Chronic 

Child Neglect

What’s Inside:

• What is chronic neglect?

• Scope of the problem

• Characteristics of families

• Effects on children

• Effects on society

• Practice principles

• Chronic neglect casework

• Competencies and training

• Implications for child welfare 

organizations

• Examples of promising interventions 

and evidence-informed programs

• Conclusion: The importance 

of hope

• Appendix: National Statistics 

on Child Neglect

Chronic child neglect is one of the most 

daunting challenges to the well-being 

of children and families receiving child 

welfare services. The child welfare system 

is primarily geared to protect children who 

are in imminent danger or who experience 

egregious harm at the hands of their parents 

or caregivers (Kempe, Silverman, Steele, 

Droegemueller, & Silver, 1962). Chronic child 

neglect, however, which is less visible and 

often less sensational, is more pervasive and 

difficult to resolve. 

Child Welfare Information Gateway

Children’s Bureau/ACYF

1250 Maryland Avenue, SW

Eighth Floor

Washington, DC 20024

800.394.3366

Email: info@childwelfare.gov

https://www.childwelfare.gov

STATE MANAGERS SERIES

BULLETIN FOR 

PROFESSIONALS

January 2013

Use your smartphone to 

access this bulletin online.
Chronic Child Neglect https://www.childwelfare.gov

2 This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare 

Information Gateway. Available online at https://www.childwelfare.gov/pubs/chronic_neglect.cfm

This bulletin for professionals discusses 

what we know about chronic neglect and 

then reviews ways to work with families 

experiencing chronic neglect, including critical 

elements of successful casework practice, 

examples of what agencies are doing, and 

ways agencies can integrate child welfare 

approaches to chronic neglect with prevention 

and early intervention efforts.

What Is Chronic Neglect?

While a universal definition of chronic neglect 

does not exist, there are several professionally 

agreed upon identifiers. Chronic neglect 

occurs when:

1. One or more needs basic to a child’s 

healthy development are not met.

2. The neglect is perpetrated by a 

parent or caregiver.

3. The neglect happens on a recurring 

or enduring basis. 

When these three identifiers result in 

cumulative harm or serious risk of harm to the 

child’s safety, health, or well-being, a child can 

be said to be chronically neglected. Using 

this framework, chronic child neglect can be 

defined as a parent or caregiver’s ongoing, 

serious pattern of deprivation of a child’s basic 

physical, developmental, and/or emotional 

needs for healthy growth and development 

(Kaplan, Schene, DePanfilis, & Gilmore, 2009). 

Chronic neglect differs from incident-based 

neglect in terms of duration, frequency (e.g., 

number of reports), duration of need for 

services, and referrals for multiple types of 

maltreatment.

For more information about incidentbased neglect, read Information 

Gateway’s Acts of Omission: An Overview 

of Child Neglect at https://www.

childwelfare.gov/pubs/focus/acts/index.

cfm.

There are many types of chronic neglect that 

may bring a family to the attention of a child 

welfare agency. The following table describes 

these types, as well as the associated parental 

behaviors.
Chronic Child Neglect https://www.childwelfare.gov

3 This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare 

Information Gateway. Available online at https://www.childwelfare.gov/pubs/chronic_neglect.cfm

Types of Neglect Examples

Abandonment Abandonment by parents/caregivers

Physical

• Inadequate nutrition 

• Inadequate or unsuitable seasonal clothing 

• Unreasonably unclean clothing 

• Inadequate hygiene 

• Exposure to chronically unhygienic, unsafe, 

chaotic or cluttered environment 

Medical

• Delays in medical/health care 

• Parental/caregiver failure to seek health care 

• Parental/caregiver failure to seek therapy for 

developmental delay 

Psychological/Emotional • Deprivation of emotional nurturance 

• Emotional absence of parent/caregiver

Developmental

• Parental/caregiver failure to recognize 

developmental capacities/limits 

• Parent/caregiver failure to address developmental 

needs

• Parent/caregiver failure to foster ordinary 

developmental milestones 

Supervisory

• Being left alone for extended or prolonged 

periods given the child’s age and capacities 

• Being left in a locked, closed vehicle 

• Parental/caregiver incapacitation 

Guidance

• Exposure to antisocial/criminal behaviors by 

parents/caregivers 

• Exposure to illicit drug use by parents/caregivers 

• Parental/caregiver failure to prevent/discourage 

risk taking or criminal behavior 

Educational

• Parental/caregiver failure to ensure school 

enrollment or other necessary educational 

institutions 

• Parent/caregiver failure to discourage frequent 

absenteeism 

Source: The Australian Office for Children, Youth and Family Support: http://www.dhcs.act.gov.au/__data/assets/pdf_file/0008/165635/

OCYFS_Neglect_Practice_Paper.pdf
Chronic Child Neglect https://www.childwelfare.gov

4 This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare 

Information Gateway. Available online at https://www.childwelfare.gov/pubs/chronic_neglect.cfm

Scope of the Problem

For more than a decade, State reports to 

the National Child Abuse and Neglect Data 

System (NCANDS), a Children’s Bureau 

initiative, have shown that the great majority 

of maltreatment reports in the United States 

involve neglect rather than physical or sexual 

abuse. The most recent Child Maltreatment 

reports show that children who experienced 

neglect made up approximately threequarters of children who were identified as 

maltreatment victims (U.S. Department of 

Health and Human Services [HHS], 2009, 

2010, 2011). Additionally, cases involving 

neglect are more likely to recur than cases 

involving other maltreatment types (DePanfilis 

and Zuravin, 1999; Marshall & English, 1999; 

Fluke & Hollinshead, 2003) and recur more 

quickly than abuse cases (DePanfilis & Zuravin, 

1999).

