Exploring the risks of substantiated physical neglect related to poverty and parental characteristics: A national sample

Children and Youth Services Review 29 (2007) 110 – 121 www.elsevier.com/locate/childyouth

Exploring the risks of substantiated physical neglect related to poverty and parental characteristics: A national sample Vernon Carter a,⁎, Miranda R. Myers b,1 a b

University of New Hampshire, 105 Main Street, Thompson Hall, Durham, New Hampshire 03824, United States University of New Hampshire, 55 College Road, Pettee Hall, Durham, New Hampshire 03824-3599, United States Received 5 April 2006; received in revised form 26 July 2006; accepted 2 August 2006 Available online 26 September 2006

Abstract This paper uses data from the National Study of Protective, Preventive, and Reunification Services Delivered to Children and Their Families, 1994 to estimate the effects of several indicators of poverty and parental characteristics associated with substantiated physical neglect. Results suggest there is a high correlation between substantiated physical neglect and several indicators of poverty (i.e. AFDC, food stamps, Medicaid, unemployment, and WIC). After controlling for family characteristics in a logistic regression, those indicators of poverty were not found to be predictive of substantiated physical neglect. Only WIC recipients had an association, and they were less likely to have physical neglect substantiated. The two strongest predictors of physical neglect were related to primary caretakers who were twice as likely to have physical neglect substantiated if they had mental health or substance abuse problems. © 2006 Elsevier Ltd. All rights reserved. Keywords: Poverty; Physical neglect; Children; Parental characteristics

1. Introduction The National Clearinghouse on Child Abuse and Neglect Information (2004) states that there are four major types of maltreatment: neglect, physical abuse, sexual abuse, and emotional abuse. According to the Department of Health and Human Services (2005) child neglect was the most prevalent form of child maltreatment in the United States during 2003. More children suffered ⁎ Tel.: +1 603 862 3000. E-mail addresses: [email protected] (V. Carter), [email protected] (M.R. Myers). 1 Tel.: +1 603 862 0215; fax: +1 603 862 4374. 0190-7409/$ - see front matter © 2006 Elsevier Ltd. All rights reserved. doi:10.1016/j.childyouth.2006.08.002

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from neglect in the United States than from physical and sexual abuse combined. Child neglect accounted for 61% (551,754) of all child maltreatment victims with children under three more likely to be neglected. Though only a small percentage of childhood fatalities (2 per 100,000) were related to child maltreatment, 41% of those victims were less than 1 year old and 38% of all child maltreatment fatalities were connected to neglect. While most forms of child maltreatment remained stable during 2003, the rate of child neglect continued to increase (7.3%–7.5%) (U.S. Department of Health and Human Services, 2005). As the number of child neglect victims continues to rise, it is evermore necessary to examine predictors of child neglect (U.S. Department of Health and Human Services, 2004). The purpose of the present article is to utilize a national sample to explore several indicators of poverty and parental characteristics associated with one form of child maltreatment: physical neglect. The dataset for the present study was obtained from the National Study of Protective, Preventive, and Reunification Services Delivered to Children and Their Families, 1994 (NSPPRS) (National Data Archive on Child Abuse and Neglect, 1997). 1.1. Background 1.1.1. Neglect One of the difficulties with defining neglect has been the failure of the stakeholders (state legislators, child protective services, and researchers) to reach a consensus on the meaning of neglect (Goldman, Salus, Wolcott, & Kennedy, 2003). Zuravin and DePanfilis (1997) defined child neglect as the failure (either by omission or intention) of the primary caregiver to provide a child with the basic necessities of life, such as food, shelter, clothing, medical and mental health care, education and supervision of the child's activities. The Third National Incidence Study of Child Abuse and Neglect (Sedlak & Broadhurst, 1996) defined neglect as encompassing physical neglect, child abandonment and expulsion, medical neglect, inadequate supervision, emotional neglect, and educational neglect by parents, parent substitutes, or other adult caretakers of children (Sedlak & Broadhurst, 1996). The National Clearinghouse on Child Abuse and Neglect Information (2004) stated four types of neglect, including physical, medical, educational, and emotional. As a result of the various definitions, many researchers and practitioners believe child fatalities resulting from abuse and neglect are underreported. Specifically, recent studies have estimated that as many as 50 to 60% of deaths resulting from abuse or neglect are not recorded (Crume, DiGuiseppi, Byers, Sirotnak, & Garrett, 2002; Herman-Giddens et al., 1999). Thus, in order to understand the prevalence of child neglect and abuse, it is necessary to differentiate and break down the types of child maltreatment. Neglect covers a variety of child maltreatment issues. This study will focus on one type of neglect: physical neglect. According to the National Child Abuse and Neglect Data System (NCANDS), physical neglect accounts for the majority of child maltreatment cases. More specifically, 7.1 of every 1000 children in the United States experience physical neglect (American Humane, 2003). For the purpose of the present study physical neglect will be defined as a parent or caregiver not providing the child with basic necessities (e.g., adequate food, clothing, shelter, and hygiene). 1.1.2. Poverty Researchers have examined the context in which child maltreatment occurs and have often found it to be impacted by socio-environmental factors such as financial difficulty or poverty (Courtney et al., 1996; Drake & Zuravin, 1998; Sedlak & Broadhurst, 1996). The Third National

