Making judgments about risk in substantiated cases of supervisory neglect

Child Abuse & Neglect 27 (2003) 821–840

Making judgments about risk in substantiated cases of supervisory neglect夽 Carol Coohey∗ School of Social Work, University of Iowa, 354 North Hall, Iowa City, IA 52242, USA Received 8 May 2001; received in revised form 21 August 2002; accepted 14 September 2002

Abstract Objective: The purpose of this study was to determine which factors were used by investigators to determine level of risk among substantiated cases of supervisory neglect. The conceptual model included three sets of factors—the severity of the supervision problem, characteristics of the mother (e.g., prior involvement with child protective services (CPS), motivation, substance use) and characteristics of the investigator—as potential explanations for increased risk. Methods: A case-control design was used to compare 113 mothers whose names were placed on the child abuse registry for substantiated supervisory neglect (higher risk) with 45 mothers whose names were not placed on the registry but who had a substantiated report of supervisory neglect (lower risk). Two readers coded every investigative report. Results: Five out of 14 of the predictors had a unique effect on the investigator’s assessment of higher risk in the multivariate analysis: a child was harmed, the mother did not take responsibility for the problem, there was no extenuating circumstance, she was being battered, and she had prior involvement with CPS. There was also an interaction between being battered and the type of supervision problem. When a mother failed to protect her child from a third party, being battered decreased the likelihood that the investigator would place the mother’s name on the state’s registry. Conclusion: More research is needed on specific types of supervision problems to develop a risk assessment instrument for supervisory neglect. Without one, it is difficult to see how investigators and others can be expected to know whether a child is likely to be harmed in the future. © 2003 Elsevier Science Ltd. All rights reserved. Keywords: Supervisory neglect; Child neglect; Risk assessment

夽 This study was supported by grants from the Edna McConnell Clark Foundation, the Iowa Department of Human Services, and the University of Iowa. ∗ Corresponding author.

0145-2134/$ – see front matter © 2003 Elsevier Science Ltd. All rights reserved. doi:10.1016/S0145-2134(03)00115-7

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Introduction Supervision problems probably represent the largest single type of child maltreatment (30%), accounting for more substantiated incidents of maltreatment than either physical abuse (19.3%) or sexual abuse (10.1%; Coohey, 2003). Not only does lack of supervision (LOS) occur frequently, it can have serious consequences. Children are as likely to die from neglect as they are from physical abuse. Most children who die from neglect are killed by cars, fires, falls, or water because they are not adequately supervised (Greenland, 1987: New York City and Los Angeles County; Keller, 1996: Virginia; Margolin, 1990: Iowa; US Department of Health and Human Services, 1981). Despite the sometimes deadly consequences of supervisory neglect, only two studies have been published that focused on supervision problems (Coohey, 1998; Jones, 1987). Yet, child protective service (CPS) workers, judges, and others need to know which factors are more likely to be related to future risk to decide how intensively to monitor or treat these families. Because of the amorphous nature of supervision problems, predictive statements regarding risk are difficult and may be influenced by organizational factors and individual bias. Unlike physical abuse, incidents of supervisory neglect typically include no injury (Manly, Cicchetti, & Barnett, 1994). In Jones’s (1987) study, investigators cited no injury in 82% of their substantiated reports of supervisory neglect. Of the harm that was identified, case readers could only attribute 38% directly to the supervision problem. Similarly, Zuravin (1988) found that 75% of neglected children suffered no immediate physical harm. If there is no injury, an investigator cannot evaluate a parent’s intent to injure his or her child. Without injury or intent, an investigator must rely on other factors to determine whether a child is at continued risk of harm, and if so, how great that risk is. The purpose of this study is to understand which factors CPS investigators use to determine that some families are at higher risk of continued maltreatment than other families after supervisory neglect has been substantiated. A satisfactory answer to this question could help isolate specific items for a standardized risk assessment instrument for supervisory neglect.

Literature The literature review begins with a definition of supervisory neglect and its subtypes. Next, the conceptual framework is presented. Three major sets of factors—that may account for variation in the level of risk assigned to cases by CPS investigators—are discussed. The first section focuses on the severity of what the parent did at the time of the supervision problem. Severity of supervisory neglect is broken down into actual harm and potential harm to the child. The second section looks at characteristics of the parent before and after the supervision problem that may be important in the investigator’s assessment of risk. The third section includes investigator level factors. Because only one study has examined the level of risk among cases of substantiated supervisory neglect (Jones, 1987), the conceptual framework is based on a small number of studies on reoccurring or chronic neglect and the theoretical writings of authors trying to understand the nature of supervision problems. Figure 1 summarizes the components of the model.

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Figure 1. The influence of severity of supervisory neglect, and parent and investigator characteristics on assessment of risk of future harm.

Definitions Coohey (2003) reviewed several prominent child maltreatment typologies and two state typologies (Jones, 1987; Illinois Department of Children and Family Services, 1999; Iowa

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Department of Human Services, 1997; Magura & Moses, 1986; Sedlak & Broadhurst, 1996; Sedlak et al., 1997; Trocmé, 1996; Wolock & Horowitz, 1977; Zuravin & Taylor, 1987) to derive a consensual definition of supervisory neglect. She concluded that supervisory neglect occurs when a parent fails to provide the child with adequate protection from harmful people or situations, and that it can be divided into five different parenting behaviors: did not watch closely enough, provided inadequate substitute child care (includes four subtypes), failed to protect from a third party (includes four subtypes), allowed to engage in a harmful activity, and drove recklessly or while intoxicated. Appendix A provides a definition for each subtype.