See the Appendix for a chart of statistics on 

cases of substantiated neglect in the United 

States from 2000 through 2010.

Characteristics of 

 Families

Several parental stressors are associated 

with chronic neglect, including poverty, 

mental health issues, and substance abuse 

(Tanner & Turney, 2003; Wilson & Horner, 

2003). Of all forms of maltreatment, neglect 

has the strongest relationship to poverty 

(Loman, 2006). This relationship is not 

causal but contributory—neglect is strongly 

associated with measures of socioeconomic 

disadvantage, which include welfare 

dependence, homelessness, low levels of 

education, and single-parent families—as 

well as limited income. It is often difficult to 

distinguish when neglect is a direct effect of 

family poverty and when it arises from lack of 

concern, insufficient knowledge of parenting, 

poor financial planning, mental incapacity, 

addiction, parental disabilities and medical 

conditions, or other factors. 

Families’ lives at home are frequently 

characterized by a chaotic, unpredictable, and 

disorganized family life; low social cohesion 

and fewer positive interactions; fewer actual or 

perceived social supports and social isolation; 

a lack of life skills; limited nurturing; perceived 

or learned powerlessness; and exposure 

to violence and crime. The communities in 

which these families live are often typified 

by community poverty, high unemployment, 

inadequate housing, and high crime rates 

(Cahn & Nelson, 2009).

In addition, these families are often victims 

of intergenerational issues. If parents do 

not engage in developmentally appropriate 

activities to encourage their children’s physical, 

mental, and academic growth and promote 

their safety and well-being, their children are 

less likely to learn how to do those things 

when they are parents.
Chronic Child Neglect https://www.childwelfare.gov

5 This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare 

Information Gateway. Available online at https://www.childwelfare.gov/pubs/chronic_neglect.cfm

Effects on Children

Neglected children, relative to children 

impacted by other types of maltreatment, 

experience more severe cognitive and 

academic deficits, social withdrawal, and 

internalizing behaviors (Hildyard & Wolfe, 

2002). Although single incidences of physical 

and sexual abuse may sometimes appear to 

be more extreme than neglect, the effects of 

chronic neglect, if not addressed, can have a 

considerable impact on the long-term health 

and well-being of children and youth. 

Child trauma expert Bruce Perry (2003) has 

indicated that the impact of child neglect is 

often similar to that of trauma. Permanent 

changes in the brain, including lack of neural 

connections and pathways may permanently 

limit the child’s ability to develop normally.

Three Tiers of Chronic Neglect

Core Traumatic 

Issues

Familial Issues Impacting 

Parenting 

External Situational 

Factors 

 

Substance 

 Abuse

Interpersonal

 Violence

Developmental 

 Challenges

Mental Illness

Childhood traumatic 

experiences

Poverty

 Social Isolation

Lack of Resources

Environmental

 Risks

Lack of Education

Cultural Factors

Outside Stressors

This Ecological Framework illustrates how the accumulation of experiences and factors across three tiers—core traumatic issues, family issues, 

and external factors—contributes to chronic neglect. Adapted from an ecological framework used by the World Health Organization at http://

www.who.int/violenceprevention/approach/ecology/en/index.html and Bronfenbrenner’s Ecological Model of Human Development (1979).

Children who have been the subject of chronic 

neglect exhibit problems with attachment, 

cognitive development, emotional selfregulation, social self-confidence, social 

competence, perseverance in problemsolving, and empathy and social conscience. 

They may experience language delay, as well 

as conduct disorders. The younger the child 

and more prevalent the neglect, the greater 

the cumulative harm and more pernicious 

the consequences for the child (Perry, 2000, 

in American Humane Association, 2010). The 

unremitting daily impact of these experiences 

on the child can be profound and exponential, 

diminishing a child’s sense of safety, 

stability, and well-being (American Humane 

Association, 2010).

Given that neglect often co-occurs with other 

types of maltreatment, isolating the impacts of 

neglect alone is challenging. More research is 

needed in this area (Corso, 2010).
Chronic Child Neglect https://www.childwelfare.gov

6 This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare 

Information Gateway. Available online at https://www.childwelfare.gov/pubs/chronic_neglect.cfm

Effects on Society

In assessing the impact of chronic neglect on 

society, studies show a significant economic 

toll as resources are disproportionately 

dedicated to chronic neglect families to 

increase supports and enhance their capacity 

to parent their children. One study found 

that the costs associated with families who 

chronically neglect their children are seven 

times greater than the costs associated with 

families not experiencing chronic neglect in 

the child welfare system (Loman & Siegel, 

2004). Another study indicated that one-half 

of all child welfare expenditures are spent 

on chronic neglect cases, with one-fifth of 

all families responsible for one-half of the 

spending, averaging $13,000 per year per 

family over a 5-year period (Lange & Ghazvini, 

2007). 

High-cost and long-term solutions can be 

considered if there are significant future 

benefits, especially cost-avoidance results. 

Cost-benefit and cost-effectiveness studies are 

essential to new programs aimed at chronic 

neglect families.

Practice Principles

While practice elements remain the same 

in many aspects of working with all families 

involved with child welfare, there are distinct 

aspects that require new or additional 

elements in order to effectively partner with 

and assist families impacted by chronic 

neglect.

An Ecological Framework

Using an ecological development framework 

that targets interventions at all the levels of 

the individual, family, community, and society 

is recommended. Principles for implementing 

these interventions and working with families 

to reduce risk of neglect include the following 

(DePanfilis, 2002):

• Provide attention to basic, emergency, and 

concrete needs.

• Support families in identifying and meeting 

children’s basic needs.

• Practice community outreach.

• Assess families to tailor interventions.

• Form helping alliances with families.