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Incidence Study of Child Abuse and Neglect (NIS-3) compared incidence of child maltreatment in families with an annual income of at least $30,000 to families with annual incomes below $15,000. Results indicated that families earning less than $15,000 per year were 22 times more likely to experience an incidence of child maltreatment than those with incomes above that level (Sedlak & Broadhurst, 1996). An examination of specific poverty-related variables also confirmed an association between poverty and child maltreatment. Unemployment, receiving Aid to Families with Dependent Children (AFDC) benefits, getting Medicaid, and receiving food stamps have all been cited as being associated with child maltreatment (Albert & Barth, 1996; Ards, Myers, Chung, Malkis, & Hagerty, 2001; Goldman, Salus, Wolcott, & Kennedy, 2003; Wu et al., 2004). Not all researchers support the strict casual relationship between poverty and child maltreatment. Drake and Pandey (1996) have questioned the relationship between neighborhood poverty and specific types of child maltreatment. Findings revealed that 18 times as many incidents of neglect were reported in communities with the highest rates of poverty compared to communities with the lowest rates of poverty. Although the poorest communities had the highest rates of neglect, findings revealed that the rates of neglect did not go up proportionately as levels of poverty increased. They found a more significant increase in the rates of neglect between the less poor and moderate poor than between the moderate poor and the most poor. To explain such an aberration, the researchers hypothesized that there must be other factors at work in the communities, factors which are individual- or family-oriented, which need to be examined. Although several researchers have reported an association between child neglect and low income (Brown, Cohen, Johnson, & Salzinger, 1998; Chaffin, Kelleher, & Hollenberg, 1996), poverty is not the whole explanation for neglect. It should be noted that the majority of poor parents do not neglect their children. Other stressors or factors associated with poverty may explain the association between poverty and neglect (Dubowitz, Papa, Black, & Starr, 2002). That is, poverty may indirectly cause heightened parental stress, poor health, single parenting, early child bearing, and residence in more dangerous communities. Thus, examining parental characteristics and indicators of poverty associated with child neglect is essential in unraveling the poverty–neglect relationship. 1.1.3. Parental characteristics While the association between parental characteristics and child maltreatment has been documented in many studies, the findings of these studies demonstrated a great deal of variability. Characteristics of parents or primary caregivers associated with child maltreatment include the following: history with Child Protective Services (CPS) (Shook, 1999); the number of children in the home and marital status (Sedlak & Broadhurst, 1996); maternal age (Lee & George, 1999); parents' education (Brown et al., 1998); mental health problems (Coohey, 1998); substance abuse (Sun, Shillington, Hohman, & Jones, 2001); domestic violence (Osofsky, 2003); and physical health (Coohey, 1998). Furthermore, children living with several siblings, children under the age of three, and female children are at a greater risk for experiencing child neglect (Sedlak & Broadhurst, 1996; U.S. Department of Health and Human Services, 2004, 2005). Although race is an additional characteristic frequently cited in the child maltreatment literature, there is no consensus as to the association between the two. The National Incidence Study of Child Abuse and Neglect (NIS-3) by Sedlak and Broadhurst (1996) compared rates of child maltreatment between African American and White families. Results indicated no difference when looking at the incidences of child maltreatment. However, race was found to be significant in the Lee and George (1999) study that examined child maltreatment among the 1982–1988 birth cohorts in Illinois. When compared to White children, African American children were five times more likely to be indicated for neglect.

