Children’s Bureau/ACYF/ACF/HHS

800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov

Neglect accounts for over three-quarters of 

confirmed cases of child maltreatment in the 

United States—far more than physical or sexual 

abuse (U.S. Department of Health and Human 

Services [HHS], Administration for Children and 

Families [ACF], Children’s Bureau [CB], 2017c). 

It continues, however, to receive less attention 

from practitioners, researchers, and the media. 

Some reasons may be that neglect is not well 

understood and is difficult to identify, prevent, 

and treat effectively. 

This bulletin for professionals addresses the 

scope of the problem of child neglect, its 

consequences, and the importance of prevention. 

It provides definitions and strategies for assessing 

neglect, presents an overview of prevention and 

intervention, and suggests sources of training and 

informational support.

WHAT’S INSIDE

Scope of the problem

Defining child neglect

Types of neglect

Reasons for neglect

Consequences of 

neglect 

Special considerations

Assessment

Prevention and 

intervention

Training

Conclusion

References

BULLETIN FOR 

PROFESSIONALS

July 2018

Acts of Omission: An 

Overview of Child Neglect
Acts of Omission: An Overview of Child Neglect https://www.childwelfare.gov

2

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This publication is available online at https://www.childwelfare.gov/pubs/focus/acts/.

Scope of the Problem

According to the latest Children’s Bureau Child 

Maltreatment report, more than 514,000 children were 

neglected in 2015, accounting for 75.3 percent of all 

unique victims of child maltreatment (HHS, ACF, CB, 

2017c). In addition, neglect was either the sole cause or 

one of the contributors to nearly 73 percent of the 1,670 

deaths related to child maltreatment in 2015. 

These statistics include only children who came to the 

attention of State child protective services (CPS) agencies. 

The National Incidence Study (NIS) of Child Abuse and 

Neglect, which generates broader estimates by gathering 

data from sources beyond CPS agencies, generally shows 

higher numbers of maltreatment than those shown in 

the Child Maltreatment reports. The most recent version, 

NIS-4, uses data from 2005 to 2006 to show that more 

than 2.2 million children were neglected, accounting for 

about 77 percent of all children harmed or endangered by 

maltreatment (Sedlak et al., 2010). Although the rates of all 

types of maltreatment have declined in recent years, rates 

of neglect have decreased much less than the other types 

(Child Trends, 2016). The persistently high rates of neglect 

and its serious consequences point to the need for more 

effective prevention and for early intervention in cases of 

neglect.

Defining Child Neglect

Both Federal and State laws provide basic definitions 

of child abuse and neglect. The Federal Child Abuse 

Prevention and Treatment Act (CAPTA) (42 U.S.C.A. 

§5106g), as amended by the CAPTA Reauthorization Act

of 2010, defines child abuse and neglect as the following,

at 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

 An act or failure to act which presents an imminent risk

of serious harm

The Justice for Victims of Trafficking Act of 2015 (P.L. 

114-22) expanded the Federal definition of “child abuse 

and neglect” and “sexual abuse” to include a child who is 

identified as a victim of sex trafficking or severe forms of 

trafficking in persons (HHS, ACF, CB, 2017b).

Neglect is commonly defined in State law as the failure of 

a parent or other person with responsibility for the child 

to provide needed food, clothing, shelter, medical care, 

or supervision to the degree that the child’s health, safety, 

and well-being are threatened with harm (Child Welfare 

Information Gateway, 2016b). Some States specifically 

mention types of neglect in their statutes, such as 

educational neglect, medical neglect, and abandonment; 

in addition, some States include exceptions for 

determining neglect, such as religious exemptions for 

medical neglect and financial considerations for physical 

neglect. 

State Statutes and Publications

To see how your State addresses neglect 

definitions in law, see Information Gateway’s State 

Statute publication Definitions of Child Abuse and 

Neglect, available at https://www.childwelfare.

gov/topics/systemwide/laws-policies/statutes/

define/. 

Most States publish policy or procedure manuals 

to help professionals apply legal definitions 

of child abuse and neglect in practice. Use 

Information Gateway’s State Guides and Manuals 

Search to find your State’s resources online, 

available at https://www.childwelfare.gov/topics/

systemwide/sgm/. 
Acts of Omission: An Overview of Child Neglect https://www.childwelfare.gov

3

Child neglect is generally thought of as the inability 

of a parent or caregiver to meet a child’s basic needs, 

potentially placing the child at risk of serious harm. 

For definitions, many State laws focus on omission in 

care by parents or caregivers, but holding parents or 

caregivers accountable for harm that results from failing 

to care for their children is challenging for child welfare 

workers who may feel uncomfortable labeling failure to 

provide necessary care as “neglect.” Definitions and 

accountability are complicated by multiple and interacting 

factors, such as the following (Dubowitz, 2013):

 Whether care is adequate to meet a child’s needs

 If harm is actual or potential

 Variety in the types of neglect

 Whether the neglect was intentional

These factors create difficulties in developing standard 

definitions of neglect, and the varied definitions 

contribute to a lack of consistency in research on neglect 

and responses to that research.

Types of Neglect

Although State laws vary regarding the types of neglect 

included in definitions, summarized below are the most 

commonly recognized categories of neglect:

 Physicalneglect: Abandoning the child or refusing

to accept custody; not providing for basic needs like

nutrition, hygiene, or appropriate clothing

 Medicalneglect: Delaying or denying recommended

health care for the child

 Inadequatesupervision: Leaving the child

unsupervised (depending on length of time and

child’s age/maturity), not protecting the child from

safety hazards, not providing adequate caregivers, or

engaging in harmful behavior

 Emotionalneglect: Isolating the child, not providing

affection or emotional support, or exposing the child

to domestic violence or substance use

 Educationalneglect: Failing to enroll the child in

school or homeschool, ignoring special education

needs, or permitting chronic absenteeism from school

For more information on types of neglect, visit 

Information Gateway’s webpage on the Identification 

of Neglect at https://www.childwelfare.gov/topics/can/

identifying/neglect. 

