouragement

to help them provide for the needs of their children.

For children with special needs, having a strong and

secure attachment to their primary caregivers, in turn,

may moderate the negative effects of the disability

and provide protection from neglect.180

Other Child Characteristics

Other child characteristics associated with neglect

include:

Being born prematurely, with a low birth weight,

or with birth anomalies;

Being exposed to toxins in utero;

Experiencing childhood trauma;

Having an antisocial peer group, such as being a

gang member.181 

Children who are premature or havelow birth weights

may be at risk for neglect becausetheir parents may be

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confused, anxious, or feel helpless, which may make it

harder for them to relate to the baby. These parents

also may have fewer or less positive interactions

with the infant, restricting the formation of positive

attachments.182

Some child characteristics that appear to be protective

factors against neglect include:

Good health;

A history of adequate development;

Above-average intelligence;

Hobbies and interests;

Humor;

A positive self-concept;

Good peer relationships;

An easy temperament;

A positive disposition;

An active coping style;

Good social skills;

An internal locus of control (believing one’s

behavior and life experiences are the result of

personal decisions and efforts);

A lack of self-blame;

A balance between seeking help and

autonomy.183

Recently there has been a shift toward a strengthsbased focus with a greater emphasis on resilience

and protective factors and a movement away from

focusing solely on risk factors, particularly for

preventing neglect and its recurrence. The belief is

that prevention strategies are mosteffective when they

involve building up a family’s strengths. However,

research suggests that solely focusing on building

up protective factors, while not resolving some of

the risk factors, may not be a particularly effective

strategy. Intervention strategies should address both

risk and protective factors to provide the most help

to families.184 

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 42 Risk and Protective Factors

Resilience

Resilience can be defined as the ability to thrive, mature, and increase competence in the face of adverse

circumstances.185 Some children who are neglected are able not only to survive the neglect, but also to

achieve positive outcomes despite it. What sets these children apart may be a greater number of protective

factors related to either themselves, their parents, or their environment. One important finding from

research is that resiliency can be developed at any point in life. For example, teenagers who exhibit

learning or behavior problems may become well-functioning, productive adults by the time they are

30.186 Resilience is thought to stem from ordinary human processes, such as parenting, thinking skills,

motivation, rituals of family and culture, and other basic systems that foster human adaptation and

development. These ordinary processes should be recognized, promoted, and supported so that they work

well and can help children.187

Throughout this chapter, many protective factors have been mentioned. These factors may not only make

a child less likely to be neglected, but also may mitigate the effects of neglect on a child. The probability

that a neglected child will be resilient increases when there are enough protective factors to counteract risk

factors.188 Just as some risk factors are associated with one another (e.g., poverty and living in an unsafe

neighborhood), the same is true of protective factors. For example, being part of a mentoring program or

having parents who support a child’s education may lead to greater educational achievements for a child.189
Child Neglect: A Guide for Prevention, Assessment, and Intervention 43

Child protective services (CPS) is responsible for

receiving and evaluating reports of suspected

child abuse and neglect, determining if the reported

information meets statutory and agency guidelines

for child maltreatment, and judging the urgency

with which the agency must respond to the report.

In addition, CPS provides the public, as well as

individuals who report allegations of child abuse or

neglect (frequently referred to as “reporters”), with

information about State statutes, agency guidelines,

and the roles and responsibilities of CPS.

After receiving a report, CPS conducts an initial

assessment or investigation, which may include the

following:

A determination of whether the report of child

maltreatment is substantiated.

A safety assessment to determine if the child’s

immediate safety is a concern. If it is, CPS

develops a safety plan with interventions to

ensure the child’s protection while keeping the

child within the family or with family members

(e.g., kinship care or subsidized guardianship), if

at all possible and appropriate.

A risk assessment to determine if there is a risk of

future maltreatment and the level of that risk.

A service or case plan, if continuing agency

services, is needed to address any effects of child

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maltreatment and to reduce the risk of future

maltreatment.190

During the initial assessment or investigation, CPS

mustdeterminewhether childabuse orneglect occurred

and can be substantiated and whether to conduct

an evaluation to determine the risk of maltreatment

occurring in the future. The initial assessment

identifies the risk and safety factors of concern in the

family. The family assessment:

Considers the relationship between the strengths

and the risks;

Identifies what must change in order to:

Keep children safe;

Reduce the risk of (future) neglect;

Increase permanency;

Enhance child and family well-being. 

Consequently, while the initial assessment identifies

problems, the family assessment promotes an

understanding of the problems and becomes the

basis for the prevention and intervention, or the

case plan.191 Exhibit 5-1 presents an overview of the

typical CPS process.

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Chapter 5

Assessment of

Child Neglect
 44 Assessment of Child Neglect

Exhibit 5-1

Overview of Child Protective Services Process
Child Neglect: A Guide for Prevention, Assessment, and Intervention 45

Framework for Practice 

Practitioners generally agree that a strengths-based,

child-centered, family-focused, and culturally

responsive framework for prevention, assessment,

and intervention of child neglect and other forms

of maltreatment will promote the best outcomes for

children and families.192 This integrative framework

for practice builds upon five main perspectives:

An ecological perspective, which conceptualizes

human behavior and social functioning within

an environmental context. Individual, family,

community, societal, and cultural factors interact

to influence how people behave. Child neglect

and other forms of maltreatment are viewed

as the consequence of the interplay between a

complex set of risk and protective factors at each

of these levels.

A strengths-based perspective, which refers to

practice methods and strategies that draw upon

the balance of strengths and the needs of children,

families, and communities. Strengths-based

practice involves a shift from a deficit approach,

which emphasizes problems, to a more positive

partnership with the family. The assessment

focuses on the strengths related to individual

family members, the family as a unit, and the

broader neighborhood and environment.

A developmental perspective, which refers to

understanding an individual’s and family’s growth

and development from a lifespan perspective. It

examines individuals and families interacting

with their environments over the course of time

and tailors interventions based on the specific

developmental needs of each child and the

family.

A permanency planning orientation, which

holds that all children have a right to a permanent

home. Practitioners focus on safely maintaining

children in their own homes when possible or, if

necessary, placing them permanently with other

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families. Interventions include a set of goaldirected activities designed to help children live

in safe families who offer a sense of belonging and

legal, lifetime family ties.

A culturally competent perspective, which

requires practitioners to understand the

perspective of clients or peers who may come

from culturally diverse backgrounds and to

adapt their practice accordingly. Basic cultural

competence is achieved when organizations

and practitioners accept and respect differences,

engage in an ongoing cultural self-assessment,

expand their diversity knowledge and skills, and

adapt service models to fit the target populations,

culture, situation, and perceived needs.193

The integration of these perspectives provides a strong

framework for a comprehensive assessment of the

presence and severity of neglect in families who come

to the attention of the child welfare system. 

Intake

When a referral is made to CPS, a decision is made

whether it should be “screened in” or “screened out”

for investigation or assessment. For a case to be

screened in, there usually has to be a specific allegation

of maltreatment or an imminent threat or danger to

the child. Cases that are screened in then receive

an initial assessment or investigation. Families may

be referred to CPS multiple times without having a

referral screened in because each incident in question

may not meet the State or local standards for neglect

that are used by the particular CPS agency. In cases

of neglect where no actual injury occurred, it often is

difficult for a CPS caseworker to determine if a child

is at risk of being harmed or how great the risk is;

therefore, these cases may be screened out.194

Many CPS agencies only screen in the most serious

cases. Consequently, cases in which it is reported that

a child may be at risk for neglect (e.g., a child living in

a dirty house with used drug needles on the floor), but

actually has not been harmed, may go uninvestigated.

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Unfortunately, some children and families who could

benefit from services are not receiving them either due

to being screened out or to having an unsubstantiated

case. In addition, families who have unsubstantiated

incidences of neglect and do not receive services are

likely to be referred later for incidences that are more

serious. Receiving even one form of service may

reduce the likelihood that a neglectful family would

be re-referred. For the safety and well-being of the

child, it would be more beneficial for these families to

receive services to prevent neglect from occurring.196

Initial Assessment or Investigation

Determining whether child neglect has occurred is

based on the answers to two primary questions: “Do

the conditions or circumstances indicate that a child’s

basic needs are unmet?” and “What harm or threat of

harm may have resulted?” Answering these questions

requires sufficient information to assess the degree to

which omissions in care have resulted in significant

harm or significant risk of harm. CPS caseworkers

alsomustmaketheir determination ofwhether neglect

has occurred based on State or local statutes. Unlike

the other forms of maltreatment, this determination

may not be reached by examining one incident; the

decision often requires considering patterns of care

over time. The analysis should focus on examining

how the child’s basic needs are met and on identifying

situations that may indicate specific omissions in care

that have resulted in harm or the risk of harm to the

child.197

Community service providers and others in the field

have expressed concern that CPS agencies screen out

many neglect cases during investigations because

circumstances have not yet met the CPS threshold for

neglect. By the time these families at risk for neglect

are served by CPS, they often have acute and chronic

needsthatrequirelong-terminterventionand aremore

likely to experience recurrences of child maltreatment

than abusive families.198 These conditions point to

the need for effective ways to target and serve atrisk families as soon as they are identified with risks

that could lead to child neglect. When conducting

an initial assessment or investigation, a caseworker

should note whether a child has unmet physical and

medical needs and if there is a lack of supervision.

Providing Services to At-risk Families with Unsubstantiated Cases

Some States have found creative ways to provide services to families with unsubstantiated cases of

maltreatment. The following are a few examples:

Create a third dispositional category. Some States offer a third category for cases in addition to

substantiated and unsubstantiated, such as “inconclusive” or “unable to determine.” This allows at-risk

families to receive some supportive services that they might not have access to otherwise.

Employ an alternative response model. In these models, which are sometimes called “dual track,”

“multiple response,” or “flexible response” models, cases are divided into low-risk and high-risk categories

during intake. Cases that are low-risk follow a service-oriented track, while cases that are high-risk follow

the regular investigative track. Agency staff then can focus most of their time on investigating high-risk

cases, and voluntary services can be offered to low-risk cases. 

Use volunteers. In many cases that are deemed low-risk, well-trained volunteers could adequately provide

services to families. An additional benefit of using volunteers is that they may seem less threatening or

stigmatizing than CPS caseworkers. Although training and resources for volunteers may be costly at first,

the use of volunteers often proves to be cost-effective in the long run.195
Child Neglect: A Guide for Prevention, Assessment, and Intervention 47

Unmet Physical and Medical Needs

Affirmative answers to any of the following questions

may indicate that a child’s physical or medical needs

possibly are unmet:

Havethe parents or caregiversfailed to providethe

child with needed care for a physical injury, acute

illness, physical disability, or chronic condition?

Have the parents or caregivers failed to provide

the child with regular and ample meals that meet

basic nutritional requirements or havethe parents

or caregivers failed to provide the necessary

rehabilitative diet to a child with particular health

problems?

Have the parents or caregivers failed to attend

to the cleanliness of the child’s hair, skin, teeth,

and clothes? It is difficult to determine the

difference between marginal hygiene and neglect.

Caseworkers should consider the chronicity,

extent, and nature of the condition, as well as the

impact on the child.

Does the child have inappropriate clothing for

the weather? Caseworkers should consider the

nature and extent of the conditions and the

potential consequences to the child. They also

must take into account diverse cultural values

regarding clothing.

Does the home have obviously hazardous physical

conditions (exposed wiring or easily accessible

toxic substances) or unsanitary conditions (fecesor trash-covered flooring or furniture)?

Does the child experience unstable living

conditions (frequent changes of residence or

evictions due to the caretaker’s mental illness,

substance abuse, or extreme poverty)?

Do the parents or caregivers fail to arrange for a

safe substitute caregiver for the child?

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Have the parents or caregivers abandoned the

child without arranging for reasonable care and

supervision?199

Home accidents pose a significant risk to young

children and often occur because of a lack of

supervision. More than 90 percent of all fatalities and

injuries to children younger than 5 years of age can

be attributed to accidents within the home.200 Since

almost all accidents are preventable, an evaluation of

hazardous home conditions is essential to ensure a

safe environment for children. The Home Accident

Prevention Inventory is a useful tool for a household

safety assessment. In situations where an occurrence is

clearly determined to be an accident, involvement with

CPS is minimal or nonexistent. Resources in most

communities can help these families. A parenting

class, informational pamphlet, instructional video, and

other educational materials can help parents identify

and remove hazards or place them out of reach.201

Exhibit 5-2 lists common home accident hazards.

Practitioners should basetheir assessments on relevant

theory and research and consider possible underlying

causes of inadequate care. What would explain a very

dirty house? Is the parent in poor physical health? Is

he or she overwhelmed by too many young children?

Is the parent depressed and unable to respond,

uncertain about what is needed, or resentful toward

the child? Assessing the detailed circumstances and

behaviors within the widest possible context will help

ensure a successful intervention plan.202

Lack of Supervision

While State statutes vary, most CPS professionals

agree that children under the age of 8 who are left

alone for any substantial amount of time are being

neglected.203 In determining whether neglect has

occurred, the following issues should be considered:

The child’s age, physical condition, mental

abilities, coping capacity, maturity, competence,

knowledge regarding how to respond to an

emergency, and feelings about being alone.

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 48 Assessment of Child Neglect

The type and degree of indirect adult supervision.

For example, is there an adult who is regularly

checking in on the child?

The length of time and frequency with which the

child is left alone. Is the child being left alone all

day, every day? Is he or she left alone all night?