Conceptual model Severity of supervisory neglect The first component of the model includes the severity of the supervision problem (see Figure 1). When determining severity—how bad the parent’s behavior was at the time of the supervision problem—investigators assess both the type and level of actual harm, if any, and the likelihood that the child could have been harmed—potential harm—by the parent’s lack of supervision (US Department of Health and Human Services, 1987). Actual harm. There is no evidence that injury is a salient factor in predicting repeated neglect. However, there are other types of harm that could contribute to an investigator’s conclusion that a child is at greater risk. A child may go without food and be hungry when left alone at home (Magura & Moses, 1986), may be sexually abused when left with an inadequate caretaker (Trocmé, 1996), may not have adequate clothing when locked out of the house, or be emotionally harmed by the caregiver’s behavior (Barnett, Manly, & Cicchetti, 1993). English and Marshall (1999) tried to determine which risk factors were used by caseworkers to determine level of risk among cases of neglect. If a child was either emotionally harmed or if a child’s basic needs were not met, caseworkers thought that there was greater risk of continued maltreatment. To capture fully the influence of actual harm on the investigator’s decision to label a child at higher risk, different types of harm need to be evaluated. Potential harm. In addition to determining whether the child was actually harmed, investigators assess the likelihood that the child could have been harmed at the time of the supervision problem. Several authors have suggested that potential harm is a function of the parent’s ability to protect the child and the child’s age, development, and ability to protect him or herself (Barnett et al., 1993; Magura & Moses, 1986; Trocmé, 1996; Zeller, 1992; Zuravin, 1991). Two studies have looked at whether the child’s age increased the risk of subsequent maltreatment among families who had neglected their children. Both Jones (1987) and Marks and McDonald (1989) found that families with younger children were at higher risk of recurrence. While the age of the child is thought to decrease the child’s capacity for self-protection, several factors may reduce the parent’s ability to protect his or her child. Supervisory neglect may be perceived as more severe by the investigator if the parent’s substance use impairs his or her ability to make decisions (Barnett et al., 1993), if the parent is further away from the

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child (Magura & Moses, 1986), if the parent exposes the child to potential harm for a greater amount of time (Barnett et al., 1993), if the parent provides inadequate supervision frequently (Trocmé, 1996), and if the parent lets the child go near dangerous objects (Barnett et al., 1993). A problem with this list of indicators for potential harm is the dubious assumption that they apply to all types of supervision problems. While this is an empirical question, it seems likely that they do not. For instance, a parent who is farther away from his or her child would be less likely to see and, therefore, be able to prevent the child from being harmed. However, when a parent leaves his or her child with adequate caretakers but without consent or adequate planning, the distance between the parent and child is unlikely to influence the level of potential harm, and therefore, the investigator’s decision. Parent characteristics The second component of the model includes the parent’s characteristics. In this framework, parent characteristics include what the parent says or does before or after the incident of supervisory neglect that could influence the investigator’s assessment of risk. This includes the parents’ prior involvement with CPS, the parents’ motivation to change their behavior, and the parents’ capacity to care for their children. Parent’s prior CPS involvement. While the relationship between past CPS involvement and repeated supervisory neglect is unknown, prior CPS involvement was associated with a subsequent report of maltreatment among neglect cases in several studies (Baird, 1988; English & Marshall, 1999; Jones, 1987; Marks & McDonald, 1989; Wood, 1997). It seems reasonable that the investigators would also question the parents’ motivation and capacity to supervise their children adequately in the future based on the knowledge that the current problem was not an isolated event but a pattern that preceded the incident. Parent’s motivation. Investigators may assess risk by asking parents about their role in the supervision problem and what they intend to do to prevent the problem from reoccurring. The investigators could conclude that children are at greater risk of harm if their parents denied that neglect took place, if they minimized it or their role in it, or if they were unwilling to do something so that the problem would not recur. In Baird’s (1988) study, if the worker thought that the parent was not motivated to change his or her behavior, the neglect was more likely to recur. In Jones’ (1987) study of supervisory neglect, the most common response that mothers gave for their behavior was that there was nothing wrong with it. English and Marshall (1999) found that among cases of neglect, caseworkers were more likely to rate caretakers who did not recognize that there was a problem at higher risk of continued maltreatment. In Marks and McDonald’s (1989) study, caregivers who appeared angry or hostile, or who did not understand that they had too high expectations for their children, were more likely to repeat maltreatment. Similarly, Nelson, Saunders, and Landsman (1993) found that caregivers who had been involved with CPS for more than 3 years were more likely to be rated as having inappropriate expectations and poorer knowledge of their children’s development than the caregivers with a single incident of child neglect. It seems likely that if parents do not see their role in the supervision problem, investigators will conclude that they will be less motivated to change their behavior than parents that do and be more likely to repeat their behavior.

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Parent’s capacity. When trying to decide if a child is likely to receive adequate supervision in the future, the investigator may look at the parent’s capacity for change given other serious problems in his or her life. For instance, the parent’s ability to provide adequate supervision in the future may be undermined by a substance abuse problem, by a mental health problem, or if a parent is being battered. Substance abuse and poor mental health are major problems associated with supervisory neglect. From a secondary analysis of Gaudin, Polansky, Kilpatrick, and Shilton’s data (1991–1993), Coohey (1998) reported that mothers who had provided inadequate supervision were more likely to have a drug or alcohol problem (41%) and be clinically depressed (57%) than mothers who provided adequate supervision (5.3% and 35.8%, respectively). Similarly, in Hixon’s (1992) dissertation on mothers who did and did not provide adequate supervision, a serious substance abuse problem made the largest contribution to the discriminant function, followed by a serious mental, physical, or emotional impairment. Substance abuse and mental health also appear to increase the likelihood of subsequent maltreatment among neglected children. Among cases of substantiated supervisory neglect in New York State, Jones (1987) found that mothers with mental health or substance abuse problems were more likely to be re-referred. If one or both caregivers had a substance abuse problem in Baird’s (1988) study, they were more likely to continue to neglect their children. Finally, several studies on child neglect found that poor mental health was related to recurrence (Jones, 1987; Marks & McDonald, 1989; Nelson et al., 1993; Wood, 1997). If a parent has a substance abuse or mental health problem, it seems plausible that an investigator will conclude the parent is less able to focus on the child’s needs in the future and provide adequate supervision. It is less clear how woman battering might be related to supervisory neglect or whether investigators use information about battering to determine whether a child is at greater risk of ongoing supervisory neglect by the victim of battering. Still, numerous studies have found a relationship between child maltreatment and woman battering (see Edleson, 1999, for a review), and two studies on neglect found higher substantiation (Smith, Sullivan, & Cohen, 1995) and placement rates (Zuravin & DePanfilis, 1997) for families in which mothers had been battered. In Beeman, Hagemeister, and Edleson’s (2001) study, investigators assessed families with both domestic violence and child maltreatment as being higher risk than maltreatment-only families. Hence, it would be useful to know if battering is more likely to be noted in supervisory neglect cases labeled higher risk by investigators. During the past decade, some writers have challenged the appropriateness of holding battered mothers accountable for failing to protect their children from a third parties’ abuse. For cases involving failure to protect—a major type of supervisory neglect—it would be important to know whether investigators thought the battered mother continued to pose a risk to her child.

