The expert witness in child abuse and neglect: An interdisciplinary process

The legal system is an important part of a society's response to child abuse and child neglect. Courts need to be guided in their deliberations by experts from many different professions. Consultation and in-court expert testimony is necessary from medicine, psychology, psychiatry, social work and other professions both to prove child abuse and neglect and establish the power of the court to act on behalf of a child but also to guide the court in the intervention strategy most suited to the needs of the child and his family. Non-lawyers often feel uncomfortable in the legal setting. The adversary process is foreign to their training and professional experience. Collaboration with a lawyer greatly improves their effectiveness in court. Lawyers, on the other hand, need to make maximum use of medical and social-psychological experts in the court process in the interests of their clients; but to do so lawyers need a basic understanding of the other professions. With an emphasis on a process of mutual education, the paper presents a framework for collaboration between lawyers and expert witnesses in child abuse and neglect cases. “Expert witness” is defined; informal consultation is encouraged; suggestions for selecting a collaborator are made; initial contracts between lawyer and expert, case conferencing and preparation for trial are discussed; specific advice on direct and cross examination is provided.     

Fatal child neglect: Characteristics,causation, and strategies for prevention

Research in child fatalities because of abuse and neglect has continued to increase, yet the mechanisms of the death incident and risk factors for these deaths remain unclear. The purpose of this study was to systematically examine the types of neglect that resulted in children's deaths as determined by child welfare and a child death review board. This case review study reviewed 22 years of data (n = 372) of child fatalities attributed solely to neglect taken from a larger sample (N = 754) of abuse and neglect death cases spanning the years 1987–2008. The file information reviewed was provided by the Oklahoma Child Death Review Board (CDRB) and the Oklahoma Department of Human Services (DHS) Division of Children and Family Services. Variables of interest were child age, ethnicity, and birth order; parental age and ethnicity; cause of death as determined by child protective services (CPS); and involvement with DHS at the time of the fatal event. Three categories of fatal neglect – supervisory neglect, deprivation of needs, and medical neglect – were identified and analyzed. Results found an overwhelming presence of supervisory neglect in child neglect fatalities and indicated no significant differences between children living in rural and urban settings. Young children and male children comprised the majority of fatalities, and African American and Native American children were over-represented in the sample when compared to the state population. This study underscores the critical need for prevention and educational programming related to appropriate adult supervision and adequate safety measures to prevent a child's death because of neglect.     

Redrawing the line: An exploration of how lay people construct child neglect

While there has been an increasing professional and political focus on the prevalence and harmfulness of child neglect, little has been done to explore what child neglect means outside child protection circles. This qualitative study explores lay constructions of child neglect by thematically analyzing focus group discussions between 46 self-defined ‘lay’ people in England.Participants viewed neglect as extremely damaging for children and as arising when children’s physical, emotional, training and supervisory needs were unmet due to abnormal parental behavior. Children with unmet needs were positioned as deprived, unloved, uncontrolled and escaping. They were only positioned as neglected when failure to meet their needs was attributable to a lack of parental knowledge and skill (clueless parents), a lack of appropriate parental disposition (underinvested parents) or both (unsuitable parents). ‘Normal’ parents – those with the appropriate parental disposition, skills and knowledge – who failed to meet their children’s needs were not seen as neglectful but rather as overburdened.As ‘normal parenting’ has fragmented in late modernity, society wide consensus on child neglect was felt by participants to have retreated to child protection definitions, alienating lay understandings. If child neglect really is ‘everybody’s business’, then it is important that lay people are included in forging new definitions of and responses to meeting the needs of children.     

Race,ethnicity, and child maltreatment: An empirical analysis

Using central registry data for Texas for 1975–1977 of validated cases of abuse and of neglect, a study was conducted to investigate empirically the relationship of child maltreatment to ethnicity, addressing methodological issues that merit consideration in such studies.The ethnic composition of the at-risk population was 61% Anglos, 15% Blacks, and 24% Mexican-Americans. The annual rates for all abuse and neglect were 2.87, 3.17, and 3.94 per 1,000 under 18 population for Anglos, Mexican-Americans, and Blacks, respectively. Abuse was more predominant among Anglos, accounting for 33.5% of the validated cases of maltreatment, than among Mexican-Americans and Blacks, accounting for 25.2% and 29.4% of the maltreatment, respectively. Neglect was the major dynamic of maltreatment for Mexican-Americans and Blacks, accounting for 65.6% and 61.2% of the maltreatment, respectively, with Anglos having 55.4% of the maltreatment due to neglect. These relationships were not altered when rural-urban differences were taken into consideration.     