• Empower families and use strengths-based 

approaches.

• Address readiness to change.

• Embrace cultural competence.

• Use outcome-driven service plans.

Chronic Neglect 

 Casework

The multiple needs of families impacted by 

chronic neglect suggest that caseworkers 

must have access to the necessary resources, 

a flexible work environment, and the authority 

to make decisions in response to changing 

circumstances and needs (Kaplan et al., 2009). 

The following sections describe how chronic 

neglect may be addressed in casework.

It is important to recognize and remember 

that the accumulation of harm experienced by 
Chronic Child Neglect https://www.childwelfare.gov

7 This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare 

Information Gateway. Available online at https://www.childwelfare.gov/pubs/chronic_neglect.cfm

families requires resolute and reliable practice. 

An emphasis on positive attitudes and positive 

qualities of helpers are imperative with this 

population of families.

Intake

In screening maltreatment reports, workers 

can, with the support of tools and protocols, 

determine whether the case is “chronic.” 

Indicators of chronicity can be straightforward, 

such as a specific number of reports in a given 

period of time. Other indicators are a family’s 

history of need around cumulative harm rather 

than immediate safety issues and/or a pattern 

of involvement with the agency that is seldom 

acute. While the complexities of a case can 

be revealed through family engagement and 

assessment, it is reasonable to begin with a 

simplified discernment, such as the number of 

reports in a given time period.

Engagement

Engagement with the family increases the 

caseworker’s ability to influence factors 

affecting safety. The quality of the relationship 

between the parents and the worker is the 

most powerful factor in change. Engaging 

families who have minimal energy and interest 

requires exceptional skills, patience, and 

staying power (Thompson & Lockwood, 2008).

In order to successfully engage the family, a 

caseworker must demonstrate to the family 

that he or she:

• Trusts the family and can be trusted

• Possesses a belief that the family is more 

than the problem that brought them into 

the system

• Understands family needs from the family’s 

point of view

• Understands the effort it takes for a family 

to change

• Has a sincere interest in supporting change

Assessment

In order to fully understand the safety 

and risk factors associated with chronic 

neglect, a comprehensive, individualized 

assessment must be conducted to identify 

family members’ unique strengths, needs, 

and relevant targeted services (Johnson, 

2009). Approaches to neglect need to move 

away from incidence-based intervention 

and assessment and toward assessment 

of cumulative harm, with intervention and 

support aimed at the long-term.

In order to make that determination, the 

initial assessment considers (1) family history 

and cumulative harm, not just immediate 

safety, and (2) the pattern of prior referrals. 

Assessment and actions need to address the 

parents’ underlying issues. Analysis should 

focus on examining how the children’s basic 

needs are met and on identifying situations 

that may indicate repeated or a variety of 

omissions in care that result in harm to the 

children (DePanfilis, 2006). Assessing the 

detailed circumstances and behaviors within 

the widest possible context will help ensure a 

successful intervention plan (Jones & Gupta, 

2003). It is important to solicit the parents’ 

perspectives on what presents challenges 

and impedes their success as well as what 

increases their capacity and opportunities to 

respond to their child’s needs effectively. 

Case Planning and Intervention

Partnering with families to develop the 

case plan can benefit both families and 

caseworkers. Parents feel that their voice 
Chronic Child Neglect https://www.childwelfare.gov

8 This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare 

Information Gateway. Available online at https://www.childwelfare.gov/pubs/chronic_neglect.cfm

is heard as they weigh in on the family’s 

strengths and needs; workers share 

responsibility for devising a plan that is 

tailored to meet the unique circumstances 

of the family. Information Gateway’s (2012) 

Engaging Families in Case Planning (https://

www.childwelfare.gov/pubs/engaging_

families.cfm) describes ways to promote 

skillful engagement and provides examples 

of successful family engagement using such 

techniques as family group decision making, 

family partnership meetings, and solutionbased casework.

Timing is critical with intervention. It is 

important to provide families with help 

before situational and sporadic neglect 

becomes chronic and before chronic neglect is 

combined with physical abuse or sexual abuse 

(Wilson, 2010). In addition, given the critical 

early development of brain physiology before 

age 3 (Perry, 2003), there is a need to explore 

preventive interventions that can reduce the 

consequent development deficits and break 

the intergenerational cycle. 

Common practices used in effective 

interventions include the following (American 

Humane Association, 2010):

• Meeting concrete (survival) needs first

• Building a trusting relationship with 

the whole family through maximum 

involvement of family members and 

informal networks 

• Making more frequent/intensive visits over 

a longer time

• Tailoring interventions to the family to help 

them achieve individualized goals

• Building life skills and problem-solving 

skills around time, money, and family 

planning via goals that are small, specific, 

measurable, achievable, and related to 

outcomes

• Helping the family build or strengthen their 

support network

• Promoting self-care and teaming

• Planning for a longer-term intervention 

(greater than 1 year)

• Using interventions with an ecological 

approach that considers the family’s 

multiple systems (community, school, 

extended family, etc.) 

• Using interventions that have a strong 

focus on skill building (communication, 

problem-solving, parenting, interpersonal 

relationships)

• Connecting families with informal networks 

in their communities

In order to be effective, these essential 

components require infrastructure support 

such as small caseloads for specialized 

chronic neglect workers or units, competent 

communication and leadership practices, 

and solution-focused supervisors with clinical 

expertise in identifying and responding to 

the vicarious trauma of workers (American 

Humane Association, 2010).
Chronic Child Neglect https://www.childwelfare.gov

9 This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare 

Information Gateway. Available online at https://www.childwelfare.gov/pubs/chronic_neglect.cfm

In 1996 and 1997, the Children’s Bureau 

funded demonstration projects to 

address the prevention, intervention, and 

treatment needs of neglected children 

and their families. One project focused 

specifically on chronic neglect. The Family 

Network Project, in Buffalo, NY, was 

run by a partnership between the local 

Parents Anonymous organization and the 

Erie County Department of Social Services 

and offered the following services to 

chronic neglect families: 24-hour crisis 

intervention and support counseling, 

family-focused assessments, home-based 

support, concrete services, and parent 

education and support groups. Based 

on data from 92 families, the project 

exceeded its goals, which included safe 

housing, mastery of daily living skills, 

appropriate child discipline, health 

care, and mental health care. Families 

who were assigned one caseworker 

for their entire service term recorded 

greater improvements in all domains 

than families with multiple caseworkers. 