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The association between substance abuse and child maltreatment in the literature has been inconsistent as well. Strong relationships between maternal drug use and child maltreatment have been found (Albert & Barth, 1996; Sun et al., 2001). The 1999 study by the National Center on Addiction and Substance Abuse at Columbia University reported that children of parents who abused substances were four times more likely to be neglected than children of parents who did not abuse substances. Paxson and Waldfogel (1999) found a preliminary association between drug use and child maltreatment; however, when drug use was controlled with other fixed effects in a model, its relationship was no longer statistically significant. 2. Current study Although there is preliminary research on poverty and the parental characteristics associated with child neglect, the literature lacks consensus regarding which parental characteristics and which indicators of poverty are associated with neglect. Furthermore, few studies focus on physical neglect, utilize a national sample, or control for potential confounding variables such as maternal education, mental health, substance abuse, caregiver age, and marital status. Consequently, discerning the effects specifically attributable to neglect is difficult, and such research should be interpreted cautiously. The goal of the present study is to examine the poverty–neglect relationship and to delineate parental characteristics associated with substantiated physical

Table 1 Sample characteristics for substantiated physical neglect cases (n = 431) Variables

CPS intervention Previous open case Demographic and other controls High School/GED Gender child Female Domestic violence Caregiver substance abuse Caregiver mental health Married African American Latina/o White Poverty AFDC Food stamps Medicaid Unemployed WIC

χ2

Total

No

Yes

n

n

%

n

%

421

226

54

195

46

4.15*

266

161

61

105

39

20.14**

430

224

52

206

48

1.86

374 374 344 416 416 416

190 253 116 267 389 176

51 68 34 64 94 42

184 121 228 149 27 240

49 32 66 36 6 58

86.79** 40.04** 12.49** 6.30* 4.51* 1.24

340 304 333 349 293

146 111 97 163 230

43 37 29 47 79

194 193 236 186 63

57 63 71 53 21

12.16** 21.8** 27.73** 18.28** 1.98

Variables

Total

Mean

SD

Range

Age of caregiver Age of child Number of children

383 429 430

34.40 7.77 2.66

15.40 5.25 1.48

16–99 0–21 0–9

*p b .05. **p b .01.