The safety of the child’s environment,

neighborhood, and home.205

Distinguishing Risk and Safety Assessments

Assessing risk differs from assessing safety. A risk 

assessment is the collection of information to determine

the degree to which a child is likely to be abused or

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neglected in the future. A safety assessment involves the

identification and evaluation of the imminent risk of

harm regarding the specific vulnerability of a child.206

Depending on where they fall on a continuum of

severity and chronicity, factors are typically relevant

to both risk and safety assessments. Caseworkers

should work with families to develop an effective and

accomplishable safety plan. This is usually an in-home

or out-of-home service strategy created after the initial

assessment or investigation that specifically addresses

and manages risk of harm.207 In addition, risk and

safety assessments should be ongoing throughout the

life of the case, not just during the initial assessment.

Exhibit 5-3 lists some of the types of information

collected in risk and safety assessments.

Exhibit 5-2

The Home Accident Prevention Inventory204

Poison by Solids and Liquids

Medicines

Detergents and cleaners

Polishes and waxes

Alcoholic beverages

Beauty products

Insecticides and pesticides

Paints and stains

Solvents and thinners

Glues and adhesives

Petroleum products

Fertilizers and herbicides

Poisonous house plants

Fire and Electrical Hazards

Combustibles

Fireplaces without screens

Outlets or switches (without plates)

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Suffocation by Objects

Plastic bags

Crib or blind cords

Ingestible small objects

Sharp and Dangerous Objects

Firearms

Kitchen knives and utensils

Falling Hazards

Balconies

Steps

Windows

Drowning Hazards

Bathtubs and sinks

Buckets

Pools

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Child Neglect: A Guide for Prevention, Assessment, and Intervention 49

Family Assessment Process

The family assessment is a comprehensive process for

identifying, considering, and weighing factors that

affect the child’s safety, permanency, and well-being.

It is designed to gain a greater understanding about

the strengths, needs, and resources of the family. The

assessment should be conducted in partnership with

the family to help parents or caregivers recognize

and remedy conditions so that children can be safe

and the risk of neglect can be reduced. Family

assessments must be individualized and tailored to

the unique strengths and needs of each family. When

possible and appropriate, this assessment also should

be undertaken through family decision-making

meetings and other means designed to involve the

extended family and support network.209 

Conduct the Initial Assessment

In theinitial information-gathering part ofthe process,

the caseworker should ask the following questions to

inform the assessment:

What are the risk factors and the needs of the

family that affect safety, permanency, and wellbeing?

What are the results of neglect that affect safety,

permanency, and well-being?

What are the individual and family strengths?

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Exhibit 5-3

Risk and Safety Assessment Information208

Neglect and Other Maltreatment Child

Caregiver actions and behaviors responsible for

the neglect

Duration and frequency of the neglect

(chronicity of neglect)

Physical and emotional manifestations in the

child (severity of neglect)

Caregiver’s attitude toward the child’s

condition and the assessment process

Caregiver’s explanation of the events and

effects of the maltreatment

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Developmental level

Physical and psychological health

Current functioning

Child’s explanation of events and effects, if

possible and appropriate

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Family Functioning Parents and Caregivers

Power and issues of control within the family

Interactions and connections with others outside

the family

Quality of relationships

Problem-solving ability

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Current functioning

Relationships outside the home

Financial situation

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What do the family members perceive as their

needs and strengths?

What must change in order for the effects of

neglect to be addressed and therisk of neglect and

other maltreatment to be reduced or eliminated?

What is the parent or caregiver’s level of readiness,

motivation, and capacity for change to ensure

safety, permanency, and family well-being?210

CPS caseworkers need sensitive interviewing and

analytic skills to engage the family in a partnership,

to gather and organize the information, to analyze

and interpret the meaning of the information, and to

draw accurate conclusions based on the assessment.

To accomplish the purposes of the family assessment,

caseworkers should:

Review the initial assessment or investigation

information;

Begin to develop a family assessment plan;

Conduct thefamily assessment by interviewing all

members of the household and other individuals

the family identifies as having an interest in the

safety and well-being of the child;

Consult with other professionals as appropriate;

Develop a safety plan, if necessary;

Analyze information and make decisions.211

Review the Initial Assessment or Investigation

Information

Based on the information obtained in the initial

assessment or investigation, the caseworker should

develop a list of issues to address during the family

assessment process. The following questions are

examples of areas that the caseworker typically will

want to examine:

What was the nature of the neglect (type, severity,

chronicity)?

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What was the family’s understanding of the

neglect?

Which risk factors identified during the initial

assessment or investigation are most influential?

What is the child’s current living situation with

regard to safety and stability?

Was a safety plan developed? What has been the

family’s response to this plan?

What is currently known about the parent or

caregiver’s history? Are there clues that suggest

that further information about the past will

help explain the parent or caregiver’s current

functioning?

What is known about the family’s social support

network? Who else is supporting the family?

Who will be available on an ongoing basis for the

family to rely on? What weak linkages might be

strengthened to offer more support?

Are there any behavioral symptoms observed in

the child? How has the child functioned in school

and in social relationships? Who else may have

information about any behavioral or emotional

concerns?

Have problems been identified that may need

further examination or evaluation (drug or

alcohol problems, domestic violence, psychiatric

or psychological problems, health needs)?

What additional information about the family

will help provide an understanding of the risk

and protective factors related to the potential of

continued neglect?212

Develop a Family Assessment Plan

Based on the areas identified through the review,

the caseworker should consider the following when

developing a plan for how the family assessment

process will occur:

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Child Neglect: A Guide for Prevention, Assessment, and Intervention 51

When will the first meeting be held with the

family?

How often will meetings with the family occur?

Where will meetings be held?

Will the services of other professionals be needed

(for psychological tests or alcohol or other drug

abuse assessments)?

Who will be involved in each meeting? Are there

other persons (friends, extended family, other

professionals) who have critical information

about the needs of this family? How will they be

involved in the process?

What reports may be available to provide

information about a particular family member or

the family as a system (from school or health care

providers)?

When will the information be analyzed and a

family assessment summary completed?

How will the caseworker share this information

with the family?213

Conduct the Family Assessment

Oncethe plan for the assessment has been established,

the caseworker conducts interviews with the child

and family to determine their treatment needs. Three

types of meetings are usually held:

Meeting with the family. If possible, and if it

is safe for all family members, the caseworker

should:

Meetwith theentirefamily in an introductory

session to begin the family assessment;

Attempt to gain an initial understanding of

thefamily’s perception of its current situation

and of the agency;

Bespecific with thefamily about the purposes

of the family assessment;

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Address mutually identified problems that

increase the risk of future child neglect. 

To gainabetterunderstanding offamilydynamics,

at least one assessment meeting beyond the

introductory session should be conducted with

the entire family to observe and assess their roles

and interactions. 

Meetings with individual family members.

Meetings with individual family members,

including the children, should be held, if possible.

They are not interrogations; the caseworker

is trying to understand the person and the

situation better. The caseworker should attempt

to obtain family members’ perceptions about

family strengths and how they can be enhanced

to reduce the risk of neglect. In interviews with

the children, the emphasis will likely be on

understanding more about any effects of neglect.

In interviews with the parents, the emphasis is on

trying to uncover the causes for the behaviors and

conditions that present risk, as well as to obtain

the parents’ perceptions of their problems. 

Meeting with the parents or caregivers. When

working with families with more than one adult

caregiver, the caseworker should arrange to hold

at least one of the meetings with all the adults

together, if it is possible and safefor them. During

this interview, the caseworker should observe

and evaluate the nature of the communication;

consider and discuss parenting issues, aswell asthe

health and quality of their relationship; and seek

each adult’s perception of the problems, current

situation, and family. The caseworker should be

alert to signs that could indicate the possibility

of spouse abuse and avoid placing any adult in

a situation that could increase the risk of harm,

such as referring to previously disclosed sensitive

information. As appropriate or if requested,

the caseworker also may provide referrals for

additional resources or services, such as a contact

for the local domestic violence victims advocate

or shelter, to clients.214

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 52 Assessment of Child Neglect

Consult Other Professionals

While the CPS caseworker has primary responsibility

for conducting the family assessment, other

community providers frequently may be called upon

to assist when there is a specific client condition or

behavior that may require additional professional

assessment. For example:

The child or parent exhibits an undiagnosed

physical health problem or the child’s behaviors

or emotions do not appear to be age-appropriate

(hyperactivity, excessive sadness and withdrawal,

chronic nightmares, or bed wetting);

The parent exhibits behaviors or emotions that

do not appear to be controlled, such as violent

outbursts, extreme lethargy, depression, or

frequent mood swings;

The child or parent appears to have a chemical

dependency.216

A good way to judge whether outside referrals are

needed is to review the gathered information and to

assess whether significant questions still exist about

therisks and strengths in this family. Sometimes other

providers contributeto the assessment process because

of their role as advocates for the child. For example, if

the juvenile or family court is involved, the child may

•

•

•

have a Guardian ad Litem (GAL) or court-appointed

special advocate (CASA) who advises the court on

needed services based on interviews conducted with

the child and family members.217

Analyze Information and Make Decisions

To individualize the response to a particular child and

family, the caseworker identifies the critical risk factors

by examining the information in terms of cause,

nature, extent, effects, strengths, and the family’s

perception of the neglect. The caseworker and family

then should identify the necessary changes, translate

them into desired outcomes, and match the outcomes

with the correct intervention to increase safety, wellbeing, and permanency for the children.218 

Structured Assessment Measures

Each source of data regarding a child’s neglect may

provide different findings. Research has pointed

to some of the limitations of CPS case records and

caseworkers as sources of information for neglect

definitions.219 

Use of standardized assessment measures will increase

the validity and reliability of assessments. These

measures attempt to establish the minimal parenting

Father Involvement and the Child and Family Services Reviews

The 1994 amendments to the Social Security Act mandated the development of regulations to review

States’ child and family services. In response, the Children’s Bureau developed and implemented the Child

and Family Services Reviews (CFSRs), a results-oriented, comprehensive monitoring system designed to

assist States in improving outcomes for the children and families they serve. As noted in the CFSRs, a

common challenge with respect to child well-being was a lack of father involvement in case planning. The

findings show that child welfare systems were often not making adequate efforts to establish contact with

fathers, even when fathers were involved with the family. Additionally, agencies were less likely to assess

the needs of fathers, to search for paternal relatives as possible placements or for other involvement, or

to provide fathers with services than they were with mothers.215 Also, if the mother was not contacted,

then the father was also not likely to be contacted. In general, child welfare agencies recognize this lack

of involvement and are working to address the issue primarily through initiating changes in policies,

protocols, and practice guidelines.
Child Neglect: A Guide for Prevention, Assessment, and Intervention 53

standards, which, if not met, constitute evidence of

neglect. The focus on minimal adequacy stems from

the culture’s concern about intervening in matters

of individual and family autonomy. The concept

of minimally adequate parenting implies that there

may be dimensions of parenting or child care which

are essential, that proficiency in parenting falls along

a continuum of each dimension, and that parenting

adequacy begins to be questionable at some points or

within some range of that continuum.222 Dimensions

that may be more difficult to quantify along a

continuum would include adequacy of affection and

emotional support. Other dimensions usually are

easier to quantify, such as money management and

providing sufficient food, shelter, and clothing for the

child.

An assessment tool that shows promisefor determining

the possible existence of neglect is the Neglect Scale,

an easy-to-administer, retrospective, self-report

measure that can be administered to diverse client

populations.223 Other standardized clinical assessment

measures include observational measures (Family

Assessment Form, Child Well-being Scales, Home

Observation for Measure of the Environment) and

self-report measures (Family Functioning Style Scale,

Family Needs Scale, Support Functions Scale).

Cultural Competence in Assessment

By increasing their knowledge about the culture, beliefs, and child-rearing practices of their clients, CPS

caseworkers can increase their awareness and appreciation of cultural differences while accepting that some

cultural practices may be harmful to the child. Recognition of differences among related cultural groups will

help guard against misplaced assumptions about the risk and protective factors in the child’s environment. 

For example, the cultural values, beliefs, and practices within the Latino culture are not necessarily the same

for Mexican Americans, Cuban Americans, and Puerto Rican Americans. 

Parental motives cannot simply be categorized as intentional or unintentional, but also must be considered

in a cultural context. For example, immigrant parents sometimes do not use car seats because they believe

their babies will feel abandoned if not held in their parents’ arms. Nevertheless, the law requires the use of

car seats to protect children from potential harm.220

In deciding whether a cultural practice is potentially harmful to a child, the following questions can foster a

culturally sensitive consideration of the issue of neglect:

What exactly is the practice?

Is it safe?

Is actual or potential harm involved?

Is there a significantly better option?

Are there potentially harmful implications of deviating from the cultural practice?

Have the child’s basic needs not been met?

Is it against the law?221

•

•

•

•

•

•

•
 54 Assessment of Child Neglect

For more information on assessment, see A Coordinated Response to Child Abuse and Neglect: The Foundation 

for Practice and Child Protective Services: A Guide for Caseworkers at http://www.childwelfare.gov/pubs/

usermanual.cfm.