Chronic Neglect

Although some individual incidents of neglect 

may not appear harmful, multiple incidents 

occurring over time can have a severely negative 

impact on a child. Chronic neglect occurs when 

the following three conditions exist and result 

in cumulative harm or serious risk of harm to a 

child’s safety, health, or well-being (Child Welfare 

Information Gateway, 2013a): 

 At least one need basic to a child’s healthy

development is not met

 The neglect is perpetrated by the child’s

parent or caregiver

 The neglect occurs on a recurring or enduring

basis

Chronic neglect can be hard to identify and 

treat; affected families face complex problems 

that often require long-term assistance and 

community support. Specialized interventions 

and tools are required to address these 

needs, the unusual nature of neglect, and its 

detrimental effects (Corwin et al., 2014). For 

more on strategies to address chronic neglect, 

see Information Gateway’s bulletin Chronic Child 

Neglect at https://www.childwelfare.gov/pubs/

chronic-neglect/. 

The model on page 4, from the National Alliance for 

Children’s Trust and Prevention Funds, provides a more 

comprehensive framework for understanding the family 

context and the broader environment in which child 

neglect occurs. 

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5

Reasons for Neglect 

To fully understand the reasons for neglect, it is important 

to move beyond considerations of child neglect only as 

a function of parent or caregiver characteristics (National 

Alliance of Children’s Trust & Prevention Funds [Alliance], 

2014). Considerations should include the following four 

levels of the socioecological model (Alliance, 2013):

1. Child/Individual

2. Family/Parents

3. Community/Neighborhood

4. Society

To better understand the influences on individual families, 

it is important to explore the context for these different 

areas in the lives of families. 

Examples of factors in each of the levels of the 

socioecological model that contribute to and protect 

against child neglect include the following:

 Child/Individual—Physical, emotional, intellectual, and

other personal characteristics of the parent or child;

current or past trauma; nurturing and attachment

capacity of the parent and child; resilience

 Family/Parents—Healthy partner relationship; physical,

emotional, and economic well-being; parent-child

interactions

 Community/Neighborhood—Adequate resources

to meet community needs (e.g., safe playgrounds,

libraries, access to healthy foods); networks for support

and assistance; neighborhood violence

 Society—Family policies that provide supports

for families, lack of clarity on adequate parenting

standards, concrete supports available to all families

Understanding reasons for neglect that extend 

beyond parents and caregivers may lead child welfare 

professionals to use strengths-based approaches and 

preventive strategies with parents who need support.

For more information on the Alliance, visit http://www.

ctfalliance.org/

Consequences of Neglect

Although the initial impact may not be as obvious as 

physical or sexual abuse, the consequences of child 

neglect are just as serious. The effects of neglect are 

cumulative, and long-term research like that being 

performed by the Longitudinal Studies of Child Abuse 

and Neglect (http://www.unc.edu/depts/sph/longscan/), 

funded by the Children’s Bureau, helps child welfare 

professionals better understand outcomes for children 

affected by neglect.

Neglect can have a negative effect on children in the 

following areas (Center on the Developing Child at 

Harvard University, 2012):

 Health and physical development—Malnourishment,

impaired brain development, delays in growth or

failure to thrive

 Intellectual and cognitive development—Poor

academic performance, delayed or impaired language

development

 Emotional and psychological development—

Deficiencies in self-esteem, attachment, or trust

 Social and behavioral development—Interpersonal

relationship problems, social withdrawal, poor impulse

control

The impacts in these areas are interrelated; problems in 

one developmental area may influence growth in another 

area. In addition, research has established a clear link 

between child maltreatment, including neglect, with 

health and well-being issues (Metzler, Merrick, Klevens, 

Ports, & Ford, 2017).

The effects of neglect can vary, however, based on the 

following factors:

 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

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6

Trauma and Neglect 

While trauma—an emotional response to an intense 

event that threatens or causes harm—is often discussed 

in terms of witnessing or being harmed by an intensely 

threatening event, one or multiple experiences of 

neglect can also have a traumatic effect, especially in 

severe cases. Child neglect is one common type of 

childhood trauma that results in distress, posttraumatic 

stress disorder, and posttraumatic stress symptoms 

(De Bellis & Zisk, 2014). Children’s experiences with 

neglect can negatively affect brain development by 

changing how they respond to intense events, thereby 

disrupting their ability to cope with adversity (Child 

Welfare Information Gateway, 2015; National Scientific 

Council on the Developing Child, 2012). A recent literature 

review addressing the traumatic nature of child neglect 

emphasizes the need for trauma-informed interventions 

and provides the following intervention guidelines when 

working with children who have been neglected and their 

families (Milot, St-Laurent, & Éthier, 2016): 

1. Assess	trauma	experiences

2. Provide	a	safe	environment

3. Build	a	feeling	of	emotional	security

4. Improve	parental	sensitivity

5. Develop	child	emotional	self-regulation

6. Offer	parents	emotional	therapeutic	support

More information on addressing trauma in children who 

have experienced neglect and their families is available 

in the National Child Traumatic Stress Network’s Child 

Welfare Trauma Training Toolkit (http://www.nctsn.org/

products/child-welfare-trauma-training-toolkit-2008) 

and Information Gateway’s bulletin for professionals, 

Supporting Brain Development in Traumatized Children 

and Youth (https://www.childwelfare.gov/pubs/

braindevtrauma).