Investigator characteristics The third component of the model includes the investigator’s characteristics. Pecora, Whittaker, and Maluccio (1992) argue that workers’ decisions may reflect organizational behavior, individual bias, and other idiosyncratic factors more than the likelihood that a child will be maltreated. Therefore, investigator characteristics, such as years of experience and

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supervisory input into decision-making, need to be controlled to understand investigators’ decision-making. Although risk in cases of supervisory neglect has not been thoroughly examined, research on child neglect suggests a plausible relationship between increased risk and the severity of neglect and the characteristics of the parent. Accordingly, several hypotheses will be tested. An investigator will be more likely to conclude that a child is at higher risk if the severity of what the mother did during the LOS incident was greater; if she had prior involvement with CPS; if she was unwilling or unmotivated to change her behavior; and if she had a history of substance abuse, a history of poor mental health, or been battered. Several additional research questions will be explored. Does the type of supervisory neglect increase the level or risk? If the mother commits more than one type of supervisory neglect, does the level of risk increase? Does an investigator’s level of experience or his or her supervisor influence the decision?

Methods Design and sample A case-control design was used (Schlesselman, 1982) to compare mothers who provided inadequate supervision and had their names placed on the child abuse registry (higher risk) to mother who provided inadequate supervision but did not have their names placed on the registry (lower risk). All reports of child maltreatment substantiated by investigators from the Linn County, Iowa Department of Human Services offices between December 1995 and February 1998 were screened. Only reports with a parental perpetrator were included. Grandparents, other relatives, siblings, foster parents, childcare providers, other, and unknown perpetrators were excluded, resulting in 602 substantiated incidents of child maltreatment. Two readers independently read all 602 reports regardless of whether the type of maltreatment met the state of Iowa’s definition for inadequate supervision. Coohey’s (2003) definitions and coding rules were used to identify families with at least one type of supervision problem. If the incident involved supervisory neglect, then the readers were instructed to code up to three types of inadequate supervision for each incident. (No incident included more than three types of supervision problems.) If the two readers disagreed on subtypes, then a third reader resolved the discrepancy. Of the 602 reports, 228 incidents included at least one type of supervision problem. From these reports, mothers that had at least one substantiated incident involving supervisory neglect and who were living in the home at the time of the incident were included in the sample. After excluding fathers and mothers not living in the home, there were 180 incidents. Twenty-two of these mothers had more than one substantiated incident of supervisory neglect. Consequently, one of her incidents was selected randomly. Of the 158 mothers selected into the final sample, 113 mothers were assigned to the registered or case group, and 45 mothers were assigned to the not registered or comparison group. To be placed on the Iowa registry, the investigator must conclude that the person “responsible for the abuse continues to pose a danger to the child named or another child” (Iowa Department of Human Services, 1997, p. 63). When making the decision to register a parent’s name for supervisory neglect, state of Iowa investigators are

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Table 1 Demographic characteristics Not registered (n = 45)

Registered (n = 113)

All incidents (n = 158)

53.3 46.7

54.0 46.0

53.8 46.2

60.0 53.5 53.8

61.1 38.6 25.0

60.8 42.7 33.0

Caucasian (%) Mother Partner

91.9 81.3

85.0 71.8

86.9 74.5

Employed full-time (%) Mother∗ Partner∗∗

48.9 66.7

30.1 31.9

35.4 41.7

Age (M) Mother Partner Youngest child∗∗ Oldest child∗∗

27.8 33.1 3.0 7.0

30.0 34.2 4.6 9.1

29.4 33.8 3.9 8.5

2.4

2.4

2.4

Type of household (%) Mother only Mother and partner Mother had a partner (%) Married (%) Partner was biological father of all of her children (%)∗∗

Number of children (M) ∗

p < .05. ∗∗ p < .01.

expected to evaluate three sets of factors: (a) the age of the child, the length of time endangered, and the likelihood that the child could have been harmed; (b) the number of prior substantiated reports and occurrences of inadequate supervision during the current incident; and (c) the caretaker’s response, receptiveness to alternative methods of supervision, discipline, and care; and other contributing factors to the problem that continue to exist. The CPS’s manual does not tell investigators how to weigh these factors in making the registry decision. Table 1 provides demographic information for the entire sample and for mothers who were and were not registered. The two groups of mothers did not differ on ethnicity, marital status, age, or the number of children they had. However, compared to the mothers whose incidents were not registered, the mothers whose incidents were registered were more likely to have been unemployed, have partners who were unemployed, and have partners who were not the biological fathers of all of their children. The children of the mothers who were registered tended to be older than those of the mothers who were not registered. Measures The report for the family’s current incident was read by two coders; a third reader resolved any disagreements between the first and second reader. Inter-rater reliability between the first