For more information on these instruments, see:

Neglect Scale: http://pubpages.unh.edu/~mas2/NS7A.htm

Family Assessment Form: http://www.srpublications.com/socialwork/Family-Assessment-Form.htm

Child Well-being Scales, Home Observation for Measure of the Environment: http://www.family.

umaryland.edu

Family Functioning Style Scale: http://www.childwelfare.gov/preventing/programs/whatworks/

familyconnections.cfm

Family Needs Scale: http://www.clas.uiuc.edu/special/evaltools/cl00950.html

Support Functions Scale: http://www.acf.hhs.gov/programs/opre/ehs/perf_measures/reports/

resources_measuring/res_meas_phiu.html.

•

•

•

•

•

•
Child Neglect: A Guide for Prevention, Assessment, and Intervention 55

The goal of the initial prevention or intervention

should be to address safety and other emergency

needs and to increase the caregiver’s readiness for

change-oriented practices or behaviors. By the time

families experiencing neglect come to the attention

of CPS agencies, they often have acute and chronic

needs that require long-term intervention. These

families are significantly more likely to experience

recurrence of child neglect than abusive families. In

some CPS agencies, families experiencing neglect are

given less priority than those dealing with physical or

sexual abuse, even though their risk of recurrence may

be particularly high. 224 

Effective ways must be found to target and serve

these at-risk families as soon as they are identified to

minimize risks that could lead to child neglect and

abuse. This chapter discussesthe principles comprising

the foundation of prevention and intervention, their

theoretical framework, and key steps in implementing

their practice. Examples of successful interventions

are also presented.

Principles for Effective Prevention and

Intervention

Efforts targeting single risk factors may be as effective

in preventing neglect and its recurrence as programs

that are individualized and offer multiple services.225

Either way, services must be based on principles

that empower families, build upon strengths, and

respect cultural diversity. The following are some

Chapter 6

Child Neglect Prevention

and Intervention

The Importance of Receiving Services at an Early Age

Programs that promote a positive and responsive parent-child relationship are desirable as prevention and

intervention strategies. Optimally, parents can be assisted when their children are very young and thefamilies

are not yet presenting serious child behavior problems. Chances for better parent-infant relationships are

improved, and the likelihood of child neglect is diminished.226 The intensity of interventions required for

children to catch up is expensive and unlikely to be available. For children of families living in poverty,

the support needed for proper development often exceeds what their parents can provide. These children

may benefit from quality child care or preschool settings, such as Head Start, a component not typically

considered in most interventions for neglected children. These center-based programs can offer the parent

respite from child care and teach the child communication and problem-solving skills that may buffer the

child from some effects of neglect.227
 56 Child Neglect Prevention and Intervention

basic principles for practitioners who intervene with

families when children’s basic needs are unmet:

Have an ecological-developmental framework. As

discussed in Chapter 5, Assessment of Child Neglect,

neglect may be viewed within a system of risk and

protective factors interacting at multiple levels,

including the individual, the family system, and the

larger social system. To be mosteffective, intervention

should be directed at these multiple levels, depending

on the specific needs of the family. Examples include

affordable child care, education and employment

opportunities, low-income housing, and large-scale

drug prevention and treatment initiatives.

Understand the importance of outreach and

community. Because families experiencing neglect

tend to be poor, socially isolated, and lacking access

to resources, interventions must include aggressive

outreach and be designed to mobilize concrete formal

and informal helping resources. Since in-office, oneto-one counseling by professionals often has proven

to be ineffective with families experiencing neglect,

services provided in the home and within the local

community areessentialto understand thefamily in its

daily environment. It must be a collaborative process

between the family and community in which people

plan and carry out goals together for strengthening

their neighborhood.228

Carry out a comprehensive family assessment.

Caseworkers should conduct an assessment to

determine the type of neglect that has occurred and

its contributing causes (e.g., the child’s parent has

a substance abuse problem or the child lives in a

dangerous neighborhood). Whenever possible, the

caseworker should include other service providers in

the assessment. A comprehensive assessment can be

made using standardized clinical measures of risk and

protective factors, as well as by assessing parenting

attitudes, knowledge, and skills.229 (See Chapter 5,

Assessment of Child Neglect, for more information.)

Establish a helping alliance and partnership

with the family. This is one of the most important

principles for effective intervention. It may be a

challenge, however, because many caregivers with

neglect problems tend to have difficulty forming and

sustaining interpersonal relationships. By attending

to the communication styles of family members, the

caseworker is more likely to engage the family in an

active partnership, thereby helping the family develop

communication skills and build more sustaining

relationships with others.230

Utilize an empowerment-based practice. Teaching

families how to manage the multiple stresses and

conditions of their lives effectively empowers family

members to solve their own problems and to avoid

dependence on the social service system. The role of

the helper becomes one of partner, guide, mediator,

advocate, and coach.231

Emphasize family strengths. A strengths-based

orientation addresses problems, helps build on a

family’s existing competencies, and promotes healthy

functioning of the family system. The intervention

enables caregivers to meet the needs of family

members who then will be better able to have the

time, energy, and resources for enhancing the wellbeing of the family.232

Develop cultural competence. Risk and protective

factors for child neglect may differ according to

race and ethnicity. Because minority families are

disproportionately represented in the child welfare

system and neglect cases represent more than onehalf of the caseload of child welfare agencies, it is

imperative to increase the cultural competence of

service providers. Cultural competency requires

acceptance of and respect for differences, diversity

of knowledge and skills, and adaptation of services

to fit the target population’s culture, situation, and

perceived needs.233

Ensure developmental appropriateness.

Practitioners must consider the developmental

needs of the children, the caregivers, and the family

as a system in their assessments and intervention

strategies. Children whose physical and emotional

needs have been neglected often will suffer significant

developmental delays. Ifthe caregivers are adolescents,
Child Neglect: A Guide for Prevention, Assessment, and Intervention 57

they may have difficulty assuming parental roles

and responsibilities. The family system also may be

stressed when the family includes caregivers across

generations.234

Theoretical Frameworks and Approaches

The preceding principles of neglect prevention suggest

that when risk factors are present, community groups

or other agencies can assist families to reduce risk and

to strengthen protective factors, thereby preventing

future incidences of child neglect. Effective programs

focus on developing basic problem-solving skills,

providing for the family’s concrete needs, teaching

behavior management strategies, and addressing

environmental factors.235 Specific interventions

should be matched to address the most pressing

needs of each individual family member and to target

individualized family outcomes. 

Within a single case of neglect, multiple approaches

and models may be employed depending on the

family members, the circumstances surrounding the

neglect, and local and agency practice standards.

Additionally, these approaches and models are not

mutually exclusive; the strategies employed in each

approach or model may overlap. 

Differential Response Strategies

Reliance on an authoritative, investigative response is

not appropriatefor many families, but this is often the

only means of entry into the child welfare system of

services. Traditional services often have been criticized

as being too invasive and focused on severe problems

while not providing enough services to children at

low or moderate risk of maltreatment.236 In response

to this concern, some States have implemented a

differentialresponsesysteminwhich only familieswith

the most serious maltreatment or those at the highest

risk are subject to a mandatory CPS investigation.

Other families with less serious maltreatment and

who are assessed at low or moderate risk receive a

voluntary family assessment and a preventive servicesoriented response. Instead of an investigation that

concentrates on determining whether maltreatment

has already occurred, the assessment focuses on

what might happen in the future and on what types

of interventions will best meet the needs of specific

families. 

Exhibit 6-1 lists appropriate responses to families

who are assessed by practitioners as being at mild,

moderate, or severe risk for experiencing neglect,

as well as the individuals responsible for providing

services.

This dual-track or multiple-response approach

provides greater flexibility to respond differentially,

considering the children’s safety, the degree of risk

present, and the family’s need for support services.

For example, in cases of severe abuse and neglect or

of criminal offenses against children, an investigation

will commence. In less serious cases where the

family may benefit from community services, a

comprehensive assessment will be conducted so that

the family’s strengths and needs can be matched with

the appropriate community services. States that

have implemented differential response systems have

shown that a majority of cases can be handled safely

through an approach that emphasizes service delivery

and voluntary family participation, as well as the factfinding of “traditional” CPS investigations.237

Child-centered Strategies

The focus of child-centered strategies is on providing

children at risk of, or already experiencing, neglect

with necessary services to ensure their safety and

to provide them with the skills and support to

overcome maltreatment successfully. Child-centered

interventions include pediatric care, mentoring,

or behavioral and mental health treatment. For

younger children, preschool interventions, such as

parent-child educational play and Early Head Start,

may be considered. Programs fostering an open and

educational climate are helpful for middle-school

children and can help them enhance self-control,
 58 Child Neglect Prevention and Intervention

develop communication and problem-solving skills,

and learn how to resist negative social influences.239

Parent-centered Strategies 

The focus of parent-centered strategies is on enabling

caregivers to meet the needs of all family members,

including themselves, in a balanced way, providing

parentswith theresourcesto ensurethesafety andwellbeing of the family. Strategies focus on the enduring

and underlying protectivefactors, along with therisks,

to optimize a match of interventions. Examples that

show promise in improving parenting skills and the

parent-child relationship include parenting education

programs, such as Parents as Teacher and Parents and 

Children Together (P.A.C.T.), and treatment programs

that address problems such as depression, substance

abuse, and domestic violence.240

Family-centered Strategies

Family-centered strategies involve parents, children,

and other members of the family system, where

appropriate. Coordination of multiple service

providers, as well as faith- and community-based

organizations, may be needed to support a family’s

various needs. Family-centered strategies focus on

enhancing parenting skills and helping familiesrecover

from neglect. CPS caseworkers work with the family

by training parents in behavioral and social skills,

setting short-term goals with clearly defined action

steps, providing in-home teaching and skills training

to parents to improve parent-child interactions, and

teaching home management skills.

Neglectful families often showhigh rates ofrecidivism.

In-home instruction is often the best strategy to

prevent recurrence and is also a successful strategy

for working with families at risk for neglect. Parents

tend to respond positively to the more personalized,

outreach nature of the home-visitor approach.241

While providing in-home instruction, caseworkers

can teach behaviors that encourage attachment,

appropriate feeding and child care practices, infantExhibit 6-1

Possible Responses to Families238

Types of Cases Responses Suggested Organizations Responsible

Mild Risk Early intervention, family support, formal

or informal services, parent education,

housing assistance, community neighborhood

advocacy.

Community programs

Moderate Risk Appropriate formal services, coordinated

family support, safety plans, community

support services.

CPS and community programs

Severe Risk Intensive family preservation or reunification

services, child removal, court-ordered services,

foster care, adoption, criminal prosecution.

CPS and law enforcement

For more on parent-centered and other strategies,

see Emerging Practices in the Prevention of Child 

Abuse and Neglect at http://www.childwelfare.

gov/preventing/programs/whatworks/report/.
Child Neglect: A Guide for Prevention, Assessment, and Intervention 59

toddler stimulation, successful money management,

and proper nutrition. Providing information related

to child development characteristics and capabilities

is an important element of many in-home services.

When possible, training should be provided during

subsequent pregnancies for high-risk families and

during the postpartum period.242

Utilization of Concrete Resources 

The lack of concrete resources and the stress of

poverty that come from living in neglected and unsafe

neighborhoods are risk factors for neglect. Helping

families access concrete resources is often essential

before they can deal with other factors in their lives

that may affect the care of their children. Examples

of concrete resources include housing; emergency

financial, food, and energy assistance; affordable and

quality child care; transportation; home management

assistance; and free or low-cost medical care. These

resources are needed to help families move beyond

mere survival to optimal functioning.243

Utilization of Social Supports

As discussed in Chapter 4, Risk and Protective 

Factors, parents who experience loneliness, lack social

support, and are socially isolated may be more prone

to neglecting their children than families who have

a strong network of social supports. Building social

supports can serve as a means of stress prevention as

well as a stress buffer. Being in the company of others

can enhance self-esteem, provide a sense of belonging,

improve access to healthy role models, and provide

incentives to comply with social norms.244

Social support interventions include any activities or

programs that address social isolation, loneliness, or

other deficits in the social network of families. Social

supports provide the following:

Emotional support through affirmation,

compassion, and empathy;

•

Feedback, advice, encouragement, and guidance

in coping with demands such as managing

emotional stress and child rearing;

Access to information, services, and material

resources and assistance (neighbors and friends

may provide advice about schools and child care

or donate needed items, such as clothing or a car

seat);

Assistance in learning new job skills, making

home repairs, managing household needs, and

creating financial plans using an informal social

network of neighbors, friends, and workplace

colleagues.245

Research suggests that social support interventions,

in combination with casework and case management

services, are effective in improving the functioning of

neglectful families.246 Social support interventions

must be managed carefully to maximize the

advantages of the support while minimizing potential

disadvantages. Excessive social support may not only

foster dependency in the recipient, but also increase

feelings of indebtedness or the need to reciprocate. 

Sometimes those offering emotional support find it

difficult to challenge the recipient’s behavior (e.g.,

substance abuse).247 It is crucial for CPS, as well

as community- and faith-based groups, to provide

assistance to the support network of troubled families

to prevent their exhaustion and burnout. Working

in teams on home visitations has been effective in

“supporting the supporters,” while organizing mutual

support groups may provide much needed assistance

for the informal support network.248 

Utilization of Community Services

Both informal and formal provision of community

services can help reduce family stresses that can

contribute to child abuse and neglect. To be

effective, social support needs to be integrated with

community services, such as social skills training,

home-based family interventions, emergency

assistance, parenting education, intensive therapy,

•

•

•
60 Child Neglect Prevention and Intervention

and, in some cases, substance abuse treatment.