TraumaAdaptedFamilyConnections (TA-FC) is 

based on the principles of Family Connections (FC), 

an in-home, evidence-based neglect prevention 

intervention that began in 1996 as a demonstration 

project funded by the Children’s Bureau. The 

intervention began at the University of Maryland 

School of Social Work (UM SSW) Ruth H. Young 

Center for Families and Children and aimed to 

prevent neglect in at-risk families. TA-FC is part of 

the Family Informed Trauma Treatment Center at 

UM SSW, as well as the National Child Traumatic 

Stress Network. It is a manualized, trauma-focused 

practice designed to last up to 6 months and 

incorporates (1) trauma-focused family assessment 

and engagement, (2) education for families on 

trauma causes and symptoms, (3) safety capacity 

building within the community and immediate 

environment, (4) trauma-informed parenting 

practices, and (5) trauma-informed approaches to 

working with families. TA-FC is replicated across 

the social services. In child welfare, one program in 

Cleveland, OH, uses TA-FC to strengthen families 

reuniting after child removal due to homelessness, 

and one program in Washington, DC, assists 

grieving teens with difficulties at school and at 

home. TA-FC is also used in a county and a State 

site as an alternate response to unsubstantiated 

cases. Successes include, but are not limited to, 

reductions in posttraumatic stress symptoms 

and depression in both caregivers and children; 

reductions in caregiver anxiety; improvements 

in child behaviors; and improved outcomes in 

caregiver, child, and family well-being and safety 

(Collins et al., 2015). 

Find more information about FC at http://www.

family.umaryland.edu/fc-replication or contact 

Diane DePanfilis at 917.453.2296.

For more information about TA-FC, go to http://

www.family.umaryland.edu/fc-trauma/ or contact 

Kathryn Collins at 410.706.0814.

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7

Fatal Neglect 

A child’s death is the most tragic consequence of 

neglect, and neglect caused or contributed to nearly 

three-quarters of all child maltreatment-related deaths in 

2015 (HHS, ACF, CB, 2017c). A study of child fatalities in 

Oklahoma due solely to neglect found that fatalities due 

to lack of supervision and a dangerous environment were 

much more common than those caused by deprivation 

of needs or medical neglect (Welch & Bonner, 2013). 

Neglect fatalities can be difficult to identify due to 

lack of definitive medical evidence, limited resources 

for testing, varying levels of expertise and training for 

relevant personnel, and differing interpretations of child 

maltreatment definitions (U.S. Government Accountability 

Office, 2011). 

For more information, visit the website of the National 

Center for Fatality Review and Prevention at https://www.

ncfrp.org. 

Risk Factors

While the presence of a risk factor does not mean that a 

child will be neglected, multiple risk factors are a cause 

for concern. Research indicates that many familial and 

societal factors, such as the following, place children at 

greater risk of being harmed or endangered by neglect:

 Poverty

 Single-parent status

 Dysfunctional family structure

 Lack of adequate support systems

 Lack of adequate family resources

 Mental health concerns

 Substance use disorders

 Domestic violence

 Parental childhood abuse (Hamilton & Bundy-Fazioli,

2013)

For more information on risk factors, see Information 

Gateway’s Factors That Contribute to Child Abuse and 

Neglect webpage at https://www.childwelfare.gov/topics/

can/factors/contribute.

Protective Factors

Although several factors place children at greater risk 

of neglect, families with one or more of the following 

protective factors may be less likely to experience abuse 

or neglect (Center for the Study of Social Policy, 2016; 

Child Welfare Information Gateway, 2014b):

 Knowledge of parenting and child development

 Parental resilience

 Social connections of parents

 Concrete supports

 Social and emotional competence of children

 Nurturing and attachment1

For more information on protective factors for child abuse 

and neglect, see the following resources:

 Information Gateway’s Protective Factors to Promote

Well-Being webpage at https://www.childwelfare.gov/

topics/preventing/promoting/protectfactors/

 Information Gateway’s issue brief Protective Factors

Approaches in Child Welfare at https://www.

childwelfare.gov/pubs/issue-briefs/protective-factors/

 The Centers for Disease Control and Prevention’s

webpage Child Abuse and Neglect: Risk

and Protective Factors at https://www.cdc.gov/

violenceprevention/childabuseandneglect/

riskprotectivefactors.html

1 The Children’s Bureau incorporated nurturing and attachment, the sixth 

protective factor, for prevention efforts and has integrated key elements of the 

Strengthening Families’ protective factors framework (the first five protective 

factors listed) into its ongoing prevention work through the Office on Child 

Abuse and Neglect.

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8

Special Considerations

Neglect rarely occurs in isolation; commonly related 

issues include poverty, substance use, and domestic 

violence. There are special considerations for addressing 

these issues with children who are at-risk or neglected 

and their families.

Poverty 

Poverty is frequently linked to child neglect, but child 

welfare professionals should understand that most 

poor families do not neglect their children. NIS-4 data 

indicate that children from low socioeconomic status 

households (annual incomes below $15,000, family 

member participation in a poverty program, and/or 

parent education less than high school) were about 

seven times more likely to be neglected than children in 

higher socioeconomic households (Sedlak et al., 2010). 

While poverty is clearly linked with maltreatment, the 

relationship is not simple. Poverty increases the risk of 

neglect by interacting with and worsening related risks 

like family stress, access to necessary resources (e.g., 

healthy food and medical care), and the inability to 

provide appropriate care for children (Eckenrode, Smith, 

McCarthy, & Dineen, 2014). Because chronic neglect 

is commonly associated with co-occurring issues like 

cognitive development, mental health, or substance use 

disorder concerns (Child Welfare Information Gateway, 

2013c), families living with neglect in poverty are likely to 

struggle with an array of risk factors. Lack of housing and 

transportation, in addition to lack of access to substance 

use disorder treatment, are common themes in child 

neglect cases.

Caseworkers must differentiate between neglectful 

situations and poverty; in many States, definitions of 

neglect include considerations for a family’s financial 

means. For example, if a family living in poverty was not 

providing adequate food for their children, it would be 

considered neglect only if the parents were aware of 

but chose not to use food assistance programs. Taking 

poverty into consideration can prevent unnecessary 

removals and place the focus on providing concrete 

services for families to protect and provide for their 

children.

Children’s Bureau Grant Projects

In 2014, the Children’s Bureau awarded five 3-year 

projects in its Grants in Child Maltreatment 

Research Using Innovative Approaches cluster. 