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neglect while controlling for the aforementioned variables. More importantly, controlling for these potential confounding variables will help clarify the effect of poverty on substantiated physical neglect. 3. Research questions Using secondary data, parenting and poverty factors were explored in relation to official Child Protective Services data on substantiated physical neglect. The specific research questions that were addressed include the following: Research question 1: Are there particular characteristics of parents (e.g. age, education, number of children, health, substance abuse, marital status, and race/ethnicity) that are closely associated with substantiated physical neglect? Research question 2: Are there specific indicators of poverty (e.g. unemployment; AFDC; Food Stamps; Medicaid; Women, Infants, and Children [WIC]) that are closely associated with substantiated physical neglect? 4. Method 4.1. Sample The dataset for the present study was obtained from the National Study of Protective, Preventive, and Reunification Services Delivered to Children and Their Families, 1994 (NSPPRS) (National Data Archive on Child Abuse and Neglect, 1997). The NSPPRS study examined the characteristics of children and families with open cases who received child protective services between March 1, 1993 and March 1, 1994. This nationally representative sample was comprised of 2109 cases of children receiving child protective services. The sample reflected the full range of services offered by CPS: from the initial investigation of abuse/neglect reports received through adoption services offered to children whose parents' rights had been terminated. The analyses presented here reflect a subset of cases where physical neglect was found to be substantiated (n = 431). The sample's racial/ethnic makeup on the children for whom “physical neglect” was substantiated was as follows: 58% White, 36% African American, and 6% Latina/o (Table 1). Two population groupings were left out the analyses because their numbers were too small. American Indian/Alaskan and Asian/Pacific Islander children combined accounted for less than 3% of the sample. The sample design for NSPPRS involved a stratified two-stage random sample covering the entire nation (United States), with the primary sampling units (PSUs) being county child welfare agencies. The initial sampling frame was created by using cluster sampling techniques to select over 3000 counties from the 1990 Census. From this data, the sample was stratified by size of population: the groupings ranged from towns of 5000 to cities over 500,000 persons. The second stage involved selecting cases from child welfare agencies providing child protective services for children within the sampled counties. To gather information, telephone interviews with child protective service workers were conducted in which workers were asked questions related to current service delivery and case worker decisions from the past six months. For additional details on the NSPPRS study design and sampling procedures, see the National Data Archive on Child Abuse and Neglect (1997).

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4.2. Data analysis Data analyses were performed using the statistical software Stata (StataCorp, 2004). The dependent variable “physical neglect” was conceptualized to be a dichotomous nominal variable. The allegation of physical neglect was or was not substantiated. The analyses were conducted in two stages. The first stage utilized correlational analyses to examine the strength and direction of the bivariate relationships between substantiated physical neglect and poverty related variables. Multivariate analyses were employed in the last stage to determine the effect of the poverty variables on the dependent variable (substantiated physical neglect) while controlling for other variables (e.g., primary caregiver characteristics). Once all the variables are entered to develop a more parsimonious model, a backwards step-wise procedure was followed where all the nonstatistically significant (p N .05) variables were removed one at a time. 4.3. Measurements 4.3.1. Dependent variable The definitions vary widely in the manner in which researchers measure neglect. Slack, Holl, Altenbend, McDaniel, and Stevens (2003) discuss how physical neglect is often described as a single domain encompassing many different types of neglect. Physical neglect in this dataset describes a caregiver's failure to provide food, clothing, shelter, and hygiene. Other variables in the dataset address emotional neglect, failure to thrive, medical neglect, abandonment, and lack of supervision. The dependent variable in this study was whether or not the allegation of physical neglect was substantiated (0 = no, 1 = yes). 4.3.2. Independent variables The key independent variables were indicators of poverty and low income: AFDC, Food Stamps, Medicaid, unemployment, and WIC. All independent variables were recoded to be dichotomous (0 = no, 1 = yes). AFDC, Food Stamps, Medicaid, and WIC all provide different services and are federally funded programs whose recipients must meet certain low income requirements. More specifically, AFDC, which has since been replaced by TANF, provided cash assistance to families; Food Stamps enabled low income persons to reduce the effects of hunger and poor nutrition; Medicaid was designed to meet the basic medical and health needs for low income persons (Appendix C, n.d.); unemployment refers to the primary caretaker in the dataset who had no current work status: neither full, part-time or sporadically working. It included persons who were unemployed (looking and not looking), retired, in school, keeping house or were too disabled to work (National Data Archive on Child Abuse and Neglect, 1997a, p.8); and WIC was a supplemental program for low income women who are pregnant, breast feeding, or with young children that sought to provide food, nutrition, and education (Food and Nutrition Service, 2005). The effects of poverty have often thought to be confounded by race/ethnicity. The variable describing race/ethnicity was grouped into three categories: White, African American, and Latina/o. The race/ethnicity variables were all recoded to be dichotomous (0 = no, 1 = yes). 4.3.3. Control variables The primary caregiver and child's age were continuous variables. The child's gender indicated the child's sex in the dataset (0 = Male, 1 = Female). The following explanatory variables were all recoded to be dichotomous (0 = no, 1 = yes) and provided information about primary caregiver