CPS typically is the lead agency in coordinating

communication between various parties and services

within the community. Other professionals involved

in community prevention and intervention efforts

include law enforcement, educators, early child

care providers, health care providers, mental health

professionals, legal and judicial system professionals,

substitute care providers, the faith community,

community organizations, support services providers,

and other concerned citizens. Integration of these

service systems and providers will help ensure that

families can be supported appropriately across their

developmental life span.249

Assistance programs are most likely to succeed when

they provide an array of benefits to the general

population so that recipients are not stigmatized by

identification with the program. If this is not possible,

assistance can be incorporated into programs that

target a wide-ranging population. Contracting with

community-based services can help meet the needs of

children and families within their own neighborhood,

reducing the amount of time and burden on families

who otherwise may need to travel long distances to

receive such services. Community-based programs

also attempt to do the following:

Prevent the accumulation of risk factors;

Focus on resilience and adaptation;

Facilitate active involvement of parents, children,

and others;

Ensure sufficient services to at-risk populations;

Provide timely, careful, and expert evaluation,

assessment, and follow-up services;

Build safe environments to permit families

to establish structure, routines, rituals, and

organization.250

Examples of community service strategies include:

Public assistance programs offering job

training, subsidized child care, and nutritional

•

•

•

•

•

•

•

support (e.g., the Special Supplemental Nutrition

Program for Women, Infants, and Children

[WIC] program).

Schools providing social support through

programs, such as Head Start, that incorporate

parental involvement into early childhood

education, or after-school programs that provide

social and educational assistance, peer counseling,

and tutoring as well as social support to children

with special needs.

Faith-based and community organizations and

recreational groups offering a variety of services

to assist high-risk families, including community

food pantries, clothing, soup kitchens, and

recreational and related activities.

In-home assistance in which formal helpers

provide families with the opportunity to consider

each person’s viewpoint on family problems and

the development of new modes of interaction.251

Cognitive-behavioral Interventions 

Cognitive-behavioral interventions use behavior

modification techniques in individual therapy sessions

with caregivers who have neglected. They include:

Verbal instruction—providing information

about appropriate child care;

Social skills training—demonstrating methods

for managing child care tasks;

Stress management—teaching relaxation

techniques or cognitive coping skills;

•

•

•

•

•

•

For more detailed information on the roles and

responsibilities of various service providers within

the community, see A Coordinated Response to Child 

Abuse and Neglect: The Foundation for Practice at

http://www.childwelfare.gov/pubs/usermanual.

cfm.
Child Neglect: A Guide for Prevention, Assessment, and Intervention 61

Cognitive restructuring—replacing selfdefeating thoughts with beliefs and behaviors

that lead to improved functioning.

These techniques are especially useful with neglectful

families if they target both the environment and

the individual. For example, Project STEEP (Steps

Toward Effective, Enjoyable Parenting), which was

developed at the University of Minnesota, is an

intensive, individual, in-home counseling and group

interventionprogramthatseekstochangenegativeselfperceptions and to break the intergenerational cycle

of maltreatment. (For more information on Project

STEEP, go to http://education.umn.edu/ICD/

harriscenter/STEEPinfo.htm.) Project SafeCare uses

an ecobehavioral approach and reports improvements

in nutrition, home cleanliness, personal hygiene, and

identifying and reporting children’s illnesses.253 (For

moreinformation about Project SafeCare, visit http://

www.friendsnrc.org/downloads/05ConfPres/

Fidelity.pdf or http://www.cdc.gov/ncipc/pubres/parenting/ChildMalT-Briefing.pdf.)

The following examples are cognitive-behavioral

methods for addressing child neglect that have been

• shown to improve home safety, affective skills for the

parents, and infant development stimulation.

Home safety. Hazardous physical environments

increase a child’s risk of injury from accidents and

from highly stressed parents who may become

physically abusive while trying to prevent a child

from injuring him or herself from a household

hazard. A safety assessment can be followed by

personalized training and educational activities.

These activities may include audiovisual

presentations of how to resolve safety hazards, use

of self-feedback stickers, and printed guidelines

(e.g., the proper use of safety plates and electrical

tape).

Affective skills training. Parents learn positive

ways of interacting with their children, including

developing the ability to provide corresponding

physical and verbal messages, assuming an equal

position of height with the child, and actively

initiating positive, nurturing physical contact

with the child.

Stimulating infant development. Teaching

parents how to nurture infants can reduce the

•

•

•

Helping Families Accept Assistance to Meet Their Needs

Families at risk of child neglect and in need of support are most likely to regard assistance positively when

they:

Have opportunities to reciprocate (or are required to repay) the aid they receive;

Accept assistance because they perceive the need for help rather than because of external judgments of

inadequacy or incompetence;

Perceive the benefactor’s intentions as a combination of altruism and self-interest (i.e., the benefactor

has a genuine interest in the family, but also is paid or provided other benefits for helping);

Believe that the assistance comes largely from an impersonal source (e.g., agency, organization);

Regard their need for assistance as externally instigated (e.g., job layoff) rather than as stemming from

personal inadequacies;

Receive assistance in circumstances that reduce stigma (e.g., benefits widely shared by community

members);

Obtain aid in a way that does not invade privacy or limit autonomy.252

•

•

•

•

•

•

•
62 Child Neglect Prevention and Intervention

risk of developmental or emotional difficulties

with their babies. Stimulation activities include

frequent use of affectionate words and childparent interactive play.254

Systems of Care

A Systems of Care approach is a collaborative effort

on the part of service agencies to support children and

families with complex needs in an integrated manner.

Systems of Care enable cross-agency coordination

of services regardless of where or how children and

families enter the system. Agencies work strategically,

in partnership with families and other formal and

informal support systems and can address neglect

based on a family’s unique needs. This approach has

been a catalyst for changing the way public agencies

organize, purchase, and provide services. It has been

applied across the United States in various ways at

the macro level (through public policy and system

change) and at the micro level (in the way service

providers directly interact with children and families

in need of assistance). To do so effectively, agencies

participating in Systems of Care must:

Agree on common goals, values, and principles

that will guide their efforts;

Develop a shared infrastructure to coordinate

efforts toward the common goals of safety,

permanency, and well-being;

Work within that infrastructure to ensure the

availabilityofanarrayofhigh-quality,communitybased services to support families and children

safely in their homes and communities.255

•

•

•

Interventions with Special Populations

CPS and other organizations that provide neglect

prevention and intervention services serve many

special populations, including families of color and

parents with intellectual disabilities.

Serving families of color through communitybased services. In response to concerns about

the over-representation of minority children in

the child welfare system, the Children’s Bureau

sponsored an exploratory, qualitative study of

the child welfare system’s response to children

of color, specifically, African-American children.

The study identified strategies that child welfare

agencies were using or should use to meet

the needs of minority children and families.

By providing prevention services within the

neighborhood or local community to support

families before they come to the attention of

the system, it is hoped that fewer minority

children would enter the system in the first place.

Establishing strong connections with minority

communities and engaging community leaders

may help child welfare agencies collaborate

more effectively and share resources with local

agencies and organizations. This will hopefully

empower communities to find solutions to their

own problems and build an internal support

system.256 

Supporting parents with intellectual

disabilities. Parents with intellectual disabilities

often are identified as being at risk for physical

and psychological neglect of their children.

Expanded services are needed to enhance the

effects of parent education to improve parental

competencies and to reduce the risk of child

neglect and developmental or behavior problems.

•

•

For more information on minority children in the

child welfare system, see Children of Color in the 

Child Welfare System: Perspectives from the Child 

Welfare Community at http://www.childwelfare.

gov/pubs/otherpubs/children/index.cfm.

For additional information and to communicate

with other professionals about the Systems of

Care approach, visit http://www.childwelfare.

gov/systemwide/service_array/soc/.
Child Neglect: A Guide for Prevention, Assessment, and Intervention 63

Behavioral, performance-based teaching

strategies often work well with this population.

Practitioners should receive training on the

impact of intellectual disabilities on adults as well

as behavioral skills training. These techniques

includesimpleinstructions,task analysis, pictorial

prompts, modeling, feedback, role-playing, and

positive reinforcement. 

These same techniques also are effective in

teaching parenting skills to parents without

intellectual disabilities. Research has shown that

the rate of child removal dropped considerably

following interventions that increased parents’

child care skills. Furthermore, in-home services

for at-risk children that improve parenting skills

and knowledge of child development may be

more feasible and cost-effective than placing

children in specialized preschools.257 Exhibit 6-

1 summarizes various interventions that can be

used with neglected children and their families.

Key Steps in the Intervention Process

Regardless of which intervention approaches and

models are implemented, certain steps are necessary

Exhibit 6-1

Interventions for Neglect Cases258

Concrete

Support Social Support Developmental Cognitive andBehavioral Individual Family System

Housing

assistance

Emergency

financial,

food, or other

assistance

Transportation

Clothing,

household

items

Availability or

accessibility

to community

resources

Hands-on

assistance to

increase safety

and sanitation

of home (home

management

aids)

Free or low-cost

medical care

Available and

affordable

quality child

care

–

–

–

–

–

–

–

–

Individual

social support

(parent aide,

volunteer)

Connections

to faith-based

activities

Mentor

involvement

Social support

groups

Development of

neighborhood

child care and

respite care

services

Neighborhoodcentered

activities

Social

networking

Recreation

programs

Cultural

festivals and

other activities

–

–

–

–

–

–

–

–

–

Therapeutic child

care

Individual

assistance with

developmental

skills (e.g.,

parenting)

Home visits

with focus on

developmental 

needs of family

members

Peer groups

(often at schools)

geared to

developmental

tasks

Mentors

to provide

nurturing,

cultural

enrichment,

recreation, and

role modeling

–

–

–

–

–

Social skills

training

Communication

skills building

Teaching of home

management,

parent-child

interaction, meal

preparation, and

other life skills

Individual or

group therapeutic

counseling 

(e.g., regarding

childhood

history)

Parenting

education

Employment

counseling and

training

Financial

management

counseling

Problem-solving

skills training

–

–

–

–

–

–

–

–

In- and

out-patient

counseling

and

detoxification

for substance

abuse

12-Step

programs

Mental health

in-patient and

out-patient

counseling

Crisis

intervention

Stress

management

Play therapy

–

–

–

–

–

–

Home-based,

family-centered

counseling

regarding family

functioning,

communication

skills, home

management,

and roles and

responsibilities

Center-based

family therapy

Enhancing

family strengths

Building

nurturing

behaviors

Refining family

dynamics and

patterns

–

–

–

–

–
64 Child Neglect Prevention and Intervention

to make them appropriate for the needs of the child

and family, including:

Building a relationship with the family;

Developing case and safety plans;

Establishing clear, concrete goals;

Targeting outcomes;

Tracking family progress;

Analyzing and evaluating family progress.

Building a Relationship with the Family

Establishing good rapport with each family member

will help the caseworker understand the family

dynamics as well as build trust in the collaborative

process between the caseworker, family, and other

providers. When families believe their feelings and

concerns have been heard, respected, and considered,

they are more likely to be engaged in the planning

and actions necessary to change the behaviors and

conditionsthat contributetoneglect. CPScaseworkers

also should be prepared for the often emotionally

draining effect that the apathy of neglectful families

may have on professionals, volunteers, and community

paraprofessionals.259

Developing Case and Safety Plans

Interventions should be structured to increase

protective factors or to decrease risk factors identified

in the family assessment process. That information

can be used to tailor the intervention to facilitate

changes the family must make to meet a child’s basic

needs, to eliminate the risks of child neglect, and to

develop a safety plan, if needed. Flexibility is critical

in designing case plans so that they are responsive to

the family’s changing needs and resources.

The case plan that a CPS caseworker develops with a

family is its roadmap to successful intervention. The

purposes of case planning are to:

•

•

•

•

•

•

Identify strategies with the family that address

the effects of neglect;

Provide a clear and specific guide for changing

behaviors and conditions that influence risk;

Establish a benchmark to measure client progress

for achieving outcomes.260

Establishing Clear, Concrete Goals

In setting the goals of the intervention, family

members and their informal support networks

should be involved in developing plans to maximize

the chances for improving family functioning and

reducing the risk of neglect. Providing concrete,

measurable, and achievable goals with continuous

positive feedback will help families accomplish their

individualized outcomes and goals. Goals should

indicate positive behaviors or conditions that will

result from the change and not concentrate only on

reducing negative behaviors.

Once goals are identified, the next step is to break

them down into small, incremental tasks. These tasks

describe what the children, family, caseworker, and

other service providers will do and identify timeframes

for accomplishing each task. Families should be able

to understand what is expected of them and what

they can expect from the caseworker and other service

providers. Caseworkers should attempt to anticipate

potential obstacles to task performance and to devise

strategies for overcoming them.261

Targeting Outcomes

Outcomes should be targeted so that both the risks

and the effects of neglect are reduced due to changes

in the behaviors or conditions that contributed to

it. Outcomes should address issues related to four

areas—the child, the parents or other caregivers,

the family system, and the environment—and be

designed to contribute to the achievement of safety,

permanency, and family well-being.262

•

•

•
Child Neglect: A Guide for Prevention, Assessment, and Intervention 65

Child outcomes. Outcomes for children focus

on changes in behavior, development, mental

health, physical health, peer relationships, and

education. Examples of desired outcomes would

be improved behavior control (as evidenced by

managing angry impulses) or developmental

appropriateness and adjustment in all areas of

functioning (as evidenced by an improvement in

the child’s physical development within the range

of the chronological age).