The purpose of the funding was to encourage and 

support child maltreatment research that used 

innovative research designs to address knowledge 

gaps in the field. Four of the five projects 

supported efforts to determine the efficacy or 

effectiveness of interventions that focus on child 

neglect. The grantees and their projects included 

the following: 

1. An Ecological Systems Approach to the

Investigation of Child Neglect: Early Head

Start/Child Welfare Study III (Grantee:

Children’s Hospital Corporation)

2. Housing Services in Child Welfare: Economic

Evaluation of Systems Coordination (Grantee:

Washington University in St. Louis)

3. Addressing the Needs of Families Referred

for Neglect and Substance Abuse: The FAIR

Efficacy Trial (Grantee: OSLC Developments,

Inc.)

4. Intervening in Child Neglect: A

Microsimulation Evaluation Model of Usual

Care (Grantee: Washington University in St.

Louis)

5. MPSY Rhode Island Child and Family WellBeing: Wraparound Services for CPS-Identified

Families (Grantee: Yale University)

For more on the FAIR Efficacy Trial, see page 11 of 

this bulletin or visit http://www.oslcdevelopments.

org/fair/; to learn more about Early Head Start/

Child Welfare Study III, see page 17 of this bulletin. 

For brief descriptions of each of the projects 

funded, visit the Children’s Bureau’s Discretionary 

Grant Library at https://library.childwelfare.gov/

cbgrants/ws/library/docs/cb_grants/GrantHome. 

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9

Substance Use 

Parentalsubstanceuse. According to Adoption and 

Foster Care Analysis and Reporting System data for 

fiscal year 2016, parental substance use is frequently 

reported as a reason for removal (34 percent) (HHS, 

2017a), particularly in combination with neglect (Correia, 

2013). Family life for children with one or both parents 

who misuse drugs or alcohol often can be chaotic 

and unpredictable. Children’s basic needs—including 

nutrition, supervision, and nurturing—may go unmet, 

which can result in neglect (Child Welfare Information 

Gateway, 2014a). These parents may also have difficulty 

conforming to expected parenting roles (Parolin & 

Simonelli, 2016) and providing healthy parent-child 

attachment (Lander, Howsare, & Byrne, 2013). While 

treating the parent’s substance use is a priority, treatment 

must be combined with services to address the child’s 

needs and improve overall family functioning. 

To learn how to help parents dealing with substance use, 

child welfare workers may refer to Supporting Recovery 

in Parents With Co-Occurring Disorders in Child Welfare, 

a three-part video series created by the Center for 

Advanced Studies in Child Welfare in partnership with 

the Minnesota Center for Chemical and Mental Health 

(https://www.cascw.org/portfolio-items/supportingrecovery-in-parents-with-co-occurring-disorders-in-childwelfare-training-videos).

More information is available in Information Gateway’s 

bulletin Parental Substance Use and the Child Welfare 

System at https://www.childwelfare.gov/pubs/factsheets/

parentalsubabuse.

Substance-exposednewborns. The rates of opioid 

misuse and dependence is increasing in many 

communities, including among pregnant and parenting 

women (HHS, ACF, CB, 2016). Child welfare systems report 

increased caseloads, primarily among infants and young 

children entering the foster care system, and hospitals 

report increased rates of infants experiencing neonatal 

abstinence syndrome associated with opioid use during 

pregnancy. The Comprehensive Addiction and Recovery 

Act of 2016 (CARA) requires State CPS agencies to 

develop and monitor safe-care plans for infants affected 

by prenatal substance exposure (HHS, ACF, CB, 2016), 

which may require CPS intervention to place these 

infants in out-of-home care. The ACF memorandum on 

the CARA amendments provides guidance to States on 

implementing CARA in relation to infants affected by 

substance use (https://www.acf.hhs.gov/sites/default/files/

cb/pi1702.pdf). 

For additional information on substance-exposed 

newborns, watch “A Framework for Intervention for 

Infants with Prenatal Exposure and Their Families,” a web 

presentation by the Children’s Bureau’s Office on Child 

Abuse and Neglect and the Substance Abuse and Mental 

Health Services Administration (SAMHSA), in partnership 

with the National Center on Substance Abuse and Child 

Welfare (NCSACW), at https://youtu.be/nEaTjxydGp4.

For other resources, visit the NCSACW website, which is 

cosponsored by the Children’s Bureau and SAMHSA at 

https://www.ncsacw.samhsa.gov, and browse the website 

of the Child Welfare League of America at https://www.

cwla.org/details-on-cara-act-drug-legislation.

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10

CHILDREN’SBUREAUGRANTPROJECT:FamiliesActivelyImprovingRelationships(FAIR) is a behavioral 

intervention that addresses substance use and psychosocial needs of parents involved in the child welfare system 

due to neglect. The FAIR program (also discussed on p. 9 of this bulletin) targets parents and families, many 

of whom are homeless or living in isolated, rural communities struggling particularly with methamphetamine 

and/or opiate use. Currently, FAIR is being provided throughout Lane County, OR. Core components span four 

integrated treatment targets, including parenting, substance use, mental health, and ancillary needs. Specific 

strategies include a family-based program with a parent-focused approach; 3-week, high-intensity, daily 

treatments followed by approximately 8 months of weekly sessions; strong relationships with family-focused 

corporations that donate toys and household items for incentives, budgeting, and shopping practice; and service 

coordination. 

The FAIR team includes counselors, skills coaches, a resource builder, and a clinical supervisor who travel 

regularly to clients’ homes or other convenient locations, combining help with daily activities while providing 

support for trauma, depression, parental stress, poverty, and other determinants of substance use. An efficacy 

study of the model, funded by the Children’s Bureau, uses a dynamic wait-list design to evaluate how parents 

who receive FAIR improve on measures including substance use, parenting skills, emotional regulation, child 

supervision, and appropriate discipline. Support from the Children’s Bureau grant enabled the team to examine 

the impact of the FAIR model on neglectful parenting, mental health, child welfare system outcomes, and 

other needs, including housing, employment, and support with court and school attendance. As of the date 

of this publication, results from the study indicate that 62 percent of children remain either at home or return 

home within 8 months of the start of the program. Of the 23 percent of parents engaging in opiate use at the 

beginning of the study, none were using opiates at 16 months. Outcomes from this study replicate findings from 

a randomized clinical pilot trial of mothers who were randomly assigned to FAIR or to usual services. For more 

information about the model, visit the FAIR website at http://www.oslcdevelopments.org/fair or contact Lisa 

Saldana, project director, at 541.485.2711 or lisas@oslc.org. 