Three-fourths of the families sustained 

their improvements 6 months after 

termination of services. Changes were 

more substantial for families that stayed in 

the program for at least 3 months.

Read the project’s final report here: 

http://library.childwelfare.gov/cbgrants/

ws/library/docs/cb_grants/Record?w=NA

TIVE%28%27PDT+%3D+%27%27Grantee

+Final+Reports%27%27+AND+YEAR+%

3D+2002%3A2002+%27%29&upp=0&rp

p=25&order=native%28%27year%2FDesc

end%27%29&r=1&m=9

FEDERAL FUNDING 

TO ADDRESS NEGLECT

Case Closure and Beyond

Chronic neglect cases require specialized 

caseworker skills due to the intensity and 

duration of the practitioner’s involvement 

in the family’s life and the significance of 

particular steps/actions. A plan should be in 

place that addresses what the family can do 

if they begin to find themselves slipping into 

their former circumstances. At a minimum, 

these plans will provide family members with 

ways to access and receive ongoing family or 

community support as well as needed services 

and assistance. For families needing ongoing 

assistance, the caseworker should ensure that 

a warm handoff to community services has 

occurred. 

It is good practice to anticipate and prepare 

for a family crisis as case closure nears, since 

the experience of ending the relationship may 

be different for different family members. It 

is also important for the caseworker to get 

the family’s consent to allow visits after case 

closure. Visits at 3 and 6 months may serve as 

“boosters” that also allow for status updates 

and some assistance if needed. 

Competencies and 

 Training

Competencies and responsibilities of 

supervisors and workers who specialize in 

chronic neglect are somewhat distinct from 

the core child protection competencies. The 

following sections review those competencies 

and then discuss the types of training that can 

promote those competencies.
Chronic Child Neglect https://www.childwelfare.gov

10 This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare 

Information Gateway. Available online at https://www.childwelfare.gov/pubs/chronic_neglect.cfm

Competencies and Responsibilities 

of Caseworkers Who Specialize 

in Chronic Neglect

Caseworkers need specialized knowledge and 

experience with this population of families in 

order to be effective. Characteristics and skills 

should include:

• Exceptional engagement skills, patience, 

and staying power

• Ability to assess and identify child 

developmental needs

• Understanding of the distinction between 

immediate harm and cumulative harm

• Understanding of the concept of low 

impact/high frequency events compared to 

high impact/low frequency events

• Ability and willingness to enlist not 

only formal support networks but also 

informal networks such as family supports, 

relatives, neighbors, churches, and other 

nonprofessionals 

• Knowledge of protective factors that 

families can build and strategies for helping 

them build these protective factors

• Ability to instill hope, which is a key to 

intervention and change, in particular to 

counteract the pervasive impacts of despair 

and demoralization

• Awareness of the signs and symptoms of 

secondary trauma and strategies to address 

it 

More information on the protective factors 

is available in Child Welfare Information 

Gateway’s Preventing Child Maltreatment 

and Promoting Well-Being: A Network for 

Action 2012 Resource Guide: https://www.

childwelfare.gov/preventing/preventionmonth/

guide2013/

Competencies/Responsibilities 

of Supervisors Who Specialize 

in Chronic Neglect

Supervisors will be able to coach their 

caseworkers for both competence and 

confidence by building caseworker 

knowledge, skills, and abilities needed 

to implement family-centered, strengthsbased casework with fidelity. This building of 

competence and confidence occurs through:

• Partnering and relationship-building

• Skillful use of questions

• Listening

• Observing 

• Providing constructive feedback

In addition to these five skills, many 

supervisors will require additional training 

to optimize their work with the chronic 

neglect worker. Supervisors should be able 

to provide support (vs. require compliance 

of the worker), use clinical expertise, assist in 

solving problems and making decisions, serve 

as mentors, monitor workers for secondary 

trauma, and encourage self-care strategies 

and behaviors. Much like the flexibility 

required of workers who work with families 

impacted by chronic neglect, the flexibility 

of supervisors can, among other things, 

encourage creative thinking and solutions 

within the legal framework in which this work is 

performed.

Specialized Training

Specialized training is essential to optimizing 

the performance of both workers and 

supervisors working on chronic neglect cases. 

Such training should provide workers and 
Chronic Child Neglect https://www.childwelfare.gov

11 This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare 

Information Gateway. Available online at https://www.childwelfare.gov/pubs/chronic_neglect.cfm

their supervisors with an understanding of the 

characteristics of families that are chronically 

involved with the child welfare system, the 

patterns of maltreatment associated with 

this repeated involvement, and the areas in 

which these families often need services and 

supports. Examples include the following:

• Enhanced training on family engagement

is necessary, with a focus on involving 

families and their informal supports as 

“experts” on their own family’s strengths 

and needs. 

• Caseworkers must be skilled in 

understanding what families are 

communicating. If caseworkers better 

understand the families’ needs by 

effectively listening to them, there is a 

greater likelihood of success through 

developing a supportive relationship and 

tailoring services to meet individual needs. 