Parent or caregiver outcomes. Outcomes for

parents or caregivers can focus on many areas,

such as mental health functioning, problemsolving ability, impulse control, substance abuse

treatment, and parenting skills. A sample desired

outcome would be improved child management

skills, such as establishing and consistently

•

•

following through with rules and limits for

children.

Familyoutcomes. Theseoutcomesfocusonissues

such as roles and boundaries, communication

patterns, and the level of social support received.

A sample desired outcome would be enhanced

family maintenance and safety (as evidenced by

the ability to meet family members’ basic needs

for food, clothing, shelter, and supervision).

Environmental outcomes. These outcomes

focus on factors such as social isolation, housing

issues, or neighborhood safety. A sample desired

outcome would be utilizing social supports.264

Exhibit 6-2 provides someexamples linking identified

problems to possible outcomes. 

•

•

Goals Should Be SMART

Specific—The family should know exactly what has to be done.

Measurable—Goals should be measurable, clear, and understandable so everyone knows when they have

been achieved.

Achievable—The family should be able to accomplish the goals in a designated time period given the

resources that are accessible and available to support change.

Realistic—The family should have input and agreement in developing feasible goals.

Time limited—Time frames for goal accomplishment should be determined based on an understanding of

the family’s risks, strengths, and ability and motivation to change. The availability and level of services also

may affect time frames.263
66 Child Neglect Prevention and Intervention

Exhibit 6-2

Matching Risks to Outcomes265

Risk or Problem Desired Client Outcomes

Condemned housing (no heat or running water,

children diagnosed with lead poisoning, safety

hazards for young children)

Household safety

Financial management skills

Problem-solving skills

•

•

•

Acting out behavior (refusing to listen, throwing

temper tantrums, fights with peers)

Behavioral control

Social skills

Impulse control

•

•

•

Communication problems or conflicts (domestic

violence, parent-child conflict)

Conflict management skills

Decision-making skills

Impulse control

Family functioning

•

•

•

•

Frequent moves (in and out of placement,

numerous schools, numerous caregivers)

Financial management

Problem-solving skills

•

•

Parental addiction • Recovery from addiction

Inappropriately harsh parenting, inappropriate

expectations of children

Parenting knowledge

Emotional control

•

•

Fear of expressing feelings, verbally abusive, not

recognizing feelings of others

Communication skills

Empathy

•

•

Lack of social supports Supportive linkages with sources of formal and

informal support

•

For more on outcomes and interventions, see Child Protective Services: A Guide for Caseworkers at http://

www.childwelfare.gov/pubs/usermanual.cfm.
Child Neglect: A Guide for Prevention, Assessment, and Intervention 67

Tracking Family Progress

Determining the extent and nature of a family’s

progress is central to CPS intervention. Monitoring

change should begin as soon as the intervention is

implemented and continue throughout the life of a

case until the targeted outcomes have been achieved.

Caseworkers should evaluate family progress regularly

by following these steps:

Review the case plan. Outcomes, goals, and

tasks must be written so that they can be used

to determine progress toward reducing risk and

treating the effects of maltreatment. 

Collect and organize information on family

progress. Once the case plan is established, each

contact with the children and family should focus

on assessing the progress being made to achieve

established outcomes and to reassess safety. 

Collect information from all service providers.

Referrals to service providers should clearly specify

the number, frequency, and methods of reports

expected. The caseworker also must communicate

clearly any expectations for reporting concerns,

observable changes, and family progress. It is the

caseworker’sresponsibility toensurethesubmission

of these reports and to request meetings with the

service providers, if indicated. 

Engage the child and family in reviewing

progress. Using the case plan as a framework

for communication, the caseworker should meet

with the family to review progress jointly. Family

members should be asked about their perceptions

of progress. 

Measure family progress. Change is measured

during the evaluation of family progress on two

levels. The most critical risk factors (identified

during thefamily assessment)shouldbereassessed.

The second level of measurement evaluates the

extent to which specific outcomes have been

accomplished by the family, caseworker, and

service providers.

•

•

•

•

•

Document family progress. Thorough

documentation allows the caseworker to measure

family progress between the initial assessment

and the current evaluation. This documentation

provides the basis for case decisions.266

Analyzing and Evaluating Family Progress

Once the information has been collected, the

caseworker should analyze it to help determine

progress and to decide on further actions. The

evaluation of a family’s progress should address the

following issues:

Is the child safe? Have the protective factors,

strengths, or safety factors changed, thereby

warranting the development of a safety plan or a

change in an existing safety plan?

What changes have occurred in the factors

contributing to the risk of neglect?

What progress has been made toward achieving

the case goals and outcomes? 

How effective have the services been in achieving

the outcomes and goals? Specific questions that

should be considered are: 

Have services been provided in a timely

manner?

Has the family participated in services as

scheduled? 

Has the service provider developed rapport

with the family? 

Is there a need to alter the plan of service

based on changes in the family?

What is the current level of risk in the family? 

Have the risk factors been reduced sufficiently

so that the parents or caregivers can protect their

children and meet their developmental needs,

allowing the case to be closed?

•

•

•

•

•

–

–

–

–

•

•
68 Child Neglect Prevention and Intervention

For children in out-of-home care, is reunification

likely in therequired timeframe, or is an alternate

permanency plan needed? 267

Promising Practices for Intervention

Several programs have shown promise in providing

effective interventions for reducing the risks and

effects of child neglect.

Family Connections Program

Family Connections in Baltimore, Maryland, was

designated by the Children’s Bureau as the only

nominated child maltreatment prevention program

proven effective by a rigorous evaluation (see

Emerging Practices in the Prevention of Child Abuse and 

Neglect at http://www.childwelfare.gov/preventing/

programs/whatworks/report). Family Connections

targets families with children between the ages of 5

and 11 who are considered to be at risk for child abuse

and neglect, but have no current CPS involvement.

The program promotes the safety and well-being of

children and families by identifying and developing

formal and informal supports to address each family’s

individual needs and to build upon its strengths. Staff

members work with families on problem-solving,

positive disciplinary methods, coping strategies,

developmental social supports and community

connections, and opportunities for positive family

interactions through community activities. 

• Evaluation results showed that children in 90 percent

of the at-risk families in the program served in 2000–

2001 were not suspected of being abused or neglected.

Other outcomes included:

A decrease in risk factors and an increase in

protective factors for neglect;

An increase in social support for caregivers,

caregiver satisfaction with parenting, and

appropriate parenting attitudes among

caregivers;

A decrease in caregiver stress, drug use, and

depressive symptoms;

A decrease in child behavioral problems.268

Nurse-Family Partnership

Nurse-Family Partnership (NFP) is a prenatal and

early infancy project that originated in Elmira, New

York and has been replicated in other cities. NFP

is one of the most well-known, evidence-based

programs addressing child neglect. The program

incorporated randomized clinical trials evaluating the

efficacy of intensive, nurse home-visitation during

pregnancy and the first 2 years of a child’s life. Initial

outcomes and analyses of a 15-year follow-up of

families who received home visitations indicated that,

in comparison to the control families, there was a 48

percent reduction in child maltreatment and a 59

percent reduction in arrests. Other program benefits

included better prenatal health and improved school

readiness.269 

Although this study did not specifically target

neglect, the NFP project documented that providing

professional support in difficult transition periods

for high-risk families is an effective strategy for

developing family strengths and preventing negative

outcomes. Because of the encouraging findings, the

Office of JuvenileJustice and Delinquency Prevention

of the U.S. Department of Justice made NFP part of

its “Weed and Seed” Initiative. In 1999, the National

Center for Children, Families and Communities was

•

•

•

•

While listed in a U.S. Department of Health 

and Human Services publication, a program or 

organization’s inclusion does not in any way connote 

its endorsement.

For moreinformation on Family Connections, visit

http://www.family.umaryland.edu/community

_services/fc.htm.
Child Neglect: A Guide for Prevention, Assessment, and Intervention 69

established to disseminate the program nationwide.

Currently, more than 700 nurses participate in

NFP programs with more than 13,000 families in

approximately 250 counties.270 For more information

on NFP, visit http://www.nursefamilypartnerhip.

org.

Parent Empowerment Program

In 1996, the Child Protection Center of the Division

of Community Pediatrics at Montefiore Medical

Center in New York City initiated the Parent

Empowerment Program, a social support educational

intervention targeted to socially isolated and resourcepoor teen mothers in the South Bronx. The program

included a 6-month parenting group that focused

on accessing medical services and building a social

support system. Practices considered effective in this

program included home visitation that helped build

rapport between clinicians and the young women,

a flexible parenting skills curriculum that could be

modified to meet the pressing needs of program

participants, and the provision of immediate medical

and mental health services.271 For more information

on the Parent Empowerment Program, visit http://

montekids.org/programs/cpc.

Project SafeCare

From an ecobehavioral perspective, child neglect

is best addressed within the context of the family

environment. Project SafeCare has been tested

extensively to determine the key components of

effective intervention with parents at risk of child

maltreatment. The program is a modified version of

the model, Project 12-Ways. Whereas the original

project contained 12 areas of intervention, Project

SafeCare focuses on three areas that are particularly

relevant to neglect and young parents: home safety,

infant and child health care, and bonding and

stimulation.

The model, which involves 15 weeks of intervention

with 5 weeks concentrating on each area, is conducted

on a one-on-one basis with social workers or nurses

who often use videos. Parents are given instructions,

view modeling of various skills and activities, and

practice these skills with feedback from an in-home

counselor. Since child neglect often is associated with

dangerous or unclean conditions at home, parents are

taught about safety hazards, cleanliness, and creating

a safe and clean environment for infants and children,

including the use of latches and locks. They also are

taught specific tasks, such as recognizing when a child

is ill, seeking emergency treatment, calling the doctor,

and self-treating an illness. Project SafeCare also

trains parents to increase positive interactions with

their infants or children by learning skills to structure

activities and to plan stimulating play, interactions,

and daily living activities (e.g., bathing and dressing).

Program evaluation data have consistently shown

that families served by Project SafeCare are at lower

risk for recidivism during and after treatment than

matched comparison families who also are involved

with CPS agencies and who receive services other

than Project SafeCare.272 For more information on

Project SafeCare, visit http://www.cdc.gov/ncipc/

pub-res/parenting/ChildMalT-Briefing.pdf.

Head Start, Early Head Start, and the Early Head

Start/Child Welfare Services Initiative

Head Start (HS) is designed to foster healthy

development in low-income children. Program

grantees and delegate agencies deliver a range of

services that are responsive and appropriate to each

child’s and to each family’s heritage and experience and

that encompasses all aspects of a child’s development

and learning. For moreinformation about Head Start,

visit http://www2.acf.dhhs.gov/programs/hsb.

Early Head Start (EHS) promotes healthy prenatal

outcomes, enhances the development of infants and

toddlers, and promotes healthy family functioning.

For more information about Early Head Start, visit

the Early Head Start National Resource Center at

http://ehsnrc.org/.

The Early Head Start/Child Welfare Services (EHS/

CWS) initiative provides a unique opportunity for
 70 Child Neglect Prevention and Intervention

a select group of EHS grantees, in partnership with

their local CPS, to demonstrate how to serve children

in the child welfare system best using the Early Head

Start model. The EHS/CWS initiative wasestablished

through a partnership between the Head Start Bureau

and the Children’s Bureau. The goal of EHS/CWS is

to expand the service network in local communities

so that it meets the needs of this unique population.

EHS/CSW target populations vary from site to site.

Some grantees serve infants and toddlers, while others

may target only infants or only toddlers. Programs

may also choose to focus on children in the child

welfare system who remain at home, but receive

ongoing services, children who were removed from

the home and placed in out-of-home care, or children

in the child welfare system because they are at-risk for

abuse or neglect. In addition, programs may choose

to focus on children whose parents have certain

problems, such as being incarcerated or being in a

substance abuse recovery program.

Although each grantee is developing its unique theory

of change and a locally designed evaluation, most

EHS/CWS projects are addressing outcome objectives

that include safety, permanency, and well-being for

children. Many of the grantees also have developed

evaluation plans to measure intermediate outcomes

that are expected to occur prior to these longer-term

outcomes. These include improved parenting skills,

parent-child interactions, and coping strategies for

dealing with stress.

While each of the grantees is expected to conduct

its own local evaluation and is being provided with

evaluation technical assistance, as necessary, the

Children’s Bureau is sponsoring an independent

evaluation of the initiative as well. For more

information about the EHS/CWS initiative, visit

http://www.ehsnrc.org/highlights/childwelfare.

htm.

Legal Intervention with Neglectful Families

The involvement of law enforcement and the courts occurs less frequently with neglectful families than in

cases of physical and sexual abuse and, therefore, is not always a key step. More often, the confrontation

that comes from the neglect report and the CPS investigation is sufficient to move the family toward

needed change.273 Legal intervention is sometimes necessary, however, to ensure the safety of the neglected

child and to bring about the needed changes in the family. Formal confrontation in court of the family’s

failure to meet minimally adequate standards of care may create the tension necessary to move the family

toward providing adequate care for the children. 

CPS caseworkers must balance an official, authoritative stance with a helper role, which requires the

caseworker to incorporate the use of confrontation and challenging skills with empathy and supportive

help. A neglectful family must understand that the care of its child is unacceptable, yet still be encouraged

by the caseworker’s readiness to help them improve.