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11

 The National Center on Domestic Violence, Trauma

& Mental Health’s Tips for Supporting Children

and Youth Exposed to Domestic Violence: What

You Might See and What You Can Do at http://

www.nationalcenterdvtraumamh.org/wp-content/

uploads/2012/05/Tipsheet_Children-Exposed_

NCDVTMH_May2012.pdf

Assessment

Identifying child neglect may seem more difficult than 

identifying other forms of maltreatment because neglect 

usually involves the absence of a certain behavior, 

rather than the presence. A thorough strengths-based 

assessment of the child’s safety, risk, and protective 

factors, in collaboration with the parent, can help 

determine what kinds of services and supports the family 

may need and want. As in any assessment, it is important 

to talk with the parents to identify community and societal 

factors that may be presenting challenges that seem 

insurmountable to them. Often, the parent is seeking help 

to make changes and meet family needs and is not finding 

the assistance they need. Identifying these concerns is 

part of any comprehensive assessment. 

Consider the possibility of neglect when the child:

 Is frequently absent from school

 Begs or steals food or money

 Lacks needed medical or dental care, immunizations,

or glasses

 Is consistently dirty and has severe body odor

 Lacks sufficient clothing for the weather

 Uses alcohol or other drugs

 States that there is no one at home to provide care

Consider the possibility of neglect when the parent or 

other adult caregiver:

 Indicates that lack of necessary supports is impacting

the ability to meet the child’s needs

 Feels overwhelmed addressing a range of challenges

 Appears to be indifferent to the child

 Seems apathetic or depressed

 Behaves irrationally or in a bizarre manner

Domestic Violence

Most States do not include exposure to domestic violence 

in their legal definitions of child abuse or neglect (Child 

Welfare Information Gateway, 2013b). Children may 

witness domestic violence in their homes or be neglected 

by parents who are unresponsive to their children due 

to their own fears (Child Welfare Information Gateway, 

2016a). However, nonviolent parents who are victims of 

domestic violence are sometimes charged with “failure 

to protect” for not preventing the child from witnessing 

domestic violence (California Partnership to End Domestic 

Violence, 2015). In collaboration with domestic violence 

professionals, child welfare caseworkers should consider 

the victim’s access to resources or services outside the 

home, as well as the victim’s reasonable efforts to ensure 

the child has basic necessities and lives in the least 

detrimental environment possible.

A strong relationship with the victim parent is a protective 

factor that can increase a child’s resilience, and keeping 

the victim safe is a critical step toward protecting the child 

(Listenbee et. al, 2012; Russell, 2015). To address domestic 

violence cases involving children, workers should keep 

the victim parent and child together whenever possible; 

enhance the safety, stability, and well-being of all victims; 

and hold perpetrators of violence accountable through 

mechanisms such as batterer intervention programs. For 

more information, see the following resources:

 Information Gateway’s Domestic Violence and the

Child Welfare System at https://www.childwelfare.gov/

pubs/factsheets/domestic-violence

 Information Gateway’s What Is Child Welfare? A Guide

for Domestic Violence Services Advocates at https://

www.childwelfare.gov/pubs/cw-domestic-violence

 The Greenbook Initiative at http://www.thegreenbook.

info

 The National Council of Juvenile and Family Court

Judges: Family Violence and Domestic Relations at

http://www.ncjfcj.org/our-work/domestic-violence

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Find more information about these and other indicators in 

Information Gateway’s What Is Child Abuse and Neglect? 

Recognizing the Signs and Symptoms at https://www.

childwelfare.gov/pubs/factsheets/whatiscan. 

The initial assessment should determine if neglect 

occurred and examine the child’s safety and risk. Two 

of the most crucial factors that child welfare workers 

should consider are: (1) whether the child has any unmet 

cognitive, physical, or emotional needs; and (2) whether 

the child receives adequate supervision (DePanfilis, 2006). 

For assessment tools to gauge children’s safety and risk, 

see Child Neglect: A Guide for Prevention, Assessment, 

and Intervention at https://www.childwelfare.gov/

pubPDFs/neglect.pdf. 

Because neglect is so difficult to define and to 

recognize in a clinical setting, the need to train social 

work graduate students and caseworkers is critical, 

as missing opportunities to address child neglect can 

prolong serious maltreatment (Hamilton & Bundy-Fazioli, 

2013; Tufford, Bogo, & Asakura, 2015). The following 

suggestions address the differing values of workers and 

parents and the role of personal and cultural frames 

of reference that caseworkers should consider when 

assessing parents for neglect: 

 Balance the challenges facing the client with the ethical

and legal responsibilities as mandated reporters.

 Demonstrate empathy while screening for potential

maltreatment (demonstrate compassion for the person

and accountability for the behavior).

 Take time to understand clients’ behaviors, thoughts,

and feelings, particularly with clients from different

ethnic and cultural backgrounds (Tufford et al., 2015).

 Assess the co-occurring problems within the family.

 Engage the family and other service providers in

collaborative relationships to alleviate neglect within

the family.

 Rely on knowledge and competence of the six

core values of the National Association of Social

Workers Code of Ethics: service, social justice, dignity

and worth of the person, importance of human

relationships, integrity, and competence (DeLong

Hamilton & Bundy-Fazioli, 2013; National Association

of Social Workers, 2008).