• Training should also include comprehensive 

family assessment as opposed to a more 

limited focus on the specific allegations 

contained in a single report of maltreatment 

(Center for Community Partnerships in 

Child Welfare of the Center for the Study of 

Social Policy [CSSP], 2006).

• To better serve children who repeatedly 

experience child maltreatment, all direct 

service providers should have access to 

and receive ongoing training to develop 

an in-depth understanding of child 

development and current research on early 

brain development.

• To prevent recurrences of neglect and to 

help families become stronger, all workers 

should be trained in the Strengthening 

Families Protective Factors framework 

and the strategies that can help families 

build protective factors (http://www.

cssp.org/reform/strengthening-families). 

More information on protective factors is 

available in Information Gateway’s annual 

resource guide on prevention at https://

www.childwelfare.gov/preventing, and 

a free online training on a strengthsbased approach to helping families 

build protective factors is available from 

the National Alliance of Children’s Trust 

and Prevention Funds at http://learner.

ctfalliance.org/login/index.php. 

• To help adult family members understand 

their own trauma and the importance of 

protecting their children from trauma, all 

workers would benefit from training on the 

Adverse Childhood Experiences (ACES) 

research, conducted by the Centers for 

Disease Control and Prevention (http://

www.cdc.gov/ace/).

There must be an organizational commitment 

to collaborate with other child- and familyserving systems and community-based 

organizations so that caseworkers and 

supervisors can develop strong working 

relationships with community service 

providers. Cross-training child welfare, mental 

health, substance abuse, and domestic 

violence service providers can build workers’ 

internal capacity to identify, assess, refer, and 

intervene, as appropriate, in response to a 

chronic neglect family’s multiple needs. For 

example, an effective partnership and crosstraining between early childhood education 

providers and child welfare workers is essential 

to the well-being of chronically neglected 

young children (CSSP, 2006). 

Other programs such as Circle of Parents

and Parents Anonymous show promise 

in providing peer support to parents by 
Chronic Child Neglect https://www.childwelfare.gov

12 This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare 

Information Gateway. Available online at https://www.childwelfare.gov/pubs/chronic_neglect.cfm

matching them with other parents who have 

previous experience with child welfare and 

have successfully resolved their own family 

issues. These experienced and trained parents 

(Parent Leaders) serve as mentors, providing 

support, guidance, and hope to parents 

struggling to meet their children’s needs. The 

California Evidence-Based Clearinghouse for 

Child Welfare identifies several Parent Partner 

programs: http://www.cebc4cw.org/topic/

parent-partner-programs-for-families-involvedin-the-child-welfare-system. 

Implications for Child 

 Welfare Organizations

Child welfare agencies may need to 

restructure and rethink their organization and 

policies to better meet the needs of families 

experiencing chronic neglect. Steib and Blome 

(2009) recommend specific changes that 

agencies can make, including:

• Moving away from the idea of quick 

fixes and toward plans for long-term 

interventions to address chronic neglect

• Fostering leadership that supports and 

promotes family engagement approaches

• Reorganizing so that staff work in teams to 

ensure continuity with families when there is 

worker turnover

• Allowing specialized chronic neglect units 

to hire workers with masters degrees and to 

maintain a manageable workload

• Relying on methodologically sound 

evaluation and outcome data instead of 

anecdotal indicators

• Permitting services to be long-term when 

needed

• Using cost-benefit research to determine 

the cost of not providing needed benefits 

and services to children experiencing 

chronic neglect

Public agencies need to focus on prevention 

and early intervention and on developing 

partnerships with other community and 

informal support systems to promote effective 

prevention strategies for chronic neglect. 

The only way to address chronicity is to 

interrupt the cycle before it begins (Kaplan 

et al., 2009). Child welfare research and 

practice have evolved so that there is also a 

general recognition of the need for multiple, 

differential responses to child maltreatment. 

Short-term interventions have little impact 

on families chronically involved with the 

child welfare system, and thus using them 

in this way can be a waste of already-limited 

resources. Public child welfare agencies need 

to identify ways and resources to train the 

workforce on chronic neglect as well as the 

co-occurring issues that burden the lives of 

these families.

A Framework for 

Addressing Chronicity

The Center for the Study of Social Policy 

(2006), in a report on chronic abuse and 

neglect, lists seven areas of action as 

a framework for agencies to increase 

understanding of and strengthen responses to 

the needs of this population:

1. Develop a better understanding 

of the phenomenon of “repeated 

involvement” or “chronicity.”
Chronic Child Neglect https://www.childwelfare.gov

13 This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare 

Information Gateway. Available online at https://www.childwelfare.gov/pubs/chronic_neglect.cfm

2. Assess whether change is needed in 

management, staffing, and training in 

the agency and in the court.

3. Assess the current array of services 

and supports for families with chronic 

involvement.

4. Determine ways to listen to parents 

when developing a plan to address 

the family’s needs. 

5. Assess how well the needs of 

children and youth are being met.

6. Assess the level of involvement 

with community-based efforts that 

focus on economic development 

of neighborhoods, community 

revitalization, employment training 

and preparation, and affordable and 

safe housing.

7. Improve the level of collaboration 

with other child and family-serving 

agencies.

Integrating Approaches Along 

the Child Welfare Continuum

Two child welfare approaches—differential 

response and prevention—have particular 

relevance for addressing chronicity.

Differential response systems may be the 

most promising framework for treatment of 

neglect and chronic neglect. Greater breadth 

and depth are encouraged in conducting 

family assessments in differential response 

systems; thus, workers are better able to 

detect safety and risk factors (Johnson, 

2009). Agencies may set up a chronic 

neglect pathway that can identify families 

that repeatedly come to the attention of 

the child welfare agency (Johnson, 2009). 