In extreme cases of child neglect, when persistent intervention efforts have failed to bring about a

minimally adequate level of care, and the family’s response offers little hope of providing adequate care,

court action to terminate parental rights is necessary to free the child for adoption or other permanent

placement. Termination proceedings in court require the CPS or foster care caseworker to be prepared

with factual observations, written documentation, and witnesses, if available, to convince the court of the

wisdom and justice of this action. The presumption in most juvenile and family courts is in favor of the

rights of the biological parent. Convincing evidence must be presented to prove that parental care is less

than minimally adequate, likely to remain so, and that adoption is the least detrimental alternative for the

child.274 
Child Neglect: A Guide for Prevention, Assessment, and Intervention 71

CONCLUSION

Although child neglect is the most common type

of maltreatment, its causes, effects, prevention, and

treatment often are not as prominently discussed and

explored as are those for physical or sexual abuse.

Neglect, like other types of maltreatment, has many

contributing factors at the individual, familial, and

community levels. The complexities of neglect

present difficulties not only for an overburdened

child welfare system, but also for community- and

faith-based programs, researchers, legislators, and

other service providers. It is key, therefore, that these

groups work collaboratively to develop promising

and effective practices for preventing neglect and for

mitigating its effects on children and society. Part

of this process is providing individuals, families, and

communities with the knowledge, resources, and

services to deal with the challenges associated with

neglect. Child welfare agencies can only provide a

part of the solution. Neglect must be viewed not only

as an individual or a family problem, but also as a

community issue requiring a community response.

Child Neglect: A Guide for Prevention, Assessment, and Intervention 73

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245 Thompson, R. A. (1992). Social support and the 

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246 Gaudin, J. (1993a); Gaudin, J. M., Wodarski, J. S.,

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247 Thompson, R. A. (1995).

248 Thompson, R. A. (1995).

249 Black, M. M., & Dubowitz, H. (1999).

250 Thomlison, B. (2004).

251 Thompson, R. A. (1995).

252 Thompson, R. A. (1995).

253 DePanfilis, D. (1999). (pp. 211–236).

254 Lutzker, J. R. (1990). Behavioral treatment of child

neglect. Behavior Modification, 14(3), 301–315.

255 Child Welfare Information Gateway. (2005). The 

systems of care approach [On-line]. Available: http://

www.childwelfare.gov/systemwide/service_array/soc/

learn/approach.cfm.

256 Chibnall, S., Dutch, N. M., Jones-Harden, B.,

Brown, A., Gourdine, R., Smith, J., Boone, A., &

Snyder, S. (2003, December). Children of color in 

the child welfare system: Perspectives from the child 

welfare community [On-line]. Available: http://www.

childwelfare.gov/pubs/otherpubs/children/children.

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257 Feldman, M. A. (1998). Parents with intellectual

disabilities: Implications and interventions. In J. R.

Lutzker (Ed.), Handbook of child abuse research and 

treatment (pp. 401–420). New York: Plenum.

258 DePanfilis, D. (1999).

259 DiLeonardi, J. W. (1993). Families in poverty and

chronic neglect of children. Families in Society: The 

Journal of Contemporary Human Services, 74(9), 557–

562.

260 DePanfilis, D., & Salus, M. (2003).

261 DePanfilis, D., & Salus, M. (2003).

262 DePanfilis, D. (2000c). How do I match risks to

client outcomes? In H. Dubowitz & D. DePanfilis

(Eds.), Handbook for child protection practice (pp.

367–372). Thousand Oaks, CA: Sage.

263 Cournoyer, B. (in press). The social work skills 

workbook (4th ed.). Pacific Cove, CA: Brooks/Cole.

264 DePanfilis, D. (2000c).

265 DePanfilis, D. (2000c).

266 DePanfilis, D., & Salus, M. (2003).

267 Morton, T. (2000). When can a child be safely

reunited with his or her family? In H. Dubowitz &

D. DePanfilis (Eds.), Handbook for child protection 

practice (pp. 522–525). Thousand Oaks, CA: Sage.

268 Child Welfare Information Gateway. (2003, April).

Baltimore’s Family Connections program proven
86 Endnotes

to prevent child maltreatment. Children’s Bureau 

Express [On-line]. Available: http://cbexpress.acf.

hhs.gov/articles.cfm?article_id=633; Child Welfare

Information Gateway. (n.d.). Family Connections 

– National program replication project [On-line].

Available: http://www.childwelfare.gov/preventing/

programs/whatworks/familyconnections.cfm.

269 Nurse-Family Partnership. (n.d.). Research 

evidence [On-line]. Available: http://www.

nursefamilypartnership.org/content/index.cfm?fuseac

tion=showContent&contentID=4&navID=4.

270 Holden, E. W., & Nabors, L. (1999); U.S.

Department of Health and Human Services,

Substance Abuse and Mental Health Services

Administration. (n.d.). Nurse-family partnership 

program [On-line]. Available: http://modelprograms.

samhsa.gov/pdfs/FactSheets/NurseFP.pdf; Nurse

Family Partnership. (n.d.). NFP sites [On-line].

Available: http://www.nursefamilypartnership.org.

271 Pulido, M., & Kory, W. P. (2001). Final report 

for OCAN neglect grantees. New York, NY: Child

Protection Center, Division of Community

Pediatrics, Montefiore Medical Center.

272 Lutzker, J. R., & Bigelow, K. M. (2002). Reducing 

child maltreatment: A guidebook for parent services. 

New York, NY: Guilford; Lutzker, J. R., Bigelow, K.

M., Doctor, R. M., Gershater, R. M., & Greene, B.

F. (1998). An ecobehavioral model for the prevention

and treatment of child abuse and neglect. In J. R.

Lutzker (Ed.), Handbook of child abuse research and 

treatment (pp. 239–266). New York, NY: Plenum;

Berry, M., Charison, R., & Dawson, K. (2003). Early 

childhood. Proceedings from the Annual Meeting of

the Society for Neuroscience, New Orleans, LA.

273 Gaudin, J. (1993a).

274 Harris, J. C., & Bernstein, B. E. (1980). The lawyer

and social worker as a team: Preparing for trial in

neglect cases. Child Welfare, 59(8), 469–­477.
Child Neglect: A Guide for Prevention, Assessment, and Intervention 87

Adjudicatory Hearings – held by the juvenile and

family court to determine whether a child has been

maltreated or whether another legal basis exists for

the State to intervene to protect the child.

Adoption and Safe Families Act (ASFA) – signed

into law November 1997 and designed to improve

the safety of children, to promote adoption and other

permanent homes for children who need them, and

to support families. The law requires CPS agencies

to provide more timely and focused assessment and

intervention services to the children and families that

are served within the CPS system.

CASA – court-appointed special advocates (usually

volunteers) who serve to ensure that the needs

and interests of a child in child protection judicial

proceedings are fully protected.

Case Closure – the process of ending the relationship

between the CPS worker and the family that often

involves a mutual assessment of progress. Optimally,

cases are closed when families have achieved their

goals and the risk of maltreatment has been reduced

or eliminated.

Case Plan – the casework document that outlines the

outcomes, goals, and tasks necessary to be achieved in

order to reduce the risk of maltreatment.

Case Planning – the stage of the CPS case process

where the CPS caseworker develops a case plan with

the family members.

Caseworker Competency–demonstratedprofessional

behaviors based on the knowledge, skills, personal

qualities, and values a person holds.

Central Registry – a centralized database containing

information on all substantiated/founded reports

of child maltreatment in a selected area (typically a

State).

Child Abuse Prevention and Treatment Act

(CAPTA) – see Keeping Children and Families Safe

Act.

Child Protective Services (CPS) – the designated

social services agency (in most States) to receive

reports, investigate, and provide intervention and

treatment services to children and families in which

child maltreatment has occurred. Frequently, this

agency is located within larger public social service

agencies, such as Departments of Social Services.

Concurrent Planning – identifies alternative forms

of permanency by addressing both reunification or

legal permanency with a new parent or caregiver if

reunification efforts fail.

Cultural Competence – a set of attitudes, behaviors,

and policies that integrates knowledge about groups

of people into practices and standards to enhance the

quality of services to all cultural groups being served.

Differential Response – an area of CPS reform that

offers greater flexibility in responding to allegations

Appendix A

Glossary of Terms
88 Appendix A—Glossary of Terms

of abuse and neglect. Also referred to as “dual track”

or “multi-track” response, it permits CPS agencies to

respond differentially to children’s needs for safety,

the degree of risk present, and the family’s needs for

services and support. See “dual track.”

Dispositional Hearings – held by the juvenile and

family court to determine the legal resolution of

cases after adjudication, such as whether placement of

the child in out-of-home care is necessary, and what

services the children and family will need to reduce

the risk of maltreatment and to address the effects of

maltreatment.

Dual Track – term reflecting new CPS response

systems that typically combine a nonadversarial

service-based assessment track for cases where children

are not at immediate risk with a traditional CPS

investigative track for cases where children are unsafe

or at greater risk for maltreatment. See “differential

response.”

Evaluation of Family Progress – the stage of the

CPS case process where the CPS caseworker measures

changes in family behaviors and conditions (risk

factors), monitors risk elimination or reduction,

assesses strengths, and determines case closure.

Family Assessment – thestage of the child protection

process when the CPS caseworker, community

treatment provider, and the family reach a mutual

understanding regarding the behaviors and conditions

that must change to reduce or eliminate the risk of

maltreatment, the most critical treatment needs that

must be addressed, and the strengths on which to

build.

Family Group Conferencing – a family meeting

model used by CPS agencies to optimize family

strengths in the planning process. This model brings

the family, extended family, and others important

in the family’s life (e.g., friends, clergy, neighbors)

together to make decisions regarding how best to

ensure safety of the family members. 

Family Unity Model – a family meeting model used

by CPS agencies to optimize family strengths in the

planning process. This model is similar to the Family

Group Conferencing model. 

Full Disclosure – CPS information to the family

regarding the steps in the intervention process, the

requirements of CPS, the expectations of the family,

the consequences if the family does not fulfill the

expectations, and the rights of the parents to ensure

that the family completely understands the process.

Guardian ad Litem – a lawyer or lay person who

represents a child in juvenile or family court. Usually

this person considers the “best interest” of the child

and may perform a variety of roles, including those

of independent investigator, advocate, advisor, and

guardian for the child. A lay person who serves in this

role is sometimes known as a court-appointed special

advocate or CASA.

Home Visitation Programs – prevention programs

that offer a variety of family-focused services to

pregnant mothers and families with new babies.

Activities frequently encompass structured visits to

the family’s home and may address positive parenting

practices, nonviolent discipline techniques, child

development, maternal and child health, available

services, and advocacy.

Immunity – established in all child abuse laws to

protect reporters from civil law suits and criminal

prosecution resulting from filing a report of child

abuse and neglect. 

Initial Assessment or Investigation – the stage

of the CPS case process where the CPS caseworker

determines the validity of the child maltreatment

report, assesses the risk of maltreatment, determines

if the child is safe, develops a safety plan if needed to

assure the child’s protection, and determines services

needed.

Intake – the stage of the CPS case process where the

CPS caseworker screens and accepts reports of child

maltreatment.

Interview Protocol – a structured format to ensure

that all family members are seen in a planned strategy,
Child Neglect: A Guide for Prevention, Assessment, and Intervention 89

that community providers collaborate, and that

information gathering is thorough.

Juvenile and Family Courts – established in most

States to resolve conflict and to otherwise intervene

in the lives of families in a manner that promotes the

best interest of children. These courts specialize in

areas such as child maltreatment, domestic violence,

juvenile delinquency, divorce, child custody, and

child support.

Keeping Children and Families Safe Act – The

Keeping Children and Families Safe Act of 2003

(P.L. 108-36) included the reauthorization of the

Child Abuse Prevention and Treatment Act (CAPTA)

in its Title I, Sec. 111. CAPTA provides minimum

standards for defining child physical abuse and neglect

and sexual abuse that States must incorporate into

their statutory definitions in order to receive Federal

funds. CAPTA defines child abuse and neglect as “at

a minimum, any recent act or failure to act on the

part of a parent or caretaker, which results in death,

serious physical or emotional harm, sexual abuse or

exploitation, or an act or failure to act which presents

an imminent risk of serious harm.”

Kinship Care – formal or informal child placement

by the juvenile court and child welfare agency in the

home of a child’s relative.

Liaison – the designation of a person within an

organization who has responsibility for facilitating

communication, collaboration, and coordination

between agencies involved in the child protection

system.

Mandated Reporter – individuals required by

State statutes to report suspected child abuse and

neglect to the proper authorities (usually CPS or law

enforcement agencies). Mandated reporters typically

include professionals, such as educators and other

school personnel, health care and mental health

professionals, social workers, childcare providers, and

law enforcement officers. Some States identify all

citizens as mandated reporters.

Multidisciplinary Team – established between

agencies and professionals within the child protection

system to discuss cases of child abuse and neglect

and to aid in decisions at various stages of the CPS

case process. These teams may also be designated by

different names, including child protection teams,

interdisciplinary teams, or case consultation teams.

Neglect – the failure to provide for the child’s basic

needs. Neglect can be physical, educational, or

emotional. Physical neglect can include not providing

adequate food or clothing, appropriate medical care,

supervision, or proper weather protection (heat or

coats). Educational neglect includes failure to provide

appropriate schooling, special educational needs, or

allowing excessive truancies. Psychological neglect

includes the lack of any emotional support and love,

chronic inattention to the child, exposure to spouse

abuse, or drug and alcohol abuse.

Out-of-Home Care – child care, foster care, or

residential care provided by persons, organizations,

and institutions to children who are placed outside

their families, usually under the jurisdiction of

juvenile or family court.