Sexual abuse in the national incidence study of child abuse and neglect: An appraisal

The National Incidence Study of Child Abuse and Neglect was a major, government sponsored effort to collect data on reported and unreported child abuse. It used a systematic representative sample methodology and very precisely developed definitions of child abuse. This paper reviews some of the main limitations of the study in regard to findings on sexual abuse. First, there is probably less “new” data in the study on sexual abuse than on other forms of abuse, since so many of the study cases of sexual abuse were “officially reported” cases. In addition, the study limited its definition of sexual abuse only to cases where a caretaker was the perpetrator, a definition that is much more restrictive than what is used in many treatment programs. Finally, the data on perpetrators has a number of problems that stem from the study's definitions of sexual abuse. The paper makes suggestions for future incidence type studies of sexual abuse.     

Oral health in children investigated by Social services on suspicion of child abuse and neglect

Child abuse and neglect (CAN) are likely to have negative consequences on health; however, for oral health, studies on associated outcomes are sparse. The purpose of this study was to assess oral health and oral health behaviors in relation to suspected CAN among children being investigated by the Swedish Social Services. The material comprised data from the Social Services and dental records; the sample, 86 children and 172 matched controls. The children in the study group had a higher prevalence of dental caries than the control group; in addition, levels of non-attendance and dental avoidance were high, as was parental failure to promote good oral health. We found four factors that, taken together, indicated a high probability of being investigated because of suspected CAN: prevalence of dental caries in primary teeth, fillings in permanent teeth, dental health service avoidance, and referral to specialist pediatric dentistry clinics. If all four factors were present, the cumulative probability of being investigated was 0.918. In conclusion, there is a high prevalence of dental caries, irregular attendance, and a need for referral a pediatric dental clinic among Swedish children under investigation due to suspected CAN. Social context is an important factor in assessing the risk of developing dental caries, the inclination to follow treatment plans, and the prerequisites for cooperation during treatment. Routinely requesting dental records during an investigation would provide important information for social workers on parental skills and abilities to fulfill the basic needs of children.     

Patterns of reported child abuse and neglect

Confirmed reports of abuse and neglect logged in a large state registry file from 1977 to 1984 are analyzed. Boys tend to sustain more frequent and more serious injuries. Victims of male perpetrators tend to sustain more serious injuries. A modest same-sex perpetrator/victim pattern is revealed for physical abuse; males are more likely to physically abuse boys while females are more likely to physically abuse girls. Among younger victims (aged 12 and younger) boys outnumber girls in all reporting categories except sexual abuse. Among adolescent victims, female victims greatly outnumber male victims in all reporting categories. Similarities between adolescent physical abuse and spouse abuse are noted; males are are the predominant perpetrators and females the predominant victims. As expected, victim age emerged as a strong predictor of severity of physical abuse injury. Several other factors including social isolation, mental health problems, lower income, and unemployment of the father are identified as modest predictors of severity.     

Prediction and prevention of child abuse and neglect

Utilizing an interview, a questionnaire, and observations during labor, delivery, and the postpartum period, a sample of one hundred mothers was identified as at high risk for abnormal parenting practices. These mothers were randomly divided into a “High-Risk Intervene” group (N=50) and a “High-Risk Nonintervene” group (N=50). The “Intervene” group received comprehensive pediatric follow-up by a single physician, a lay health visitor, and/or a public health nurse in the home. The “Non-intervene” group received routine care, although the results of these screening procedures were shared with the physicians and nurses responsible for their ongoing care. Another group of 50 mothers, who delivered during the same time period and who were assessed as low risk in terms of abnormal parenting practices, served as controls. When the children were approximately two years old (mean age 26.8 months), 25 families in each of the three groups were chosen at random for detailed evaluation.     

Navajo child abuse and neglect study: A comparison group examination of abuse and neglect of navajo children

The presence of vastly different cultural influences on child rearing and family life in Native Americans than are found in the general population offers an opportunity to examine the issue of child abuse and neglect in a different cultural context. A study was conducted to obtain baseline data and to isolate types and circumstances associated with maltreatment of Navajo children under 9 years of age. Records from tribal and state courts, the Bureau of Indian Affairs (BIA), state social services and a sample of ambulatory pediatric cases were reviewed to elicit abuse or neglect status data for calendar year 1975. Data on 365 abuse or neglect cases were compared with 867 nonabused or nonneglected children (comparison group). A double blind case numbering system was employed to ensure confidentiality of data obtained. Abuse cases were dichotomized according to litigation status (e.g., adjudicated versus documented by clinical findings). Neglect cases were categorized by perceived parental control over circumstances leading to the neglect (e.g., voluntary versus involuntary neglect). Reliability sub-studies were conducted by study staff and Navajo volunteers to assess the degree of agreement in the classification of study case status. Tribal census data for 1975 provided baseline information from which the incidence of abuse or neglect involving Navajo children was established. Extrapolated study data suggests up to 8.6% of the reservation resident Navajo children under age 9 to have been abused or neglected. Various sociode-mographic characteristics differentiating the abusive and neglectful families from those of the nonabused or nonneglected children in the comparison group are reported.     