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characteristics: has a high school diploma or GED certificate, experienced domestic violence, has a mental health or substance abuse problem, and marital status. 5. Results 5.1. Correlations The correlational analyses (Table 2) for the association between substantiated physical neglect and the poverty related variables demonstrated a positive direction for all five variables (n = 1225). An examination of the correlational coefficients found substantiated physical neglect to be strongly associated with Medicaid recipients (r = .12, p b .001) and those who were unemployed (r = .12, p b .001). Furthermore, significant results were also found when comparing substantiated physical neglect and Food Stamp recipients (r = .11, p b .001) and substantiated physical neglect and AFDC recipients (r = .08, p b .001). The weakest correlation was between WIC and substantiated physical neglect (r = .03, p b .160). 5.2. Logistic regressions The results of the direct logistic regressions predicting substantiated physical neglect are found in Table 3. Model 1 showed the results for demographic information and the aforementioned control variables. Six of the 12 variables were found to be statistically significant as predictors of substantiated physical neglect. To a lesser degree but also positive for substantiated physical neglect was the number of children in the home. Negative or inverse relations were found for the age of the child, being African American and a parent having a high school diploma. Older children and holders of diplomas were less likely to be associated with substantiated physical neglect. The introduction of the five poverty related variables to the control variables and demographics had a significant effect upon the model. The results for Model 2 showed only three of the 17 variables to be statistically significant when predicting substantiated physical neglect. The strongest predictors of substantiated physical neglect were a primary caregiver with a substance abuse (OR = 2.35, p b .001) and mental health problems (OR = 2.27, p b .001). The age of the child was found to be negatively associated with substantiated physical neglect (OR = .94, p = .004). None of the poverty related variables were statistically significant: AFDC, Medicaid recipients, Food Stamp recipients, unemployment, and WIC. The inclusion of these variables into the model eliminated the statistical significance of three variables: holding a high school diploma, number of children in the home, and domestic violence. Table 2 Correlations between indicators of poverty and substantiated physical neglect (n = 1225)

1. Physical neglect 2. AFDC 3. Food stamps 4. Medicaid 5. Unemployed 6. WIC

1

2

3

4

5

6

– .08** .11** .12** .12** .03

– .73** .70** .51** .39**

– .66** .53** .41**

– .46** .37**

– .28**

–

Note. WIC is not statistically significant with substantiated physical neglect (r = .12, p = .16). *p b .05. **p b .01.

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Table 3 Logistic models predicting substantiated physical neglect Variables

Model 1 OR

Previous open case 1.10 Demographics and controls Age of caregiver .99 Age of child .94** High school/GED .71* Number of children 1.16** Gender (female) .84 Domestic violence 1.48* Caregiver substance abuse 2.06** Caregiver mental health 2.10** Married 1.06 African American .69* Latina/o .63 Income and poverty AFDC Food Stamps Medicaid Unemployed WIC Constant −.99* − 2 log likelihood − 504.26

Model 2 CI .81, 1.50 .97, 1.00 .91, .97 .51, .98 1.04, 1.29 .62, 1.15 .99, 2.21 1.49, 2.84 1.51, 2.93 .76, 1.48 .47, 1.00 .32, 1.22

SE .36 n = 1029

OR 1.15 .99 .94** .79 1.07 .88 1.32 2.35** 2.27** 1.04 .66 .62 .65 1.20 1.31 1.17 .71 − .82 − 390.41

Model 3 CI

OR

CI

.92** .62** 1.11*

.89, .96 .45, .86 1.00, 1.24

1.65* 2.00** 2.17**

1.09, 2.49 1.44, 2.77 1.55, 3.04

.80, 1.50 .97, 1.00 .90, .98 .53, 1.16 .94, 1.22 .62, 1.25 .83, 2.11 1.62, 3.41 1.55, 3.32 .70, 1.54 .43, 1.04 .29, 1.36

.37, 1.13 .71, 2.03 .79, 2.18 .77, 1.78 .43, 1.16 .63* SE .46 −1.07* n = 817 − 479.52

.41, .96 SE .26 n = 985

Note. OR = odds ratio. CI = 95% confidence intervals. SE = standard error. ⁎p b .01. ⁎⁎p b .001.