When the third referral is received by the 

hotline (or another number as designated by 

agency policy or protocol), the family receives 

specialized response and intervention. Having 

a dedicated chronic neglect pathway allows 

for targeted screening and case assignment 

to workers with specialized knowledge of 

and expertise in working this population. It 

provides an opportunity for the agency to 

assign a family to a worker who is familiar 

with them, and conversely, offers families an 

option to work with someone they already 

know (Johnson, 2009). With easy access to 

case history at the second and third report, 

child protective services may respond by 

offering voluntary, concrete services to the 

family and assist in building support systems 

(Gilmore, 2009). Concrete Support and 

Social Connections are just two of the known 

protective factors.

For more information about differential 

response, visit the Children’s Bureau’s National 

Quality Improvement Center on Differential 

Response in Child Protective Services at 

http://www.differentialresponseqic.org. 

Many prevention services (e.g., respite, family 

support, home visiting, etc.) are effective 

at different points of families’ involvement 

with the child welfare system and may keep 

families from becoming chronically involved. 

Unsubstantiated cases of maltreatment 

often signal significant need of services. 

One option for agencies is to mandate that 

a second report of maltreatment triggers an 

enhanced assessment and case management 

plan to ensure needed services are accessed, 

regardless of immediate risk of harm (JonsonReid, 2012).

Some of the most promising prevention 

initiatives nationwide are types of community 
Chronic Child Neglect https://www.childwelfare.gov

14 This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare 

Information Gateway. Available online at https://www.childwelfare.gov/pubs/chronic_neglect.cfm

empowerment, including the investment in 

early childhood education (Wilson, 2010). 

In times of economic hardship, community 

agencies, churches, and neighborhoods can 

join together to support child development 

in poor families (Wilson, 2010). Community 

programs that sustain morale under these 

conditions will:

• Provide concrete emergency assistance to 

families on the verge of destitution

• Offer ongoing emotional support, 

especially to single-parent families

• Involve families in creating a better future 

for their children 

• Make sustained investments in poor 

children’s intellectual and social 

development (Wilson, 2010)

Examples of Promising 

Interventions and 

Evidence-Informed 

Programs

As more innovative programs are tested and 

more research is carried out, both researchers 

and practitioners are learning more about 

what works in addressing chronic neglect. 

The following are two examples of programs 

focused on chronic neglect.

Minnesota and the Family 

Asset Builder

In 2009, Casey Family Programs and the 

American Humane Association partnered to 

develop a new intervention model for cases of 

chronic child neglect. The model, called the 

Family Asset Builder (FAB), was implemented 

in two Minnesota counties in February 2011. 

It is a strengths-based, solution-focused 

approach that calls for chronic neglect workers 

with reduced caseloads to partner with and 

more fully engage families through frequent 

and consistent contact over an 18-month 

period. Preliminary results suggest that the 

model has enabled workers to establish 

better working relationships with families 

and focus more productively on manageable 

goals. It also has given workers a sense of 

accomplishment regarding the program’s 

positive impact on families.

For more information, visit the Casey website: 

http://www.casey.org/Resources/Initiatives/

FamilyAssetBuilder/default.htm

Missouri and the Chronic 

Neglect Worker

In response to the highly publicized 1995 

death of an infant due to chronic neglect, as 

well as part of a larger reform effort, the St. 

Louis, MO, child welfare system revamped its 

practice by making the following changes:

• Changing removal criteria to focus on 

accumulation of harm

• Providing training and new processes 

focused on assessment

• Revamping the criteria for case closure in 

cases of chronic neglect

• Developing a protocol for coordination 

between agencies

• Reducing caseloads (Johnson, 2009) 

A chronic neglect worker position was 

created, and this specialist was responsible for 

identifying and working with families impacted 
Chronic Child Neglect https://www.childwelfare.gov

15 This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare 

Information Gateway. Available online at https://www.childwelfare.gov/pubs/chronic_neglect.cfm

by chronic neglect. Other innovations included 

hiring a chronic neglect family support 

worker from the neighborhood, integrating 

social work students in meaningful functions, 

using family team meetings and a family 

relationships map, and providing specialized 

training for workers. 

For more information, read Frances Johnson’s 

(2009) “Chronic Neglect Practice With St. 

Louis Families,” Protecting Children, Vol. 24, 

at http://www.americanhumane.org/assets/

pdfs/children/pc-pc-chronic-neglect-st-louis.

pdf. 

In addition, Missouri’s Child Welfare Manual

includes a chapter on chronic neglect and 

recommended practice: http://www.dss.

mo.gov/cd/info/cwmanual/section7/ch1_33/

sec7ch10.htm. 

Conclusion: The 

 Importance of Hope

Hope is the linchpin to intervention and 

the motivation to change, in particular, to 

counteract the omnipresent impacts of despair 

and demoralization. Hope aims to raise 

expectations of a better future and increase 

the possibility of its attainment (Kaplan, et 

al., 2009). Families that have hope are able 

to look ahead and envision a time when their 

problems are under control and their children 

are happy and healthy. Workers who can 

maintain a positive, forward-thinking attitude 

and who can radiate that optimism have a 

greater chance of igniting hope in families 

who may have had little reason to be hopeful 

in the past.

EVIDENCE-INFORMED PROGRAMS

The following list provides links to 

programs that focus on prevention or 

intervention to help families with chronic 

neglect. Each of these programs has 

some level of empirical support for their 

effectiveness; program activities have been 

found, based on an objective standard, to 

lead to intended goals.