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and second reader exceeded .89 for all variables. The dichotomous independent variables were coded one if the attribute was present (0 = if the attribute was not present). Type and number of supervision problems. There were a sufficient number of cases, at least 35, to test the effect of three types of problem on the registry decision: did not watch closely enough (0 = all other types), provided inadequate substitute child care (0 = all other types), and failed to protect from a third party (0 = all other types). If the family had more than one type of supervision problem, they received a one. Severity of supervisory neglect. Nine types of actual harm were coded: seven types of unmet basic needs (inadequate attention to food, shelter, clothing, hygiene, physical health, emotional health, and educational), sexual assault, and physical injury. See Appendix B for definitions. The case readers were instructed to record only harms that occurred during the time the child received inadequate supervision. No attempt was made to determine the level of harm. Four dichotomous variables were created: a child’s basic need was not met, a child was sexually assaulted, a child was injured, and any child was harmed (unmet need, sexually assaulted, or injured). Four dichotomous variables were included to measure potential harm: the age of the youngest victim; whether the mother, father, or both were using alcohol or drugs during the supervision problem; the presence of a dangerous object; and more than one LOS event occurred during the current incident (e.g., a child was left home alone on more than one occasion). The variable dangerous objects was coded one, if the readers concluded that “a child could have been physically harmed, been injured, or died because of objects, conditions, or hazards close to the child” (e.g., weapons, broken glass, matches, standing or scalding water, moving vehicles, drugs, chemicals). Parent characteristics. From the investigator’s list of all prior substantiated incidents recorded in the current report, four dichotomous variables were coded: the family had a prior substantiated incident of maltreatment, the incident had occurred within the last year, the maltreatment in the prior substantiated incident was committed by the mother, and the mother received services before the incident. The mother’s motivation to change her behavior after the incident was substantiated was also evaluated using four dichotomous variables. If the mother said what she did was wrong, then she received a one (0 = if she denied it or said what she did was not wrong). A second approach to evaluating the mother’s motivation for change was to code statements by the mother that seemed to minimize the severity of the problem. If she said, for example, the child knew what to do, was old enough, was not far away, was not left very long; the substitute caretaker was appropriate; or that it only happened once, then the mother received a one for the variable described an extenuating circumstance for the problem. Next, the reader determined, whether the mother was willing to do something, however minimal, so that the supervision problem would not recur. Finally, based on everything the mother said and did during the investigation, the reader determined whether the mother took responsibility for her role in the supervision problem. Five dichotomous variables measured the mother and her partner’s capacities. The reader determined that a mother had a problem with alcohol or drugs if the investigator, the mother, or

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other credible person said she had a problem with or needed treatment for her alcohol or drug problem, if she was receiving treatment for a drug or alcohol problem, or if there was other clear evidence that her use of alcohol or drugs had significantly impaired her ability to parent, work, or obey the law. The same coding rule was used to create a variable for the mother’s partner: partner had problem with alcohol or drugs. If the mother, her partner or both, had a problem with alcohol or drugs, the family received a score of one. The reader determined that a mother had a major mental health problem if the investigator, mother, or other credible person said she had a mental health problem; was in individual therapy to address a major mental health problem; was taking an anti-anxiety, -depressant, or -psychotic drug; or was suicidal. The mother received a one, if there was credible evidence that the mother was battered by her current partner (e.g., she went to a domestic violence shelter, her partner was arrested for battering her). Investigator characteristics. Finally, the number of years of experience that the investigators had working for CPS and who they had as a supervisor were included as potential predictors of registry. There were only two supervisors; each had more than 30 years of supervisory experience and supervised the same investigators during the study period. Quality of investigative reports Investigative reports have both advantages and disadvantages compared to other data collection approaches. Because investigators must determine whether the maltreatment occurred, they are in a unique position to collect detailed information from multiple sources (parents, children, and other witnesses) that researchers could not access at the time of the supervision problem. In this study, investigative reports typically included six or seven, single-spaced pages. The 21 investigators appear to have had, on average, a substantial amount of experience: 20 years (SD = 8.4) at CPS and 14 years (SD = 9.3) as investigators. All investigators had bachelor’s, but not master’s, degrees. Based on an analysis of all 602 incidents, the families appeared to have been assigned randomly to supervisors, and supervisors appeared to have assigned randomly incidents to investigators unless the families had a prior confirmed incident. About one-third of the families who repeated maltreatment had the same investigator. Despite their level of experience, there is no assurance that investigators assessed every variable (e.g., mental health) or included the same level of detail for each variable in the study. Data analysis The bivariate relationships between the potential predictors and registry, the dichotomous dependent variable, were calculated using χ2 and t tests. Next, logistic regression identified the effect of three domains—demographic and investigator characteristics, type and severity of supervisory neglect, and parent’s characteristics—on the likelihood that the mother would have her name placed on the registry. The variables that were not related to registry in the bivariate analysis (p > .05), were linear combinations, or were highly correlated with other variables (r > .60), were not included in the multivariate model. For example, the index “a child was harmed” was selected over other measures of harm (basic need was not met, sexually

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assaulted, and physically injured). The variable “mother, partner or both were using alcohol or drugs” during the problem was selected over “mother, partner or both had a drug or alcohol problem.” All of the variables were entered simultaneously into the model along with one multiplicative, first-order interaction term.

Results Bivariate analyses The incidents involving failure to protect made up a larger proportion of registered cases (27.4%) than non-registered cases (13.3%). There was no difference between the two groups on the other types of supervisory neglect. If there was more than one type of supervisory neglect (e.g., failed to protect and provided inadequate substitute child care), however, mothers’ names were more likely to be placed on the state’s registry (see Table 2). The severity of supervisory neglect was examined next. The inadequately supervised children were more likely to have their basic needs unmet than to have been sexually assaulted or physically injured, although all types of harm were related to registering the mothers’ names (basic need unmet: p < .05; sexually assaulted: p < .07; injured: p < .08). For potential harm, only two variables were significant. The investigators were more likely to register mothers with older victims of supervisory neglect. This finding was not in the expected direction. If the mother, her partner, or both were using alcohol or drugs during the supervision problem, the investigator was more likely to register the mother. The presence of dangerous objects, which occurred in 46% of the incidents, was not a factor in whether the investigator registered the mother. Nor, was there a significant relationship between the number of times the supervision problem occurred (e.g., left the child home alone once vs. more than once) and whether the investigator placed the mother’s name on the registry. Several variables were used to examine the parents’ capacities. If there was a prior substantiated incident, if the mother had committed the maltreatment in the prior substantiated incident, or the maltreatment had occurred in the last year, then the investigator was more likely to register the mother. If the mother had received services from CPS or another social service agency, she was also more likely to be registered. All four indicators of motivation to change were related to registry. Unexpectedly, investigators were less likely to register mothers if the mothers described an extenuating circumstance for the problem. Although not conceptualized as an indicator of potential harm, it probably should have been. Instead of measuring the mother’s level of motivation, it appears that investigators recorded these rationales to document a lower level of potential harm at the time of the supervision problem. For example, when the investigator wrote that the mother said the substitute childcare provider was adequate or that her child had not been left alone very long, the investigator seemed to be agreeing with the mother’s assessment and subsequently concluding that the child was at a lower risk of harm. As expected, if the case reader thought that the mother was taking responsibility for the problem or if she was willing to do something so the problem would not recur, investigators were less likely to register the mother. If the mother said what she did was wrong, she was less likely to be registered, although this finding was not significant (p < .09). Whether she had a