Model 3 showed the results of the backwards step-wise procedure where all the non-statistically significant ( p N .05) variables are removed one at a time. The removal of the nonstatistically significant variables improved the overall fit of the model. The larger chi square in Model 3 (χ2(7, n = 985) = 104.41, p b .001) indicates an improvement over Model 2 (χ2(17, n = 817) = 90.79, p b .001). There are now seven variables that are statistically significant predictors of substantiated physical neglect. Primary caregivers with mental health (OR = 2.17, p b .001) and substance abuse problems (OR = 2.00, p b .001) are twice as likely to have physical neglect substantiated. Domestic violence (OR = 1.65, p = .017) and the number of children in the home (OR = 1.11, p = .048) were both predictors of substantiated physical neglect. The following three variables showed negative relationships with substantiated physical neglect: age of primary child (OR = .93, p b .001), having a high school diploma (OR = .62, p = .005), and recipients of WIC (OR = .63, p = .032). 6. Discussion 6.1. Research question 1 Logistic regressions addressed the first research question and indicated several caregiver characteristics and one child characteristic closely associated with substantiated physical neglect. More specifically, the backwards step-wise procedure, which removed the non-statistically significant ( p N .05) variables one at a time, revealed seven statistically significant predictors of

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substantiated physical neglect. Findings indicated that primary caregivers with mental health problems and primary caregivers with substance abuse problems were twice as likely to have physical neglect substantiated. So, it seems there may be an issue of co-morbidity: the combination of the mental health and substance abuse problems. The substance abuse finding is supported by the National Center on Addiction and Substance Abuse at Columbia University (1999) study which found parents with substance problems more likely to neglect their children. The association between mental health and neglect has been reported before (Coohey, 1998). Glaun and Brown (1999) reported the co-morbidity of substance abuse and psychiatric problems for 17% of the caregivers in their sample of 656 Australian families brought into court for child protection issues. Domestic violence and the number of children in the home were also predictors of substantiated physical neglect. The domestic violence finding was supported by Shepard and Rashick (1999) study who found domestic violence to occur in 35% of substantiated child neglect cases. In regards to the number of children residing in the home, Sedlak and Broadhurst (1996) sampled 35 CPS agencies around the country and found that families with four or more children in the home were more likely to have neglect substantiated. The following three variables showed negative relationships with substantiated physical neglect: age of primary child, having a high school diploma, and recipients of WIC. That is, younger children are more likely to experience physical neglect, and caregivers with a higher education and recipients of WIC are less likely to have physical neglect substantiated. One possible explanation for why WIC is not a predictor of substantiated physical neglect could be attributed to the effectiveness of the program. For example, the fundamental goal of WIC is to improve the health of nutritionally at-risk women, infants and children. Several studies have examined the effectiveness of the program, and findings demonstrate that WIC has positively affected the following: birth outcomes, diet and diet-related outcomes, infant feeding practices, cognitive development, and rates of childhood immunization (Food and Nutrition Service, 2005). Therefore, since children under three are at a higher risk of being physically neglected, and WIC helps mothers of young children, families who participate in WIC are less likely to neglect their children. 6.2. Research question 2 Correlational analyses and logistic regressions were conducted to address the second research question regarding poverty. Correlational analyses indicated a positive association between substantiated physical neglect and the five poverty related variables: Medicaid, unemployment, and receiving Food Stamps, AFDC, and WIC. Interestingly, the weakest correlation was between WIC and substantiated physical neglect, which again could be suggestive of the efficacy of the program. Furthermore, logistic regressions revealed only three of the 17 variables to be statistically significant when predicting substantiated physical neglect. Primary caregivers with a substance abuse problem and primary caregivers with mental health problems were the strongest predictors of substantiated physical neglect. Similar to the correlational analyses, the age of the child was found to be negatively associated with substantiated physical neglect. One other variable, being African American, approached statistical significance (OR = .65, p = .064). This negative relationship is in contrast to what some researchers have found to be a strong positive relationship between neglect and being African American (Lee & George, 1999). Although correlational analyses suggested associations between poverty and substantiated physical neglect, the logistic regressions indicated that none of the poverty related variables were statistically significant in predicting substantiated physical neglect. This contrasts with the Cash and Wilke (2003) study of 1404 mothers with substance abuse addictions and mental health