• Circle of Security

• Family Connections

• Healthy Start

• Healthy Families

• Helping Families Prevent Child Neglect

• Nurse Family Partnership

• Families and Centers Empowered 

Together (FACET)

• Nurturing Parents Program

• Project Healthy Grandparents

• Project Safe Care

• Project Twelve Ways

• Strengthening Families Program

• Therapeutic Child Care
Chronic Child Neglect https://www.childwelfare.gov

16 This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare 

Information Gateway. Available online at https://www.childwelfare.gov/pubs/chronic_neglect.cfm

“A touch of hope, a trustworthy attachment, growing self-esteem and a sense of being in 

control make the unbearable somewhat less so.” (Krugman, 1987, in Kaplan, et al., 2009)

“By hypothesis, any factor or set of factors that influence the hopes of poor parents that they 

may one day have a better life, affects their morale, which, in turn, affects their parenting 

practices.” (Wilson & Horner, 2005, in Kaplan, et al., 2009)

“Goals regarding intervention should be founded on building hope, self-esteem and selfsufficiency for both the parents and the children.” (Gaudin, 1993, in Kaplan, et al., 2009)

References

American Humane Association. (2010). Child welfare policy briefing: Chronic neglect, 1(4). 

Washington, DC: American Humane Association. Retrieved from http://www.americanhumane.

org/assets/pdfs/children/advocacy/11th-chronic-neglect.pdf

Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and 

design. Cambridge, MA: Harvard University Press.

Cahn, K., & Nelson, K. (2009). Mobilizing community responses to chronic neglect: A researchto-practice approach. Protecting Children, 24(1), 34-45. Retrieved from http://www.

americanhumane.org/assets/pdfs/children/protecting-children-journal/pc-24-1.pdf

Center for Community Partnerships in Child Welfare of the Center for the Study of Social Policy 

(2006). Families with repeat involvement with child welfare systems: The current knowledge 

base and needed next steps. New York, NY: Center for the Study of Social Policy. Retrieved 

from http://www.cssp.org/publications/child-welfare/child-welfare-misc/families-with-repeatinvolvement-with-child-welfare-systems.pdf

Child Welfare Information Gateway. (2012). Engaging families in case planning. Washington, DC: 

U.S. Department of Health and Human Services, Children’s Bureau. https://www.childwelfare.

gov/pubs/engaging_families.cfm

Corso, P. S. (2010). Dollars and lives: The economics of healthy children. Chicago, IL: Prevent 

Child Abuse of America. Retrieved from http://www.preventchildabuse.org/publications/cap/

documents/CorsoWHTPPR.pdf

DePanfilis, D. (2002). Helping families prevent child neglect: Final report. Baltimore, MD: University 

of Maryland. Retrieved from http://www.family.umaryland.edu/ryc_research_and_evaluation/

publication_product_files/selected_presentations/presentation_files/pdfs/final_report.pdf
Chronic Child Neglect https://www.childwelfare.gov

17 This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare 

Information Gateway. Available online at https://www.childwelfare.gov/pubs/chronic_neglect.cfm

DePanfilis, D. (2006). Child neglect: A guide for prevention, assessment and intervention. Third 

Edition. Fairfax, VA: ICF International (Contract Number HHS-282-98-0025).

DePanfilis, D., & Zuravin, S. J. (1999). Epidemiology of child maltreatment recurrences. Social 

Service Review, 73(2), 218–239.

Fluke, J. D., & Hollinshead, D. M. (2003). Child maltreatment recurrence: A leadership initiative of 

the National Resource Center on Child Maltreatment. Duluth, GA: National Resource Center on 

Child Maltreatment. Retrieved from http://www.nrccps.org/PDF/MaltreatmentRecurrence.pdf

Gaudin, J. (1993). Effective interventions with neglectful families. Criminal Justice and Behavior, 

20(1), 66–89.

Gilmore, D. (2009). Chronic Neglect Research Meeting: Synthesis of Proceedings. Denver, CO: 

American Humane Association.

Hildyard, K., & Wolfe, D. (2002). Child neglect: Developmental issues and outcomes. Child Abuse 

& Neglect, 26, 679–695.

Johnson, F. (2009). Chronic neglect practice with St. Louis families. Protecting Children, 24(1), 

46-56. Retrieved from http://www.americanhumane.org/assets/pdfs/children/pc-pc-chronicneglect-st-louis.pdf

Jones, J., & Gupta, A. (2003). Neglect and its impact on child welfare. In M. Bannon & Y. Carter 

(Eds.), Protecting children from abuse and neglect in primary care (pp.72–82). Oxford: Oxford 

University Press.

Jonson-Reid, M. (2012). Long term service use patterns across systems for child neglect. Presented 

at the 18th National Conference on Child Abuse and Neglect, Washington, DC. Retrieved from 

https://www.pal-tech.com/intranet/OCAN/3594_Boyce,_C.-Research_on_Child_Neglect.pdf

Kaplan, C., Schene, P., DePanfilis, D., & Gilmore, D. (2009). Introduction: Shining light on chronic 

neglect. Protecting Children, 24(1), 1-8.

Kempe, C. H., Silverman, F. N., Steele, B. F., Droegemueller, W., & Silver, H. K. (1962). The 

battered-child syndrome. Journal of the American Medical Association, 181(1), 17–24.

doi:10.1001/jama.1962.03050270019004

Krugman, S. (1987). Trauma in the family: Perspectives on the intergenerational transmission 

of violence. In B. van der Kolk (Ed.), Psychological trauma (pp. 127–151). Washington, DC: 

American Psychiatric Association.
Chronic Child Neglect https://www.childwelfare.gov

18 This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare 

Information Gateway. Available online at https://www.childwelfare.gov/pubs/chronic_neglect.cfm

Lange, K., & Ghazvini, A. (2007). Frequently seen families: Practical help for the most difficult cases 

of chronic neglect. Presentation at the 16th National Conference on Child Abuse and Neglect, 

Portland, OR.