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Table 2 Bivariate relationships between hypothesized predictors and registry (n = 158) Not registered

Registered

All incidents

Type and number of problems (%) Mother . . . Didn’t watch closely enough Provided inadequate substitute child care Failed to protect from a third party∗ More than one type of problem (%)∗

33.3 62.2 13.3 8.9

34.5 51.3 27.4 21.2

34.2 54.4 23.4 17.1

Severity of supervisory neglect Actual harm during the LOS (%) Any child was harmed (%)∗∗∗ A child’s basic need was not met (%)∗ A child was sexually assaulted (%) A child was injured (%)

33.3 31.1 2.2 11.1

65.5 51.3 9.7 23.0

56.3 45.6 7.6 19.6

3.4

5.1

4.6

15.6 2.2 15.6 42.2 48.9

28.3 11.5 31.9 46.9 53.1

24.7 8.9 27.2 45.6 51.9

17.8 13.3 4.4 55.6

61.9 48.7 31.0 71.7

49.4 38.6 23.4 67.1

31.1 60.0

18.6 35.4

22.2 42.4

77.8 55.6

56.6 25.7

62.7 34.2

28.9 7.4 31.1

40.7 29.0 46.9

37.3 13.9 42.4

26.7 8.9

27.4 23.0

27.2 19.0

33.3 66.7 19.9

50.4 49.6 19.3

45.6 54.4 19.5

Potential harm during the LOS Age of the youngest victim (M)∗∗ Were using alcohol or drugs (%) Mother Partner∗ Mother, partner, or both∗ Presence of a dangerous object (%) More than one LOS event occurred (%) Parent characteristics Parent’s prior CPS involvement Prior substantiated incident∗∗∗ By mother (%)∗∗∗ Incident had occurred in last year (%)∗∗∗ Mother received services before the incident (%)∗ Mother’s motivation Mother . . . Said what she did was wrong (%) Described an extenuating circumstance for the problem (%)∗∗ Was willing to do something (%)∗∗ Took responsibility (%)∗∗∗ Parent’s capacity Had a problem with alcohol or drugs (%) Mother Partner∗ Mother, partner, or both∗ Mother . . . Had a major mental health problem (%) Was battered by her current partner (%)∗ Investigator and organizational characteristics Had supervisor (%)∗ A B Years of experience at CPS (M)

Note: LOS = lack of supervision. ∗ p < .05. ∗∗ p < .01. ∗∗∗ p < .0001.

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Table 3 Logistic regression results Variable

Logit B

Odds ratio, exp(B)

Demographic and investigator characteristics Partner was biological father Mother was employed full-time Partner was employed full-time Investigator had supervisor A

−.38 −.57 −.79 .02

.68 .57 .45 1.02

Severity of supervisory neglect Mother failed to protect from third party Mother had more than one type of supervision problem Any child was harmed At least one partner was using alcohol or drugs during the LOS Mother described an extenuating circumstance Age of youngest victim

−.14 .37 1.17 .58 −.94 .01

.87 1.45 3.22∗ 1.79 .39# 1.01

2.29 −.20 −1.09 3.16 −4.94

9.86∗∗ .82 .34∗ 23.7∗∗ .01∗∗

Parent’s characteristics Had prior substantiated incident Mother received services before incident Mother took responsibility Mother was battered by her current partner Mother failed to protect X battered Constant χ2 −2 log likelihood

.35 67.47∗∗∗ 121.32∗∗∗

p = .056. p < .05. ∗∗ p < .01. ∗∗∗ p < .0001. #

∗

major mental health problem or a problem with drugs or alcohol was not related to registry, although being battered was. To rule out the possibility that the different perceptions of risk were due to investigator characteristics, two variables were examined. If the investigator had supervisor A, the mother was more likely to be registered than if he or she had supervisor B. The number of years of experience that the investigator had was not related to registry. Logistic regression analyses Table 3 presents logits (log of the odds ratio or logged odds) and relative odds ratios. The odds ratios estimate the likelihood of registry given a one-unit change in each predictor and controlling for all other variables in the model. Odds ratios greater than one indicate an increase in the likelihood of registry (Pampel, 2000). The final model, which estimated predictive efficiency, included 15 predictors (14 variables plus one interaction term). Five variables and the interaction term were significant (Cox & Snell’s, 1968, pseudo-R2 = .35).

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Table 4 Comparison of actual registry with predictions of registry Actual

Not registered Registered Sensitivity Specificity False-positive rate False-negative rate Positive predictive value

Predicted Not registered

Registered

Total

32 8

16 105

45 113 92.9% 71.1% 7.1% 28.9% 86.7%

Mothers with children who were harmed were three times more likely to have their names placed on the state’s registry. If the investigator documented a rationale from the mother for the problem, the likelihood of registry decreased by a factor of .39 (p = .056). If the mother had a prior confirmed incident, she was 10 times more likely to have her name registered than if she had no prior confirmed incident. If she took responsibility for the behavior, her odds of registry decreased by a factor of .34. Finally, mothers who were battered were 24 times more likely to have their names registered than mothers who were not battered. One interaction term—failure to protect from a third party X was battered—was examined. When mothers failed to protect their children, being battered decreased the likelihood that investigators would place their names on the registry. Conversely, when mothers committed other types of supervisory neglect, being battered increased the likelihood that investigators would conclude their children were at higher risk of continued maltreatment. Predictive efficiency was assessed by calculating specificity, sensitivity, and predictive values (Table 4). The model did a good job of predicting the actual registry decision for each family: there were few false-positives (7%) but a higher number of false-negatives (29%). The large number of false-negatives could be attributed to the study’s methodology. The investigators may not have systematically or accurately recorded some information, such as mental health problems. Overall, 87% of the families were correctly classified.