Interviewing. One of the main activities of child neglect 

investigations involves interviewing children, parents, 

and others who may have knowledge to assist in the 

assessment. Caseworkers should understand that 

children who have been neglected may be traumatized 

by their experiences. They should also be careful to not 

retraumatize them and avoid asking leading or suggestive 

questions. Consider these guidelines when interviewing 

children who may have been neglected (Faller, 2013): 

 Set ground rules and expectations about the interview

and inform the child of your role.

 Build rapport with the child by engaging her or him in

brief conversations about interests and activities.

 Ask more open-ended questions before asking closedended questions; closed-ended questions that provide

more information should be followed by more openended questions.

 Recap what the child has shared during the interview in

the child’s own words and ask if there is anything else

he or she would like to share or ask before ending the

interview.

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In situations of child neglect, caseworkers will likely need 

to explore several domains, such as substance use or 

domestic violence, related to the child’s experiences. The 

types of questions asked will vary depending on the child 

and her or his capacity to provide a narrative about the 

neglect and the type(s) of neglect experienced. Following 

are example questions to consider when determining 

whether children have experienced neglect (Faller, 2013):

 Who are the people important to you?

 Who takes care of you?

 Who helps you get dressed?

 Who cooks for you?

 Who takes care of you when you’re sick?

 Where do you sleep?

 Who cleans at your house?

 Who does the laundry?

 Does anyone at your house drink alcohol, such as beer,

wine, or hard liquor?

 Are there any drugs at your house?

For more information about interviewing children 

who have been neglected, refer to Faller’s “Gathering 

Information from Children about Child Neglect” at 

http://ow.ly/dKoc30dY9cK, or Information Gateway’s 

factsheet Forensic Interviewing: A Primer for Child Welfare 

Professionals at https://www.childwelfare.gov/pubs/

factsheets/forensicinterviewing. 

Safety. Determining the child’s safety is as critical in the 

decision-making process in cases of possible neglect as it 

is in cases of physical or sexual abuse. The determination 

should consider threats of danger in the family, the 

child’s vulnerability, and the family’s protective capacity, 

including any risks, needs, and complicating factors. 

Caseworkers may want to consider using an assessment 

that includes four areas of inquiry for parents, children, 

and other stakeholders (Turnell & Murphy, 2014):

1. What	are	family	and	stakeholders	worried	about?	(Past

harm,	future	danger	and	factors	that	could	jeopardize

safety)

2. What	is	working	well?	(Current	safety)

3. What	needs	to	happen?	(Future	safety)

4. Where	is	the	family	on	a	safety	scale	of	0	to	10?

(Family	and	caseworker	judgment)

The results of the assessment will inform whether the 

family requires additional assessment and intervention. A 

low-risk family may be referred for differential response 

(see box below), while the most severe cases may require 

placement in out-of-home care, preferably with relatives, 

to ensure the child’s immediate safety while the family is 

assessed and a safety and service plan is developed. 

For assessment tools and resources, see Information 

Gateway’s webpage Screening & Assessment in Child 

Protection at https://www.childwelfare.gov/topics/

responding/iia. 

The Children’s Bureau’s Capacity Building Center for 

States is developing a suite of products focused on 

quality contacts among caseworkers and children, 

youth, and families. Building quality contacts can 

improve assessment of children’s risk of harm. For 

more information on the evolving suite, which will 

promote collective impact through a variety of 

publications and learning tools with definitions, program 

guidance, and supervisory and practice tips, visit 

https://capacity.childwelfare.gov/states/focus-areas/

foster-care-permanency/quality-matters. 

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14

Prevention and Intervention

The services and supports that children who are at risk for 

neglect or who have been neglected and their families 

vary greatly depending on the type of neglect they 

experienced; the severity of their situation; and underlying 

risks, strengths, and many other factors. Analyzing the 

information gathered during the assessment is essential 

to developing an effective case plan in collaboration 

with the family, its support network, and related service 

providers.

Beginearly. Research on the developing brain stresses 

the need for babies and young children to participate 

responsively in reciprocal (“serve and return”) and 

dynamic interactions with people who care for them 

(Center on the Developing Child at Harvard University, 

2012). Without sufficient attention and security, the 

circuitry of the developing brain, as well as other 

developing organs and metabolic systems, can be 

disrupted. Although it can be difficult to prevent neglect 

and identify it in its early stages, caseworkers can have 

a greater impact on families the earlier they intervene. 

At this stage, practitioners should assess the parent’s 

readiness to enhance their parenting abilities and help 

the family focus on meeting the child’s developmental 

needs. Caseworkers should assume that parents want 

to improve the quality of their children’s care but need 

support to identify and build on their strengths and to 

potentially address any underlying trauma from previous 

life experiences.

For more on early intervention with families, read 

Information Gateway’s Addressing the Needs of Young 

Children in Child Welfare: Part C—Early Intervention 

Services at https://www.childwelfare.gov/pubs/partc.

Differential Response

Using family-centered and partnership-based 

approaches, differential response lets child 

welfare agencies focus on the family and the 

child’s environment to meet the needs of families 

(Casey Family Programs, 2012). To address this 

need, several States use differential response, 

also referred to as “dual-track,” “multiple-track,” 

or “alternative-response” systems in which 

families with low risk are redirected to voluntary, 

often community-based, services to receive the 

supports they need. This approach allows CPS to 

respond in multiple ways to allegations of neglect 

or abuse. For low- or moderate-risk situations with 

no immediate safety concerns, CPS conducts a 

family assessment to determine the family’s needs 

and strengths. 