Parens Patriae Doctrine – originating in feudal

England, a doctrine that vests in the State a right of

guardianship of minors. This concept has gradually

evolved into the principle that the community, in

addition to the parent, has a strong interest in the care

and nurturing of children. Schools, juvenile courts,

and social service agencies all derive their authority

from the State’s power to ensure the protection and

rights of children as a unique class.

Parent or Caretaker – person responsible for the care

of the child.

Physical Abuse – the inflicting of a nonaccidental

physical injury upon a child. This may include,

burning, hitting, punching, shaking, kicking, beating,

or otherwise harming a child. It may, however,

have been the result of over-discipline or physical

punishment that is inappropriate to the child’s age.
 90 Appendix A—Glossary of Terms

Protective Factors – strengths and resources that

appear to mediate or serve as a “buffer” against risk

factorsthat contributetovulnerability tomaltreatment

or against the negative effects of maltreatment

experiences.

Protocol – an interagency agreement that delineates

joint roles and responsibilities by establishing criteria

and procedures for working together on cases of child

abuse and neglect.

Psychological Maltreatment – a pattern of caregiver

behavior or extreme incidents that convey to children

that they are worthless, flawed, unloved, unwanted,

endangered, or only of value to meeting another’s

needs. This can include parents or caretakers using

extreme or bizarreforms of punishment orthreatening

or terrorizing a child. The term “psychological

maltreatment” is also known as emotional abuse or

neglect, verbal abuse, or mental abuse.

Response Time – a determination made by CPS

and law enforcement regarding the immediacy of the

response needed to a report of child abuse or neglect.

Review Hearings – held by the juvenile and family

court to review dispositions (usually every 6 months)

and to determine the need to maintain placement in

out-of-home care or court jurisdiction of a child.

Risk – the likelihood that a child will be maltreated

in the future.

Risk Assessment – to assess and measure the

likelihood that a child will be maltreated in thefuture,

frequently through the use of checklists, matrices,

scales, and other methods of measurement.

Risk Factors – behaviors and conditions present in

the child, parent, or family that will likely contribute

to child maltreatment occurring in the future.

Safety – absence of an imminent or immediate threat

of moderate-to-serious harm to the child.

Safety Assessment – a part of the CPS case process

in which available information is analyzed to identify

whether a child is in immediate danger of moderate

or serious harm.

Safety Plan – a casework document developedwhen it

is determined that the child is in imminent or potential

risk of serious harm. In the safety plan, the caseworker

targets the factors that are causing or contributing to

the risk of imminent serious harm to the child, and

identifies, along with the family, the interventions that

will control the safety factors and assure the child’s

protection.

Secondary Prevention – activities targeted to prevent

breakdowns and dysfunction among families who

have been identified as being at risk for abuse and

neglect. 

Service Agreement – the casework document

developed between theCPS caseworker and thefamily

that outlines the tasks necessary to achieve goals and

outcomes necessary for risk reduction.

Service Provision – the stage of the CPS casework

process when CPS and other service providers provide

specific services geared toward the reduction of risk of

maltreatment.

Sexual Abuse – inappropriate adolescent or adult

sexual behavior with a child. It includes fondling

a child’s genitals, making the child fondle the

adult’s genitals, intercourse, incest, rape, sodomy,

exhibitionism, sexual exploitation, or exposure to

pornography. To be considered child abuse, these acts

have to be committed by a person responsible for the

care of a child (for example a baby-sitter, a parent,

or a daycare provider) or related to the child. If a

stranger commits these acts, it would be considered

sexual assault and handled solely be the police and

criminal courts.

Substantiated – an investigation disposition

concluding that the allegation of maltreatment or risk

of maltreatment was supported or founded by State

law or State policy. A CPS determination means that

credible evidence exists that child abuse or neglect has

occurred.
Child Neglect: A Guide for Prevention, Assessment, and Intervention 91

Treatment – the stage of the child protection case

process when specific services are provided by CPS

and other providersto reducetherisk of maltreatment,

support families in meeting case goals, and address

the effects of maltreatment.

Unsubstantiated (not substantiated) – an

investigation disposition that determines that there is

not sufficient evidence under State law or policy to

conclude that the child has been maltreated or at risk

of maltreatment. A CPS determination means that

credible evidence does not exist that child abuse or

neglect has occurred.

Child Neglect: A Guide for Prevention, Assessment, and Intervention 93

Listed below are several representatives of the many

national organizations and groups dealingwith various

aspects of child maltreatment. Please visit http://

www.childwelfare.gov/pubs/usermanual.cfm to

view a more comprehensive list of resources and visit

http://www.childwelfare.gov/organizations/index.

cfm to view an organization database. Inclusion on

this list is for information purposes and does not

constitute an endorsement by the Office on Child

Abuse and Neglect or the Children’s Bureau.

Child Welfare Organizations

American Humane Association (AHA)

Children’s Division

address:.. 63 Inverness Dr., East

. . Englewood, CO 80112-5117

phone:. . (800) 227-4645

. . (303) 792-9900

fax:. . (303) 792-5333

e-mail:. . children@americanhumane.org

Web site: www.americanhumane.org

Conducts research, analysis, and training to help

public and private agencies respond to child

maltreatment.

American Professional Society on the Abuse of

Children (APSAC)

address:.. P.O. Box 30669

. . Charleston, SC 29417

phone:. . (843) 764-2905

. . (877) 40A-PSAC

fax: (803) 753-9823

e-mail:. . tricia-williams@ouhsc.edu

Web site: www.apsac.org

Provides professional education, promotes research

to inform effective practice, and addresses public

policy issues. Professional membership organization.

American Public Human Services Association

(APHSA)

address:.. 810 First St., NE, Suite 500

. . Washington, DC 20002-4267

phone:. . (202) 682-0100

fax:. . (202) 289-6555

Web site: www.aphsa.org

Addresses program and policy issues related

to the administration and delivery of publicly

funded human services. Professional membership

organization.

Appendix B

Resource Listings of

Selected National 

Organizations Concerned 

with Child Maltreatment 
 94 Appendix B—Resource Listings of Selected National Organizations Concerned

 with Child Maltreatment

AVANCE Family Support and Education Program

address:.. 118 N. Medina

. . San Antonio, TX 78207

phone:. . (210) 270-4630

fax:. . (210) 270-4612

Web site: www.avance.org

Operates a national training center to share and

disseminate information, material, and curricula to

service providers and policy-makers interested in

supporting high-risk Hispanic families.

Child Welfare League of America (CWLA)

address:.. 440 First St., NW

. . Third Floor

. . Washington, DC 20001-2085

phone:. . (202) 638-2952

fax:. . (202) 638-4004

Web site: www.cwla.org

Provides training, consultation, and technical

assistance to child welfare professionals and agencies

while educating the public about emerging issues

affecting children.

National Black Child Development Institute

address:.. 1101 15th St., NW

. . Suite 900

. . Washington, DC 20005

phone: (202) 833-2220

fax:. . (202) 833-8222

e-mail:. . moreinfo@nbcdi.org

Web site: www.nbcdi.org

Operates programs and sponsors a national training

conference through Howard University to improve

and protect the well-being of African-American

children.

National Children’s Advocacy Center (NCAC)

address:.. 210 Pratt Ave

. . Huntsville AL 35801

phone: (256) 533-KIDS

fax: (256) 534-6883

Web site: http://www.nationalcac.org

Provides prevention, intervention, and treatment

services to physically and sexually abused children

and their families within a child-focused team

approach.

National Indian Child Welfare Association

(NICWA)

address:.. 5100 SW Macadam Ave.,

. . Suite 300

. . Portland, OR 97239

phone:. . (503) 222-4044

fax:. . (503) 222-4007

e-mail:. . info@nicwa.org

Web site: www.nicwa.org

Disseminates information and provides technical

assistance on Indian child welfare issues. Supports

community development and advocacy efforts to

facilitate tribal responses to the needs of families and

children.
Child Neglect: A Guide for Prevention, Assessment, and Intervention 95

NATIONAL RESOURCE CENTERS (NRCS)

National Child Welfare Resource Center for

Family-Centered Practice

address: Learning Systems Group

 1150 Connecticut Ave., NW,

 Suite 1100

 Washington, DC 20036

phone: (202) 638-7922

fax: (202) 742-5394

e-mail: info@cwresource.org

Helps child welfare agencies and Tribes use familycentered practice to implement the tenets of the

Adoption and Safe Families Act to ensure the safety

and well-being of children while meeting the needs

of families.

National Child Welfare Resource Center on Legal

and Judicial Issues

address: ABA Center on Children and

 the Law

 740 15th St., NW

 Washington, DC 20005-1019

phone: (800) 285-2221 (Service Center)

 (202) 662-1720

fax: (202) 662-1755

e-mail: ctrchildlaw@abanet.org

Web site: www.abanet.org/child

Promotes improvement of laws and policies affecting

children and provides education in child-related law.

National Resource Center for Child Protective

Services

address: 925 #4 Sixth Street NW

 Albuquerque, New Mexico 87102

phone: (505) 345-2444

fax: (505) 345-2626

e-mail: theresa.costello@

 actionchildprotection.org

Web site: http://www.nrccps.org

Focuses on building State, local, and Tribal

capacity through training and technical assistance

in CPS, including meeting Federal requirements,

strengthening programs, eligibility for the CAPTA

grant, support to State Liaison Officers, and

collaboration with other NRCs.

National Resource Center for Family-Centered

Practice and Permanency Planning

address: National Resource Center for

 Family-Centered Practice and

 Permanency Planning

 Hunter College School of

 Social Work

 129 East 79th Street

 New York, NY 10021

phone: (212) 452-7053

fax: (212) 452-7475

Web site: http://www.hunter.cuny.edu/

 socwork/nrcfcpp/

Provides training and technical assistance and

information services to help States through all

stages of the CFSRs, emphasizing family-centered

principles and practices and helping States build

knowledge of foster care issues. Partners with the

Child Welfare League of America and the National

Indian Child Welfare Association to provide

training, technical assistance, and information

services.

Adoption and Safe Families Act to ensure the safety

and well-being of children while meeting the needs

of families.

National Child Welfare Resource Center on Legal

and Judicial Issues

address: ABA Center on Children and

 the Law

 740 15th St., NW

 Washington, DC 20005-1019

phone: (800) 285-2221 (Service Center)

 (202) 662-1720

fax: (202) 662-1755

e-mail: ctrchildlaw@abanet.org

Web site: www.abanet.org/child

Promotes improvement of laws and policies affecting

children and provides education in child-related law.
 96 Appendix B—Resource Listings of Selected National Organizations Concerned

 with Child Maltreatment

National Resource Center on Domestic Violence:

Child Protection and Custody

address:.. Family Violence Department

. . National Council of Juvenile

. . and Family Court Judges

. . P.O. Box 8970

. . Reno, NV 89507

phone:. . (800) 527-3223

fax:. . (775) 784-6160

e-mail:. . fvdinfo@ncjfcj.org

Web site: http://www.ncjfcj.org/dept/

. . fvd/res_center

Promotes improved court responses to family

violence through demonstration programs,

professional training, technical assistance, national

conferences, and publications.

Prevention Organizations

National Alliance of Children’s Trust and

Prevention Funds

address:.. 5712 30th Ave. NE

. . Seattle, WA98105

phone:. . 206-526-1221

fax:. . 206-526-0220

e-mail:. . trafael@juno.com

Web site: www.ctfalliance.org

Assists State children’s trust and prevention funds to

strengthen families and protect children from harm.

Prevent Child Abuse America

address:.. 200 South Michigan Ave.

. . 17th Floor

. . Chicago, IL 60604-2404

phone:. . (800) 835-2671 (orders)

. . (312) 663-3520

fax:. . (312) 939-8962

e-mail:. . mailbox@preventchildabuse.org

Web site: www.preventchildabuse.org

Conducts prevention activities such as public

awareness campaigns, advocacy, networking,

research, and publishing, and provides information

and statistics on child abuse.

Community Partners

The Center for Faith-Based and Community

Initiatives

e-mail:. . CFBCI@hhs.gov

Web site: www.hhs.gov/faith/

Welcomes the participation of faith-based and

community-based organizations as valued and

essential partners with the U.S. Department of

Health and Human Services. Funding goes to faithbased organizations through Head Start, programs

for refugee resettlement, runaway and homeless

youth, independent living, childcare, child support

enforcement, and child welfare.

Family Support America

(formerly Family Resource Coalition of America)

address:.. 205 West Randolph Street

. . Suite 2222

. . Chicago, IL 60606

phone:. . (312) 338-0900

fax:. . (312) 338-1522

e-mail:. . info@familysupportamerica.org

Web site: www.familysupportamerica.org

Works to strengthen and empower families and

communities so that they can foster the optimal

development of children, youth, and adult family

members.

National Exchange Club Foundation for the

Prevention of Child Abuse

address:.. 3050 Central Ave.

. . Toledo, OH 43606-1700

phone:. . (800) 924-2643

. . (419) 535-3232

fax:. . (419) 535-1989

e-mail:. . info@preventchildabuse.com

Web site: www.nationalexchangeclub.com

Conducts local campaigns in the fight against child

abuse by providing education, intervention, and

support to families affected by child maltreatment. 
Child Neglect: A Guide for Prevention, Assessment, and Intervention 97

National Fatherhood Initiative

address:.. 101 Lake Forest Blvd.