Discussion This case-control study tested whether three sets of variables—demographic and investigator characteristics, type and severity of supervisory neglect, and parent’s characteristics— influenced an investigator’s assessment of risk. The multivariate analysis suggest that children who are harmed during the supervision problem, mothers who have had a history with CPS, mothers who cannot provided a compelling explanation for the problem, and mothers who do not take responsibility for the problem are more likely to be judged at higher risk for future harm by CPS investigators. The most important variable in predicting risk was whether the mother was being battered by her current partner—except for those battered mothers who had failed to protect their children from third parties. These mothers were less likely to have their

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names placed on the registry than battered mothers who committed other types of supervisory neglect. Despite the importance placed on assessing potential harm in the literature, three out of four of the variables used in the bivariate analysis to assess potential harm at the time of the supervision problem were not significant or were significant but not in the expected direction. The mothers who had older victims were more likely to be registered even though the literature suggests that potential harm is greater during supervisory neglect for families with younger children. If the mother, her partner, or both were using drugs or alcohol at the time of the supervision problem, then the mother was more likely to be registered. However, when the age of the youngest victim and the use of substances were added to the multivariate model, neither variable had a significant effect on registry. These results suggest that when other factors are considered, the age of the victim does not seem to influence the investigator’s decision to register. Nor did the presence of dangerous objects close to the child seem to affect the likelihood of registry. Perhaps the presence of dangerous objects only becomes important when the child is actually harmed by them, or only some types of objects are important in the registry decision. This study has several limitations that should be noted. First, some indicators of potential harm at the time of the supervision problem, such as frequency and duration, could not be adequately tested. For instance, the number of times the child was endangered, or frequency, was tested but did not seem to affect the decision to register mothers. This may be the result of lumping all types of supervision problems together in the analysis. For example, a mother who repeatedly does not keep an eye on her child—but is nearby—may be judged lower risk than a mother who repeatedly leaves a very young child home alone. The length of time the child was endangered, or duration, was not included in the analysis because it did not seem to apply to all types of supervisory neglect. For example, if a parent left a toddler home alone overnight, that factor may increase potential harm and accurately predict subsequent maltreatment. A parent who left a toddler overnight with an adequate caretaker but without adequate planning would probably not raise the level of potential harm substantially. Despite the difficulty in testing potential harm in this study, it is likely to remain a critical area of assessment for investigators. To examine frequency and duration for each type of supervision in future studies, enough cases will need to be screened to produce the requisite number of cases for each type of supervisory neglect. This may require over-sampling of some subtypes, such as abandonment. Second, it was not always clear why the investigator included some information in the narrative reports. For example, initially it appeared as though investigators who recorded a rationale from mothers for the supervision problems were documenting ways that the mothers were minimizing the severity of the problem. Instead, investigators appear to be recording extenuating circumstances that in the investigators’ minds decrease risk. Perhaps, this problem could be addressed by asking the investigators two questions: do they believe the rationale increases or decreases the parent’s responsibility and do they believe the parent is minimizing the severity of the problem. Third, this study relied on a judgmental model to determine the risk of subsequent maltreatment. These investigators had a substantial amount of experience assessing risk associated with supervision problems, they appeared to use a uniform set of criteria for assessing risk, and they had the same supervisors over the length of their tenure. Yet, it is not clear that they made accurate predictions, because no follow-up was completed to see if the supervision problem

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persisted. Future research could compare investigators’ assessments of risk with the actual recurrence of maltreatment to estimate the accuracy of investigators’ judgments. Of course, a great deal of subsequent maltreatment will remain undetected making it difficult to definitively answer this question. In the absence of other studies on supervisory neglect and risk, it is difficult recommend items for an instrument that would accurately predict increased risk for all types of supervision problems. Yet, it seems reasonable that investigators recommend more intense services for families where children are harmed, for mothers who have had prior involvement with CPS, and for mothers who do not take responsibility for the supervision problem. These factors were related to repeated maltreatment in other studies on child abuse and neglect using actuarial models (Baird, Wagner, & Neuenfeldt, 1993; Schuerman, Rzepnicki, & Littell, 1994). Until we better understand the relationship between battering and type of supervision problem, CPS workers should not assume that battering directly increases the risk of harm to the child by the mother and require battered mothers to participate in services that are not required for non-battered mothers. This study provided a preliminary step in sorting out which factors relate to risk in families where supervisory neglect has occurred. More research is needed. Without sustained empirical attention to this type of child maltreatment and without the development of instruments relevant to supervisory neglect, it is difficult to see how investigators and others can be expected to know whether a child is likely to be harmed in the future.

Acknowledgments The author would like to thank Amy Butler and Steve Hillis for their helpful comments. References Baird, S. (1988). Validation research in CPS risk assessment: Three recent studies. Washington, DC: CPS Risk Assessment Project, American Public Welfare Association. Baird, C., Wagner, D., & Neuenfeldt, D. (1993). Actuarial risk assessment and case management in child protective services. Madison, WI: National Council on Crime and Delinquency. Barnett, D., Manly, J. T., & Cicchetti, D. (1993). Defining child maltreatment: The interface between policy and research. In D. Cicchetti & S. L. Toth (Eds.), Child abuse, child development, and social policy (pp. 7–73). Norwood, NJ: Ablex. Beeman, S. K., Hagemeister, A. K., & Edleson, J. L. (2001). Case assessment and service receipt in families experiencing both child maltreatment and woman battering. Journal of Interpersonal Violence, 16, 437–458. Coohey, C. (1998). Home alone and other inadequately supervised children. Child Welfare, 77, 291–310. Coohey, C. (2003). Defining and classifying supervisory neglect. Child Maltreatment, 8, 145–156. Cox, D. R., & Snell, E. J. (1968). A general definition of residuals. Journal of the Royal Statistical Society Series, 30, 248–275. Edleson, J. L. (1999). The overlap between child maltreatment and woman battering. Violence Against Women, 5, 134–154. English, D. J., & Marshall, D. B. (1999). Risk assessment and CPS decision making. In American Humane Association (Ed.), Twelfth national roundtable on child protective services risk assessment: Summary of proceedings (pp. 123–130). Englewood, CA: Author.