For more information see the following resources: 

 Information Gateway’s Differential Response to

Reports of Child Abuse and Neglect at https://

www.childwelfare.gov/pubs/issue_briefs/

differential_response

 Children’s Bureau’s National Quality

Improvement Center on Differential Response

in Child Protective Services (no longer updated

but housed on the Kempe Center website) at

http://www.differentialresponseqic.org

 Child welfare jurisdictions interested in

implementing differential response should

access The Differential Response (DR)

Implementation Resource Kit: A Resource

for Jurisdictions Considering or Planning for

DR at http://www.ucdenver.edu/academics/

colleges/medicalschool/departments/

pediatrics/subs/can/DR/Documents/

Differential%20Response%20%28DR%29%20

Implementation%20Resource%20Kit--May%20

2014%5B1%5D.pdf

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15

Provideconcreteservicesfirst. Most parents cannot 

focus on interventions like parenting classes when they 

are still addressing crises in their families. In the early 

stages of working with a family, caseworkers should 

ensure that basic needs are met before expecting parents 

to fulfill other aspects of their case plan. Some concrete 

supports to address include the following:

 Housing and utilities

 Food and clothing

 Safety for domestic violence victims and their pets

 Transportation

 Child care

 Health care and public benefits

 Attention to past trauma affecting the parent’s life

Engagepartners.Because child neglect is often 

associated with other needs, such as mental health 

services, having partners in place is often important. Child 

welfare professionals should develop relationships with 

community partners who can provide necessary services 

for children experiencing neglect. 

Focusonstrengths. Child welfare workers and other 

related professionals can form better relationships 

with families by encouraging them to focus on positive 

parenting strategies and supports they already have in 

place. The six protective factors described earlier can 

serve as a framework for assessing families’ strengths and 

helping them identify ways to build on those strengths 

to protect their children from harm. The National Child 

Abuse Prevention Month website provides the most 

recent Prevention Resource Guide for child abuse 

prevention. It offers numerous tools and strategies 

for talking with families about their strengths and 

incorporating them into service systems (https://www.

childwelfare.gov/topics/preventing/preventionmonth). 

Children’s Bureau Grant Project: 

Investigation of Child Neglect of 

Child Neglect in Early Head Start

The Ecological Systems Approach to the 

Investigation of Child Neglect in Early Head Start 

(EHS) (discussed briefly on p. 9 of this bulletin) 

builds on the rigorous research of three previous 

EHS studies: two previous and ongoing EHS 

Child Welfare Studies and the EHS Research 

and Evaluation Project (EHSRE). EHS is a twogenerational program that serves infants and 

toddlers under the age of 3, pregnant women, 

and their families to provide a safe and enriching 

environment that promotes physical, mental, 

social, and emotional development and wellbeing. This project examines the impact of 

EHS on children’s resilience to neglect by using 

secondary data from the EHSRE, which included a 

sample subset of 2,794 children and their families 

who participated in 16 EHS programs across 

the country. It also investigates outcomes of 

children from birth to the 5th grade and focuses 

on identifying specific characteristics of the 

neglect experiences of their target population 

and how such characteristics influence both 

child outcomes and program impact. For more 

information about this project, visit the website at 

https://www.brazeltontouchpoints.org/promisingevidence-that-early-head-start-can-prevent-childmaltreatment/ or contact Catherine C. Ayoub, 

Ed.D., project director, at 857.218.4374.

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16

Encourageincrementalchange. Most changes don’t 

happen overnight. In families that are stressed by the 

demands of caring for their child, parents may feel 

overwhelmed if child welfare workers expect them to 

accomplish too many goals too quickly (Corwin et al., 

2014). In collaboration with the family, caseworkers 

can establish a contract with parents to affirm their 

commitment to make required changes to keep their 

children safe and able to develop normally (Farmer & 

Lutman, 2014). 

It is important to start with the most basic needs (e.g., 

food, housing, safety), then address critical underlying 

issues (e.g., substance use, mental health). Once those 

supports are in place, there will be fewer obstacles to 

achieving higher family functioning. Many programs that 

work with families affected by neglect require intensive, 

long-term services to help them achieve changes over 

time.

ProvideIntensiveFamilyPreservationServices. Shortterm crisis support to high-risk families can prevent 

unnecessary child placement in out-of-home care. 

Children and families experiencing severe neglect may 

benefit from these kinds of services to address urgent 

issues, like housing or financial assistance, followed 

by ongoing family preservation and support to target 

underlying risk factors.

The National Family Preservation Network offers 

a continuous quality improvement intensive family 

preservation tool for use with Intensive Family 

Preservation Services (http://www.nfpn.org/

assessment-tools/cqi-ifps-instrument).

Engagethefamily’ssocialsupportnetwork. Because 

caseworker time with the family is limited, a strong social 

support network for the family can reinforce lessons 

learned and address needs as they arise. Caseworkers 

should seek out relatives, friends, community members, 

and other service providers who will help the family 

practice and build new skills over time. Positive 

relationships with other caring adults can help support 

the child’s healthy development and serve as a source of 

respite for parents if they face future crises.

NewJersey’sStrengtheningFamiliesInitiative

offers an approach to child abuse and neglect 

prevention by emphasizing child and family 

strengths as essential components of prevention 

efforts statewide. Using Strengthening Families 

through the Early Care and Education Framework 

developed by the Center for the Study of 

Social Policy, programs incorporate protective 

factors—parental resilience, social connections, 

knowledge of parenting and child development, 

concrete support in times of need, and social and 

emotional competence of children—into their 

services, and professionals are trained to identify 

and build upon strengths in at-risk families. Early 

child care and education centers play a significant 

role in helping build these protective factors 

among the children and families they serve. 

Using the following seven strategies, centers 

are well positioned to help families strengthen 

protective factors that have been proven 

effective in preventing child abuse and neglect: 

(1) observe and respond to early warning signs

of child abuse or neglect, (2) facilitate the social

and emotional development of children, (3) value

and support parents, (4) strengthen parenting,

(5) link families to services and opportunities,

(6) respond to family crises, and (7) facilitate

friendships and mutual support. Learn more

about the New Jersey Department of Children

and Families at http://www.nj.gov/dcf/families/

early/strengthening.

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17

Help the family find a local parent support group through 

Circle of Parents® (http://www. circleofparents.org) or 

Parents Anonymous® (http://www.parentsanonymous.

org), or connect them to a respite program using the 

ARCH National Respite Network and Resource Center’s 

locator service (http://archrespite.org/respitelocator).