Prenatal prediction of child abuse and neglect: A prospective study

Five hundred eighty-seven women in a combined Maternity-Infant, Children and Youth project were interviewed at between 3 and 6 months of gestation by a skilled masters degree social worker (M.S.W.) using a Family Stress Checklist developed at the University of Colorado Health Sciences Center. Only 7% of the women were scored as “high risk” for serious parenting problems. Neither single status nor teenage status increased the risk significantly. A review of charts of 100 of the children whose mothers had been considered “at risk” was conducted 2 to 2.5 years later, and compared with 100 charts on children whose mothers had been considered at “no risk,” giving the following results: Twenty-five children had experienced failure to thrive, neglect or abuse. Twenty of these were from the original high risk mothers, giving an incidence of neglect/abuse in that group of 52%. The no risk control group of 100 mothers showed a 2% incidence of abuse/neglect; a low risk group showed a 4% incidence of abuse/neglect; and a mid-score group had an abuse/neglect rate of 5%. The scale proved a remarkably accurate predictor, with a sensitivity (percent correct negatives) of 89%. The authors suggest use of such scales prenatally or even before conception as a step toward the development of true preventive measures.     

An alternative to foster care for victims of child abuse/neglect: a university-based program

Two central forces dominated the conception and development of the Parents and Children Together (PACT) project: the need for provision of an in-home alternative to foster care for abuse and/or neglect families and the prevention of further abuse and/or neglect in the family. Wayne State University in Detroit is the site for Parents and Children Together (PACT) project, a contractual service of the Michigan Department of Social Services (DSS). Graduate students provide in-home services to referred families who, due to child abuse or neglect, would otherwise have their child(ren) removed from the home. This family-based work is a one-year cooperative education experience for students interested in professions in the human services. This report discusses the PACT project as a grant operated through the university, the specification of course work associated, and the attraction of students to graduate study with "hands-on" experience. All of these program attributes, as well as the resource of the project for research, make it an important effort for the university. Further, the university has an additional meaningful role with community residents. Beyond university and student opportunities, the DSS and its clients benefit by having broad-based expertise brought into homes on a weekly basis. Annual success rates of keeping children out of foster care are cited along with cost effectiveness. The university's role in levels of prevention in a highly coordinated community effort is indicated.     

Educational neglect: Understanding 20 years of child welfare trends

Educational neglect is an understudied phenomenon that is difficult to define and also to address. While it is clear that attending to children’s academic needs is important to child development, few studies focus on educational neglect and therefore little is known about its associated risk factors and the outcomes following this form of maltreatment. The purpose of this research was to (a) determine the rate at which child welfare service providers investigate educational neglect in Canada and identify any trends in rates over time, (b) better understand educational neglect and its distinction from other types of neglect and truancy, and (c) understand how child welfare services respond to allegations of educational neglect. Data from five cycles of the Ontario Incidence Studies of Reported Child Abuse and Neglect were examined. A trend analysis was conducted followed by a mixed-method examination of educational neglect investigations. Results indicate that rates of investigated educational neglect in Ontario have been consistently low over time. However, these investigations are significantly more likely to be substantiated and to be transferred to ongoing child welfare services compared to investigations of other subtypes of neglect. Educational neglect investigations involving younger children are more likely to note risk factors for caregivers whereas those involving adolescents are more likely to note functioning issues for youth. The findings are discussed in relation to international trends in educational neglect and policy and practice implications are explored.     

Children hospitalized with child abuse and neglect: a case-control study

A case-control study of 45 hospitalized abused children was conducted to reassess the risk factors for child abuse when confounding by social class was minimized. Cases were matched for age, sex, family structure, and social class with children admitted to hospital for an acute illness. Abused children were more likely to have younger parents, fewer siblings, and to have been separated from their mothers during the first year of life. Their parents were more likely to have been abused as children and to have a poor relationship with the child's other parent. The families of abused children had encountered more stressful life events in the preceding 12 months. Other previously recognized "risk factors" were not shown to have a statistically significant association with child abuse. Because child abuse is more prevalent in lower socioeconomic families, the association with many of these factors has been accepted as implying a causal relationship. Matching procedures which attempted to eliminate confounding by social class and family structure cast doubts on some previously held beliefs about the risk factors for child abuse.     