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problems for whom child neglect had been substantiated. The poverty variable in this study was found to be statistically significant after it was included with all the explanatory variables. Though Berger's (2006) research doesn't focus on mental health or substance abuse issues, it does look at economic resources and their impact on low income parents. Berger's findings support an economic theory that demonstrates low income families with more economic resources (i.e. AFDC benefits, food stamps) are less likely to experience CPS interventions. Hence, those families with more economic resources would less likely be substantiated for physical neglect. Finally, the inclusion of the poverty variables into the model eliminated the statistical significance of three variables: earning a high school diploma, number of children in the home and domestic violence. Poverty is often confounded with other explanatory variables when examining child neglect. Therefore these results could suggest an interaction between the indicators of poverty and education level, number of children, and domestic violence. Once again, Berger's (2006) economic theory of increased economic supports for families would ameliorate the impact of the aforementioned variables as predictors of substantiated physical neglect. Finally, future research should explore the interaction of poverty indicators with other salient independent variables within the data. 6.3. Limitations The major limitation of this study was that it was cross sectional: a one-time snapshot of the data obtained at the time of the interview with the CPS worker. The secondary data analysis used looked back at the data and described associations between variables; however, the preferred way to make inferences would be to do a prospective study. A prospective study would allow a researcher to more clearly examine the causal affects of the variables: which variables came first. In addition, this data was collected prior to the passage of two laws that could affect the prevalence of physical neglect in the United States. In 1996 the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PWORA) became law. This legislation may have a dramatic effect upon the number of abused and neglected children who become involved with CPS. Also, the Adoption and Safe Families Act of 1997 (n.d.), which (if fully implemented) would ultimately change the way CPS addressed issues of safety and reasonable efforts. The full impact of these changes remains unknown. Finally, the data in this national sample were collected using complex survey techniques. Stata 8.0 (StataCorp, 2004) was the software utilized in the aforementioned analyses. The NSPPRS dataset was obtained from National Data Archive on Child Abuse and Neglect (NDACAN). In order to utilize the complex survey techniques that Stata offers one needs certain key survey variables that were not included in the data. NDACAN was contacted and asked to supply the survey variables. They were unable to provide the needed variables. Therefore, in the aforementioned analyses, the data were treated as if it were a simple random sample, which it is not. As a consequence, this reduces the generalizability of these findings beyond this sample. Overall, these analyses make a contribution to the literature by supplying empirical data delineating the indicators of poverty and parental characteristics predicting substantiated physical neglect. 7. Implications for social work This research can assist child protective service workers by addressing the problem of physical neglect by looking at three of the findings in particular. The first factor is the positive influence of WIC. Families who participate in the WIC program significantly reduce the likelihood they will