Culturalcompetenceandneglect. As with all child 

protection practice, cultural issues must be taken into 

consideration when assessing and intervening with 

families at risk of neglect. For example, parents from a 

culture in which shared caregiving is the norm may see 

no problem with allowing young children to care for 

their siblings, perhaps in a way that does not conform to 

cultural norms in the United States (Sawrikar, 2016).

When working with diverse families, child welfare workers 

should focus on ensuring that children’s needs are met 

and that they are not harmed or endangered. Consult 

with knowledgeable staff or community members on how 

best to intervene in a way that is consistent with families’ 

cultural practices. Visit the Cultural Competence section 

of the Information Gateway website for more information 

at https://www.childwelfare.gov/topics/systemwide/

cultural. 

Other information on cultural competence includes the 

Standards and Indicators for Cultural Competence in 

Social Work Practice by the National Association of Social 

Workers at https://www.socialworkers.org/LinkClick.

aspx?fileticket=7dVckZAYUmk%3D&portalid=0.

The National Family Preservation Network offers an 

evidence-based cultural competence training at http://

www.nfpn.org/assessment-tools/cultural-competence.

A comprehensive, evidence-based, communitybased service program, GrandparentFamily

Connections(GFC), grew from the Family 

Connections program designed to help families 

who have entered the child welfare system. 

The GFC program, which began with a 2003–

2008 grant award from the Children’s Bureau, 

offers a family-strengths perspective, assisting 

grandparent-headed households across the city 

of Baltimore, MD. GFC focuses on families living 

in urban poverty. It has sustained funding from 

State and community partners to strengthen 

family connections and enhance the future of 

grandchildren involved in the program. Core 

components include using a trauma-informed 

lens to support the emergency, concrete needs 

of families, such as foodbanks and housing, 

parenting groups, legal services, respite services, 

and aging programs. The University of Maryland 

provides training and support to the Baltimore 

Health and Human Services staff to deliver 

comprehensive home-based services that 

promote stress management, parent education 

and advocacy, and parenting practice models.

Find more information about GFC at http://www.

family.umaryland.edu/fc-gfc or contact Frederick 

Strieder at 410.706.5521.

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18

Promising Practices for Neglect

The following interventions for neglect were retrieved 

from the California Evidence-Based Clearinghouse for 

Child Welfare and are available at http://www.cebc4cw.

org/topic/interventions-for-neglect. Both received a 

scientific rating of 2, which indicates they are supported 

by research evidence.

 ChildhavenChildhoodTraumaTreatment. Provides

therapeutic child care to children ages 1 month

through 5 years who are at risk for or have experienced

abuse and neglect and their families. Services are

provided daily (5.5 hours a day for 5 days a week) in a

licensed child care setting. Programs are individualized

to the child and family need. (http://www.childhaven.

org)

 Homebuilders®.Designed to prevent unnecessary

placement of children outside the home. The program

delivers family preservation services that are home and

community based. The services aim to enlist parents as

partners in assessment, treatment planning, and goal

setting. (http://www.institutefamily.org)

 CombinedParent-ChildCognitiveBehavioral

Therapy(CPC-CBT): A short-term evidence-based

therapy program for children ages 3–17 and their

parents (or caregivers) to improve the parent-child

relationship and reduce children’s issues resulting from

maltreatment. (http://www.caresinstitute.org/services_

parent-child.php)

 NurturingParentingProgramforParentsandTheir

SchoolAgeChildren5to11Years: A 15-session,

family-centered evidence-based program where one

of the goals for parents is to gain parental empathy

toward meeting the needs of their children. (http://

nurturingparenting.com/ecommerce/category/1:3:2)

 Maternal,Infant,andEarlyChildhoodHome

Visiting (MIECHV): A Federal program that provides

pregnant women and families, particularly those at

risk for child maltreatment, with in-home services

that teach caregivers basic parenting skills, support

healthy child development, and show promise

in reducing child abuse and neglect. (https://

mchb.hrsa.gov/maternal-child-health-initiatives/

home-visiting-overview)

Training

Effective training is important for caseworkers addressing 

the often complex issues faced by children at risk of being 

neglected and their families. Because neglect is still 

misunderstood by many professionals serving children 

and families, many trainings address neglect under the 

umbrella of child maltreatment. Ongoing training can 

help caseworkers remain aware of the latest research and 

refresh their skills over time.

Child welfare practitioners can learn more about 

training in child neglect by visiting the websites of the 

National Child Abuse and Neglect Technical Assistance 

and Strategic Dissemination Center at http://www.

cantasd.org and the National Child Welfare Workforce 

Institute at http://ncwwi.org/index.php/teams-services/

university-partnerships.

The National Family Preservation Network (http://

www.nfpn.org/SearchResults/tabid/83/Default.

aspx?Search=training) provides training guides and tools 

for a variety of training needs, including the following: 

 Trauma Training (http://www.nfpn.org/articles/

trauma-training)

 Assessment Training (http://www.nfpn.org/products/

training-packages)

The New York Society for the Prevention of 

Cruelty to Children provides the correspondence 

course and onsite lecture Identifying and 

Reporting Child Abuse and Neglect Training 

(http://www.nyspcc.org/training-institute/

identifying-reporting-child-abuse-neglect-training).

Conclusion

Child neglect is the most prevalent type of child 

maltreatment but has historically received the least 

attention from researchers and others. Child neglect 

continues to be a complex problem that is difficult to 

define, prevent, identify, and treat.

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Acts of Omission: An Overview of Child Neglect https://www.childwelfare.gov

19

Assessing neglect involves a thorough examination of 

the child’s safety and risk as well as the larger family and 

community context. To understand neglect, caseworkers 

should know how to address related problems such 

as poverty, substance use, and domestic violence. 

Interventions for children and families affected by 

neglect require customized and coordinated services. 

Defining, preventing, identifying, and treating child 

neglect is a significant challenge but one that researchers, 

professionals, communities, and families must face 

together if they are to protect children from its harmful 

consequences.

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omission: An overview of child neglect. Washington, 

DC: U.S. Department of Health and Human Services, 

Children’s Bureau.