An ecological analysis of infant neglect by adolescent mothers

To inform efforts to prevent child neglect, we investigated a wide range of risk factors that have been largely unexamined in relation to infant neglect, the most commonly occurring form of child maltreatment. Using an ecological model of child neglect, we assessed the influence of characteristics at the level of the child, the mother, the family, and broader childrearing contexts on adolescent mothers’ likelihood of being a perpetrator in a substantiated case of neglect against their firstborn infants (n = 383, M = 12 months). Several factors were associated with infant neglect by young mothers: median block income, low infant birth weight, maternal smoking, maternal childhood history of neglect and of positive care, intimate partner violence (IPV) perpetrated by either the mother or her partner, and maternal use of mental health services. In multivariate models, income, a maternal childhood history of positive care, IPV by either a mother or her partner, and mental health service usage made significant contributions to the odds that a mother neglected her infant. Our findings suggest that these factors have particular salience to policymakers’ and practitioners’ efforts to identify high risk families and to intervene during the earliest months of life to prevent child neglect.     

Parents in prison: A child abuse and neglect prevention strategy

Parents in Prison is an innovative family support service housed at the Tennessee State Prison for Men. Developed in response to inmates' recognition of the need for child abuse and neglect prevention services relevant to men who are in prison, the program model has potential for becoming a major service delivery strategy. Leadership for Parents in Prison is provided by an inmate committee which receives consultation and assistance from a community advisory board and an institutional sponsor. Program components--correspondence and classroom courses, monthly events featuring community guest speakers, and family-focused social activities and projects--address family needs during incarceration and upon return to community living. These diverse components and the flexible service delivery format permit widespread inmate participation not readily available in a prison setting. Parents in Prison successes demonstrate that the period of incarceration can be used to improve parental skills and knowledge and to strengthen family relationships. They also demonstrate the viability of a family support service which relies on inmate leadership, community volunteer participation, and institutional support. The future success of this model depends on replication in other prison settings, dissemination of the program products which have been and continue to be developed, and rigorous, systematic examination of the impact that participation has on child abuse and neglect problems associated with a father's incarceration.     

Primary prevention of child abuse and neglect: Identification of high-risk adolescents

Based on the result of the study, the following conclusions are made:

1. 1. The parenting inventory developed has adequate levels of content validity, construct validity, internal reliability, and stability over time.

2. 2. Approximately 13% (150) of the adolescents responding to the inventory had factor scores -1 or more standard deviations below the group mean. It is concluded that the further the score deviates below the mean, the greater the risk the adolescent becomes for practicing abusive parenting behaviors.

3. 3. Abused adolescents have significantly lower mean scores than non-identified abused adolescents, suggesting that abused adolescents espress attitudes towards parenting and child-rearing which are similar to the parenting and child-rearing practices of abusive parents.

4. 4. Female adolescents, whether members of the abused or non-identified abused group, have higher mean scores than abused or non-identified abused male adolescents. The results suggest that male adolescents of both groups express more abusive parenting attitudes than females of both groups.

5. 5. Each of the four group parenting constructs can effectively be used to discriminate between abused and non-identified abused adolescents. Construct B:

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, however, had the greatest discriminatory capability.

The results of the study have indicated the utility of the inventory in assessing the parenting attitudes of adolescents and in discriminating between adolescents identified as abused and those non-identified as abused. In its present stage of development, the inventory may only be validly used to identify adolescents' attitudes towards child-rearing and parenting. Before the inventory is employed to identify potential child abusers for treatment purposes, it is recommended that longitudinal research be concluded. Such research should be designed to provide data relative to the predictive validity of the inventory.     

Substantiation of reported child abuse or neglect: predictors and implications.

Underreporting and overreporting of suspected child abuse and neglect cases reduce the efficiency of child protection services. We used all the reports in South Australia for 1988-1989 (N = 3,228) to study the determinants of the decision by child protection workers to register a reported incident as being one of child abuse and neglect. Logistic regression showed that registration (substantiation) was predictable from two variables: the age of the alleged victim and the caseworker's estimate of severity. This latter variable needs investigation, as despite its crucial role we have no information on how caseworkers form a judgment about severity.