Loman, L. A. (2006). Families frequently encountered by child protection services. A report on 

chronic abuse and neglect. St. Louis, MO: Institute of Applied Research. Retrieved from 

http://www.iarstl.org/papers/FEfamiliesChronicCAN.pdf

Loman, L. A., & Siegel, G. L. (2004). Differential response in Missouri after five years: Final report.

St. Louis, MO: Institute of Applied Research. Retrieved from http://www.iarstl.org/papers/

MODiffResp2004a.pdf

Marshall, D., & English, J. (1999). Survival analysis of risk factors for recidivism in child abuse and 

neglect. Child Maltreatment, 4(4), 287- 296.

Perry, B. D. (2000). The Neurodevelopmental costs of adverse childhood events. Retrieved 

from http://www.juconicomparte.org/recursos/Neuroarcheology%20of%20childhood%20

maltreatment_zmH8.pdf

Perry, B. D. (2003). Bonding and attachment in maltreated children: Consequences of emotional 

neglect in childhood. Retrieved from http://teacher.scholastic.com/professional/bruceperry/

bonding.htm

Steib, S., & Blome, W. W. (2009). How can neglected organizations serve neglected children? 

Protecting Children, 24(1), 9-19.

Tanner, K., & Turney, D. (2003). What do we know about child neglect? A critical review of the 

literature and its application to social work practice. Child and Family Social Work, 8, 25–34.

Thompson, D., & Lockwood, B. (2008). Engagement, collaboration and safety. Presentation at 

the 2008 National Conference on Differential Response of the American Humane Association. 

Columbus, OH.

U.S. Department of Health and Human Services, Children’s Bureau. (2009). Child Maltreatment 

2008. Retrieved from http://www.acf.hhs.gov/programs/cb/resource/child-maltreatment-2008

U.S. Department of Health and Human Services, Children’s Bureau. (2010). Child Maltreatment 

2009. Retrieved from http://www.acf.hhs.gov/programs/cb/resource/child-maltreatment-2009

U.S. Department of Health and Human Services, Children’s Bureau. (2011). Child Maltreatment 

2010. Retrieved from http://www.acf.hhs.gov/programs/cb/resource/child-maltreatment-2010
Chronic Child Neglect https://www.childwelfare.gov

19 This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare 

Information Gateway. Available online at https://www.childwelfare.gov/pubs/chronic_neglect.cfm

Wilson, D. (2010). Trends in child neglect. Protecting families in hard economic times. Presentation 

in Salem, OR, at Casey Family Programs. Retrieved from http://cms.oregon.egov.com/DHS/

children/beyondfc/docs/casey-pwrpnt-child-neglect-trends.pdf?ga=t

Wilson, D., & Horner, W. (2003). Theory and practice in chronic child neglect. Unpublished paper, 

Olympia, WA: Division of Children & Family Services.

Wilson, D., & Horner, W. (2005). Chronic child neglect: Needed developments in theory and 

practice. Families in Society: The Journal of Contemporary Social Services, 86(4), 471–481.

World Health Organization. Violence Prevention Alliance: The ecological framework. Geneva, 

Switzerland. Retrieved from http://www.who.int/violenceprevention/approach/ecology/en/index.

html

Acknowledgment: 

This bulletin was developed by Child Welfare Information Gateway in partnership with Caren 

Kaplan, M.S.W. This document is made possible by the Children’s Bureau, Administration on 

Children, Youth and Families, Administration for Children and Families, U.S. Department of Health 

and Human Services. The conclusions discussed here are solely the responsibility of the authors 

and do not represent the official views or policies of the funding agency.

Suggested Citation:

Child Welfare Information Gateway. (2013). Chronic child neglect. Washington, DC: U.S. 

Department of Health and Human Services, Children’s Bureau. 
Chronic Child Neglect https://www.childwelfare.gov

Appendix

National Statistics on the Number and Percentages of Child Neglect Cases

Year1 Number of Children With Substantiated 

Reports of Child Maltreatment2

Number (percent) Who 

Were Victims of Neglect

2000 862,455 515,792 (59.8)

2001 903,089 516,635 (57.2)

2002 895,569 523,704 (58.5)

2003 787,156 479,567 (60.9)

2004 872,088 544,050 (62.4)

2005 899,4543 564,765 (62.8)

2006 885,245 567,787 (64.1)

2007 740,517 436,944 (59.0)

2008 758,289 539,322 (71.1)

20094 693,174 543,035 (78.3)

2010 688,251 538,557 (78.3)

Numbers are taken from Federal Child Maltreatment Reports (https://www.acf.hhs.gov/programs/cb/research-data-technology/statisticsresearch/child-maltreatment) and are based on tables at the end of Chapter 3 presenting case-level data for type of maltreatment. 

1 2 3 4

1 States include District of Columbia and Puerto Rico. Not all States reported case-level data every year. The reports used aggregate 

data when case-level data were not available.

2 Victims of neglect may have also experienced other types of maltreatment, including medical neglect. Medical neglect is not included 

in this number.

3 Increase in total number of victims in 2005 is largely attributed to the inclusion of case-level data from Alaska and Puerto Rico, which 

had not been included in 2004.

4 Beginning in 2009, Child Maltreatment reports broke down the numbers by unique vs. duplicate count victims. The duplicate count 

of child victims counts a child each time he or she was found to be a victim. The unique count of child victims counts a child only once 

regardless of the number of times he or she was found to be victim during the reporting year. These numbers refer to unique victims.

U.S. Department of Health and Human Services 

Administration for Children and Families 

Administration on Children, Youth and Families 

Children’s Bureau