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physically neglect their children. Therefore, at a time of constrained resources, it is important for CPS workers to recommend a federally financed program like WIC when they receive that first report alleging neglect of younger children. Whether the allegation is true or false, introducing the family to the WIC program may reduce the likelihood of a future neglect report. Finally, the issue of co-morbidity for caregivers with mental heath and substance abuse problems should be assessed when physical neglect has been substantiated. Strategies for addressing these problems simultaneously must be developed if the likelihood of reducing future neglect reports is to be accomplished. Caregivers with such problems need acknowledgement and specialized treatment modalities in order to increase positive treatment outcomes. Future research should investigate the affect of poverty on other types of neglect being substantiated (i.e. emotional neglect, failure to thrive and lack of supervision). References Adoption and safe families act of 1997. (n.d.). Retrieved April 14, 2005, from http://hadm.sph.sc.edu/Students/Kbelew/ HR867Sum.htm Albert, V., & Barth, R. (1996). Predicting growth in child abuse and neglect reports in urban, suburban, and rural counties. Social Service Review, 70, 58−82. American Humane. (2003). Child neglect. Retrieved February 9, 2006, from http://www.americanhumane.org/site/ PageServer?pagename=nr_fact_sheets_childneglect Appendix C (n.d.). Study program descriptions. Retrieved February 24, 2006, from http:www.//aspe.hhs.gov/HSP/appprocess03/AppendixC.htm Ards, S., Myers, S., Chung, C., Malkis, A., & Hagerty, B. (2001, August). Racial reporting bias and child maltreatment. Paper presented at the International Society for the Prevention of Child Abuse and Neglect VIII European conference on child abuse and neglect, Istanbul, Turkey. Retrieved December 18, 2001, from http://www.hhh.umn.edu/centers/ wilkins/ispcan.pdf Berger, L. (2006). Children living out-of-home: Effects of family and environmental characteristics. Children and Youth Services Review, 28, 158−179. Brown, J., Cohen, P., Johnson, J. G., & Salzinger, S. (1998). A longitudinal analysis of risk factors for child maltreatment: Findings of a 17-year prospective study of officially recorded and self-reported child abuse and neglect. Child Abuse and Neglect, 22, 1065−1078. Cash, S., & Wilke, D. (2003). An ecological model of maternal substance abuse and child neglect: Issues, analyses, and recommendations. American Journal of Orthopsychiatry, 73, 392−404. Chaffin, M., Kelleher, K., & Hollenberg, M. (1996). Onset of physical abuse and neglect: Psychiatric, substance abuse, and social risk factors from prospective community data. Child Abuse and Neglect: The International Journal, 20, 191−203. Coohey, C. (1998). Home alone and other inadequately supervised children. Child Welfare, 77, 291−310. Courtney, M. E., Barth, R. P., Berrick, J. D., Brooks, D., Needell, B., & Park, L. (1996). Race and child welfare services: Past research and future directions. Child Welfare, 75, 99−133. Crume, T., DiGuiseppi, C., Byers, T., Sirotnak, A., & Garrett, C. (2002). Under ascertainment of child maltreatment fatalities by death certificates, 1990–1998. Pediatrics, 110, 18−26. Drake, B., & Pandey, S. (1996). Understanding the relationship between neighborhood poverty and child maltreatment. Child Abuse and Neglect, 20, 1003−1018. Drake, B., & Zuravin, S. J. (1998). Bias in child maltreatment reporting: Revisiting the myth of classlessness. American Journal of Orthopsychiatry, 68, 295−304. Dubowitz, H., Papa, M. A., Black, M. M., & Starr, R. H. (2002). Child neglect: Outcomes in high-risk urban preschoolers. Pediatrics, 109, 1100−1107. Food and Nutrition Service. (2005). How WIC helps. Retrieved March 7, 2006, from http://www.fns.usda.gov/wic/ Glaun, D. E., & Brown, P. F. (1999). Motherhood, intellectual disability and child protection: Characteristics of a court sample. Journal of Intellectual & Developmental Disability, 24, 95−105. Goldman, Salus, Wolcott, & Kennedy (2003). A coordinated response to child abuse and neglect: The foundation for practice. Chapter 3: What is child maltreatment? National clearinghouse on child abuse and neglect information. Retrieved July 1, 2005, from http://nccanch.acf.hhs.gov/pubs/usermanuals/foundation/foundationc.cfm

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