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Gaudin, J., Polansky, N. A., Kilpatrick, A. C., & Shilton, P. (1991–1993). Family structure and functioning in neglectful families (SIB-066). Ithaca, New York: National Data Archive on Child Abuse and Neglect, Cornell University. Greenland, C. (1987). Preventing CAN deaths: An international study of deaths due to child abuse and neglect. New York: Tavistock. Hixon, D. F. (1992). The concept of neglect in child welfare. Unpublished doctoral dissertation, University of Pittsburgh, PA. Illinois Department of Children and Family Services. (1999). Reports of child abuse and neglect. Available: http://www.state.il.us/DCFS/300apb.htm. Iowa Department of Human Services. (1997). Child protective handbook. Des Moines, IA: Author. Jones, M. A. (1987). Parental lack of supervision: Nature and consequences of a major child neglect problem. Washington, DC: Child Welfare League of America. Keller, S. J. (1996). Child fatalities in Virginia: 1994. Richmond, VA: Office of the Chief Medical Examiner, Virginia State Fatality Review Team. Magura, S., & Moses, B. S. (1986). Outcome measure for child welfare services. New York: Child Welfare League of America. Manly, J. T., Cicchetti, D., & Barnett, D. (1994). The impact of subtype, frequency, chronicity, and severity of child maltreatment on social competence and behavior problems. Development and Psychopathology, 6, 121–143. Margolin, L. (1990). Fatal child neglect. Child Welfare, 69, 309–319. Marks, J., & McDonald, T. (1989). Risk assessment in child protective services: Predicting recurrence of child maltreatment. Portland, ME: National Child Welfare Resource Center. Nelson, K. E., Saunders, E. J., & Landsman, M. J. (1993). Chronic child neglect in perspective. Social Work, 38, 661–671. Pampel, F. C. (2000). Logistic regression: A primer. Thousand Oaks, CA: Sage. Pecora, P. J., Whittaker, J. K., & Maluccio, A. N. (1992). The child welfare challenge: Policy, practice, and research. New York: Aldine de Gruyter. Schlesselman, J. J. (1982). Case-control studies: Design, conduct, analysis. New York: Oxford. Schuerman, J. R., Rzepnicki, T. L., & Littell, J. H. (1994). Putting families first: An experiment in family preservation (pp. 143–196). New York: Aldine de Gruyter. Sedlak, A., & Broadhurst, D. (1996). Third national incidence study of child abuse and neglect (NIS-3): Final report. Washington, DC: National Center on Child Abuse and Neglect. Sedlak, A., Broadhurst, D., Shapiro, G., Kalton, G., Goksel, H., Burke, J., & Brown, J. (1997). Third national incidence study of child abuse and neglect: Analysis report. Washington, DC: National Center on Child Abuse and Neglect. Smith, S. L., Sullivan, Q. E., & Cohen, A. H. (1995). Factors associated with the indication of child abuse reports. Journal of Social Service Research, 21, 15–33. Trocmé, N. (1996). Development and preliminary evaluation of the Ontario Child Neglect Index. Child Maltreatment, 1, 145–155. US Department of Health and Human Services. (1981). National study of the incidence and severity of child abuse and neglect. Washington, DC: Author. US Department of Health and Human Services. (1987). CRF [Code for regulation] S1340.2 Definitions. Washington, DC: Government Printing Office. Wolock, I., & Horowitz, B. (1977). Factors relating to level of child care among families receiving public assistance in New Jersey. Vol. 2: Appendices. Final report to the National Center on Child Abuse and Neglect (DHEW Grant 90-C-418). Washington, DC: National Clearinghouse on Child Abuse and Neglect Information. Wood, J. A. (1997). Risk predictors for re-abuse or re-neglect in a predominantly Hispanic population. Child Abuse & Neglect, 21, 379–389. Zeller, G. L. (1992). The impact of case characteristics on child abuse report decisions. Child Abuse & Neglect, 16, 57–74. Zuravin, S. J. (1988). Child abuse, child neglect, and maternal depression: Is there a connection? In National Center on Child Abuse and Neglect (Ed.), Child neglect monograph: Proceedings from a symposium (pp. 40–55). Washington, DC: Clearinghouse on Child Abuse and Neglect Information.

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Résumé Objectif: Cette étude a voulu déterminer quels sont les facteurs qu’utilisent les enquˆeteurs pour évaluer le niveau de risque dans des cas prouvés de négligence. Le modèle conceptuel de l’étude comprenait trois ensembles de facteurs: la sévérité du problème de supervision, les caractéristiques de la mère (avant d’avoir été connue des services de protection de l’enfance, sa motivation, son recours à des drogues ou alcool) et les caractéristiques de l’enquˆeteur. Méthode: Dans le contexte d’une étude comparative, on a retenu 113 cas de mères inscrites dans les registres de mauvais traitements pour avoir manqué à leurs responsabilités de surveiller leur enfants adéquatement (risque élevé), ainsi que 45 mères qui n’ont pas été inscrites dans les registres mais qui avaient été signalées aux autorités pour avoir négligé leurs responsabilités de surveillance (risque moins élevé). Deux évaluateurs ont coté chacun des cas signalés. Résultats: Parmi les 14 facteurs servant à prédire la négligence, les évaluateurs en ont noté 5 qui représentent des risques élevés: il y a eu du tort fait à l’enfant; la mère n’a pas reconnu sa part de responsabilité vis-à-vis de sa négligence; il n’existait aucune circonstance atténuante; la mère était une femme battue; et elle était déjà connue des autorités de la protection de l’enfance. On a noté un lien entre l’agression envers la mère et le type de négligence vis-à-vis de son enfant. Lorsque la mère n’a pas su protéger son enfant devant les dangers d’une tierce partie, le fait qu’elle ait été victime d’agressions réduisait la probabilité que les enquˆeteurs l’inscrivent dans les registres de l’état. Conclusion: Il faudra des recherches nouvelles sur les différents types de problèmes reliés au manque de supervision maternelle afin d’élaborer un instrument qui pourra évaluer justement le risque. Sans cet instrument, on se demande comment les évaluateurs et autres intervenants pourront prédire les mauvais traitements.