. . Suite 360

. . Gaithersburg, MD 20877

phone:. . (301) 948-0599

fax:. . (301) 948-4325

Web site: www.fatherhood.org

Works to improve the well-being of children by

increasing the proportion of children growing up

with involved, responsible, and committed fathers.

For the General Public

Childhelp USA

address:.. 15757 North 78th St.

. . Scottsdale, AZ 85260

phone:. . (800) 4-A-CHILD

. . (800) 2-A-CHILD (TDD line)

. . (480) 922-8212

fax:. . (480) 922-7061

e-mail:. . help@childhelpusa.org

Web site: www.childhelpusa.org

Provides crisis counseling to adult survivors and

child victims of child abuse, offenders, and parents,

and operates a national hotline.

National Center for Missing and Exploited

Children (NCMEC)

address:.. Charles B. Wang International

. . Children’s Building

. . 699 Prince St.

. . Alexandria, VA 22314-3175

phone:. . (800) 843-5678

. . (703) 274-3900

fax:. . (703) 274-2220

Web site: www.missingkids.com

Provides assistance to parents, children, law

enforcement, schools, and the community in

recovering missing children and raising public

awareness about ways to help prevent child

abduction, molestation, and sexual exploitation.

Parents Anonymous

address:.. 675 West Foothill Blvd., Suite 220

. . Claremont, CA 91711

phone:. . (909) 621-6184

fax:. . (909) 625-6304

e-mail:. . Parentsanonymous@

. . parentsanonymous.org

Web site: www.parentsanonymous.org

Leads mutual support groups to help parents provide

nurturing environments for their families.

For More Information

Child Welfare Information Gateway

address:.. 1250 Maryland Avenue, SW

. . Eighth Floor

. . Washington, DC 20024

phone:. . (800) 394-3366

. . (703) 385-7565

fax:. . (703) 385-3206

e-mail:. . info@childwelfare.gov

Web site: http://www.childwelfare.gov/

Collects, stores, catalogs, and disseminates

information on all aspects of child maltreatment

and child welfare to help build the capacity of

professionals in the field. A service of the Children’s

Bureau.

Child Neglect: A Guide for Prevention, Assessment, and Intervention 99

Each State designates specific agencies to receive

and investigate reports of suspected child abuse and

neglect. Typically, this responsibility is carried out by

child protective services (CPS) within a Department

of Social Services, Department of Human Resources,

or Division of Family and Children Services. In some

States, police departments also may receive reports of

child abuse or neglect.

Many States have local or toll-free telephone

numbers, listed below, for reporting suspected abuse.

The reporting party must be calling from the same

State where the child is allegedly being abused for

most of the following numbers to be valid.

For States not listed, or when the reporting party

resides in a different State from the child, please call

Childhelp, 800-4-A-Child (800-422-4453), or your

local CPS agency. States may occasionally change the

telephone numbers listed below. To view the most

current contact information, including State Web

addresses, visit http://www.childwelfare.gov/pubs/

reslist/rl_dsp.cfm?rs_id=5&rate_chno=11-11172.

Alabama (AL)

334-242-9500

Alaska (AK)

800-478-4444

Arizona (AZ)

888-SOS-CHILD

(888-767-2445)

Arkansas (AR)

800-482-5964

Colorado (CO)

303-866-5932

Connecticut (CT)

800-842-2288

800-624-5518 (TDD)

Delaware (DE)

800-292-9582

District of Columbia (DC)

202-671-SAFE (7233)

Florida (FL)

800-96-ABUSE

(800-962-2873)

Hawaii (HI)

808-832-5300

Idaho (ID)

800-926-2588

Illinois (IL)

800-252-2873

217-524-2606

Indiana (IN)

800-800-5556

Iowa (IA)

800-362-2178

Kansas (KS)

800-922-5330

Kentucky (KY)

800-752-6200

Maine (ME)

800-452-1999

800-963-9490 (TTY)

Massachusetts (MA)

800-792-5200

Appendix c

State Telephone

Numbers for Reporting

Child Abuse
 100 Appendix C—State Telephone Numbers for Reporting Child Abuse 

Mississippi (MS)

800-222-8000

601-359-4991

Missouri (MO)

800-392-3738

573-751-3448

Montana (MT)

866-820-KIDS (5437)

Nebraska (NE)

800-652-1999

Nevada (NV)

800-992-5757

775-684-4400

New Hampshire (NH)

800-894-5533

603-271-6556

New Jersey (NJ)

877-652-2873

800-835-5510 (TDD/ TTY))

New Mexico (NM)

800-797-3260

505-841-6100

New York (NY)

800-342-3720

518-474-8740

800-369-2437 (TDD)

Oklahoma (OK)

800-522-3511

Pennsylvania (PA)

800-932-0313

Puerto Rico (PR)

800-981-8333

787-749-1333

Rhode Island (RI)

800-RI-CHILD

(800-742-4453)

South Carolina (SC)

803-898-7318

South Dakota (SD)

605-773-3227

Tennessee (TN)

877-237-0004

Texas (TX)

800-252-5400

512-834-3784

Utah (UT)

800-678-9399

Vermont (VT)

800-649-5285 (after hours)

Virginia (VA)

800-552-7096

804-786-8536

Washington (WA)

866-END-HARM

(866-363-4276)

800-562-5624 (after hours)

800-624-6186 (TTY)

West Virginia (WV)

800-352-6513
Child Neglect: A Guide for Prevention, Assessment, and Intervention 101

As a result of the Social Security Amendments of 1994, the U.S. Department of Health and Human Services

developed and implemented the Child and Family Services Review (CFSR), a results-oriented, comprehensive

monitoring system designed to assist States in improving outcomes for children and families who come into

contact with the Nation’s public child welfare systems. As of June 2005, all the States (and Puerto Rico and

the District of Columbia) had completed the first two phases–statewide assessment and onsite review-and

were engaged actively in the third, or Program Improvement Plan (PIP), phase. Several States have already

completed their PIPs. Because the CFSR process is designed to promote continuous quality improvement, all

States that are not in substantial conformity in the initial review begin a full review 2 years after the approval

of their PIPs.

The purpose of the CFSRs is to enhance the goals of children’s safety, permanency, and well-being. Seven

outcomes, measured by 23 indicators or “items,” related to these three goals are assessed in the CFSR. The

seven outcomes are:

Safety Outcome 1—Children are first and foremost protected from abuse and neglect.

Safety Outcome 2—Children are safely maintained in their homes when possible.

Permanency Outcome 1—Children have permanency and stability in their living situations.

Permanency Outcome 2—The continuity of family relationships and connections is preserved.

Well-being Outcome 1—Families have enhanced capacity to provide for children’s needs.

Well-being Outcome 2—Children receive services to meet their educational needs.

Well-being Outcome 3—Children receive services to meet their physical and mental health needs.

As discussed throughout Child Neglect: A Guide for Prevention, Assessment, and Intervention, there are myriad

challenges facing families experiencing neglect. Many States also experienced challenges in their efforts to

ensure the safety, permanency, and well-being of children who encounter the child welfare system. To identify

1

U.S. Department of Health and Human Services, Administration for Children, Youth, and Families (ACYF). (2005). Child and 

Family Services Review Update [On-line]. Available: http://www.acf.hhs.gov/programs/cb/cwrp/geninfo/cfsr_updates/jun05.htm.

•

•

•

•

•

•

•

Appendix D

Neglect and the Child and

Family Services Reviews
 102 Appendix D—Neglect and the Child and Family Services Reviews

these challenges, a content analysis was conducted on the CFSR final reports for the 35 States participating

in a CFSR from FY 2002 to FY 2004. (States participating in a CFSR in FY 2001 were not included in this

analysis because the final reports for that year did not use the same format for content requirements as reports in

subsequent years.) The content analysis focused on identifying challenges that were common across the 35 States

for specific indicators. A challenge was considered a “common challenge” if it was relevant to approximately

one-third of the 35 participating States (or 12 States).

With an emphasis on neglect, the following table examines some of the challenges to achieving several of the

safety, permanency, and well-being outcomes associated with the issues discussed in this manual.

Common Challenges Identified with Respect to CFSR Safety, Permanency, and Well-being Indicators

and Number of States for Which Concerns Were Relevant—FY 2002–20042

Safety Indicators Common Challenges

# (%) of

States

N = 35

Timeliness of

investigations

Reports that are not designated “high priority” or “emergency” are

not being routinely investigated in accordance with established

timeframes.

• 12 (34)

Repeat maltreatment Maltreatment allegations on families with open child welfare cases

are not being reported as new allegations, and therefore there is

no formal assessment of the validity of the allegation.

• 16 (46)

Services to families to

protect children in their

homes and prevent

removal

Agency risk and safety assessments often are not sufficiently

comprehensive to capture underlying family issues, such as

substance abuse, mental illness, and domestic violence, that may

contribute to maltreatment.

• 22 (63)

The agency is not consistent in providing services to ensure

children’s safety while they remain in their own homes (either

prior to or after reunification).

• 18 (51)

Risk of harm to child The agency is not consistent in providing sufficient services to

address risk of harm to children, particularly in the in-home

services cases.

• 22 (63)

The agency does not consistently monitor families to assess service

participation and changes in risk factors.

• 20 (57)

2

U.S. Department of Health and Human Services (ACYF). (2005). General findings from the federal child and family services review 

[On-line]. Available: http://www.acf.hhs.gov/programs/cb/cwrp/results/statefindings/genfindings04/ch1.htm.
Child Neglect: A Guide for Prevention, Assessment, and Intervention 103

Permanency Indicators Common Challenges

# (%) of

States

N = 35

Re-entry The agency does not have sufficient and/or adequate postreunification services.• 13 (37)

Stability of foster care

placements

Emergency shelters frequently are used for initial placements

and as “temporary” placements after a disruption occurs, even

for young children.

• 18 (51)

There is a scarcity of appropriate placement options for

children with developmental disabilities or with severe behavior

problems.

• 19 (54)

The agency does not consistently provide services to foster

parents to prevent placement disruptions.

• 21 (60)

There is little matching of placements. Placements tend to be

based on availability rather than on appropriateness.

• 21 (60)

Permanency goal for child A case goal of long-term foster care often is established

without thorough consideration of the options of adoption or

guardianship.

• 15 (43)

Concurrent planning efforts are not being implemented on a

consistent basis when appropriate.

• 26 (74)

The goal of reunification often is maintained for too long a

period of time before reconsideration.

• 24 (69)

The agency is not filing for termination of parental rights (TPR)

in a timely manner and reasons for not filing are not provided

in the case files.

• 12 (34)

Reunification,

guardianship, and

permanent placement

with relatives

The agency is not consistent in its efforts to provide the services

to parents or ensure parents’ access to the services necessary for

reunification.

• 18 (51)

Adoption The agency is not consistent with regard to conducting adoption

home studies or completing adoption-related paperwork in a

timely manner.

• 17 (49)

• The appeals process for TPR decisions is extremely lengthy. 12 (34)

Visiting with parents and

siblings

The agency is not consistent in its efforts to ensure sufficient

visitation among siblings in foster care.

• 18 (51)

Preserving connections The agency is not consistent in its efforts to ensure that

children’s connections to extended family are being preserved

while children are in foster care.

• 19 (54)

Relative placement The agency is not consistent with regard to seeking paternal

relatives as potential placement resources for children entering

foster care.

•
 104 Appendix D—Neglect and the Child and Family Services Reviews

Well-being Indicators Common Challenges

# (%)

of States

N = 35

Needs and services of

child, parents, foster

parents

The agency is not consistent in providing appropriate services to

meet the identified needs of children and parents.

• 31 (89)

The agency is not consistent in conducting adequate assessments

to determine the needs of children, parents, and foster parents.

• 30 (86)

The agency is not consistent in providing services to support

foster parents or relative caretakers.

• 20 (57)

Child and family

involvement in case

planning

• Fathers are not sufficiently involved in case planning. 35 (100)

Children, who are of an appropriate age, are not sufficiently

involved in case planning.

• 35 (100)

• Mothers are not sufficiently involved in case planning. 35 (100)

Workers visit with

children

The frequency of face-to-face contacts between workers and

children is not consistently sufficient to ensure children’s safety

and well-being.

• 27 (77)

When establishing face-to-face contacts with children, workers

are not consistently focusing on issues pertinent to case planning

and achieving goals.

• 14 (40)

Workers visit with parents The frequency of face-to-face contacts between workers and

parents is not consistently sufficient to ensure children’s safety

and promote attainment of case goals.

• 34 (97)

The agency does not make concerted efforts to establish contact

with fathers, even when fathers are involved in their children’s

lives.

• 13 (37)

When establishing face-to-face contactswith parents,workers are

not consistently focusing on issues pertaining to case planning

and achieving case goals.

• 14 (40)

Educational needs of the 

child

Many children in foster care experience multiple school changes

as a result of placement changes.

• 20 (57)

The agency is not consistent in providing services to meet

children’s needs with respect to identified education-related

problems.

• 18 (51)

Physical health of the

child

The number of dentists/doctors in the State willing to accept

Medicaid is not sufficient to meet the need.

• 27 (77)

The agency is not consistentin providing childrenwith preventive

health and dental services.

• 14 (40

The agency is not consistent in conducting adequate, timely

health assessments.

• 13 (37

Mental health of the child

• There is a lack of mental health services for children. 25 (71)

The agency is not consistent in conducting mental health

assessments.

• 24 (69)

Additional information on the CFSRs is available at: http://www.acf.hhs.gov/programs/cb/cwrp/

results.htm.