Resumen Objetivo: El objetivo de este estudio fue determinar qué factores fueron utilizados por los investigadores para determinar el nivel de riesgo en casos confirmados de negligencia por falta de supervisión. El modelo conceptual incluye tres grupos de factores como explicaciones potenciales del aumento de riesgo: la severidad del problema de supervisión, las caracter´ısticas de la madre (por ejemplo, implicación previa con Servicios de Protección Infantil, la motivación, el abuso de sustancias), y las caracter´ısticas del investigador. Método: Se utilizó un diseño “casos-control” para comparar 113 madres cuyos nombres fueron inscritos en el registro de casos confirmados de negligencia por falta de supervisión (denominados como “riesgo elevado”) con 45 madres cuyos nombres no fueron inscritos en el registro pero que s´ı tuvieron informe confirmado de negligencia por falta de supervisión (denominados como “bajo riesgo”). Dos lectores codificaron cada informe de investigación. Resultados: En un análisis multivariado, cinco de cada 14 predictores tuvieron un único efecto en la evaluación del investigador como del alto riesgo: un niño fue herido; la madre no asumió la

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responsabilidad del problema; no hubo circunstancias atenuantes, ella estaba siendo maltratada; y ella tuvo una implicación previa con el Servicio de Protección Infantil. También hubo un efecto interactivo entre ser maltratado y el tipo de problema de supervisión. Cuando una madre fracasaba en proteger a su hijo/a de un tercero, el hecho de ser maltratado produc´ıa un efecto negativo en la probabilidad de que el investigador incluyera el nombre de la madre en el registro. Conclusión: Se necesita más investigación sobre tipos espec´ıficos de problemas de supervisión para poder desarrollar un instrumento de evaluación del riesgo sobre la negligencia por falta de supervisión. Sin ese instrumento es dif´ıcil observar cómo los investigadores y otras personas pueden predecir si un niño/a tiene probabilidad de ser dañado en el futuro.

Appendix A Definitions for types of supervision problems (See Coohey, 2003 for criteria used to distinguish subtypes). 1. Did not watch closely enough. The parent was near the child, but the parent did not know exactly where the child was, whom s/he was with, what s/he was doing, or did not check up on him or her often enough. 2. Provided inadequate substitute care Left alone. The parent temporarily left the child alone without a caretaker and was not nearby. Left with suitable caretaker but without consent/adequate planning. The parent temporarily left the child with or sent the child to a person who was able to adequately care for the child but without proper planning or consent. Refused custody/abandoned. The parent permanently refused to take care of the child. Left with unsuitable caretaker: not a child abuser. The parent temporarily left the child with a person who was not able to adequately care for the child. Unsuitable caretakers include a person who was too young; used alcohol or drugs; had a mental health problem; was inattentive; or was inappropriate (e.g., stranger). 3. Failed to protect from third party Left with unsuitable caretaker: child abuser. The parent temporarily left the child with an alleged or known child sexual or physical abuser. Exposed to child abuse. The parent exposed the child to an alleged or known child sexual or physical abuser or put the child at risk of being exposed to future abuse. Exposed to domestic violence. The parent exposed the child to battering or put the child at risk of being exposed to future battering. Exposed to person engaged in an illegal or inappropriate activity. The parent exposed the child to a person engaged in an illegal or inappropriate activity or put the child at risk of being exposed to this person in the future. These persons include someone who was using alcohol or drugs; selling drugs, guns, or pornography; having sex in front of the children; or engaging in another illegal or inappropriate activity.

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Appendix A (Continued ) 4. Allowed, encouraged, or forced to engage in a harmful activity. The parent knew the child was engaged in an illegal or other harmful activity and did not try to stop it. These activities include a child who was using alcohol or drugs; not attending school; coming home late; staying out all night; or engaging in another illegal or harmful activity (e.g., prostitution). 5. Drove recklessly or while intoxicated. The parent drove recklessly or while intoxicated with the child in or on a motor vehicle.

Definitions for types of harm Food. The child did not receive regular or ample meals needed to meet basic nutritional requirements (e.g., a child was hungry; had to ask for or steal food from someone not in a caretaker role; had to beg for food from a caretaker; had eaten a nonfood item [e.g., dog food, grass] or spoiled food; got food poisoning; was malnourished or dehydrated; was not given food or liquids as a punishment). Shelter. The child was not warm enough, cool enough, or dry enough, because there was insufficient/excessive heat or excessive moisture in the home or s/he had no home at all (e.g., a child lived in a car, abandoned building, or other substandard enclosure; was left outside during inclement weather or overnight; was made to sleep in an unfinished basement, a closet, an attic that had insufficient heat or excessive moisture). Clothing. The child did not have essential or seasonally appropriate clothing to be warm enough, dry enough, or clean enough (e.g., rainwear, gloves, hat, lightweight items). Hygiene. The child’s person or clothing was unsanitary to the point that the child experienced discomfort or the child’s health was impaired (e.g., diaper not changed; garbage or feces on a child; teeth encrusted with green or brown matter; child emits body or mouth odor; hair is encrusted). Physical health. The child’s injury, illness, or disability was left untreated by medical personnel, because the parent did not bring the child to their attention, or the child’s physical health was adversely affected by the parent’s act or omission. Emotional health. The child was visibly afraid (e.g., was crying, shaking, hiding; ran to a neighbor for help). Educational. The school-age child did not attend school or was not enrolled in school. Sexual assault. The child experienced one of the following attempted or completed sex acts: fondling; digital penetration; oral sex; genital to genital contact; vaginal or anal intercourse; other sex act (e.g., exhibitionism). Physical injury. The child had one of the following injuries: hyperemia; bruise; contusion; black eye; sprain or dislocation; wound, cut, laceration, or puncture; broken tooth; ruptured eardrum; frost bite or exposure; skull or other bone fracture; eye injury; burn; internal injury; subdural hemorrhage or hematoma; brain damage; poison ingestion.